Fight or Flight Response

• The final exam will be held in class on March 18th, from 8:00 a.m. to 10:00 a.m.
• The exam consists of multiple-choice questions and requires a scantron.

General concepts

• The Fight-or-Flight theory was researched by Walter Cannon in 1929.
• Fight-or-Flight theory is marked by sympathetic activation.
• During fight or flight, blood flow to skeletal muscles increases
• Fight or flight causes increased heart rate and blood pressure and opening of airways
• Fight or flight causes pupils to dilate, eyes to adjust, and sweat increases.
• Digestive and urinary activities are inhibited during fight or flight
• Epinephrine and norepinephrine are released during fight or flight.
• Fight or flight affects the parasympathetic and sympathetic systems.
• Tend-and-befriend describes how humans respond to stress with social affiliation and nurturing behavior.
• Tend-and-befriend applies most readily to women.
• Psychological appraisals of stress include primary and secondary appraisals.

Primary Appraisal

• Primary appraisal asks, "Is the event positive, negative, or neutral?"
• If negative, primary appraisal asks, "Does it imply threat, harm, or challenge?"

Secondary Appraisal

• Secondary Appraisal asks, "Do I have the coping abilities and resources?"
• Secondary Appraisal asks, "Are they sufficient to meet the threat, harm, or challenge?"
• Subjective Appraisal = stressor leading to your reaction to the stressor, which leads to a stress response.
• Stressor: event in the outside world that knocks you out of balance.
• Stressors can be an expectation or anticipation of an event.
• Previous Day Health Complaints can lead to Next Day Health Complaints.
• General Adaptation syndrome was researched by Hans Selye in 1936.

Alarm Phase

• During the Alarm phase, the body shows changes upon initial exposure to a stressor (fight-or-flight).
• Breathing rate, heart rate, and blood pressure increase quickly during the alarm phase.
• Burst of energy aids in dealing with the stressful situation during the alarm phase.

Resistance Phase

• The body enters resistance in the resistance phase if it continues to be "alarmed".
• Resistance phase allows for a successful mobilization to combat the stressor.

Exhaustion Phase

• If exposure to stress continues, the body enters exhaustion.
• Exhaustion phase is a negative outcome to stress because energy resources are depleted.
• Stages of delay behavior affect different types of coping styles.

Types of coping styles

• Coping styles include behavioral and psychological efforts to master, tolerate, reduce, or minimize stressful events.
• Problem-focused coping involves doing something constructive about the situation.
• Types of Problem-focused coping: confronting the problem directly, use of time management, dialogue with the individual, getting resources to deal with the problem
• Emotion-focused coping regulates the emotional effects of a situation through behavioral or mental methods.
• Behavioral Emotion-focused coping: Watching TV, seeking out others for comfort, drinking/ eating, express feeling
• Cognitive Emotion-focused coping: Positive reframing, avoid thinking about it, process feelings

Types of Social Support

• Types of social support includes tangible assistance, informational support, emotional support, and invisible support.
• Under the Social convoy model, you have convoy membership stable over time and no longer role dependent (spouse, close friends, close family).
• Under the Social convoy model, convoy membership is somewhat role-related and likely to change over time (family relative, friends, neighbors).
• Under the Social convoy model, convoy membership is tied directly to role relationships and is most vulnerable to role changes (neighbors, supervisors, distant family, professionals, coworkers).
• Socioemotional selectivity theory (SST) states that Emotion Trajectory begins in infancy, dips during adolescence, begins to increase in middle age, and remains same during old age
• Socioemotional selectivity theory (SST) states that Knowledge Trajectory increases from infancy, begins to dip during middle age, and remains same during old age.

Social determinants of health (SDOH)

• SDOH includes Economic Stability: Employment, Income, Expenses, Debt, medical bills, support.
• SDOH includes Neighborhood and Physical Environment: Housing, Transportation, Safety, Parks, playgrounds, walkability, zip code/ geography.
• SDOH includes Education: Literacy, Language, Early Childhood education, vocational training, higher education.
• SDOH includes Food: Hunger, Access to healthy options.
• SDOH includes Community and Social Context: Social Integration, Support systems, community engagement discrimination, stress.
• SDOH includes Health Care system: health coverage, provider availability, provide linguistic and cultural competency, quality of care.
• SDOH includes Health outcomes: mortality, morbidity, life expectancy, health care expenditures, health status, functional limitations.
• Social support is generally beneficial during non-stress times and during highly stressful times.
• Low support correlates with maladaptive coping.
• Higher support correlates with adaptive coping.
• Stressors impact health through social support.
• Social support is inbetween stressors and health.

Diathesis-stress model

• Diathesis: a predisposition or vulnerability (inherited predisposition to develop the disorder).
• Stress: Environmental stressors (Prenatal trauma, childhood sexual or physical abuse, family conflict, significant life changes).
• Development of the Disorder: The stronger the diathesis, the less stress is necessary to produce the disorder (psychological disorder).
• Cognitive restructuring
• Cognitive restructuring allows one to find meaning and sense of control and restore self-esteem.
• Stress management
• Stress management techniques activate your PNS and slow down breathing and heart rate and is a psychological intervention.
• Cisgender women and elderly persons use health services at a higher rate than cosgender men and younger individuals.

Misusing health services

• Misusing health services involves using health services for emotional disturbances.
• Examples of misusing health services:
  • Hypochondriasis: worry excessively about one's health
  • Somaticizers: those who express distress and conflict through bodily symptoms
  • Worried well: people concerned about physical and mental health
  • Delay behavior: person may live with one or more serious symptoms for months without seeking care
  • Appraisal delay: the time it takes a person to interpret that a symptom is an indicator of an illness and is quicker when experiencing severe pain or bleeding
  • Illness delay: the time between recognizing that a symptom implies an illness and the decision to seek medical attention and to seek treatment for new symptoms
  • Utilization delay: the time between deciding to seek medical care until actually going to use in the health service and involves consideration of barriers and benefits (e.g. cost)
• Common sense models of illness

Culture

• Culture impacts: recognizing symptoms (am I sick?), seeking treatment, treatment and adherence, appraisal/delay, illness delay, utilization delay, and patient practitioner interactions.
• Forms of alternative and complementary medicine
• Patient-Provider relations and Issues with poor Patient-Provider relations
• Types of treatment for chronic illness
• Placebo effect
• Defining quality of life
• How does chronic disease affect aspects of our “self”?

Additional Terms

• Nonadherence: when patients indirectly disobey their doctors' orders often by modifying and supplementing their treatment plans
• Adherence: Extent to which a patients behavior matches with his or her practitioners advice
• Malingering: Exaggerate or feign illness in order to escape duty or work
• Medical student syndrome is when medical students study an illness, many begin to imagine that they have it
• Cortisol
  • Released by the adrenal cortex
  • Inhibits aspects of immune functioning
  • Regulates other physiological processes
• Self-efficacy
  • Conviction that one can successfully execute the behavior required to produce the outcome
• Self-esteem and Optimism
  • Personality trait that buffers us against stress and illness but may delay us from seeking treatment.
  • Is a key factor in influencing health behaviors
• Hardiness
  • A psychological ability to endure difficult conditions
• Psychological control
• Lay-referral network
  • Social: lay referral network is an informal network of family and friends
• Somaticizer
  • To convert psychological distress or emotional issues into physical symptoms or bodily complaints
• Worried well
  • A group of patients who are perceived as using health services inappropriately or disproportionately, when other more deserving patients should be given attention
• Hypochondriac
  • A person with a psychological disorder characterized by excessive preoccupation with one's health and constant worry about developing physical illness
• Secondary gains
• Evidenced based medicine
• Biopsychosocial model
• Illness behaviors
  • Three models of illness: acute illness, chronic illness, cyclic illness
• Primary and secondary appraisals in coping
  • Am I okay? What can I do?

Prevention/intervention

• Confirmation bias: is the phenomenon by which, when we believe something is true, we change the way we interpret new information and the way we look at the world because of it to confirm our belief and have a bias in how we process information
• Attributions

Cultural competence

• Cultural competence: a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations.
• In healthcare:
  • Coordinate with traditional heaters, use community health workers and incorporate culture-specific attitudes and values into health promotion tools
  • Include family and community members in health care decisions
  • Locate clinics in geographic areas that are easily accessible for certain populations
  • Provide linguistic competency in all areas of health care
• Provider needs to have knowledge and awareness of:
  • health -related beliefs, practices and cultural values of diverse populations; illness and diagnostic incidence and prevalence among culturally and ethnically diverse populations; treatment efficacy data (if any) of culturally and ethnically diverse populations
• Cultural awareness and sensitivity

Definitions of health

• WHO defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
• Health psychologists study psychological influences on how people stay healthy, why people become ill, and how they respond when they get ill and focus on health promotion and maintenance, prevention and treatment of illness, etiology and correlates of health, illness and dysfunction, the health care system, and the formulation of health policy

Medical/integrative approaches to treatment (Chapter 3)

• Medical/integrative approaches to treatment include: acupuncture, aromatherapy, ayurveda, chiropractic, dietary supplements, electromagnetic fields, homeopathic medicine, mediation, massage therapies, naturopathic, Qi gong, Reiki, Spinal manipulation, and therapeutic touch

The nervous system: CNS/PNS

• CNS: Central Nervous System
  • Brain
    • Medulla: Breathing, heart rate blood pressure
    • Reticular formation: Tells brain what to do (sleep; arousal; attention)
    • Cerebellum: Balance; coordinating movements
    • Sensory processing, endocrine structures and higher reasoning
    • Thalamus: Integrates sensory input from the environment; sensory relay station
    • Hypothalamus: Organizes responses to stressors; maintains balance; eating, sleep, and hormonal responses
    • Cerebral cortex: "Thinking part” of the brain; elaboration of thought
      • Parietal: senses: touch and spatial awareness
      • Temporal: auditory processing and communicates with hippocampus to produce long-term memories; hearing
      • Occipital: visual processing
      • Frontal lobe: executive functioning
    • Limbic system: (includes amygdala, hippocampus) emotional center
      • Emotional behavior, motivation and learning
    • Spinal Cord
  • PNS: Peripheral Nervous System (Body)
• The endocrine system
  • Pituitary gland
  • Thyroid
  • Adrenal glands
  • Ovaries
• What factors influence health behaviors (Chapter 7)
  • Types of behaviors: well behavior, symptom-based behavior, and sick-role behavior
• Different types of health messages.
• Identify what occurs during each stage according to the Transtheoretical model of behavior change.

Stages of Transtheoretical model of behavior change

• Precontemplation: not aware of behavior, no intention to change
• Contemplation: aware that the problem exists, thinking about change, weighing pros and cons
• Preparation: intend to change, modified but not committed
• Action: modified and commitment to time and energy
• Maintenance: working to prevent relapse
• Termination phase: no longer tempted by the unhealthy behavior that's been changed

Components of the health belief model (HBM)

• Components of the health belief model are: perceived threat (seriousness, susceptibility, cues to action), beliefs and barriers (will the behavior reduce risk? benefits outweigh costs?)
• Components of the health belief model equal the likelihood of performing the health behavior
• Components of the health belief model are measured through questions.
• Other factors of the health belief model include gender, age, and education level
• Strengths of HBM: useful constructs, focuses on people's belief it is a subjective model
• Weakness of HBM: assumes behavior is rational, assumes people have the skills to alter behavior, ignites social context of many health behaviors
• Self-determination theory includes:
• Competence (feeling effective at one's activities), Autonomy (having a choice, being able to be yourself), relatedness (feeling connected to others, sense of belonging); this leads to motivation and engagement which leads to enhanced performance and well-being Components of the theory of planned behavior are: People decide their intentions in advance of most involuntary behaviors Intentions are best predictors of what people will do Attitudes, subjective norms, perceived control leads to intentions which leads to actions Strengths of TPB: Incorporates social aspect of health behaviors, does not assume people want to be healthy, includes person's beliefs about their ability to change Weakness of TBP: Predicts intentions, not actual behaviors, people don't always do what they intend to do

Eating disorders

• Eating disorders have treatments such as cognitive-behavioral treatments, family therapy, pharmacological agents; with treatment, 60-80% recover.
• Anorexia nervosa: Severe restriction of food intake, fear of gaining weight, distorted body image, and weight loss; can be a fatal disease; affects about 1% of the population
  • Higher rates among women and predominates with teens and twenties.
  • Higher rates of anorexia nervosa in western cultures
• Bulimia nervosa: binge eating followed by purging behaviors (vomiting, laxative use), feelings of guilt; eating ~2 hours large amounts of food; 1z/wk, 3 months (criteria for diagnosis)
  • Bulimia nervosa symptoms: menstrual problems, swelling of cheeks and jaws, sore throat, swollen salivary glands, bloating, stained or chipped teeth, and cuts or scars on back of hands
• Binge eating disorder: recurrent episodes of binge eating without compensatory behaviors and feelings of loss of control
• Avoidant restrictive food intake disorder (Arfid): restriction of food intake due to sensory sensitivities or gear of changing
• PICA: Persistent eating of non-food substances (dirt, hair, paper)

Obesity and health issues

• Obesity: BMI ~above 30 kg/ m^3
  • Class 1 obesity: BMI 30-35
  • Class 2 obesity: BMI 35-40
  • Class 3 obesity: BMI more than 40
• Causes of obesity: genetics, environments, socioeconomic status, eating behavior (overeating/ poor nutrition), physical inactivity/ sedentary lifestyle
• Effects of obesity: infertility, psychological problems, sleep apnea, cancer, arthritis, cvd, insulin resistance/ diabetes
• Health compromising behaviors
• The role of personality in health
• Big five personality traits:
  • Conscientiousness: ethical, dependable, productive, and purposeful
  • Agreeableness: sympathetic, warm, trusting, and cooperative
  • Neuroticism: anxious, insecure, guilt-prone, and self-conscious
  • Openness to experience: daring, nonconforming, and imaginative
  • Extraversion: talkative, sociable, fun-loving, and affectionate

The role of personality in coping

• Optimism, Extraversion, Conscientiousness, agreeableness lead to engagement coping
• Neuroticism leads to disengagement coping
• Disability types and psychological issues living with a disability
• Types of disabilities:
  • ADHD (15.9%)
  • Learning disability (4.7%)
  • Blind/ low vision (4.2%)
  • Autism (4%)
  • Deafness, hearing loss (2%)
  • Mobility (1.7%)
  • Speech or language disorder (1.1%)
• Psychological issues for disabilities:
  • The patient: high levels of anxiety, depersonalization
  • Health care professional: burnout leads to emotional exhaustion, depersonalization, and perceived inadequacy
• Coping with disability and chronic illnesses

Adapting to disability/ chronic illness

• Adaptation to disability/ chronic illness involves:
  • Performance of daily tasks
  • Decreases psychological disorders
  • Low negative affect / high positive mood
  • Good functional status
  • Satisfaction in multiple domains of life

Approaches to coping include

• Approaches to coping include: gratitude, appraisals, support, and optimism
• Death across the lifespan
• Leading cause of death: heart disease, cancer, unintentional injury, stroke, etc.
• Leading causes of death per life stage: Infancy: congenital abnormalities Early childhood: unintentional injuries, congenital abnormalities Teen years: UO homicide and suicide Early adulthood: UI, cancer, heart disease Middle adulthood: cancer, heart disease, UI Other adulthood strokes: heart diseases, cancers
• Stages of death:
• Denial
• anger
• bargaining
• depression
• acceptance
• Cancer screening/incidence/mortality

Cancer

• Cancers: Gastrointestinal, sarcoma, skin cancer/ melanoma, gynecologic, genitourinary, blood, breast, endocrine, head/neck, central nervous system, brain, eye, lung, hepatobiliary
• Rates of Cancer
  • Female 32%, lung and bronchus 12%
  • More women to get breast cancer
  • Male: 29% Prostate and 11% colon and rectum
  • Men have high rates of prostate
• Less men and women are dying; mortality rates decreasing
• Prevention and screening: adverted 4.75 million 80% of deaths and 98% lung cancer deaths averted due to prevention- stop smoking efforts
• Treatments: curative, surgery: remove tumor and possible surrounding tissue; radiation, beam or internal therapy; chemotherapy: drug therapy
• Cancer, stress, and immunity