PSYC 328: Health Psychology
Terms in this set (630)
what is health psychology?
understanding psychological influences on how people stay healthy, why people become ill, and how they respond when they do get ill
what is the definition of health according to WHO?
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
NOT defined by absence of disease
what is the optimum state of health?
how is wellness achieved?
must be able to
- identify aspirations
- realize aspirations
- satisfy needs
- change/cope with environment
what are the main focuses of health psychologists?
(1) health promotion and maintenance
(2) prevention and treatment of illness
(3) etiology and correlates of health/illness
(4) improving health care and policy
what is the ultimate goal of health psychology?
- understand behavioral factors involved in health
- find effective theory/methods to change behaviors, reduce risk, and optmize health
what is the history of the mind-body relationship?
(1) prehistoric period
- early cultures e.g. egypt
- mind-body = unit
- disease = evil spirits
- treatment = trephination
(2) ancient greece
- bodily functioning plays role in health/illness
- hippocrates' humoral theory
- bodily temperaments associated with each humour
(3) middle ages
- supernatural and religious explanations
- disease = god's punishment for evildoing
- church = guardian of medical knowledge
- treatment = torture the evil out of the body
- biomedical model
- body seen as machine that houses the soul
- reemergence of scientific approach (autopsy)
- patient's thoughts/beliefs are central to changes in physical state
- mind and body are separate
- physicians take care of the body
- theologians take care of the mind
what is the biomedical model of health?
illness is explained on the basis of aberrant somatic processes (e.g. biomedical imbalances, neurophysiological abnormalities)
assumes that psychological and social processes are independent from disease process
how does the biomedical model of health view mind/body?
- mind and body are separate
- physical evidence is the only basis for diagnosis and treatment of illness
what contributed to the development of the biomedical model?
(1) psychoanalytic contributions
- conversion hysteria
- specific unconscious conflicts = physical disturbances that symbolize the repressed conflicts
- patient converts conflicts into symptoms/physical illness
(2) psychosomatic medicine
- dunbar and alexander
- patterns of personality linked rather than specific conflict
- anxiety produced becomes unconscious and takes physical toll on the body = organic disturbance (e.g. ulcers)
- psychosomatic medicine: bodily disorders are caused by emotional conflicts
(3) behavioral medicine
- cbt becomes more popular in 60s
- people wanted more observable and testable interventions
- behavioral medicine emerged
- b.f. skinner
- interdisciplinary field concernedwith integrating behavioral science and biomedical science
what are the criticisms of the biomedical model of health?
- reduces illness to low-level processes e.g. chemical imbalance
- doesn't recognize the role of more general social/psyc processes
(2) SINGLE-FACTOR MODEL
- explains illness in terms of biological malfunction rather than multiple factors
(3) ASSUMES MIND-BODY DUALISM
(4) EMPHASIS ON ILLNESS OVER HEALTH
what are the current views of the mind-body relationship?
- physical health is interwoven with psychological and social environment
- mind and body cannot be separated in terms of health and illness
what is the biopsychosocial model of health?
mind AND body together determine health and illness
fundamental assumption = health and illness are consequences of the interplay of biological/psychological/social factors
what do holistic approaches emphasize in health theory?
emphasize the interrelation of all of the body's system
- view illness as a disharmony between systems
- healing = restore physical and psychological balance
what are the advantages of the biopsychosocial model of health?
(1) maintains biological, psychological, and social factors as important determinants of health/illness
- macrolevel (social support)
- microlevel (chemicals)
(2) mind and body inseperable
- both influence health
(3) emphasis on both health and illness
- not a deviation from steady state
- health = something achieved through attention to all three factors
how does the biopsychosocial model work? i.e. how do all three factors interact if they aren't from the same level (macro vs micro)
with systems theory
systems theory is an extension of the biopsychosocial model
- maintains that all levels of organization are linked to each other hierarchically
- change in any one level will affect change in all other levels
- i.e. changes in micro will have changes in macro and vice-versa
what are the clinical implications of the biopsychosocial model?
(1) always consider the interacting role of all three factors
(2) recommendations for treatment should always examine the three sets of factors
(3) patient and practitioner relationship is significantly important
Why is the field of health psychology needed?
(1) CHANGING PATTERNS OF ILLNESS
- major causes of death/illness before was acute disorders (short-term)
- today, shifted to chronic illness
health psychology is important for dealing with chronic illnesses because:
- these are diseases in which psychological and social factors are implicated as causes
- people may live with chronic diseases for years and psychological issues may arise
(2) ADVANCES IN TECHNOLOGY AND RESEARCH
- new technologies make it possible to advance research
(3) ROLE OF EPIDEMIOLOGY
- morbidity = #of cases of a disease that exist at some given point in time (subcategories = prevalence and incidence)
- mortality = #of deaths due to a particular disease
(4) CHANGING PERSPECTIVES ON HEALTH AND HEALTH CARE
- integral part of an expanding health care system
- emphasis on prevention has the potential of reducing health care costs
- conduct research on satisfaction of health care services (e.g. lalonde report, epp report)
(5) INCREASED MEDICAL ACCEPTANCE
- increasing acceptance of health psychologists within medical community
(6) CONTRIBUTIONS TO HEALTH DEMONSTRATED
- health psychologists developed good behavioral interventions for managing pain, modifying bad habits, and managing side effects of treatments
what is the purpose of health psychology training? (careers in practice/research)
- MD or PHD in clinical psyc
- physiotherapists (new ways of performing old tasks)
- occupational therapists (goalsetting, therapy program)
- social workers
- graduate training (PHD)
- academic, government or NGO settings
what are common research designs in health psychology?
- 2 or + conditions differ from each other
- differ in pre-determined ways
- randoml assigned
- evaluate treatments/interventions
- evaluate effectiveness
- compare changes in variables
- doesn't determine causality
- follow sample over time
- study histories
what are the guiding principles of tri-council statement?
- respect for human dignity
- respect for free and informed consent
- respect for vulnerable persons
- respect for privacy and confidentiality
- respect for justice and inclusiveness
- balancing harms and benefits
- minimize harm and maximize benefits
what is the nervous system?
a complex network of interconnected nerve fibers that function to regulate important bodily functions, including the response to and recovery from stress
what does the nervous system consist of? (2 main systems)
central nervous system and peripheral nervous system
what is the central nervous system?
carries voluntary nerve impulses to skeletal muscles and skins, and involuntary impulses to muscles and glands
brain + spinal cord
what is the peripheral nervous system?
the sensory and motor neurons that connect the central nervous system to the rest of the body
how is the peripheral nervous system divided?
what is the somatic nervous system?
- controls voluntary movements
- connects nerve fibers to voluntary muscles
- provides the brain with feedback in the form of sensory info
what is the autonomic nervous system?
- controls involuntary movements of organs
- connects the central nervous system to all internal organs
- works through neurotransmitters
- takes longer to stop effects of the ANS because neurotransmitters travel slowly
how is the autonomic nervous system divided?
what is the sympathetic nervous system?
- catabolic system
- mobilizes and exerts energy
- reacts to stress
- prepares the body to emergencies
what is the parasympathetic nervous system?
- anabolic system
- conserves energy
- restores the body to a normal state
- acts antagonistically with the SNS
what is homeostasis?
the ability to maintain a relatively stable internal environment in an ever-changing outside world
what is the command center of the body?
- receives afferent impulses from the peripheral nervous system
- sends efferent impulses to internal organs and extremities
what are the three sections of the brain?
hindbrain, midbrain, forebrain
what does the hindbrain consist of?
medulla, pons, cerebellum
what is the medulla?
- @ base of brainstem
- responsible for the regulation of involuntary activities like
(1) heart rate (speeds up/down)
(2) blood pressure (constriction)
what is the cerebellum and what happens if it is damaged??
- coordinates voluntary muscle movement
- maintains balance
- maintains muscle tone
- maintains posture
damage to the area?
- can't coordinate muscles
- disturbance in posture
- lack of muscle tone
what is the pons?
link between hindbrain and midbrain
helps control respiration
what is the midbrain?
- major pathway for sensory and motor impulses
- impulses moving between forebrain and hindbrain
- coordinates visual and auditory reflexes
- suppresses pain
- maintains consciousness
- major area for dopamine and parkinson's
what does the forebrain consist of?
telencephalon and diencephalon
what does the diencephalon consist of?
thalamus and hypothalamus
what is the thalamus?
- relay station for sensory input
- relays to the cerebral cortex
- combines info and stores data
what is the hypothalamus?
(1) regulates the parts of the medulla that control:
- cardiac function
- blood pressure
(2) regulates water balance in the body
(3) reguates hormones
- through pituitary gland
(4) regulates appetite
(5) important transition center between thoughts generated in the cortex and their impact on the internal organs
what does the telencephalon consist of?
the cerebral cortex
what is the cerebral cortex?
- both hemispheres
- largest portion of the brain
- sensory impulses are received/interpreted in cerebral cortex
- motor impulses are generated from the cerebral cortex and goes down
cerebral cortex involved in
- higher order intelligence
what is the limbic system?
- the emotional brain
- network of structures that play a key role in emotions and stress
- responsible for basic appetite and urges necessary for survival (hunger, thirst, anger)
damage to limbic system
- desires and drives are flattened out
which two structures of the brain are important in stress and emotional responses?
amygdala and hippocampus
what is the amygdala?
controls strong emotions such as fear and anger
what is the hippocampus?
learning and memory
- responds to threats
- emotionally charged memories
what are neurotransmitters?
chemical messengers that regulate nervous system functioning
what are catecholamines?
epinephrine and norepinephrine
- promote sympathetic nervous system activity
- released during stress
what do catecholamines do?
- increase heart rate
- dilate heart capillaries
- constrict blood vessels
- increase blood pressure
- decrease digestion/urination
what are the disorders of the nervous system?
- cerebral palsy
- multiple sclerosis
what is epilepsy?
- chronic disease of the CNS
- core sympt.: seizures
- cannot be cured
- can only be controlled by medications or behavioral interventions
(1) usually idiopathic i.e. no known cause
(2) symptomatic caused by:
- injury during birth
- injury to head
- infectious disease
- metabolic/nutritional disorders
- inherited tendency toward epilepsy
what is Parkinson's disease?
- progressive degeneration of the basal ganglia (controls smooth motor coordination)
- death of cells that generate dopamine in the basal ganglia
- slowness of movemnet
onset: 60+ years of age
what is cerebral palsy?
- chronic non-progressive disorder of posture and movement
- core = lack of muscle control
- mental handicaps
- difficulties of sensation/perceptions
- problems with sight/hearing/speech
- older children = severe accident or physical abuse
- young children = lack of oxygen to the brain during childbirth
what is Alzheimer's disease?
- a progressive degenerative disease of the brain that results in dementia
- impairments to thinking and memory
- prevalence on the rise because of aging population
what is multiple sclerosis?
- degenerative disease of certain brain tissues
- autoimmune disorder
- mental deterioration
- double vision
- dragging feet
- loss bladder/bowel control
- speech difficulties
- extreme fatigue
- disintegration of myelin
- autoimmune disorder
- system fails to recognize own tissue; interprets myelin as foreign
what is huntington's disease?
- degenerative disease of the central nervous system
- hereditary = gene has been isolated
- similar symptoms to epilepsy
- chronic physical deterioration
- chronic mental deterioration
- involuntary muscle spasms
- loss of motor abilities
- personality changes
what is paraplegia and quadriplegia?
paraplegia: paralysis of the lower extremities
quadriplegia: complete paralysis of all 4 limbs
incomplete spianl cord injury: no complete loss of function and sensation below the injury
complete spinal injury: complete loss of motor and sensory impulses; results in loss of bladder and bowel control
what is the endocrine system?
- controls bodily activities
- governs slow-acting responses of long duration
- glands = secrete hormones into blood that stimulate changes in target organs
the endocrine system is regulated by what two structures?
hypothalamus and pituitary gland
what is the pituitary gland?
the master gland of the endocrine system; it is divided into two lobes:
what is the anterior pituitary lobe?
governs GROWTH through hormones
(1) somatotropic (STH)
(3) thyrotrophic (TSH)
- thyroid gland
(4) adrenocorticotropic (ACTH)
- adrenal gland
what is the posterior pituitary lobe?
extension of the hypothalamus
- called antidiuretic hormone ADH
- water-absorbing of kidneys
- affected by alcohol
- reason for hangovers
what are the adrenal glands?
- pair of endocrine glands
- sit on top of each kidney
- each adrenal gland consists of
(1) adrenal medulla
- contains epinephrine
- contains norepinephrine
(2) adrenal cortex
- stimulated by ACTH
- releases steroid hormones (androgens, estrogens, glucocorticoids)
IMPORTANCE OF ADRENAL GLANDS
- involved in physiological and neuroendocrine reactions to stress
- cortisol initiates parasympathetic nervous system
what is insulin?
a hormone produced by the pancreas to lower blood sugar
- stimulates the transportation and storage of fat cells, glycogen, and protein synthesis
what happens when we get stressed?
sympathetic nervous system activates
- reduction of insulin
- increase of glucocorticoids
- insulin is inhibited
- energy storage stops
stress hormes causes
- triglycerides break down
- increase fatty acids
- increase glycerol
- increase glucose
- increase amino acids
what are disorders of the endocrine system?
- diabetes type I
- diabetes type II
what is diabetes?
- chronic endocrine disorder
- the body is either not able to manufacture insulin or to properly use it
what is type I diabetes?
- partly genetic in origin
- autoimmune disorder
- pancreatic cells that produce insulin are destroyed
- cannot produce insulin anymore
WHAT HAPPENS WHEN THERE IS NO INSULIN?
- cannot store glucose/fatty acids
- cannot use properly glucose/fatty acids
- excess in glucose/fatty acids causes the gumming up of blood vessels
- gummed up blood vessels causes kidney failure, blindness, or chronic pain
- stress makes things worse by adding more glucose and more fatty acids to an already gummy bloodstream
- glucocorticoids make fat cells less sensitive to insulin
what is type II diabetes?
- disease of lifestyle
- insulin-resistant caused by excess body fat
- as fat cells fill up, the body resists insulin's attempt to store more fat cells
- excess glucose and fatty acids damage blood vessels
- pancreas responds by producing even more insulin
- can cause the pancreatic cells to die over time (becomes type1)
what is the cardiovascular system composed of?
heart, blood, and blood vessels
what does the cardiovascular system do?
(blood) acts as the transport system of the body
- carries oxygen
- carries carbon dioxide
- carries nutrients
- carries waste products
- carries hormones
what does the heart do?
pumps blood throughout the body
what is the cardiac cycle?
the period between the start of one heartbeat and the beginning of the next
regular rhythmic phases of contraction and relaxation
how is blood pressure measured?
- blood pumped out of the heart
- blood pressure increases inside the vessels
- muscles relax
- blood pressure drops
- blood taken into heart
what are the disorders of the cardiovascular system?
what is atherosclerosis?
- disease of the arteries
- major cause of heart disease
- deposits of cholesterol on arterial walls
- forms plaques
- arteries become narrower
- blood flow is reduced
- nutrients can't pass through as much
- damages the tissues
- damaged arterial walls causes formation of blood clots
- blood clots cuts blood flow altogether
DISEASE OF LIFESTYLE
- poor health habits (smoking, high-fat diet, no exercise, chronic stress)
RISK FACTOR FOR
what are the two primary clinical manifestations of atherosclerosis?
(1) ANGINA PECTORIS
- "chest pain"
- occurs because muscle tissue of heart needs to continue its activity
- however there isn't enough supply of oxygen
(2) MYOCARDIAL INFARCTION (MI)
- "heart attack"
- occurs when clot has developed in a coronary vessel
- bocks the flow of blood to heart
what is arteriosclerosis?
- hardening or thickening of the arterial walls
- lose their elasticity
- blood cannot move
- blood pressure increases
- salts, calcium, scar tissue react with elastic tissue of the arteries
what is an aneurysm?
- an enlargement/bulge of an artery wall
- caused by a weakening of the artery wall.
- rupture of aneurym = death (loss of blood pressure)
what is phlebitis?
- inflammation of a vein wall
- often accompanied by water retention and pain
- caused by infection surrounding the vein
- chief threat = blood clot production
what is blood pressure?
it is the force that blood exerts against the blood vessel walls
systolic = the pressure as the heart contracts and pushes the blood out
dyiastolic = the pressure when the heart relaxes between heartbeats
blood pressure is influenced by what? (3 things)
(1) cardiac output
- pressure against arterial walls
- greater as the volume of blood flow increases
(2) peripheral resistance
- resistance to blood flow in the small arteries of the body
(3) structure of arterial walls
- damaged or clogged arterial walls
- causes an increased blood pressure
what is hypertension?
chronic high blood pressure
- too high cardiac output, OR
- too high peripheral resistance
psychosocial issues involved:
- chronic negative affect
- stress levels
what does the blood consist of?
plasma (55%) = liquid portion of blood
blood cells (45%) = solid portion of blood
what do blood cells contain?
plasma electrolytes (salts)
where are blood cells manufactured?
in the bone marrow (substance in hollow cavities of the bones)
what does bone marrow contain?
5 types of cells that form different types of blood
- produce white blood cells
- produce white blood cells
- produce lymphocytes
- produce red blood cells
- produce platelets
what are white blood cells?
- protect the body against infectious disease and foreign invaders
- two main types: phagocytes and lymphocytes
- absorb/remove foreign substances
- secrete digestive enzymes
- enzymes engulf and act on bacteria/foreign substances
what are lymphocytes?
type of white blood cell that combats foreign substances
- produce antibodies
- antibodies destroy substances
- fight infection and disease
what are red blood cells?
cells that have no nuclei
- carries oxygen through body
- carries carbon dioxide through body
what are platelets?
- small cell fragments
- clump together to block small holes that develop in blood vessels
BLOT CLOTTING ROLE
- help form thromboplastin
- thromboplastin acts on fibrinogen in plasma
- transform it into fibrin
- fibrin produces clotting
what disorders are related to white cell production?
what is leukemia?
- disease of bone marrow
- common form of cancer
- excessive production of white blood cells
- overloaded plasma
- reduces the #of red blood cells
consequence of reduction of red blood cells:
- starves body of nutrients and oxygen
- causes anemia in short-term (i.e. shortage of red blood cells)
- can cause death if untreated
what is leukopenia?
- deficiency of white blood cells
- reduced ability to combat infections
- can arise from turberculosis, measles, or pneumonia
- leaves a person more susceptible to diseases
what is leukocytosis?
- excessive number of white blood cells
- response to many infection (e.g. mononucleosis, appendicitis)
what are disorders related to red cell production?
- sickle-cell anemia
- aplastic anemia
what is anemia?
- deficiency of red blood cells or hemoglobin
- may be linked to iron deficiency or bone marrow production of red blood cells
what is aplastic anemia?
bone marrow fails to produce sufficient number of red blood cells
what is sickle-cell anemia?
- genetic disorder of RBCs
- inability to produce RBCs
- sickled-shape cells instead of flattened spheres
- contain abnormal hemoglobin protein molecules
- high vulnerability to rupture
what is hemophilia?
- clotting disorder
- unable to produce thromboplastin and fibrin (clotting agents aren't produced)
- blood cannot clot
what is the function of the immune system?
- surveillance system of the body
- primary function = distinguish what is the self and what is the foreign
- attack and rid the body of foreign invaders
- can also interact with psychological and neuroendocrine processes to affect health
what are the four ways in which microbes that cause infection can be transmitted?
- bodily contacts
- e.g. handshaking, kissing
- environmental transmission
- microbes passed to an individual
- e.g. airborne particles, dust, water, food
- transmitting agent
- picks up microbe, changes it into a form conducive to growth in human body
- passes the disease in human
- e.g. mosquito
- passage of a microbe through carrier
- carrier not directly involved in the disease process
- e.g. dirty hands, bad water, flies
what is the natural course of infection?
(1) incubation period
- period between infection is contracted and the time symptoms appear
(2) nonspecific symptoms
- precede the onset of disease
- microbes are colonizing
- toxins produced
(3) acute phase
- disease and symptoms are at their height/peak
(4) period of decline
- if nonfatal
- organisms expelled from mouth, nose, digestive tract...
infections can be: (3)
- remain at original site
- do not spread throughout body
- confined to particular area
- toxins sent to other parts of the body
- causes other disruptions
- number of different areas affected (or body systems)
primary vs secondary infections
- initial infection within a given patient
- infections that follow a primary infection
- occur because body's resistance is lowered from fighting the primary infection
- oftentimes poses greater risks than primary infection
what is immunity?
the body's resistance to injury from invading organisms. can develop in two ways
- defence against pathogens (i.e. does not provide defence against particuar pathogens, but against many of them)
- acquired through disease
- through vaccinations
temporary = at birth/through breast-feeding
what are the two responses of the body against invading organisms?
nonspecific immune mechanisms
specific immune mechanisms
what are nonspecific immune mechanisms?
a general set of responses to any kind of infection/disorder --- infection is contained rapidly and early on
mediated in 4 ways:
(1) anatomical barriers
- e.g. skin, mucous
- white blood cells (phagocytes) ingest microbes
(3) antimicrobial substances
- enzymes kill invading microorganisms
(4) inflammatory response
- local reaction to infection
- increases blood flow
what are specific immune mechanisms?
fight particular microorganisms and their toxins
- acquired by contracting disease
- acquired through vaccination
- antigens are foreign substances whose presence stimulates production of antibodies
- involves a delay of several days before full defence is mounted
what are the two basic immunity reactions?
what is humoral immunity?
immune response mediated by B-lymphocytes
- provide protection against bacteria
- neutralize toxins produced by bacteria
- prevent viral reinfection
- produce and secrete antibodies
- produce and secrete antibodies that bind to pathogens
- help phagocytes identify pathogens
WHEN ACTIVATED, TWO TYPES OF B-CELLS ARISE
- mature, antibody-secreting plasma cells (produce antibodies)
- resting, nondividing memory B-cells
what is cell-mediated immunity?
immune response that involve T-lymphocytes (no antibodies)
- operate at cellular level i.e. doesn't release antibodies in bloodstream
- secrete chemicals that kill invading organisms
- slower-acting response
TWO TYPES OF T-LYMPHOCYTES
(1) Tc cells (cytotoxic)
- respond to specific antigens
- kill by producing toxic substance
(2) Th cells (helper)
- enhance functioning of Tc
- enhance functioning of B-cells
how is the lymphatic system related to the immune system?
lymphatic system = drainage system of the body
lymphatic tissue located all over the body
important organs in lymphatic system
- spleen (production of B- and T-cells)
- tonsils (filter out microorganisms that enter respiratory tract)
- thymus gland (help T-cells mature)
what are disorders related to the immune system?
- progressive impairment of immunity
- characterized by specific humoral or cell-mediated immune response that attacks body's own tissues
- body fails to recognize own tissue
- produce antibodies to fight own body
- e.g. multiple sclerosis
what are the two interrelated systems that are involved in the stress response?
how does the sympathetic nervous system get activated?
- cerebral cortex labels events as stressful
- sets off chain reaction
- info transmitted to hypothalamus
- hypothalamus initiates stress
- stimulates the medulla in adrenal glands
- medulla secretes catecholamines
- catecholamines = fight-or-flight response (blood pressure, heart rate...)
where does the HPA activation theory come from?
hans selye's general adaptation syndrome
- nonspecific physiological reactions occur in response to stress
- alarm, resistance, exhaustion
what is the activation sequence of the HPA axis?
- hypothalamus releases CRF
- CRF stimulates pituitary gland
- pituitary gland secretes ACTH
- ACTH stimulates adrenal cortex
- adrenal cortex releases glucocorticoids
what are the effects of long-term stress?
EXCESSIVE DISCHARGE OF CATHECOLAMINES
- suppression of immune functions
- increase blood pressure/heart rate
- provoke variations in normal heart rhythm
- neurochemical imbalances
- verbal functioning programs
- memory problems
- concentration problems
- pronounced HPA activation
- not sure if cause or effect
- shifts from hips to abdominal area
- high waist-to-hip ratio
- marker for chronic stress
sympathetic arousal versus HPA axis
- stress acts on cortex
- stimulates hypothalamus
- acts on medulla
- releases catecholamines
- produces fight-or-flight response (increase blood pressure, sweat...)
- stress acts on cortex
- stimulates hypothalamus
- secretes CRF
- activates pituitary
- secretes ACTH
- activates adrenal cortex
- secretes cortisol
- reduces inflammation, conserves carbohydrate stores
what is health promotion?
general philosophy that has as its core idea that good health/wellness is a personal and collective achievement
- involves not only individual behavior
- wide range of social and environmental interventions
what is WHO's definition of health promotion?
the process of enabling people to increase control over and improve their health
how does health promotion differ from disease prevention?
- positive conception of health
- holistic approach
- reflective of biopsychosocial model
- negative view of health being the absence of illness
- efforts are on early detection and prevention
- reflective of biomedical model
what are health behaviors?
behaviors undertaken by people to enhance or maintain their health
- positive behaviors (promote good health)
- negative behaviors (create risk for illness)
- treatment-related behaviors
what is a health habit?
health-related behavior that is firmly established and performed automatically without awareness
- develops in childhood
- stabilizes around 11-12 y.o.
how are health habits developed?
- initially through reinforcement
- eventually become independent of reinforcement
- maintained by environmental factors
- highly resistant to change
what are Belloc and Breslow's seven important good health habits (1972)?
1) sleep 7-8hrs per night
2) no smoking
3) eat breakfast everyday
4) no more than 1-2 alcoholic drinks per day
5) regular exercise
6) no eating between meals
7) no more than 10% overweight
what are the three types of prevention?
primary, secondary, tertiary
what is primary prevention?
- instill good health habits
- change poor health habits
- universal approach
- combat risk factors before illness develops (diet, exercise, safety)
(1) employ behavior-change methods to get people to alter their problematic health behaviors
(2) keep people from developing poor health habits in the first place
what is secondary prevention?
- target at-risk groups for disease
- subgroups: age, gender, SES, occupation, family history
what is tertiary prevention?
- target people who already have the disease
- clinical approach
- limit the impact of the disease (e.g. rehabilitation)
what are the roles of behavioral factors in diseases?
nearly 1/2 of deaths in canada are caused by modifiable behaviors!
- physical inactivity
- poor diet
successful modification of health behaviors have several benefits
(1) reduce deaths due to lifestyle diseases
(2) delay time of death/increase longevity
(3) expand number of years during which a person enjoy life free from disease
(4) decrease costs
what 12 factors influence health behaviors?
- personal control
- social influences
- access to health care services
- supportive environments
- cognitive factors
- personal goals
- perceived symptoms
how does SES influence health behaviors?
CORRELATES OF BETTER HEALTH HABITS
- low stress
- high social support
- SES gradient in health are psychosocial in nature
- dose-response relation
- subjective SES is a good predictor of health
- developmental origins = prenatal exposure to stress, early childhood experiences...
how does age influence health behaviors?
- typically better in childhood
- deteriorate in adolescence
- deteriorate in young adulthood
- improves among retired adults under 73
- deteriorate among adults older than 73
how does gender influence health behaviors?
- girls eat better
- girls engage in unhealthy dieting
- girls engage in less sports
how do values influence health behaviors?
variations between cultures
- e.g. exercise may be considered desirable in one culture but not in the other
how does personal control influence health behaviors?
perception that one's own health is under personal control determines health habits
HEALTH LOCUS OF CONTROL
- the degree to which people perceive themselves to be in control of their health, perceive powerful others to be in control of their health, or regard chance as the major determinant of their health
- if seen under personal control (i.e. internal locus) = more likely to practice good health habits; more self-efficacious
how do social influences influence health behaviors?
- family, friends, workplace
- peer pressure
- media sources
how do personal goals influence health behaviors?
habits are tied to personal goals
- personal fitness
- athletic achievement
how do perceived symptoms influence health behaviors?
- smokers may control smoking based on sensations of their throats
- e.g. wake up with smoker's cough, will cut back in the belief that they are precisely vulnerable to health problems at that specific time and not before
how does place influence health behaviors?
where someone lives can have an impact on the practice of their health behaviors
- rural areas have less access to services
- makes it difficult to follow through with intentions to practice preventative health behaviors
- less healthy eating habits
- lower leisure time; phys. activity
- higher rates of smoking
how do supportive environments influence health behaviors?
- creating communities/cities with green space
- walking and biking pathways
- access to healthy food options
how do cognitive factors influence health behaviors?
- belief that certain behaviors are beneficial
- sense that one may be vulnerable to an underlying illness if one does not practice a particular behavior
- similarly, being less health conscious or thinking less about the future can lead to unhealthy behavior choices
what are the barriers in modifying poor health behaviors?
(1) little incentive for good behavior in the short-term
- the payoffs are not apparent
- esp. true for adolescents
(2) poor habits are hard to change
- health habits are established around age 12
(3) poor habits are often enjoyable and pleasurable
(4) poor health habits are addictive and automatic
are health habits related to each other?
modestly related, fairly independent
- knowing one health habit does not enable to predict another with great confidence
- must tackle them one at a time
- some have different determinants
- the same behavior may have different motives in different people
- factors controlling a health behavior can change over time
are health habits stable or unstable?
- different habits are controlled by different factors
- different factors may control the same health behavior for different people
- factors controlling health bheavior may change over the history of the behavior
- factors controlling the health behavior may change across a person's lifetime
why is there so much focus on children and adolescents' health behaviors?
adolescence is a new period of development
- 20th century
- marked by a divergence of social and physical develeopmental milestones
- many chronic health problems are affected by behaviors and experiences in adolescence
- health habits are shaped and constrained by social learning
what is the teachable moment?
refers to the fact that certain times are better than others for teaching particular health practices - crucual point at which a person is ready to modify a behavior
- most arise in early childhood
- others arise because they are built into health care delivery system (dentist, basic immunizations, annual checkups)
- pregnancy (smoking)
what is the window of vulnerability?
concerning smoking and drug use in adolescents
- students are first exposed to these habits among their peers and siblings
- may have greater influence due to peer pressure, desire to conform, feelings of vulnerability
- linked to the developing prefrontal cortex
how does adolescent health behaviors influence adult health?
precautions taken in adolescence may be better predictors of disease after age 45
what are the benefits in focusing on the intervention of at-risk people?
- early identification can prevent/eliminate poor health habits
- efficient and effective use of health promotion dollars
- makes it easier to identify other risk factors that may interact with targeted factors
what are the problems in focusing on the intervention of at-risk people?
don't always perceive their risk correctly
- unrealistically optimistic about own vulnerability
- people can become hypervigilant/restrictive
- people may be defensive/minimize significance of their risk factors
what theories and models are used for understanding health behaviour change?
- education campaigns
- fear appeals
- message framing
- expectancy-value theory
- health beliefmodel
- theory of planned behavior
- implementation intentions
- stages of change
what is the "attitude change" approach?
it assumes that if we give people correct information about the implications of their poor health habits, they may be motivated to change those habits in a healthy direction
what are educational appeals?
they make the assumption that people will change their habits if they have the correct information
what are the different strategies used in educational appeals?
(1) colorful and vivid communication
(2) speaker is: expert, prestigious, trustworthy, likable, and similar to audience
(3) primacy and recency effects (no strong arguments in middle)
(4) short, clear, and direct
(5) conclusions stated explicitly
(6) extreme messages produce more attitude change
(7) emphasis on problems that may occur if illness-detection behaviors not undertaken
what are the limitations of educational appeals?
- limited success
- not easy
- information not necessarily received accurately (some view the problem as common or less serious)
- knowledge is necessary but doesn't provide information about behavior change
what are fear appeals?
assumes that if people are fearful that a particular habit is hurting their health, they will change their behavior to reduce their fear
what are the limitations to fear appeals?
persuasive messages that elicit too much fear may undermine health behavior change
- fear alone not sufficient to change behavior
- recommendations for action may be needed
greatest behavior changes will be caused by strong fear appeals and good recommendations for action/information about efficacy
what is message framing and to which theory is this related to?
assumes that matching the framing of the message with the health behavior might impact the effectiveness of the message
what is prospect theory?
related to message framing
prospect theory: different presentations of risk information will change people's perspectives and actions
prospect of loss can make people engage in difficult high cost behaviors
- high-risk = behaviors that have uncertain outomes
- loss-framed = emphasis on potential problems
-low-risk = behaviors with certain outcomes
- gain-framed = stress benefits
congruency effect in message framing
effectiveness of the type of message framing may also depend on how congruent the message is with the individual's own motivation
how it works: increases feelings of self-efficacy for engaging in behavior
- seek to max rewards
- more influenced by gain-framing
- seek to min loss
- more influenced by loss-framed
what do social-cognition models of health behavior suggest?
suggest that beliefs people hold about particular health behaviors motivate their decision to change that behavior
what is the expectancy-value theory?
underlies the social-cognition model of health behaviors
people will choose to engage in behaviors that they expect to succeed in and that have outcomes that they value
what is bandura's social cognitive theory?
based on self-efficacy
- behaviors result from self-efficacy expectancies
- the belief that one is able to control one's practice of a behavior
- behavior results from efficacy expectancies and outcome expectancies
- self-efficacy is a powerful determinant of behavior by promoting persistence in the face of difficulties, as well as a strong conviction to follow through with the behavior
what is the health belief model?
the OG model: states that whether a person practices a particular health behavior can be understood by two main factors
1) perceived health threat
2) perceived threat reduction
the NEW model: includes two other factors to help address challenges to changing behaviors
3) cues to action
what is perceived health threat (health belief model)?
whether a person perceives a personal health threat
(1) general health values
- interest about health
- concern about health
(2) perceived susceptibility
- specific beliefs about personal vulnerability
(3) perceived severity
- beliefs about the consequences
- whether serious or not
what is perceived threat reduction (health belief model)?
whether a person believes a health measure will reduce threat
(1) perceived efficacy
- whether individual thinks a health practice will be effective
(2) perceived barriers
- whether the cost of undertaking the measure exceeds the benefits of the measure
what are cues to action (health belief model)?
the perception of the health threat and the perceived threat reduction account for an individual's readiness to act
they active the readiness to act, they stimulate the behavior
what is self-efficacy (health belief model)?
helps understand why some may not perform a health behavior that they feel will effectively reduce a health threat
what supports the health belief model?
explains people's practice of health habits quite well
- predicts preventive dental care, breast self-examination, AIDS risk-related behaviors, sexual risk-taking behaviors, drinking/smoking intentions...
- health beliefs are a modest determinant of intentions to take these health measures
how does a health psychologist use the health belief model to change health behaviors?
- it helps predict some of the circumstances in which people's health behaviors will change
- highlighting perceived vulnerability and simultaneously increasing the perception that a particularhealth behavior will reduce the threat are somewhat successful in changing behavior
what are the criticisms of the health belief model?
- health beliefs alone are modest determinants of people's intentions to take preventative health measures
- disregards the importance of emotional and social factors, and change
what is the theory of planned behavior?
azjen's theory attempts to link health attitudes directly to behaviors
- i.e. a health behavior is the direct result of a behavioral intention
behavioral intentions are made up of which three components in planned behavior theory?
(1) attitudes toward the specific action
- beliefs about the outcomes of the behavior
- evaluations of the outcomes of the behavior
(2) subjective norms regarding the action
- normative beliefs
- what a person believes others think that person should do
- motivation to comply
(3) perceived behavioral control
- needs to feel like is capable of performing the action contemplated
- the action undertaken will have the intended effects
what are the benefits of the theory of planned behavior?
useful addition to the understanding of health-behavior processes because:
(1) provides a model that links beliefs directly to behaviors
(2) provides a picture of people's intentions with respect to a particular health habit (more nuanced view of intentions for a particular behavior)
what are the limitations of the theory of planned behavior?
- validity of the theory is questionable (few experimental tests of prediction)
- utility of the theory is questionable
- doesn't explain long-term behavior change
- does not explain the intention-behavior link i.e. what actually gets people to do what they intended to do
what is the evidence for the theory of planned behavior?
predicts a broad array of health behaviors such as
- condom use among injection drug users
- sunbathing/sunscreen use
- oral contraceptives
- mammography participation
theory of planned behavior and health belief model: usefulness?
- useful at predicting health behaviors when people are MOTIVATED to change
- not useful for predicting long-term health behavior
- not useful at explaining how people can change
what are implementation intentions?
having good intentions is often not enough to ensure changes being successful...
therefore, forming implementation intentions helps bridge the gap between intention and behavior
implementation intentions are specific behavioral intentions that highlight the how, when, and where of a behavior; also includes the if-then contingency plan to deal with anticipated barriers.
what is an effective implementation intention?
SPECIFIC TYPE OF INTENTION
- clear plan of how the intention can be carried out
- has a stronger influence on behavior than a more general intention for behavior (specific = better predictor)
what are the caveats to attitude change and social-cognitive models?
- not successful at explaining spontaneous behavior change
- don't predict long-term behavioral changes
- communications designed to change attitudes about health behaviors can evoke defensive processes
- think about disease can produce negative mood = lead to ignore
- view health behavior change as a rational process, neglecting other factors like affective variables
what is the transtheoretical model of behavior change?
acknowledges that changing a bad health habit cannot take place all at once, and that intentional behavior change occurs in stages
-as people attempt to change their behavior, they move through a variety of stages using different processes to help them get from one stage to the next until a desired behavior is attained
- people will change their behavior when they are ready to change it (at right stage)
what are the stages of the transtheoretical model of behavior change?
- no intention of changing
- not always aware of problem
- seek treatment because coerced
- aware of their problem
- think about it
- no commitment to take action
- weigh pros and cons
- focus on the positive aspect of enjoyable health habit
- intend to change behavior
- not yet begun to do so
- modified their target behavior somewhat
- didn't completely commit in eliminating behavior altoghether
- modify behavior to overcome the problem
- time and energy commitment
- stop behavior
- modify lifestyle/environment
- work to prevent relapse
- consolidate gains
- 6+ months free of behavior
what is the importance of the stages of change model?
captures the process that people actually go through
- illustrates successful change doesn't occur @ first try/all at once
- explicates why many people are unsuccessful in changing behavior
- help explain why many interventions show dismal rates of success
what does intervention look like in the transtheoretical model?
- provide information
- discuss pros and cons of changing behavior
- discuss methods for change
- make explicit commitments to change
action + maintenance
- coping skills
- social support
what are the strengths of the transtheoretical model?
- not static like other models
- hypothesizes the how and when of behavior change
- views change as process rather than event
- recognizes that people at different stages need different interventions
what are the criticisms of the transtheoretical model?
- are there real stages?
- is change a continuum rather?
- changes in stages may happen quicker than the model assumes
- does it predict long-term change?
- only cross-sectional evidence
how are cognitive-behavioral approaches used to change health behaviors?
CBT approaches to health habit modification change the focus to the target behavior itself
- conditions that elicit it
- conditions that maintain it
- factors that reinforce it
focuses heavily on the beliefs that people hold about their health habits through:
- self observation
- self monitoring
- classical conditioning
- operant conditioning
- stimulus control
- self control
what is self-observation?
1st step: discriminate target behavior
understanding the factors affecting target behavior before change is initiated
to do so, one needs to self-monitor
what is self-monitoring?
2nd step: record/chart behavior
understand target behavior's frequency, antecedents and consequences
why do CBT programs use self-observation and monitoring as the first steps toward behavior change?
because a person must understand the dimensions of a target behavior before change can be initiated
what is the ostrich problem?
people are resistant to tracking their health behaviors because the desire to self-protect or self-enhance when behavior change is slow can conflict with the desire to reach one's health behavior goal
what is classical conditioning?
essence of pairing of an unconditioned reflex with a new stimulus, producing a conditioned reflex
one of the first methods used for health behavior change
- works well
- but client knows why they work
- heavily dependent on client's willing participation
what is operant conditioning?
pair a voluntary behavior with systematic consequences
- key is reinforcement
- positive reinforcement or negative reinforcement increases behavior likelihood
therefore, altering reinforcement or its schedule is required to change behavior
how does operant conditioning help change health behaviors?
- at start, will be positively reinforced for any action that moves them closer to their goal
- as progress is made, greater behavior change may be required for the same reinforcement
i.e. when first target behavior is reached and maintained, need to increase the 'difficulty' for the reinforcement to be valuable
what is modelling?
modelling is learning that occurs by virtue of witnessing another person perform a behavior
important for long-term behavior change
- implicit in self-help programs that treat destructive health habits e.g. alcoholism (AA)
- join group of people who are also having the same problem and have some success
can be used for reduction of anxiety that can give rise to bad habits
- helpful to observe models who are fearful but are able to control their distress
what is stimulus control?
individuals who practice poor health habits develop ties between those behaviors and stimuli to their environment
- each of these stimuli can come to act as a discriminative stimulus that is capable of eliciting the target behavior
stimulus control interventions:
(1) rid the environment of discriminative stimuli
(2) create new discriminative stimuli that signal that the new response will be reinforced
what is self-control of behavior?
the individual who is the target of the intervention acts as their own therapist and learns to control the antecedents and consequences of the target behavior to be modified
- contingency contracting
- covert self-control
- skills training
- motivational interviewing
- relaxation training
what is contingency contracting?
an individual forms a contract with another person (e.g. therapist) detailing what rewards or punishments are contingent on the performance or non-performance of a behavior
- e.g. smoker gives money to therapist each time smoke a cigarette and get the money back when successfully stop smoking
what is covert self-control?
trains individuals to recognize and modify internal monologues of self-criticism/self-praise to promote health behavior change
- cognitive restructuring (recognize negative thoughts and replace with more helpful thoughts)
- self-talk (self-administer positive instructions)
what is skills training?
some poor health habits are developed in response to, or are maintained by the anxiety that people experience in social situations (e.g. SOC)
social skills training/assertive training intervention goals:
(1) reduce anxiety that occur in social situations
(2) introduce new skills for dealing with situations that previously aroused anxiety
(3) provide an alternative behavior for the poor health habit that arose in response to SOC
what is motivational interviewing?
- client-centered counseling style
- principles drawn from psychotherapy and behavior change theory
- designed to get people to work through ambivalence they might be experiencing about changing health behaviors
- get client to think through and express own reasons for and against change
- get interviewer to listen and provide encouragement rather than give advice
what is broad-spectrum CBT?
- therapist selects several complementary methods to intervene in the modification of target behavior
what are the advantages of broad-spectrum CBT?
(1) set of techniques can deal with all aspects of a problem
(2) tailored to each individual
(3) impart a broad range of skills that can be used to modify not one, but several habits at the same time
what is the biggest problem faced in health-habit modification?
abstinence violation effect = a lapse in vigilance can lead to loss of control
how are lapses useful?
- help people see that they can control habits
- understand what triggers a lapse
- can actively try to prevent another lapse
- booster sessions
- reminding of values
- further skill building
how are lapses useful?
- help people see that they can control habits
- understand what triggers a lapse
- can actively try to prevent another lapse
who is more likely to relapse?
knowledge is limited
- genetic factors
- withdrawal effects
- conditioned associations
more likely when
- under stress
less likely if
- good social support
what are the consequences of relapse?
- reduced sense of self-efficacy
- some ppl may perceive that they can control their habits to a certain degree
how is relapse managed?
with relapse prevention (having people identify situations that are more likely to promote a relapse)
- booster sessions
- reminding of values
- further skill building
- cue elimination (restructure environment to avoid situations that evoke targeted behavior)
what is social engineering?
it involves modifying the environment in ways that affect people's ability to practice a particular health behavior
- passive strategy (i.e. the individual does not take personal action)
- mandated by legislation (e.g. ban drugs)
- sometimes more successful to use social engineering to modify health behaviors
- ideal for education and prevention
what are the reasons for intervening the family to improve health?
(1) children learn health habits from their parents
(2) families have more organized and routininized lifestyle, so often builds in healthy behaviors
(3) multiple family members are affected by one member's health habits
(4) if behavior change is introduced at family level, all family members are on board ensuring greater commitment and social support
why are schools a desirable venue for health-habit modification?
(1) most children go to school, i.e. a big part of the population is reached
(2) school population is young, i.e. can intervene before bad health behaviors are developed
(3) schools have natural intervention vehicles, i.e. class
(4) sanctions can be used to promote health behaviors, i.e. vaccination
what are preventable injuries?
injuries that are not purposefully inflicted; accidental
they represent one of the major causes of preventable death (esp. traffic accidents); economic cost of unintentional injuries = $518 billion per year
what are different types of preventable injuries?
(1) home and workplace
(2) motorcycle and automobile
- single greatest cause of death from unintentional injury
what is known about road fatalities?
(1) inequality of who dies in a car crash
- gap of traffic fatalities between the educated and the less educated even after adjusting for age, sex, and racial differences
(2) when they occur
- distinct rhythm in traffic fatality
- evenings and mornings higher
- fridays and saturdays after midnight very high
what works at preventing/reducing traffic accidents and what approaches are used?
- safer roads
- safer cars
- better drivers (laws on impaired driving, seatbelts, cellphone use...)
combination of approaches
- social engineering
what is known about the effectiveness of breast cancer screening and what are the recommendations?
- death rate dropped 25% since the initiation of breast cancer screening programs in 1986
- not routinely perform clinical breast exam as a screen for breast cancer
- women aged 50-69 should have a mammogram every 2 years
- breast self-examinations are not an effective method of screening according to WHO
why is screening through mammography so important for older and for at-risk women?
(1) prevalence of breast cancer remains very high
(2) majority of breast cancers continue to be detected in women aged 40+, so screening for this group is cost-effective
(3) early detection can improve survival rates
which approaches/models can be applied to mammography?
health belief model
theory of planned behavior
compliance with mammography recommendations are low for which specific groups and why?
significant gap in participationbetween women in highest and lowest income groups
less likely to get screened if
- no regular family doctor
what are common deterrents for mammogram participation?
- fear of radiation
- anticipated pain
- fear of cancer
- perception of need
what increases women's use of mammograms?
in a study:
- repeated mammography use increased substantially with an intervention that included the mailing of a "mammogram due soon" postcard and two follow-up automated phonecalls
how is the transtheoretical model of behavior change (stages) used in mammograms?
- researchers used the transtheoretical model to predict mammography use
- tried to establish women's stage of change to examine whether it predicted getting a mammogram at a 2-year follow-up
- less likely if in precontemplation, contemplation, action, or relapse stage
- more likely if in maintenance stage
- interventions for increasing mammography behavior may be more successful if they are geared to the stage of readiness of prospective participants
how is the health belief model used in mammography use?
HEALTH BELIEF MODEL
- changing attitudes toward mammography may increase the likelihood of obtaining one
- e.g. perceiving greater benefits
- e.g. fewer costs/barriers
how is the theory of planned behavior used in mammography use?
THEORY OF PLANNED BEHAVIOR
- perceived behavior control is important for predicting mammography use
- other factors may enhance the effectiveness (optimism, risk perception, social support)
- greater perceived behavioral control, greater risk perception, greater belief that behavior will affect outcome all relate to mammogram screening
what are the two different types of prostate cancer screening?
DIGITAL RECTAL EXAM
- most common method
- susceptible to false positives
- susceptible to false negatives
PROSTATE SPECIFIC ANTIGEN TEST
- blood test
- susceptible to false positives
- susceptible to false negatives
what is known about colorectal cancer and its screening?
- colorectal cancer is the 2nd highest cause of cancerous death in Western countries
- increasing rates in Aboriginal Canadians
factors that predict the practice of other cancer-related behaviors also predict participation in colorectal cancer screening:
- perceived benefits of the procedure
- physician's recommendation to participate
- low perceived barriers
colorectal screening is distinctive because it shows if one has polyps, which are benign conditions that increase risk for the cancer, but doesn't detect malignancies
what are health psychologists' role in sun safety practices?
(1) promote safe sun practices
- educational interventions
- alert people to risks of skin cancer
- alert people to the effectiveness of sunscreen use for reducing risk
(2) debate on individualized or generic materials' effectiveness for changing sun safety behaviors
- both are effective
- generics have advantage of reaching greater number of ppl
what are the problems with getting people to engage in safe sun practices?
(1) tans are perceived as attractive
(2) effective sunscreen use is influenced by
- perceived need for sunscreen
- perceived efficacy of sunscreen
- social norms regarding use of sunscreen
- social attitudes toward appearance-related benefits of tanning
(3) evidence that just getting into the habit of using sunscreen is one of the best predictors of effective sunscreen use
(4) health belief model
- increased perceived self-efficacy
- reduced perceived barriers
what is aerobic exercise?
- sustained exercise
- strengthens heart/lungs
- improve body's oxygen utilization
- long duration
- high endurance
what were the results on exercise and cardiovascular health in a study done by Lee, Blair & Jackson (1999) who followed a sample of 21,925 men over 18 years?
- physical activity and body mass at baseline predicted risk of cardiovascular disease
- being aerobically fit or unfit predicted the risk of cardiovascular disease
what are some health benefits of regular exercise?
- resting heart rate
- blood pressure
- use of energy sources
- cardiovascular disease
- menstrual cycle/hormones
- cancer risk
- maximum oxygen consumption
- strength and efficiency of heart
- slow-wave sleep
- HDL cholesterol
- immune system function
- cognitive function
how much exercise is recommended?
- moderate-to-vigorous physical activity
- can be accumulated in bouts of 10min
what did research on exercise and cognitive functioning conclude?
- sedentary older adults
- aerobic vs stretching/toning
- exercise group performed better in cognitive executive functioning 6 monts later
BAKER ET AL 2010
- randomly assigned ppl with mild cognitive impairments
- 4 times a week for an hour
- aerobic exercise vs stretching/balance
- exercise group showed significant improvement in executive functioning
- stretching group continued to decline
how does time perspective influence exercise behavior?
HALL & FONG 2003
- students who signed up to use fitness classes were assigned to 1/3 groups
- time perspective intervention (focused on long-term advantages of exercise)
- goal-setting intervention
- no intervention/control
EFFECTS OF EACH INTERVENTION ON MONTHLY PHYSICAL ACTIVITY:
- time-perspective = +11hrs
- goalsetting = +3hrs
- control = +1hr
what are the effects of exercise on psychological health?
- regular exercise: improves mood/feelings of well-being IMMEDIATELY after a workout
- some improvement in general mood and well-being as a result of long-term participation in an exercise program
how much exercise is needed to improve psychological well-being?
- mood improvement after just 10min of exercise building up to 20min
- no additional improvements over longer duration
- beneficial effects on mood of people with MDD after 30min
is regular exercise effective in the treatment of depression?
WOMEN ASSIGNED TO
- exercise improved their mood significantly
- exercise improved as much as drug or combo
- when treatment discontinued, those who continued exercise were less likely to become depressed again compared to drug treatment
- an increase in symptoms of depressoin is one of the risks of stopping exercise
- the impact of exercise on well-being should not be overstated
- effects are often small
- expectations that exercise has a positive effect on mood may be a reason why people report this experience
what are the 3 main determinants of regular exercise?
characteristics of setting
how does time management influence regular exercise?
- schedules are erratic
- lack of time and stress undermine good intentions
how do individual characteristics influence regular exercise?
MORE LIKELY INITIALLY:
- perceive themselves as athletic
- enjoy their form of exercise
- positive attitude toward phys. activity
- strong sense of self-efficacy
- social support from friends
- boys get more exercise at an early age
- middle-age women get less exercise (lifestyle reasons)
- first nations off reserve and metis are more likely to have physically active lifestyles
- sense of support and group cohesion
- engage in exercise with others reinforce social norms
- believe that one will be able to perform exercise regularly
- more likely to practice
- more likely to perceive that they are benefiting from it
how do the characteristics of the exercise setting influence regular exercise?
- convenient and accessible exercise settings lead to higher rates of adherence
- lack of resources for physical activity can be a barrier among those with low SES
- best predictor of regular exercise is regular exercise itself (long-term practice = habit)
what are the 2 main characteristics for interventions in exercise?
- individualized exercise programs
what are the strategies used in intervention programs for exercise?
THEORY OF PLANNED BEHAVIOR
- participation is predicted from initial behavioral control and stable exercise habits
- promote adherence
- contingency contracting
- self reinforcement
- self monitoring
- goal setting
- interventions designed to increase physical activity that are matched to the stage of readiness of the sample are more successful than interventions without this focus
what are individualized exercise programs?
understanding the individual's motivation and attitudes with respect to exercise provides the underpinnings for developing an individualized exercise program
HIGH ADHERENCE IF
- activity that they enjoy
- develop goals
- are motivated
- do it for the pleasure
- don't do it for specific outcome
- realistic expectations
SMARTPHONE APPS: EFFECTIVE?
- ideal way to affect health behavior change on a larger scale
- but only implement a limited number of behavior-change techniques
what is the importance of having a health diet?
because it is an important and controllable risk factor for many leading causes of death
what is the best-known relationship between dietary factors and disease risk?
the relationship between total cholesterol level and disease
- diet is the only determinant of a person's lipid profile
- therefore it is an important one because it is completely dependent and controllable
- switching to polyunsaturated and monounsaturated fats good
dietary habits to reduce cancer risk
because diet contributes to the incidence of cancer for over 20%, it is important to change one's diet to improve health
- example: high fiber diets (lowers insulin levels)
- statin drug substantially reduces the amount of cholesterol
why are people resistant in modifying their diet?
- typical reason why people change their diet is to improve appearance rather than health
- dietary preferences are often established around 11-12, therefore hard to change
what are problems of maintaining change in diet?
adherence is high at first but often declines over time because
- insufficient attention to the needs for long-term monitoring
- percetion that there will be health benefits
what are the changes made in diets that often make it hard to maintain?
drastic dietary changes
- hard to find/prepare
changes in lifestyle
- meal planning
- cooking methods
- eating habits
- hard to alter taste preference
- comfort foods turn off cortisol
how does stress affect eating?
- consume more fatter foods
- fewer fruits/veggies
- more snacking
what are the three main areas of intervention to modify diet?
what are individual interventions in modifying diets?
begin with education and self-monitoring
- many ppl have poor idea of the importance of particular nutrients and how much of them their diet actually includes
- stimulus control
- self monitor
- contingency training
- motivational interviewing
- different interventions are required for different stages
- contemplating stage more likely to enroll in intervention than precontemplation
what family interventions are useful in modifying diet?
- when all family members are committed to and participate in dietary change, it is easier for the target family meber to do as well
- different aspects of diet are influenced by different family members
- e.g. = husband's food preferences are more powerful determinant of what the family eats if the couple does not have an egalitarian relationship style (!!!!!!!!!!!!!!)
what are community interventions for modifying diet?
school system is categorized as
- not having nutrition program
- not having healthy menu
- not having intensive/multifaceted nutrition program
schools with intensive programs show
- lower obesity
- higher physical activity
- healthier diet
- no significant difference between the two types of schools
- therefore, just having healthier menu is not sufficient in reducing childhood obesity
SOCIAL ENGINEERING + INDIVIDUAL EFFORTS
- banning snacks from schools
- make school lunch programs more nutritious
- make snack foods more expensive
- make healthy foods less expensive
how is eating regulated?
LEPTIN + INSULIN
- circulate in blood
- concentrations are proportionate to body fat mass
- decrease appetite by inhibiting neurons that produce
NPY and AgRP stimulate eating
what is leptin?
- signal the neurons of hypothalamus as to whether the body has enough energy or needs more energy
- brain's control center for eating reacts to leptin = increase or decrease appetite in consequence
(1) inhibits neurons that stimulate appetite
(2) activates neurons that suppress appetite
what is ghrelin?
- stimulates appetite
- secreted by special cells in stomach
- plays a role in why dieters who lose weight gain it back so quickly
- stimulates appetite by activating NPY and AgRP
- ghrelin spikes before meals
- ghrelin drops after meals
what is the role of the ventromedial hypothalamus?
STUDIES WITH RATS
- shown that may be a possible brain mechanism for the control of some eating and its regulation
DAMAGE TO VMH
- eat excessive amount of food
- little sensitivity to internal cues related to hunger
- respond to food-related external cues (e.g. sight of food)
- some people who are obese may have a malfunctioning VMH
what is the obesity epidemic?
obesity = excessive accumulation of body fat (>20-27 in women, >15-22% in men)
worldwide obesity has doubled since 1980 that stem from a combination of
- genetic suscepbility
- increasing availability of high-fat and high-energy foods
- low levels of physical activity
why are people getting more obese?
- more ads and promotions for food
- portion sizes have increased
- healthful foods aren't often available
- carbs and fat consumption have increased
- calorie intake has increased
why is BMI a poor indicator of body mass?
- doesn't account for whether it is fat or muscle that is contributing to a person's weight
- doesn't account for where the fat is distributed
what are the better measurements for assessing obesity-related illnesses?
what is stress weight?
- comes about especially in response to stress
- apple shape
- more physically and psychologically reactive to stress
- show greater cardiovascular and neurendocrine reactivity to stress
what is so bad about fat?
release of lipids (e.g. cholesterol) in the blood increases the risk of atherosclerotic plaques
- more lipid release tells the body its energy stores are sufficient
- causes the decrease in the transformation of glucose into fat
- more glucose in the blood can lead in turn to insulin resistance (diabetes type II)
what is known about the morbidity of childhood obesity?
prevalence has increased over the past 20 years
- boys 5-11 = 3x increase compared to girls
- young women at particular risk for substantial weight gain during their teens and 20s
why should childhood obesity be considered a major health problem?
- 60% of overweight children already showing risk factors for cardiovascular disease (e.g. increased blood pressure, lipid levels)
- significant negative psychological consequences for children's self-esteem (twice as likely to report low self-esteem)
what major factors lead to childhood obesity?
(1) increased sedentary lifestyle
- TV, videogames
- less likely to be obese if participate in organized sports/activities
- stronger link between inactivity and obesity for boys than for girls
(2) parental behaviors
- related to child's obesity
- having one obese parent greatly increases the odds
what is the relationship between fat cells and obesity?
obesity depends on
- number of fat cells
- size of fat cells
- fat cells large
- normal number
- exceptionally large
- excessive number
what determines the number and size of fat cells and propensity to be obese?
CHILDHOOD: WINDOW OF VULNERABILITY FOR OBESITY
- #of fat cells determined in first few years of life through genetic factors and early eating habits
- large# leadsto marked propensity for fat storage = promotes obesity in adulthood
- poor eating habits in adolescence = affect size of fat cells, not number
family history and obesity
overweight parents are more likely to have overweight children
- genetic factors
- lifestyle factors
SES, culture, and obesity
- before, women of low SES heavier than women of high SES
- now, only women in highest household income groups are maintaining low rates of obesity
- men in highest income groups have highest rates of obesity
- rates of obesity are rare
- insufficient foods
- prevalence of obesity rises with SES and increasing wealth
- implicated in childhood obesity
- as income level of neighborhood rises, obesity declines
- poorest neighborhoods = 40%
- richer neighborhoods = 27%
- effects present when children are 10-11 years old
- thinness value for women in high SES
- leads to cultural emphasis on dieting and physical activity
stress and eating
stress affects people's eating habits differently
stress influences what foods are consumed
- ppl who eat in response to stress = dieters who change their food choices from low-calorie/low-fat to high-calorie/high-fat when stresses
- anxiety and depression
- contribute to weight gain
- susceptibility to overeating in response to emotional distress associated with weight gain in women over a 20 year period
- women more likely to overeat when stressed
- high-fat and sweet foods
why is it so hard to lose weight?
- food always available
- habits/attitudes formed in childhood
- body has mechanisms in place to resist weight loss
SET POINT THEORY
- every individual has an ideal biological weight that cannot change very much
- fallacy: not true that we eat because our weight gets too low and we stop eating because our weight reached the ideal point
what tools for weight control has proven to be successful?
- stimulus control
- portion size control
- cut out processed foods
- manage stress
- psychological distress
what are the 4 main treatment/strategies for weight loss?
- appetite-suppressing drugs
- multimodal approach
dieting for weight loss
- trained to restrict calorie intake
- trained to restrict carb intake
- education about caloric values and dietary characteristics of foods
- small effect
- rarely maintained for long
WHY NOT EFFECTIVE?
- rarely matches clients' expectations
- disappointment contribute to regaining weight
- self-set diet = success and adherence rates low
- very low carb/fat diets help initially lose the weight
- but diet that is the hardest to maintain
surgery for weight loss
- radical way of controlling extreme obesity
- reserved for ppl who are 100%+ overweight
- ppl who have failed to lose weight repeatedly
- who have complicating health problems that make weight loss urgent
appetite-suppressing drugs for weight loss
- can produce substantial weight loss
- regain weight quickly
- especially ineffective if attribute weight loss to the drug rather than own efforts
underscores the importance of perceived self-efficacy in any weight loss program
multimodal approach for losing weight
- readiness/motivation to lose weight is screened (self-esteem, body dissatisfaction)
- keep records of what/when/how much/where
- defines behavior
- makes client aware of patterns
- behavior analysis (modify environment, develop new discriminative stimuli)
CONTROL OVER EATING
- train to gain control over eating process
- e.g. count each mouthful
- initial successful weight loss
- better eating-self regulation
- maintenance of weight loss
- cognitive restructuring
- identify maladaptive thoughts
- more successful
- important diet control
- important for self-recrimination that occurs when unsuccessful (esp. women)
how is sleep related to health?
we spend 1/3 of our lives sleeping
insufficient sleep affects
- cognitive functioning
- performance at work
- quality of life
what are the characteristics of health-compromising behaviors?
(1) WINDOW VULNERABILITY IN ADOLESCENCE
- peer culture BIG influence
(2) SELF PRESENTATION
- appear sophisticated, cool
(3) PLEASURABLE, ADAPTIVE, AND THRILL-SEEKING
- behaviors that are pleasurable
- enhances teens' ability to cope with stressful situations
(4) DEVELOPMENT OF BEHAVIOR OCCURS GRADUALLY
- gradually: exposed, becomes susceptible, experiments, regular use
- not all at once
- different interventions for different stages
(5) SUBSTANCE ABUSE PREDICTED BY SOME OF THE SAME FACTORS
- high levels of conflict with parents
- poor self control
- suggests coping mechanisms
- similar profile among those who abuse substances (deviant behavior, low self-esteem, problematic family relationship)
(6) PROBLEM BEHAVIORS ARE RELATED TO THE LARGER SOCIAL STRUCTURE IN WHICH THEY OCCUR
- more common in low social classes
- develop from exposure to hardships/poor health
- greater exposure to problem behaviors
- more stressful situations in lowSES
what are the four main dimensions of substance use disorder?
(1) risky use
(2) impaired control
(3) social impairment
(4) pharmacological effects
what is harm reduction?
intervention strategy for substance use disorders
- public health response
- approach that focuses on risk/consequences rather than on the use
- implemented at community level
- focuses on facilitating safe use of substances
what are the 4 main classes of illicit drugs that are particularly addictive/harmful?
what are the main consequences of illicit drug use?
(1) economic/legal problems
(2) physical problems
- lung damage
- inside nose damage
- risk for HIV
- increased heart rate/blood pressure which increases risk for strokes/death
(3) mental health problems
- short term anxiety and confusion of having a bad trip
- long term memory and personality change
- lowered inhibition, affected judgment
what are the low-risk alcohol guidelines?
- max. 10 drinks per week
- max. 2 drinks a day
- max. 15 drinks per week
- max. 3 drinks a day
what are the genetics of alcohol use disorder?
- offspring of alcoholics were 4x more likely to develop problems with alcohol
- implicated in 50% of vulnerability
- higher among men
- gap is narrowing however
drinking, emotion regulation, and stress
- drinking occurs in part as an effort to buffer the impacts of stress
- enhance positive emotions
- decrease negative emotions
(A) positive reinforcement
- enhancement: gives pleasant feeling
- social: make social gatherings fun
(B) negative reinforcemnet
- coping: cheer up when bad mood
(2B) conformity: others won't make fun if not drinking
what are the social origins of drinking?
SOCIAL/CULTURAL ENVIRONMENT OF THE DRINKER
- learn early in life to associate drinking with pleasant social occasians
- develop social life around drinking
- marriage predicts decreases in involvement in social activities = therefore drinking too
WINDOWS OF VULNERABILITY
- chemical dependence
- developing adolescent brain
- diminished abililty to control
(2) late middle age
- problem drinking
- coping method
what are possible treatments for alcohol use disorder?
some mature out of alcoholism
- 10-20% stop on own
- 32% stop with minimal help
- higher SES higher success rates
- treatment programs
- relapse prevention
- community based
- minimal interventions
what are the treatment programs for alcohol use disorder (AUD)?
- most commonly sought source
- maintains that alcoholism is a disease that can be managed, but never cured
- effectiveness unclear
- short-term, intensive inpatient
- outpatient afterwards
what are the CBT behavior modification techniques for alcohol use disorder (AUD)?
- problem drinker understands the situation that give rise to and maintain drinking
- person agrees to a psychologically or financially costly outcome in the event of a failure
- responsibility and capacity to change rely entirely on client
- about the drinking
- about the effectiveness of efforts
what pharmacological agent can be used for the treatment of AUD?
- aids to prevent relapse
- blocks opioid receptors
- makes rewarding effects of alcohol weak
what stress management techniques can be used to treat AUD and why?
they can substitute drinking because drinking is sometimes used as a method for coping with stress
- assertive training
- social skills
what is relapse-prevention intervention?
- practice coping/social skills in high-risk-for-relapse situations
- recognition that people often stop and restart addictive behaviors several times before successfuly stopping
- understand that occasional relapse is normal
- drink refusal techniques
- substitution for non-alcoholic beverages in high-risk situations
what are the 6 main factors that are consistently associated with success in alcohol treatment?
(1) identify factors in environment that control drinking.
(2) modify factors and instill coping skills to manage.
(3) moderate the length of participation ~6-8 weeks.
(4) outpatient aftercare.
(5) inclusion of stress management component.
(6) active involvement of relatives in treatment process.
are minimal interventions effective?
OSLIN ET AL 2013
- veterans with depression
- veterans at risk for drinking prob.
- usual care
- telephone alcoholism and depression management
- telephone: beneficial changes, viable, low-cost; better than usual care
can recovered drinkers ever drink again?
moderate drinking is an approach to nondependent problem drinking
- does not promote total abstinence
- offer guide to help decide if moderate drinking is a viable option for them
what is the moderation management website?
online groups and forums
core principles based on CBT
- goal setting
- self monitoring
- self control of drinking
does it work?
- attracts nondependent problem drinkers
- effective with less heavy drinkers
what are advantages of moderate drinking rather than total abstinence?
(1) moderate drinking represents a realistic social behavior for the environments that a recovered problem drinker may encounter
(2) traditional therapeutic programs that emphasize total abstinence often have high dropout rates
what are different preventive approaches to AUD?
appeal to adolescents especially
(1) social influence programs
- teach young teens drink-refusal techniques
- coping methods for dealing with high-risk situations
(2) media campaigns
- provide resources/info about consequences
- illustrate neg. consequences
- challenge youth to resist social pressure
(3) social engineering
- increase taxes on alcohol
- restrict advertisement
which aspect of alcohol is the one that mobilizes the general public the most against alcohol abuse?
DRINKING AND DRIVING!
- increased media attention on the problem
- caused drinkers to develop self regulatory techniques to avoid driving when drunk (designated driver, taxi...)
is modest alcohol consumption a health behavior?
ADDS TO LONG LIFE!
- reduced risk of heart attack
- lower blood pressure
- lower risk of dying after a heart attack
- decreased risk of heart failure
- less thickening of the arteries with age
- increase in high density lipoprotein cholesterol - HDL
- fewer strokes
what is the general profile of a smoker?
- less health conscious
- more likely to engage in other unhealthy behaviors
- more accidents/injuries @ work
- take off more sick time
- use more health benefits
- spend more days in hospitals
- not true that smoking and alcohol serve as an entry level drug to subsequent substance use
what does "synergistic effect" mean and how does it apply to smoking?
enhances the detrimental effects of other risk factors in compromising health
SMOKING + CHOLESTEROL
- smoking and choleterol interact to produce higher rates of morbidity and mortality
- how? because nicotine stimulates the release of free fatty acids, which increases the synthesis of triglycerides
- in turn, this decreases good HDL cholesterol
what are other synergistic effects of smoking?
SMOKING + STRESS
- men = nicotine increases magnitude of heart rate reactivity to stress
- women = reduce heart rate, increase blood pressurer responses
SMOKING + STRESS + SES
- low SES = greater harm because disadvantaged due to stressful life circumstances
SMOKING + EXERCISE
- engage in less physical activity as they continue smoking
SMOKING + BREAST CANCER
- substantial increase in risk of breast cancer after menopause
- active/passive smokers = increased risk
- 65% increase among premenopausal women who have been exposed to second-hand smoking but are non-smokers
SMOKING + DEPRESSION
- a depressed person who smokes is at greater risk for cancer
- immune alterations associated with MDD interact with smoking (e.g. elevated white blood cell count)
- smoking can also be a potential cause of depression
why do people smoke?
- begins early
- peer/family influence
how do peer influences shape smoking behaviors?
most important factor in beginning smoking in adolescence
- social contagion
nonsmokers have contact with
- others who are trying out smoking
- regular smokers
how does the home environment influence smoking behaviors?
parental smoking is linked with adolescent smoking
- 75% of adolescent daily smokers report having at least one parent that smoked
- adolescents with at least one smoker living in the household is 3xmore likely to smoke themselves
SOCIAL LEARNING THEORY
- adolescents tend to mimic others' behaviors
- presence of peers/family members who smoke can encourage smoking by reducing the perception that smoking is harmful
what are the genetics of smoking?
- runs in families
- twin adoption studies = genetic influences
- genes that regulate dopamine are likely candidates for heritable influences on cig. smoking
- especially on whether they are able to stop smoking and resist relapse during treatment phase
adolescence are more likely to start smoking if:
feel social pressure
major stressor in family
why is smoking hard to change?
deeply entrenched behavior that may be influenced by
- phys addiction
- mood, since it elevates it
- weight control
many smokers have successfuly quit on their own
- good self-control skills
- good self-confidence in their ability to stop
- belief that the benefits of quitting are substantial
why do people continue to smoke?
smoking is an addiction
- affects dopamine
- affects norepinephrine
- both neurotrans. enhance memory, alertness and mood
maintained by social learning and rewards
what are 4 main [focused] interventions to reduce smoking?
(1) nicotine-replacement theory
(2) multimodal interventions (transtheoretical)
(3) social support + stress management
(4) maintenance and relapse prevention
how have media campaigns helped in smoking prevention?
helped spread antismoking attitudes in the general public
- changes in social norms have motivated people to quit
- however, the attitude-change campaigns themselves do not help smokers quit
- need direct approaches
what are the pros and cons of a harm reduction approach to smoking (i.e. vaping)?
- fewer health risks
- nicotine not known to cause cancer
- second-hand vapor less harmful
- nicotine = addictive
- affects memory/concentration
- alter brain dev in adolescents
- vaping liquid = poisonous
- limited evidence of safety on long-term use
what is stress?
negative emotional experience accompanied by predictable biochemical, psychological, cognitive, and behavioral changes that are directed toward altering the stressful event or to accommodating its effects
what is a stressor?
initially, found to be stressful events themselves (e.g. crowds)
study of stressors has helped define some conditions that are more likely to produce stress
how a potential stressor is perceived determines whether it will be experienced as stressful or not
what is person-environment fit?
stress is a consequence of a person's appraisal processes
stress is determined by person-environment fit
1) when a person's resources are more than adequate to deal = little stress and sense of challenge
2) when a person perceives that their resources will be sufficient only at the cost of great effort = moderate amount of stress
3) when a person perceives that their resources will not suffice = great deal of stress
what is the person-environment fit process?
stress results from the process of
1 - appraising events as harmful/threatening/challenging
2 - assessing potential responses
3 - responding to those events
what are the 5 main theories and models of studying stress?
- james-lange theory
- general adaptation syndrome
- cognitive transaction model
what is the james-lange theory of stress?
the theory describes when there is a threat in the environment, our body undergo physiological reactions
the emotions come after, i.e. they result from and in response to the physiological changes
what is the fight-or-flight theory of stress?
- proposes that when an organism perceives threat, the body is aroused and motivated via the SNS and the endocrine system
FOCUS IS ON
- adrenomedullary response
- i.e. catecholamine secretion
the response takes the body out of a state of homeostasis temporarily to respond to stress
what is the general adaptation syndrome model of stress?
- father of stress research
- coined term with physiological interpretation
HOW IT CAME ABOUT
- exposed rats to variety of stressors like cold or fatigue
- all stressors produced same pattern of phys response
- enlarged adrenal cortex
- shrinking of thymus and lymph glands
- ulceration of the stomach and duodenum
- adrenocortical response to stress
what are the strengths to the general adaptation syndrome?
- general theory of stress
- recognized interaction of physiology and environment
- framework for understanding the relation between chronic stress and disease
what are the criticisms of the general adaptation syndrome?
- assigns limited role to psychological factors
- assumes that responses to stress are uniform
- assesses stress as an outcome
what is the tend-and-befriend model of stress?
theory = in addition to fight-or-flight, humans respond to stress with social and nurturant behaviors
EVOLUTION OF STRESS
- males and females faced different adaptive challenges
- women = befriending i.e. affiliate with others and seek social contact during stress
- suggests that fight-or-flight may be down-regulated by oxytocin
- stress hormone significant for female responses
- influenced by estrogen
- increases affiliative behaviors like mothering and warmth
- therefore = evidence that women are more likely than men to respond to stress by turning to others
what is the cognitive transaction model of stress?
- relationship between a person and environment
- stress is the outcome of primary and secondary appraisal processes
- determines the meaning of the event
- harm (damage already been done)
- threat (possible/future damage)
- challenge (potential to overcome and/or profit from the event)
1964 STUDY WITH FILMS
- gruesome films
- groups who learned about the film beforehand were less stressed
- stress depended on the viewer's appraisal of the film
- assessment of one's coping abilities and resources
- subjective experience of stress = balance between primary and secondary
- focus is oriented towards immediate stressor and away fro distant concerns
- amygdala activation
what are individual differences in stress reactivity?
REACTIVITY: degree of change that occurs in autonomic, neuroendocrine, and/or immune responses as a result of stress
- reactivity to stress affects vulnerability to illness
- recovery after stress is also important for moderating the negative effects of stress
what does psychological recovery process say about stress?
the inability to recover quickly from a stressful event may be a marker for cumulative damage that stress has caused
particularly prolonged cortisol responses
what is allostatic load?
refers to the fact hat psychological systems within the body fluctuate to meet demands from stress; state is called allostasis
overtime, allostatic load builds up, i.e. it is the long-term costs of chronic or repeated stress
how is allostatic load manifested?
- reduced cell-mediated immunity
- high cortisol release
- elevated epinephrine
- memory problems
- central obesity
- high blood pressure
how do we assess stress?
using multiple measures may increase the possibility of obtaining a good model of the stress experience
- self-reports of perceived stress, life change, emotional distress
- behavioral measures
- physiological measures
- biochemical measures
what are the dimensions of stressful events?
the events themselves aren't stressful - depends on how they are appraised
what are the characteristics of potential stressors that can make them more likely to be appraised as stressful?
- more likely to produce stress
- present ppl with extra work or special problems that may tax or exceed their resources
- show stronger relationships to both physiological distress and physical symptoms
- more stressful
- if can predict, have more control even if just believe it
- no opportunity to take action
- must devote energy to understand the stressor
- overloaded ppl are more stressed
- poorer health
must stress be perceived as such to be stressful?
- perceiving stress as being harmful for one's health may be enough to increase risks for health problems
- although perception of stress and belief in its harmful effects is important, objectively defined stress also shows a relation to adverse psychological and physiological changes
whether people habituate to a stressful event or develop chronic strain depends on which three factors?
- type of stressor
- subjective experience to stress
- which indicator of stress is considered
what is psychological adaptation?
people show signs of both long-term strain and habituation to chronically stressful events
- most ppl can adapt moderately well to mild stressful events
- however it may be difficult for them to adapt to highly stressful events
- already stressed people may be unable to adapt to moderate stressors
what is physiological adaptation?
low-level stress may produce habituation in most people, but with more intense stress, damage from chronic stress can accumulate across multiple organ systems
physiological habituation may not occur when stressors are long-term and the immune system may be compromised by long-term stress
does the stressor need to be ongoing to be stressful?
- anticipation of the stressor can be as if not more stressful as its occurrence
- explains why one of the reasons that stress presents both as a health hazard and a challenge
- effects of stress often persist long after the stressful event is no longer present
what is the acute stress paradigm?
short-term stressful events are often used in labs
- acute stress paradigm = show both short-term psyc distress and strong indications of sympathetic activity and neuroendocrine responses
what are the problems in measuring stressful life events?
using the social readjustment rating scale (SRRS):
(1) items are vague
(2) individual differences in the way events are experienced aren't taken into account
(3) inventories usually include both positive and negative events
(4) researchers typically do not assess whether those events have been successfully resolved
(5) assessing specific stressful events may also tap ongoing life strain
(6) some ppl may just be prone to report more stress in their lives, or experience more intensely
(7) time period between stress and illness
how do minor hassles produce stress and impact health?
- reduce well being
- produce phys symptoms
- worsen symptoms in ppl already ill
what are the sources of chronic stress?
- bad social relationships
- high-stress job
- managing chronic illness
what is PTSD?
type of chronic strain that results from severely traumatic events whose residual effects may remain in the individual for years
what are risky families?
families that are high in conflict or abuse and low in warmth and nurturance
- produce offspring with problems in stress-regulatory systems
- by virtue of having to cope with a chronically stressful family environment, children develop heightened sympathetic reactivity to stressors and exaggerated cortisol responses
what is iso-strain?
low status occupations related to more stress and poorer health
- high demands
- low control
- low support
why is it hard to conduct research relating chronic stress to mental and physical health?
1- hard to demonstrate that a particular chronic stressor is the factor contributing to illness
2- chronic stress is assessed subjectively on the basis of self-reports
3- inventories that attempt to assess chronic strain may also tap psychological distress and neuroticism rather than the objective existence of stressful conditions
4- picks up the effects of chronic strain so that the impact of chronic strain on psychological and physical health is obscured
what is coping?
coping is defined as the thoughts and behaviors used to manage the internal and external demands of situations that are appraised as stressful
what are the important aspects of the definition of coping?
RELATIONSHIP BETWEEN COPING AND STRESSFUL EVENT IS A DYNAMIC PROCESS
- series of transaction between person and environment
- not a one time action
- coping is a set of responses occurring overtime
- environment and person influence each other
- encompasses many actions and reactions to stressful circumstances
- emotional reactions therefore can be thought of as part of coping processing
what are the aspects of personality that influence how a person will cope with a stressful event?
INTERNAL COPING RESOURCES
- negative affectivity
how does negative affectivity influence coping?
NEGATIVE AFFECTIVITY: pervasive negative mood marked by anxiety, depression, and hostility (disease-prone)
some ppl are predisposed to experience stressful events more powerfully
- affects their psychological distress, physical symptoms, and rates of illness
- among those who already have a family history of certain illnesses
- associated with elevated cortisol secretion
- can create false impression of poor health when none exists
how does pessimism influence coping?
PESSIMISM: stable dispositional characteristic to expect negative outcomes in the future
PESSIMISTIC EXPLANATORY STYLE: explain their negative life events in terms of internal, stable, and global qualities
- may have immunocompetence, i.e. poorer cell-mediated immunity
- linked to low SES which relates to poor health
how does perfectionism influence coping?
PERFECTIONISM: setting of and preoccupation with excessively high standards accompanied by a tendency to engage in self-criticism
- associated with poorer health outcomes
- generates stress
- engage in more maladaptive coping strategies
socially-prescribed perfectionism: belief that others hold unrealistically high standards for their behavior -- also relates to poor health outcomes
what are appropriate internal coping resources?
INTERNAL COPING RESOURCES
- psychological control
how does optimism influence coping?
DISPOSITIONAL OPTIMISM: general expectancy that good things, not bad, will happen in the future
- leads ppl to cope more effectively
- use more adaptive coping strategies like seeking social support, have more positive mood
- better stress regulation = quicker cortisol recovery
how does self-compassion influence coping?
SELF-COMPASSION: treating oneself with kindness, feeling connected with humanity, and being mindfully aware of distressing experiences
- buffer the negative effects of stress
- most beneficial in times of suffering and challenge
- associated with seeking medical attention sooner after experiencing a health threat
how does gratitude influence coping?
GRATITUDE: orientation towards noticing and appreciating the positive in life
- positive coping styles (emotional support seeking, instrumental social support seeking, active coping)
- associated with good sleep quality
how does psychological control influence coping?
PSYC CONTROL: belief that one can determine one's own health behavior, influence one's environment, and bring about desired outcomes
- closely related to self-efficacy
how does self-esteem and conscientiousness influence coping?
- found to moderate stress
- tendency to be diligent, thoughtful and thorough
- predicts longevity bc conscientious people are better able to recognize and avoid harmful situations or because they practice good health habits
these coping resources are assets that can be drawn upon in stressful times
what is a coping style and what are the different types?
COPING STYLE is a general propensity to deal with stressful events in a particular way which can be differentiated from coping strategies, which are specific behaviors/thoughts people use to deal with stressors
what is approach-related coping style?
- more successful if one can focus on the info present in the situation rather than emotions
- more successful if there are actions that can be taken to reduce the stressor
- cognitive/emotional efforts needed to deal with long-term threats
- may pay a price in anxiety and physiological reactivity in the short-term
what is avoidance-related coping style?
- effective coping for short-term threats
- if the threat is repeated/persists over time, a strategy of avoidance may not be successful
- may not make enough cognitive/emotional efforts to anticipate and manage long-term problems
what are the different coping strategies and how are they distinguished?
distinguished according to the target of coping efforts
1- problem-focused coping
2- emotion-focused coping
3- relationship-focused coping
what is problem-focused coping?
attempting to do something constructive about the stressful conditions that are harming/threatening/challenging
emerges in childhood
if something constructive can be done, problem-focused coping is used
what is emotion-focused coping?
conscious efforts to regulate emotions experienced because of the stressful event
emerges in childhood/early adolescence
if the situation must simply be accepted, emotion-focused coping is used
what are the subtypes of emotion-focused coping?
1) emotional distress experienced in rumination, which is detrimental to health
2) emotional-approach coping, which consists of clarifying, focusing on, and working through the emotions experienced in conjunction with a stressor
- benefits for a broad array of stressful situations
- especially beneficial for women (heightens oxytocin effects)
- soothing effect on stress regulatory systems
what is relationship-focused coping?
it underscores the importance of the interpersonal processes involved in dealing with stress
- social support can come in the form of support from partner and can impact an outcome
interplay of the stress experienced and expressed by one partner and the coping reactions of the other can have important implications for the outcomes of both
- when both partners respond empathetically to each other's needs during stress, this empathetic responding can help reduce daily stress
- faster cortisol recovery after being stressed
what is coping flexibility?
COPING FLEXIBILITY: being able to discontinue an ineffective strategy and switch to an alternative and more adaptive strategy
people who are better able to shift their coping strategies to meet the demands of a situation cope better with stress than those who do not
- suggested by the fact that problem-solving and emotional approaches may work better for different stressors
what are external coping resources?
EXTERNAL RESOURCES include time, money, education, children, friends, family, job, standard of living, presence of positive life events, and absence of other life stressors
the MOST POTENT external resource with respect to health is SES
- high ses = less likely to have medical/psyc disorders
- high ses = less mortality from all causes of death
- relationship is so strong, even animals show it
what is psychological resilience?
RESILIENCE comes from individual differences in how people cope with stressful events
- positive events, good mood, and opportunities for rest, relaxation, and renewal may help people cope more effectively with life stressors and/or prevent stressful events from taking a toll on health
PSYCHOLOGICAL RESILIENCE is the ability to bounce back from negative emotional experiences and by adapting flexibly to the changing demands of stressful experiences
- being able to experience positive emotions appears to be one important method of coping that resilient people draw on
coping efforts center on what 5 main tasks?
1) reduce harmful environmental conditions and enhance the prospects of recovery
2) tolerate or adjust to negative events or realities
3) maintain a + self-image
4) maintain emotional equilibrium
5) continue satisfying relationships with others
what are coping outcomes?
they are used to assess successful coping:
(1) measures of physiological and biochemical functioning
- coping efforts are judged as successful if they reduce arousal and its indicators such as heart rate and pulse
(2) whether and how quickly people can return to their pre-stress activities
(3) coping judged according to its effectiveness in reducing psychological distress
(4) whether it terminates, lessens, or shortens the duration of the stressful event itself
what is social support?
defined as information from others that one is loved and cared for, esteemed and valued, and part of a network of communication and mutual obligations from parents, a spouse or lover, other relatives, friends, social and community contacts, or even a devoted pet
high levels of social support = less stress experienced when confront stressful experience and may cope better
what forms can social support take?
- involves the provision of material support (services, financial assistance, goods)
- help individuals understand a stressful event better and determine what resources and coping strategies can be mustered to deal with it
- the individual can determine how threatening the stressful event is likely to be and can profit from suggestions about how to manage the event
- can be provided by reassuring the person that they are a valuable individual who is cared for
- can enable a person under stress to approach it with greater assurance
- when one receives help from another but is unaware of it and that help is most likely going to benefit the self
- perceiving that one has social support goes a considerable distance in providing the health and mental benefits of social support
implicit vs explicit social support
EXPLICIT SOCIAL SUPPORT
- designed to target a specific problem or is meant for a specific purpose (tangible, emotional, informational)
IMPLICIT SOCIAL SUPPORT
- when social support originates from implicit social networks without being directly targeted at a specific problem
- simply knowing that you have a social network that you can rely upon if there was a stressful event
- receiving support from that network without actively seeking it out
what are social support outcomes?
(1) effects on psychological distress
(2) physiological/neuroendocrine response
(3) illness and health habits
what are the effects of social support on psychological distress?
lack of social support during times of need can itself be very stressful
- loneliness leads to health risks because lonely people appear to have more trouble sleeping and show more cardiovascular activation
- social support reduces psychological distress during times of stress
what are the effects of social support on illness and health habits?
can lower the likelihood of illness, speed recovery from illness/treatment, and reduce the risk of mortality due to serious illness
people with higher levels of social support have
- less complications during childbirth/pregnancy
- report less pain
- have lower rates of myocardial infarction
- are less likely to show age-related cognitive decline
advantages of social support can be cumulative during times of stress
what are the biopsychosocial pathways of social support?
beneficial effects on the cardiovascular, endocrine, and immune systems
- perception of social support associated with lower systolic blood pressure in working women
- suggests that the presence of, or the perception of social support may have enabled these women to go through a stressful workday without
what are the two possibilities of the role of social support in moderating stress?
DIRECT EFFECT HYPOTHESIS
- social support is generally beneficial during non-stressful times as well as during highly stressful times
- health and mental health benefits of social support are chiefly evident during periods of high stress
- when there is little stress, social support may have few physical or mental health benefits
evidence suggests both direct effects and buffering effects
- social integration/quantitative assessment = direct effect
- qualitative assessment = buffering effect
what is social support extraction?
effectiveness of social support depends on how an individual uses a social support network
- some ppl are better than others at extracting the support they need
factor that may affect how well an individual is able to extract, use, and benefit from social support is ATTACHMENT
what kinds of support are most effective?
- too much/overly intrusive may exacerbate stress
- when controlling/directive, may have benefits on health behaviors, but produce psychological distress
certain types take time before beneficial effects are noticed
- emotional/social associated with increases in severity of depressive symptoms
- BUT, when duration of symptoms are examined, actually predicts decreased duration
- i.e. talking to others about one's depressive symptoms may make them even more aware of their symptoms, but then having this type of support might help reduce how long one feels depressed
what is the matching hypothesis?
a match between one's needs and what one receives from others in one's social network
- social support is effective when one meets the needs
- empathetic understanding helps support providers sense what kinds of support will be most helpful to a person going through a stressful event
what are the main coping interventions?
- mindfulness training
- stress management
- relaxation training
what is mindfulness training?
MINDFULNESS-BASED STRESS REDUCTION (MBSR)
- systematic training in meditation
- assists ppl in self-regulating their reactions to stress
- more aware of the present moment
- small but reliable benefits (quality of life/sleep sign. improved; long-lasting)
what is disclosure?
when people undergo traumatic events and cannot/do not communicate about them, those events fester inside
- inhibition of traumatic events involves phys. work
- forced to inhibit thoughts and emotions = increases phys. activity
- talking/writing about the event helps decrease blood pressure and heart rate
what are stress management programs?
(1) learn what stress is and how to identify stressors
(2) acquire and practice skills for coping with stress
(3) practice stress management techniques in targeted stressful situations and monitor effectiveness
what is relaxation training?
designed to affect the physiological experience of stress by reducing arousal
- improve salivary cortisol levels
- reduce stress by altering pathways involved in the expression of immune system cells involved in inflammation
what is the canadian health care act?
"to promote, protect, and restore the physical and mental well-being of residents and to facilitate reasonable access to health services without financial or other barriers"
- public administration
who's who in health care?
PHYSICIANS: diagnosis and treatment-focused
PARAMEDICS: professional diploma, provides emergency care in the field
NURSES: care-focused, often screen and triage patients, give treatment instructions
OCCUPATIONAL THERAPISTS: help develop, rehabilitate, or maintain daily living skills and work skills
PHYSIOTHERAPISTS: focus on mobility, physical activity, injury prevention
SPEECH LANGUAGE PATHOLOGISTS: diagnose and treat communication disorders
AUDIOLOGISTS: diagnose and treat hearing issues
DIETITIAN: provides nutritional advice to patients and create specialized diets
SOCIAL WORKER: supports patients/families, coordinates social services
what are the different types of nurses?
REGISTERED NURSES (RN)
- 4-year bachelor's degree
LICENSED PRACTICAL NURSE
- college degree
- work under direction of RNs or physicians
- additional training to prescribe drugs and give diagnoses
what are the clinical psychologists' role in the hospital?
- diagnosis and treatment of mental disorders
- emergency room = assess risk of self harm or harm to others
- psychosocial rounds = interdisciplinary daily case review
- psychological testing = assess cognitive function among patients
- mental health support
what is delay behavior and what are the different time periods?
DELAY BEHAVIOR: time between when a person recognizes a symptom and when the person obtains treatment
(1) appraisal delay
- time it takes an individual to decide that a symptom is serious
(2) illness delay
- time between recognition that a symptom implies illness and the decision to seek treatment
(3) behavioral delay
- time between deciding to seek treatment and actually doing so
(4) medical delay
- time that elapses between the person's making an appointment and receiving appropriate care
portrait of the delayer generally bears strong similarities to the one of the non-user of services
- elderly delay less than middle-aged
- ppl who don't have a regular physician
- ppl who seek treatment primarily in response to pain/social pressure
how do symptoms predict delay?
nature of the symptoms predicts delay:
- when it is similar to one that previously turned out to be minor, the individual seeks treatment less quickly than if it is new
- highly visible symptoms
- symptoms that don't hurt
- symptoms that don't change quickly
- symptoms that aren't incapacitating
when do we seek help? (awareness, trust, access)
AWARENESS OF THE PROBLEM
- recognize and interpret symptoms
- illness schemas
TRUST IN HEALTH SERVICES
- racism in the ER
- forced and coerced sterilization in aboriginal women
- rural and remote areas are severely underserved
- systemic delays (wait time...)
how do we recognize a symptom?
- neuroticism affects perception of symptoms
- SYMPTOM PERCEPTION HYPOTHESIS = ppl who are high in neuroticism recognize their symptoms more quickly and report them more quickly
- depression = increased physical symptom reporting only when recalled retrospectively
- anxiety = increased reports of symptoms only for momentary symptoms
- in how quickly they are recognized and what kinds of symptoms are recognized
- medical students' disease: as they study every illness, imagine that they have it and symptoms appear to emerge
- a boring situation makes people more attentive to symptoms
- a symptom is more likely to be perceived when at home
- positive mood: perceive themselves as healthier, report fewer symptoms
- negative mood: report more symptoms, are more pessimistic about their vulnerability to future illnesses
how do we interpret symptoms?
- ppl who have experienced with a medical condition estimate the prevalence of their symptoms to be greater and often regard the condition as less serious than do ppl with no history of it
- depends on educ, SES, age, gender
- lack of social support, limited attentional resources, low expectations about health, low health literacy all interfere with interpretation of symptoms
- play a role in the experience and interpretation of symptoms
- simply expecting symptoms activate brain areas associated with the experience of symptoms
- symptoms that affect highly valued parts of the body are interpreted as more serious (eyes, face)
what are illness schemas?
organized conceptions of illness; people have concepts of health and illness that influence how they react to symptoms
- identity (label, name)
- consequences (symptoms/treatments)
- causes of illness
- duration of illness
- cure (if can be cured)
3 MODELS OF ILLNESS
- acute (caused by viral/bacterial agent, short in duration)
- chronic (several factors, long duration, severe consequences)
- cyclic (alternating periods during which there are no symptoms and many)
What is a lay referral network?
it is an informal network of family and friends who offer their own interpretations of symptoms well before any medical treatment is sought (family, friends, internet)
- beneficial -- 1 and a half times more likely to exercise and eat more fruits/veggies a year later
what is cyberchondria?
an excessive use of internet health sites that fuel health anxiety
what predicts the use of health services?
- psychosocial factors
how does age predict the use of health services?
- very young and elderly use the most
- declines in adolescence
- increases again in late adulthood
how does gender predict the use of health services?
WOMEN use more than men
- pregnancy and childbirth
- better homeostatic mechanisms, i.e. report pain earlier = more sensitive to disruptions
- social norms; more acceptable for women to seek help
- economic factors
- medical care more fragmented, i.e. need to visit different types of physicians
how does SES predict the use of health services?
- lowest SES and with least education are less likely to have visited a family physician in the previous year compared to those in the highest SES groups or with high education
- people with lower SES and education who don't consult family physicians are more likely to make 4+ visits in a given year compared to those with higher SES
- differences in access
- differences in how services are used
how does culture predict the use of health services?
influence the types of medical and health services that people use
- varies by ethnicity (ethnic minorities are more likely to visit physicians, but not a specialist)
- linguistic barriers
how does psychosocial factors predict the use of health services?
an individual's attitudes/beliefs about symptoms and health services influence who uses them
health belief model: whether a person seeks treatment for a symptom can be predicted by two factors
1- extent to which person perceives a threat
2- degree to which person believes that a particular health measure will be effective
what are the facilitators to help-seeking?
- parents' attitudes and behaviors with regards to health care
- knowledge of health services
- positive past experiences in healthcare settings
- trust in provider and system
- perceived seriousness of problem
- lack of stigma
how are health services misused?
FOR EMOTIONAL DISTURBANCES: WHY DOES IT HAPPEN?
(1) stress and emotional responses to it creates a number of physical symptoms
- anxiety and depression produce physiological symptoms that make people consult more
- worried well group: concerned about physical and mental health and are inclined to perceive minor symptoms as serious; committed to their self-care
- somaticizers: individuals who express distress and conflict through bodily symptoms
(2) medical disorders are perceived as more legit than psychological ones
(3) illness brings benefits (secondary gains) e.g. time off work
(4) may represent a true malingering
- only acceptable excuse to not go to work is to call in sick
how does hospitalization impact the patient?
- loss of control
- constant interruptions
- poor diet/sleep
- being poorly prepared for procedures
- medical errors
- fear of loss of life
- being treated badly
what are the two key trends in canadian hospitals?
1- average length of hospital stay decreased
2- outpatient visits have increased
what are recent trends in hospitalization?
- more walk-in clinics handling less serious complaints
- more community primary health centers
- more hospices
- more home care and distance treatments
- shift from inpatient to day surgeries
- more health promotion and illness prevention
- expanded role for health psychologists
- greater emphasis on continuity of care
canadian hospitals have adopted a new organizational model based on which model?
the johns hopkins model
- structuring of specialty areas within the hospital as functional units that are headed by a physician chief
- maintains an environment of subordination rather than fostering teamwork and leaves nurses and other professionals with little power in health care decisions
what is "work of worrying"?
IRVING JANIS 1958
- studied pre-surgery anxiety
- grouped patients according to levels of fear experienced
(1) high anxiety pre-surgery = high anxiety post-surgery and negative side effects
(2) low anxiety = became angry, upset, many complaints
(3) moderate anxiety = coped best with post-operative stress; vigilant, but not overwhelmed
WORK OF WORRYING : some anticipatory worry helps patients cope with surgery
why is patient-provider communication important?
people judge the quality of care by the manner in which it is delivered
- not judged by technical quality
- empathetic and caring judged as more competent than cool and aloof providers
what is patient consumerism?
factor that influence heavily the patient-provider interaction
it is the patient's increasing desire and need to be involved in the decisions that affect their health
- want to take more active roles
- increased emphasis on maintaining and achieving good health
- internet research to inform the self about health
is the medical office an effective-communication-prone setting?
- average visits last 12-15min
- when trying to explain symptoms, physician interrupts patient before 23 seconds
- difficult to present complaints when one is in pain
- anxiety/embarrassment about symptoms or examination reduces ability to articulate
- provider is on a tight schedule and wants to extract significant information quickly
what is holistic health?
its philosophy is the idea that health is a positive state to be actively achieved and not merely the absence of disease
it is a viewpoint that acknowledges psychological and spiritual influences on achieving health and it gives patients responsibility for both achieving health and curing illness through behaviors, attitudes, and spiritual beliefs
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)
- herbal medicine
- spiritual healing
- more open, reciprocal
- more emotional contact into relationship
- interpersonal care and communication rated higher with CAM providers than with physicians
what are provider behaviors that contribute to faulty communication?
- interrupt 18-22 secs in
- loss of important info
USE OF JARGON
- use it bc keeps patients from asking too many questions, discovering that the provider is not certain what the patient's problem is
- carryover from technical training
- underestimate patient's understanding of illness/treatment
- simplistic explanations
- forestalls questions
- feel helpless
- overly familiar terms
- overly caring and infantilizing
- feel incompetent
- negatively impact health
- first nations
- social distancing
- provider from same race = higher satisfaction ratings
- sexism in medical practice
what are the patient's contributions to faulty communication?
- present exaggerated picture of symptoms
- retain little information because of too high anxiety
- unable to understand simple info about own case
- linguistic barriers further complicate
- use of internet helps
PATIENT ATTITUDES TOWARD SYMPTOMS
- respond to different cues about illness than do practitioners
- place considerable emphasis on pain and symptoms
- providers more concerned with underlying illness
what are the interactive aspects of the communication problem?
may perpetuate faulty communication
- the interaction does not provide the opportunity for feedback to the provider
- rarely knows whether info was communicated effectively
patient does not return?
- treatment cured disorder
- patient got worse and sought treatment elsewhere
- treatment has failed but disorder cleared up
- patient died
provider may find it hard to know when a satisfactory personal relationship has been established
- patients are cautious with providers
- if dissatisfied, more likely to just change providers rather than directly complain
2 MAIN POINTS
1) learning is fostered by positive feedback, rather than by negative (tells the other that what they are doing is right); the provider is getting negative feedback
2) learning occurs only with feedback (for the provider, lack of feedback is the rule)
how can we improve patient-provider communication?
- physicians who communicate effectively have revealed the only one reliable predictor of physician sensitivity: physician's reported interest in people
- suggests that provider sensitivity is more a manner of motivation than skill
- enlists the patient directly in decisions about medical care
- successful in improving the relationship
- effective with difficult patients
- teach them skills for eliciting information from their physicians
- think about questions before a visit or just perceiving that the physician is open to their questions improves communication
- poor provider communication skills are tied to non-adherence
- providers are high status figures for patients, and what they say is accepted as valid
what is treatment non-adherence?
- when patients do not adopt the behaviors and treatments that their providers have recommended for them
- when patients modify or supplement a prescribed treatment regimen
- common when involves health habits, is complex, or is time-consuming
how do we measure adherence?
relies heavily on self-reports
- general adherence relies on retrospective recall of adherence behaviors
- yields unreliable and artificially high estimates
- know they are supposed to adhere, therefore may bias their answers to appear more cooperative
treatment outcome may be a good way to assess non-adherence
what are the causes of adherence and non-adherence?
- fosters adherence
- understand the treatment regimen
- highest when receive clear and jargon-free explanations
- satisfaction with relationship predicts adherence (warm, caring, respectful)
- qualities of the treatment regimen influences the degree of adherence
- treatments that must be followed for a long period of time and that are complex and interfere with other desirable behaviors show low levels of adherence
- complex self-care show the lowest levels
- avoidant coping strategies are associated with poor adherence
what are the effective ways to reduce non-adherence?
ESTABLISH EFFECTIVE AND EMPATHETIC COMMUNICATION
(1) improve patient understanding (clear, jargon-free language)
(2) improve patient satisfaction (caring, respectful)
(3) patients are given opportunities to make informed decisions
what is the placebo effect?
a placebo is any medical procedure that produces an effect in a patient because of its therapeutic intent and not its specific nature, whether chemical or physical
- placebo effect is not just psychological
- placebo response is complex
- psychologically mediated chain of events that has physiological effects
- work in part by stimulating the release of opioids (body's natural ability to recover from illness)
what are the factors that strengthen the placebo effect?
- warmth, confidence, empathy, reassurance, takes time
- high need for approval, low self-esteem, externally oriented toward environment, anxiety
- formality of medications, devices, uniforms
- drug that looks like medicine
- foul-tasting or peculiar-looking pills
what is the significance of pain?
- feedback is crucial for survival
- inability to experience pain causes serious health problems
- we live with minor pains all the time and we use it for minor adjustments (rolling over)
- pain is the symptom that most likely leads an individual to seek treatment
- depression and anxiety worsen the experience of pain
- patients fear pain when undergoing treatments
why is pain difficult to study?
fundamentally is a psychological experience and the degree to which it is felt and how incapacitating it is depends on how it is interpreted
HOWARD BEECHER WWII study
- the meaning attached to pain substantially determines how it is experienced
- for a soldier, pain meant he was alive and likely to go home
- for a civilian, pain is an unwelcomed intrusion
what are the main influences on pain?
- coping styles
complex nature of pain
how does culture influence pain?
- no ethnic/racial differences in the ability to discriminate painful stimuli
- some members of cultures report pain sooner and react more intensely than others
(e.g. chinese report lower pain tolerance compared to canadians)
how does gender influence pain?
women typically show greater sensitivity to pain
- but great deal of variation
- depending on when pain is assessed and what type is assessed
hormone fluctuations across menstrual cycle influence pain perception in women
how do coping styles influence pain?
ways in which we cope with pain influence how pain is interpreted and how individuals experience it
- pain catastrophizing
- coping style
- ruminate, magnify, and feel helpless
pain catastrophizing leads to more dramatic pain reports
- risk factor for prolonged pain and disability
- resilience in contrast is protective for pain catastrophizing bc bounce back from intense pain by experiencing + emotions
how do we measure pain?
- draw on the large informal vocabulary we use to describe pain
- mcgill pain questionnaire - provides indications of the nature of pain and its intensity
- pain catastrophizing scale - measures pain-related catastrophic thinking
- observable behaviors that arise as manifestations of chronic pain
4 types of pain behaviors
(1) facial/audible expressions of distress
(2) distortions in posture/gait
(3) negative affect
(4) avoidance of activity
terminology of pain
ALGESIC: pain producing
ANALGESIC: pain preventing
HYPERALGESIA: increased pain sensation elicited by a noxious stimulus
NOXIOUS: stimulus that damages or threatens damage to tissue
NOCICEPTOR: primary afferent neuron that is sensitive to a noxious stimulus
NOCICEPTION: detection of tissue damage by nociceptors; transmission of nociceptive information to the brain
the experience of pain is
- a protective mechanism to bring into consciousness the awareness of tissue damage
- accompanied by motivational and behavioral responses such as withdrawal and intense emotional reactions such as crying or fear
what are the 3 kinds of pain perception?
- pain perception that results from mechanical damage to the tissue of the body
- experience of pain due to temperature exposure
- general category referring to pain that triggers chemical reactions from tissue damage
what is the pathway of nociception?
- nociceptors in peripheral nerves first sense injury
- in response, release chemical messengers
- messengers are conducted to spinal cord
- passed directly to the reticular formation and thalamus and into cerebral cortex
- identify site of injury
- send messages back down to the spinal column which leads to muscle contraction
- contractions help block pain and change other bodily functions
nociception occurs through the activity of which peripheral nerve fibers to send pain signals to the brain?
- small myelinated fibers
- transmit sharp pain
- unmyelinated fibers
- transmit dull and aching pain
- respond to pressure
- respond to vibration
- can suppress pain
what are the 2 theories of pain suggested by Ronald Melzack?
- gate control theory
- neuromatrix theory
what is gate control theory?
proposed that psychological factors play a significant role in the experience of pain
there is a neural pain gate that can open and close to modulate pain
- gate is opened by pain signals traveling up small nerve fibers
- gate is closed by large fibers or by information coming from the brain
what are the fibers involved in gate control theory?
open the gate
(transmit sharp pain)
(transmit aching pain)
close the gate
(responds to pressure)
what are the factors that open the pain gate?
OPENING THE GATE
- extent of injury
- inappropriate activity levels
- focusing on pain
what are the factors that close the pain gate?
CLOSING THE GATE
- counter stimulation (e.g. massage, heat)
- positive emotions
- concentration on smtg else
- involvement/interest in life activities
what are the limitations to gate control theory?
cannot explain some types of chronic pain, such as PHANTOM LIMB PAIN
what is the neuromatrix theory?
extension of the gate control theory
a genetically determined neural network gives perception of the body, a sense of self, and can generate chronic pain even when no limbs are present
- network of neurons that extends throughout areas of the brain to create the felt representation of a unified physical self (body-self neuromatrix)
- neuromatrix is constantly updated by sensory input with all the cognitive and emotional meaning attached to that input
- generates nerve impulses that are continuously and cyclically processed and synthesized into a pattern called neurosignature
- for each pain experience, a neurosignature is created to reflect the factors that are unique to that particular experience
therefore, it is this neurosignature generated from the body-self neuromatrix and not sensory inputs that give rise to pain
what is phantom limb pain?
the absence of inputs does not stop the networks from generating messages about missing body parts
- phantom limbs are a mystery only if we assume that the body sends sensory messages to a passively receiving brain
- becomes comprehensible once we recognize that the brain generates the experience of the body
- sensory inputs merely modulate that experience; don't directly cause it
what is an effective therapy for phantom limb pain?
- illusion to change the neurosignature of pain in a missing limb
- the reflection of the intact limb is superimposed on the location of the amputated limb, tricking the brain into thinking the phantom limb is real
what is the ascending pain pathway?
- painful stimulus is transmitted through C and A-Delta into the spinal cord
- transferred in the dorsal horn
- up the spinothalamic tract (brainstem to midbrain to thalamus)
- thalamus dispatches the message to the limbic system, the cingulate cortex, and to the somatosensory cortex
what did d.v. reynolds' 1969 study confirm in the neurochemical bases of pain and its inhibition?
confirmed the hypothesis that the brain can control the amount of pain an individual experiences by transmitting messages back down the spinal cord to block the transmission of pain signals
- demonstrated that by electrically stimulating a portion of a rat's brain, one could produce high levels of analgesia
- the animal could not feel pain of abdominal surgery
- phenomenon was termed: STIMULATION PRODUCED ANALGESIA (SPA)
akil, mayer, and liebeskind uncovered the existence of endogenous opioid peptides. what are those?
OPIATES are drugs manufactured by plants that help control pain
OPIOIDS are opiate-like substances produced within the body that constitute a neurochemically-based internal pain regulation system
OPIOIDS are produced in many parts of the brain and glands of the body and project onto specific selective receptor sites in various parts of the body
ENDOGENOUS OPIOID PEPTIDES are important in the natural pain-suppression system of the body
what are the 3 general families of endogenous opioid peptides?
- produce peptides that project to the limbic system and brain stem
- peptides that have widespread neuronal, endocrine, and central nervous system distributions
- found in the gut, posterior pituitary, and in the brain
how does WHO define pain?
suggests that pain is a disease in its own right and that effective pain management is a global health patient issue that must be addressed
what is acute pain?
results from a specific injury that produces tissue damage, such as a wound or a broken limb
- urgent search for relief
- disappears when tissue damage is repaired
- short in duration
- defined as pain that goes on for less than 6 months
what is chronic pain and its subtypes?
typically begins with an acute episode and does not decrease with treatment and time
CHRONIC BENIGN PAIN
- 6+ months
- intractable to treatment
- pain varies in severity
- involve a number of muscle groups
RECURRENT ACUTE PAIN
- series of intermittent episodes of pain that are acute in character
- however, chronic inasmuch as the condition persists for 6+ months
CHRONIC PROGRESSIVE PAIN
- 6+ months
- increases in severity over time
- malignancies and degenerative disorders
why is the distinction between chronic and acute pain important in clinical management?
(1) present different psychological profiles
(2) pain control techniques that work well for acute pain aren't successful for chronic pain
(3) chronic pain involves complex interaction of phys, psyc, social, and behavioral components
(4) chronic pain has widespread effects
what determines the transition from acute to chronic pain?
- functional disability appears to have an important role (disruptions to social relationships, work, recreation)
- goals are set aside
- self-esteem suffers
- chronic pain behaviors emerge
- often related to depression or personality traits
what does the lifestyle of chronic pain look like?
entirely disrupts one's life
- job left/loss
- leisure activities abandoned
- withdrawal from family/friends
- lifestyle evolved around pain
can also take a special toll on relationships
- family, marriage
- sexual relationships deteriorate
- reduction of social contact
what is the minnesota multiphasic personality inventory (mmpi)?
assesses the pain profile of a patient
- developing psychological profiles of different groups of patients has proven to be useful for treatment and in specifying problems that patients with particular types of pain have or may develop
- chronic pain patients typically show elevated scores on three MMPI subscales
how does depression and pain interact?
pain is not sufficient to develop depression, but rather, leads to a reduction in activity level which in turn can lead to changes in depression
- depression can increase pain perceptions
- depression can feed back into the total pain experience both aggravating pain itself and increasing the likelihood of debilitating pain behaviors
- depression that's associated with chronic pain can also interfere with returning to work after injury
what is pain control?
PAIN CONTROL can mean that a patient:
- no longer feels anything in an area that once hurt
- still feel sensations but not pain
- feel pain but is no longer concerned about it
- is still hurting but are able to stand it
what are the main approaches for pain control?
- sensory control (counterirritation)
- biofeedback (train to relax body)
- relaxation (focus on reducing stress)
- guided imagery
pharmacological control of pain
- most popular painkiller
- disadvantage of addiction and tolerance
- first line defense
- sufficient and successful for acute pain
- drug that directly act on higher brain regions involved in pain
- combats pain by reducing anxiety, improving mood, affecting downward pathways from the brain that modulate pain
- limitations over long term
- can make pain worse
- inability to concentrate
- addiction (OxyContin)
surgical control of pain
involves cutting or creating lesions in the pain fibers at various points in the body so that pain sensations can no longer be conducted
- disrupt the conduct of pain from periphery to spinal cord
- interrupt flow of pain sensations from the spinal cord upward to the brain
- can worsen the problem bc damages the nervous system
- damage itself can be a chief for chronic pain
sensory control of pain
- inhibit pain in one part of the body by stimulating or mildly irritating another area
- suppresses pain to some extent
the process of learning to control bodily states by monitoring the states to be controlled
operant learning process
- target body function that is needed to be brought under control
- function is converted into a tone
- function is tracked by a machine and info about it is passed to the patient
- patient makes an effort to change bodily processes through trial and error
- patient learns what thoughts/behaviors will modify the bodily function
oldest technique for managing pain which rely on pain reduction techniques
- state of relaxation
- trance induced
- explicitly told that the hypnosis will reduce pain
- suggestion itself is sufficient
- hypnosis is a distraction from the pain experience, therefore reducing pain
- patient is instructed to think about pain differently
long, thin needles inserted into specially designated areas of the body that theoretically influence areas in which a patient is experiencing a disorder
- goal: cure illness
- used in pain management bc has analgesic effect
psychologically based techniques
- patients believe it'll work
- expectations reduce pain
- belief that it'll reduce pain reduces anxiety, inducing relaxation state
- increases endogenous opioids
- suggests that there is a relevant physiological change associated with its use
focus attention on an irrelevant and attention-getting stimulus
distracting oneself with high level of activity, can turn attention away from pain
- can control acute pain and discomfort
- can control slow-rising pains which can be anticipated and prepared for, or can be used to control the discomfort of a painful medical procedure
- aggressive imagery may improve coping with the uncomfortable effects of illness/treatment by enhancing perceptions of control over the pain
what are pain management programs?
coordinated form of treatment that were developed to treat chronic pain
- interdisciplinary programs that bring together neurological, cognitive, behavioral, and psychological expertise involving pain
- enable patients to reduce pain
- increase levels of activity
- reduce perceptions of disability
- return to work
- lead meaningful lives
what do pain management programs consist of?
- initial evaluation
- individualized treatment
- patient education
- relaxation training
- cognitive restructuring
- relapse prevention
- family involvement
chronic illness in canada
58% of the population has a chronic health condition
- higher among women, low income, seniors, indigenous
- 2/3 of all deaths in canada
what is quality of life?
the degree to which a person is able to maximize physical, psychological, vocational, and social functioning
- important indicator of recovery from, or adjustment to chronic illness
- important aspect of quality of life is people's perceptions of their own health
what are the components of quality of life?
- physical functioning
- psychological status
- social functioning
- disease or treatment-related symptomatology
how is quality of life assessed?
emphasis is placed on how much the disease and its treatment interferes with activities if daily living
- engaging in social activities
- health assessment questionnaire (HAQ)
disease specific measures
- e.g. asthma quality of life questionnaire
why study quality of life?
- basis for interventions
- help identify problems
- monitor impact of unpleasant treatments
- therapies can be compared
- inform decision-makers about long-term survival
what are the three common emotional phases when reacting to chronic illness?
reacting to chronic illness: denial
- defense mechanism by which ppl avoid implications of an illness
- act as if illness not severe, will go away, or has few long-term implications
- during acute phase
- immediately after diagnosis
- keeps patients from having to come to terms with the full range of problems posed by the illness at a time when isn't able to do so completely
- can mask the fear associated until the patient is more accustomed to the diagnosis
reacting to chronic illness: anxiety
- esp. common in people with stroke, heart disease, and cancer
- get v. overwhelmed by changes in their lives and with the prospect of death
- constantly vigilant to changes in physical conditions
- each minor ache/pain may prompt a fear of possible recurrence
- with adaptive functioning
- may be debilitated by their emotional distress even before therapy begins
reacting to chronic illness: depression
- occurs somewhat later in the adjustment process
- can occur intermittently
- likelihood of having clinical depression is highest for those with chronic fatigue syndrome
- exacerbates the risk and course of several chronic disorders
- complicates treatment adherence
- complicates medical decision making
- important because it has an impact on the symptoms experienced and the overall prospects for rehabilitation
- can exacerbate symptoms and complicate the treatment of major chronic diseases
- linked to suicide
- many of the phys. signs of depression may be symptoms of the disease/treatment
WHO GETS DEPRESSED?
- increases risk with the severity of the illness
what is benefit finding?
people can experience positive reactions to chronic illness (hope, optimism)
- perceive that they have narrowly escaped death
- re-ordered their priorities in a more satisfying way
- find meaning in the smaller daily activities of life in response to the illness
BENEFIT FINDING: acknowledgement of the positive effects of illness in one's life
- important indicator of adjustment to chronic illness
- ability to reappraise one's situation positively has been tied with a more positive mood
what is the self composed of?
stable set of beliefs about one's qualities/attributes
global evaluation of one's qualities/attributes
what is the self-concept composed of and how do they change in chronic illness?
the self-concept is a composite of self-evaluations regarding multiple aspects of one's life:
- body image
- can change during illness, affecting treatment adherence
- personal goals
- illness can affect satisfaction from job/career, or pleasure from hobbies/leisure
- social identity
- fears about withdrawal or support
- personal goals
- loss of independence and strain of imposing on others can reduce self-esteem
body image and chronic illness
body image is the perception and evaluation of one's physical functioning and appearance
- plummets during illness
- affected body part evaluated negatively
- whole body image takes on a negative aura
importantly implicated in chronic image
- related to self-esteem
- increased likelihood of depression/anxiety
- influences how adherent a person is to treatment
personal goals/self image and chronic illness
achievement through vocational activities and personal goals is also an important aspect of self-esteem and self-concept
- many ppl derive their primary satisfaction from their job/career
- others take great pleasure in hobbies/leisure
chronic illness threatens valued aspects of the self = self-concept damaged
social identity and chronic illness
rebuilding social life is an important aspect of readjustment after chronic illness
- interactions with family/friends critical source of self-esteem
- social resources provide patients with chronic illness with needed information, help, and emotional support
what are the 5 identified coping strategies?
1- social support (direct problem solving)
2- distancing (don't let it get to me)
3- positive focus
4- cognitive escape (wishing the situation would go away)
5- behavioral escape (eating, drinking)
people with chronic illnesses tend to use which type of coping method?
report fewer active coping methods (planning, problem solving)
report more PASSIVE coping strategies (positive focus, escaping)
- reflects that some chronic diseases raise many uncontrollable concerns that active coping strategies cannot directly address
which coping strategies work and don't work?
- increased psychological distress
- risk factor for adverse responses to illness
- may exacerbate the disease process itself
- predicts good adjustment to certain illnesses (MS, spinal cord injury)
- actively solicit health-related info about condition may cope better
- lower psychological distress when using positive and confrontative responses to stress
what is an important factor to consider when assessing the use of coping strategies?
- longer duration use strategies such as active coping, positive re-framing, and acceptance
- shorter duration tend to use behavioral disengagement and other avoidant strategies
therefore, the development of more adaptive coping strategies may take time as the individual learns to adjust to their illness
successful vs unsuccessful adjustment to chronic illness
if patients are to adjust to chronic illness satisfactorily, they must integrate their illness into their lives
- alteration in activities and some degree of management
patients who are unable to incorporate their illness into their lives may fail to follow their treatment regiment and be non-adherent to it
- improperly attuned to possible signs of recurrent or worsening disease
- may engage in inappropriate behaviors that pose a risk to their health
- may fail to practice important health behaviors that could reduce risks
patients' beliefs about chronic illness
- problem in adjustment is that patients adopt an inappropriate model for their disorder, especially acute models
- important for healthcare providers to probe patients' beliefs about their illness to check for gaps/misunderstandings
- self-blame is widespread
- perceive themselves as having brought on their illness
- takes toll on coping and well-being
- leads to guilt, depression
- can also represent an effort to assume control over the disorder and such feelings can be adaptive in coping with and coming to terms with the disorder
- belief in control and sense of self-efficacy
- with respect to the disease and its treatments
- can lead to improved adjustment
- may prolong life
what is physical rehabilitation?
involves several goals:
- learn how to use body
- learn how to sense changes in environment to make appropriate accommodations
- learn new physical management skills
- learn necessary treatment regimen
- learn to control energy expenditure
need to develop a comprehensive program and ensure adherence to treatment regimen through appropriate education
what are the vocational issues in chronic illness?
- job discrimination
- just anticipating it can have negative consequences
- needs to be assessed early in recovery process
- many don't have private insurance plan to cover meds
- those who cut back on work can lose that insurance plan
what are the main potential interaction issues in chronic illness?
- negative responses from others
- impact on family
- caregiving role
- impact on sexuality
social interaction issues: negative responses from others
patients aren't the only ones responsible for the difficulties that arise in their interactions with others
- ppl hold pejorative stereotypes about certain groups of patients
- helps to work through problems with family members
- helps lay the groundwork for reestablishing social contacts
social interaction issues: impact on the family
family is a social system
- disruption in the life of one member can affect others'
- chief changes: increased dependency on other members
- role strains can emerge
- assume new roles
- realize that their time to purse activities has declined
social interaction issues: caregiving role
- primary caregiver = most strain
- intermittent or supplementary
- needs increase as the disease progresses to the point where the caregiver has responsibility for every activity that the patient must undertake
family members who provide caregiving are at increased risk for distress, depression, and a decline in health
typical caregiver is a woman in her 60s caring for elderly spouse or parent
social interaction issues: impact on sexuality
many chronic illnesses lead to a decrease in sexual activity
condition prompts temporary restrictions, OR
decline is traced to psychological origins, e.g. loss of desire
social interaction issues: gender
- women who have a chronic illness may have a higher burden of disease than men
- account for their poorer self-related health
- hospitalization of one's spouse can also increase risk of death for both
- women with chronic illness experience more distress than men
- women continue to carry a burden of household responsibilities and activities even after being diagnosed with a chronic illness
how can parents of children with a chronic illness help improve coping?
- have a realistic attitude towards the disorder and its treatment; can soothe the child emotionally and provide informed basis for care
- parents are free of depression
- parents have a sense of mastery over the child's illness
- parents avoid expressing distress
- child is encouraged in the engagement of self-care
what are the main psychological interventions to manage chronic illness?
- individual therapy
- brief psychotherapeutic interventions
- patient education
- relaxation, stress management
- social support
- family support
managing chronic illness: individual therapy
most common intervention
important differences from psychotherapy:
- episodic rather than continuous therapies (recurrence, worsening conditions can present a crisis)
- collaboration of patient's physician and family is critical
- requires more frequently respect for a patient's defenses (traditionally challenge them, but chronic illness patients use these defenses as a benign function in protecting them)
managing chronic illness: brief psychotherapeutic interventions
several short-term interventions
range from informal communication to brief psychotherapy
goal: alleviate emotional distress
internet-based CBT (ICBT)
- seems promising
- chronic somatic conditions = improve disease related impact outcomes and disease-specific physical outcomes
managing chronic illness: patient education
therapeutic patient education programs that include coping skills training relative to particular disorders have been found to improve functioning for a broad variety of chronic diseases
- increase knowledge about disease
- reduce anxiety
- increase patients' feelings of purpose and meaning in life
- improve coping skills
- increase adherence to treatment
- clear and simple
- less sleep disturbances
- better sleep duration
managing chronic illness: relaxation, stress management, and exercise
induce ppl to approach stressful situations mindfully rather than reacting to them automatically
- mindfulness-based stress reduction (MBSR)
- exercise training programs
managing chronic illness: social support interventions
patients who report good social relationships are more likely to be positively adjusted to their illness
social support groups
- discuss issues of mutual concern
- additional source of support
- satisfy unmet needs of social support
what are the leading causes of death between ages 1 to 15?
what are the main causes of infant mortality?
1) congenital abnormalities
2) sudden infant death syndrome (SIDS)
what is sudden infant death syndrome?
causes aren't entirely known
- infant just stops breathing
- more likely to occur in lower class suburban environments
- more likely if mother smoked during pregnancy
- more likely if baby put to sleep on side/stomach
not a 'gentle' death for parents
- suspicion of others who won't understand
adjustment is better for mothers of SIDS infants if they don't blame themselves for the death
what are the main causes of death in early childhood?
- motor vehicle accidents
- accidental drowning
- falls in home
what are the main causes of death in later years of childhood?
- automobile accidents take over as the chief external cause
- cancer is the 2nd leading cause between 1-15 years of age
what are children's understanding of death?
AGES 5 AND UNDER
- death = great sleep
- not scared/saddened
- don't understand finality/irreversibility
- develop concept of finality
- no biological understanding
- personified idea of death
- e.g. shadows, ghosts
- believe that occurs because of supernatural being
- understand death
- universal and inevitable
- process of death
- understand won't return
what is the leading cause of death in young adulthood?
- automobile accidents
what are the common reactions to death by young adults?
envision trauma, fiery accidents
perception somewhat realistic
major cause is unintentional injury involving automobiles
what are the reactions to young adult death?
most tragic after death of child
- YAs are products of years of socialization, and education
- verge of starting own families
- seems like a waste of life
- robbed of change to develop/mature
when YAs receive a diagnosis of terminal illness
- feel shock
- sense of injustice
- anger; medical staff find it difficult to work with them
long and drawn-out period of dying
- bc otherwise healthy
- few biological competitors for death
- not likely to succumb to complications
are thoughts of death common in middle age?
- because prominent in middle age
- midlife crisis that occur in 40s-50s is believed to stem partly from gradual realization of impending death
- prefer painless and non-mutilating death
premature death in adulthood
"sudden death occurring before projected age of 81 years"
- heart attack
evidence of environmental factors that contribute like adverse childhood events
- domestic violence in home
- criminality in family
why is death easier in old age?
more prepared to face death
- initial preparations made
- thought about it extensively
- seen friends/relatives die
- seen friends/relatives express readiness to die
- came to terms with issues associated with death (loss of appearance, withdrawal from activities because of limited energy, failed to meet goals they once had)
terminal phase of illness is generally shorter because there are more than one competing biological factor to death
- greater chance to achieve death with dignity
the elderly usually die of:
cancer, stroke, heart failure, general physical decline that predisposes infectious diseases or organ failure
what is a good death?
INSTITUTE OF MEDICINE: "one that is free from avoidable suffering for patients, families, and caregivers in general accordance with the patient's and family's wishes
what are the 6 components that enhance the quality of dying?
1- pain/symptom management
2- clear decision making
3- preparation for death
5- contributing to others
6- affirmation of the whole person
other approaches have focused on assessing a good death using a self-report scale
GOOD DEATH INVENTORY assess 10 dimensions associated with quality-of-death outcomes for patients
- not being a burden to others
- phys/psyc/spiritual comfort
- good relationships with family/caregivers
- sense of control over future
Is there a "right to die?"
important social trend affecting terminal care is the 'right to die' movement
- dying should become a matter of personal choice and control
- associated with feeling more fatigued, depressed, and more of a burden to others
what are the moral and legal issues in dying?
EUTHANASIA (ending life of a person who is suffering from a painful terminal illness)
- physician = oath to do no harm
- reduces rather than support patient's autonomy
more passive measures
- "advance care directives" are advocated by those who believe that a person should have a choice in dying
- can request that extraordinary life-sustaining procedures NOT be used if unable to make the decision on their own
- helps ensure the patient's preferences
what are the changes in a patient's self-concept in relation to dying?
- becomes difficult for them to maintain control of biological and social functioning
- incontinent, drooling, distorted facial expressions
- intermittent pain, uncontrollable vomiting/retching
- experience shocking deterioration in appearance due to weight loss
- mental regression
- inability to concentrate
- cognitive declines
what are the issues in social interactions in relation to dying?
threats to the self-concept that stem from loss of mental/physical functioning can spill over into threats to social interactions
- want and need social contact
- BUT, will be afraid that their obvious mental and phys deterioration will upset visitors
- some disengagement will be normal
- may represent a grieving process
what are communication issues in relation to dying?
- open comm. when prognosis is favorable
- when it worsens and therapy becomes more drastic, communication starts to break down
family members may become cheerfully optimistic with the patient, but confused and frightened when they try to elicit info from medical staff
what are kubler-ross' stages of dying?
- initial reaction
- defense mechanism to avoid complications
- act as if illness not severe
- normal and useful to protect patients from full realization
- decisions made regarding future
- "why me"
- harder responses to manage for outsiders
- feel like being blamed by the patient for being healthy
- abandons anger
- different strategy
- trades good behavior for good health
- pact with God
- sudden rush of charitable activity
- come to terms with lack of control
- acknowledges that little can be done
- realization coincides with evidence that illness won't be cured
- anticipatory grief
- too weak to be angry
- too accustomed to idea of death to be depressed
- preparations, goodbyes
is kubler-ross' theory useful?
- useful for pointing out counselling needs for the dying
- has broken through the silence and taboos surrounding death
HOWEVER, as a theory, limitations:
- not empirically supported as a stage theory
- does not acknowledge the anxiety which can be present through the process
what is the significance of hospital staff to the patient?
- for amelioration of their pain
- only ppl who see the patient on a regular basis
- only ppl who know the patient's actual physical state
- only source of realistic info
- know the patient's true feelings
what is the risk of terminal care for medical staff?
least interesting phys. care
- bc often palliative care (make patient feel comfortable)
- more interested in curative care (cure the disease)
terminal care = custodial work
- burn out just from watching patients die
- tempted to withdraw into an efficient manner rather than warm/supportive
- minimize personal pain
controversial issue regarding patient-staff interaction:
- if info about the patient's illness should be disclosed to them entirely
what are the useful set of goals that avery weisman has outlined for medical staff in their work with the dying?
(1) INFORMED CONSENT
- patients should be told the nature of their condition and treatment
(2) SAFE CONDUCT
- physicians and other staff members should act as helpful and supportive guides for the patient
(3) SIGNIFICANT SURVIVAL
- physician and other medical staff should help the patient use his or her remaining time as well as possible
(4) ANTICIPATORY GRIEF
- both the patient and his or her family members should be aided in working through their anticipatory sense of loss and depression
(5) TIMELY AND APPROPRIATE DEATH
- patients should be allowed to die when and how they want to go as much as possible; should be allowed to die with dignity
individual counseling with the terminally ill
therapy for dying patients is different from typical psychotherapy
- short term
- nature and timing of visits depend on the inclination and energy levels of the patient
- not scheduled visits
- agenda set mostly by the patient
- emotionally exhausting to be involved with people who only have a short time to live
what is symbolic immortality?
a sense that one is leaving behind a legacy through one's child or work, or that one is joining the afterlife and becoming one with God
some dying patients find meaning in this
family therapy with the terminally ill
appropriate way to deal with common issues raised by terminal illness
- death-related plans/decisions
- need to find meaning in life
may be mismatched in their adjustment to the illness
- needs of the living and of the dying may conflict
- therapists help family members find a balance between their own needs and the patient's
management of terminal illness in children
working with terminally ill children is the most stressful of all terminal care
- hardest kind of death to accept
- psychologically painful
- physically painful
counseling with a terminally ill child can proceed like counseling with an adult
- therapist takes cues f what to say directly from the child
- talk about what the child wants
family as well
- parents blame themselves
- family dynamics often disrupted
- needs of other children ignored
what is the grieving process?
- bereavement: state/condition caused by loss through death
- grief: sorrow, hurt, anger, guilt, confusion
- mourning: the way in which we express grief
** grief can be accompanied by positive changes!
- disruption caused by loss may precipitate post-traumatic growth for some individuals as they come to view their relationships with new meaning and gain new spiritual insights as a result of their loss
what issues do survivors face after the death of a family member?
- regular routine was replaced by illness-related activities
- may be hard to remember what one used to do before the illness began
- may not feel like resuming activities
- left with lots of time, little to do
- grieving can go on for months; show restlessness and inabilities to concentrate
- explaining the death of a parent/sibling to child can be difficult
- can raise complications, esp. in the case of death of sibling, because at one point children may wish their sibling death and they will feel like they somehow caused it
- best to not wait until death occurs to help child cope with death
what are the disadvantages of dying in hospitals?
2/3 of canadians will die in hospitals
- depersonalized care
- fragmented environment
- lack of emotional support
- restricted visits
- can be long, mechanized, painful
what are the main alternatives to hospital care for the terminally ill?
- hospice care
- home care
what is hospice care?
idea behind it = the acceptance of death in a positive manner, emphasizing the relief of suffering and the improvement of quality of life, rather the cure of illness
designed to assist patients in gaining more control over life to effectively manage pain and provide palliative care and emotional support
patient's psychological comfort is stressed
- encouraged to personalize living areas (wear own clothes, bring in familiar things)
- oriented toward improving patient's social support system
- less stressful for families as they are encouraged to spend full days and stay over
what is home care?
common choice of care for many terminally ill patients
- often easier for the patient psychologically
- harder and more stressful for family however
- at least one family member's energies must be devoted to the patient on an almost full-time basis
why is coronary heart disease the number 2 killer in canada (i.e. what are the origins)?
DISEASE OF MODERNIZATION
- alterations of diets
- reductions in activity levels
*causes a lot of premature deaths, i.e. before 75yo
what is coronary heart disease?
- a disease anywhere within the cardiovascular system (heart, blood vessels, veins)
- caused by atherosclerosis (narrowing of the coronary arteries, which are the vessels that supply the heart with blood)
the flow of oxygen/nourishment to heart is obstructed
- causes pain which radiates across chest/arms (angina pectoris, or chest pain)
- when severe deprivation occurs, can produce myocardial infarction (heart attack)
how is coronary heart disease a disease of inflammation?
inflammatory processes implicated in the development of the disease
low-grade inflammation appears to underlie many cases of cardiovascular disease
especially, the involvement of IL-6 and C-reactive protein (CRP)
systematic disease rather than a disease of the coronary arteries because it is responsive to inflammatory processes
what is IL-6?
- stimulates processes that contribute to the buildup of atherosclerotic plaque
what is the c-reactive protein?
- first responder when we get hurt
- assesses inflammation
- increases in concentration in response to inflammation
- produced in the liver
- released in bloodstream in the presence of acute/chronic inflammation
- migrates to damaged vessels and helps trap bad cholesterol in the inflamed clot
PREDICTOR OF CHD
- elevated CRP levels are associated with an increased waist circumference and low levels of physical activities
what are major risk factors for CHD?
- high blood pressure*
- central obesity*
- low HDL cholesterol*
- insulin resistance*
- high triglycerides and LDL*
- phys. inactivity
- high cardiovascular reactivity
also, family history of heart disease is important (genetically based predisposition)
- exacerbated by low SES
- exacerbated by harsh family environment
what is "metabolic syndrome"?
a cluster of conditions that help predict people with high risks of heart attacks
need 3 or more:
- high blood pressure
- central obesity
- low HDL cholesterol
- insulin resistance
- high triglycerides and LDL
what is the role of stress in CHD?
by damaging ENDOTHELIAL cells
- facilitates deposit of lipids
- increases inflammation
- contributes to atherosclerotic lesions
more common among LOW SES
- esp. males
- symptoms/signs develop earlier
- low SES associated with low phys activity, high cholesterol, and being overweight
INDIRECT EFFECT of stress
- link between work-stress and heart disease
- high stress = low phys activity
- high stress = poor diet
- in turn, increases risks of heart attacks
- urban/industrialized countries have higher CHD incidence
- acculturation to western society
- distress associated with cultural change
- poor social support
what are the sex differences in CHD?
leading killer of women
- women have 50% chance of dying from their 1st heart attack compared to 30% for men
women seem to be protected at younger ages relative to men
- higher HDL bc of pre-menopause
- estrogen may modulate sympathetic arousal
how are anger and hostility implicated as risk factors?
proneness to the expression of anger implicated as risk factor for heart disease and survival
anger implicated in hypertension
hostility tied to high levels of IL-6 and to metabolic syndrome
what is cynical hostility?
suspiciousness, resentment, frequent anger, antagonism, and distrust of others
- have more conflict with others
- more negative affect
- more sleep disturbances
cynical hostility AND defensiveness is the most problematic combination
- oppositional orientation toward people
- shows greatest association between cardiovascular responses, heart rate, blood pressure
hostility's developmental antecedents
developed in childhood
- feelings of insecurity about oneself and negative feelings towards others
particular child-rearing practices may foster hostility
- parental interference
- lack of acceptance
development of hostility in sons is promoted by family environment that are:
- non supportive
- high in conflict
expressing vs harboring hostility
expression of hostile emotions is associated with enhanced cardiovascular reactivity
however, suppressing the expression of the emotions may be more detrimental
hostility and social relationships
- more interpersonal conflict
- less social support
- reactivity to stress esp. engaged during interpersonal conflict
study of husbands/wives
- high hostility husbands show greater blood pressure reactivity in response to marital interaction
- not found for wives
- seek/produce more stressful interpersonal encounters
what are the mechanisms linking reactivity and psychological factors?
VASOCONSTRICTION in peripheral areas of the heart
- at same time, heart accelerates
- transfers more blood through shrinking vessels
- produces wear/tear on coronary arteries
- produces atherosclerotic lesions
CATECHOLAMINES exert direct chemical effects on blood vessels
- altering levels prompt continual changes in blood pressure
- undermines resilience of vessels
what is the role of depression in CHD?
independent risk factor that is environmentally based
tied to inflammatory process
- elevated C-reactive protein
- depression promotes inflammation
- atherosclerosis is an inflammatory process
treatment of depression may improve the prospects of long-term recovery from a heart attack
what are other psychosocial risk factors for CHD?
- implicated in sudden cardiac death
- impairs parasympathetic response
- anxiety appears to reduce vagal control of heart rate
- negative affectivity in general important to consider
- social dominance = poor heart health
- feelings of isolation
- mental state characterized by extreme fatigue, feeling of being dejected/defeated, and enhanced irritability
- predicts likelihood of heart attack
HELPLESSNESS, PESSIMISM, RUMINATION
what is the role of delay in managing heart disease?
ROLE OF DELAY
- patients often delay before seeking treatment
- reason for high rates of mortality/disability following heart attacks
what is initial treatment in managing heart disease?
coronary artery bypass graft (CABG)
- treats blockage of major arteries
- can lead to cognitive dysfunction
- improves angina and psychological distress
what is cardiac rehabilitation in managing heart disease?
"active and progressive process by which individuals with heart disease attain their optimal physical, medical, psychological, social, emotional, vocational, and economic status"
- produce relief from symptoms
- reduce severity of disease
- limit further progression
- promote psyc adjustment
- promote social adjustment
- restore sense of self-efficacy
what does successful cardiac rehabilitation depend on?
- patient's active participation
- full commitment to behavior-change efforts
- beliefs that patients hold about disorder
- respond to disease and treatment with optimism
what are possible pharmacological treatments for CHD?
beta-adrenergic blocking agents
- resist the effects of sympathetic nervous system stimulation
- for recovering/at-risk patients of heart attacks
- prevents blood clots
- block enzyme that causes platelets to aggregate
- following acute coronary event
- targets LDL cholesterol
- surpasses all other drugs for reducing incidence of death, heart attacks, strokes
how is diet and activity levels modified for managing heart disease?
imposed to lower cholesterol
- reduce smoking
- lose weight
- control alcohol intake
- cardiovascular function
- psychological recovery
- relapse prevention program
resumption of previous activities
- return work
stress and CHD
stress can trigger fatal cardiac events and interfere with the practice of important health behaviors
- direct relationship between stress and CHD risk through the involvement of adverse changes in health behaviors
MORE AT RISK:
social support gaps
high social conflict
negative coping styles
^^ people that are especially targeted for stress management intervention following diagnosis of coronary artery heart disease
targeting depression and CHD
high depression/anxiety and CHD = decreased heart rate variability
suggests that they may have sustained alterations in their autonomic nervous system modulation over time
evaluation of cardiac rehabilitation
- blood pressure reduction
^^ successful in reducing patients' standing on risk factors for heart disease and reducing risk of death from cardiovascular disease
do better if
- high social support
apart from advantages, what are potential problems with social support?
- help recover from surgery
- improve quality of life
- reduce distress
- improve cardiac symptoms
- women in particular are targeted with the effects of social support in the long-term
FACTORS THAT ERODE the potential for social support
- feelings of loss of independence
- feelings of shame/helplessness
- difficulties adhering to regimen while the spouse is highly motivated = can be seen as criticism or controlling behavior
- especially following heart attack
- patient sees caregiver/spouse as controlling, overprotective
- caregiver/spouse sees patient as dependent and irritable
Classic study on cardiac invalidism
- wives of recovering husbands
- only wives who took part in the treadmill task personally increased their perceptions of their husbands' efficiency/abilities
what is hypertension?
high blood pressure
1- cardiac output is too high (i.e. pressure is put on the arterial walls as blood flow increases)
2- in response to peripheral resistance (i.e. resistance to blood flow in small arteries of body)
why is hypertension a serious medical problem?
risk factor for cardiac and cerebrovascular disease
- leading risk factor for death
- untreated hypertension can affect cognitive functioning (learning, memory, attention)
how can chronic stress lead to high blood pressure?
repeatedly increasing blood pressure during stress increases the force on the vessel walls
- need to work harder to regulate blood pressure
- veins build thicker muscle layer to control increased pressure, therefore constricting flow
when blood returns to the heart in the left ventricle with more force, the heart builds muscle to accommodate, leading to left ventricular hypertrophy and risk of arrhythmia
how is hypertension measured?
by a sphygmomanometer
- greatest force developed during contraction of the heart's ventricles
- sensitive to volume of blood leaving the heart
- sensitive to arteries' ability to stretch and accommodate blood
- pressure in arteries when heart is relaxed
- related to resistance of blood vessels to blood flow
DIAGNOSIS OF HYPERTENSION
- systolic pressure greater value when diagnosing
- mild = 140-159
- moderate = 160-179
- severe = 180+
keeping systolic blood pressure under 120 is best
what are the risk factors for hypertension?
ESSENTIAL HYPERTENSION (i.e. unknown cause):
(1) blood pressure reactivity in childhood/adolescence predicts later development (genetic component)
(2) <50y, males are at greater risk; >55, both are at 90% risk for developing hypertension
(3) high sodium and fat intake
(4) if one parent has high blood pressure, offspring has 45% chance; if both parents, 95% chances
(5) emotional factors
- negative affect
- frequent experiences of intense arousal
- tendency towards anger
- suppressed hostility
how does stress affect blood pressure?
repeated exposure to stressful events during which heightened blood pressure reactions occur
can result from exposure to
- chronic social conflict (discrimination, low SES)
- job strain
- migration from rural to urban areas
how do we study stress and hypertension?
bring in people into the lab and see how they respond to physical or mental challenges that are stressful (e.g. arithmetic tasks)
identify stressful circumstances and examine rates of hypertension and how blood pressure ebbs and flows
what personality factors contribute to hypertension?
- hostility, defensiveness
- expressed anger and a potential for hostility = exaggerated blood pressure responses especially under stress
- ruminating on the source of one's anger = blood pressure
how does social support influence hypertension?
in those with hypertension, high hostility can compromise their social support system
- quality of personal relationships influence whether social support is going to be beneficial or not
hostility = associated with hypertension via its effects on interpersonal interactions
what are the drug treatments for hypertension?
DIURETICS = reduce blood volume by promoting excretion of sodium
(1) beta-adrenergic blockers
- decrease cardiac output
- increase plasma renin activity
(2) central adrenergic inhibitors
- decrease sympathetic outflow from the central nervous system
what are the cognitive behavioral treatments for hypertension?
- progressive muscle relax
has potential success in lowering blood pressure
what are the problems in treating hypertension?
(1) HIDDEN DISEASE
- don't know that hypertensive
- symptomless disease
- often only diagnosed with go in for standard exam
- early detection important
- untreated hypertension related to low quality of life
- affected by symptomless nature
- 'feel fine'
- difficult to get them to take meds on regular basis
- need to educate fully
what is a stroke?
3RD LEADING CAUSE DEATH
- disturbance in blood flow to brain
- can occur when blood flow to localized areas is interrupted
- can occur by cerebral hemorrhage (i.e. large tissues compressed against skull due to blood leaking into brain)
- more follows in its wake
- can lead to severe disability/death
- simple intervention important e.g. aspirin
what are the risk factors for stroke?
- high blood pressure
- heart disease
- high red blood cell count
- psych. distress
- anger expression
likelihood increases with age
occurs more in men
women more likely to die
what are transient ischemic attacks?
- little strokes
- produce temporary weakness, clumsiness, loss of feeling on one side
- produces temporary dimness or loss of vision in one eye
- results from insufficient blood flow to a part of the brain
- occurrence of these attacks combined with elevated blood pressure can increase risk of having stroke within 7 days
what are the consequences of a stroke?
all aspects of life affected
what motor problems can result from a stroke?
motoric impairments occur on the side opposite to the side of the brain that was damaged in the stroke
what cognitive problems can result from a stroke?
depends on which side of the brain that was damaged
LEFT BRAIN DAMAGE
- communication disorders (e.g. aphasia)
- cognitive disturbances (e.g. intellect reduction, learning difficulties)
RIGHT BRAIN DAMAGE
- can't process/make use of certain visual feedback
- e.g. eat food on one side of plate, shave one side of face
- cannot understand words read
- seem to be able to perceive only last part of each words
what emotional problems can result from a stroke?
LEFT BRAIN DAMAGE
RIGHT BRAIN DAMAGE
what relationship problems can result from a stroke?
symptoms that interfere with effective communication
- e.g. facial muscles fail to work properly; produces apparent disfigurement
- leads to memory loss
- can't concentrate
- inappropriate emotional expression
- accumulating effects of small strokes
- may produce alzheimer-like symptoms
what are the types of rehabilitative interventions for stroke?
- cognitive remedial training
- training specific skills
- stimulating environments to challenge capabilities
- psychotherapy (more effective than drugs for post-stroke depression)
COGNITIVE PROBLEMS T(X)
- made aware they have problems
- hopefulness regarding optimism of patients to recover their faculties
- rely on neurorehabilitation (relies on the brain's ability to rebuild itself and learn new tasks)
what is the prevalence of diabetes?
one of the most chronic illnesses in the country and one of the fastest-growing chronic health concerns in the world
- affects 6.7 million ages 12+
- rising to 8% by 2030
- 6th leading cause of death
majority of deaths among those with diabetes are due to heart disease and stroke
what is diabetes?
chronic disease of impaired carbohydrate, protein, and fat metabolism that results from insufficient secretion of insulin, OR from insulin resistance
cells of the body need energy to function
- primary source: GLUCOSE
- results from digestion of foods with carbohydrates
INSULIN is a hormone produced by beta cells in the pancreas
- bonds to receptor sites on outside of a cell
- acts as a key to permit glucose to enter the cells
what is hyperglycemia?
HIGH BLOOD SUGAR
when there is not enough insulin to produce, or when insulin resistance develops (i.e. glucose can't be used by the cells), glucose stays in the blood instead of going into the cells
body attempts to rid itself of this excess glucose, yet the cells aren't receiving the glucose they need to send signals to the hypothalamus that more food is needed
what are the main types of diabetes?
- insulin dependent
- little to no insulin are produced
- must be replaced by insulin injections
- 10% of cases
- insulin resistant
- insulin is not produced enough, or not adequately used
- 90% of cases
- temporary condition
- affects 2-4% of pregnant women
what is type I diabetes?
- abrupt onset of symptoms
- result from lack of insulin prod.
- can result from viral infection
- can result from autoimmune r(x)
immune system falsely identifies cells in the pancreas as invaders
- destroy the cells
- compromises/eliminates ability to produce insulin
develops early in life
- earlier for girls
- between 5-6, or 10-13
- freq. urination
- unusual thirst
- excessive drinking
- weight loss
symptoms are due to the body's attempt to find sources of energy which prompts itself to feed off its own fats and proteins
what is type II diabetes?
- milder type
- disorder of middle/old age
- over 40+ years
- obesity major contributor
- glucose metabolism involves balance between insulin production and responsiveness
- as foods are digested, carbs are broken down into glucose
- glucose absorbed from intestines into blood
- rising levels of glucose triggers pancreas to secrete insulin
- when the balance goes amiss, sets the stage for type II
triggering of type II diabetes
- cells in muscle, fat, and liver lose some ability to respond fully to insulin
- in response, pancreas temporarily increases production of insulin
- insulin producing cells give out from exhaustion
- result: insulin production falls
- balance between insulin action and secretion dysregulation
more common among overweight men and of low SES
what are the health complications of diabetes?
- thickening of arteries due to buildup of wastes in blood
- leading cause of blindness
component of metabolic syndrome
- interabdominal fat
- elevated lipids
cluster of symptoms that is potentially fatal because strongly linked to increased risk of stroke and myocardial infarction (heart attack)
what is the relationship between stress and diabetes?
- those with diabetes are sensitive to the effects of stress
- lack of social support may be more of an important predictor of poor diabetes control than stress
- anger and hostility implicated in impairment of glucose levels
what is key to successful control of diabetes?
- can be challenging
- ideal treatment is patient centered and directed
how does one manage type I diabetes?
monitor glucose levels throughout the day and take immediate action when needed
t(x) goal: keep blood sugar at normal levels
- regular insulin injection
- dietary control
- weight control
- #of calories stay constant
what does adherence to self-management programs for type I diabetes look like?
appear to be very low
- many complications that arise from diabetes are not evident for 15-20 years after its onset
- complications don't frighten people into being adherent
how does one manage type II diabetes?
often are unaware of health risks they face
- education important
- involves reducing sugar and carb intake
obesity seems to tax insulin system
- encourage normal weight achievement
- exercise encouraged
- helps glucose in the blood and helps reduce weight
what is healthy aging?
no universally accepted definition
federal and provincial ministers of canada have identified 5 key issues of healthy aging:
1- social connectedness
2- phys. activity
3- healthy eating
4- prevention of falls
5- tobacco control
aging of the population
substantial shift in the population toward the older years
as pop. ages, we can expect to see a higher incidence of chronic, but not life-threatening conditions
- hearing loss
future health promotion efforts should place great weight on positive factors that may reduce morbidity and delay mortality
more focus on understanding the positive experiences that can promote healthy aging and adjustment to chronic illness
- self compassion
what are the emerging issues in chronic illness management for the future?
(1) greater focus on quality of life and controlling costs associated with chronic illness
(2) addressing health disparities in the management of chronic illness formed by social and structural determinants of healthy aging
(3) empowering people to manage terminal illness and enabling them to die physically and psychologically comfortable deaths
(4) further examinations of gender/health
where is stress research headed?
- biopsychosocial pathways from stress to health are better understood (e.g. role of inflammation)
- new research on at-risk populations for stress-related disorders, the role of stress in the experience of pain, and role of early life stress to neurodegenerative diseases in old age
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