Clinical Textbook - Chapter 5 PDF

Clinical Textbook- Chap.5 Health Psychology- Concerned with the e ects of stress and other psychological factors in the development and maintenance of physical problems. Behavioural Medicine- Approach to physical illness that is concerned with psychological factors that may predispose an individual...

Clinical Textbook- Chap.5 Health Psychology- Concerned with the e ects of stress and other psychological factors in the development and maintenance of physical problems. Behavioural Medicine- Approach to physical illness that is concerned with psychological factors that may predispose an individual to medical problems. - Can include stressful life events, personality trays, coping styles, and lack of support. Stress- When we experience or perceive challenges to our physical or emotional well- being that exceed our coping resources and abilities. - Interactive because it is a dynamic interplay between the organism and environment. - Can result from both positive (like wedding days) and negative stress (distress- causes more damage). Stress and the DSM - PTSD was classi ed as an anxiety disorder, as now is considered a trauma and stress related disorder (adjustment and acute acute stress disorder are also included there). Factors Predisposing a Person to Stress Individual Characteristics- Coping skills, optimism, psychological control, self-esteem, and social control have all been liked to reduced levels of distress. Genetics- Can play a role in how reactive we are to stress. - A gene (5HTTLPR) was linked to how likely it was that people would become depressed in reaction to a stressor (“short” gene carriers experienced more depression). Exposure- Being exposed to a single stressful experience can enhance responsiveness to stressful events that occur later (sensitization). Characteristics of Stress 1. The severity of the stressor. 2. The chronicity (how long it lasts- the longer, the more impact it has). 3. The timing of the stressor (multiple stressors at the same time are worse). 4. How closely the stressor a ects our lives. 5. How controllable the stressor is (predictability is less stressful). fi ff ff  Measuring Life Stress Social Readjustment Rating Scale- A self-report checklist of common, stressful life experiences. Life Events and Di culties Schedule- An extensive manual that provides rules for rating both acute and chronic forms of stress. Resilience- Healthy psychological and physical functioning after a potentially traumatic event. - Factors that increase resilience include being male, being older, being more positive, and being well educated (social class). Stress and Physical Health Allostatic Load- The biological cost of adapting to stress. - Stress can worsen immunity, allergies, headaches, the risk for having heart attacks and arthritis. - Mental stress raises blood pressure, elevates epinephrine, and reduces oxygen supply to the heart. Sympathetic-Adrenomedullary System- Designed to mobilize resources and prepare for a ght-or- ight response. - Begins in the hypothalamus, which stimulates the sympathetic nervous system which causes the adrenal glands to secrete adrenaline and noradrenaline. - As they circulate through blood, they cause an increase in heart rate and causes the body to metabolize glucose more rapidly. Hypothalamic-pituitary-adrenal System- The hypothalamus will release corticotropin- releasing hormone, which stimulates the pituitary gland. - The pituitary gland then secretes adrenocorticotropic hormone which induces the adrenal cortex to produce stress hormones called glucocorticoids (cortisol). Cortisol- Good hormone to have in an emergency as it prepares the body for ght or ight. - If there are high levels over an extended period, it can damage brain cells, especially in the hippocampus (caused by the HPA axis staying active). Immune System Psychoneuroimmunology- The study of interactions between the nervous system and the immune system. - There is a feedback loop because a person’s psychological state can in uence the immune system, and the immune system can also in uence mental state. Immune System- Aimed to protect the body from viruses and bacteria. If it is weak, the body can succumb to damage, and if it is to strong, it can turn on the body’s own cells. fl fi fl ffi fl fl fi  Leukocytes- Body’s rst line of defence; produced the bone marrow and stored in various places throughout the body. B-Cell- Produces speci c antibodies that are designed to respond to speci c antigens (virus, bacteria, tumor and cancer cells). - When it recognizes an antigen, it begins to divide and produce antibodies, being helped by cytokines that are released by the t-cells. T-Cell- Has receptors on its surface that recognize one speci c type of antigen (but can not recognize them by themselves). - Become activates when immune cells called macrophages detect antigens and start to digest them, releasing interleukin-1. - When activated, t-cells destroy the antigen. Stress and Immunity - Can delay healing of wounds because stress is linked to the suppression of the immune system. Cytokines- Small protein molecules that are chemical messengers and allow immune cells to communicate with one another. - Act on the brain and create symptoms of illness like tiredness and loss of appetite. - Play a role in mediating the in ammatory and immune response. Pro-in ammatory Cytokines- Help us deal with challenges to the immune system by augmenting the immune response. - Are suppressed during stress, which brings about longer healing. Anti-in ammatory Cytokines- Decrease or dampen the response that the immune system makes, sometimes by blocking the synthesis of other cytokines. Chronic Stress- Pro-in ammatory cytokines is increased in people who are under prolonged stress because chronic stress interferes with the body’s ability to turn o cytokine production. - Impairs the body’s ability to respond to signals that will terminate the immune systems reactivity, resulting in in ammation. fl fl fi fl fi fi fl fl fi ff  Stress and Aging - Traumatic stressors experienced during childhood increase risk of premature death. Telomeres- The protective part of chromosomes that shorten with age, and especially with stress. - If they do not function correctly, the risk of disease is increased. - Telomere length is maintained by telomerase, and cortisol reduces the activity of this enzyme. Emotion and Health Personality- Type A personalities (competitive drive, commitment, impatience, hostility) was associated with an increase risk of coronary heart disease and heart attacks. - Type D personalities (negative, insecure, anxious) also had increased heart attacks. Depression- Associated with disrupted immune function and increased risk of heart disease. - Is caused by long term exposure to pro-in ammatory cytokines manifests itself as symptoms of depression, and also contribute to the growth of plaque in blood vessels. - Dose-response relationship; the more severe the depression, the shorter the telomeres. Anxiety- Increased risk for sudden cardiac death. Social Isolation- Increased risk for developing heart disease. - Connection and emotional support can prevent future cardiac events. Positive Emotion- Depression, anger, and anxiety are important to avoid because they are associated with poor health. - An optimistic outlook on life has bene cial health consequences. - Positive psychology can be used to help focus on positive traits to improve physical and mental well-being. - Forgiveness and not holding grudges is better for mental health. Emotion Regulation- Emotion regulation skills are predictors for better heart health. - People with better cognitive control had a less pronounced increase in pro- in ammatory cytokine production in response to emotional stimuli. Treatment of Stress-Related Disorders Biological Interventions - People with coronary heart disease can receive surgery and medication to lower cholesterol and reduce the risk of blood clots. - Antidepressant medication (SSRIs) can be given to people with myocardial infarctions and to depressed people to lower the risk of relapse. fl fi fl Psychological Interventions Emotional Disclosure- Opening up and writing about life problems is an e ective therapy, although ndings on writing are mixed. - Patients are given an opportunity for emotional catharsis, or gives people an opportunity to rethink their problems (reframing). Biofeedback- Aims to make patients more aware of such things as their heart rate, level of muscle tension, or blood pressure. - Done by connecting people to monitoring equipment and then providing a cue when they are successful at making a desired response. Relaxation and Meditation- Transcendental meditation and relaxation techniques can lower hypertension and release tension headaches. Cognitive Behaviour Therapy- Helps manage problems by cognitively restructuring thoughts, target negative patterns, and adopt practical tools for problem management. - Has been shown to alleviate headaches, abdominal pain, and arthritis. Stress and Mental Health - For adjustment disorders, PTSD, or acute anxiety disorder to develop, stress is a necessary cause but not a su cient cause (not everyone who experiences stress will develop these problems). Adjustment Disorder- A psychological response to a common stressor (divorce, loss) that results in clinically signi cant behavioral or emotional symptoms. - Symptoms must begin within 3 months of the onset of the stressor. - Person must experience more distress that would be expected given the circumstances or be unable to function as usual. - Person’s symptoms lesson or disappear when the stressor ends or the person learns to adapt. - If symptoms last more than 6 months, the diagnosis is changed. Post-traumatic Stress Disorder- Moved out of the anxiety disorders section and is now grouped with trauma and stressor related disorders. - Entered the DSM when veterans were unable to go back to work and were emotionally scarred from the Vietnam War, and was viewed as a normal response to an abnormal stressor. - Can be caused by any extreme, terrifying, and stressful event that is life-threatening and outside ordinary bounds (combat, rape, con nement, natural disaster). - Symptoms fail to abate even when the traumatic event has passed and the danger os over (disorder of non recovery). - Leads to the traumatic event being re-experienced involuntarily and with the same full emotional force, and requires symptoms to last min. 1 month. fi fi ffi fi ff PSTD Causes and Risk Factors- Traumatic event causes a pathological memory. Symptoms Include: Intrusion- Recurrent re-experiencing of the traumatic event through nightmares, intrusive images, and physiological reactivity to reminders of the trauma Avoidance- E orts to avoid thoughts, feelings, or reminders of the trauma. Negative alterations in cognitions and mood- Feelings of detachment, negative emotional states like shame or anger, or distorted blame of oneself or others. Arousal and Reactivity- Hyper-vigilance, excessive response when startled, aggression, and reckless behavior. Prevalence of PTSD- Lifetime prevalence (at some point has experienced it) is 6.8% and is higher in women. Rates of PTSD After Trauma- Traumatic events that result from human intent are more likely to cause PTSD. - Prevalence of PTSD increase when people are directly exposed to the traumatic event. - The type of diagnostic criteria also changes the prevalence (interview vs. questionnaire). Military Combat- PTSD was coined as “shell-shock” during WWI who thought it was a natural consequence produced by brain hemorrhages. - An estimated 10% of WWII veterans developed what was known as “combat exhaustion”. - 7-12% of people will return with PTSD from serving in combat, due to recent gures from wars. - Clinicians are observing veterans with compulsive checking behaviours and increased rates of suicide. Causal Factors- Is subject to controversy because by de nition, PTSD should be caused by trauma, but that some people can develop PTSD while some will not, even if exposed to the same thing. - Risk factors are being female, having high levels of neuroticism, preexisting problems with depression and anxiety, having family history of mental illness, low social support, subjective cognitive appraisals. - Pre-traumatic stress (imagining what could happen in the future) predicts levels of PTSD symptoms. - Protective factors such as good cognitive abilities can bu er against PTSD. - Epigenetic research (gene-environment) has discovered that if people have a mutated 5HTTLPR gene (s/s genotype), people seem to develop more PTSD. - Hippocampus is reduced in size in people with PTSD. (twin studies). ff fi ff fi  Biological Factors- Soldiers with the s/s genotype of the 5HTTLPR gene developed a gaze bias after Iraq and were more attentive to negative stimuli (interaction between biological and environmental stimuli. - Depression and PTSD are highly comorbid. Socio-Cultural Factors- Being a member of a minority group places people at a higher risk for developing PTSD. - Further psychological deterioration of people with PTSD can be cause by an unsupportive social environment. - Intervention that promote morale and encourage cohesion have proved e ects at reducing psychological casualties (also mail, internet, food, air conditioning). Long-Term E ects of PTSD- Soldiers who did exceptionally well during deployment can experience delayed onsets of PTSD. Acute Stress Disorder- Symptoms of PTSD that last between 3 days-1 month. - If symptoms persist beyond 4 weeks, the diagnosis can be changed to PTSD. Prevention and Treatment of Stress Disorders Prevention- Reducing the frequency of traumatic events can be preventive. - Starting to prepare people in advance with information on coping skills to reduce maladaptive responses. - Stress-inoculation Training- A cognitive behavioural technique that prepares people to tolerate an anticipated threat by changing the things they say to themselves before or during a stressful event. Treatment Telephone Hotlines- National and local telephone hotlines provide help for people under severe stress, as well as speci c hotlines for rape or runaways. Crisis Intervention- Short-term crisis therapy is of short and focuses on the immediate problem with which an person is having di culty. - Focused on helping the person through the immediate crisis, not on “remaking” their personality. Psychological Debrie ng- Designed to help and speed up the healing process in people who have experienced disasters or traumatic situations. - Provided with emotional support and encouraged to talk about their experiences during the crisis. - Literature reviews failed to support the clinical e ectiveness of the approach. Medication- Antidepressants and antipsychotics are used for treatment of symptoms. - Prozac, Paxil, and E exor provide modest bene ts. ff ff fi fi ffi fi ff ff Cognitive Behavioural Treatments- Designed to modify excessively negative appraisals of the trauma, decrease the threat that patients experience when they have negative memories, and remove problematic cognitive and behavioral strategies. - Prolonged Exposure- Patient is asked to vividly recount the traumatic event over and over until there is a decrease in his or her emotional responses. - Ten 90-minute treatment sessions led to a reduction of symptoms and a decrease in the number of women meeting diagnostic criteria for PTSD. Trauma and Physical Health- Traumatic events are not only bad for the mind, they also damage the body.