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behavioral medicine
knowledge derived from behavioral science is applied to prevention, diagnosis, and treatment of medical problems
health psychology
study of psychological factors that promote and maintain health, as well as health care systems and health policy
2 primary paths psychological and social factors influence health
psychological factors influence biological processes
behavioral patterns increase disease risk
______ % of the leading causes of death in the US are linked to behavioral/lifestyle patterns
50%
examples of lifestyle patterns that can lead to death
smoking
poor eating habits
lack of exercise
insufficient injury control
General adaptation syndrome (GAS) - theory of stress response
Phase 1 - alarm response (to immediate danger)
Phase 2 - resistance (attempt to cope with stress)
Phase 3 - exhaustion (body suffers damage with stress that lasts too long)
Physiology of stress
Stress activates HPA axis
hypothalamus releases corticotropin-releasing factor (CRF) and stimulates pituitary gland
pituitary gland activates adrenal gland, secreting cortisol
hippocampus turns off stress response
what happens to hippocampus by chronic stress
it becomes damaged by chronic secretion of cortisol
social status in animals
subordinate animals have chronically high levels of stress, which compromises ability to respond to stress over time, and leads to compromised immune system
benefit of high social status: predictability and controllability of environment
diagram of contributions to stress response
as sense of control or ability to cope increases, our feelings range along continuum from depression, anxiety, stress, to excitement
psychoneuroimmunology
psychological influences on neurological component of immune response
what happened when rats where given sugar water
rats given sugar water with a drug that suppresses immune system
later, sugar water along suppressed immune system
immune system function
identify and eliminate foreign materials (antigens)
2 parts of immune system
humoral
cellular includes white blood cells (leukocytes), B and T cells (lymphocytes), and macrophages
macrophages
body's first line of defense
surround antigens and destroy them
signal lymphocytes
lymphocyte B cells
in humoral
release molecules that seek antigens in blood with purpose of neutralizing them
produce immunoglobulins that act as antibodies, which combine with antigens to neutralize them
memory B cells
created so next time antigen is encountered, immune response is faster
lymphocyte T cells
cellular part
don't produce antibodies
killer T cells destroy viruses and cancer cells
memory T cells created to speed up response to same antigen
T4 cells (helper T cells) enhance immune response by signaling B cells to produce antibodies and tell other T cells to destroy antigen
suppressor T cells suppress production of antibodies by B cells when not needed
what happens with too many T4 cells
helper T cells overreact and attack normal cells
in developing world, most die within _______ of AIDS
1 year
what is best treatment for AIDS
highly active antiretroviral therapy (HAART)
suppresses virus, slows progression and decreased mortality
severe side effects
US AIDS cases by mode of transmission
male to male sexual contact: _____%
heterosexual contact: ______ %
injection drug use: _________%
other: _______%
50%; 32%; 17%; 1%
what exacerbates AIDS progression
high stress
low social suppor
outcomes of cognitive-behavioral stress-management (CBSM) in those with AIDS
increased T-helper cells
lower antibodies
enhanced psychological adjustment
psychoncology
study of psychological factors in cancer
psychological and behavioral contributions to etiology and maintenance of cancer
perceived lack of control
poor coping responses
stressful life events
life-style risk behaviors
psychological factors impact cancer risk by impacting functions such as
immune function
viral actviity
DNA repair processes
Gene expression
psychosocial treatments for cancer improve
health habits
treatment adherence
endocrine function
stress response/coping
what is hypertension
high blood pressure
hypertension increases the risk for
heart disease
kidney disease
because it taxes blood vessels
hypertension prevalence
27.6% of North Americans aged 35-64
African Americans have 2x greater risk because of experiences of stereotype threat o
risk factors for hypertension
excessive sodium intake
sympathetic arousal
stress level
expressed anger
hostility
psychological factors that have been used to explain individual differences in blood pressure
personality
coping style
level of stress
psychological factors that contribute to cardiovascular disease
loneliness
depression
feelings of uncontrollability
coronary heart disease
blockage of arteries supplying blood to heart
psychological and behavioral risk factors associated with coronary heart disease
stress, anxiety, anger
poor coping skills
low social support
what is CHD linked to
type A behavior pattern (anger, excessive drive and competitiveness, impatience, accelerated speech, agitated motor activity)
chronic negative affect, low socioeconomic status, and stressful experiences
what factors reduce risk of CHD
positive emotions and optimistic style
reverse capacity model for risk factors for CHD
acute pain
follows an injury and disappears once injury heals/effectively treated
chronic pain
may begin with acute episode but doesn't decrease over time
pain behaviors
limping, complaining, avoiding activities
why is severity of pain not a good predictor of one's reaction to it
some experience intense pain and continue to work productively, rarely seek medical service, and lead normal lives
chronic pain is worsened by
low perceived control
negative emotion
poor coping skills
low social support
pain behaviors may be increased by
compensation (e.g., paid time off)
social reinforcement (sympathy)
gate control theory of pain
neurological processes (anxiety, fear, intense concentration) affect the degree to which pain is detected
negative emotions - message from brain is to be vigilant against danger
positive emotions - brain sends inhibitory signal to close gate
endogenous (natural) opioids
pain-inhibiting natural chemicals that may be increased by exercise
called endorphins
why do females have additional pain-regulation mechanisms
to facilitate childbirth
neurochemistry may be based on estrogen-dependent neuronal system
nature of chronic fatigue
lack of energy and fatigue that doesn't improve with adequate sleep
may have aches and pains or low fever
symptoms of chronic fatigue syndrome
subjective memory impairment
sore throat
tender lymph nodes
muscle pain
joint pain
headache
unrefreshing sleep
malaise lasting more than 24 hours
causes of chronic fatigue syndrome
unknown
may be response to stress
treatment of chronic fatigue syndrome
medications ineffective
CBT helpful (includes increasing activity, regulating rest, and stress reduction)
Core beliefs of someone with chronic fatigue syndrome
I am inadequate
lifestyle of someone with chronic fatigue syndrome
achievement-oriented and hard working
puts on brave face
doesn't ask for help
thoughts of someone with chronic fatigue syndrome
I must be physically ill
i'm making myself worse
there's nothing I can do
I should try harder to cope
I can beat this
biofeedback
psychosocial treatment of physical disorder
monitor and control bodily responses (heart rate, blood pressure, muscle tension, EEG rhythms)
increase sense of control
improves patient's ability to control bodily processes
relaxation and meditation
psychosocial treatment of physical disorder
progressive muscle relaxation
transcendental meditation: focuses attention on repeated mantra
increased sense of control and mastery
may improve headache, hypertension, acute and chronic pain
comprehensive stress and pain reduction program
monitor and identify stressful events (times, intensity, triggers)
monitor somatic symptoms
muscle relaxation
cognitive therapy
increase coping strategies (time management, assertiveness training)
more effective than individual components
drugs vs. stress reduction programs
medication decreases efficacy of comprehensive programs
high relapse when stopped
tolerance built over time
coping through denial
denial about physical condition can be helpful
helpful at early stages
later, more helpful to face situation
what is the leading cause of death from ages 1-45
accidents
injury prevention
repeated warnings not enough
programmatic efforts needed (teach children to escape fires and cross streets)
AIDS prevention
preventable by changing behaviors (safe-sex, sanitary use of needles, regular check-ups, strong peer support programs)
smoking cessation in China
capitalize on family relationships (children persuade fathers to stop)
distribute anti-smoking literature
target at-risk populations
stanford three community study
looking to reduce risk factors of CHD
conducted in 3 similar communities
each community either got: no intervention, media blitz, media blitz plus face-to-face intervention
highest benefit from media blitz plus live intervention
what is abnormal sexual behavior?
normative facts and statistics
cultural considerations
gender differences in sexual behavior and attitudes
how many partners in a lifetime and past year
15 or more (lifetime): men = 21.4%, female = 8.3%
4 or more (past year): men = 6%; female = 2.9%
homosexual sex attraction or behavior statistics
men = 10% women = 9%
sex in age 75-85 statistics
men = 38.5% active female = 16.7% active
gender differences in masturbation
men = 72% report ever masturbating female = 42% report ever masturbating
males masturbation may be easier and physical gratification more emphasized for men
gender differences in casual premarital sex
men are more permissive, but the gap is shrinking
gender differences in elements of satisfaction
women are more likely to seek demonstrations of love and intimacy
men are more likely to focus on arousal
no differences in gender differences of
acceptability of homosexuality
acceptability of masturbation
importance of sexual satisfaction
sexual self-schemas
beliefs about one's own sexuality
gender differences in sexual beliefs
females more likely to value experience of passionate and romantic feelings
minority of females hold embarrassed, conservative, or self-conscious views toward sex
males have fewer negative core beliefs about sex
men are more likely to emphasize dominance and aggression
cultural differences on views on sexuality in children
Sambia believe receiving semen contributes to development in children (emphasize homosexual oral sex between young boys)
Munda emphasize mild heterosexual activity (mutual masturbation) among cohabitating children
development of sexual orientation
bio-psycho-social influences
homosexuality (only small genetic component: 50% of identical twins raised together do NOT share same sexual orientation)
why did DSM III remove homosexuality as a disorder
no physiological differences in arousal between gay and straight
no difference in rate of psychological disturbance
gender identity confusion no more common in homosexuals
lack of full societal acceptance and different behaviors, homosexual sexual concerns differ from heterosexuals' concerns
sexual dysfunctions
involve desire, arousal, and/or orgasm
pain associated with sex can lead to additional dysfunction
sexual dysfunction present for how long to make a diagnosis
6+ months
desire phase
sexual urges occur in response to sexual cues or fantasies
arousal stage
sense of sexual pleasure and physiological signs of sexual arousal
plateau phase
brief period occurs before orgasm
orgasm phase
in males, feelings of inevitability of ejaculation, followed by ejaculation
females, contractions of walls of lower third of vagina
resolution phase
decrease in arousal after orgasm (particularly in men)
prevalence of sexual dysfunctions
common and not always distressing
40% of men have difficulty with erection/ejaculation, 63% of women have problems with arousal/orgasm
classification of sexual dysfunctions
lifelong vs. acquired
generalized vs. situational
psychological factors alone
psychological factors combined with medical condition
lifelong
chronic condition present during person's entire sexual life
acquired
disorder begins after sex has been normal
generalized
occurs every time individual attempts sex
situational
occurs with some partners or at certain times
desire disorders in men/women
men: hypoactive sexual desire
women: female sexual interest/arousal disorder
arousal disorders in men/women
men: erectile disorder
women: female sexual interest/arousal disorder
orgasm disorder in men/women
men: erectile disorder
women: female sexual interest/arousal disorder
pain disorder in women
genito-pelvic pain/penetration disorder (ex: vaginismus)
male hypoactive sexual desire disorder statistics
accounts for half of all complaints at sexuality clinics
affects 5% of men
DSM-5 for male hypoactive sexual desire disorder
persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity
symptoms have persisted for minimum of 6 months
symptoms cause distress in individual
sexual dysfunction not better explained by nonsexual disorder or consequence of relationship distress or other stressors and isn't attributable to medication or other medical condition specify whether: lifelong or acquired type specify whether: generalized or situational type
erectile disorder
difficulty achieving or maintaining erection
sexual desire intact
statistics for erectile disorder
most common problem for which men seek treatment
prevalence increases with age (60% of men over 60 experience erectile dysfunction)
female sexual interest/arousal disorder prevalence
prevalence decreases with age
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