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