Chapter Outline

  1. Introduction
    1. Biopsychosocial model holds that physical illness is caused by a complex interaction of biological, psychological, and sociocultural factors
      1. A new model for explaining patterns of disease, illness
      2. Suggests that biological factors operate in psychosocial context
    2. Health psychology is concerned with how psychosocial factors relate to the promotion and maintenance of health, and with the causation, prevention, and treatment of illness
      1. Emerged in late 1970s
      2. Ways psychological factors can influence physical health
        1. Direct effects of stress
        2. Health-impairing habits
        3. Reactions to illness
  2. Stress, personality, and illness
    1. Personality, emotions, and heart disease
      1. Hostility and Coronary Risk: Coronary heart disease results from a reduction in blood flow through the coronary arteries, which supply the heart with blood
        1. Atherosclerosis (the gradual narrowing of the coronary arteries) is principal cause
        2. Can eventually result in heart attack (myocardial infarction)
        3. Friedman and Rosenman (1974) found connection between coronary risk and pattern of behavior they called Type A personality
      2. Elements of the Type A personality
        1. Type A personality includes three elements: 1) a strong competitive orientation, 2) impatience and time urgency, and 3) anger and hostility
          1. Tend to be highly competitive, achievement-oriented workaholics
          2. Cynical about life and hostile toward others
          3. Easily aggravated, get angry quickly
        2. Type B personality is marked by relatively relaxed, patient, easygoing, amicable behavior
          1. Less hurried, competitive, than Type A's
          2. Less easily angered
        3. Recent studies indicate that hostility may be more important for coronary risk than other elements of Type A personality
          1. Apparent relationship between hostility and coronary disease, hypertension, and early mortality
          2. People high in hostility are moody, suspicious, resentful, distrusting
      3. Evaluating the risk
        1. Research on link between Type A personality and coronary risk have produced mixed results
        2. Risk for Type A's may be about double that of Type B's
      4. Explaining the connection
        1. Type A's seem to exhibit greater physiological reactivity
        2. Type A's probably create more stress for themselves
        3. Type A's tend to have less social support
        4. Type A's tend to exhibit detrimental health habits
      5. Emotional reactions and heart disease
        1. Recent research has supported hypothesis that depressive disorders are related to heart disease
    2. Stress and cancer
      1. Cancer: refers to malignant cell growth, which may occur in many organ systems in the body
      2. Research linking psychological factors to onset of cancer is weak
      3. Stress, personality factors can influence course of disease
        1. Stressors associated with diagnosis may contribute to progress of disease
        2. Impact of stress may depend on one's personality
    3. Stress and other diseases
      1. Stress has been linked to variety of illnesses (e.g., rheumatoid arthritis, vaginal infections, genital herpes)
      2. Many stress-illness connections based on tentative, inconsistent findings
    4. Stress and immune functioning
      1. Immune response: the body's defensive reaction to invasion by bacteria, viral agents, or other foreign substances
      2. Studies of animals, humans indicate stress can impair immune functioning
      3. Other studies have shown link between stress and suppressed immune response
      4. Suppressed immune functioning may make people more vulnerable to infections
    5. Conclusions
      1. Virtually all research is correlational
        1. No cause and effect relationship can be established
        2. Some research designs may have inflated correlation
      2. Research consistently indicates relationship between stress and health is modest
  3. Habits, lifestyles, and health
    1. Some people engage in health harming habits despite the abundant evidence of the damage that these habits cause
      1. Health-impairing habits creep up on people slowly
      2. Habits may involve activities that are pleasant
      3. Risks tend to lie in distant future
      4. People tend to underestimate risks associated with own health-impairing habits
    2. Smoking
      1. Health effects
        1. Smokers face much greater risk of premature death
          1. Overall risk is positively correlated with number of cigarettes smoked, tar and nicotine content
          2. Cigar, pipe smoking also associated with elevated health risks, although less hazardous than cigarettes
        2. Lung cancer, heart disease, other diseases linked with smoking
        3. Also health risks associated with second-hand smoke
      2. Giving up smoking
        1. Health risks decline when people give up smoking
        2. Most smokers would like to quit, but are reluctant to do so
        3. Evidence suggests that readiness to quit builds gradually as people cycle through periods of abstinence, relapse
        4. Evidence on effectiveness of nicotine substitutes is ambiguous
    3. Drinking
      1. Alcohol also a leading cause of health problems
      2. About two-thirds of adult population in U.S. drink
      3. Particularly prevalent on college campuses
        1. Many students engage in binge drinking
        2. Students spend far more money on alcohol than on books
      4. Why do people drink?
        1. "Who cares" brand of euphoria temporarily boosts self-esteem
        2. Negative emotions, inhibitions are dulled
        3. Out of habit
      5. Short-term risks and problems
        1. Overdose on alcohol alone is possible, but more common problem is overdosing on combinations of alcohol and sedative or narcotic drugs
        2. Effects on intellectual functioning, perceptual-motor coordination causes problems associated with driving under influence
        3. Some drinkers become prone to aggression
        4. Can contribute to reckless sexual behavior
      6. Long-term health effects and social costs
        1. Alcoholism: a chronic, progressive disorder marked by a growing compulsion to drink and impaired control over drinking that eventually interfere with health and social behavior
        2. Problem drinking associated with wide range of serious health problems (e.g., cirrhosis of liver, coronary disease, hypertension, stroke, certain types of cancer)
        3. Alcoholism can produce severe psychotic states
        4. Social problems include family problems, reduced efficiency on job
    4. Overeating
      1. Obesity: the condition of being overweight as defined in terms of body mass index (BMI) ­ weight in kilograms divided by height in meters, squared (km/m2).
        1. Common health problem
        2. Associated with increased risk of coronary disease, hypertension, stroke, respiratory problems, etc.
      2. Determinants of obesity
        1. No such thing as "obese personality"
        2. Evidence for a genetic predisposition to obesity, which causes variations in individual basal metabolic rate ­ the body's rate of energy output while at rest.
        3. Excessive eating and inadequate exercise, partly due to technological and cultural changes
        4. Set point: represents body's natural point of stability in weight
          1. Theory suggests that body monitors fat cells to keep them fairly stable
          2. Functions to keep body weight within limited range
          3. Suggests that overweight people must make permanent changes in eating habits if they want to keep weight down
        5. Some researchers suggest that vacillations in dietary restraint contribute to obesity
          1. Chronic dieters are restrained eaters who tend to eat to excess when their cognitive control is disrupted
          2. For many, the most common source of disinhibition is perception that they have cheated on their diets
          3. There is still room for argument about role of dietary restraint in obesity
      3. Losing weight
        1. Increasing number of people trying to lose weight
        2. Modest weight reduction can significantly diminish many health risks associated with obesity
        3. But popular fad diets can be perilous to one's health
        4. To lose weight, must change ratio of energy intake (from food consumption) to energy output (from physical activities)
        5. Three options in trying to change ration of energy input to energy output
          1. Sharply reduce food consumption
          2. Sharply increase exercise output
          3. Simultaneously decrease food intake and increase exercise output
        6. Most experts recommend third option
        7. Experts agree that gradual weight reduction is more likely to be maintained than rapid reductions
        8. Evidence suggests that dieters should avoid foods high in fat content
    5. Poor nutrition
      1. Nutrition: a collection of processes (mainly food consumption) through which an organism utilizes the materials (nutrients) required for survival and growth
      2. Nutrition and health
        1. Heavy consumption of foods that elevate serum cholesterol level (e.g., eggs, butter, shellfish) seems to increase risk of heart disease
        2. High salt intake contributing factor in development of hypertension
        3. High caffeine consumption may increase risk for hypertension
        4. High-fat diets may contribute to some forms of cancer
        5. Chronic, inadequate calcium intake may increase vulnerability to osteoporosis, particularly in post menopausal women
        6. High intake of vitamin E may reduce risk for coronary disease
        7. Eating habits play role in course, management of number of diseases (e.g., gall stones, kidney stones, gout)
      3. The basis for poor nutrition
        1. Poor nutrition is more widespread in U.S. than people realize
        2. Most people's nutritional shortcomings are result of ignorance, poor motivation
      4. Nutritional goals
        1. Consume balanced variety of foods
        2. Avoid excessive consumption of fats, cholesterol, sugar, salt
        3. Increase consumption of complex carbohydrates, polyunsaturated fats, natural sugars, foods with fiber
    6. Lack of exercise
      1. Benefits and risks of exercise
        1. Regular exercise associated with greater longevity
          1. Enhances cardiovascular fitness
          2. Can contribute to avoidance of obesity
          3. Linked with reduced risk for certain kinds of cancer
            1. Colon cancer in men
            2. Breast, reproductive cancer in women
          4. Can serve as buffer to reduce physical effects of stress
          5. Can produce desirable personality changes that promote physical wellness
        2. Important to note that exercise programs can have hazards
          1. Some exercise can lead to heart attacks
          2. Risks more likely in people who don't exercise regularly
      2. Devising an exercise program
        1. Look for an activity that you will find enjoyable
        2. Increase participation gradually
        3. Exercise regularly without overdoing it
        4. Reinforce yourself for participation
        5. Avoid the competition trap
    7. Behavior and AIDS
      1. Acquired immune deficiency syndrome (AIDS): a disorder in which the immune system is gradually weakened and eventually disabled by the human immunodeficiency virus (HIV)
      2. AIDS is final stage of HIV infection process
      3. Until recently, average length of survival was about 18-24 months, but encouraging advances in treatment with protease inhibitors hold promise for longer survival
      4. Current evidence suggests that stress is not a key factor modulating how rapidly AIDS progresses
      5. Transmission
        1. Through person-to-person contact involving exchange of bodily fluids, primarily semen, blood
        2. Two principal modes are sexual contact, sharing of needles by intravenous (IV) drug users
        3. No evidence that it can be spread through casual contact
      6. Misconceptions
        1. Fear that AIDS can be readily transmitted through casual contact with infected individuals
        2. Heterosexuals with variety of partners have little risk of contracting AIDS
      7. Prevention
        1. Having sexual contact with fewer partners
        2. Using condoms to control exchange of semen
        3. Curtailing certain sexual practices (i.e., anal sex)
        4. IV drug users should avoid sharing syringes
  4. Reactions to illness
    1. The decision to seek treatment
      1. Variations in perception of symptoms help explain individual differences in tendency to seek treatment
        1. More likely to seek treatment when symptoms are unfamiliar, frightening, or disruptive of work, social activities
        2. Reaction of friends, family an important factor
      2. Many people tend to put off going to doctor, clinic
        1. People often misinterpret, downplay significance of symptoms
        2. Worry about looking silly if problem turns out to be nothing
        3. Worry about "bothering" their physician
        4. Are reluctant to disrupt plans
        5. Waste time on trivial matters
    2. The sick role
      1. Some people grow to like sick role, because of its potential benefits
        1. Absolves people from responsibility for their incapacity
        2. Can be used to exempt them from normal responsibilities
      2. Attention paid to sick person may be rewarding
    3. Communicating with health providers
      1. About half of medical patients leave their doctors' offices with lack of understanding
      2. Barriers to effective provider-patient communication
          Medical visits are usually quite brief, allowing little time for discussion
        1. Illness and pain are subjective, difficult to describe
        2. Many providers use too much medical jargon
        3. Some providers discourage their patients' information seeking
        4. Patients may forget to report some symptoms
        5. Some patients are evasive because they fear a serious diagnosis
        6. Many patients are reluctant to challenge doctors' authority
      3. Key to improving communication is to not be a passive consumer
        1. Have questions prepared in advance
        2. Try to be accurate, candid in replying to doctor's questions
        3. Ask for clarification
    4. Adherence to medical advice
      1. Many patients fail to adhere to physician's instructions
        1. May be due to failure to understand instructions
        2. Instructions may be aversive, difficult
        3. Negative attitude toward physician likely to increase noncompliance
      2. Improved physician-patient communication can increase compliance
  5. Application: Understanding the effects of drugs
    1. Drug-related concepts
      1. Psychoactive drugs: chemical substances that modify a person's mental, emotional, or behavioral functioning
        1. Not all psychoactive drugs lead to drug abuse
        2. People tend to prefer drugs that elevate mood, alter consciousness
      2. Tolerance: a progressive decrease in a person's responsiveness to a drug with continued use
      3. Physical dependence: when a person must continue to take a drug to avoid withdrawal illness (which occurs when drug use is terminated)
      4. Psychological dependence: when a person must continue to take a drug to satisfy intense mental and emotional craving for the drug
        1. Not marked by clear withdrawal reaction
        2. Can create powerful, overwhelming need for drug
      5. Overdose: an excessive dose of a drug that can seriously threaten one's life
        1. Any drug can be fatal if person takes enough of it
        2. Some drugs have greater potential for overdose than others
          1. CNS depressants (narcotics, sedatives) carry greatest risk of overdose
          2. Many overdoses involve combinations of CNS depressants
    2. Narcotics
      1. Narcotics (or opiates): drugs derived from opium that are capable of relieving pain
        1. Term is used legally to refer to variety of drugs besides opiates
        2. Discussion here focuses on heroin, morphine
      2. Effects
        1. Main effect is overwhelming sense of euphoria
        2. Side effects include nausea, lethargy, drowsiness, etc.
      3. Risks
        1. High risk for both physical, psychological dependence
        2. Users tend to develop drug-centered lifestyle
        3. Overdose is real danger
        4. Potential for contraction of infectious diseases through sharing of needles
    3. Sedatives
      1. Sedatives: sleep-inducing drugs that tend to decrease central nervous system activation and behavioral activity (e.g., barbiturates, Valium)
      2. Effects
        1. Euphoria similar to drinking large amounts of alcohol
        2. Relaxed state of intoxication
        3. Side effects include diminished motor coordination, sluggish intellectual functioning, instability in emotions
      3. Risks
        1. Can produce physical, psychological dependence
        2. Among leading causes of overdoses
        3. Elevated risk of accidental injury
    4. Stimulants
      1. Stimulants: drugs that tend to increase central nervous system activation and behavioral activity (e.g., cocaine, amphetamines, caffeine, nicotine)
        1. "Crack" is freebased from cocaine
        2. Amphetamines are synthesized in laboratory
      2. Effects
        1. Produce energetic, enthusiastic euphoria
        2. Side effects include increased blood pressure, muscle tension, restlessness
      3. Risks
        1. Physical dependence is relatively mild, psychological dependence is exceptionally powerful
        2. Can suppress appetite, disrupt sleep; lead to deterioration in physical health
        3. Heavy use can lead to amphetamine or cocaine psychosis
        4. Overdoses on cocaine have increased sharply in recent years
    5. Hallucinogens
      1. Hallucinogens: a diverse group of drugs that have powerful effects on mental and emotional functioning, marked most prominently by distortions in sensory and perceptual experience (e.g., LSD, mescaline, psilocybin)
      2. Effects
        1. Intensify, distort perception, impair intellectual functioning
        2. Can produce nightmarish feelings of anxiety, fear, paranoia
      3. Risks
        1. No potential for physical dependence, psychological dependence appears to be rare
        2. No deaths attributed to overdose
        3. In sever cases of acute panic, accidents and suicide are possible
        4. Flashbacks may occur
    6. Marijuana
      1. Cannabis: the hemp plant from which marijuana, hashish, and THC are derived
      2. Effects
        1. Subtle effects on emotion, perception, cognition
        2. Mild, relaxed state of euphoria
        3. Great variability in effects among users
      3. Risks
        1. Physical dependence, overdose not problems
        2. Potential to produce psychological dependence
        3. Can cause transient problems with anxiety, depression
        4. Increased chances for respiratory, pulmonary diseases, lung cancer
        5. Like tobacco, may be hazardous for pregnant women
      4. Designer drugs
        1. Designer drugs: illicitly manufactured variations of known recreational drugs (e.g., MDMA, or "ecstasy")
        2. Probably account for only a small proportion of illicit drug use in U.S.
        3. Emergence of these drugs is alarming
          1. Long-term risks are unknown
          2. Potentially harmful impurities may be found in drug