ABNORMAL PSYCHOLOGY SIXTH EDITIONfac.hsu.edu/ahmada/3 Courses/9 Abnormal Psychology/Abnormal...

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Oltmanns and Emery

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ABNORMAL PSYCHOLOGY SEVENTH EDITION

CHAPTER EIGHT

Stress and Physical Health


CHAPTER OUTLINE

• Defining Stress

• Symptoms of Stress

• Diagnosis of Stress and Physical Illness

• Psychological Factors in Some Familiar Illnesses

• Cardiovascular Disease


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OVERVIEW

• Stress: any challenging event that requires physiological, cognitive, or behavioral adaptation

• Medical scientists now view every physical illness—from colds to cancer to AIDS—as a product of the interaction between the mind and body.

• Behavioral medicine

• A multidisciplinary field that includes both medical and mental health professionals who investigate psychological factors in the symptoms, cause, and treatment of physical illnesses


DEFINING STRESS

• Stress as a Life Event – Stress is an event that requires physiological,

cognitive, or behavioral adaptation.

– Holmes and Rahe’s (1967) Social Readjustment Rating Scale (SRRS) • Assigns stress values to life events based on the

judgments of a large group of normal adults

• Views stressors that produce more life change units as causing more stress


DEFINING STRESS

• Stress as Appraisal of Life Events – Richard Lazarus’s(1966) definition of stress

• The individual’s appraisal of a challenging life event – Primary appraisal: evaluation of the challenge,

threat, or harm posed by an event, and

– Secondary appraisal: assessment of our abilities and resources for coping with that event (Lazarus & Folkman, 1984)


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DEFINING STRESS

• Walter Cannon (1871-1945)

– First stress researcher that recognized the adaptive, evolutionary aspects of stress

– Viewed stress as the activation of the fight or flight response

– Survival value

– Fight or flight is a maladaptive reaction to much stress in the modern world.


SYMPTOMS OF STRESS

• Psychophysiological Response to Stress

– Adrenal Hormones

• When a perceived threat registers in the cortex, it signals the amygdala corticotrophin-releasing factor brainstem sympathetic nervous system adrenal glands

–Norepinephrine and epinephrine

–“Rush of adrenaline”


SYMPTOMS OF STRESS

• Psychophysiological Response to Stress – Immune System Responses

• Release of cortisol and CRF also causes immunosuppression, the decreased production of immune agents

• Psychoneuroimmunology (PNI) investigates the relation between stress and immune function.

• Short-term stressors and physical threats enhance immune responses.

• Stress impairs immune responses.


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FIGURE 8-1 The Physiology of the Stress Response


DEFINING STRESS • Psychophysiological Response to Stress

– Cannon stated chronic stress overwhelms the body’s homeostasis

– Illness and Chronic Stress

– Hans Selye (1907–1982): general adaptation syndrome (GAS) consists of three stages:

• Alarm occurs first and involves the mobilization of the body in reaction to threat.

• Resistance comes next and is a period of time during which the body is physiologically activated and prepared to respond to the threat.

• Exhaustion is the final stage, and it occurs if the body’s resources are depleted by chronic stress. Copyright © Pearson Education 2011

SYMPTOMS OF STRESS

• Psychophysiological Response to Stress

– Coping

• Problem-focused coping involves attempts to change a stressor.

• Emotion-focused coping is an attempt to alter internal distress.

– Predictability and Control

• Both dramatically reduce stress.

• Even the illusion of control can help to alleviate stress.


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TABLE 8-3 Coping Tendencies of Optimists and Pessimists

OPTIMISTS PESSIMISTS

Information seeking Suppression of thoughts

Active coping and planning Giving up

Positive reframing Self-distraction

Seeking benefit Cognitive avoidance

Use of humor Focus on distress

Acceptance Overt denial


FIGURE 8-2 Direct and Indirect Effects of Stress on Physical Illness


SYMPTOMS OF STRESS

• Health Behaviors

– Any action that promotes good health.

• Balanced diet, regular sleep, and exercise, as well as avoiding unhealthy activities like cigarette smoking, excessive alcohol consumption, and drug use

– Following Medical Advice

• Illness behavior: increased stress is correlated with such illness behaviors as more frequent visits to physicians.


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SYMPTOMS OF STRESS

• Health Behaviors – Social support in humans predicts improved

immune, cardiovascular, and endocrine functioning.

– Cultural differences • Asians and Asian Americans benefit from

implicit social support such as focusing on valued social groups during times of stress.

• Explicit social support such as seeking advice and emotional solace does not buffer stress for Asians, whereas it does for European Americans.


DIAGNOSIS OF STRESS AND PHYSICAL ILLNESS

• The DSM-IV-TR does not distinguish psychosomatic disorders from other physical illnesses.

• Contemporary Approaches – When a physical illness is the focus of treatment,

the diagnosis of psychological factors affecting medical condition is used on Axis I.

In DSM-IV-TR virtually any physical illness can be coded on Axis III, general medical conditions.


THE ROLE OF PSYCHOLOGICAL FACTORS IN SOME FAMILIAR ILLNESSES

• Cancer

– Cancer is the second leading cause of mortality in the United States today, accounting for 23% of all deaths.

– Psychological factors also are at least modestly associated with the course of cancer.

– Stress also may directly affect the course of cancer.


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• Acquired Immune Deficiency Syndrome (AIDS) – Behavioral factors play a critical role in the

transmission of HIV.

– High-risk behaviors:

• Contact with bodily fluids, intravenous drug use

– Stress is linked with more rapid progression of HIV.

– Social support is associated with a more gradual onset of symptoms.


FIGURE 8-3 The 15 Leading Causes of Death in the United Stated in 2000



• Pain Management

– Pain can be useful, but is not always adaptive.

– Reports of greater pain are associated with depression and anxiety.

– Higher levels of positive affect predict lower levels of reported pain.

– Treatments include hypnosis, biofeedback, relaxation training, and cognitive therapy. Each approach has some research support, but pain reduction is typically modest.


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FIGURE 8-4

Reports of routine pain intensity increase with age but are not strongly associated with gender.



• Sleep Disorders – Two types of primary sleep disorders are listed in

DSM-IV-TR. – Dyssomnias: difficulties in the amount, quality, or

timing of sleep • Primary insomnia, narcolepsy, breathing related

sleep disorder, and circadian rhythm sleep disorder

– Parasomnias: characterized by abnormal events that occur during sleep, e.g., nightmares


Sleep Disorders

PRIMARY INSOMNIA

• Difficulty initiating or maintaining sleep or poor quality sleep

• Lower ratings of subjective well-being

• Treatments: stimulus control, resetting circadian rhythms

PRIMARY HYPERSOMNIA

• Excessive sleepiness characterized by prolonged or daytime sleep

• In some ways, similar to narcolepsy


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Sleep Disorders BREATHING-RELATED SLEEP

DISORDERS

• Sleep apnea: obstruction of the respiratory airway

CIRCADIAN RHYTHM SLEEP DISORDER

• Mismatch between the patient’s 24-hour sleeping patterns and their 24-hour life demands that cause significant life distress


CARDIOVASCULAR DISEASE

• The number-one killer in the United States. • Cardiovascular disease (CVD) is a group of

disorders that affect the heart and circulatory system.

• The most important of these illnesses are hypertension, or high blood pressure, and coronary heart disease (CHD).

• The most deadly and well-known form of coronary heart disease is myocardial infarction (MI), commonly called a heart attack.

• Hypertension increases the risk for CHD, as well as for other serious disorders, such as stroke.



• Symptoms of Hypertension and CHD – The “silent killer” – Systolic blood pressure – Diastolic blood pressure – Hypertension is defined by a systolic reading

about 140 and/or a diastolic reading about 90 at relaxed state.

– The most notable symptom of CHD is chest pain. – 2/3 of all deaths from CHD occur within 24 hours

of a coronary event.


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• Diagnosis Of CHD – Myocardial infarction and angina pectoris are the

two major forms of coronary heart disease.

– Secondary hypertension

• Results from a known problem such as kidney or endocrine disorder

– Essential hypertension

• Diagnosed when the high BP is the principle or only disorder



• Frequency of CHD – The death rate due to CHD has declined by 25% or

more in the US and Japan.

• Risk Factors for CHD – Men: twice as likely to develop CHD as women

– Sex differences are even greater with more severe forms of the disorder.

– Age is another major risk factor.

• For men, risk for CHD increases in a linear fashion, increasing age after 40.

• For women, risk for CHD accelerates more slowly until they each menopause and increases sharply afterwards.


Why is coronary heart disease a “lifestyle disease”?

• The risk for CHD is two to three times greater among those who smoke a pack or more of cigarettes a day.

• Obesity, a fatty diet, elevated serum cholesterol level, heavy alcohol consumption, and lack of exercise also increase the risk for CHD.


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• Causes of CVD

– Biological Factors in CVD

• Deprivation of oxygen to the heart muscle

–Myocardial ischemia

–Atherosclerosis

–Coronary occlusion

–Psychological Factors in CVD

• Stress


Psychologial Factors

CARDIOVASCULAR REACTIVITY TO STRESS

• Different people exhibit different cardiovascular reactivity to stress, greater or lesser increases in blood pressure and heart rate when exposed to stress in the laboratory.

LIFE STRESSORS AND CHD: JOB STRAIN

Increased rates of CHD are found among people with high-stress occupations.

What appears to be most damaging is job strain, a situation that pairs high psychological demands with a low degree of decisional control.


Psychological Factors

TYPE A BEHAVIOR AND HOSTILITY

• Competitive, hostile, time urgent, impatient, and achievement-striving style of responding to challenge

• “Superachiever”

DEPRESSION AND ANXIETY • Depression is three

times more common among patients with CHD than in the general population, and depression doubles the risk for future cardiac events.


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PSYCHOLOGICAL FACTORS

• Social Factors

– Friends and family member can encourage a healthy or unhealthy lifestyle

– Interpersonal conflict

– Economic resources, being married, and having close friends are examples of ways to buffer CHD

– Societal norms and cultural values


CARDIOVASCUAR DISEASE

PRIMARY PREVENTION

• Encouraging healthy behaviors: quit smoking, eat well, exercise

• Media campaigns increase awareness, but their ability to reduce incidence of heart disease is unknown.

SECONDARY PREVENTION

Stress management

Coping skills

Weight reduction

Decreased alcohol use

Reduced intake of salt

Biofeedback


CARDIOVASCUAR DISEASE

• Prevention and Treatment of CHD – Tertiary Prevention

• Tertiary prevention of CHD targets patients who have already had a cardiac event, typically a myocardial infarction.

• The most effective programs are both structured and individualized for each patient.

• Type A behavior can be modified, and this may reduce the subsequent risk for CHD.


ABNORMAL PSYCHOLOGY SIXTH EDITIONfac.hsu.edu/ahmada/3 Courses/9 Abnormal Psychology/Abnormal...

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