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Lecture Videos

What is health psychology?

Mini lecture 1:

· What is health?

· Health in 1948 to present day → We now live longer (abt 10 years on average)

· We suffer and die from diff illnesses

· World Health Organization defines health as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity”

What are the differences btwn the biomedical and biopsychosocial model?

· Biomedical model: Maintains that all illness has a biological cause (Fails to consider chronic illnesses that involve a slow accumulation of damage and that you live with for long periods of time)

1. Disease is the result of a pathogen or an organ not functioning right

2. Mind and body are autonomous and separate

3. Health is the absence of disease (In this context, the WHO definition was revolutionary)

· Biopsychosocial model: Biological, psychological, and sociocultural forces act together to determine an individual’s health and vulnerability to disease Example: Anxiety Disorder

· Biological mechanisms: Genetic vulnerability, Reactive nervous system

· Psychological mechanisms: High stress, Poor coping skills

· Social influences: High level of responsibility at work, Lack of social support

What is health psychology?

· Health psychology: Examines how biological, social, and psychological factors influence health and illness

· Health psychologists use psychological science to promote health, prevent illness, and improve healthcare systems

Supplemental video 1.1

· Two main strands of health psychology

1. Health promotion: Health psychologists who work in public health and encourage people to adopt more healthy lifestyles

2. Managing health conditions: Working directly with people who experience a variety health problems

· Can help people make sense of their illness and cope with it better

· Research in health psych is important in terms of understanding mechanisms that allow people to adapt to illnesses

Biopsychosocial model of health and illness

Supplemental video 1.2

· One needs to understand not only the biological root of disease but also its psychological impact and how psychological factors contribute to disease and illness as well as the social factors that relate to it

· Not recognized as important as they really are but we would be better off if the healthcare system paid attention to the biopsychosocial model and trained practitioners in the interventions

Shortcomings of the medical model at end of life

Supplemental video 1.3

· Biomedical model is a problem-based model

· We’re ill-equipped to serve those at the end of life because we focus on their problems

· Death isn’t a medical experience and doesn’t have a set of medical problems to be solved

· Biomedical model / healthcare system only responds to problems

· Biopsychosocial model focuses on responding to problems while also preserving opportunity/ fostering opportunity for the individual to grow personally

Why become a health psychologist?

Supplemental video 1.4

· There are enormous health burdens right now

· Over the next couple of decades, there’s going to be an increased need for psychologists to be working in the area of health

· Lifestyle changes esp w/ chronic health problems

· People struggle to cope and manage chronic disease, health psychologists help with that

· Health psychology is a very diverse field

· Consulting, Teaching, Research

· What you does has a direct impact

· Valued by other oncology fields since many professions are involved with health psychology

What do health psychologists do?

Supplemental video 1.5

· Work with patients who have chronic illnesses such as gastrointestinal conditions

· Stress can have an impact on conditions and on the patient’s symptoms

· Interdisciplinary approach to helping patients cope with their health conditions

· Psychologists are viewed as an essential team member

· Health psychologists address the psychosocial needs of the patients and offer behavioral treatment options to the patients

· Treatment option includes short-term behavioral interventions to help patients learn coping skills such as Cognitive Behavioral Therapy

Supplemental video 1.6

· Behavioral medicine unit treats chronic pain and physically ill patients

· Health psychologists in private practice are also able to pursue writing and research

· Integrated care where psychological evaluation and treatment is embedded in medical practice of patients

· Helpful to physicians in determining direction of treatment to take or patients

Supplemental video 1.7

· Health psychology: A branch of psychology that focuses on the many factors which impact health and well-being

· Works with people in individual and group settings helping them enhance their emotional and physical health/ wellbeing through non-pharmacological methods

· Teach people important mindbody skills and helping them implement lifestyle changes

Textbook Ch 1

Definition of Health Psychology

· Health psychology explores how psychological factors influence health and well being, focusing on understanding behaviors, emotions, and beliefs that impact physical health outcomes

· Study issues and develop interventions

· Behavioral medicine: Multidisciplinary field with scientifically proven strategies for improving health behaviors in individual patients' lives and in entire communities

· World Health Organization defines health as “a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity”

· Many use the term wellness to refer to optimum state of health

· Health psychologists focus on health promotion and maintenance and study the psychological aspects of the prevention and treatment of illness

· They also focus on the etiology and correlates of health, illness, and dysfunction

· Etiology: Origins or causes of illness

· Health psychologists analyze and attempt to improve the healthcare system and formulation of health policy

The Mind-Body Relationship: A Brief History

· Ancient Greeks were among the earliest to identify the role of bodily factors in health and illness

· Also believed that the mind was important

· Their theories were proven untrue, but their emphasis on mind and body in health/ illness was a breakthrough

· In the Middle Ages, people swung to supernatural explanations for illness and the Church was the guardian of medical knowledge

· From Renaissance to present day, there were many advances in understanding the technical bases of medicine

· Focused primarily on organic and cellular pathology instead of superstition

· Resulted in biomedical model, but led to the assumption that psychological and social processes were irrelevant to the disease process

The Rise of the Biopsychosocial model

· Conversion hysteria: Specific unconscious conflicts can produce physical disturbances that symbolize repressed psychological conflicts

· Psychosomatic medicine: Dunbar and Alexander offered profiles of particular disorders believed to be psychosomatic in origin

· Researchers believe that the onset of disease is usually due to several factors working together, which may include a biological pathogen coupled with social and psychological factors

· Biopsychosocial model: Health and illness are the consequences of the interplay of biological, psychological, and social factors

· Emphasizes both health and illness

· Useful for the diagnostic and treatment process

The Need for Health Psychology

· Until 20th century, major causes of illness and death in the US were acute disorders

· Chronic illnesses are now the main contributors to disability and death

· There are diseases in which psychological and social factors are implicated as causes

· Because many people may live with chronic diseases for many years, psychological issues arise in their management

· New medical technologies and scientific advances create issues that can be addressed by health psychologists

· Other factors contributing to the rise of health psychology involve the expansion of healthcare services

· Because containing healthcare costs is so important, health psychology’s main emphasis on prevention can reduce the dollars devoted to the management of illness

· Health psychologists know what makes people satisfied or dissatisfied with their healthcare and can help in the design of a user-friendly healthcare system

· The healthcare industry employs millions of people. Nearly every person in the country has direct contact with the healthcare system as a recipient of services. Consequently, its impact is enormous

Health Psychology Research

· Theory: A set of analytic statements that explain a set of phenomena

· Advantages of theory for guiding research and treatment:

· Provide guidelines for how to do research and interventions

· Generate specific predictions, so they can be tested and modified as the evidence comes in

· Help tie together loose ends (Unites observations into general principles which can be incorporated into interventions”

· Experiment: Researcher creates 2 or more conditions that differ from each other in exact and predetermined ways → People are randomly assigned to these different conditions, and their reactions are measured

· Goal of random assignment is to make the treatment and comparison groups equivalent in all respects except for the treatment

· Randomized clinical trials: Target treatment is compared against the existing standard of care or a placebo control

· Evidence-based practice: Medical and psychological interventions go through rigorous testing and evaluation of their benefits

· Correlational research: Health psychologist measures whether changes in one variable correspond with changes in another variable

· Prospective research: Looks forward in time to see how a group of people change, or how a relationship between two variables changes over time

· Longitudinal research: The same people are observed at multiple points in time

· Retrospective designs: Look backward in time in an attempt to reconstruct the conditions that led to a current situation

· Epidemiology: Study of the frequency, distribution, and causes of infectious and noninfectious diseases in a population

· Morbidity: The number of cases of a disease that exist at some given point in time

· Mortality: Numbers of deaths due to particular causes

· Methodological tools include…

· Functional magnetic resonance imaging has helped produce knowledge about the autonomic, neuroendocrine, and immune systems that have made a variety of breakthrough studies possible

· Web-based technologies are widely used in health psychology interventions involving efforts to change health behaviors or providing social support to people in need of more or more helpful social contact

· Meta-analysis: Combines results from different studies to identify how strong the evidence is for particular research findings

· Qualitative research also plays an important role in health psychology since guided interviews and narratives can provide insights into health processes that summary statistics may not provide

What is health psychology training for?

· Students who are trained in health psych as undergrad can have many different occupations

· Some go into medicine, becoming physicians and nurses

· Experience in health psychology allows some healthcare practitioners to conduct research as well

· Other health psych students go into the allied health professional fields such as social work, occupational therapy, dietetics, physical therapy, or public health

· Students who receive either a PhD in health psychology or a PsyD most commonly go into academic research as faculty members or into clinical practice, where they provide individual and group counseling

· Other PhDs in health psych practice in hospitals, medical groups, and other healthcare settings

· Teach and supervise staff and students, Serve as members of medical teams, Work with recipients of healthcare services

· Many are involved in the management of healthcare, including business and government positions

· Others work in industrial or occupational health settings to promote healthy behavior, prevent accidents, and help control healthcare costs

Week 2 Lecture videos

Mini lecture 2.1: What are health behaviors?

What are health behaviors?

· Health behaviors: Actions undertaken by people to enhance or maintain their health

· (Ex: Eating a healthy diet, Exercising regularly, Using sunscreen, Sleeping well, Practicing safe sex, Wearing seatbelts)

· Some health behaviors occur on continuum, i.e., they can also be hazardous to health

· Health behaviors can be influenced on a range of levels

· Influenced by individual advice style factors

· Health habits: Firmly established behaviors that are often performed automatically (Ex: Wearing seatbelt, brushing teeth)

Successful modification of health behaviors can:

· Reduce deaths due to lifestyle related illnesses

· Delay time of death, increasing longevity

· Expand years of life free from chronic disease complications

· Means that are available to someone create the situation

· Young vs old, Rich vs poor, More vs less educated, Stressed vs relaxed

Role of health psychologists:

· Health psychology: Examines how biological, social, and psychological factors influence health and illness

· Use psychological science to promote health, prevent illness, and improve health care systems

· Health psychologists: Study how patients handle illness, why some people don’t follow medical advice, and the most effective ways to control pain or change poor health habits

· Develop health care strategies that foster emotional and physical well-being

Mini lecture 2.2: Health behavior changes

Why is changing health behaviors so hard?

· Emotions can perpetuate poor health behaviors

· Health behaviors are independent and unstable

Emotional factors:

· Poor health behaviors can be pleasurable, automatic, addictive, or resistant to change

· People may perceive a health threat to be less relevant than it really is

Health behaviors are independent

1. Different factors control different health behaviors and health habits

· Ex: Eating vs wearing seatbelt

· Availability

· Effort (Time to cook a healthy meal vs putting on a seatbelt

2. Different factors drive the same health behaviors for different people

· Ex: Reasons for eating poorly could include stress, boredom, or social overeating

Health behaviors are unstable

· Factors controlling health behaviors can change over time

· Smoking initiated by peer pressure, maintained by reducing feelings of stress

Why change health behaviors?

· Because an ounce of prevention is worth a pound of cure

Types of prevention

· Primary: Before disease strikes

· Prevent disease or injury from occurring (Wearing seatbelt, exercising, avoid smoking)

· Secondary: In early stages of disease

· Prevent disease or injury from getting worse (Dietary changes, Monitor symptoms, Blood pressure medication)

· Tertiary: After disease strikes

· Actions are taken to contain damage (Radiation therapy, chemotherapy, rehabilitation)

Interventions in at-risk populations

· Children and adolescents:

· Socialization: The influence of parents as role models

· Using the “teachable moment”: Window of vulnerability

· Adolescent health behaviors influence adult health

· Precautions taken in adolescence may affect disease risk after 45 more than adult health behaviors

· Benefits of focusing on at-risk groups:

· May prevent or eliminate poor health habits

· Efficient and effective use of health promotion dollars

Mini lecture 2.3: Models of health behavior change

Health belief model

· Health belief model: Whether a person practices a health behavior depends on

a. Perception of health threat

· Is there a threat?

b. Perception of the possibility of threat reduction

· Will my behavior change make a difference?

· Belief in health threat + Belief that specific health behavior can reduce threat → Health behavior

Theory of planned behavior

· Theory of planned behavior: Health behavior is result of a behavioral intention

a. Attitudes toward the specific action

· Will a behavior change have positive consequences?

b. Subjective norms regarding the action

· Do I or others think that a behavior change is good?

c. Perceived behavioral control

· Can I do what needs to be done?

· Attitudes toward the specific action, Subjective norms regarding the action, Perceived behavioral control → Behavioral intention → Health behavior

Self-determination theory

· Key to behavior change:

· Autonomous motivation

· Perceived competence

Transtheoretical model of behavior change

· Stages of change:

1. Precontemplation: The “not ready” stage

· No intention to change behavior

· Unaware of a need to change

· What helps? Provide information

2. Contemplation: The “getting ready” stage

· Intending to change behavior within next 6 months

· Pros and cons weigh in equally

· What helps? Work at reducing the cons

3. Preparation: The “ready” stage

· Intending to change behavior within 30 days

· Make small changes that will help implement the behavior (e.g., tell family and friends)

· What helps? Encouragement and support

4. Action: The “doing it” stage

· Behavior has been changed within last 6 months

· Work on strengthening commitment and resisting relapse

· Most successful interventions: Learning techniques to keep commitment (e.g., substitute healthy activities; self-reward)

5. Maintenance: The “keeping it up” stage

· Behavior was changed more than 6 months ago

· Consolidate gains, prevent relapse

· What helps? Support from people who also practice healthy behavior

Week 2 Supplemental videos

Supplemental video 2.1: Health promotion and health behavior

· Change population health through multiple levels

· Social behavioral scientists that identify structures in societies that exacerbate health problems among diff groups of people

· Use behavioral theories and strategies to reduce barriers and increase incentives for individual health behavior changes that impact population level health

· Work with other disciplines in public health

· Biostatistics and epidemiology use data to identify where a pop. health problem might exist

· Take the data and investigate further WHY those problems exist and for WHOM

· Sometimes support other disciplines in other contexts

· Health promotion and health behavior: Science of understanding people and building a fully functioning public health enterprise that addresses health and health equity across our entire population

· Ex: Tobacco control as a public health risk

· Health promotion and health behavior is an interdisciplinary field that draws from psychology, human development, family sciences, sociology, anthropology, education, behavioral sciences, medicine, and more

· Prevention interventions, Multi-level models, Social determinants, Public health programs

Supplemental video 2.2: Primary, secondary, and tertiary prevention

· Levels of prevention: No disease → Asymptomatic disease → Clinical course

· Primary –Onset→ Secondary – Clinical -diagnosis→ Tertiary

· Primary: Removes disease risk factors (Ex: Immunizations, Folate, Exercise, Seat belts)

· Secondary: Early detection and treatment (Ex: Screening)

· Tertiary: Reduce complications (Beta blockers post MI)

Supplemental video 2.3: Health belief model

· Explains a person’s behavior when faced with behavior change such as eating healthier or being more physically active

· Made by social psychologists in the 50’s to project health behaviors

· Adapted to explain the behavior of reluctant individuals

· Health belief model revolves around 6 constructs

1. Perceived susceptibility: Individual considers the negative consequences of a condition and how harmful it is

2. Perceived severity: A person’s belief on how serious an addition might be in what the consequences are (Perception of the extent of harm from a disease)

3. Perceived barriers: The perceived cost or hindrances of the new behavior change

4. Cues to action: The forces that make an individual feel like they need to take action

5. Self-efficacy: A person’s ability to believe they can achieve the behavior change

6. Perceived benefits: Belief in the efficacy of the device action to reduce the seriousness of the disease or harmful state

Supplemental video 2.4: Theory of planned behavior

· Theory of reasoned action: Intentions are the best predictor of behavior

· Theory of planned behavior: Intentions are the product of 3 different processes

1. Behavioral attitudes: How a person thinks and feels about behavior

· Affective attitude: Whether a person believes a behavior to be enjoyable or unenjoyable

· Instrumental attitude: Whether the behavior is perceived the be beneficial or harmful

2. Subjective norms: Support given or not given to significant others (Ex: Family and friends)

· Injunctive norms: Refer to whether others encourage the behavior

· Descriptive norms: Relate to others doing the behavior as well

3. Perceived behavioral control: The extent to which the person feels capable and has confidence in their ability to execute the desired behavior will play a role in their intentions and actual behavioral outcomes

· Theory of planned behavior states that when a person perceives an activity as enjoyable with good benefits, where they have the support and encouragement of others as well as members of their social group that already engage in the behavior, and ultimately feel that they have the ability to meet the demands of the task, they will form stronger intentions and be more likely to engage in the activity

Supplemental video 2.5: Transtheoretical model of change

· Helps us understand the different stages in this process from not being ready to change through contemplation, and then maintenance

· 5 stages of change:

1. Precontemplation:

· Not ready

· Unlikely to engage in the near future

· Encouraged to think about positives and negatives

· Down & defensive

2. Contemplation:

· Getting ready

· Intention to engage in the behavior

· Appreciate the positives of change

· May still try to avoid action

· Has the thought but is unlikely to act

3. Preparation:

· Ready to engage in action

· Gradual steps to fit into their life

· Might tell family and friends

· Key concern is regarding the individual’s competence

· Thinking of it like a pre-game warm-up

4. Action: Doing the behavior

· Need to keep working hard

· Useful to learn techniques to enhance commitment

· Doing well but could move back through the stages

5. Maintenance:

· Have changed and sustained behavior

· Share experiences and seek support

· Important to be self-aware

· Need to be challenged

· Feel competent to overcome barriers

· Behavior change is not always linear and it can be cyclical due to the fact that many people often do not succeed in maintaining changes in their lifestyle

Textbook Ch 3

An introduction to health behaviors

Role of behavioral factors in disease and disorder

· Patterns of disease in US changed substantially

· Acute infectious diseases has declined, but there has been an increase in mortality from largely preventable disorders

· Role of behavioral factors in development of these disorders is clear (Nearly half of the deaths are caused by preventable factors)

· It’s also important to note that an individual’s ability to engage in healthy behaviors can be constrained or facilitated by contextual factors

Health promotion: An overview

· Health promotion: A philosophy that has at its core the idea that good health, or wellness, is a personal and collective achievement

· According to WHO, health promotion “is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions”

· For the individual, it involves developing a program of good health habits

· For the medical practitioner, health promotion involves teaching people how to achieve a healthy lifestyle and helping people at risk for particular health problems offset or monitor those risks

· For the health psychologist, health promotion involves the development of interventions to help people practice healthy behaviors

· For community and national policy makers, health promotion involves emphasizing good health, reducing inequities that impede health, and providing information and resources to help people change poor health habits

· Successful modification of poor health behaviors has several beneficial effects

1. Reduces deaths due to lifestyle-related diseases

2. Can delay the time of death, thereby increasing life expectancy

3. Practice of good health behaviors can expand the number of years during which a person may enjoy life free from the complications of chronic disease

Health behaviors and health habits

· Health behaviors: Behaviors undertaken by people to enhance or maintain their health

· Health habit: A health behavior that is firmly established and often performed automatically, without awareness

· Primary prevention: Taking measures to combat risk factors for illness before an illness has a change to develop

1. Get people to alter their problematic health behaviors

2. Keep people from developing unhealthy habits in the first place

Practicing and changing health behaviors: An overview

· Younger, more affluent, better-educated people with low levels of stress and high levels of social support typically practice better health habits than people under higher levels of stress with fewer resources

· Values affect the practice of health habits

· Taking cultural values into account can aid health promotion efforts

· People who regard their health as under their personal control practice better health habits than people who regard their health as due to chance

· The health locus of control scale: Measures the degree to which people perceive their health to be under personal control, control by the health practitioner, or chance

· Social norms that develop in families, among friends, and in communities can have powerful effects on both health-enhancing and health compromising behaviors

· Health habits are tied to personal goals

· Some health habits are controlled by perceived symptoms

· Access to the healthcare delivery system affects health behaviors

· There is often little immediate incentive for practicing healthy behaviors

· Health habits develop during childhood/adolescence when most people are healthy and unhealthy habits have no severe effect on health for years

· As a result, unhealthy habits have a chance to make inroads

· Emotions may lead to or perpetuate unhealthy behaviors

· Health habits are only modestly related to each other

· Why are health habits relatively independent of each other and unstable?

1. Different health habits are controlled by different factors

2. Different factors may control the same health behavior for different people

3. Factors controlling a health behavior may change over the history of the behavior

4. Factors controlling a health behavior may change across a person’s lifetime

· Health behaviors are elicited and maintained by different factors for different people and these factors change over the lifetime as well as over the course of the healthy habit

Intervening with children and adolescents

· Healthy habits are strongly affected by early socialization, esp. The influence of parents as both teachers and role models

· Health promotion efforts capitalize on teachable moments (Some periods are better than others for modifying health practices)

· Health habits people practice as teenagers or college students may determine which chronic diseases they develop and what they ultimately die of in adulthood

Intervening with at-risk people

· Working with at-risk populations can be an efficient and effective use of health promotion dollars

· Helps identify other factors that may increase risk

Problems of focusing on at-risk people

· Ethical issue in informing at-risk people if their personal risk is unknown

Health promotion and older adults

· Focuses on maintaining a healthy balanced diet, maintaining a regular exercise regimen, taking steps to reduce accidents, controlling alcohol consumption, eliminating smoking, reducing the inappropriate use of prescription drugs, obtaining a flu shot, reducing frailty, and remaining socially engaged

· A healthy older adult population is essential both for quality of life and for controlling healthcare spending

Ethnic and gender differences in health risks and habits

· Health promotion addresses ethnic and gender differences n vulnerability to health risks

· Health promotion efforts with different ethnic groups need to take account of culturally different social norms

· Consideration of health practices in the community, informal networks of communication that can make interventions more successful, and language

· Health behaviors vary in complex ways as a function of gender, age, sexual orientation, socioeconomic status, race and ethnicity, and other characteristics

Changing health habits

· Focuses on how theories inform behavior change efforts because theoretically guided interventions

1. Provide specific guidelines for constructing interventions

2. Provide criteria for evaluating interventions

3. Generate conclusions that can have broad applicability to other health behaviors and settings

Attitude change and behavior

· Educational appeals: Make the assumption that people will change their health habits if they have good information about their habits

· Attitudinal approaches to changing health habits often make use of fear appeals

· Assumes that if people are afraid that a particular habit is hurting their health, they will change their behavior to reduce the fear

· A health message can be phrased in positive, gain-framed, or negative, loss-framed terms

The health belief model

· Health belief model: Whether a person practices a health behavior depends on 2 factors

1. Whether a person perceives a personal health threat

2. Whether the person believes that a particular health practice will be effective in reducing that threat

· Perception of a health threat is influenced by at least 3 factors

1. General health values, which include interest in and concern about health

2. Specific beliefs about personal susceptibility to a particular disorder

3. Beliefs about the consequences of the disorder, such as whether they are serious

· Whether a person believes a health measure will reduce threat has 2 subcomponents

1. Whether the person thinks the health practice will be effective

2. Whether the cost of or barriers to undertaking that measure exceeds its benefits

· Self-efficacy: The belief that one can control one’s practice of a particular behavior

Theory of planned behavior

· Theory of planned behavior: A health behavior is the direct result of a behavioral intention

· Behavioral intentions are made up of 3 components

1. Attitudes toward the specific action

2. Subjective norms regarding the action

3. Perceived behavioral control

Evaluation of attitude theories

· Help us understand and change health behaviors

· May provide informational base for altering health habits but not always the impetus to take action

· Assume behavior changes are guided by conscious motivation, ignoring the fact that some behavior change occurs automatically and is not subject to awareness

Self-regulation and health behavior

· Self-regulation: People control their own actions, emotions, and thoughts

Self-determination theory

· Self-determination theory (SDT): People are actively motivated to pursue their goals

· Targets two important components as fundamental to behavior change

1. Autonomous motivation: People experience free will and choice when making decisions

2. Perceived competence: Belief that one is capable of making the health behavior change

Implementation intentions

· A theoretical model that emphasizes implementation intentions integrates conscious processing with behavioral enhancement

· When a person desires to practice a health behavior, it can be achieved by making a simple coherent plan that links critical situations or environmental cues to goal-directed response

· By forming an implementation intention, a person can delegate the control of goal-directed responses to situational cues, which may then elicit the behavior automatically

· Self-affirmation: Occurs when people reflect upon their important values, personal qualities, or social relationships

· Leads to positive changes in intentions and actual health behaviors

Cognitive-behavioral approaches to health behavior change

Cognitive-behavioral therapy

· Cognitive-behavioral therapy (CBT): Use several complementary methods to intervene in the modification of a target problem and its context

Self-monitoring

· Self-monitoring: Assesses the frequency of a target behavior and the antecedents and consequences of that behavior

· Learning to discriminate the target behavior and charting the behavior

Stimulus control

· Stimulus-control interventions: Involve ridding the environment of discriminative stimuli that evoke the problem behavior, and creating new discriminative stimuli, signaling that a new response will be reinforced

Self-control of behavior

· Cognitive restructuring: Trains people to recognize and modify their internal monologues to promote health behavior change

· Self-reinforcement: Involves systematically rewarding oneself to increase or decrease the occurrence of a target behavior

· Behavioral assignments: Home practice activities that support the goals of a therapeutic intervention

Motivational interviewing

· Motivational interviewing (MI): Client-centered counseling style designed to get people to work through any ambivalence they experience about changing their health behaviors

Relapse prevention

· Abstinence violation effect: Feeling of loss of control that results when a person has violated self-imposed rules

· Initially when people change their behaviors, they are vigilant, but over time, vigilance fades and the likelihood of relapse increases

· Relapse prevention techniques: Begin by asking people to identify the situations that may lead to relapse so they can develop coping skills that will help them to manage that event

Evaluation of CBT

· Advantages of CBT for health behavior change are several

1. A carefully selected set of techniques can deal with all aspects of a problem

2. Therapeutic plan can be tailored to each individual’s problem

3. Range of skills imparted by multimodal interventions may enable people to modify several health habits simultaneously, such as diet and exercise, rather than one at a time

The transtheoretical model of behavior change

Stages of change

· Transtheoretical model of behavior change: Analyzes the stages and processes people go through in bringing about a change in behavior and suggested treatment goals and interventions for each stage

1. Precontemplation: Occurs when a person has no intention of changing behavior

2. Contemplation: People are aware that they have a problem and are thinking about it but have not yet made a commitment to take action

3. Preparation: People intent to change their behavior but have not yet done so successfully

4. Action: People modify their behavior to overcome the problem

5. Maintenance: People work to prevent relapse and to consolidate the gains they have made

Using the stage model of change

· At each stage, particular types of interventions may be most appropriate

· Perceived barriers: Aspects of one’s life that interfere with practicing good health behaviors

Changing health behaviors through social engineering

· Much health behavior change occurs not through programs such as CBT interventions, but through social engineering

· Social engineering: Modifies the environment in ways that affect people’s abilities to practice a particular health behavior

· Social engineering solutions to health problems can be more successful than individual behavior modification

· Choice architecture strategies: Attempts to nudge people toward healthy choices through modifying the choice environment

· Most health behavior change cannot be legally mandated, and people will continue to engage in unhealthy habits even when their freedoms to do so are limited by social engineering

· Health psychology interventions have a very important role in health behavior change

Venues for health-habit modification

The practitioner's office

· Physicians are highly credible sources for instituting health habit change, and their recommendations have the force of expertise behind them

· Some health-habit modification is conducted by psychologists and other health practitioners privately on a one-to-one basis, usually using cognitive-behavioral techniques

1. Individual treatment a person receives makes success more likely

2. Intervention can be tailored to the needs of the particular person

The family

· Increasingly, health practitioners intervene with families to improve health

· Family life can be suited to building in health behaviors

· Children learn their health habits from their parents and multiple family members are affected by any one member's health habits

· If behavior change is introduced at the family level, ideally all family members are on board, ensuring greater commitment to the behavior-change program and providing social support for the person whose behavior is the target

Self-help groups

· Self-help groups: Bring together people with the same health habit problem, and often with the help of a counselor, they attempt to solve their problems all together

· Cognitive-behavioral principles and social support contributes to their success

Schools

· School population is young, and consequently, we may be able to intervene before children have developed unhealthy habits

· Interventions can change the social climate in a school regarding particular health habits in ways that foster behavior change

· Even in college, social networks continue to be good targets for health interventions

Workplace interventions

· On-the-job health promotion programs that help employees stop smoking, change their diet, exercise regularly, control hypertension, and limit drinking, among other problems

· Some workplaces provide health clubs, restaurants that serve healthy foods, and gyms that underscore the importance of good health habits

· Workplace interventions have benefits, including higher morale, greater productivity, and reduced healthcare costs to organizations

Community-based interventions

· Door to door campaigns, media blitz, grassroots community programs, or mixed intervention involving media and personal contact

· There are several advantages of community-based interventions

1. Such interventions reach more people than individually based interventions or interventions in limited environments

2. Community-based interventions can build on social support for reinforcing adherence to recommended health changes

3. Neighborhoods can have profound effects on health practices, especially those of adolescents

Mass media

· Goal of health promotion is to reach as many people as possible, so mass media has great potential

· Bring about modest attitude change but less long-term behavior change

· Alerts people to health risks and reaches people from socially disadvantaged groups

· Health behaviors in characters can act as role models

· By presenting a consistent media message over time, the mass media can have a cumulative effect in changing the values associated with health practices

Cell phones and landlines

· Automated phone interventions can prompt people to maintain health behavior change

· Texting represents another potentially effective low cost intervention

· Programs to contact older adults by telephone each day can make sure their needs are being met, and efforts have incorporated lifestyle advice into these volunteer programs, such as recommending physical activity

· Such daily contact can also increase the older adult’s experience of social support

Internet and social media

· The internet provides information and low-cost access to health interventions for millions of people

· Websites for health habits have been developed and internet-delivered, computer-tailored lifestyle interventions targeting single or multiple risk factors simultaneously, have shown some success

· Internet-delivered interventions to change health behaviors appear most likely to be effective if the use a credible source, prompts to engage in the behavior, goal setting, feedback on and monitoring of behavior, and human coaching and personalization

· Can also be used to augment the effectiveness of other interventions

· Tailored e-coaching that provides individualized feedback can supplement standardized interventions for health-related behavior change

· CBT interventions for health habit modification delivered via the internet can be as effective as face-to-face interventions, and they have advantages of costing less, saving therapists’ time, reducing waitlist and travel time, and providing interventions to people who might not seek out a therapist on their own

· Internet also enables researchers to recruit a large number of people for studies at relatively low cost, thus enabling data collection related to health habits

· Interactive social media interventions can also be useful in increasing physical activity and engagement in medical screening but have not yet shown consistent positive effects on other health behaviors

Week 3 Lecture Videos

Mini lecture 3.1: Alcohol use

Characteristics of health compromising behaviors

· Many of these behaviors share a window of vulnerability in adolescence:

· Drinking to excess

· Smoking

· Using illicit drugs

· Having unsafe sex

· Using risk-taking behaviors

Why?

· Behaviors are tied to peer culture

· Image of these behaviors as “cool”

· Behaviors, though dangerous, are pleasurable

· Behaviors develop gradually

· Substance abuse of all kinds is predicted by some of the same factors

Why is it so difficult to stop? Health behaviors are unstable

· Emotional factors

· Stress reduction, feeling calm

· Feeling self-confident

· Instability: Change over time

· Initiated: e.g., stress, peer pressure

· Maintained: e.g., addiction, emotion regulation

Scope of the problem

· 3rd leading cause of preventable death in US

· Alcohol consumption is linked to high blood pressure, stroke, cirrhosis of the liver, fetal alcohol syndrome, and some cancers

· 41% of traffic-related deaths are linked to alcohol

Risk factors

· Family history of alcohol abuse

· Having 2 or more adverse events during childhood

· Beginning to drink early, by age 16 or sooner

· Drinking more than 1-2 drinks per day

· Smoking cigarettes (Particularly teenagers)

· Being under a lot of stress

· Having a pre-existing psychiatric disorder (Such as depression or anxiety)

· Men have higher rates of alcoholism than women

· Broken homes

Treatment approaches

· Treatment success

· 10-20% stop drinking on their own

· 32% can stoop with minimal help

· Without employment or social support, prospects for recovery are dim

Last class: Types of prevention

· Primary: Before disease strikes

· Prevent disease or injury from occurring (Wearing seatbelt, exercising, avoid smoking)

· Secondary: In early stages of disease

· Prevent disease or injury from getting worse (Dietary changes, monitor symptoms, blood pressure medication)

· Tertiary: After disease strikes

· Actions are taken to contain damage (Radiation therapy, chemotherapy, rehabilitation)

Preventing use of alcohol

· Primary prevention: Educational programs for children, risk groups (e.g., red ribbon week)

· Legal approach

· Control of production/ sales

· Raising taxes

· Raising minimum age?

· Improve mental health

· Reduce stressors in risk groups

· Parents as role models

· Secondary prevention

· Early diagnosis

· Adequate treatment of

· With drawal symptoms

· Addiction (Physiological, psychological, social)

· Complications (Depression, anxiety, cirrhosis, vitamin D deficiency)

· Post detoxification counseling and follow up

· Change in environment (Home, school, work, friends)

· Ex: Alcoholics Anonymous

· Tertiary prevention

· After care programs

· Vocational guidance

· Counseling

· Recreation

Take home messages

· Alcoholism: A multifactorial disorder with a window of vulnerability in adolescence

· Unstable behavior which may result in disease

· Because of the severe consequences, primary prevention programs are particularly important

Mini lecture 3.2: Eating behaviors

Are high caloric foods good for you?

· Yes and no

· Throughout our history as humans, we’ve used lots of caloric energy to get food, so high caloric foods was important for us

· Modern day is different since we aren’t as active

· Our bodies evolved to desire high caloric foods despite not needing it as much

Why should health psychologists care?

· Ex: Eating behavior and coronary heart disease risk

· Eating unhealthy foods contributes to plaque buildup

· How so? Let’s take a look at cholesterol

· Cholesterol is oil based but blood is waterbased

The body’s solution to the glob-problem

· It packages cholesterol into protein covered particles (lipoproteins) that mix with blood well

LDL - The bad guys

· LDL particles take cholesterol to the parts of the body that need it

· LDL particles act as ferries

· But, if there’s too much LDL, LDL deposits the cholesterol into the arteries → Blockages → Heart attacks

· That’s why LDL is often called “bad cholesterol”

HDL - The good guys

· HDL take up excess cholesterol and takes it to the liver for recycling

· HDL particles act as vacuum cleaners

Behavior change can reduce disease risk

· Saturated fats and trans fats increase LDL cholesterol

· Unsaturated fats increase HDL cholesterol

Determinants of WHAT we eat?

· Preferences and aversions

· Species-typical

· Sweet and fatty foods → High energy

· Salty foods → Sodium rich

· Bitter foods → Often associated with toxins

· Learned

· We learn from experience of others (e.g., parents)

· Many food preferences are culturally specific

Determinants of WHEN and HOW MUCH we eat

· People are more likely to eat on Friday-Sunday because of social constructs

· Time spent with family and friends, Around more people on the weekends

· Meal size is bigger with more people present

Resistance to modifying diet

· Difficult to get people to modify their diet

· Problem of maintaining change

· Some dietary recommendations are restrictive, monotonous, expensive, and hard to find/ prepare

Developing a healthy diet

· Health belief model: Belief in health threat + Belief that specific health behavior can reduce threat → Health behavior

· Theory of planned behavior: Attitudes toward specific action + Subjective norms regarding the action + Perceived behavioral control → Behavioral intention → Health behavior

· Transtheoretical model of change:

· Stages of change: Precontemplation, Contemplation, Preparation, Action, Maintenance

Week 3 Supplemental Videos

Supplemental video 3.1: Alcohol use disorder

· 3rd leading cause of preventable death and disability in the United States

· Jon Ebbert, MD: Primary care provider and addiction specialist

· Alcoholism is a risky use behavior that’s been normalized

· >14 drinks per week for men and >7 drinks per week for women

· 80% of ppl struggling w/ substance abuse in the US are struggling w/ alcohol use disorder

· 5% has alcohol use disorder

· How do you know when someone has a problem?

· Alc consumption although not causing significant social legal or psychological problems, it is associated w/ significant adverse health consequences

· Rising rate of liver cirrhosis is related to alcohol use

· A lot of people have functional alcoholism

· Caffeine + alcohol can be incredibly dangerous bc they can consume higher levels with caffeine than they could otherwise

· Caffeine wears off faster than alcohol

Treatment options

· Medication for alcohol use work though diff mechanisms to make patients feel that the alcohol is not as reinforcing

· Changing drug use to consume alc → feel high to consume alc → feel nothing, it’s easier to quit

· Psychosocial support is also important

Supplemental video 3.2: Half of us Macklemore on drug abuse

· Drank and smoked weed in highschool

· Tried to quit to pursue music but kept falling back into old habits

Dangers of oxy

· Most intense drug he took

· Synthetic heroin

· Had a strong grip even without being done often

· Felt lack of serotonin

· Has become an epidemic

Hurting loved ones

· Visited brother in Europe and felt sick

· Parents didn’t like him because of the selfish nature of addiction

· His family knew that he had a drug problem because of his behavior

· Discarding someone else’s emotions for selfish needs

Getting help

· Dad told him to go to rehab

· Seeking help saved him

· Wanted to get clean and new that his highest potential was when he was sober

· Other things pulled him down into the place of using

· Important to be part of a recovery community

Shortcuts

· Wanted to take adderall to write a song but if he did he would be compelled to take it more

· Drugs are something that wears you down

Losing a friend

· Ran into an old friend that was addicted to Oxy

· Bad anxiety and was into pills

· Overdosed and died at 20 years old

Helping friends

· Easiest way to give advice is to ask questions

· If you ask the right questions, the truth comes out

Taking responsibility

· Artists and music make a major impact on someone’s life

· Wants to use his music to influence the others to make the right decisions

· Otherside: Song about the dangers of drug abuse

Supplemental video 3.3: Alcohol and other drugs panel

· Raised by an alcoholic → Picking up those traits

· Family normalized and enabled alcohol use due to culture

· Got progressively worse

· Other cultures considered it taboo so didn’t support alcoholism

· Got cut off from family until getting sober

Steps to recovery if a family member is an addict

· Professionals that step in and hold an intervention

· Getting educated on 12 step programs for addictions

· Person has to be ready and willing to realize that they have a problem/ need help

· Al-anon and Alcoholics Anonymous

· Had to lose his loved ones to realize the reality

Nicotine use during recovery

· Don;t give everything up at once

· Gave up alcohol first and them smoking

Saying NO to urges while in recovery

· Replace unhealthy habits with healthier habits

· Thinking about life before getting sober

Being in recovery while in college

· Was able to focus and pay attention in class while sober

· Academic probation during addiction

· Initially didn’t think going to college while in recovery was possible, but realized it was

Hitting rock bottom in addiction

· Didn’t realize that it was a problem

· Every bottom has a trapdoor

· Just kept getting worse

· Had to reach spiritual bottom

Advice for students questioning substance use

· Think about the future and focus on goals

· Knowing when to seek help is an internal thing

Circle of friends when in recovery

· Most friends are in recovery because it’s easier to relate and talk about common goals

· Engage in other activities

· Found group that cares

Supplemental video 3.4: Anorexia nervosa

The journey of anorexia: Arley’s story

· Moved from family farm to go to boarding school in 2014

· Fell into anorexia

· Anorexia is a disease that affects the entire family

· Thoughts of healthy eating consumed her after going to a new school and getting into rowing

· Continued to cut more and more foods out of diet

· Incredibly fatigued but still went to the gym

· Lack of personality led parents to take action

· Guilt because family had to put their life on hold for her

· Realized the only way to fix it was to get better

Recovery

· Reading her old journal and realizing how much her mindset had changed since recovery

· Didn’t acknowledge that it was a problem at the time

· Anorexic brain can take over and become you

· Living with anorexia is like living with a horrible brain that defies everything you know to be true in order to decrease your calorific consumption

· Recovery has been the hardest thing she’s ever done

· Taken out of school and studied at home

· Isolation from friends

Family’s perspective

· Took a long time to understand how difficult dealing with anorexia was

· Her dad regrets not picking it up on it earlier

· Interfered with her relationship with sister

· When she looked in the mirror and envisioned other people’s perspectives she could see how bad it was getting, but when she looked through her own perspective it didn’t look as bad

· Worst points for her mom was when she had to start refeeding her

Supplemental video 3.5: Obesity epidemic

· Approx 1 in 3 adults and 1 in 6 children are obese

· Obesity is a major cause of death, attributable to heart disease,cancer, and diabetes

· Results from people consuming more calories than they can burn

Challenges

· Consequence of complicated changes in the environment where food is more readily available and physical activity is lacking

· The way we eat has changed, Americans are eating more processed foods and at restaurants more often

· We are constantly bombarded by food and consuming larger portions

· People in poor and rural communities have less access to quality grocery stores

· May be cheaper to purchase less healthy foods

Solutions

· Eat more fruits and vegetables and less fatty and sugary foods

· We can drink more water instead of sugared drinks

· Get recommended amount of physical activity

· Restrict television viewing

· Communities can expand access to fruits and vegetables through farmers market programs

· Advocate for quality nutrition programs and physical education

· Traffic-safety measures and crime prevention strategies

· Safer roads for physical activity

· Sidewalks and bike lanes

· More supermarkets in low income areas

· Employers can offer work-site health programs

· Changes in schools, child-care settings, work sites, and communities

Supplemental video 3.6: Childhood obesity

· Prevalence has increased drastically among children and adolescents

· Food choices and lack of physical activity

· 1 out of 6 american children are obese

· Can lead to various health problems and socioemotional problems

· Multitude of reasons

· Lifestyle in our society

· Can check BMI to see if child is obese

· BMI: Body mass index, Ratio of weight to height

· 95th percentile and above could be obesity

· Important to look at eating habits and physical activity habits that a child develops over time

· Parents provide, Children decide

· Provide healthy options and a regular schedule of eating

· Most children should eat 3 meals and 1-2 snacks a day

· Hormonal implications: Early puberty in children (esp in girls), increased risk for PCOS and other hormonal difficulties

· Psychologists managing obesity usually work with families and focus on health behavior and how the body is being treated (nutrients, healthy eating habits)

· Eating while watching something can distract us and we won’t realize how much we’re eating

· Few medication options

· Lifestyle change is the most important

Textbook Ch 4

Exercise

Benefits and prevalence of exercise

· Can decrease risk of several chronic diseases

· Accelerates wound healing in those with injuries and can be critical to recovery from disabilities

· Children and adolescents need 60 minutes of moderate to vigorous physical activity each day to attain maximal health benefit

· For adults, performing muscle-strengthening activities at least 2 days a week is recommended

· For adults who mostly sit at work, alternating btwn sitting and standing can lower mortality risk

· Most people find exercise to be more intrinsically enjoyable than they expected

· Improves mood and emotional well being

· Beneficial effects of exercise on cognitive functioning, esp on executive functioning involved in planning and higher-order reasoning

· Employee fitness programs can reduce absenteeism, increase job satisfaction, and reduce healthcare costs

Determinants of regular exercise

· Most people’s participation in exercise is erratic

· Adults report lack of time, stress, interference with daily activities, and fatigue as barriers to exercising

· Several factors increase the likelihood of regular exercise

1. People who come from families in which exercise is practiced

2. Positive attitudes toward physical activity

3. Strong self-efficacy for exercising

4. People who have energy

5. Extroverted and sociable

6. High in well-being

· Convenient and easily accessible exercise settings promote exercise

Exercise interventions

· Interventions that incorporate principles of self-control and that muster motivation can be successful in changing exercise habits

· Helping people form implementation intentions

· Transtheoretical model of behavior change

· Family based interventions

· Relapse prevention techniques

Unintentional injury prevention

Home and workplace unintentional injuries

· Driven primarily by unintentional poisoning via opioid ingestion

· Most programs to prevent injuries in children help parents supervise their children effectively and modify the environment

· Employment in construction is the source of the most workplace fatalities

· Explanations and measures to reduce this disparity have received too little attention

· Falls in the home accounted for one quarter of the preventable deaths in 2022

· For people over age 65, falls are leading cause of injury

· Strategies to reduce falls have increasingly been a focus of research and interventions

Motorcycle and automobile unintentional injures

· More than half of road fatalities are among pedestrians, motorcyclists, and cyclists

· Solutions include speed limits, helmet laws, and seatbelts

· Many people exceed the speed limit and use phones while driving

Vaccinations and screening

Vaccinations

· Parents are urged to get their children vaccinated against measles, polio, diphtheria, whooping cough, and tetanus, among other childhood disease

· In some cases, refusing to get vaccinations for children comes from the mistaken beliefs that a vaccine causes disease or that it causes another disorder

· WHO identified “the reluctance or refusal to vaccinate despite availability of vaccines” as one of the 10 threats to global health

· 2 vaccination doses of girls and boys against HPV is recommended

· Vaccine hesitancy: The reluctance or refusal to get vaccinated despite the availability of vaccines

· Systematic and structural factors are important determinants

Screenings

· Early detection of cancer can reduce cancer mortality

· Mammography screening for breast cancer is recommended in women for age 40-74

· Meta-analysis demonstrated that measures of Health Belief Model constructs were linked to engagement in cervical cancer screening

Sun safety practices

· Excessive exposure to UV light is a chief risk factor for skin cancer

· Parents play an important role in ensuring that children reduce sun exposure

· Communications to adolescents and young adults emphasize the immediate adverse effects since adolescents and young adults are more attuned to immediate concerns

· Ex: Freedom from concern about skin cancers or improvements in appearance

· Even brief interventions directed to sun safety practices can be effective

Healthy eating

· Hedonic eating: Eating that is pleasure-driven, Not to satisfy hunger or obtain needed calories, but rather driven by the sheer delight of eating

Changing diet

· A diet high in fruits, vegetables, with some whole grains, peas and beans, poultry, and fish and low in refined grains, potatoes, and red and processed meats lowers the risk of coronary heart disease

· Switching from trans fats and saturated fats to polyunsaturated fats and monounsaturated fats is a healthful change, as is reducing added sugar

Resistance to modifying diet

· The typical reason people switch to a diet low in cholesterol, fats, calories, and additives and high in fiber, fruits, and vegetables is to improve appearance, not to improve health

· Some diets are restrictive, monotonous, expensive, and hard to implement

· Tastes are hard to alter

· Foods that are high in fat and sugars turn off stress hormones

· A preference for meat, a lack of health consciousness, a limited interest in exploring new foods, and low awareness of the link between eating habits and illness are all tied to poor dietary habits

Stress and diet

· Stress has a direct and negative effect on diet

· People under stress eat more fatty foods, fewer fruits and vegetables, and are more likely to snack and skip breakfast

· People with low-status jobs, high workloads, and little control at work also have less healthy diets

· Sheer cognitive burden of daily life can interfere with the ability to control food consumption by preventing people from monitoring their eating

Who controls their diet?

· People who have high self-control are better able to manage a healthy diet than people with lower executive control skills

· When people are informed about social norms regarding diet, they are more likely to make a change toward those norms

Interventions to modify diet

· Efforts to induce dietary change have focused heavily on reducing portion size, snacking, and sugary drink consumption

· Most diet change is implemented through cognitive-behavioral interventions

· Two critical factors for improving diet

1. Drawing on social support for making a dietary change

2. Increasing one’s sense of self-efficacy

· Interventions often focus on people who have or are at risk for a chronic disease

· Community interventions aimed at dietary change have been undertaken

· Ex: Community gardens and nutrition education campaigns

· Taking dietary interventions to ethnic identity and making them culturally and linguistically appropriate may achieve particularly high rates of success

· Social engineering and other changes to the environment can promote healthy eating

Sleep

What is sleep?

· Sleep has a powerful effect on risk of infectious disease, risk of depression, poor responses to vaccines, and the occurrence and progression of several chronic diseases including cardiovascular disease, diabetes, and cancer

· 2 broad types of sleep

1. Non-rapid eye movement (NREM)

2. Rapid eye movement (REM)

· NREM sleep consists of four stages

1. Theta waves: Lightest and earliest stage, Tuning out sounds around us but we are easily awakened by any loud sound

2. Breathing and heart waves even out, Body temp drops, and brain waves alternate between short bursts called sleep spindles and large K-complex waves

3. Deep sleep, Marked by delta waves

4. Also deep sleep

· During REM sleep, eyes dart back and forth, breathing and heart rates flutter, and we often dream vividly

· Beta waves

· Important for consolidating memories, solving problems from the previous day, and turning knowledge into long-term memories

Sleep and health

· 50-70 million Americans have sleep disorders

· ⅓ of adults report on average getting fewer than 7 hours of sleep a night

· Stress impairs sleep through increasing people’s preservative thoughts

· Chronic insomnia: Have trouble falling asleep, staying asleep, or getting good quality sleep for at least three nights a week for at least three months

· Sleep apnea: Breathing stops and starts repeatedly during sleep

· Narcolepsy: Overwhelming daytime drowsiness and falling asleep suddenly

· People who have strong social support, are physically active, and practice self-compassion sleep better than people without those resources

Interventions to promote good sleep

· Cognitive-behavioral treatment for insomnia has ample evidence of effectiveness in both the general population and in clinical populations

· Cognitive restructuring, sleep restriction, mindfulness and values-based approaches, and stimulus control

· Behavioral interventions have been undertaken for the treatment of insomnia, including mindfulness-based interventions, relaxation therapy, control of sleep-related behaviors, and cognitive-behavioral interventions

Rest, renewal, savoring

· An important set of health behaviors that is only beginning to be understood involves deep relaxation and renewal, the restorative activities that help people savor the positive aspects of life, reduce stress, and restore emotional balance

· Health psychologists suspect that rest, renewal, and savoring have health benefits

Textbook Ch 5

Characteristics of health-compromising behaviors

· Multi-morbidity: Having 2 or more long-lasting health conditions is increasing

· Racial-ethnic disparities in mortality are apparent across many leading causes of death in the United States

· Health compromising behaviors: Behaviors practiced by people that undermine or harm their current or future health

· Health-compromising behaviors are multi-determined

· Many health-compromising behaviors share several additional important characteristics

1. Window of vulnerability in adolescence

· Many of these behaviors are tied to the peer culture

2. Many of these behaviors are pleasurable, enhancing the adolescent’s ability to cope with stressful situations, and some represent thrill seeking, which can be rewarding in its own right but can also be dangerous

3. These behaviors develop gradually, as the person is exposed to the behavior, experiments with it, and later engages in it regularly

4. Substance abuse of all kinds are predicted by some of the same factors

5. Many of these behaviors start out as experiments but can become addictions

6. Contextual factors are the most important contributors to health compromising behaviors

Marijuana use

· Marijuana, derived from the cannabis plant, is the most popular recreation drug

· In locations that legalize marijuana, its use increases

· The most studied chemicals in marijuana are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD)

· Both are psychoactive compounds

· When marijuana is smoked, the chemicals rapidly pass from the lungs into the bloodstream and on to the brain and other organs

· The chemicals are absorbed more slowly when eaten

· Euphoria, relaxation, heightened sensory perceptions, altered time perception, and increased appetite are among marijuana’s common effects, but other experiences are less positive including anxiety, paranoia, or panic

· Marijuana use, especially when it’s chronic, can negatively affect later health

· 9-30% of people who use marijuana develop cannabis use disorder

· Peer influences, familial, and interpersonal factors are important in predicting marijuana initiation and use over time

· Having parents who started using marijuana in adolescence vs adulthood predicts earlier use in their offspring

· Motivational interviewing combined with cognitive-behavioral therapy can be effective for treating people who have cannabis use disorder

· When individuals have severe cannabis use disorder and a co-occurring anxiety disorder, therapy integrated with anxiety reduction treatment can be particularly effective

Obesity and behavioral contributors

What is obesity?

· Obesity: An excessive accumulation of body fat

· WHO estimates that 890 million adults worldwide have obesity and more than 2 billion are overweight

· The unavailability of healthy foods at affordable local prices contributes to unhealthy eating, and unhealthy eating patterns can contribute to weight gain

Risks of obesity

· Obesity is a risk factor for many diseases

· Contributes to the development of 13 types of cancer

· Contributes substantially to deaths from cardiovascular diseases and is tied to atherosclerosis, hypertension, type 2 diabetes, and heart failure

· Increases risks in surgery, anesthesia administration, and childbearing

· Chief cause of disability

· Can result in psychological distress

Obesity in childhood

· Approximately 20% of adolescents in the US have obesity

· Genetic contributors to obesity can combine with risks conferred by low socioeconomic resources, increasing overall risk

· Adverse social relationships are related to higher BMI into adulthood

Psychosocial and behavioral contributors to obesity

· Depression and weight gain are linked

· Set point theory of weight: The idea that each individual has an ideal biological weight, which cannot be greatly modified

Stress and eating

· Stress is associated with greater consumption of unhealthy foods and lower consumption of healthy foods

Interventions

· Initially successful weight-loss programs show high rates of relapse

· Obesity can be prevented

· Especially if intervention is administered when children are 6-12 years old

· Most weight-loss programs begin with dietary treatments

· Bariatric surgery represents a radical way of controlling extreme obesity and is usually reserved for people who have extreme obesity, who have been unable to lose weight through other methods, and who have complicating health problems that make weight loss urgent

· Numerous medications have been tried with the goal of eliminating obesity, but side effects, addictive potential, limited efficacy, and regain of weight after initial weight loss hampered success

Cognitive behavioral therapy (CBT)

· Researchers now believe that compulsive overeating that can lead to obesity shares the same brain circuitry as other addictive disorders, making it a difficult problem to treat

· Screening: Some programs begin by screening applicants for their readiness to lose weight and their motivation to do so

· People who are battling a health issue such as obesity will often show an attentional bias in favor of cues related to the issue

· Additional retraining: Involves breaking or at least modering this automatic attentional bias by distracting one’s self, focusing on other aspects of the environment, or engaging in physical activity

· Clients are trained to modify stimuli in their environment that have previously elicited and maintained their eating and to take steps to modify their food consumption

· Clients are urged to gain control over the eating process itself, teaching the person to eat less and enjoy it more

· Success in modifying eating habits can be supported by a positive reinforcement

· Cognitive restructuring is an important part of weight-reduction programs

· The formation of explicit implementation intentions and a strong sense of self-efficacy also predicts weight loss

· Exercise is a critical component of any weight-loss program

· Efforts to lose weight can be stressful so reducing life stress through techniques such as mindfulness training and acceptance and commitment therapy can be helpful

· Social support is important for losing weight

· Family environment is critical for weight loss

· Relapse prevention techniques are incorporated into treatment programs, including matching treatments to the eating problems of particular clients, restructuring the environment to remove temptation, rehearsing high-risk situations for relapse, and developing strategies to deal with high risk situations

Evaluation of cognitive-behavioral weight-loss techniques

· Cognitive-behavioral programs typically produce success, with weight loss of nearly 2 pounds a week for up to 20 weeks and long-term maintenance over at least 2 years

· Interventions w/ children and adolescents show good results when parents are involved

· Meta-analysis showed these interventions can reduce emotional eating and increase cognitive restraint

· Meta-analysis of ONLINE interventions showed similar effects, but not as strong

· Long-term maintenance of weight loss can be improved by daily weighing

Eating disorders

Anorexia nervosa

· Anorexia nervosa: Disorder in which a person restricts energy intake leading to a low body weight, has an intense fear of gaining weight, and is preoccupied with shape and weight

· Genetic factors are implicated in developing anorexia nervosa

· Serotonin, dopamine, and estrogen systems

· Interactions btwn genetic factors and risks in environment may play a role

· History of abuse or neglect in childhood is related to the development of anorexia

· Chief target of therapy is to bring the person’s weight back up to a safe level, a goal that often must be undertaken in a residential treatment setting

· Most successful treatment has been family-based treatment

Bulimia nervosa

· Bulimia nervosa: Characterized by alternating cycles of binge eating and purging through such behaviors as vomiting, laxative abuse, excessive exercise, extreme dieting or fasting, and drug or alcohol abuse

· Binging appears to be caused at least in part by dieting

· People with bulimia are typically of normal weight or overweight

· Like other eating disorders, bulimia has multifactorial causes

· Societal contexts that promote thinness, Taking part in sports in which the athlete needs to comply with a weight standard, Parental criticism, Cortisol levels, Genetics

· A barrier to treating bulimia is that many people don’t believe either that their problem is a serious one or that an intervention will overcome it

· Family-based treatment, Individual cognitive-behavioral therapy, and anti-depressants can be helpful

Binge eating disorder

· Binge eating usually occurs when the individual is alone

· Can be triggered by negative emotions produced by stressful experiences and distress about the binge-eating is apparent

· Overvaluing body appearance, a larger body mass than is desired, dieting, and symptoms of depression are implicated in triggering binge episodes

· Large-scale efforts are essential to prevent and reduce binge eating and related disorders

· Body project: An evidence-based, peer educator-delivered eating disorder prevention program which uses the train-the trainer approach, is effective in reducing thin-ideal internalization and eating disorder symptoms in college aged women

Alcohol use disorder and problem drinking

The scope of the problem

· 62% of Americans report drinking alcohol

· Men are at greater risks of alcohol use disorder than women, although the gap is narrowing in that the prevalence of alcohol use disorders is rising dramatically in women

· Often co-occurs with other disorders such as PTSD

Origins of alcohol use disorder and problem drinking

· Genetic factors appear to be implicated

· Specific genetic patterns and modeling

· Drinking occurs, in part, as an effort to buffer the impact of stress, including the experience of both psychological and physical pain

· Many people begin drinking to enhance positive emotions and reduce negative ones

· Two windows of vulnerability for alcohol use and disorder

1. When chemical dependence generally starts (ages 12 and 21)

2. Late middle age, in which problem solving drinking may act as a coping method for managing stress

· Depression and alcohol use disorder are linked

Treatment of alcohol use disorder

· As many as half of all people with alcohol use disorder stop or reduce their drinking on their own

· People with alcohol use disorder who have more socioeconomic resources and who are in highly socially stable environments do well in treatment programs

· Without employment and social support, the prospects for recovery are more dim

Treatment programs

· Detoxification: Short-term, intensive inpatient treatment followed by a period of continuing treatment on an outpatient basis

· A self-help group, especially Alcoholics Anonymous, is the most commonly sought source of help for alcohol-related problems

· 3 medications currently are approved to treat alcohol use disorder

Cognitive-behavioral treatments (CBTs)

· Goals of CBT are to decrease the reinforcing properties of alcohol, to teach people new behaviors inconsistent with alcohol abuse, and to modify the environment to include reinforcements for activities that do not involve alcohol

· Learning coping techniques and relapse prevention skills

· Many CBT programs begin with a self-monitoring phase

· Many include stress management techniques that can be substituted for drinking

· In some cases, family therapy and group counseling are added

Relapse prevention

· A meta-analysis of alcohol treatment outcome studies estimates that more than 50% of treated patients relapse within the first 3 months after treatment

· Relapse prevention techniques are essential

· Coping skills and social skills for high-risk-for-relapse situations

· Evidence shows that cognitive behavioral treatments to treat alcohol disorders are successful across a broad range of people and situations

Evaluation of alcohol treatment programs

· Several factors are associated with successful alcohol treatment programs

1. Focus on factors in the environment that elicit drinking and modifying those factors or instilling coping skills to manage them

2. A moderate length of participation and involving relatives and employers in the treatment process

· Even minimal interventions administered by a computer can make a dent in drinking problems

· Online interventions that emphasize problem-solving skills and substituting other behaviors for drinking may be especially effective

· Social engineering approaches such as banning alcohol advertising, raising the drinking age, and enforcing penalties for drunk driving can complement formal intervention efforts

Prevention approaches to alcohol abuse

· Induce adolescents to avoid drinking altogether or to control their drinking before such problems set in

· Research suggests some success with social influence programs

1. Enhances adolescents’ self-efficacy, which, in turn, may enable them to resist the passive social pressure than comes from seeing peers drink

2. Can change social norms that typically foster adolescents’ motivation to begin using alcohol, replacing them with norms stressing abstinence or controlled alcohol consumption

Drinking and driving

· Thousands of vehicular fatalities result from drunk driving each year

· With increased media attention to the problem of drunk driving, drinkers seem to be developing self-regulatory techniques to avoid driving while drunk

Smoking and vaping

Synergistic effects of smoking

· Enhances the detrimental effects of other risk factors

· Smoking and cholesterol interact to produce higher rates of heart disease than would be expected from simply adding together their individual risks

· Smoking interacts synergistically with depression to increase risk for cancer and heart disease

A brief history of the smoking problem

· Used to be considered a sophisticated habit

· Critics argue that the tobacco industry has disproportionately targeted smoking appeals to minority group members and teens

Why do people smoke?

· There appear to be genetic influences on smoking

· People who smoke cigarettes are generally less health conscious and have fewer years of education than nonsmokers

· Starting to smoke results from a social contagion process through contact with others who smoke

· Smoking runs in families

· Adolescents are more likely to start smoking if their parents smoke

· Smoking clusters in social networks but these geographic clusters also appear to spread quitting

Self-identity and smoking

· Low self-esteem, dependency, feelings of powerlessness, and social isolation all increase the tendency to imitate others’ behavior, and smoking is no exception

· Identifying oneself as a smoker impedes the ability to quit smoking, whereas identifying oneself as a quitter can promote it

Nicotine addiction and smoking

· Smoking is an addiction

· People smoke to maintain blood levels of nicotine and to prevent withdrawal symptoms

· In studies that alter nicotine level in bloodstream, smokers do not alter their smoking behavior enough to compensate for those changes

· Responsive to rapidly changing forces in the environment long before such forces can affect blood plasma levels of nicotine

Interventions to reduce smoking

· Changing attitudes towards smoking so people view it in a negative light

· Nicotine replacement therapy significantly increases initial smoking cessation

· Health psychologists have moved to a therapeutic approach to the smoking problem

· Attentional retraining: Helps smokers reorient their attention away from smoking-related cues, both internal and in the environment

· More successful over the short term in the presence of a supportive partner and nonsmoking supportive friends

· Stress management training is helpful for successful quitting

· People who have a strong sense of themselves as non-smokers do better in treatment than those who have a strong sense of themselves as smokers

· Self-determination theory: Targets those with autonomy and self-control cognitions from the vantage point of stopping smoking

· Relapse prevention techniques are typically incorporated into smoking cessation programs

· Preparing people for withdrawal

· Abstinence violation effect: A single lapse reduces perceptions of self-efficacy, increases, negative mood, and reduces beliefs that one will be successful in stopping smoking

· Smokers need to focus on the positive and remind themselves that a single lapse is not necessarily worrisome

· Adult smokers are well served by cognitive-behavioral interventions that include self-monitoring, modification of the stimuli that elicit and maintain smoking, reinforcing successful smoking cessation, and relapse prevention techniques such as rehearsing alternative coping techniques in high-risk situations

· For adolescents, inexpensive, efficient, short-term interventions may be more effective

· People who quit on their own are typically well-educated and have good self-control skills, self-confidence in their ability to stop, and a perception that the health benefits of stopping are substantial

· Easier if there’s a supportive social network that doesn’t smoke

· Brief interventions by physicians and other healthcare practitioners can bring about smoking cessation and control relapse

· A variety of self-help aids and programs have been developed for smokers to quit on their own

· Internet interventions are an approach that has several advantages

1. People can seek them out when they’re ready to and without regard to location

2. They can deal with burgers to smoke by getting instant feedback from an internet service

3. Effects last longer for a year

Smoking prevention programs

· Smoking prevention programs: Aim to catch potential smokers early and attack the underlying motivations that lead people to smoke

· The central components of social interventions are…

1. Information about the negative effects of smoking is carefully constructed to appeal to adolescents

2. Materials are developed to convey a positive image of the nonsmoker (Rather than the smoker) as an independent, self-reliant individual

3. The peer group is used to foster not smoking rather than smoking

· Overall, social influence programs can reduce smoking rates

· What is needed are programs that will reach the child likely to become a regular smoker

Chapter 2: Systems of the body

The nervous system

Nervous system overview

· Nervous system: A complex network of interconnected nerve fibers

· Made up of the central nervous system, consisting of…

1. Brain and spinal cord

2. Peripheral nervous system: Consists of the rest of the nerves in the body

· Sensory nerve fibers provide input to the brain and spinal cord by carrying signals from sensory receptors

· Motor nerve fibers provide output from the brain or spinal cord to muscles and other organs, resulting in voluntary and involuntary movement

· Peripheral nervous system: Made up of somatic nervous system and autonomic nervous system

· Somatic nervous system: Connects nerve fibers to voluntary muscles and provides the brain w/ feedback about voluntary movement

· Autonomic nervous system: Connects central nervous system to all internal organs over which people do not customarily have control

· Regulation of the autonomic nervous system occurs via the sympathetic nervous system and the parasympathetic nervous system

The brain

· The brain is the commanding center of the body, receiving sensory impulses from the peripheral nerve endings and sending motor impulses to the extremities and to internal organs to carry out movement

· Hindbrain has 3 main parts

1. Medulla: Responsible for the regulation of heart rate, blood pressure, and respiration

2. Pons: Serves as a link between the hindbrain and the midbrain and also helps control respiration

3. Cerebellum: Coordinates voluntary muscle movement

· Forebrain includes…

1. Thalamus: Involved in the recognition of sensory stimuli and the relay of sensory impulses to the cerebral cortex

2. Hypothalamus: Helps regulate cardiac functioning, blood pressure, respiration, water balance, and appetites, including hunger and sexual desire

3. Cerebral cortex: Involved in higher-order intelligence, memory, and personality

· Consists of 4 lobes: Frontal, Parietal, Temporal, and Occipital

· Limbic system: Plays an important role in stress and emotional responses

· Amygdala and hippocampus are involved in detection of threat and in emotionally charged memories

· Cingulate gyrus, the septum, and areas in the hypothalamus are related to emotional functioning as well

Role of neurotransmitters

· Neurotransmitters: Electric and chemical signals that help neurons of the central nervous system communicate

· Catecholamines: Stimulation of of the sympathetic nervous system prompts the secretion of epinephrine and norepinephrine (Release of catecholamines prompts important bodily changes that are critically important in response to stressful circumstances

· Parasympathetic functioning: A counterregulatory system that helps restore homeostasis following sympathetic arousal

Disorders of the nervous system

· 3 most burdensome neurological disorders in terms of causing disability are…

1. Stroke

2. Dementias

3. Migraine headaches

Dementia

· Dementia: A serious loss of cognitive ability beyond what might be expected from normal aging

· Most common form of dementia is Alzheimer’s disease

· In addition to early stages of cognitive decline, esp difficulty w/ short term memory, social functioning and use of language are disrupted as the disease progresses

· Smoking, being sedentary, having high fasting plasma glucose, and excessive alcohol consumption are lifestyle factors implicated in its development, and there are also genes that predispose to the disease

The endocrine system

Endocrine system overview

· Endocrine system: Complements the nervous system n controlling bodily activities

· Regulated by the hypothalamus and pituitary gland

· Pituitary gland has two lobes

1. Posterior: Produces oxytocin, which controls contractions during labor and lactation and is also involved in social affiliation, and vasopressin, or antidiuretic hormone (ADH)

2. Anterior: Secretes hormones responsible for growth

a. Somatotropic: Regulates bone, muscle, and other organ development

b. Gonadotropic: Controls growth, development, and secretions of the gonads

c. Thyttropic: Controls growth, development, and secretion of thyroid gland

d. Adrenocorticotropic: Controls growth and secretions of the cortical region of the adrenal glands

The adrenal glands

· Adrenal glands: Small glands located on top of each of the kidneys

· Each adrenal gland consists of an adrenal medulla and an adrenal cortes

· Hormones of the adrenal medulla are epinephrine and norepinephrine

Disorders involving the endocrine system

· Diabetes: A chronic endocrine disorder in which the body is not able to manufacture or properly use insulin

1. Type 1 diabetes: A severe disorder that typically arises in late childhood or early adolescence and is at least partly genetic in origin (Autoimmune disorders)

2. Type II diabetes: Insulin may be produced by the body, but there may not be enough of it, or the body may not be sensitive to it (Heavily a disease of lifestyle, and risk factors include obesity and low physical activity, among other factors

The cardiovascular system

Cardiovascular system overview

· Cardiovascular system: Comprises the heart, blood vessels, and blood

· Acts as the transport system of the body

The heart

· The heart functions as a pump, and its pumping action causes the blood to circulate throughout the body

· Left side of the heart takes in oxygenated blood from the lungs and pumps it out into the aorta, from which the blood passes into the smaller vessels to reach cell tissues

· Blood exchanges its oxygen and nutrients for the waste materials of the cells and is then returned to the right side of the heart, which pumps it back to the lungs via the pulmonary artery

· Once oxygenated, the blood returns to the left side of the heart through pulmonary veins

· Heart performs these functions through regular rhythmic phases of contraction and relaxation known as the cardiac cycle

1. Systole: Blood is pumped out of the heart, and blood pressure in the blood vessels increases

2. Diastole: Muscle relaxes, blood pressure drops, and blood is taken into the heart

· A number of factors influence the rate at which the heart contracts and relaxes

Disorders of the cardiovascular system

· Atherosclerosis: Caused by deposits of cholesterol and other substances on the arterial walls, which forms plaques around the arteries that reduce flow of blood through the arteries and interfere with the passage of nutrients from the capillaries into the cells, leading to tissue damage

· Associated with several primary clinical manifestations

1. Angina Pectories: Chest pain, which occurs when the heart has insufficient supply of oxygen or inadequate removal of carbon dioxide and other waste products

2. Myocardial infarction (MI): Heart attack, which results when a clot has developed in a coronary vessel and blocks the flow of blood to the heart

3. Ischemia: A condition characterized by lack of blood flow and oxygen to the heart muscle

· Congestive heart failure (CHF): Occurs when the heart's delivery of oxygen-rich blood is inadequate to meet the body’s needs

· Arrhythmia: Irregular beating of the heart, which, at its most severe, can lead to loss of consciousness and sudden death

Blood pressure

· Blood pressure: The force that blood exerts during the blood vessel walls

· Influenced by several factors

1. Cardiac output: Pressure against the atrial walls is greater as the volume of blood flow increases

2. Peripheral resistance: Resistance to blood flow in the small arteries of the body (Arterioles), which is affected by the number of red blood cells and the amount of plasma the blood contains

· If arterial walls have been damaged, clogged by deposits of waste, or if they’ve lost their elasticity, blood pressure will be higher

· Hypertension: Chronically high blood pressure, that is the consequence of too high a cardiac output or too high a peripheral resistance

The blood

· An adults body contains approx. 5 liters of blood, consisting of plasma and cells

· Plasma: The fluid portion of blood

· Blood cells: Manufactures in the bone marrow in the hallow cavities of bones (Bone marrow contains hematopoietic stem cells that make the 2 main types of blood cells)

1. White blood cells: Play a central part of the immune system and play an important role in responding to infection and injury (3 main types of immune cells in blood are lymphocytes, monocytes, & granulocytes)

2. Red blood cells: Contain hemoglobin, which is needed to carry oxygen and carbon dioxide throughout the body

3. Platelets: Clump together to block small holes that develop in blood vessels, and also play an important role in blood clotting

The respiratory system

Respiratory system overview

· Respiratory system: Inspiration brings oxygen and expiration eliminates carbon dioxide

· Respiration, or breathing, has 3 main functions

1. To take in oxygen

2. To excrete carbon dioxide

3. To regulate the composition of blood

Structure and functions of the respiratory system

· Air is inhaled through nose and mouth and then passes through the pharynx and larynx to the trachea

· Trachea: A muscular tube extending downward from the larynx, Divides at its lower end into primary bronchi

· Each bronchus enters a lung → Subdivides into secondary bronchi → Microscopic alveolar ducts (Which contain alveoli)

· Alveoli and capillaries are responsible for the exchange of oxygen and carbon dioxide

· Inspiration: An active process brought about by the contraction of muscles

· Expiration: A passive function brought out by the relaxation of the lungs

· Respiratory movements are controlled by a respiratory center in the medulla

Disorders associated with the respiratory system

· Asthma: A severe allergic reaction typically to a foreign substance, including dust, dog or cat dander, pollens, or fungi

· Viral infections: The respiratory system is vulnerable to infections, especially the common cold, a viral infection of the upper and sometimes lower respiratory tract

· Bronchitis: An inflammation of the mucosal membrane inside the bronchi of the lungs

· Influenza: Flue viruses attack the lining of the respiratory tract, killing healthy cells

· Bacterial infections: Do not cause permanent damage to upper respiratory tract but main danger is the possibility of secondary infection and permanent damage to other tissues

· Chronic obstructive pulmonary disease (COPD): Include chronic bronchitis and emphysema, Not curable but preventable since the chief cause is smoking

· Pneumonia: Two main types

1. Lobar pneumonia: A primary infection of the entire lobe of a lung

2. Bronchial pneumonia: Confined to the bronchi, Secondary infection that may occur as a complication of other disorders

· Tuberculosis (TB): An infectious disease caused by bacteria that invade lung tissue

· Lung cancer: Disease of uncontrolled cell growth in tissues of the lung

Dealing with respiratory disorders

· A number of respiratory disorders can be addressed by health psychologists

· Smoking is implicated in both pulmonary emphysema and lung cancer

· Dangerous substances in the workplace and air pollution are also factors that contribute to the incidence of respiratory problems

· Health psychologists have conducted research on many of these problems and discussed the clinical issues they raise

· Issues of long-term physical, vocational, social, and psychological rehabilitation become important

The digestive system and the metabolism of food

The functioning of the digestive system

· Food is first lubricated by saliva in the mouth → Passes through esophagus

· As food progresses from stomach to duodenum, the pancreas becomes involved in the digestive process

· Most metabolic products are water soluble and can be easily transported in blood, but some substances like lipids, are not and must be transported by lipoproteins

· Lipids include fats, cholesterol, and lecithin

· Absorption of food takes place primarily in the small intestine → Produces enzymes that complete breakdown of proteins to amino acids

· Food passes into large intestine → Acts largely as a storage organ for accumulation of food residue and helps in reabsorption of water

Disorders of the digestive system

· Gastroesophageal reflux disease (GERD): Results from an abnormal reflux in the esophagus, commonly due to changes in barrier btwn esophagus and stomach

· Gastroenteritis: Inflammation of the lining of stomach and small intestine

· Diarrhea: Characterized by watery and frequent bowel movements

· Dysentery: Similar to diarrhea except that mucus, pus, and blood are also excreted

· Peptic ulcer: An open sore in the lining of the stomach or duodenum, resulting from hypersecretion of hydrochloric acid and occurring when pepsin digests a portion of the stomach wall or duodenum

· Appendicitis: A common condition that occurs when wastes and bacteria accumulate in the appendix

· Hepatitis: “Inflammation of the liver” → Disease produces swelling, tenderness, and sometimes permanent damage

A. Hepatitis A: Caused by viruses and is typically transmitted through food and water

B. Hepatitis B: Vaused by a virus and is transmitted by the transfusion of infected blood, by improperly sterilized needles, through sexual contact, and through mother-to-infant contact

C. Hepatitis C: Spread via blood and needles and is most commonly caused by blood transfusions and inadequate sterilization of medical equipment

Gut-brain connection

· Human gut contains trillions of microbes, which include fungi, viruses, and bacteria

· Disturbances in gut microbiome have been linked with a variety of physical conditions and is closely connected with central nervous system and can modulate mood, cognition, and behavior across the lifespan

· Dysbiosis in the gut microbiome involves imbalance bacterial composition or changes in bacterial activity or distribution in the gut

· Three types of loss

1. Beneficial bacteria

2. Too much growth of potentially harmful bacteria

3. Loss of bacterial diversity

· Gut microbiome is influenced by environmental and lifestyle factors

The renal system

Renal system overview

· Renal system: Consists of the kidneys, ureters, urinary bladder, and urethra

· Kidneys: Responsible for regulation of bodily fluids, Produce urine

· Uterers: Contain muscle tissue, which contrasts and cause peristaltic waves to move urine to the bladder

· Urinary bladder: A muscular bag that acts as a reservoir for urine

· Urethra: Conducts urine from the bladder out of the body

· Urine contains surplus water, surplus electrolytes, waste products from the metabolism of food, and surplus acids or alkalis

· Urine can offer important diagnostic clues to many disorders

· One of the chief functions of the kidneys is to control the water balance in the body

· The urinary system regulates bodily fluids by removing surplus water, surplus electrolytes, and the waste products generated by the metabolism of food

Disorders of the renal system

· Urinary tract infections: Women are especially vulnerable and can result in considerable pain, especially on urination

· In many types of kidney disease, large numbers of nephrons are destroyed/ damaged and remaining nephrons can’t perform normal functions

· Nephrons: Basic structural and functional units of the kidneys

· Glomerular nephritis: Involves inflammation of glomeruli in the nephrons of kidneys that filter blood

· Tubular necrosis: Destruction of epithelial cells in tubules of kidney

· Kidney failure: A severe disorder because of inability to produce an adequate amount of urine will cause waste products of metabolism, & surplus inorganic salts and water, to be retained in body

Reproductive system

Ovaries and testes

· Female has 2 ovaries located in pelvis

· Each month, one of the ovaries releases an ovum (egg), which is discharged at ovulation into the fallopian types

· If the ovum is not fertilized, it remains in the uterine cavity for about 14 days and is then flushed out of the system w/ the urine endometrium and its blood vessels

· Ovaries produce the hormones estrogen and progesterone

· In males, testosterone is produced by the interstitial cells of the testes under the control of the anterior pituitary lobe

Fertilization and gestation

· When sexual intercourse takes place and ejaculation occurs, sperm are released into the vagina

· These sperm proceed upward through the uterus into the fallopian tubes, where one sperm may fertilize an ovum

· The fertilized ovum then travels down the fallopian tube into the uterine cavity, where it embeds itself in the uterine wall and develops over the next 9 months into a human being

Disorders of the reproductive system

· Sexually transmitted diseases (STDs): Occur through sexual intercourse or other forms of sexually intimate activity

· Include herpes, gonorrhea, syphilis, genital warts, chlamydia, and AIDS

· For people w/ vaginas, a risk from several STDs is chronic pelvic inflammatory disease (PID), which may produce severe abdominal pain and infections that may compromise fertility

· The reproductive system is also vulnerable to cancer, including testicular cancer in men and gynecologic cancers in women

· Approx. 12-13% of US hertero couples may have infertility

· Infertility: Inability to conceive a pregnancy after 1 year of regular sexual intercourse without contraception

· Menopause is NOT a disorder of the reproductive system

· It occurs when a women’s reproductive life ends

Genetics and health

Genetics and susceptibility to disorders

· Genetic studies have provided valuable information about the inheritance of susceptibility to disease

· In humans, several types of research help demonstrate whether a characteristic is genetically based

· Twin research is another method for examining the genetic basis of a characteristic

· Examining the characteristics of twins reared together as opposed to twins reared apart is also informative regarding genetics

· Studies of adopted children also help identify which characteristics have genetic origins and which are primarily the product of the environment

· Research has increasingly uncovered genetic contribution to many health disorders and behavioral factors that may pose risks to health

· Genetics will continue to be of interest as the contribution of genes to health continues to be uncovered

· Importance of interactions btwn genes and environment as contributors to health and disease

· Environmental, psychosocial, and behavioral factors influencing whether genes are expressed

· Gene expression: Process by which genetic information is turned into a function

Genetics and health psychology

· Health psychologists have important roles to play with respect to genetic contributions to health disorders

1. Making people aware of genetic risk factors and providing educational info

2. Genetic counseling to help people decide whether to be screened and how to cope with genetic vulnerabilities if they test positive

3. Counseling for people who have family history of genetic disorders, gave birth to a child w/ a genetic disorder, or those with reproductive problems

· Children, adolescents, and young adults sometimes learn of a genetic risk to their health, as research uncovers such causes

· Carriers of genetic risks may experience distress

· In some cases, genetic risks can be offset by behavioral interventions to address the risk factor

· Health psychologists have an important role to play in research and counseling related to genetic risks, esp. If they can help people modify their risk status and manage their distress

The immune system

Immune system overview

· Direct transmission involves bodily contact, such as handshaking, kissing, and sexual intercourse

· Indirect transmission (or environmental transmission) occurs when microbes are passed to an individual via airborne particles, dust, water, soil, or food

· Biological transmission occurs when a transmitting agent picks up microbes, changes them into a form conducive to growth in the human body, and passes them on to the human

· Mechanical transmission is the passage of a microbe to an individual by means of a carrier that is not directly involved in the disease process

Infection

· Once a microbe has reached the body, it penetrates into bodily tissue via any of several routes

· Whether the microbes gain a foothold in the body and produce infection depends on 3 factors

1. Number of organisms

2. Virulence of organisms

3. Body’s defensive capacities

Course of infection

1. Incubation period between the time the infection is contracted and the time the symptoms appear

2. Period of nonspecific symptoms, which precede the onset of disorders

3. Primary infection initiated by the microbe may also lead to secondary infections

Immunity

· Immunity: The body’s resistance to invading organisms

· Natural and specific immunity

· Nonspecific immune mechanisms: A general set of responses to any kind of infection or disorder

· Specific immune mechanisms: Fight particular microorganisms and their toxins

· Humoral and cell-mediated immunity

· Humoral immunity: Directed against extracellular pathogens mediated by B lymphocytes

· Cell-mediated immunity: Directed against intracellular pathogens

· Lymphatic systems role in immunity

· Lymphatic system: Drainage system of the body that’s involved in important ways in immune functioning

· Lymphatic capillaries drain water, proteins, microbes, and other foreign materials from spaces between the cells into lymph vessels

Disorders related to the immune system

· Infectious disorders were at one time thought to be acute problems that ended when their course had run

· Now, infectious diseases merit closer examination

· Inflammatory response that is productive against provocations is coming under increasing investigation as a contributor to chronic disease

· Autoimmunity: Body attacks the body’s own tissues

Chapter 6: Stress

What is stress

What is a stressor

· Stressor: Stressful events

· Although the COVID-19 national public health emergency ended officially on May 11, 2023, APA psychologists involved in interpreting the results characterized the findings as indicative of collective trauma

Appraisal of stressors

· Primary appraisal: Occurs as a person is trying to understand what the event is and what it will mean

· Secondary appraisals: Assess whether personal resources are sufficient to meet the demands of the environment

· Stress, then, is determined by person-environment fit

Origins of the study of stress

Fight or flight

· Fight-or-flight response: Cannon proposed that when an organism perceives a threat, the body is rapidly aroused and motivated via the sympathetic nervous system and the endocrine system

· Fight: Aggressive responses to stress, such as getting angry or taking action

· Flight: Reflected in social withdrawal or withdrawal through substance use or distracting activities

Selye’s general adaptation syndrome

· General adaptation syndrome: When a person confronts a stressor, it mobilizes itself for action

· Response is nonspecific with respect to the stressor

· Consists of three phases:

1. Alarm: Person becomes mobilized to meet the threat

2. Resistance: Person makes efforts to cope with the threat

3. Exhaustion: Occurs if the person fails to overcome the threat and depletes physiological resources in the process of trying

Criticism of the general adaptation syndrome

· Selye’s model has been criticized on several grounds

1. It assigns a very limited role to psychological factors, and researchers now believe that the psychological appraisal of events is critical to experiencing stress

2. Not all stressors produce the same biological responses

3. Concerns whether exhaustion of physiological resources or their chronic activation is most implicated in dress

4. Seyle assessed stress as an outcome but people experience many debilitating effects of stress after an event has ended and even in anticipation of its occurrence

Tend-and-Befriend

· Tend-and-befriend: The theory maintains that, in addition to fight or flight, people and animals respond to stress with social affiliation and nurturant behavior towards offspring

How does stress contribute to illness?

· Early concentrations to the study of stress have helped researchers identify the pathways by which stress leads to poor health

· Four routes: Physiology, Health behaviors, Psychosocial resources, Use of health services

1. First set of pathways involve direct effects on physiology

2. People who live with chronic stress have poorer health habits than people who don’t, and acute stress often compromises health habits

3. Stress affects psychosocial resources in ways that can adversely affect health

4. People are less likely to adhere to a treatment regiment when they are under stress, and they are more likely to delay seeking care for disorders that should be treated

Physiology of stress

· Two interrelated systems are heavily involved in the stress response

1. Sympathetic adrenomedullary (SAM) system

2. Hypothalamic-pituitary-adrenocortical (HPA) axis

Sympathetic activation

· Sympathetic arousal stimulates the medulla of the adrenal glands, which, in turn, secrete the catecholamines epinephrine (EP) and norepinephrine (NE)

· Parasympathetic functioning helps put the “brakes” on the stress response, and it may also become dysregulated in response to stress

HPA activation

· Hypothalamus releases corticotrophin-releasing hormone (CRH) → Stimulates pituitary gland to secrete adrenocorticotropic hormone (ACTH) → Stimulates the adrenal cortex to release glucocorticoids

· Repeated activation of the HPA axis in response to chronic or recurring stress can ultimately comprise its functioning

Effects of long-term stress

· Excessive discharge of epinephrine and norepinephrine can lead to suppression of immune function, produce adverse changes such as increased blood pressure and heart rate, provoke variations in normal heart rhythms, and produce neurochemical imbalances

· Corticosteroids have immunosuppressive effects, which can comprise the functioning of the immune system

· The health consequences of HPA axis activation may be more significant than those of sympathetic activation

· Stress may also comprise immune functioning

Individual differences in stress reactivity

· Reactivity: The degree of change that occurs in autonomic, neuroendocrine, and/or immune responses as a result of stress

· Psychobiological reactivity to stress is an important factor that influences the stress-illness relationship

Physiological recovery

· Recovery following stress is also important in the physiology of the stress response

· Inability to recover quickly from a stressful event may be a marker for the cumulative damage that stress has caused

Allostatic load

· Allostatic load: Physiological costs of chronic exposure to physiological changes that result from repeated or chronic stress

· Indicators of allostatic load

1. Decrease in cell-mediated immunity

2. Inability to shut off cortisol in response to stress

3. Lowered heart rate variability

4. Elevated epinephrine levels

5. A high waist-to-hit ratio

6. Hippocampal volume

7. Problems with memory

8. Elevated blood pressure

· Consequences of allostatic load can be severe

· Prevents cardiovascular disease, decline in physical and cognitive functioning, and early mortality

· Relationship of stress to both acute disorders, such as infection, and chronic disorders, such as heart disease, is now well known

What makes events stressful

Dimensions of stressful events

· Although events are not necessarily inherently stressful, some characteristics of events make them more likely to appraised as stressful

· Negative events produce more stress than do positive events

· Produce more psychological distress and physical symptoms than positive ones do

· A positive stress mindset toward a potentially stressful event, such as acknowledging it, rethinking it as a challenge, and proactively meeting its demands, can beneficially affect health outcomes

· Uncontrollable or unpredictable events are more stressful than controllable or predictable ones especially if they are also unexpected

· Ambiguous events are more stressful than clear–cut events

· Overloaded people experience more stress than people with fewer tasks to perform

· People are more vulnerable to stress in central life domains than in peripheral ones, because important aspects of the self are heavily invested in central life domains

· Events that are negative, uncontrollable, ambiguous, or overwhelming or that involve central life goals are experienced as more stressful than events that are positive, controllable, clearcut, or manageable or that involve peripheral life tasks

Must stress be perceived as such to be stressful?

· Discussion of stress thus far has emphasized the importance of perception

· Objective stressors can have effects independent of the perceived stress they cause

· Both subjective and objective measures of stress independently predicted psychological distress and health complaints

Can people adapt to stress

· Chronic strain: If a stressful event becomes a permanent or chronic part of the environment

· Most people are able to adapt psychologically to moderate or predictable stressors

· Vulnerable populations, such as children and the elderly show little adaptation to chronic stressors

· Most people can adapt to mildly stressful events, but it may be difficult or impossible to adapt to highly stressful events, and already-stressed people may be unable to adapt to even moderate stressors

Must a stressor be ongoing to be stressful?

· The anticipation of a stressor can be as stressful as its actual occurrence, and sometimes more so

· Adverse aftereffects of stress often persist long after the event itself is no longer present

How has stress been studied?

Studying stress in laboratory

· Acute stress paradigm: Consistently finds that when people perform stressful tasks, they become psychologically distressed and show physiological arousal

· Helpful for identifying who is most vulnerable to stress

Inducing disease

· A way of studying the effects of stress has involved intentionally exposing people to viruses and then assessing whether they get ill and how ill they get

· People who reported stress in their lives, and esp chronic interpersonal problems or being unemployed or underemployed were more likely to get sick

· Approach has been used to study factors that protect against stress. Such as social support

Stress life events

· Another line of stress research assesses stressful life events

· Holmes and Rahe maintained that when a person must adjust to a changing environment, the likelihood of stress increases

· Although scores on life event inventories predict illness, the relation is quite modest

1. Some items on the list are vague

2. Because events have preassigned point values, individual differences in how events are experienced are not taken into account

3. Inventories include both positive and negative events, as well as events that people choose

4. Time between stress and illness

Sources of chronic stress

Effects of early life experiences

· Early life adversity in childhood can affect not only health in childhood, but also health across the lifespan into adult and old age

· Physical or sexual abuse in childhood increases health risks because abuse can result in intense, chronic stress that taxes physiological systems and difficulties regulating emotions

· Children who grow up in risky families also have difficulty forming good social relationships

· Stress in adolescence also affects health both during adolescence and into adulthood

· Warm and attentive parenting can mitigate these effects

· At present it is unknown whether early life stress permanently programs stress systems or whether some of these effects are reversible

Chronic stressful conditions

· Sometimes chronic stress is long-term and grinding, and is an important contributor to psychological distress and physical illness

· Research relating chronic stress to health outcomes is difficult to conduct because it’s hard to show that a particular chronic stressor is the factor that caused illness

· Chronic systemic problems are related to health problems

Stress in the workplace

· Studies of stress in the workplace are important for several additional reasons

1. They help identify some of the most common stressors of everyday life

2. They provide evidence for the stress-illness relationship

3. Work stress may be one of our preventable stressors and so provide possibilities for intervention

4. Stress-related physical and mental health disorders account for a growing percentage of disability and social security payments to workers

· As people have moved into sedentary office jobs, the amount of exercise they get in their work lives has declined substantially

· Even jobs that require high levels of physical exertion may include so much stress that the benefits of exercise are eliminated

· Work overload is a chief factor producing high levels of occupational stress

· Role conflict and role ambiguity are associated with stress

· Role ambiguity: Occurs when a person has no clear idea of what to do and no idea of the standards used for evaluating work

· Role conflict: Occurs when a person receives conflicting info about work tasts or standards from different individuals

· Inability to develop satisfying social relationships at work has been tied to job stress, psychological distress at work, and poor physical and mental health

· Lack of control over one’s work life is a major stressor as it predicts dissatisfaction at work and absenteeism as well as physiological arousal that predicts disease

· Unemployment is a major life stressor that increases psychological distress, physical symptoms, physical illness, alcohol abuse, low birth weight of offspring, elevated inflammation, and compromised immune functioning

· Stress shows up in ways other than illness that may be extremely costly to an organization