“your one and only car”. stress and health § behavioral medicine § interdisciplinary field...
TRANSCRIPT
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“Your One and Only Car”“Your One and Only Car”
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Stress and HealthStress and Health§ Behavioral Medicine
§ interdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease
§ Health Psychology§ subfield of psychology that provides
psychology’s contribution to behavioral medicine
§ Behavioral Medicine§ interdisciplinary field that integrates
behavioral and medical knowledge and applies that knowledge to health and disease
§ Health Psychology§ subfield of psychology that provides
psychology’s contribution to behavioral medicine
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Stress and IllnessStress and Illness§ Leading causes of death in the US in
1900 and 2000§ Leading causes of death in the US in
1900 and 2000
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Stress and IllnessStress and Illness§ Stress
§ the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging
§ Stress§ the process by
which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging
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When stress is good and leads to something desirable such as studying for a big exam and then receiving a good grade on the exam, it is called eustress.
When the stress has negative effects such as confusion, an inability to make decisions, and illness, it is called distress.
StressStress is defined as the physical pressure and strain that result from change.
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Stress AppraisalStress Appraisal
Stressful event(tough math test)
Threat(“Yikes! This isbeyond me!”)
Challenge(“I’ve got to apply
all I know”)
Panic, freeze up
Aroused, focused
Appraisal Response
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Sequence of Steps in the Fight or Flight Behaviors
1. The brain appraises a situation as threatening and dangerous.
2. The lower brain structure secretes a stress hormone.
3. The stress hormone signals the adrenal glands to secrete adrenaline.
4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.
Fight or Flight (Walter Cannon)
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The General Adaptation Syndrome (Hans Selye)
Defined as a series of stages the body goes through when exposed to stressful situations.
1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical.
2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor.
3. The third stage is exhaustion. It is marked by body exhaustion and health problems.
Alarm Resistance Exhaustion
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Stress and IllnessStress and Illness§ General
Adaptation Syndrome § Selye’s
concept of the body’s adaptive response to stress in three stages
§ General Adaptation Syndrome § Selye’s
concept of the body’s adaptive response to stress in three stages
Stressresistance
Phase 1Alarm
reaction(mobilize
resources)
Phase 2Resistance(cope with stressor)
Phase 3Exhaustion(reservesdepleted)
The body’s resistance to stress canlast only so long before exhaustion sets in
Stressoroccurs
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Stressful Life EventsStressful Life Events§ Catastrophic Events
§ earthquakes, combat stress, floods
§ Life Changes§ death of a loved one, divorce, loss of job,
promotion
§ Daily Hassles§ rush hour traffic, long lines, job stress,§ Burnout-- physical, emotional, and
mental exhaustion brought on by persistent job-related stress
§ Catastrophic Events§ earthquakes, combat stress, floods
§ Life Changes§ death of a loved one, divorce, loss of job,
promotion
§ Daily Hassles§ rush hour traffic, long lines, job stress,§ Burnout-- physical, emotional, and
mental exhaustion brought on by persistent job-related stress
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Some Psychological Stressors for High School StudentsLife Event Stress Points
Divorce of parents 98
Expulsion from school 79
Major injury or illness 77
Getting a job 62
Major illness of close friend 56
Peer difficulties 45
Moving away 41
Christmas 30
Vacation 25
Traffic ticket 22
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Perceived ControlPerceived Control Our personal control and optimism is
related to stress and our immune system.
With loss of perceived control, we are vulnerable to ill health.
Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.
Our personal control and optimism is related to stress and our immune system.
With loss of perceived control, we are vulnerable to ill health.
Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.
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Perceived ControlPerceived Control§ Health consequences of a loss of control§ Health consequences of a loss of control
No connection to shock source
To shock control To shock source
“Executive” rat “Subordinate” rat Control rat
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Poverty and InequalityPoverty and Inequality Poorer people are more at risk for
premature death. People also tend to die younger in
areas where there is greater income inequality.
People at every income level are at greater risk of death if they live in a community with great income inequality.
Poorer people are more at risk for premature death.
People also tend to die younger in areas where there is greater income inequality.
People at every income level are at greater risk of death if they live in a community with great income inequality.
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Perceived ControlPerceived Control§ Equality and Longevity§ Equality and Longevity
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Stress and the HeartStress and the Heart
§ Coronary Heart Disease§ clogging of the vessels that nourish the heart muscle
§ leading cause of death in many developed countries
§ Coronary Heart Disease§ clogging of the vessels that nourish the heart muscle
§ leading cause of death in many developed countries
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Stress, Personality, & Heart DiseaseStress, Personality, & Heart Disease
Coronary heart disease is North America’s leading cause of death
Habitually grouchy people tend to have poorer health outcomes
Chronic negative emotions have negative effect on immune system
Coronary heart disease is North America’s leading cause of death
Habitually grouchy people tend to have poorer health outcomes
Chronic negative emotions have negative effect on immune system
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6 factors that increase the risk of heart disease: 6 factors that increase the risk of heart disease:
1. Smoking 2. Obesity 3. High fat diet 4. Physical Inactivity 5. Elevated blood pressure 6. Elevated Cholesterol + stress
and personality
1. Smoking 2. Obesity 3. High fat diet 4. Physical Inactivity 5. Elevated blood pressure 6. Elevated Cholesterol + stress
and personality
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Stress and the Heart Stress and the Heart Hopelessness
scores3.5
3
2.5
2
1.5
1
0.5
0 Heart attack DeathLow risk Moderate risk High risk
Men who feel extreme hopelessnessare at greater risk for heart attacksand early death
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Stress and the Heart Stress and the Heart
§ Type A § Friedman and Rosenman’s term for
competitive, hard-driving, impatient, verbally aggressive, and anger-prone people
§ Type B§ Friedman and Rosenman’s term for
easygoing, relaxed people
§ Type A § Friedman and Rosenman’s term for
competitive, hard-driving, impatient, verbally aggressive, and anger-prone people
§ Type B§ Friedman and Rosenman’s term for
easygoing, relaxed people
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Research on type A Personality
Time urgency & competitiveness not associated with poor health outcomes
Negative emotions, anger, aggressive reactivity
High levels of hostility increase chance of all disease (e.g., cancer)
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Explanatory style
Optimism use external, unstable, & specific
explanations for negative events predicts better health outcomes
Pessimism use internal, stable, & global
explanations for negative events predicts worse health outcomes
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Stress and the Heart
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Stress and Disease§ Psychophysiological Illness
§ “mind-body” illness§ any stress-related physical illness
§ some forms of hypertension§ some headaches
§ distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease
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Stress and Disease§ Lymphocytes
§ two types of white blood cells that are part of the body’s immune system
§ B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections
§ T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances
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Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.
Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.
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Stress and Disease
§ Conditioning of immune suppression
UCS(drug)
UCR(immunesuppression)
UCS(drug)
UCR(immunesuppression)
CS(sweetenedwater)
CS(sweetenedwater) CR
(immunesuppression)
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Conflict
Conflict arises when a person needs to decide between two alternatives.
Types of conflict:
Approach - Approach
Avoidance - Avoidance
Approach - Avoidance
Double Approach - Avoidance
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Approach-Approach
The person is attracted to two goals.
The approach - approach conflict is not all bad. You have to decide between two attractive choices.
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Approach - Avoidance
The person is attracted to one goal but it comes with a
negative aspect.
The approach - avoidance conflict can be distressing.
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Avoidance - Avoidance
The person has to choose between them.
The avoidance - avoidance conflict presents two undesirable goals.
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Double Approach - Avoidance
The person has two goals, each has both good and
bad characteristics.
The double approach - avoidance conflict is the most common.
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Stress and Disease§ Negative emotions and health-related
consequences§ Negative emotions and health-related
consequences
Unhealthy behaviors(smoking, drinking,
poor nutrition and sleep)
Persistent stressorsand negative
emotions
Release of stresshormones
Heartdisease
Immunesuppression
Autonomic nervoussystem effects
(headaches,hypertension)
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Promoting Health
§ Aerobic Exercise§ sustained exercise that increases heart and lung fitness
Depressionscore
14
13
12
11
10
9
8
7
6
5
4
3
Before treatmentevaluation
After treatmentevaluation
No-treatmentgroup
Aerobicexercise
group
Relaxationtreatment
group
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Why Does Exercise Work? Exercise and Mood Releases chemicals -- norepinephrine -- serotonin -- endorphins Sense of accomplishment Improved physique
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Why Does Exercise Work?
Exercise and Health Strengthens heart Lowers blood pressure Lowers blood pressure
reactivity to stress Moderate exercise adds two
years to one’s expected life.
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Promoting Health§ Biofeedback
§ system for electronically recording, amplifying, and feeding back information regarding a subtle physiological state
§ blood pressure§ muscle tension
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BiofeedbackBiofeedback Feedback about subtle bodily responses
e.g., tension in forehead Not controlling body’s responses People can influence some of these
responses finger temperature forehead tension
Reduce intensity of migraines Help with some chronic pain Relaxation crucial to biofeedback success
Feedback about subtle bodily responses e.g., tension in forehead
Not controlling body’s responses People can influence some of these
responses finger temperature forehead tension
Reduce intensity of migraines Help with some chronic pain Relaxation crucial to biofeedback success
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Promoting Health§ Modifying Type A life-style can
reduce recurrence of heart attacks§ Modifying Type A life-style can
reduce recurrence of heart attacks
Percentageof patients
with recurrentheart attacks
(cumulativeaverage)
6
5
4
3
2
1
0
Year1978 1979 1980 1981 1982
Life-style modification patients
Control patients
Modifying life-stylereduced recurrent
heart attacks
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RelaxationRelaxation
Meditation can lower blood pressure, heart rate, oxygen consumption
Can it help with stress-related disease?
Meditation can lower blood pressure, heart rate, oxygen consumption
Can it help with stress-related disease?
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Social SupportSocial Support Feeling liked, affirmed, and
encouraged by intimate friends and family--promotes happiness and health.
Social support calms the cardiovascular system and lowers stress hormones.
Feeling liked, affirmed, and encouraged by intimate friends and family--promotes happiness and health.
Social support calms the cardiovascular system and lowers stress hormones.
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Promoting HealthPromoting Health§ Social support across the life span§ Social support across the life span
12-14 18-19 25-34 45-54 65-74 15-17 20-24 35-44 55-64 75+ Age in years
100%
90
80
70
60
50
Percentagewith high
support
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Life events
Tendency toward
Health Illness
Personal appraisal
Challenge Threat
Personality typeEasy going
NondepressedOptimistic
HostileDepressedPessimistic
Personality habitsNonsmoking
Regular exerciseGood nutrition
SmokingSedentary
Poor nutrition
Level of social support
Close, enduring Lacking
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Spirituality & Faith CommunitiesSpirituality & Faith Communities Personal prayer, meditation, or other
spiritual and religious practices can enhance medical treatment.
Those who attend religious services experience lower death rates from coronary heart disease.
Personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment.
Those who attend religious services experience lower death rates from coronary heart disease.
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Promoting Health Promoting Health
§ Religious Attendance§ Religious Attendance
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Promoting Health Promoting Health § Predictors of mortality§ Predictors of mortality
1
0.8
0.6
0.4
0.2
0
Men Women
Not smoking Regular exercise Weekly religious attendance
Relativerisk
of dying
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Promoting Health § The religion factor is mulitidimensional§ The religion factor is mulitidimensional
Religiousinvolvement
Healthybehaviors
(less smoking,drinking)
Social support(faith
communities,marriage)
Positiveemotions
(less stress,anxiety)
Better health(less immune systemsuppression, stress
hormones, and suicide)
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Promoting Health
§ Complementary and Alternative Medicine§ unproven health care treatments
not taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies
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Alternative systems ofmedical practice
BioelectromagneticApplications
Diet, nutrition,life-style changes
Herbal medicine
Manual healing
Mind-body control
Pharmacological and biological treatments
Subfields of Alternative MedicineHealth care ranging from self-care according to folk principles,
to care rendered in an organized health care system based onalternative traditions or practices
The study of how living organisms interact with electromagnetic (EM) fields
The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention
Employing plan and plant products from folk medicine traditionsfor pharmacological use
Using touch and manipulation with the hands as a diagnosticand therapeutic tool
Exploring the mind’s capacity to affect the body, based on traditional medical systems that make use of the interconnected-ness of mind and body
Drugs and vaccines not yet accepted by mainstream medicine
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Promoting Health Promoting Health § Smoking-related early deaths§ Smoking-related early deaths
40,000
30,000
20,000
10,000
0
33,348
1,686 1,135 556 202
Smoking Suicide Vehicle HIV/ Homicide crash AIDS
Cause of death
Numberof deaths
per 100,000
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The Physiological Effects of Nicotine
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Promoting Health Promoting Health § Fewer Canadian smokers§ Fewer Canadian smokers
Males
Females
1970 1974 1978 1982 1986 1990 1994- 1996- 1995 1997
Year
60%
50
40
30
20
10
0
Percentageof Canadians
smoking
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Smoking PreventionSmoking Prevention
§ U.S. teen smoking§ U.S. teen smoking
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Smoking Prevention
§ Results of a smoking inoculation program
§ Results of a smoking inoculation program
Percentageof studentswho smoke
20
15
10
5
0 0 4 9 12 16 21 33
Seventh grade Eighth grade Ninth grade
Months of study
Control school
School with smokingPrevention program
Fewer teens took upsmoking when “inoculated” against it
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“You are what you eat”. Eating foods that provide the biochemical building blocks for those neurotransmitters affect our mood and behavior. People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.
“You are what you eat”. Eating foods that provide the biochemical building blocks for those neurotransmitters affect our mood and behavior. People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.
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Obesity & Weight Control
§ Obesity and body mass index
§ Obesity and body mass index
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Obesity and Weight Control § Obesity and mortality§ Obesity and mortality
18.5 18.5- 20.5- 22.0- 23.5- 25.0- 26.5- 28.0- 30.0- 32.0- 35.0- 40 20.4 21.9 23.4 24.9 26.4 27.9 29.9 31.9 34.9 39.9
Body-mass index (BM I)Men Women
2.8
2.6
2.4
2.2
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
Relativerisk ofdeath
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Weight Discrimination
§ When women applicants were made to look overweight, subjects were less willing to hire
§ When women applicants were made to look overweight, subjects were less willing to hire
Willingnessto hire scale
(from1:definitely
not hire to7: definitely
hire)
0
1
2
3
4
5
6
7
Women Men
Normal Overweight
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Weight ControlWeight Control§ Effects of a severe diet§ Effects of a severe diet
Caloric intake
in caloriesper day
Body weight
in kilograms
Metabolism:Oxygen
consumptionin liters
per hour
3000
2000
1000
0 8 16 24 32
Days
165
160
155
150
145
140
Days Days
26
25
24
23
22
218 16 24 32 8 16 24 32
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Weight ControlWeight Control§ Trading risks§ Trading risks
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Weight ControlWeight Control§ Thinning of Miss America§ Thinning of Miss America
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Weight ControlWeight Control
§ Most lost weight is regained
§ Most lost weight is regained
-20
-15
-10
-5
0
5
10
1 2 3 4 5
Weightchange
in pounds
Posttreatment
Years of follow-up
Startingpoint
Normal trend for untreated obesepeople: Gradually rising weight
After participation in behavioralProgram: Much of initial weight
loss regained
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Weight ControlWeight Control§ Obesity
was more common among those who watched the most television
§ Obesity was more common among those who watched the most television
<2 2-3 >4Hours of television watched per day
in 1990s study
Boys Girls
32
30
28
26
24
22
20
Skinfold fatmeasure (mm)
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The Physiology of ObesityThe Physiology of Obesity Fat Cells
A fat cell can vary from relatively empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.
Fat Cells A fat cell can vary from relatively
empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.
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Set points and MetabolismSet points and Metabolism Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.
Metabolism is the rate at which we burn calories.
Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.
Metabolism is the rate at which we burn calories.
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The Genetic FactorThe Genetic Factor There is a genetic influence on
body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.
Rather, people’s weights resemble those of their biological parents.
Identical twins have closely similar weights, even when reared apart.
There is a genetic influence on body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.
Rather, people’s weights resemble those of their biological parents.
Identical twins have closely similar weights, even when reared apart.
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Losing WeightLosing Weight
Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.
Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.
Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.
Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.
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HELPFUL HINTS FOR LOSING WEIGHT
HELPFUL HINTS FOR LOSING WEIGHT
• Minimize exposure to tempting food cues
• Take steps to boost your metabolism• Be Realistic and Moderate• Modify both your metabolic rate and
your hunger by changing the food you eat.
• Don’t starve all day and eat one big meal at night.
• Beware of the binge.• Set realistic goals.
• Minimize exposure to tempting food cues
• Take steps to boost your metabolism• Be Realistic and Moderate• Modify both your metabolic rate and
your hunger by changing the food you eat.
• Don’t starve all day and eat one big meal at night.
• Beware of the binge.• Set realistic goals.