1. NO CLASS ON THURSDAY FEB. 13

2. 1. Counterproductive coping a. Isolation b. Negative beliefs 2. Social Support: a. Hazards of positive support b. Hazards of no support 3.Negative stereotypes 4.Medical complications and risks 5. Double binds (1-4, above) Psycho-social Complications of Chronic Pain

3. Wrong model: Pain  Depression --- What’s missing? Correct model: Pain  ↓ activity  ↓ mastery  ↓ control  Depression Pain and Depression

4. Pain Prone Personality Are some personalities more prone to experiencing, reporting pain? MMPI = Minnesota Multiphasic Personality Inventory a. Acute pain pats : Hypochondriasis – overly attend to body Hysteria – extreme emotionality/exaggerate symps. b. Chronic pain pats :Neurotic triad: Hypcondriasis + hysteria + depression Secondary gain : What are social benefits of pain? Attention, special identity “Functional type”: neurotic triad + schizo / psychopathology / paranoia Danger of “Pain Prone Personality” concept? 1. Negative stereotypes 2. Causal direction

5. Drugs Surgery Sensory Control: Counter-irritation “MECHANICAL” PAIN REDUCTION TECHNIQUES

6. Biofeedback Relaxation Hypnosis Acupuncture Guided Imagery Cognitive Reframing Distraction Pain Management Programs “PSYCHOSOCIAL” PAIN REDUCTION TECHNIQUES

7. Pain Relief Through Virtual Reality Severe burns one of most painful conditions to treat: cleaning, re-bandaging excruciating. Pennebaker symptom research suggests that distraction should do what to pain? Reduce it.Why?Competition of cues. SnowWorld: Virtual Reality program designed for pain relief. Patients enter SnowWorld during procedures Shoot snowballs at snowmen, penguins Report pain reductions 30%-50% Note SnowWorld colors. Why?

8. Summary Benefits of Psychosocial Approaches Change meaning of experience Provides skill set, reduces helplessness Gives patients an active role in pain management Success with techniques increases self-efficacy Changes ways of thinking

9. 1. Evaluation a. pain b. functional status: life style changes, limitations c. Emotional and mental functioning 2. Treatment plan a. Pre-set time. Not indefinite. b. Specific goals. c. Contract 3. Program a. Education 1. Nature of pain: physio, psychological 2. Pain reduction techniques b. Therapy 1. Psycho therapy 2. Cognitive therapy: c. Family therapy d. Relapse prevention Pain Management Programs

10. Class 7: Stress I

11. Stress: Health Psych “Bullseye” Integrates mental states, bodily states, environmental conditions Window to core psych processes: * How we make sense of events, and how interpretations affect health. Emotions, emotions & thinking, emotional control Social relations in coping and in failed coping Stress is where psych can do most for health. Causes of illness, Treatment of illness, illness prevention

12. What Are Stressful Events?

13. Broken Heart Syndrome Temporary heart condition due to loss-related stress Chest pain, due to surge of stress hormones. Loss-related stress?Break-up Death Departure “Stress cardiomyopathy” Duration: typically 1 week

14. Stress is a negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects. Taylor, p 168. Stress Defined

15. Cannon Model of Stress Walter Cannon, 1932 Fight or Flight response SNS + endocrine mobilizes body for fight or flight Stressful events _____You can fight:..... _____You can flee... _____You can neither fight nor flee, "traps" Which are the most stressful? X

16. General Adaptation Syndrome (GAS) Hans Selye (1956) All stressors produce same pattern: Enlarged adrenals Shrunken thymus Shrunken lymph Ulcerated stomach Per Selye: Prolonged stress --> cardiovascular disease arthritis hypertension compromised immune system

17. 1. SAM: Sympathetic-adrenomedullary Event  cortex  hypothalamus  SNS  adrenal medulla   catecholamines  charged feeling  increased BP, HR, etc. SAM Corresponds to Cannon's stress model 2. HPA: Hypothlamic-pituitary-adreocortical Event  cortex  hypothalamus  coritcotrophin releasing factor (CRF)  pituitary  adrencorticotropic hormone (ACTH)  adrenal cortex  corticosteriods  conserves carbos  reduces inflammation HPA corresponds to Selye's stress model Physiology of Stress

18. SAM and HPTA Stress Patterns

19. Health Implications of Sustained Stress Catecholamine elevation, sustained, inhibits immune system Cardiovascular effects 1. Arteriosclerosis 2. Senility: neurons in hippocampus 3. Depression 4. Fat distribution: Higher waist-to-hip ratio 5. Sudden death syndrome

20. Stress, Opioids, and Illness Susceptibility Opiates are?Pain-reducing drugs, from plants. Morphine, heroin Endogenous opiods (aka endorphines): Like opiate, produced by body. Stress triggers endorphine production Stress  opioid release  immune suppression  ? ↑ illness susceptibility

21. Prolonged Stress Widens “Window of Vulnerability” Chronic stress  ↑ recovery phase  ↑ cortisol phase  ↑ immune suppression  ↑ illness risk. Allostatic load = effects of cumulative stress exposure

22. Reactivity and Stress Vulnerability People vary in stress reactions NOT just a matter of being mentally tough / whimpy Physical constitutions differ Autonomic NS Neuroendocrine response Immune response Study of children 3-5 yrs old, reactivity Measure reactivity to stressor -- a. cardio (HR, BP) b. immune Parents track stressor reactions, illness for 12 weeks Result: stress leads to illness among ____ Low Reactive____ High Reactive X

23. Stress as Function of Person-Environment Fit Low Stress: Resources>>Challenge Moderate Stress:Resources≥Challenge High Stress:Resources<Challenge