Stress-Related Illnesses: A Biopsychosocial Perspective

• Certain illnesses or disorders were called psychosomatic, because psychologists believed that deep-stated conflicts and emotional reactions were the culprits.

• Alexander stated that stomach ulcers are linked to infantile cravings to be fed and feelings of dependency. In adulthood, these conflicts become reawakened and activate the gastrointestinal system.

Stress isn’t the major cause of ulcers. Instead, the bacterium Helicobacter pylori is one of the culprit.

Still, stress may play role in contributing to ulcers, by reducing the efficiency of the immune system and increasing vulnerability to the bacterium. Higher rates of ulcers associated with earthquakes, being a prisoner of war, economic crises, and other anxiety-provoking events.

• Authentic (real) illnesses that emotions and stress contribute to or maintain are called psychophysiological.

Emotions and stress are associated with physical disorders, like Coronary Heart Disease (CHD) and AIDS.

• For Biopsychosocial Perspective, many physical illnesses depend on the complex role of genes, lifestyle, immunity, social support, everyday stressors, and self-perceptions.

Coronary Heart Disease (CHD)

• is the complete or partial blockage of the arteries that provide oxygen to the heart.

• CHD is associated with stress and personality traits.

• Top cause of death in the world.

Atherosclerosis. Cholesterol deposits in the large arteries form plaque, restricting the flow of blood. This condition, called

atherosclerosis, can result in stroke and heart attack.

Coronary Heart Disease• Factors of heart attack:Smoking, high cholesterol, high blood pressure, family

history of CHD, diabetes.

High levels of stress hormones triggered by extreme stress can lead to disruptions in normal hearth rhythm, atherosclerosis and sudden death.

Stress is associated with behavioral risk factors (poor diet,

inadequate exercise) for CHD.

Personality in CHD

• Characteristics of Type A personality: – competitive, hard driving, ambitious, impatient,

perfectionistic, prone to hostility, stubborn, cynical and controlling.

• Type A personality place one at high risk for CHD.

Why can chronic anger be bad for our health?

• The anger component of the Type A personality can be deadly, increasing our risk for CHD.

Coping with Stress

• What would be helpful if you are a survivor of İst earthquake (1999)?

• Social support encompasses interpersonal relations with people, groups, and the larger community. It can provide us with emotional comfort, financial assistance and information to make decisions, solve problems and contend with stressful situations.

Support and comfort from others can buffer the effects of highly aversive situations.

Gaining control• Gaining control of situations can relieve stress. Five

types of control:1. behavioral control: problem-focused and is more

effective in relieving stress than avoidance-oriented coping- avoiding actions to solve our problems.

2. cognitive control : is the ability to cognitively restructure or think differently about negative emotions. It includes emotion- focused coping.

Gaining Control

3. Decisional control : the ability to choose among alternative courses of action.

4. Informational control : the ability to acquire information about a stressful event.

Proactive coping is a situation when we anticipate stressful events and take steps to prevent or minimize difficulties before they arise.

Therefore, stressful circumstances are perceived as opportunities for growth.

5. Emotional control is the ability to repress and express emotions. Writing a diary facilitates emotional control.

Catharsis – the disclosing of painful feelings – can be useful, but only if it involves problems; can be harmful,when it reinforces a sense of helplessness, when we voice our rage about something we can’t or won’t change.

According to research on the expression of anger, how will this girl feel after punching this pillow repeatedly?

• Answer: Although many psychotherapies encourage this cathartic release of anger, research shows that it actually heightens long-term stress.

Crisis Debriefing• A single group session, 3-4 hour conducted soon

after a trauma designed to prevent PTSD. It encourages group members to discuss and process their negative emotions.

• Research shows it is not helpful, and may instead increase risk of developing PTSD.

Crisis debriefing sessions, in which people discuss their reactions to a traumatic event

in a group, may actually increase PTSD risk.

Flexible Coping• Ability to adjust coping strategies as the situation

demands is critical to coping with many stressful situations.

• Suppressing and avoiding emotions distracts us from problem solving.

• Accepting circumstances and feelings we can’t change and finding positive ways of thinking about our problems can be a strong means of coping with stress.

Research suggests that instructing someone not to think of something, like a white bear, often results in increases

in the very thought the person is trying to suppress (Wegner et al., 1987).

Individual Differences• Our attitudes, personality and socialization shape our

responses.

• Hardiness is a set of attitudes where you– View change as a challenge rather than a threat,– Are committed to their life and work,– Believe you can control events.

According to Maddi and Kobasa(1984)’s study, people whose attitudes toward life reflected high levels of control, commitment, and challenge remaind healthier than those whose attitudes didn’t.

• Hardiness is related to low-levels of anxiety proneness and general tendency to react calmly to stress.

Individual Differences

• Optimistic persons are more productive, focused, and handle frustration better.

• Higher levels of spirituality and religion have many of the same benefits.

Optimists—who proverbially see the glass as “half full,” rather than “half empty”—are more likely than pessimists

to view change as a challenge.

Individual Differences

• Some ways of reacting to stress are actually counterproductive.

• Ruminating – focusing on negatives and endlessly analyzing what caused problems and their consequences.

• Seen more frequently women, in part due to early socialization.

• Men may be more likely than women to play sports, which often decreases the tendency to ruminate when stressed out.

• Women are more likely to analyze and talk about their problems.

Summary

• The Brain-Body Reaction to Stress – Psychoneuroimmunology– Stress related illnesses

• Psychosomatic (CHD)

• Coping with stress• Social support• Gaining control• Crisis debriefing• Hardiness• Optimisim X Pessimisim

Good Health and Less Stress

• Health psychology (behavioral medicine) integrate behavioral sciences with the medicine. It has contributed to our understanding of the influences of stress and other psychological factors on physical disorders.

• It combines educational and psychological interventions to maintain health, and prevent and treat illness.

• Health psychologists work at hospitals, rehabilitation centers, medical schools, industry, government agencies, academic and research settings.

• A health psychologist:

– teaches patients stress management skills– teaches pain reduction techniques– helps people to mobilize social support, comply with

medical procedures and maintain healthy lifestyles.

• Here are four behaviors to promote health:

– Stop smoking– Control alcohol consumption– Achieve a healthy weight– Exercise

Stop Smoking!• Leading cause of preventable death in US.• 24% of men and 18% of women smoke

– 1 in 4 smokers dies from smoking-related diseaseA 30-40 years old male smoker with a two-pack-a-day

habit loses about 8 years of his life on average. Smoking causes CHD; stroke; lung cancer and low-birth-

weight during pregnancy.

• Only 5% of smokers who try to quit succeed.

Curb Alcohol Consumption

• Heavy episodic drinking (binge drinking) is five or more drinks on one occasion for men, four or more for women.

• Associated with increases in cancer, liver problems, cardiovascular diseases, and pregnancy complications.

• In controversial studies, moderate drinking (wine) lessen the risk of heart disease and stroke.

Heavy drinking can produce long-term physical problems.

Achieve a Healthy Weight• Two-thirds of Americans are overweight, with half

of those being obese.• “Obesity epidemic” is a risk for whole world, due to

decreased physical activity.

• Calculated based on body-mass index (BMI)WeightHeight2

Achieve a Healthy Weight• Obesity puts you at a higher risk for heart disease, stroke,

cancer, and diabetes.

• The more inactive we are and the more time we spend watching TV, the more likely we are to be obese.

• Losing weight reduces blood pressure, cholesterol and risk of diabetes, and anxiety; increases mood.

• Suffer a variety of emotional and social problems as well– Teasing, depression, anxiety

• Prejudice and discrimination are present.

Being overweight or obese increases the risk of various physical health problems, and is also associated with depression and other adjustment difficulties.

• Metabolic syndrome

• Fat around the abdomen links to metabolic syndrome, high blood pressure, diabetes, atherosclerosis, cancer and aging.

Tips to Achieve a Healthy Weight• Avoid fad and crash diets (yo-yo effect)

• Exercise regularly

• Monitor total calories and body weight

• Eat properly (good fats, low salt, high fiber foods)

• Get social support

• Control portion size

The huge number of diet books published each year can be bewildering to people who are trying to lose weight. How many of these books are based on adequate science?

Exercise• Regular aerobic exercise has many benefits

– Promote the use of oxygen in the body– Lower blood pressure and risk for CHD– Improve lung function– Decrease diabetes risk– Cut the risk of breast and colon cancer.– Prolonge life span. – Improve cognitive functioning in old adults,– Improve the growth of neurons.

• 30 minutes several times a week is the best.

Aerobic exercise, including rowing, swimming, and biking, is an excellent way to lose weight, stay fit, and maintain or even improve cardiovascular health.

Change is Easier Said than Done

• Personal inertia. It is difficult to try new things. • Misestimating risk and causes of death.• Feeling powerless to change, because our habits are

so deeply entrenched. • Prevention programs attempt to stop unhealthy

habits before they develop. The earlier in life we develop unhealthy habits, the more likely they’ll create problems.

Prevention programs contain the following elements:

• Educating young people about risks and negative effects of obesity, smoking and excessive drinking;

• Educating young people about positive health behaviors, such as good nutrition and the importance of exercise;

• Teaching young people to recognize and resist peer pressure to engage in bad behaviors;

• Exposing young people to positive role models who don’t drink or smoke;

• Teaching effective coping skills for daily living and dealing with stressful life events.

Complementary & Alternative Medicine• Alternative medicine is health care practices and

products used in place of conventional medicine.

• Complementary medicine refers to products and practices that are used together with conventional medicine.

• They’ve not yet been shown to be safe and effective using scientific standards.

TYPE OF THERAPY

Natural products

Meditation

Chiropractic and related methods

Massage

Yoga

Diet-based therapies

Homeopathy

Acupuncture

Biofeedback

The Type of Alternative Health Care

Biologically Based Therapies

• Most herbal supplements and treatments have not found to be effective.– shark cartilage (cancer), gingko biloba (cognitive

decline in aging, AD), etc.

• Vitamins and dietary supplements as well.– Calcium, vitamin C

• Not regulated by the FDA.

Manipulative Methods• Includes chiropractic manipulation,

where spine is manipulated to treat pain and illness.

• No more effective than safe treatments like exercise, relaxation, and physical therapy.

• Some people may benefit from the attention, support and advice they receive from chiropractors, which may relieve stress and create a strong placebo effect.

Chiropractors typically manipulate the spine and muscles to treat a variety of health problems. But there’s little evidence that their approaches are more effective than those derived from traditional medicine.

Mind-Body Medicine• Biofeedback is feedback by a device that provides almost

an immediate output of a biological function, such as heart rate. Some patients use this feedback to modify physiological responses associated with stress or illness.

• Relaxation training and biofeedback are equally effective in reducing stress and treating anxiety, headaches, insomnia, and side effects associated with cancer chemotherapy.

Biofeedback of forehead muscle tension can provide substantial control of this tension, thereby offering relief from muscle contraction headaches. But biofeedback may often be no more effective than relaxation.

Mind-Body Medicine

• Meditation refers to a variety of practices that train attention and awareness.

• Associated with a variety of positive effects:– Heightened creativity, empathy, alertness, self-esteem.– Decreased anxiety, interpersonal problems and

recurrences of depression.– Increased blood flow to brain and immune function.

In Western countries, people practice meditation to achieve stress reduction, whereas in non-Western countries, people practice meditation to achieve insight and spiritual growth.

Energy Medicines

• Based on the idea that disruptions in our body’s energy field can be mapped and treated.

• Acupuncture involves placing needles on body to relieve energy (qi) blockages.

• No scientific evidence to support.

Acupuncture ancient Chinese practice of inserting thin needles into more than 2,000 points in the body to alter energy forces believed to run through the body.

Placebos and CAM• Acupuncture and other CAM treatments aren’t

more effective than placebos or fake treatment.

• Fake acupuncture treatments do as well at treating back pain and migraines.

• Placebos and acupuncture both stimulate the release of endorphins.

• “Placebo power” in Parkinson’s disease.

• Reiki is a Japanese energy therapy and spiritual healing practice in which practitioners suggest that patients relax and then place their hands on or above them to rebalance and focus reiki energy (qi) on different body parts.

• Researchers have not found evidence that reiki is helpful in treating medical or stress-related conditions. What explanation, other than energy transfer, could account for reports of stress reduction or symptom improvement following reiki treatment?

Answer: Alternative explanations include: the placebo effect, relaxation, and naturally occurring

changes in the course of an illness.

Whole Medical Systems• Homeopathic medicine is based on the premise

that consuming an extremely diluted dose of a substance that produces an illness in a healthy person will alleviate that illness. It is remedies that feature a small dose of an illness-inducing substance to activate the body’s own natural defenses.

• Like goes with like: the role of representativeness in erroneous and pseudoscientific beliefs. Medicine that contain no medicine isn’t medicine.

• No evidence that it is effective for any problem.

Why is CAM so Popular?

1. Produce placebo effects and instill hope.

2. People assume natural products improve health, because they see no negative side effects.

3. Symptoms come and go. False correlation with symptom relief.

4. Attribute success to CAM instead of conventional medicine.

5. Misdiagnosis and non-severity of problem.

Think Before You Try CAM

• To use or not to use, that is the question. • We must ask two questions before trying an

alternative approach:– Does it lack a scientific rationale, or contradict well-

accepted scientific laws or principles?– Do carefully done studies show that the product or

treatment is less effective than conventional approaches?

The answer to both questions is “yes”, we should skeptical.

Zakkum mucizeye gidiyor, ama ‘Zakkumcu Dr.’ hâlâ küskün!

• “Zakkum kanseri iyileştiriyor” açıklamasıyla yıllar önce vatan haini ilan edilen Dr. Ziya Özel, haklı çıktı... FDA ilk olumlu raporunu verdi. ABD Onkoloji Birliği, patenti Dr. Ziya Özel’e ait olan zakkum ekstreli kanser ilacının FDA tarafından yapılan Faz 1 deneme çalışmasının başarıyla sonuçlandığını açıkladı.