PS371: Behavioral Medicine/Health Psychology

Behavioral Medicine

• Knowledge from behavioral science applied to …

  • development …

  • diagnosis …

  • prevention …

  • treatment of medical problems

• Interdisciplinary

Health psychology

• Sub-field of Behavioral Medicine

• Focus: factors that promote & maintain health

• Assist formulation of …

  • improvements to health care systems

  • health care policy

Psychological, social impact on health

• May adversely impact health:

  • Psychological factors lead to biological processes, which lead to illness, disease

• Long-standing behavioral patterns increase risk for physical disorders

• May also positively impact health

  • Examples: Exercise … yoga … relaxation training

• Effects of acute or prolonged stress primary interest

• Other potential focal interests include:

  • inequity in healthcare decisions

  • risk factors for significant medical conditions

  • interpersonal factors affecting prevention, treatment, outcome

Psychophysiological disorders

• Best known:

  • Ulcers … asthma … insomnia … headache … coronary heart disease … hypertension

• To this list you may add:

  • Ulcerative colitis … fibromyalgia … irritable bowel syndrome … chronic fatigue syndrome (among others)

Hans Selye

• Study of effects of chemicals on health of lab rats

• Test rats injected with chemical extracts

• “Control” rats injected with saline

• Test animals developed ulcers, other physiological problems

• So did animals injected with saline!

• Selye concluded that experimental procedures, conditions → adverse outcomes

• Underlying cause … stress

• Defined stress as …

  • biological syndrome

  • reaction to some physiological shock to organism’s system

  • disruption of stable, internal balance (organismic homeostasis)

General Adaptation Syndrome

• Body goes through several stages in response to chronic stress

• alarm reaction … body prepares to fight or flee

• resistance … mobilize coping mechanisms to respond to the stress

• exhaustion … resulting in illness, even death

Stress

• Brief exposure to stressors may enhance functioning

  • Immediate response to virus is an enhancement in immunity

• Long-lasting exposure may lead to deterioration

• Biological … Psychological … Social stressors have similar effects

  • Make a person more susceptible to illness, alter course of disease

• More recent definitions include:

• Condition where expectations do not match perceptions of internal or external environment

• Stress: operates at unconscious level

• Distress: conscious awareness of impact

• Biological cost of adapting to stress = allostatic load

• Represents physiological consequences of chronic exposure

• May have implications for physical or mental health functioning

Sympathetic nervous system

• Mobilizes resources during times of threat / danger

• With activation …:

  • heart beats faster

  • blood flow increases

  • respiration increases

  • adrenal glands stimulated

Hypothalamic–pituitary–adrenal (HPA) axis

• Hypothalamus → pituitary

• stimulate adrenal glands

• produce surge of epinephrine, cortisol

• Also note … hippocampus sensitive to cortisol …

  • helps turn off stress response

  • Emotional memories

• Higher cortisol levels may harm hippocampus, have adverse effects on cognitive abilities

Cardiovascular disease

• Hypertension (HTN)

• Secondary: known biological cause (e.g., excess dietary salt)

• Essential: no verifiable physiological cause; assumed due to physiological and psychological factors

• > 33% population > 20 y/o have HTN

• Majority (~90%) have no verifiable physiological cause

• 20-64 y/o: male ≥ female 65+ y/o: female ≥ male

Hypertension (HTN) & psychosocial factors

• Association with personality factors:

• negative emotions (e.g., anger, hostility), their suppression

• more likely in African Americans

  • Culturally mediated

• Personality association stronger with increasing age, accumulation over time, body’s ability to adjust to suppressed anger

• Association with social factors: loneliness, depression, uncontrollability

• Levels of social support and blood pressure associated

Hypertension (HTN) & Genetics

• HTN runs in families

• those with family history show grerater reactivity

• offspring twice as likely to develop HTN

• elevated blood pressure evident during first weeks of life

Hypertension (HTN) & Stress

• Stress and heart attack

• long-term survival related to subsequent stress

• high stress without treatment leads to higher risk for later heart attack, 3 times more likely to die during 5-year follow-up

• Men at greater risk for heart attack

Treatment of hypertension

• Impact of cognitive-behavioral therapy, other non-drug therapies consistent with drug treatment effects

• Mediation

Psychological sequelae of physical illness

• Some infected with COVID-19 experience long-term effects

  • post-COVID conditions (PCC) or long-COVID

• Symptoms last much longer than usually expected / persist despite recovery from acute infection … may include:

  • Tiredness that interferes with daily life

  • Difficulty breathing / shortness of breath

  • Chest pain

  • Headache

  • Sleep problems

  • Changes in smell or taste

  • … and many more

Long COVID

• Many report variety of neurological/neuropsychiatric symptoms/disorders

• Such symptoms of neuro-COVID may include:

  • fatigue

  • brain fog

  • memory issues

  • attention difficulties

  • sleep disturbance

  • anxiety

  • dysphoria

• Severity of initial illness predicts probability of presence/severity of long-COVID, but not necessarily the experience of neuro-COVID symptoms

• World Health Organization reported that anxiety and depressive disorders increased by 25% worldwide during first year of COVID-19 pandemic

  • disproportionately seen in women

  • young people more likely to present with suicidal / self-harming behavior

• Still, COVID not necessarily responsible for this dramatic increase

• Must recognize wide-ranging stressors, including but not limited to

  • health risks / illness

  • changes in work / school-based activities

  • loss of family members / friends due to death / isolation

  • social isolation / withdrawal

  • financial strain

  • social / political discord …

• Increased availability of services (e.g., telehealth) insufficient to meet need

Reactions to traumatic stressors

• Do adverse consequences necessarily follow from exposure to biological and/or psychological stressors?

• George Bonanno and colleagues studied this relationship for many years. Argue that four distinct trajectories of response follow exposure to potentially traumatic events:

  • Chronic distress

  • Delayed reaction

  • Recovery

  • Resilience

Resilience

• Definition: Process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.

• Many previously saw this as rare (reflecting exceptional emotional strength) or as representing denial (illusory mental health)

• Resilience now recognized as more common than other three types of responses combined

• Most common outcome following traumatic experience is stable trajectory of healthy functioning!

• Unfortunately, attempts to predict resilience reveal a paradox:

  • Correlates of resilient outcomes are (statistically) modest, so it is not possible to accurately identify who will be resilient to potentially traumatizing experiences

• Among most consistently reported predictors:

  • Personality variables

  • Financial / educational assets

  • Coping/ emotional regulation strategies

  • Experience and expression of positive emotions

  • Demographics factors (e.g., male gender, greater educational attainment)

  • Exercise

Psychological treatment of physical disorders

• Unlike with exposure therapy (e.g., for Specific Phobia), when may not want to use such techniques …

• Relaxation training, biofeedback, meditation, hypnosis, others beneficial against hypertension

• Alone and in combination these may also help with:

• Headaches, insomnia, asthma, diabetes, chronic pain, irregular heartbeat, and others