Chapter 7 - Pain PDF

Chapter 7 Understanding and Managing Pain Mr. Arman Imran Ashok M. Clin. Psych....

Chapter 7 Understanding and Managing Pain Mr. Arman Imran Ashok M. Clin. Psych. [email protected] Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 1  Ice Breaker Activity 1. Break into small groups of no more than five people. 2. As a group discuss methods you use to deal with pain. Do you take medication? Try to “power through” it? Distract yourself? Do something else? Does your understanding of the source of the pain impact what you do about it? 3. Discuss the strategies your group members identified as a class. Were there common themes? Do some methods seem preferable to others? Why? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2  Chapter Objectives (1 of 2) By the end of this chapter, you should be able to… Trace the route of a pain signal from receptors in the peripheral nervous system to the brain Understand the role of neurochemicals in the perception of pain Understand the current definition of pain as a biopsychosocial phenomenon Identify the differences between acute, chronic and pre-chronic pain Identify the psychological factors that can influence the perception of pain Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3  Chapter Objectives (2 of 2) Understand and contrast three theories of pain and how they differ in their ability to ex-plain several “mysteries” of pain Understand some of the major types of pain syndromes Identify the strengths and limitations of three methods of measuring pain: self-report, behavioral assessment, and physiological measurement Identify the major medical approaches for managing pain, as well as their potential risks Identify major behavioral techniques for managing pain, and the psychological factors that each technique addresses Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4 Pain and the Nervous System 7.1 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 5  Discussion 1 Have you ever heard about endorphins, the naturally occurring neurotransmitters that play a role in modulating pain? a) Have you ever been aware of your body’s endorphin activity, for example, in a “runner’s high” or in giving birth? b) Why would an endorphin system be so important? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6  Somatosensory System Pain is the unpleasant feeling caused by illness or injury and is important for survival. protective mechanism what's to alert you going wrong Without it, we wouldn’t know when something was potentially wrong. The Somatosensory system conveys sensory information from the body to the brain, including pain. The somatosensory system consists of several senses, including touch, light/deep pressure, cold, warmth, tickling, movement, and body position. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7  1st alphabet #- ↑ > I - E x "Exit Afferent Neurons Afferent Neurons are one of three types (afferent, efferent, and interneurons) that work together to relay information from the sensory organs to the brain. − Afferent (sensory) neurons relay information from the sense organs toward the brain. − Efferent (motor) neurons result in the movement of muscles or the stimulation of organs or glands − Interneurons connect sensory to motor neurons. Primary afferents are specialized receptors in sense organs that convert physical energy into neural impulses and carry this information to the brain to be processed. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8  Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or 9 9 duplicated, or posted to a publicly accessible website, in whole or in part.  Involvement in Pain Chow you perceive pain) Nociception refers to the stimulation of sensory nerve cells that may lead to the perception of pain. Nociceptors in the skin and organs are capable of responding to various types of stimulation that may cause tissue damage. There are some that are covered with myelin, which are able to conduct neural impulses faster than unmyelinated C fibers do. ↳ unmyelinated As(? ) A-beta fibers are myelinated and can conduct Y A-beta myelinated : faster > - sharp pain impulses 100 times faster than the [C : nociceptors : unmyelinated Slower - > pain after unmyelinated C-fibers. C-fibers make up 60% of sensory afferents. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10  X 11 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11  The Spinal Cord The spinal cord is the primary conduit for Center) all sensory information to reach the brain. Protected by the vertebrae, any damage enter pathway Cafferent) to the spinal cord may interrupt the flow of sensory information. efferent (exit] The spinal cord’s most important role is providing a pathway for ascending D before sensory information and descending comes motor messages. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12 13 Brain: Pain Matrix Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13  Thalamus – primary relay centre for all sensory information (except smell) 14 all major ones pass through "KL Sentral" Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14  PFC – Planning, social judgement, and executive functioning 15 Cognitive aspect of pain – meaning of pain and what to do about pain trying to do something about the pair "Planning & judgement" Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15  ACC – Affective and emotional component (e.g., sense of suffering) 16 Initiation and facilitation of coping behaviour Emotional eg. suffering. etc Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16  SSC - Primary (S1): location of pain Where the pain - is 17 - Secondary (S2): severity and quality of pain - Sharp/generic sensation Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17 18 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18  Insular Cortex - Homeostasis 19 - Survival instincts underwater breathe forced - Lack of O2, pain, low blood sugar e.. g , can't , to breathe & pain "5th lobe in brain" Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19 20 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20  Neurotransmitters and Pain communicate pain y Neurotransmitters are chemicals that are synthesized and stored in neurons In the 1970s, researchers identified naturally occurring chemicals in the brain that affect pain perception − Endorphins, enkephalins, and dynorphins modulate pain & − Glutamate, substance P, bradykinin, and prostaglandins produce pain portant Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 21 dun have to memorize The Modulation of Pain Periaqueductal gray is an area near the midbrain involved in modulation of pain. When this part of the brain is stimulated, pain relief occurs. Where these neurons make connections with neurons in the substantia gelatinosa it limits the dorsal horn neurons from carrying pain information to the thalamus. Modulating pain may be important in some survival instances as in a fight or flight scenario our bodies can shut down the pain significantly. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22 23 rubbing dampens pain ? (pressure) ↳ press other receptors , triggered thalamus ↳elease other neurotransmitter to inhibit Cerey pain Jendorphine etz ] through prick. substance p pass being released here first) Ascending Pathway of pain - pinothala- Spinothalamic tract - nociceptors nie tracf dorsal afferent neuron substance elementermitte internation Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 23  The Meaning of Pain 7.2 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 24  Discussion 2 Have you ever seen a social media exchange (or heard an exchange in real life) between people who seemed to be competing to have the worst possible pain, with each one insisting that theirs was the worst imaginable? a) Why do you think people vary so much in their experience of pain? Why is it that a stimulus that one person experiences as troublesome discomfort is experienced by another as significant pain? What physical factors might play a role? What psychological factors? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 25  The Definition of Pain Pain is defined by the IASP Subcommittee on Taxonomy as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” (cut) The inclusion of emotion into this definition creates an understanding that pain can also be subjective. Pain can be viewed in terms of three stages: immediate sensation § Acute pain - normally brief from a cut, burn, injury; adaptive in that it signals the person to avoid further injury § Chronic pain - endures over months; no adaptive reason or biological benefit § Prechronic pain - occurs between acute and chronic pain Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 26  The Experience of Pain The experience of pain is individual and subjective, though situational and cultural factors influence the experience. Henry Beecher concluded that “the intensity of suffering is largely determined by what the pain means to the patient.” Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 27  Individual Differences in the Experience of Pain Factors such as personal experience can make a difference in the way people experience pain. When people learn to associate stimuli related to a painful experience with the pain and thus develop (classically conditioned Sresponses. poked by needle , see thin& sharp things > painful - John J. Bonica observed that people who receive attention, sympathy, relief from normal responsibilities, and disability compensation for their injuries and pain behaviors are more likely to develop chronic pain than those who have a similar injury but receive fewer rewards. baby sy Social learning theory states people learn behaviors through the observation of others, so should one person observe another in pain who is receiving rewards, they may learn that pain results in rewards. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 28  Gender Differences in Pain While there are gender differences in pain response between men and women, the reason for that remains murky. It could be that gender roles play a big part in who does and does not report pain. With the same stimuli, researchers observed that men who more closely align with a masculine stereotype were less likely to report pain than men who didn’t identify as strongly with a masculine role or women. It’s also possible that women report more pain because they are more susceptible to chronic pain disorders such as fibromyalgia. men-less tolerance , less report (gender role-masculinity) women-high tolerance , more report Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 29  Discussion Activity 1 Think about someone you know who experiences chronic pain. a) How has it affected their life? What changes have they experienced as a result of the pain? Have they been able to find effective treatment? If so, what and if not, why not? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 30  Theories of Pain 7.3 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 31  1) Specificity Theory Specificity theory explains pain by hypothesizing that specific pain fibers and pain pathways exist, making the experience of pain virtually equal to the amount of tissue damage or injury. valid (some don't feel out as painful) so x e. g. paper Due to the fact that any sensation has the potential to become painful, any simple version of the specificity theory is not valid. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 32  2) Gate Control Theory of Pain Melzack and Wall formulated a theory which suggests that pain is not the result of a linear process, rather that its perception is subject to a number of modulations that can influence the experience of pain. They further hypothesized that structures in the spinal cord acted as a gate for the sensory input that the brain identifies as pain. The central control trigger consists of nerve impulses that descend from the brain and influence the gating mechanism in the spinal cord. https://www.youtube.com/watch?v=oQLFfvGM7nI Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 33  Discussion Activity 2 Think back to the ice breaker activity and the nonpharmacologic methods people use to cope with pain. a) Use the theories of pain to account for why those methods might work. b) Do any of the theories seem better able to account for the effects than others? Why? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 34  term -long Pain Syndromes 7.4 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 35  Discussion 3 Do you have a recurring source of pain? a) How many people in your class experience recurrent headaches? b) How many have low back pain? c) How many have arthritis? d) What about other types of pain, like pain from an injury? Pain from cancer? Phantom limb pain? e) Is your class similar to the U.S. population as a whole, in which 30% experience chronic or intermittent pain? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 36  Headache Pain More than 30% of people in the US experience chronic or intermittent persistent pain. Headaches are a the most common type of all pain. They are broken down into three types: 1. Migraines are recurrent attacks of pain that vary widely in intensity, frequency, and duration. Chalf head pain) 2. Tension headaches are muscular in origin and are the result of sustained contractions in the neck, shoulders, scalp, and face. 3. Cluster headaches are a severe headache that occurs daily or nearly daily in clusters. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 37 38 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 38  Low Back Pain Upwards of 80% of people in the United States experience low back pain. In most cases, the pain isn’t serious and is often caused by injury. For those who do not recover, there is a poor prognosis and the development of a chronic pain problem. $90 billion in health care expenditures are spent every year by people with low back pain. There are many causes for low back pain including injury, stress, working environment, and psychological factors. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 39  Arthritis Pain Rheumatoid arthritis is an autoimmune disorder characterized by swelling and inflammation of the joints as well as destruction of cartilage, bone, and tendons. Osteoarthritis is a progressive inflammation of the joints; affects mainly older adults. Fibromyalgia is not considered an arthritic condition; it is characterized by tender points throughout the body. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 40  Cancer and Phantom Limb Pain Pain is present in 44% of all cancer cases § Almost half of all cancer patients’ pain is left untreated Phantom Limb Pain — the experience of chronic pain in a part of the body that is missing § Reports vary, but it may be that 90% of amputees experience phantom limb pain § Pain is more likely to occur when a person experienced much pain before the amputation § There may be an emotional basis to this pain but also the CNS and PNS may make maladaptive adaptations after the amputation Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 41  Discussion Activity 3 Chronic pain is sometimes referred to as an invisible disability – one that is not immediately apparent to others. a) Do you think this is an accurate characterization? Why or why not? b) Why do you think it is that some people become terribly impatient with those who experience chronic pain? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 42 The Measurement of Pain 7.5 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 43  Discussion 4 Has a health care professional ever asked you PAIN SCALE to rate your pain on a scale of 1 to 10 and perhaps showed you an image like this one? 0–1 No Pain 1–3 Mild Pain a) Why is it so important to have a 3–5 Moderate Pain systematic way to measure pain? 5–7 Severe Pain b) Why is it so hard to devise a systematic 7–9 Very Severe Pain way to measure pain? 9–10 Worst Pain Possible Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 44  Self-Reports and Behavioral Assessments Self-reports ask people to evaluate and make ratings of their pain using: 1. Rating scales, such as the Visual Analog Scale, where people rate their pain 2. Pain questionnaires, where people are asked to make certain distinctions about their pain like sharp versus dull 3. Standardized psychological tests, where dishonesty about pain can be assessed Behavioral assessments of pain use observation of the patient to assess pain § Record body movements and facial expressions looking for signs of pain § This method may be especially useful for children and elderly who may not be able to accurately self-report on pain Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 45  Physiological Measures Physiological Measures use Electromyography (EMG) to measure levels of muscle tension, as pain may increase tension; Heart rate to help predict the perception of pain, though this only works for men. Overall, physiological assessments may not be as valid as self-report or observational methods. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 46  Managing Pain 7.6 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 47  Discussion 5 Ketum ? morphineetz. ↳ What do you know about the opiate epidemic in your community? a) How much responsibility do the drug companies that aggressively marketed pain medications to physicians and the general public while downplaying the risks associated with the new opiate formulations have? b) What about physicians who prescribed the medications? c) Should drug companies and physicians be held civilly responsible for their roles? Criminally responsible? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 48 49 dun want do much work athritis can't more a lot-muscle deterioration increase - tolerance in pain not gotna work cognitive process medication not working , go Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 49  Drugs fastest in mitigating pain (acute One of the most common medical approaches is the use of drugs in pain relief. Drugs have a variety of effectiveness depending on the pain and seriousness of the condition. The most common form of drugs to treat pain are Analgesic drugs. While these do relieve pain, many analgesic drugs to treat severe pain are opiates and run the risk of becoming addictive if used over time. Nonsteroidal anti-inflammatory drugs (NSAIDS) are a type of analgesic medication that is not narcotic nor addictive and are what you may find in the pain-killer section of your local grocery store. side effects − While they can be toxic in large doses, causing stomach issues such as ulcers, or damaging the liver, they are relatively safe and effective for most common types of pain. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 50  Surgery Surgery aims to repair the source of the pain or alter the nervous system to alleviate the pain. While it can have good success rates, depending on the type of surgery, it can also result in complications. Low back surgery is the most common type of surgery for pain reasons. The major drawbacks to surgery are that it can’t always repair the damaged tissue correctly, and it may not provide patients with sufficient pain relief. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 51  Behavioral Approaches Psychologists have been prominent in devising therapies that teach people how to manage pain. Several behavioral techniques have proven effective with a variety of pain syndromes. Relaxation training, behavioral therapy, cognitive therapy, cognitive behavioral therapy, and mindfulness all play a role in helping to control pain without as much dependence on drug therapies. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 52  Behavioral Therapy Behavioral modification is the most prominent behavioral therapy. It comes from research around operant conditioning and is the process of shaping behavior through the application of operant conditioning principles. Creinforcement & punishment ( Its purpose is to shape behavior, not alleviate feelings or sensations of pain. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 53  Cognitive Therapy and CBT Cognitive Therapy is based on the principle that people’s beliefs, personal standards, and feelings of self-efficacy strongly affect their behavior. It helps them identify irrational thoughts or “catastrophizing” and eliminate or change them. Cognitive Behavioral Therapy (CBT) is a type of therapy aimed at developing beliefs, attitudes, thoughts, and skills to make positive changes in behavior. accepting living with condition One form of CBT is acceptance and commitment therapy (ACT), which encourages acceptance of pain by focusing attention on other valuable goals and activities. The practice of mindfulness is often taught in CBT. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 54  Discussion Activity What is it about today’s society that makes treatment of pain, especially treatment of chronic pain, so challenging? a) Is it “just” a matter of not having the right medical advances, whether pharmacologic or some other method? b) How much to attitudes towards pain and those who complain of pain play a role? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 55  Self Assessment What concepts related to pain were most challenging for you to grasp? What have you learned about the physiology of pain? What about the psychology of pain? § How does your understanding of the physiology and psychology of pain affect your understanding of why people’s experiences of pain may differ so much? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 56  Summary Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 57  Summary (1 of 2) Now that you’ve completed this chapter, you should be able to: Trace the route of a pain signal from receptors in the peripheral nervous system to the brain Understand the role of neurochemicals in the perception of pain Understand the current definition of pain as a biopsychosocial phenomenon Identify the differences between acute, chronic and pre-chronic pain Identify the psychological factors that can influence the perception of pain Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 58  Summary (2 of 2) Understand and contrast three theories of pain and how they differ in their ability to ex- plain several “mysteries” of pain Understand some of the major types of pain syndromes Identify the strengths and limitations of three methods of measuring pain: self-report, behavioral assessment, and physiological measurement Identify the major medical approaches for managing pain, as well as their potential risks Identify major behavioral techniques for managing pain, and the psychological factors that each technique addresses Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 59  Chapter 11 Living With Chronic Illness Mr. Arman Imran Ashok M. Clin. Psych. [email protected] Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 1  Ice Breaker: Activity 1. Break into small groups of no more than five people. 2. In your small group, discuss what you think of when you think of someone living with a chronic illness. mid Are they young or old? Active or not so active? Financially well off or struggling? Happy alone or not happy? Develop a description of the “typical” person who is living with a chronic illness. 3. Discuss your group’s descriptions as a class. Are there common themes? Is the view generally positive? Negative? Does it focus on a particular age group? Socioeconomic status? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2  Chapter Objectives (1 of 3) After reading this chapter, you should be able to: Identify the factors that affect the impact of chronic illness on the patient, as well as interventions that can help chronic illness patients Identify the factors that affect the impact of chronic illness on the family, as well as interventions that can help family members Understand the symptoms and types of Alzheimer’s disease, as well as the risk factors for the development and progression of Alzheimer’s disease Identify treatments and interventions that can help people who live with Alzheimer’s disease Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3  Chapter Objectives (2 of 3) Recognize the burden that Alzheimer’s disease places on caregivers and interventions that can help ease this burden Understand the difference between type 1 and type 2 diabetes, in terms of risk factors, prevalence, and management of the illness Identify the factors that relate to the management of diabetes, as well as interventions that can help Understand the symptoms of asthma, as well as the risk factors that put a person at risk for the development of asthma as well as an asthma attack Identify the factors that relate to the management of asthma, as well as interventions that can help people who live with asthma Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4  Chapter Objectives (3 of 3) Understand the symptoms and physiology of HIV and AIDS, as well as the major routes of infection Identify the role that psychologists play in both the primary and secondary prevention of HIV and AIDS, and interventions that help people living with HIV and AIDS Understand the unique issues experienced by people who face death Critique Kübler-Ross’s stage theories of dying and bereavement Identify interventions that may help people adjust to a terminal illness Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5 The Impact of Chronic Disease 11.1 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 6  Discussion 1 Do you or does anyone you are close to have a chronic illness? a) What is the illness? b) What impact does it have? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7  Impact on the Patient - trying to make them live normally Chronic disease plays an enormous physical and emotional burden on a patient, as well as a patient’s family. Adapting to chronic disease includes dealing with symptoms, managing stress, working with treatment options, living as normal a life as possible, and facing the possibility of death. − E.g., some people can maintain a busy lifestyle despite living with diabetes. However, people with heart disease, rheumatoid arthritis, and cancer experienced more intrusive symptoms than did those with hypertension, asthma, or diabetes. Finding support through effective mental health treatments such as psychosocial, cognitive behavioral, and even internet-based interventions has proved to be helpful. In some cases, people have even found positive aspects to their chronic illness. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8  Impact on the Family people start treating you differently · 6 Adaptation to a chronic illness is required by the family as well. They may have to deal with grief and feelings of loss during the sick person’s lifetime because families see the person’s loss of ability and sense of self. Involving the family in psychosocial interventions benefits the well-being of both the patient and the family member. Parents of chronically ill children often suffer from difficulties like the inability to maintain a normal routine due to the care needs of their child. g. quit job to take care e. Children also suffer from a lack of understanding of their illness if they’re young, to resenting the restrictions of their illness when they’re teenagers. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9  Discussion Activity 1 As the COVID pandemic has wound down, the issue of “COVID long haulers” – people who have recovered from the acute illness phase of COVID but who continue to experience a wide array of disabling symptoms – has received more attention. a) What have you heard about this syndrome? b) How is it affecting the lives of individuals who experience it? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11  Living with Alzheimer’s Disease 11.2 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 12  Discussion 2 Suppose that you or someone you are close to has been diagnosed with Alzheimer’s disease. a) What is your initial response? Are you afraid? Angry? Resigned? b) What kind of life will you or the person you are close to have in the early stages of the disease? As it progresses? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13  Living with Alzheimer’s Risk Factors Alzheimer’s disease is a degenerative disease of the brain. It’s a major source of impairment among older people. The only way to definitively diagnose Alzheimer’s is through an autopsy, though there is a 90% accuracy rate with brain imaging technology. The biggest risk factors are age, with those under 75 having only a 3% risk, with an increase to a 17% risk for those 75 to 85, and and a 32% among people 85 and older. Additional Risk Factors include things like diet, type 2 diabetes, activity levels, and a cognitively demanding career. ↳ stress , cortisol , diseases Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14  Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or 15 15 duplicated, or posted to a publicly accessible website, in whole or in part. 16 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16  Alzheimer’s Disease, Risk and Protective Factors factors Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18  Living With Alzheimer’s Symptoms A number of the symptoms of Alzheimer’s are also symptoms of psychiatric disorders, making it difficult to diagnose. These symptoms occur in a majority of people with Alzheimer’s disease. Aside from Memory Loss, behavioral symptoms include agitation, sleep disturbances, delusions, inappropriate sexual behavior, and hallucinations. Even those with mild cases of Alzheimer’s can display these psychiatric symptoms and they can often be just as upsetting to the patient as the caregivers. The more severe the behavioral issues, the shorter the survival time. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19  Living with Alzheimer’s Disease Depression Depression is often common among Alzheimer’s patients. 20% of people with Alzheimer’s display depression. Depression may be a precursor to Alzheimer’s as well. It may be worse for those who retain awareness of their problems and find their deterioration distressing and respond with feelings of helplessness and depression. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20  Helping the Patient There is currently no cure for Alzheimer’s, but there are treatments to slow the progression and help with the physical and psychiatric disorders that come with it. While there are many drugs that work to slow the disease, none of them are able to cure it. Other ways to help are behavioral approaches: − These include sensory stimulation and reality orientation to help patients retain their cognitive abilities. (classical) - calming − Music has been shown to be very effective, as well as aromatherapy, exposure to sunlight, and muscle relaxation training. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 21  Helping the Family Caring for an Alzheimer’s patient can be very difficult for the family, especially if the patient has become abusive and no longer recognizes their family. Caring for a family member with a dementing disease creates emotional and practical burdens. Alzheimer’s patients require time, demand new skills, and can greatly disrupt the family routine. The biggest emotional impact is the feeling of loss around the relationship they once had with this individual. While there is stress associated with caring for an Alzheimer’s patient, only 19% reported feeling only strain. The other 81% found positive aspects to the caregiving, such as feelings of mastery and personal and spiritual growth. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22  Discussion Activity 2 Suppose you were developing a program to help people with Alzheimer’s disease and their families and caregivers. a) What sorts of services would you want to include for the people with dementia? What about for their families or caregivers? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 23  Adjusting to Diabetes 11.3 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 24  Discussion 3 Do you or does anyone close to you have diabetes? a) Type 1 or Type 2? b) What sort of impact does it have on daily life? On overall health? Have there ever been any health emergencies related to the diabetes? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 25  The Physiology of Diabetes Diabetes mellitus is a disorder caused by insulin deficiency. The pancreas is located beneath the stomach and produces a number of different secretions. The islet cells of the pancreas produce several hormones, including insulin. The job of insulin is to lower blood sugar levels when they get too high. Diabetes prevents the release of insulin, resulting in the body being unable to absorb and use the sugar. Coma and death are possible if diabetes isn’t controlled. There are two types of diabetes, known as type 1 and type 2. borned − Type one is insulin-dependent, meaning that the patient requires insulin to be added to their blood. Own behavior − Type two is the most common and is often the result of lifestyle choices and socioeconomic status. Being sedentary, poor, and overweight increase the risk of developing type 2. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 26 Characteristics of Type 1 and Type 2 Diabetes Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 27  The Impact of Diabetes There are many factors to consider when it comes to the impact of diabetes. Being aware of the disease means that the patient is also aware that their risk for CVD, retina damage, kidney diseases, and pancreatic cancer are all higher. Diabetics will need to test their blood sugar one to several times a day to make certain that their levels are remaining steady. Blood is the most accurate way to test, though there are less accurate alternatives. Type 2 diabetes generally does not require insulin injections but does require lifestyle changes and oral medication. Losing weight, getting exercise, and bariatric surgery can all resolve type 2 diabetes. Type 2 is likely to cause circulatory problems which can lead to cardiovascular problems, which is the leading cause of death for type 2 diabetics. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 28 29 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 29  Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or 30 30 duplicated, or posted to a publicly accessible website, in whole or in part.  Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or 31 31 duplicated, or posted to a publicly accessible website, in whole or in part.  Health Psychology’s Involvement Lifestyle changes 1 etc. with Diabetes Stress. - - bingeon. 2 Stress may play two roles in diabetes: as a possible cause of diabetes and as a factor in the regulation of blood sugar in diabetes. While the evidence is thin regarding the the link between stress being the cause of diabetes, there is much stronger evidence that stress affects glucose metabolism and control among those with diabetes. Stress management has shown a small but significant effect on blood sugar levels. Depression has also been shown to raise blood glucose levels, demonstrating that negative emotions can adversely affect diabetes. Social support and accurate information are important in the control of diabetes. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 33  Discussion Activity 3 It’s not uncommon for people to have very different attitudes towards those with Type 1 and Type 2 diabetes. a) Why do you suppose that is? Is there a difference between the types that might cause it? b) Is it fair? c) How might stigma associated with Type 2 diabetes make it more difficult for people with it to live healthier lives? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 34  The Impact of Asthma Chapter 11.4 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 35  The Disease of Asthma Asthma is a chronic inflammatory disease that causes constriction of the bronchial tubes, preventing air from passing freely. Asthma attacks display as wheezing, coughing, trouble breathing, and can be fatal in rare instances. The cause of asthma is not understood. It may not be a single disease, but a number of diseases that share symptoms yet have different underlying pathologies. The diathesis-stress model of asthma is a variation on the allergen belief, stating that certain allergens may be the cause of asthma. Those who are not exposed to the allergens but have the underlying allergy may never develop asthma. The hygiene hypothesis states that asthma is a result of the cleanliness that has become common in modern societies. Because we are exposed to fewer microbes, we are more likely to get asthma. This has been shown to be true in studies. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 36  Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or 37 37 duplicated, or posted to a publicly accessible website, in whole or in part.  Managing Asthma While both asthma and diabetes may require frequent contact with the healthcare system, their treatments are similar only in that they can both be life threatening and pose substantial adherence problems. Managing asthma may require a number of medications including pills and oral inhalers for acute attacks. Watching out for triggers is something else patients will have to do once they know what those triggers are. Boosting medication adherence and self-care are important steps to controlling asthma and avoiding life-threatening attacks. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 38  Discussion Activity 4 Do you or does anyone close to you have asthma? a) What sort of impact does it have on daily life? On overall health? Have there ever been any health emergencies related to the asthma? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 39 Dealing with HIV and AIDS 11.5 Brannon, Updegraff & Feist, Health Psychology, 10th 10th Edition. Edition.©2022 ©2022Cengage. Cengage.All AllRights RightsReserved. Reserved.May Maynot notbe bescanned, scanned,copied copiedor or duplicated, or posted to a publicly accessible website, in whole or in part. 40  Discussion 4 What do you know about HIV and AIDS? breast with shared needles a) How is HIV transmitted? unprotected oral sex , , pregnancy , & saliva X b) Who is at highest risk? Who is at lower risk? c) How can HIV transmission be prevented? Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 41  Incidence and Mortality Rates of HIV/AIDS AIDS is the result of exposure to a contagious virus, the human immunodeficiency virus (HIV). There are two variations; HIV-1 and HIV-2. HIV-1 is primarily found in the United States while HIV-2 is prominent in Africa. AIDS was first recognized in 1981 and identified in 1983 making it a fairly new disease. Deaths from AIDS spread widely during the 1980s but beginning in 2005 those death rates declined sharply. Despite the change, AIDS is still among the leading causes of death in the world, and the leading cause of death in Africa. There is currently no vaccine, but drug therapies have greatly extended the lives of those living with HIV. African Americans account for the highest number of infections in the United States, and young adults account for a percentage of new infections due to their risky behavior. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 42  Symptoms of HIV/AIDS HIV progresses over a decade or more from infection to AIDS, but the progression varies. Early symptoms are not easily distinguishable from those of other diseases. Some people experience symptoms consisting of fever, sore throat, skin rash, headache, and other symptoms that resemble the flu. − This may last from a few days to 4 weeks. After that, there is a period that can last 10 years during which infected people are asymptomatic. low viral load. As their immune system is slowly incapacitated by HIV, they may begin to experience symptoms such as weight loss, persistent diarrhea, white spots in the mouth, painful skin rash, fever, and persistent fatigue. As it progresses from there, people become susceptible to lung, gastrointestinal, nervous system, liver, bone, and brain damage from diseases most would be able to otherwise fight off. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 44 45 Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 45  The Transmission of HIV (1 of 4) HIV is an infectious organism with a high fatality rate, though it is not easily transmitted from person to person. The main routes of infection are from person to person during unprotected sex, direct contact with blood or blood products, and from mother to child during pregnancy, birth, or breastfeeding. Concentrations of HIV are especially high in the semen and blood of infected people. No evidence exists that any sort of casual contact spreads the infection. Kissing, touching, sharing plates, and even insect bites carry no risk of transmission. Male-Male Sexual Contact made up the majority of cases in the early years of the epidemic. While there was a sharp decline in new cases from male-male sex in the 1990s, that number has again risen to be more than half of new infections. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 46  The Transmission of HIV (2 of 4) Unprotected anal intercourse is an especially risky behavior. Anal intercourse can damage the delicate lining of the rectum, so the receptive person has a high risk if their partner is HIV Positive. As semen has a high concentration of the virus, it’s also possible that unprotected oral sex could lead to an infection if there is a cut in the mouth. Condoms have become the primary way to protect oneself from HIV infection during any kind of sexual activity with a male partner. · include tattoo needle Injection Drug Use is another route for infection. Sharing needles with somebody who is HIV positive puts a non-infected person at high risk for contracting the disease. Higher risk groups for infection through injection drugs include African Americans, Hispanic Americans, and women. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 47  The Transmission of HIV (3 of 4) Heterosexual contact is the leading source of HIV infection in Africa and the second leading source of infection in the United States, accounting for 25% of new cases in the US. Women are at far greater risk than men if they’re sleeping with an infected partner due to the concentration of HIV in the semen. In fact, women are 8 times more likely to be infected by their male partner than men are by their female partner. It’s been found that too much trust has been the reason for many HIV infections. Trust has led to unprotected sex with an infected partner, which results in infection. While regular condom use is important to help protect against HIV infections, most people use them as a means to prevent pregnancy. Brannon, Updegraff & Feist, Health Psychology, 10th Edition. ©2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a pub