health psych final

what do you think

Obesity

excessive accumulation of body fat. Generally, fat should constitute about 20 to 27 percent of body tissue in women and about 15 to 22 percent in men. depends on both the number and the size of an individual's fat cells.

yo-yo dieting

Successive cycles of dieting and weight gain. When dieters begin eating normally again, they may gain weight more quickly because their metabolic rate is still low.

set point theory of weight

the idea that each individual has an ideal biological weight, which cannot be greatly modified (think thermostat)

How does stress affect eating?

About half of people eat less and about half of people eat more. Preferential foods are often high in fat and sugar.

Interventions for obesity

• dieting

• Surgery (lap band, stomach staples, bypass)

• CBT (Screening, self-monitoring, attentional retraining, stimulus control, controlling eating, self-reinforcement, controlling self-talk, exercise, stress management, social support, relapse prevention

Self-monitoring

keeping careful records of what they eat, when they eat it, how much they eat, and where they eat it. This record keeping simultaneously defines the behavior, makes clients more aware of their eating patterns, and can lead to beginning efforts to lose weight

Attentional retraining

overcome attentional biases by distracting oneself and/or redirecting one's focus away from food-related cues

Stimulus control

confine eating to one place at particular times of day, and develop new discriminative stimuli that will be associated with eating, for example, using a particular place setting, such as a special placemat or napkin, and to eat only when those stimuli are present

Controlling eating

Obese people may be told to put down eating utensils after every few mouthfuls until the food in their mouths is chewed and swallowed. Longer and longer delays are introduced between mouthfuls so as to encourage slow eating (which tends to reduce intake). Finally, clients are urged to savor their food—to make a conscious effort to appreciate it while they are eating

Controlling self-talk

identify the maladaptive thoughts they have regarding weight loss and to substitute positive self-instruction

Anorexia nervosa

an obsessive disorder amount- ing to self-starvation, in which a person diets and exercises to the point that body weight is grossly below optimum level, threatening health and potentially leading to death

causes of anorexia

genetic factors, environment, being raised in families in which worth is measured by success

treatment of anorexia

CBT, family therapy, giving parents total control of the patient's eating. Since treatment is so difficult, interventions often focus on prevention strategies that include learning actual weights and sizes of other women or writing an essay denouncing the thinness ideal.

bulimia

characterized by alternating cycles of binge eating and purging through such techniques as vomiting, laxative abuse, extreme dieting or fasting, and drug or alcohol abuse. people with bulimia are typically of normal weight or overweight, especially through the hips

developing bulimia

family places high value on thinness and appearance, genetic factors, show altered stress responses, especially an atypical hypothalamic-pituitary-adrenal diurnal pattern (Ludescher et al., 2009). Cortisol levels, especially in response to stress, may be elevated, promoting eating

Treating bulimia

one of the first steps in treatment is to convince bulimics that the disorder threatens their health and that interventions can help them overcome the disorder. Combining medication and CBT is most effective.

binge eating

usually occurs when the individual is alone; it may be triggered by negative emotions produced by stressful experiences (Telch & Agras, 1996). The dieter begins to eat and then cannot stop, and although the bingeing is unpleasant, the binger feels out of control, unable to stop eating

physical dependence

when the body has adjusted to the substance and incorpo- rates the use of that substance into the normal functioning of the body's tissues

tolerance

the process by which the body increasingly adapts to the use of a substance, requiring larger and larger doses of it to obtain the same effects, and eventually reaching a plateau

craving

a strong desire to engage in a behavior or consume a substance

addiction

occurs when a person has become physically or psychologically dependent on a substance following repeated use over time

withdrawal

the unpleasant symptoms, both physical and psychological, that people experi- ence when they stop using a substance on which they have become dependent

problem drinking/alcoholism

the need for daily use of alcohol, the inability to cut down on drinking, re- peated efforts to control drinking through temporary abstinence or restriction of alcohol to certain times of the day, binge drinking, occasional consumption of large quantities of alcohol, loss of memory while in- toxicated, continued drinking despite known health problems, and drinking of nonbeverage alcohol, such as cough syrup

alcoholic

someone physically dependent on alcohol

two windows of vulnerability for alcohol use and abuse

12-21 and late middle age

how likely is alcoholism relapse

more than 50 percent of treated patients relapse within the first 3 months after treatment

What is MADD?

Mothers Against Drunk Driving. founded and staffed by the families and friends of those killed by drunk drivers and puts pressure on state and local governments for tougher alcohol control measures and stiffer penalties for convicted drunk drivers.

Why do people smoke?

Starting to smoke: invited by peers, influenced by culture and media, or if family smokes

Continuing: positively reinforced by physically stimulating effects

Not stopping: after regular use, smokers have difficulty stopping because of withdrawal symptoms such as insomnia, anxiety, distractibility, and irritability

How do people stop smoking?

Exercise, attentional retraining, social support - easier if a spouse or family member also quits. Many programs for stopping smoking begin with some form of nicotine replacement, and use CBT to help people stop smoking. Inter- ventions also include social skills training pro- grams and relaxation therapies. Relapse prevention is an important component of these programs.

Why do people keep smoking?

Tobacco addiction typically begins in adolescence, when smoking is associated with pleasurable activities.

Smoking patterns are highly individualized, and group interventions may not address all the motives underlying any particular smoker's smoking.

Stopping smoking leads to short-term unpleasant withdrawal symptoms such as distractibility, nausea, headaches, constipation, drowsiness, fatigue, insomnia, anxiety, irritability, and hostility.

Smoking is mood elevating and helps to keep anxiety, irritability, and hostility at bay.

Smoking keeps weight down, a particularly significant factor for adolescent girls and adult women.

Smokers are unaware of the benefits of remaining abstinent over the long term, such as improved psychological well-being, higher energy, better sleep, higher self-esteem, and a sense of mastery.

Passive smoking

third-leading cause of preventable death in the United States, killing more than 41,000 nonsmokers every year. Reduced by social engineering.

health-compromising behaviors

threaten or undermine good health. Many of these behaviors cluster and first emerge in adolescence.

Health problems linked to obesity

cardiovascular disease, kidney disease, diabetes, some cancers, and other chronic conditions.

Causes of Obesity

include genetic predisposition, early diet, a family history of obesity, low SES, little exercise, and consumption of large por- tions of high-calorie food and drinks. Ironically, dieting may contribute to the propensity for obesity.

CBT for obesity

can produce weight losses of 2 pounds a week for up to 20 weeks, maintained over a 2-year period

Where do we focus obesity interventions?

weight-gain prevention with children in obese families and with high-risk adults.

Impacts of alcoholism

accounts for thousands of deaths each year through cirrhosis, cancer, fetal alcohol syndrome, and accidents connected with drunk driving

Causes of alcoholism

has a genetic component and is tied to sociodemographic factors such as low SES. Drinking also arises in an effort to buffer the impact of stress and appears to peak between ages 18 and 25

Residential treatment programs for alcoholism

begin with an inpatient "drying out" period, followed by the use of cognitive-behavioral change methods including relapse prevention. However, most programs are outpatient and use principles of CBT.

Impact of smoking

accounts for more than 480,000 deaths annually in the United States due to heart disease, cancer, and lung disorders.

Why is smoking addictive?

Theories of the addictive nature of smoking focus on nicotine and nicotine's role as a neuroregulator.

Attitudes towards smoking

have recently declined

How do we stop adolescents from smoking?

programs use a social influence approach and teach youngsters how to resist peer pressure to smoke and help adolescents improve their coping skills and self-image

Stress

a negative emotional experience accom- panied by predictable biochemical, physiological, cog- nitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects.

Primary appraisal

occurs as a person is trying to understand what the event is and what it will mean. Events may be appraised for their harm, threat, or challenge

harm

the assessment of the damage that has already been done, as for example being fired from a job

threat

the assessment of possible future damage, as a person anticipates the problems that loss of income will create for him and his family

challenge

the potential to overcome or even profit from the event

Secondary appraisals

assess whether personal resources are sufficient to meet the demands of the environment

Selye's general adaptation syndrome

when a person confronts a stressor, it mobilizes itself for ac- tion. The response itself is nonspecific with respect to the stressor; that is, regardless of the cause of the threat, the person will respond with the same physiological pattern of reaction

3 phases of general adaptation syndrome

1. Alarm: the person becomes mobilized to meet the threat.

2. Resistance: the person makes efforts to cope with the threat, as through confrontation.

3. Exhaustion: occurs if the person fails to over- come the threat and depletes physiological resources in the process of trying.

Criticisms of General Adaptation Syndrome

1) it assigns a very limited role to psychological appraisal of events, which is important in the determination of stress

2) assumption that responses to stress are uniform

3) Seyle assessed stress as an outcome, such that stress is evident only when the general adaptation syndrome has runits course

tend and befriend

a theory that posits in addition to fight or flight, people and animals respond to stress with social affiliation and nurturant behavior toward offspring

How stress contributes to illness

(1) - causing the mind and body to become exhausted, worn down, and damaged

(2) - by weakening the immune system, making individuals more susceptible to disease.

(3) - motivating unhealthy behaviors in an attempt to deal with stress

(4) - Negatively affects psychological resources such as social support

(5) - Lowers use of health services

Two interrelated systems heavily involved in the stress response

sympathetic adrenomedullary (SAM) system and the hypothalamic-pituitary-adrenocortical (HPA) axis.

Sympathetic activation

When events are perceived as harmful or threatening, they are identified as such by the cerebral cortex in the brain. Information from the cortex is transmitted to the hypothalamus, which initiates sympathetic nervous system arousal. Sympathetic arousal stimulates the medulla of the adrenal glands, which, in turn, secrete the catecholamines epinephrine (EP) and norepinephrine (NE). These effects result in the cranked-up feeling we usually experience in response to stress: increased blood pressure, increased heart rate, increased sweating, and constriction of peripheral blood vessels, among other changes. The catecholamines modulate the immune system as well.

HPA activation

The hypothalamus releases corticotrophin-releasing hormone (CRH), which stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which, in turn, stimulates the adrenal cortex to release glucocorticoids.

Reactivity

the degree of change that occurs in autonomic, neuroendo- crine, and/or immune responses as a result of stress

allostatic load

the physiological costs of chronic exposure to the physiological changes that result from repeated or chronic stress, Makes the jump between homeostasis and fight-or-flight smaller, such as by increasing resting cortisol levels, heart rate, blood pressure, etc

Factors that increase stress of an event

Overload, negativity/unpredictability/ambiguity, involvement of central life goals

aftereffects of stress

a shortened attention span and poor performance on intellec- tual tasks as well as ongoing psychological distress and physiological arousal. Cognitive disruptions such as difficulty concentrating are common, and social behavior is affected as well; people seem to be less willing to help others when they are suffering from the aftereffects of stress. Worry or rumination, even when one is not aware that one is doing it, can keep heart rate, blood pressure, and immune markers at high levels

acute stress paradigm

finds that when people perform stressful tasks (such as counting backward quickly by 7s or delivering an impromptu speech to an unresponsive audience), they become psychologically distressed and show physiological arousal

Role conflict

occurs when a person receives conflicting information about work tasks or standards from different individuals

demand-control-support model

High demands and low control, combined with little social support at work

stress moderators

modify how stress is experienced and the effects it has

coping

the thoughts and behaviors used to manage the internal and external demands of situations that are appraised as stressful

negative affectivity

a pervasive negative mood marked by anxiety, depression, and hostility

psychological control

the belief that one can determine one's own behavior, influence one's environment, and bring about desired outcomes

control-enhancing interventions

use information, relaxation, and cognitive-behavioral techniques, such as learning to think differently about the unpleasant sensations of a procedure, to reduce anxiety, improve coping, and promote recovery

high self-esteem

tied to effective coping

Coping style

a propensity to deal with stressful events in a particular way

Coping strategies

attempts to address the demands of a specific stressful experience

avoidance oriented coping style

involve attempts to push away stressor-related thoughts and feelings, deny the existence or seriousness of the stressor, or distract oneself through other activities.

approach oriented coping styles

include efforts to solve the problem at hand, seek support from others, and actively accept or find benefit in the stressful experience.

Problem-focused coping

involves attempts to do some- thing constructive about the stressful conditions that are harming, threatening, or challenging an individual

Emotion-focused coping

involves efforts to regulate emotions experienced due to the stressful event

Coping interventions

• Mindfulness Meditation

• Acceptance and Commitment therapy

• Expressive writing

• Self-affirmation

• Relaxation training

• Coping Effectiveness training

Phases of stress management programs

1. Participants learn what stress is and how to identify the stressors in their own lives.

2. They acquire and practice skills for coping with stress.

3. They practice these coping techniques in targeted stressful situations and monitor their effectiveness

Time management

helps people set specific goals, establish priorities, avoid time-wasters, and learn what to ignore

Stress carriers

individuals who create stress for others without necessarily increasing their own level of stress

Social support

information and feedback from others indicating that one is loved and cared for, esteemed and valued, and included in a network of communication and mutual obligation

Types of social support

tangible, informational, emotional, invisible

Tangible support

involves the provision of material support, such as services, financial assistance, or goods.

Emotional support

listening, affirming, and empathizing with someone's feelings

Informational support

providing information that will help someone

Invisible support

support received from another person that is outside the recipient's awareness

direct effects hypothesis

maintains that social support is generally beneficial during nonstressful as well as stressful times.

buffering hypothesis

maintains that the physical and mental health benefits of social support are chiefly evident during periods of high stress; when there is little stress, social support may offer few such benefits

matching hypothesis

Different kinds of stressful events create different needs, and social support is most effective when it meets those needs

medical student's disease

As they study each illness, many medical students imagine that they have it. Studying the symptoms leads the students to focus on their own fatigue and other internal states; as a consequence, symptoms consistent with the illness under study seem to emerge

commonsense model of illness

argues that people hold implicit commonsense beliefs about their symptoms and illnesses that result in organized illness representations or schemas

Illness representations components

1. Identity, or label, for an illness is its name

2. Causes are the factors that the person believes gave rise to the illness

3. Consequences are its symptoms, the treatments that result, and their implications for quality of life

4. Time line refers to the length of time the illness is expected to last

5. Control/cure identifies whether the person believes that the illness can be managed or cured through appropriate actions and treatments

6. Emotional representations include how people feel about the illness and its possible course and treatment

7. Coherence refers to how well these beliefs hang together in a cogent representation of the disorder

acute illness

caused by specific viral or bacterial agents and is short in duration, with no long-term consequences. An example is the flu.

chronic illness

caused by multiple factors, including health habits, and is long in duration, often with severe consequences. An example is heart disease

cyclic illness

marked by alternating periods during which there are either no symptoms or many symptoms. An example is herpes.

lay referral network

an informal network of family and friends who offer their own interpretations of symptoms, often well before any medical treatment is sought

People who use health services

the very young and the very old, women, rich people, white people, socially isolated people, those who think their illness is bad and that medical care can fix it

delay behavior

Putting off seeking treatment for one or more potentially serious symptoms

appraisal delay

The time between recognizing that a symptom exists and deciding that it is serious.

Illness delay

the time between recognizing that a symptom implies an illness and the decision to seek treatment