1. Psychophysiological Disorders and Health Psychology
Chapter 9
Psychophysiological Disorders and Health Psychology

2. Chapter Outline Stress and Health Theories of the Stress-Illness Link
Cardiovascular Disorders
Socio-Economic Status, Ethnicity, and Health
Therapies for Psychophysiological Disorders
Source: page 2

3. Psychophysiological Disorders
characterized by genuine physical symptoms
caused by or worsened by emotional factors
Examples: asthma, hypertension, headache, and gastritis
Used to be termed psychosomatic disorders
DSM-IV required diagnostic judgment to indicate presence of psychological factors affecting medical condition
DSM-5 considers that psychiatric disorders and medical disorders are NOT distinct.
eliminated DSM-IV-TR Axis III – General medical conditions
The field is called Health Psychology and Behavioural Medicine
Prevention is a major focus

4. Psychophysiological vs. Conversion Disorders

5. Stress coined by Canadian scientist Hans Selye (“father” of stress)
refers to environmental conditions that trigger psychopathology
General Adaptation Syndrome (GAS) outlines the effects of sustained and unrelenting stress on our bodies, resulting in illness

6. Key Terms Stressor – stress as a stimulus
Examples found in research: electric shock, boredom, uncontrollable stimuli, catastrophic life events, daily hassles, and sleep deprivation
Two main kinds of stressors
Psychogenic
Psychological factors
Example: anticipation of bad things happening
Neurogenic
Physical stimulus
Example: Bodily injury

7. Stress and the Nervous System
1. Autonomic Nervous System (ANS)
Involuntary (automatic) response to stimuli
ANS is divided into two parts:
Sympathetic nervous system
Parasympathetic nervous system
Sympathetic nervous system responsible for dilating pupils,
 heart rate,  digestion etc.
2. Somatic Nervous System
Voluntary nervous system

8. Nervous System and Health
Sympathetic nervous system is important for responding to acute danger – ‘fight or flight’ response
however, chronic activation of the sympathetic nervous system is directly linked to health problems, according to research
Allostatic load refers to ‘wear and tear’ on the body when there is exposure to intense and prolonged demands

9. Measuring Stress The Social Readjustment Rating Scale
Stress is defined by major life events
Scores are referred to as Life Change Units
arbitrarily assigned marriage as middle ranked event
highest stress event – death of a spouse
Research:  life events (life changes),  illness

10. Measuring Stress (cont.)

11. Measuring Stress (cont.)
Life events scale criticized because it does not account well for day to day stressors termed: daily hassles
Cognitive appraisals (Lazarus, 1966) are also important in understanding stress
determines whether situations are viewed as ‘stress’ or ‘challenge’ (like a glass half-empty or half-full)

12. Burnout usually related to job stress
linked to physical problems as well as psychological problems such as depression
characterized by:
emotional exhaustion
tendency to be insensitive
lack sense of personal accomplishment
Vital exhaustion – extreme form of burnout

13. Coping and Stress Problem-focused coping
Taking direct action to solve the problem or seeking information that will be relevant to the solution; most adaptive when the individual can do something about the situation
Emotion-focused coping
Efforts to reduce the negative emotional reactions to stress; most adaptive when the situation is uncontrollable
Goodness of fit hypothesis
The adaptivity of a particular coping response depends on the match between the coping response and what is called for ideally by the problem situation

14. Ways of Coping

15. Stress and Illness Health Status of Students
Research shows college/ university students do not rate themselves as having better health even compared with older populations
Predictors of less positive health status in students:
Poorer child-parent relationship;
Low interest and achievement in school;
Lower self-esteem and
Women reported more health problems than male students
Top health problems in students:
Allergy (47.9%), back pain (41.6%), sinus infection (30.7%), depression (17.0%), strep throat (13.8%)
Top five factors interfering with academic performance:
Stress (33.9%), cold/flu/sore throat (28.2%), sleep difficulties (25.6%), concern for troubled friend/family member (18.8%), Internet use/computer games (16.9%)

16. Moderators of Stress-Illness Link
Social Support
Structural social support
basic network of social relationships
Functional social support
Quality of relationships
Emotional support
Provides a sense of being cared for by warm and sensitive others
Instrumental support
Provides more tangible forms of assistance
Social support linked to health
People with few friends or relatives tend to have  mortality rate
 levels of functional support linked to  atherosclerosis and ability of women to adjust to chronic rheumatoid arthritis

17. Psychophysiological Disorders Theories of Stress-Illness Link
Three important questions related to causes of psychophysiological disorders:
1. Why does stress produce illness in only some people who are exposed to it?
2. Why does stress sometimes cause an illness and not a psychological disorder?
3. When stress produces a psychophysiological disorder, what determines which one of the many disorders will be produced?

18. Psychophysiological Disorders (cont.) Biological Theories
Somatic-Weakness Theory
Weakness in a specific body organ
Example: congenitally weak respiratory system might predispose the individual to asthma
Specific-Reaction Theory
Individual response to stress is idiosyncratic
Prolonged Exposure to Stress Hormones
Activation of SNS and HPA axis (see next - Figure 9.6)
Stress and the Immune System
Stress impact the ANS, hormone levels, brain activity (see next - Figure 9.7)

19. HPA Axis

20. Stress and the Immune System

21. Psychophysiological Disorders (cont.) Psychological Theories
Psychoanalytic Theory
Specific unconscious emotional states are associated with specific psychophysiological disorders
Anger-in theory has been researched as possible contributor to essential hypertension

22. Cardiovascular Disorders
Two diseases involving heart and blood-circulation system appear to be adversely affected by stress
Essential Hypertension
Coronary Heart Disease (CHD)
Hypertension without identified biological cause
Sometimes called: Primary hypertension
Known as the silent killer (may go undetected for years)
Measurement of blood pressure (BP)
Systolic pressure
Amount of arterial pressure when ventricles contract and heart is pumping
Diastolic pressure
Degree of arterial pressure when ventricles relax and heart is resting
Normal blood pressure in a young adult is 120/ 80

23. Cardiovascular Disorders (Cont.) Risk Factors for High BP

24. Cardiovascular Disorders (Cont.) Predisposing Factors
Genetics – still little success in identifying specific genes
Biology – heightened cardiovascular reactivity in response to exposure to stressors
Psychology - acute stress such as anger episodes and physical exertion can trigger myocardial infarction
Chronic stress (marital conflict, financial worries) activates immune system and contributes to inflammation, which, in turn, produces coronary heart disease

25. Cardiovascular Disorders (Cont.) Coronary Heart Disease (CHD)
CHD takes 2 principal forms:
Angina pectoris
Periodic chest pains
Cause of pain—insufficient supply of oxygen to heart (ischemia) due to coronary atherosclerosis
Myocardial infarction (‘heart attack’)
Much more serious disorder
Similar to angina pectoris BUT usually results in permanent damage to the heart

26. Cardiovascular Disorders (Cont.) Risk Factors of CHD
Age
Sex (males are at greater risk)
Cigarette smoking
Elevated blood pressure
Elevated serum cholesterol
 size of the left ventricle in heart
Obesity
Long-standing pattern of physical inactivity
Excessive use of alcohol
Diabetes

27. Cardiovascular Disorders (Cont.) Psychological Diatheses
Psychological Diatheses (predispositions)
Type A behaviour pattern
Intense and competitive drive for achievement and advancement;
Exaggerated sense of the urgency;
Aggressiveness and hostility toward others
Type D (distressed) personality
Negative affectivity + social inhibition, including the inhibition of anger, anxiety and depression

28. Cardiovascular Disorders (Cont.) SES, Ethnicity, and Health
Low socio-economic status (SES) is associated with  rates of mortality from all causes
 SES more likely to engage in behaviours that  risk for disease
Smoking, eating a high-fat diet, and drinking excessive amounts of alcohol
Social gradient of health
Inequalities in SES are considered to reflect inequalities in health status
 SES also confers health disadvantages because linked with  sense of perceived controllability

29. Therapies for Psychophysiological Disorders
Treating hypertension through  CHD risk factors
 anxiety, depression, or anger is best way to  psychophysiological disorders
Also  smoking, obesity, alcohol consumption, salt intake,  exercise, etc.
Drugs can be used to  cholesterol levels
Lovastatin (Mevacor) lowers low-density lipid cholesterol
Biofeedback
Effectiveness of biofeedback has only modest empirical support
Cardiac Rehabilitation Efforts
Support and counseling aimed at  stress

30. Stress Management
Arousal Reduction
training in muscle relaxation, sometimes assisted by biofeedback
Cognitive Restructuring
See approaches by Ellis (1962) and Beck (1976)
Focus is on altering belief systems and improving the clarity of logical interpretations of experience
Mindfulness
 trait mindfulness associated with  pain catastrophization
manualized 10-week group approach for developing mindful awareness of perceptible experiences in a way that is non-evaluative and emotionally non-reactive
Behavioural Skills Training
Learning and practicing required skills, including assertion skills

31. Pain Management How common are problems with pain?
3.6 million Canadians perceived activities restricted by physical problems
Most common disabilities are linked with pain
Gate-control theory of pain
Nerve impulses connoting pain reach spinal column and spinal column controls pain sensations sent to brain
Gate—area of the spinal column known as the dorsal horns
Acute Pain
Sense of personal control important in dealing with acute pain
Chronic Pain
Traditional medical treatments seldom help with chronic pain
Maladaptive strategy for coping with pain
Catastrophization

32. Copyright
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