2. Health Psychology zBehavioral Medicine yinterdisciplinary field that integrates behavioral and medical knowledge and applies that knowledge to health and disease zHealth Psychology ysubfield of psychology that provides psychology’s contribution to behavioral medicine

3. Health & Stress Health psychology related to: physiological psychology biopsychology positive psychology

4. Psychological/Behavioral Causes zObesity zSmoking zAlcohol abuse zStress

5. Psychological/Behavioral Causes zMost of those are covered well in the book but a few notes: zObesity – yportion size control critical ySelf-regulatory resources critical zSmoking - yNeed to fix it now (much harder later)

6. Psychological/Behavioral Causes zBest health psychology theory: yTheory of Planned Behavior (p 373) zCritical components: ySelf-efficacy yOther beliefs (  attitudes  intentions -> behaviors) {Iclicker question 1}

7. zMost lost weight is regained -20 -15 -10 -5 0 5 10 12345 Weight change in pounds Post treatment Years of follow-up Starting point Normal trend for untreated obese people: Gradually rising weight After participation in behavioral Program: Much of initial weight Loss regained Graph from a Psychology textbook…

8. Stress and Health zLeading causes of death in the US in 1900 and 1991 Percentage U.S.deaths 30 20 10 0 Tuber- culosis Pneu- monia Diarrhea/ enteritis Heart disease 1900 Percentage U.S.deaths 30 20 10 0 Heart disease CancerStrokes Chronic lung disease 1991 Unlike many leading killers a century ago, today’s major killers are more lifestyle-related {Iclicker question 2}

9. Stress and the Common Cold

10. What is Stress? zStress ythe process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging Stressors Catastrophes Life changes Hassles Intervening factors Appraisal Perceived control Personality Social support Coping behaviors Stress reactions Physiological Emotional Behavioral

11. What is Stress? z Types of Stress yMajor life events (cf: Holmes & Rahe scale) yCatastrophes yDaily hassles yAcculturative stress {Iclicker question 3}

12. Stressful Life Events zCatastrophic Events yearthquakes, combat stress, floods zLife Changes ydeath of a loved one, divorce, loss of job, promotion zDaily Hassles yrush hour traffic, long lines, job stress, burnout zAcculturative stress yCross-cultural interface stress

13. Stress Appraisal Stressful event (tough math test) Threat (“Yikes! This is beyond me!”) Challenge (“I’ve got to apply all I know”) Panic, freeze up Aroused, focused Appraisal Response

14. The physiology of stress

15. Pituitary hormone in the bloodstream stimulates the outer part of the adrenal gland to release the stress hormone cortisol Sympathetic nervous system releases the stress hormones epinephrine and norepinephrine from nerve endings in the inner part of the adrenal glands Thalamus Hypothalamus Pituitary gland Adrenal glands Cerebral cortex (perceives stressor )

16. What is Stress? zGeneral Adaptation Syndrome ySelye’s concept of the body’s adaptive response to stress as composed of three stages Stress resistance Phase 1 Alarm reaction (mobilize resources) Phase 2 Resistance (cope with stressor) Phase 3 Exhaustion (reserves depleted) The body’s resistance to stress can only Last so long before exhaustion sets in Stressor occurs

17. What is Stress? zBurnout yphysical, emotional and mental exhaustion brought on by persistent job-related stress zCoronary Heart Disease yclogging of the vessels that nourish the heart muscle yleading cause of death in the United States

18. Stress and the Heart

19. Stress & Coronary Heart Disease Hopelessness scores 3.5 3 2.5 2 1.5 1 0.5 0 Heart attack Death Low riskModerate riskHigh risk Men who feel extreme hopelessness are at greater risk for heart attacks and early death iClicker question

20. Stress and Control zHealth consequences of a loss of control No connection to shock source To shock controlTo shock source “Executive” rat“Subordinate” ratControl rat

21. Hopelessness Scores “Attitude” makes a real difference 3.5 3 2.5 2 1.5 1 0.5 0 Heart attack Death Low riskModerate riskHigh risk Men who feel extreme hopelessness are at greater risk for heart attacks and early death

22. Stress & Coronary Heart Disease zType A yFriedman and Rosenman’s term for people who are competitive, hard-driving, impatient, verbally aggressive, anger-prone zType B yFriedman and Rosenman’s term for easygoing, relaxed people

23. Hostility and Heart Disease zMen with highest hostility scores as young medical students had higher rates of heart disease 25 years later. zHostility is more hazardous than a heavy workload.

24. Disclosure zEmotional Inhibition: A personality trait involving a tendency to deny feelings of anger, anxiety, or fear; in stressful situations, physiological responses such as heart rate and blood pressure rise sharply. zPeople who display this trait are at greater risk of becoming ill than people who can acknowledge feelings. z{But remember what I said about anger & catharsis…}

25. Stress and Disease zPsychophysiological Illness y“mind-body” illness yany stress-related physical illness xsome forms of hypertension xsome headaches ydistinct from hypochondriasis – misinterpreting normal physical sensations as symptoms of a disease

26. Stress and Disease zLymphocytes ytwo types of white blood cells that are part of the body’s immune system xB lymphocytes form in the bone marrow and release antibodies that fight bacterial infections xT lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses and foreign substances

27. Stress and Disease zConditioning of immune suppression UCS (drug) UCR (immune suppression) UCS (drug) UCR (immune suppression) CS (sweetened water) CS (sweetened water) CR (immune suppression)

28. Stress and Disease zNegative emotions and health-related consequences Unhealthy behaviors (smoking, drinking, poor nutrition and sleep) Persistent stessors and negative emotions Release of stress hormones Heart disease Immune suppression Autonomic nervous system effects (headaches, hypertension)

29. Promoting Health zAerobic Exercise ysustained exercise that increases heart and lung fitness ymay also alleviate depression and anxiety Depression score 14 13 12 11 10 9 8 7 6 5 4 3 Before treatment evaluation After treatment evaluation No-treatment group Aerobic exercise group Relaxation treatment group

30. Promoting Health zBiofeedback ysystem for electronically recording, amplifying, and feeding back information regarding a subtle physiological state xblood pressure xmuscle tension

31. Promoting Health zModifying Type A life-style can reduce recurrence of heart attacks Percentage of patients with recurrent heart attacks (cumulative average) 65432106543210 Year 1978 1979 1980 1981 1982 Life-style modification patients Control patients Modifying life-style reduced recurrent heart attacks

32. Life events Tendency toward HealthIllness Personal appraisal ChallengeThreat Personality type Easy going Nondepressed Optimistic Hostile Depressed Pessimistic Personality habits Nonsmoking Regular exercise Good nutrition Smoking Sedentary Poor nutrition Level of social support Close, enduringLacking

33. Smoking and Alcoholism zGenetic and environmental contributions zHigh social variables

34. Religious involvement Healthy behaviors (less smoking, drinking) Social support (faith communities, marriage) Positive emotions (less stress, anxiety) Better health (less immune system suppression, stress hormones, and suicide)

35. Weight Control zMost lost weight is regained -20 -15 -10 -5 0 5 10 12345 Weight change in pounds Post treatment Years of follow-up Starting point Normal trend for untreated obese people: Gradually rising weight After participation in behavioral Program: Much of initial weight Loss regained