PSYC 314 - Midterm 1

WHO's definition of health

health is a state of complete well-being
- physical, mental, and social wellbeing
health is not merely the absence of disease though
ex. you can eat healthy food and exercise but smoke cigs

holism

mind and body are integrated in the same system

dualism

the mind and body are separate, have different systems in place

prehistoric health beliefs

- holistic approach, believed that the body and mind were connected
- evil spirits /superstitions were thought to cause ailments
- treatments included exorcism and prayers, starving, beating

trephination

- during prehistoric times
- holes in skulls, man made, to leet evil spirits out of the body
- practiced all over the world

ancient greece and rome (500-300) health beliefs

- origins of western medicine
- mind body problem - philosophical debate about the relationship between mind and body
- plato argued that the mind and body were separate

hippocrates (460-377 BC)

- greek physician, built first hospital
- did clinical observations (signs and symptoms) and collected data, kept records
- proposed the humoral theory

humoral theory of illness

- holistic approach
- four humors (body fluids)
- blood (sanguine, cheerful), phlegm (phlegmatic, sluggish, apathy), yellow bile (choleric, hot tempered), black bile (melancholia, depressive)
- the imbalance of these would cause them to show different personality traits
- treatments were noninvasive - changes in diet, rest, consuming herbs, regulating enviornment

claudius galen (131-200AD)

- influenced by hippocrates
- scientific approach to medicine
- dissected animals
- made discoveries about anatomy (heart pumps blood though out body through arteries)
- diseases can be localized

middle ages health beliefs (400-1400AD)

- catholic church was the guardian of medical knowledge
- supernatural explanations for diseases
- disease was punishment from god
- this slowed down scientific research
- treatments included exorcism, torture, bloodletting/leeches, killing witches, prayer and good works

Renaissance (1400-1600) health beliefs

- dualistic, attempts to break away from superstitions from past centuries
- for mind problems - theologians, priests, philosophers
- for body problems - physicians, physical evidence sole basis for diagnosis

rene descartes

- philosopher and mathematician
- cartesian dualism - mind and body are separate entities
- mind and body were separated but connected through pineal gland
- mechanistic approach

anton van leeuwenhoek (1632-1723)

- invented the microscope, was able to see bacteria and microscopic life
- dualism

giovanni morgagni (1682-1771)

- did autopsies, anatomical conditions, linking specific organs to specific health conditions

germ theory of disease (mid 1800s)

- theory that diseases are caused by specific microorganisms
- biology as sole cause of disease
- dualism
- reductionism - emphasis on trying to reduce a disease to a specific cause, does not account for how they feel/social interactions
- started the improvement of hygiene systems - hand washing, sewage systems, discovery of penicillin/antibiotics

biomedical model

- dualism
- illnesses are due to bodily dysfunction
- focuses on illness/disease rather than wellness
- mental and social factors were assumed to be irrelevant

successes of biomedical model

- led to development of vaccines and antibiotics
- fewer deaths due to infectious diseases
- most prevalent causes of death are no longer due to acute conditions

limitations of biomedical model

- fails to recognize social and psychological influences on health
- focus on illness rather than health promotion
- cannot explain many puzzling medical observations

changes in life expectancy from 1921-2017

- 1921 - average lifespan 57/58
- 2017 - average lifespan 80
- due to improvements in sanitation and hygiene

life expectancy in canada by sex from 1982-2017

- increased life expectancy and levelled off in 2017
- levelled off due to opioid crisis in BC
- women live for 84 years, men live for 80

causes of death in canada: 1921 vs 2017

- 1921 - cardiovascular disease, flu, bronchitis, tuberculosis, stomach flu
- 2017 - cancers, heart disease, accidents, strokes, chronic respiratory, mostly older adults
- got rid of most acute illnesses (at least causing death)

freud (1856-1939)

- holistic
- physician and founder of psychoanalysis
- conversion hysteria - unconscious conflicts were converted into physical disturbances
- ex glove anesthesia

glove anesthesia

- freud
- loss of sensitivity in the hand and wrist
- doesn't make sense from medical perspective
- psychosomatic

early psychosomatic medicine (1930s-1950s)

- field related to psychology and psychiatry
- holistic
- founded by helen flanders dunbar
- originally focused on medical problems believed to be caused by emotional conflicts
- ex ulcers were related to oral conflicts, asthma caused by separation anxiety/lack of protection by mother
- not medically sound

early psychosomatic medicine

- psychological conflicts \> anxiety \> physiological effect via autonomic nervous system
- type A personality as a risk for heart disease
- franz alexander developed a profile of the ulcer-prone personality (type A)

years of health psychology (20th century-now)

- 1930s-1970s - discoveries about the effects of stress on physiological systems
- 1970s - health psychology and behavioural medicine emerged as fields
- present day - health psychology is an active field engaging in education, research, practice, and policy

biopsychosocial model

- biological, psychological, social factors
- interplay between micro (cellular) and macro (ecological/environmental) level processes
- multiple factors influence health and illness
- emphasis on both health and illness
- holistic approach

loneliness

- feelings of isolation, disconnectedness, and not belonging
- reflects the discrepancy between ones desired and ones actual relationships
- not necessarily the same as being alone

theory

- a set of ideas that provides a framework for asking questions, gathering information, and interpreting a phenomenon
- ex. loneliness affects how we interpret our social worlds

hypothesis

- specific predictions about the phenomenon, based on a theory
- testable and disprovable
- ex. lonelier people will show greater increases in heart rate to the stress task, compared to less lonely people

pseudoexperimental

- looks for cause and effect without random assignment
- IV would not be manipulated (persons gender, disease, loneliness score)

experimental methods

- IV - predictor, manipulated variable
- DV - measured outcome
- random assignment to experimental and control/comparison groups

loneliness promotes inflammation during acute stress experiment

- Hypothesis - lonelier people will produce more inflammation when faced with a stressor, compared to less-lonely people
- Participants - 134 adults
- Procedure - UCLA loneliness scale; blood drawn 3 times while undergoing stress task (speech, mental arithmetic)
- Blood samples were analyzed for stimulated levels of inflammation (interleukin-6)

experimental methods pros and cons

pros
- can draw causal conclusions
- lab experiments can be well controlled
cons
- relevance to real life?
- cant always manipulate IV

correlational methods

- examines correlations between variables of interest
- positive (+1.0) vs negative (-1.0) correlation coefficients
- ideal method for studying phenomena that cannot be manipulated, for practical or ethical reasons

cross-sectional research

- person is assessed only once
- comparisons are made between people
- ex. people with higher vs lower loneliness, people of different age groups
- advantages - less expensive, faster to collect data
- disadvantages - can't determine cause and effect

longitudinal research

- same people are assessed more than once across time
- examine naturally occurring experiences
- observe predictors and consequences of certain events (eg. heart attack)

longitudinal methods pros and cons

pros
- can determine the ordering of events
- ex. are people lonely before the development of diabetes?
- can examine changes across time within the same people
cons
- costly and time consuming
- biased sample?
- attritions (participants dropping out)
- can't draw causal conclusions
- can't rule out confounding variables

3 definitions of stress

response definition, stimulus definition, transactional 'cognitive' definition

how does stress influence health?

- stress can influence health with negative physiological affects (increased blood pressure), negative health habits (smoking, eating junk food), and health services and disease (medicine)

response definition of stress

- physiological response to unpleasant or threatening stimulus (stressor)
- varying stressors \> same pattern of physiological response
- according to this definition, people could face different stressors but have the same stress response for all of them

fight or flight response

- walter cannon (1932)
- fight - aggressive response
- flight - withdrawal
- allows quick response to threat
- SAM system

sympathetic-adrenal-medullary (SAM) system

- fight or flight response
- sympathetic NS is stimulated with perceived threat \> sympathetic NS prompts adrenal medulla to release catecholamines \> catecholamines (hormones from adrenals, epinephrine and norepinephrine) create fight or flight response, carried through bloodstream, causes bodily changes
- bodily changes include increased heart rate, blood pressure, sweating, pupils dilating, airflow to lungs, non essential processes slow down

homeostasis

- maintaining a stable internal environment, like body temp, blood sugar, etc
- ex. sympathetic and parasympathetic NS

sympathetic NS bodily changes

- fight or flight response
- dilated pupils, inhibits saliva, accelerates heartbeat, conversion of glucose to glycogen

parasympathetic NS bodily changes

- rest and digest response
- constricts pupil, stimulates saliva, slows heartbeat, release of bile, contracts bladder

hans selye (1956)

- general adaptation syndrome
- exposed rats to different types of stressors, observed similar pattern of physiological change
- argued that stress response was nonspecific to the stressor
- believed that chronic stress overtime can lead to poor health

general adaptation syndrome

- alarm - initial shock; fight or flight
- resistance - body adapts to stress; continued HPA activation
- exhaustion - physical damage and disease

hypothalamic-pituitary-adrenal (HPA) axis

- when a person perceives a stressful situation, the hypothalamus releases corticotropin releasing factor \> releasing factor stimulates pituitary gland to release ACTH \> ACTH travels down blood stream to adrenal glands, which stimulates the release of cortisol in your bloodstream \> adrenal cortex releases cortisol which increases blood sugar, reduces digestion, anti-inflammatory
- dysregulated cortisol is associated with health conditions, mental disorders (PTSD), premature death

criticisms of the response definition of stress

- not all responses to stressors are the same
- people can differ in stress reactivity
- ex. differences between men and women
- ignores subjective feelings, appraisals, and coping

shelley taylor et al (2000)

- tend and befriend hypothesis
- people respond to stress with social affiliation and nurturing behaviours, not just fight or flight

tend and befriend hypothesis

- role of oxytocin
- animals and humans with high oxytocin levels show social bonding and are calmer and more relaxed
- under stress, females more likely to tend and befriend
- oxytocin makes us bond stronger with in-group members and suspicious with out-group members

allostatic load

- bruce mcewen (1998)
- allostatic load is the cumulative wear and tear on the body when a person is exposed to repeated chronic stress
- repeated or prolonged exposure to stressors \> physiological responses accumulate \> allostatic load (physiological consequences of stress)
- predicts premature morality, risk for chronic health conditions

the stress response and the development of allostatic load

- might deal with stress by eating poorly, coping by drug/alcohol abuse, exercising more
- individual differences, perceived stress, and behavior responses all lead to a physiological response \= allostatic load

3 features of physiological stress responses

- exposure, reactivity, and recovery

exposure

- how frequent, intense, or long lasting are the stressors
- ex. SES status, personality, relationships, people really engaged with community/family have more stressors

reactivity

- magnitude of physiological change in reaction to stress
- ex. how you manage stress, allowing the reaction to persist is harmful for health

recover

- how long it takes to return back to normal/baseline after stressor is over
- ex. bad for physical and mental health

environmental stimulus definition of stress

- holmes and rahe (1967)
- social readjustment scale
- any situation that can be life altering
- different kinds of events can require different levels of readjustment
- ex. death of spouse, divorce, pregnancy etc. are all on a numerical scale

criticisms of stimulus definition of stress

- points are based on normative ratings
- doesn't consider the personal impact of the event
- change isn't always stressful
- other important stressors are ignored (chronic stress, daily hassles)
- many items confounded with health conditions or illness
- retrospective contamination
- if you are currently stressed, you might perceive your past events as very stressful
- r correlation of 0.12, small correlation, other factors

sources of stress vs stress itself

- major life changes are sources of stress not stress itself
- does not separate the stressor from the stress response, many times confounded with health conditions or illness

third variable problem

- aspects of personality, physiology, memory can impact both stress and high incidence of illness
- people highly neurotic might view life more stressful, inflate stress and illness

transactional definition of stress

- richard lazarus
- transactions occur between the person and the environment
- these transactions consist of our appraisals of the environmental demands and other resources for coping with it
- stress is when the person believes that demands exceed their resources
- interpretation of stressful events is more important than the events themselves
- stress is determined by both the person and stressor

transactional model of stress

- noxious environmental stimulus \> cognitive appraisal of stress \> persons response

two types of cognitive appraisal

- primary and secondary appraisal

primary appraisal

- assessment of whether the person has anything at stake in the encounter
- irrelevant/neutral, positive, or negative appraisals
- negative includes harm loss, threat, and challenge

negative primary appraisal types

- harm-loss - damage is already done (ex. lost a job)
- threat - possible future damage (ex. potential loss of job)
- challenge - potential to overcome or benefit from event (ex. hard task at work)

secondary appraisal

- assessment of whether one has sufficient resources and abilities to cope with the demands of the situation
- 'i can handle this', 'i might be able to do this', 'i cant do this'
- if you have a strong social network you might feel like the stressors are challenging but that you can overcome it

reappraisal

- susan folkman
- continuous re-assessment based on new information
- similar to initial process, may lead to more or less stress

positive reappraisal

- reframing the situation to see it in a positive light
- 'my efforts are valuable', 'this is difficult but worthwhile'

what makes events stressful?

- perceived as..
- uncontrollable or unpredictable - being in control can make it less stressful, lowers physiological stress
- ambiguous - not sure whats going on/whats at stake, requires energy to understand the situation
- overload - too much to do
- involve central life goals - identity/core values

criticisms of transactional definition

- in research studies, appraisals don't fully account for the effects of stressors on health
- blaming the victim ('stress is all in your head')
- too much focus on subjective experience

methods for examining stress (stress research)

- social readjustment rating scale (stimulus)
- biomarkers (physiological response)
- trier social stress test (physiological response)
- perceived stress scale (transactional)
- daily and chronic stress (can assess all 3 definitions of stress)

biomarkers of stress

- heart rate, blood pressure, blood, urine, or saliva for stress hormones
- SAM system - EPI and NE from urine
- HPA axis - cortisol from saliva or blood

social support network

- friends, community, family
- people who are well connected and valued tend to have better health

direct effects hypothesis

- social relationships influence health regardless of stress
- ex. married people tend to have better health compared to divorced/widowed/single people

stress buffering hypothesis

- social relationships influence health by protecting people when they are under stress

4 types of social support

- tangible support, emotional support, informational support, companionship support

tangible support

- material/instrumental air
- ex. financial assistance, services, goods

emotional support

- feeling loved and cared for by others, shows empathy

informational support

- advice and information, tends to be more helpful when someone who is qualified is giving out the information

companionship support

- support that gives a sense of belonging
- ex. part of a group, sports team

matching hypothesis

- social support is most effective when it meets the persons specific needs
- emotional support might be the most beneficial for health

relationships and social support

- confidants (eg. spouse, close friend) are important sources of social support
- in satisfying marriages, husbands get substantial health benefits
- martial strain and bad relationships are harmful for health

when is support unhelpful?

- receiving support might make a person feel guilty, inadequate, or indebted
- perceived support is more beneficial than actual support

invisible support

- receiving help but unaware of it, might be the most effective support

social support during COVID outcomes

- 60-70yr olds tend to be very active in the community: babysitting grandkids, volunteering, checking on neighbours
- older age people were helping out more and provided and received support
- older adults gave and received more emotional support, middle aged adults were more likely to give tangible support
- daily wellness outcomes - they received or gave more support tended to have a better positive outlook
- volunteering can increase well being

internal locus of control

- belief that you have control over your life
- patients in an old age home who had more control watering their plants lived longer, were happier, and felt more in control

external locus of control

- belief that outside forces are responsible

self efficacy

- belief that you can succeed at a specific activity

outcome expectancy

- belief that the behavior, if carried out properly, will produce a particular outcome

optimism

- the belief that good things are likely to happen in the future
- associated with better health due to being more motivated and persistent with sticking to good habits, self efficacy, able to adjust to goals, better at handling stress

type A & type B behaviour patterns

- type A - competitive, time urgency, angry/hostile, fast-talking, associated with greater risk of heart disease and death, tend to have worse health habits (smoking + drinking), problems with social relationships, neuroticism
- type b - easy going and relaxed

five factor model of personality

- neuroticism, extraversion, openness, agreeableness, conscientiousness

neuroticism

- more pronounced stress responses, reactive, physiological reactivity, slower to recover from stress, bad coping skills

extraversion

- outgoing and sociable, might be more susceptible to peer pressure, positive emotions, better health

openness

- openminded and adventurous, better health?

agreeableness

- better self rated health, prioritize good relationships and social harmony

conscientiousness

- most predictive of better health and good health habits, goal oriented, diligent, live longer

positive experiences buffering stress

- positive experiences are theorized to help people cope with stress
- associated with favourable health outcomes
- daily positive experiences have a direct effect on physiological functioning
- positive social interactions, whether in person or remote, were the most frequently reported positive events