Coronary Heart Disease (CHD) Risk Factors

• Health psychology studies how psychological factors impact illness and health.
• Behavioral Medicine is an interdisciplinary study of biological, psychological, and sociocultural determinants of health.

Coronary Heart Disease (CHD)

• CHD is caused by atherosclerosis, where cholesterol plaques form inside the coronary arteries and restrict blood flow.
• An artery blockage or detached plaque leads to a heart attack.
• CHD contributes to a high rate of premature deaths.

Epidemiological Risk Factors for CHD

• Advanced age is a risk factor
• Being male increases the risk
• Obesity is a risk factor
• High blood pressure is a risk factor
• Diabetes is a risk factor
• Smoking is a risk factor
• A high-cholesterol diet is a risk factor
• A sedentary lifestyle is a risk factor
• High-stress occupations are a risk factor
• Job status incongruity (high education but lower-class job) is a risk factor
• Significant life changes like relocation are risk factors

Friedman and Rosenman's Type A Pattern

• Cardiologists were interested in screening for CHD.
• Descriptions from friends of 150 male patients led to the proposal of Type A behavior patterns.
• Type A behavior is characterized by competitive achievement striving, a sense of time urgency/impatience, and easily provoked hostility.
• Type B personality is the opposite of Type A.

The Western Collaborative Group Study

• The study involved 3.5k male volunteers employed by California companies, all initially free of CHD.
• Detailed medical history, demographics, and lifestyles were collected.
• Type A patterns were assessed using a structured interview.
• Participants were followed up for 8.5 years (incidence of CHD) and 15 years (death).
• Blood pressure, cholesterol, and smoking were confirmed as key risk factors and were controlled for.

The CDC-Kaiser ACE Study

• Physicians provided 17.3k adults with a checklist of 7 categories of adverse childhood experiences (ACEs).
• ACE categories included physical, emotional, and sexual abuse, as well as family adversity such as mental illness, substance abuse, incarceration, and violation.
• ACE scores were correlated with health outcomes and medical histories.
• A dose-response relationship exists between the number of ACEs and physical and mental illness.

Stress

• Stress is the physiological and psychological responses experienced when an event/stressor places demands on an individual that are perceived to exceed their coping resources.
• Different models emphasize different aspects of this definition, leading to different measurement tools.

Holmes and Rahe Stressful Events Checklist

• Stress is defined as life events/changes that demand adjustment.
• It was initially assumed that the same events demand the same adjustment for everyone.
• Medical records of 5k patients were examined, identifying 43 life events associated with illness onset.
• Participants rated these events based on the degree of adjustment required.
• This led to the creation of the Social Readjustment Rating Scale, a checklist of 43 life events with corresponding adjustment scores.
• A higher score (in the past year) indicates a higher risk of physical illness.

Types of Stressors

• Eustress is positive and desirable stress
• Distress is negative and undesirable stress
• Major events are life changes and traumatic events
• Daily hassles are minor concerns and irritants
• Acute stressors are short-term and time-limited
• Chronic stressors are long-term, ongoing, and repeated

General Adaptation Syndrome (GAS)

• Selye defined stress as "the non-specific response of the body to any demand".
• A stress response is characterized by the same chain of physiological responses, regardless of the stressor

GAS - 3 Stages

• Alarm
• Resistance
• Exhaustion

Alarm Stage

• Activation of the Sympathetic Nervous System (SNS) via the catecholamine pathway (fight-or-flight).
• Results in rapid mobilization of resources.

Resistance Stage

• Activation of the Hypothalamic-pituitary-adrenal (HPA) axis occurs via the glucocorticoid pathway.
• Leads to a sustained supply of resources during this stage

Resistance Stage (prolonged)

• If stress is prolonged or chronic.
• Persistent activation of the SNS and HPA axis.
• Gradually causes damage to the body's systems
• Sets the stage for "diseases of adaptation" like hypertension, cardiovascular disease, high blood sugar, and immunosuppression.

Exhaustion Stage

• Continued exposure to stressors drains energy reserves during this stage
• Systems start to fail as the capacity to resist becomes depleted
• Results in illness or even death in severe cases

Limitations of Selye's GAS Model

• Selye's definition of stress was overly broad and ambiguous in his model
• Not all responses to stressors are uniform in the GAS model
• It underestimated the role of cognitive appraisals

Lazarus's Stress Appraisal Theory

• Stress is a product of the interaction between external events and the subjective perspective of the individual
• How individuals construe the event/situation and their capacity to cope with it determines the stress response.

2 Stages of Appraisal

• Primary appraisal (event): "How can it affect me?" leading to irrelevant, harm/threat, or challenge assessment
• Secondary appraisal (capacity): "Can I handle it?" based on controllability, self-efficacy, and available resources, leading to a stress and coping response

Review: Sources of Stress - What Gets to You

• Stressors are events and threats that place specific demands on a person or threaten well-being.
• Stress sources include negative life events, with even happy ones needing readjustment and preparedness.
• Chronic stress involves recurring triggers, both social and environmental.
• Events are most stressful when we perceive no way to control or deal with the challenge

Stress Reactions

• The body responds to stress with a fight-or-flight reaction, activating the hypothalamic-pituitary-adrenocortical (HPA) axis.
• The general adaptation syndrome (GAS) outlines three phases of stress response: alarm, resistance, and exhaustion.
• Chronic stress can weaken the immune system, increasing susceptibility to infection, aging, tumor growth, organ damage, and death.
• People who respond to stress with anger have a higher risk of heart disease.
• The response to stress depends on whether it's interpreted as something that can be overcome or not.
• Prolonged psychological stress can lead to burnout, particularly in emotionally demanding professions

Stress Management - Dealing with It

• Stress management includes strategies for influencing the mind, the body, and the situation.
• People manage their minds by suppressing thoughts, avoiding situations, rationally coping, or reframing
• Body management strategies involve reducing stress symptoms through meditation, relaxation, biofeedback, and aerobic exercise.
• Managing your situation can involve seeking social support, engaging in religious experiences, or finding humor

The Psychology of Illness - Mind Over Matter

• The psychology of illness concerns how sensitivity to the body leads people to recognize illness and seek treatment.
• The sick role comprises rights and obligations linked with illness; some people fake illness to accrue those rights.
• Successful health care providers interact with their patients to understand both their physical and psychological states.

The Psychology of Health - Feeling Good

• The connection between mind and body can be revealed through the influences of personality and self-regulation of behavior on health.
• Personality traits like optimism and hardiness are associated with reduced illness risk.
• Self-regulation of behaviors like eating, sexuality, and smoking is easily disrupted by stress, but maintaining self-control significantly improves health and quality of life.

Key Terms

• Stressors are specific events or chronic pressures that place demands on a person's well-being, having both immediate and cumulative effects.
• Stress is the physical and psychological response to internal or external stressors.
• Health psychology studies how psychological factors influence the causes and treatment of illness and the maintenance of health.
• Chronic stressors are sources of stress that occur continuously or repeatedly, often linked to social relationships or different environments.
• Fight-or-flight response is an emotional and physiological reaction to an emergency, coined by Walter Cannon.
• General Adaptation Syndrome (GAS) is a three-stage physiological stress response regardless of the stressor.
• Telomerase is an enzyme that rebuilds telomeres at the tips of chromosomes.
• The immune system is a complex response system that protects the body from foreign substances.
• Lymphocytes are white blood cells that produce antibodies to fight infection, including T cells and B cells.
• Type A behavior pattern is a tendency toward easily aroused hostility, impatience, time urgency, and competitive striving.
• Burnout is a state of physical, emotional, and mental exhaustion resulting from long-term involvement in an emotionally demanding situation, accompanied by lowered performance and motivation.
• Repressive coping involves avoiding feelings, thoughts, or situations that remind one of a stressor, while maintaining an artificially positive viewpoint.
• Rational coping involves facing a stressor and working to overcome it.
• Reframing involves finding a new or creative way to think about a stressor that reduces its threat.
• Stress inoculation training (SIT) helps people cope with stressful situations by developing positive ways to think about them.
• Meditation is the practice of intentional contemplation.
• Relaxation therapy reduces tension by consciously relaxing the muscles of the body.
• Biofeedback uses an external monitoring device to provide information about a bodily function for potential control, aiming for high-tech relaxation.
• Social support is aid gained through interacting with others.
• The sick role is a socially recognized set of rights and obligations linked with illness.
• Self-regulation is the exercise of voluntary control over the self to align with preferred standards.