Chapter Fifteen
-Health Psychology: An Overview

Health Psychology Defined: The study of how psychological & social variables affect health & illness.

Causes of Death - 1900

Causes of Death - 1997
Heart Disease
Cancer
Stroke

Our Health Is Clearly Related To Our Behavior & The Choices We Make

-Stress and Disease

1). Is there a connection?

Submariner Study

Cold Virus Study

STRESS AND THE COMMON COLD

2). How Does it Work?

Evidence for Immune System Suppression

Medical Student Exam Study

Alzheimers Caregivers
Death of a Spouse

Marital Conflict

Links:

THE MIND-BODY APPROACH TO ILLNESS
The Mind-Body Approach To Health: Stress Management


-Model of Stress

Stressors:

Catastrophic Events (Three-Mile Island)
Stress and Nuclear Accident

Major Life Events

Life Experience Survey:
Social Readjustment Rating Scale (SRRS)

Daily Hassles

Hassles Scale

"Americans will put up with anything provided it doesn't block traffic."
~ Dan Rather

Appraisal

A). PRIMARY

Irrelevant : an event appraised to be of little or no consequence

Harm/Loss: existing harm or loss

Threat: expectation of future harm

Challenge: events that provide an opportunity for growth

B). SECONDARY

Sufficient Coping Resources

Insufficient Coping Resources


Fight/Flight Response

Defined: A series of physiological changes that prepare us to either fight or flee from an immediate threat.

Pathway 1: Acute Stress



Pathway 2: Chronic Stress

-Lifestyle Influences on Disease Risk

Smoking & Health

Reasons for Smoking:

Quitting the Smoking Habit

Pharmacological Approaches

1). NICOTINE REPLACEMENT MEDICATIONS

Nicotine Patch

Nicotine Nasal Spray

Nicotine Gum

Nicotine Inhaler

2). NON-NICOTINE MEDICATION

Bupropion (Zyban)

Behavioral Approaches

1). Aversive Procedures

RAPID SMOKING
Smokers puff every 6 seconds until they begin to feel nauseated. Nausea acts as UCS that becomes paired with smoking-related CS's such as taste & aroma of cigarette smoke, etc. after repeated pairings of nausea & smoke the thought of smoking becomes aversive, prompting avoidance of smoking

2). Self-Management Techniques

Nicotine Fading
Stimulus Control
Contingency Contracting

Self-Help Strategies:

Quitting on Your Own:
Educate yourself about the dangers of smoking.
Quit "cold turkey."
Use self-modification techniques.
If you don't succeed, try again.

Relapse Prevention Training




Smoking in Maine:

What are some facts about Maine kids and tobacco?

Maine has the nation’s highest tobacco addiction rate for young adults (ages 18-30) and among the highest in the nation for youth tobacco addiction rates (ages 14-18)

Over half of all Maine middle-school children have tried smoking.

1 in 4 middle school boys have tried chewing tobacco.

One third of high school students who smoke have already tried to quit and are unable to.

Each year, Maine kids (minors) illegally purchase 1.4 million packs of cigarettes resulting in $2.9 million in sales.

Heart Disease

1). Risk Factors

Inherent
Family HIstory
Gender

Physiological
Hypertension
Elevated Blood Cholesterol Levels

Behavioral
Smoking
Diet (Saturated Fat)
Type A Behavior Pattern

Type A Behavior

Competitive Achievement Orientation:
Type A individuals tend to be very self-critical and to strive toward goals without feeling a sense of joy in their efforts or accomplishments.

Time Urgency:
Type A people seem to be in a constant struggle against the clock. Often, they quickly become impatient with delays and unproductive time, schedule commitments too tightly, and try to do more than one thing at a time, such as reading while eating or watching TV.

Anger/Hostility:
Type A individuals tend to be easily aroused to anger or hostility, which they may or may not express overtly.

Take a Type A Personality Test

Western Study

(Type A Behavior and Coronoary Disease)

MODE OF ACTION I



MODE OF ACTION II

HOSTILITY & TYPE A BEHAVIOR

SMOKING & ALCOHOL USE

CORONARY HEART DISEASE


MODE OF ACTION III

RESEARCH

PHYSICAL INACTIVITY

2). REDUCING THE RISK OF HEART DISEASE

STRESS MANAGEMENT

ANGER CONTROL TRAINING

DIFFICULTIES MODIFYING

Links: STRESS & HEART DISEASE: WHAT IS THE CONNECTUION?

AIDS:

Psychologists Role:

COUNSELING PEOPLE ABOUT BEING TESTED FOR AIDS

HELPING PEOPLE WITH EMOTIONAL IMPACT OF POSITIVE TEST RESULTS

COUNSELING PEOPLE ABOUT CHANGING HIGH RISK BEHAVIORS

CONDUCTING BEREAVEMENT THERAPY FOR DYING PATIENTS & THEIR SIGNIFICANT OTHERS

USING STRESS MANAGEMENT & EXERCISE TECHNIQUES TO LENGTHEN TIME BETWEEN INFECTION & FULL-BLOWN AIDS

HELP DEVELOP PREVENTION PROGRAMS


Nutrition & Eating

1) . Why Does it Matter What We Eat or How Much We Weight?

HEART DISEASE
SOME TYPES OF CANCER
STROKES
GALLBLADDER DISEASE
HYPERTENSION (SALT)

2). How Much Should I Weigh?

Body Mass Index (BMI): A ratio between weight & height. A mathematical formula which correlates with body fat.

Relative Risk of Death

Basal Metabolic Rate
Compute the number of calories you would burn if you'd stayed in bed all day.

Burn Rate Calorie Calculator
Compute the number of calories you will burn performing a range of activities.


-Coping with Stress

PSYCHOLOGICAL HARDINESS

KOBASA ET. AL. (1979) STUDIED 430 EXECUTIVES OF ILLINOIS BELL TELEPHONE FOLLOWING DIVESTITURE BY AT&T. DIFFERENCES BETWEEN HIGH STRESS/HIGH ILLNESS & HIGH STRESS/LOW ILLNESS GROUPS ARE LISTED BELOW:

Hardy personalities have a strong sense of commitment to work, values & goals.

Hardy personalities enjoy change as a challenge & not as a threat.

Hardy individuals feel they have control over their lives.

EXPLANATORY STYLE

The ways we explain good & bad events:

Pessimistic Explanatory Style: attribute failures to factors that are internal (it was my fault.) & successes to factors that are external. (I lucked out.)

Optimistic Explanatory Style: attribute failures to factors that are external & successes to factors that are internal

Research findings

OES more likely to take a problem-focused approach to coping with stress
OES more likely to complete a rehab program for alcoholics
OES make a quicker, fuller recovery from coronary-artery bypass surgery
OES report fewer illness symptoms during the semester

DISTRACTION

SOCIAL SUPPORT

Functions of Social Support:

EMOTIONAL CONCERN: Emotional concern involves listening to people's problems and expressing feelings of sympathy, caring, understanding, and reassurance.

INSTRUMENTAL AID: Instrumental aid includes the material supports and services that make adaptive behavior possible.

INFORMATION: This means giving people cognitive guidance and advice that will enhance their abilities to cope.

APPRAISAL: Appraisal is feedback from others as to how one is doing.

SOCIALIZING: Beneficial effects are derived from socializing itself, even in ways that are not oriented toward solving problems (Fiore, 1980).

SENSE OF HUMOR

"The arrival of a good clown exercises a more beneficial influence upon the health of a town than the arrival of twenty asses laden with drugs." - Thomas Sydenham, Seventeenth-Century Physician

Humor and Depression

Dear Mom and Dad,

I am sorry that I have not written, but all my stationery was
destroyed when the dorm burned down. The car crash that
followed when we drove away wasn’t as bad as it seemed at
the time, for we were all alive. I am now out of the hospital and
the doctor said that I will be fully recovered within a few years,
and I may well be able to walk one day. I have also moved in
with the boy who rescued me, since most of my things were
destroyed in the fire.

Love,

Hilary

p.s.

There was no fire, no accident, and my health is perfectly
fine. In fact, I do not even have a boyfriend. However, I did get
a D in French and a C in Math and Chemistry, and I just
wanted to make sure that you keep it all in perspective.

Mona Lisa

"WARNING: Humor may be hazardous to your illness." ~Ellie Katz~


-Stress Management and Relaxation Techniques

Diaphragmatic Breathing

The purpose of this exercise is to reestablish diaphragmatic
breathing as your normal, everyday moment-to moment resting
breathing habit. If you do no other exercise, be sure to practice this
one. It is that important. It will be most effective if you practice at
least three times a day for ten to fifteen minutes each time;
eventually, the easy rhythmic motion of the diaphragmatic breathing
will begin to replace the strained, unnatural chest breathing to which
you have become habituated. You can speed the process by being
aware of your breathing pattern as much as possible during the day,
for the more aware of it you become, the more often you correct it
(change from chest breathing to diaphragmatic breathing), and the
faster you will replace thoracic with diaphragmatic breathing.
To Practice. Before you go to sleep and just after you wake up,
place your right hand on your upper abdomen, with the little finger
directly above the navel and the fingers spread so that the thumb is
almost touching th3 chest. Place your left hand on the upper chest
with the little finger between the two breasts. As you breathe,
concentrate on the air moving down into the upper abdomen (as if
you are filling your stomach with breath). The right hand should rise
with the inhalation and fall with the exhalation; the left hand should
not move. You should feel a slight motion in the lower portion of the
chest cavity, but the upper portion should remain still. Within a few
moments you will become more rested and quiet. Do not try to
force the breath. Allow the motion to be gentle and effortless.
Notice how easy it is to breathe deeply and easily, without any
effort.
Benefits. This will lead to autonomic balance and a relaxed state,
generally. After some weeks, depending on the individual, you will
begin to notice subtle and gradual changes in your daily breathing
patterns. Its movement will be more relaxed and rhythmic. As was
discussed earlier, this leads to a greater efficiency of the pulmonary
process and reduces the amount of work for proper ventilation
perfusion.


Progressive Muscle Relaxation

Progressive Progressive Relaxation Training
One of the most frequently used techniques is the tense-relax exercise, an abbreviated variation of a training program called progressive relaxation. To learn effective differential control of muscles takes up to a year. The exercise you'll learn can be mastered in a much shorter time. Its purpose is to help you learn awareness and control of very small changes in muscle tension. To begin the tense-relax exercise, find a comfortable position. Very gently close your eyes. (A small percentage of people prefer to have their eyes open). Take a deep breath, hold it for the count of four, and then exhale slowly, letting all the tension fade away as your body begins to relax. Breathe normally with your eyes still closed. Scan your body for any signs of tension. Notice any tightness, pressure, or pain anywhere in your body. At first, this may take a minute or two, but with practice you will become aware of your tension level in just a few seconds. Then, scan to identify those areas where you are already quite relaxed.
Begin by clenching your fists (let your arms rest in your lap or at your sides. Hold them clenched for about 5 seconds, while letting the other muscles in your body remain relaxed. Notice where the tension is and how it feels. Then relax. Let go all at once, don't ease off. Now, be aware of how the muscles feel as they let go and relax more and more. This letting-go feeling is what you are most interested in -- it is what's associated with relaxation and what you can learn t do more and more.

Now, pull your forearms up against your upper arms and feel the tension in your biceps. Hold that for 5 seconds or so. Then let go all at once and "tune in" those feelings of relaxation.

Tighten your forehead muscles as much as you can. Hold for five seconds, noting how it feels. (Let those other muscles in your body remain relaxed.) Notice where the central focus of tension is and the adjacent muscles that are affected just by tightening the forehead. Now, release that tension and pay close attention to how the muscles feel at the various levels as they drift toward relaxation. After having been tight, the muscles let go by stages. It is these stages that you will learn to recognize and become familiar with. Once you can identify the various degrees of muscle tension-relaxation, you can duplicate the tense levels at will; it is the relaxed levels that are more difficult and that are learned through this exercise.

Now close your eyes tightly, Hold for 5 seconds. Then let go and be aware of the feeling as the muscles relax more and more.

With your eyes closed, roll your eyes in a large circle. BE CAREFUL; these muscles can be strained, so make the circles just large enough so you can feel the wave of tension go round and round. Then relax.

Using the same process of tensing and relaxing, go through the following:
Clench your jaw; move your tongue up and down, left, right;
Tense your neck muscles by first tensing the muscles that move your head forward, to the right, and then to the left; try to touch your shoulders in front of you; try to touch your thighs, ---calves, ---feet.
Each time, tense and then let go and be aware of the muscles as they relax more and more.
Once you have completed tensing and relaxing all muscles in the body, again take a deep breath, hold it for the count of four and release it slowly. At this point notice how your entire body feels. See if any tension that you may have noticed prior to the exercise is still present. When you decide to end the exercise, stretch fully and then continue with your daily activity, by practicing this exercise, you can learn to recognize tension when it first begins to build (any slight change in muscle tension can be noticed), and at that time reduce it to a comfortable level.)


The Relaxation Response

Meditative Relaxation: as presented by Herbert Benson in his book, The Relaxation Response. (William Morrow Company, 1975).

1) Select a Quiet Environment
Ideally. You should choose a quiet, calm environment with as few distractions as possible. A quiet room is suitable as a place of worship. The quiet environment contributes to the effectiveness of the repeated word or phrase by making it easier to eliminate distracting thoughts.

2) Select a Mental Device
To shift the mind from logical externally oriented thought, there should be a constant stimulus: a sound, word, or phrase repeated silently or aloud: or fixed gazing at an object. Since one of the major difficulties in the elicitation of the relaxation response is "mind wandering," the repetition of the word or phrase is a way to help break the train of distracting thoughts. Your eyes are usually closed if you use a repeated sound or word; of course your eyes are open if you gaze. Attention to the normal rhythm of breathing is also useful and enhances the repetition of the sound or the word.

3) Maintain a Passive Attitude
When distracting thoughts occur, they are to be disregarded and attention redirected to the repetition or gazing; you should not worry about how well you are performing the technique because this may well prevent the relaxation response from occurring. Adopt a LET IT HAPPEN attitude. The passive attitude is perhaps the most important element in eliciting the relaxation response. Distracting thoughts will occur. Do not worry about hem. When these do present themselves and you become aware of them, simply return to the repetition of the mental device. The other thoughts do not mean you are performing the technique incorrectly. They are to be expected.

4) Get into a Comfortable Position
A comfortable posture is important so that there is no undue muscular tension. Some methods call for a sitting position. A few practitioners use the cross-legged "lotus position" of the Yogi. If you are lying down, there is a tendency to fall asleep. The various postures of kneeling, swaying, or sitting in a cross-legged position are believed to have evolved to prevent falling asleep. You should be comfortable and relaxed.

Directions:

1) Sit quietly in a comfortable position.

2) Close your eyes.

3) Relax all your muscles, deeply, beginning at your feet and progressing up to your face, keep them relaxed.

4) Breathe through your nose. Become aware of your breathing. As you breathe out say the word ONE silently to yourself. For example, breathe IN...OUT, ONE-IN...OUT, ONE-etc. Breathe easily and naturally.

5) Continue for 10 to 20 minutes. You may open your eyes to check the time but do not use an alarm,. When you finish, sit quietly for several minutes at first with your eyes opened. Do not stand up for a few minutes.

6) Do not worry about whether you are successful in achieving a deep level of relaxation. Maintain a passive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them by repeating ONE. With practice the response should come with little effort. Practice the technique once or twice daily, but not within two hours after any meal, since the digestive processes seem to interfere with the elicitation of the relaxation response.

Biofeedback




Stress Management and Physical Activity

Stress and Reported Health Problems in Low and High Fitness Individuals:

Devising An Exercise Program

1) CHOOSE an activity that you find enjoyable
2) EXERCISE REGULARLY
3) INCREASE your exercise regimen gradually
4) Learn TIME MANAGEMENT skills
5) REINFORCE yourself for reaching your exercise goals

"A vigorous five mile walk will do more good for an unhappy, but otherwise healthy adult than all the medicine & psychology in the world." ~ Paul Dudley White

"I like long walks, especially when they are taken by people who annoy me." ~Fred Allen~

-Stress Management and Immune System Enhancement

COGNITIVE BEHAVIORAL STRESS MANAGEMENT & IMMUNOLOGICAL RESPONSE

-Website References

STRESS/ IMMUNE RESPONSE

(1) How Vulnerable Are You to Stress?
* A questionnaire designed to help you discover your vulnerability quotient and to pinpoint trouble spots.
http://www.uiuc.edu/departments/mckinley/health-info/stress/vul-stre.html

(2) Stress Management Strategies for the College Student
* Suggestions for ways to handle stress.
http://www.mckinley.uiuc.edu/health%2Dinfo/stress/gearshft.html

(3) FITNESS FUNDAMENTALS: Guidelines for Personal Exercise Programs
* A discussion of physical fitness guidelines developed by the President's Council on Physical Fitness & Sports.
http://www.hoptechno.com/book11.htm

(4) PSYCHOLOGICAL HEALTH AND THE IMMUNE SYSTEM
* Discussion about the effects of psychological well-being and stress on the immune system with specific reference to AIDS-related research.
http://www.immunet.org/immunet/atn.nsf/page/ZQX16104.html

(5) AIDS / HIV - AEGIS
* Aegis represents the world's largest database of information about AIDS & HIV. Use this site to springboard into anything you want to know. including the latest national headlines related to AIDS/HIV.
http://www.aegis.com/

(6) Psychoneuroimmunology at Ohio State University
http://pni.psychiatry.ohio-state.edu/jkg/index.htm

NUTRITION AND EATING

(1) Anorexia Nervosa Diagnosis
* Online screening test for ANOREXIA NERVOSA.
http://www.mentalhealth.com/dx/fdx-et01.html

(2) Bulimia Nervosa
* Online screening test for BULIMIA NERVOSA.
http://www.mentalhealth.com/dx/fdx-et02.html

SUBSTANCE ABUSE

(1) Short MICHIGAN ALCOHOL SCREENING TEST
http://www.schick-shadel.com/alcohol-testing.html

(2) WARNING SIGNS OF A DRINKINGPROBLEM
http://www.uiuc.edu/departments/mckinley/health-info/drug-alc/drinkpro.html