Health Psychology

Coping

thoughts and behaviors used to manage internal and external demand of situations appraised as stressful

Coping characteristics

Dealing with stress is ongoing process: involves perceptions, emotions, actions, internal and external resources

stages of coping process

1. stressful event, its stage, and anticipated future course

2. appraisal/interpretation of stressor

   (what is the stressor)

3. Coping responses and strategies (going over all the strategies you have)

4. coping tasks (goal in mind as you go about coping with stressor)

5. Coping outcomes (result of coping process)

negative affectivity

pervasive tendency toward negative mood

• marked by anxiety, depression and hostility

• related to poor health, mortality, high levels of stress indicators

• associated with poor response to treatment and creates illusion of poor health

positive affectivity

pervasive tendency toward positive mood

• promotes better mental and physical health

• lower levels of stress indicators

• better coping

• better immune responses

psychosocial resources

• Optimism: promotes active and persistent coping efforts (positive expectations about the future)

• Psychological control: belief that one can exert control over stressful events

• Self Esteem: associated with lower levels of stress indicators (positive view of oneself)

• Conscientiousness: may help avoid harmful coping strategies and promote positive health behaviors or compliance with treatment 

• Self confidence: helps identify resources for coping (belief in yourself)

• Being smart: associated with problem solving skills 

• Emotional Stability: ability to remain calm under stress and to regulate one’s emotions effectively 

Resilience

ability to bounce back from negative experiences and adapt to stressful situations

resources that promote resilience

coherence and purpose in life, sense of humor and trust in others, sense that life is worth it, religious beliefs

religious beliefs and health

• social support and community = health-protective

• promotes self-esteem and identity development

• reduce anxiety regarding the unknown (death)

• increases sense of control

• prohibit unhealthy behaviors = sexual behavior, alcohol, tobacco

• Criticisms: research is correlational; religious and non religious people differ in different ways

Coping style

propensity to deal with stress in a certain way

• avoidant

• approach

avoidant coping style

coping by avoiding threat

approach coping style

coping by directly taking action against the threat

• better for health in long run

• might cause anxiety in the short run

problem focused coping

attempting to do something constructive about the stressful conditions

emotion focused coping

regulating emotions experienced due to stressful event

external resources for coping

• more external resources the better

• having economic resources can help you gain more

• Time, money, education, decent job, friends, family, standard of living, presence of positive life events, absence of other life stressors, socioeconomic status (SES)

stages with collective coping with tragedy

1. Emergency stage: Alarm!

   • People talk and think about event

2. Inhibition stage: Settling In

   • Reduce discussion, still think about

3. Adaptation stage: Accepting

   • discuss and thinking about eventually diminish

John Henryism

prolonged, high effort active coping with psychosocial environmental stressors

example: working through medical crises even though its bad for you

successful coping outcomes

eliminating stressor, adjusting to negative event, maintaining positive self image, emotional equilibrium, continuing satisfying relationship with others, enhancing recovery time, low immune reactivity

mindfulness medication

teaches high awareness of present in order to accept it

acceptance commitment therapy

intervention of mindful awareness, acceptance of problem with premise that pain is inevitable in life

• doesn’t try to escape life troubles

expressive writing

• organize thoughts and find meaning

• focus on positive

• clarify own emotions

• affirms personal values

• lowers indicators of stress

self-affirmation

people affirm values that are important to them

• individuals feel better about themselves

• Lowers distress

progressive muscle relaxation

individual learns to relax all muscles in body to discharge stress

coping effectiveness training

• asses stressful events and put stressors into specific tasks

• encourages to maintain social support

stress management programs

identifying stressors, monitoring stress, avoiding negative self-talk, setting new goals

stress management program skills

• identifying stressor

• confronting stress

• monitoring stress

• avoid negative self-talk

• setting goals

• acquiring skills

• setting new goals

• engaging in positive self-talk

• time management

• planning

social support

information from others that one is:

• valued

• loved

• part of network

types of social support

• material support: tangible access (money, goods)

• informational support: information (this therapy exists)

• emotional support: reassurance (we love you!)

social support/relationships & mortality

• lowers likelihood of illness

• speeds up recovery

• reduces risk of mortality

• encourages individuals to use health resources

• social support even stronger for livelihood than exercise

biopsychosocial pathways linking social support and health

• social support has positive effects on cardiovascular, endocrine and immune system

• Lowers physiological and neuroendocrine responses to stress

• Decreases cortisol responses to stress

• Improves immune system functioning 

• Modifies brain’s response to stress

behaviors associated with oxytocin

• neuropeptide:

  • affiliation, social contact/proximity, generosity, reproductive behaviors

  • envy, xenophobia, mistrust gloating

buffering hypothesis

social support is linked to physical and mental health benefits because it buffers against stress

direct effects hypothesis

social support has direct effects on physical and mental health even during non stressful times

matching hypothesis

support that meets the need of a specific stressor is the best kind

effective kinds of social support

• financial, satisfying marriage, family support, community support

ineffective kinds of social support

• social support if its unuseful

• emotional support if its not by someone who is close to individual

• social support when person providing support is perceived as unresponsive to their needs

threats to social support

• stressful events

• intrusive social contact

• controlling or directive support

beneficial support systems

• internet based systems

• family based systems

  • families should accept patients feelings instead of forcing positivity always

chronic loneliness statistic

• loneliness effects 1 in 4 people

• increases chance of early death by 20%

• 30% more people living alone in US than in 1980

• chronic loneliness can be hard to treat

chronic loneliness interventions

• social engagement: providing opportunities for social interaction

• social skills training: teaching social skills

• social support provision: providing social support

• changing social-cognitive biases: challenging and modifying thought patterns

hypochondria

illness anxiety disorder: belief that normal bodily systems are indicators of severe illness

cyberchondira

having symptoms and self diagnosing online, seek self-treatment

attentional differences in symptom perception

• people who focus on self are quicker to notice symptoms

• people with more distractions in life and attend less to themselves experience less symptoms

stress in symtom perception

• Stress-related physiological changes are interpreted as symptoms of illness

causes of problems in patient-provider communication

• inetentivenss

• medical jargon language

• baby talk

• depersonalization

• stereotypes

• inattentiveness

• poor health literacy/education

• inability to present complaints effectively

• under reporting and over reporting

improving patient-provider communication

• listen

• use simple language

• repeat and write down instruction

• clarify

• be supportive

• come prepared but brief

• think of questions ahead of time

• listen well

commonsense model of illness

• a set of beliefs held by people about their symptoms and illnesses

• Results in organized illness representations

• Identity = name of the illness

• Causes = factors believe to have led to the illness

• Consequences = symptoms, treatments, and their implications for quality of life

• Timeline = length of time the illness is expected to last

• Control/cure = whether the person believes the illness can be managed or cured

• Coherence = how well these beliefs represent the disorder

• Acute illness

  • Believed to be caused by viral or bacterial agents

  • Short in duration, with no long-term consequences

• Chronic illness

  • Believed to be caused by multiple factors

  • Long in duration with severe consequences

• Cyclic illness

  • Alternating periods of either no symptoms or many symptoms

lay referral network

network of family and friends who offer their own interpretations of symptoms before the treatment is sought

stages of delay in seeking treatment for symptoms

• Appraisal delay

  • Time taken to decide that the symptoms is serious

• Illness delay

  • Time between the recognition that a symptom implies an illness and the decision to seek treatment

• Behavioral delay

  • Time between deciding to seek treatment and actually doing so

• Medical delay

  • Time that elapses between the persons calling for an appointment and his or her receiving appropriate medical care

causes of delay in seeking treatment

• people don’t have regular contact with doctor

• people fear medical service

• have previous symptoms to something minor

• those that aren’t hurting or changing quickly

• those who easily accommodate

• Delay is common among people

  • With no regular contact with a physician

  • Who are phobic about medical services

  • Patients no longer feel any urgency about their condition

  • Patients become alarmed by the symptoms and avoid thinking about them

  • Delay by the health care practitioner

  • Medical delay is likely when a patient deviates from the profile of the average person with a given disease

criteria to compare healthcare systems

• costs

• health outcomes

• quality of care

• social justice issues

• medical performance

chronic disease

disease lasting 3 months or more, cannot be prevented by vaccines or cured by medication are ongoing and in need of management because there is no cure

• examples: heart disease, arthritis, cancer, asthma, hearing loss

top two leading causes of death in the US

heart disease and cancer

quality of life measures

measure the extent a patients normal life activities have been compromised by disease and treatment

components:

• physical functioning

• psychological status

• social functioning

• disease and level of suffering

common emotional responses to chronic illness

denial: defense mechanism where people avoid

anxiety: patients overwhelmed by their diagnosis

depression: complicates treatment and medical decision making

effects of chronic illness on self-concept, self-esteem, and body image

• Self-concept: stable set of beliefs about one's personal qualities

• self-esteem: evaluates self-concept

• Body image: perception and evaluation of one's physical functioning and appearance

  • If you feel strong/weak

  • If you are attractive/unattractive

  • Poor body image raises the risk of depression and anxiety

  • Influences a person's adherence to treatment

coping strategies commonly used by cancer patients

• Social support/direct problem solving

• Distancing

  • Placing a mental barrier

  • "I don't let it get to me"

• Positive focus

  • People look for the silver lining or the bright side

  • Maybe learned something new

• Cognitive escape/avoidance

  • People will say things like: "I wish this would go away'

  • Does not reduce distress in the long term

  • Maladaptive form of coping

• Behavioral escape/avoidance

  • Using certain behaviors to avoid confronting a problem

  • Eating, sleeping, drinking alcohol, doing activities that take your mind off the problem

flexible coping

a flexible coping strategy that adjusts to the situation - i.e., problem solving for controllable events, emotion-focused coping for uncontrollable events

• trying different kinds of coping can help how your disease effects you

common positive emotional changes in response to chronic illness?

• Experience positive reactions and optimism

• Inspiration to act now instead of postponing g

• Acquiring more empathy and compassion

• Feeling stronger and more self-assured

• Patients can experience more meaning, they are using their time more wisely

psychological interventions for patients with chronic illness

1. Pharmacological interventions - example: prescription of antidepressants

2. Individual therapy

3. Coping skills training can improve functioning for chronic diseases

4. Relaxation, stress management, and exercise

5. Social Support Interventions

How does individual therapy for patients with chronic illness differ from therapy with clients who do not have chronic illness?

1. Can be episodic (short term)

2. Collaboration with patient's physician and family is critical

3. Requires respect for patient's defenses

4. Comprehensive understanding of the illness and its modes of treatment are required

5. Guided by cognitive behavioral therapy (CBT)

coronary heart disease

• Illness caused by atherosclerosis, which is defined as the narrowing of coronary arteries

• plaque builds up inside coronary arteries which supply heart with blood

• reduces the flow of oxygen-rich blood to the heart

risk factors associated with coronary heart disease

• High LDL cholesterol

• High blood pressure

• Elevated levels of inflammation

• Diabetes

• Cigarette smoking

• Obesity

• Lack of exercise

metabolic syndrome

Associated with 2-3 fold increased risk of cardiovascular events/death and 5-fold increased risk of developing type 2 diabetes

metabolic syndrome is a risk factor for ?

coronary heart disease

metabolic syndrome symptoms

• Obesity centered around the wait

• High blood pressure

• Low levels of HDL (good cholesterol)

• Difficulty metabolizing blood sugar

• High levels of triglycerides

How does a myocardial infarction (heart attack) happen?

• Plaque builds up and narrows arteries

• Plaque ruptures, blood clot forms

• Blood flow is interrupted, hearth attack or cardiac death follows

ole of stress in the development of coronary heart disease?

• Cumulative effects of stress reactivity damage of the endothelial cells

• accelerates heartbeat, increases blood pressure

• Prolonged recovery period after stress can also cause damage

• Chronic and acute stress are both linked to CHD and adverse clinical events

• Stress is also associated with increased inflammatory activity

men vs women coronary heart disease

• Women develop heart diseases later than men

• Estrogen prevents early onset of CHD (coronary heart disease)

• Risk of CHD increases after menopause

• CHD is the most common cause of death in women in developed nations

depression and coronary heart disease

• depression leads to pro-inflammatory cytokine

psychological aspects in the management of CHD

• Dietary instructions and an exercise program

• Stress management

• Treating depression

• Social support

• Addressing cardiac invalidism (patients and their spouses see the patient's abilities as lower than they actually are)

hypertension

high blood pressure

• supply of blood through vessels is high

systolic blood pressure

Systolic pressure = pressure in the arteries during contraction of the heart muscle (ideally less than 120)

• when heart beats

Diastolic pressure

pressure in the arteries when the heart is relaxed (ideally less than 80)

• between beats

risk factors for hypertension

• Childhood temperament and blood pressure reactivity

• Gender - prior to age 45, men at greater risk than women

• Genetic factors

• Emotional factors - hostility

• Family environment - chronic anger

• Stress - examples: job strains, family conflicts

stroke

disturbance of blood flow to the brain

primary causes of stroke

• blocked blood flow by blood clot

stroke warning signs

BE FAST

b - balance lost

e - eyes loose vision

f - face is uneven

a - arm weakness

s - speech difficulty

t - time to call

risk factors for stroke

• High blood pressure

• Heart disease

• Cigarette smoking

• High red blood cell count

• Transient ischemic attacks (brief stroke like attacks that last mins - hours)

• Negative emotions

• Sudden change in posture to a startling event

• Psychological distress

• Risk of stroke goes up with age

type 2 diabetes

disease of lifestyle, body can’t properly use insulin

type 2 diabetes risk factors

• If you are overweight

• Get little exercise

• Have high blood pressure

• You have a sibling or parent with diabetes

• You had a baby weight over 9 pounds at birth

• You are a member of a high-risk ethic groups which include, African Americas, latinos, native American's, and pacific islanders

type 2 diabetes symptoms

1. Frequent urination

2. Fatigue

3. Frequent infection of skin, gums, or urinary system

4. Pain or cramps in legs, feet, or fingers

5. Slow healing of cuts and bruises

6. Intense itching and drowsiness

7. Impotence

recent health trends in US

• Life expectancy has been decreasing in the recent years due to the opioid crisis, rising rates of suicide, and COVID

• Fewer-traffic related deaths

• Prevalence of smoking has been slowly dropping

• Fewer adults exhibit high cholesterol levels

• Exercise habits are improving

• Rates of coronary heart disease have been decreasing

• HOWEVER

  • Rates of obesity are rising

  • No change in alcohol consumption

  • No change in prevalence of many mental health problems - but rising levels during COVID

behavioral immunization

•  preventing the development of poor health behaviors and habits

  • Primary prevention with children and adolescents

behavioral immunization programs

• Programs focused on smoking, drug abuse, diet and eating disorders

strategies for promoting resilience

• Focusing on the positive factors that reduce morbidity or delay mortality

• Enhancing people's abilities to attract and maintain social support

• Studying how people:

  • Spontaneously reduce stress

  • Seek out opportunities for rest, renewal, and relaxation

health disparities

 inequalities in patterns of distribution of morbidity and mortality

health disparities examples

• Racial and ethnic differences

• Socioeconomic differences - have an impact in the delivery of medical treatment

• Gender - women, transgender people are not included as research subjects in studies of major diseases

problems with US health care

• Very expensive

• Inequitable system

• Inappropriate use of services

comprehension intervention models

• interventions targeting multiple behaviors, problems or risk factors

• Bring together all treatments/interventions known for a problem into a single cluster, and concentrate both medical and psychological expertise

• Pain management programs

• Hospice care

• Coordinated residential and outpatients rehabilitation programs (address multiple health problems simultaneously)

deaths of despair

suicide, opioid addiction

life expectancy decreasing

people are stressed

causes of stress in American society

• poor social relationships

• low economic status

  • unpredictability

• drug addiction

• depersonalization of society

• families splitting

role of media in stress

• humans surrounded by things they do not have

• lots of demands placed on people

psychoneuroimmunology (PNI)

the study of the interactions between the psychological experiences, the activity of the brain, and of the immune system

main functions of the immune system

• distinguishes between what is self (cells) and what is foreign (cells)

• attacks and rids body of foreign invaders

innate immunity

• have it at birth

• generalized defense

• provides generalized defense against pathogens

  • macrophages

  • neutrophils

  • natural kill (NK) cells

acquired immunity

• delayed response to a specific invader

  • acquired through vaccines or contracting a disease

  • specific to each pathogen

• humoral immunity: done by B cells, which produce and secrete antibodies

• cellular immunity: done by T cells, operate at cellular level

examples of immune cells

• macrophages: large

• neutrophils

• NK cells: natural killer cells

• B cells: produce and secrete antibodies, mature in bone marrow

• T helper cells: mature in thymus, operate at cellular level

C-reactive protein (CRP)

protein made by the liver when inflammation is high