“Your One and Only Car”

Behavioral Medicine

Centers for Disease Control (CDC) claim that half of the deaths in the US are due to people’s

behaviors (smoking, alcoholism, unprotected sex, insufficient exercise,

drugs, and poor nutrition).

Behavioral Medicine

Psychologists and physicians have thus developed an interdisciplinary field of behavioral medicine that integrates behavioral knowledge with medical knowledge, and applies that knowledge to health and disease

Health Psychology

Health psychology is a field of psychology that contributes to behavioral medicine. The field studies stress-related aspects of disease and asks the following questions:

1. How do emotions and personality factors influence the risk of disease?

2. What attitudes and behaviors prevent illness and promote health and well-being?

3. How do our perceptions determine stress?

4. How can we reduce or control stress?

Stress and Illness Leading causes of death in the US in 1900 and

2000

Stress

Psychological states cause physical illness.

Stress is any circumstance (real or perceived)

that threatens a person’s well-being.

When we feel severe stress, our ability to cope with it is impaired.

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Stress and Illness

Stress the process by

which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging

When stress is good and leads to something desirable such as studying for a big exam and then receiving a good grade on the exam, it is called eustress.

When the stress has negative effects such as confusion, an inability to make decisions, and illness, it is called distress.

Stress

• THE DOLPHIN STRESS TEST Below is a picture of two dolphins. If you can see both dolphins, your

stresslevel is within the acceptable range. If you see anything other than two dolphins, your stress level is too high and you need to stay home and rest.

And You Think You Have Stress…

Stress and Stressors

Stress is a slippery concept. At times it is the stimulus (missing an

appointment) and at other times it is a response (sweating while taking a test).

Stress and Stressors

Stress is not merely a stimulus or a response. It is a process by which we appraise and cope with

environmental threats and challenges.

When short-lived or taken as a challenge, stressors may have positive effects. However, if stress is threatening or prolonged, it

can be harmful.

The Stress Response SystemCanon proposed that the

stress response (fast) was a fight-or-flight

response marked by the outpouring of

epinephrine and norepinephrine from the

inner adrenal glands, increasing heart and

respiration rates, mobilizing sugar and fat,

and dulling pain.

The Stress Response System

The hypothalamus and the pituitary gland also

respond to stress (slow) by triggering the outer

adrenal glands to secrete glucocorticoids

(cortisol).

Sequence of Steps in the Fight or Flight Behaviors

1. The brain appraises a situation as threatening and dangerous.

2. The lower brain structure secretes a stress hormone.

3. The stress hormone signals the adrenal glands to secrete adrenaline.

4. This causes the muscles to tense, the heart to beat faster, and the liver to send out sugar to be used in the muscles.

Fight or Flight (Walter Cannon)

The General Adaptation Syndrome (Hans Selye)

Defined as a series of stages the body goes through when exposed to stressful situations.

1. The alarm stage is the initial stage where the body prepares for attack—either psychological or physical.

2. The second stage is called the stage of resistance. The body uses up a great amount of energy to prepare for the stressor.

3. The third stage is exhaustion. It is marked by body exhaustion and health problems.

Alarm Resistance Exhaustion

General Adaptation Syndrome

According to Selye, a stress response to any kind ofstimulation is similar. The stressed individual goes

through three phases.

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Stressful Life Events

Catastrophic Events earthquakes, combat stress, floods

Life Changes death of a loved one, divorce, loss of job,

promotion Daily Hassles

rush hour traffic, long lines, job stress, Burnout-- physical, emotional, and mental

exhaustion brought on by persistent job-related stress

Some Psychological Stressors for High School StudentsLife Event Stress Points

Divorce of parents 98

Expulsion from school 79

Major injury or illness 77

Getting a job 62

Major illness of close friend 56

Peer difficulties 45

Moving away 41

Christmas 30

Vacation 25

Traffic ticket 22

Significant Life Changes

The death of a loved one, a divorce, a loss of job, or a promotion may leave individuals

vulnerable to disease.

Perceived Control

Our personal control and optimism is related to stress and our immune system.

With loss of perceived control, we are vulnerable to ill health.

Optimists respond to stress with smaller increases in blood pressure, and they recover faster from heart bypass surgery.

Perceived Control Health consequences of a loss of control

No connection to shock source

To shock control To shock source

“Executive” rat “Subordinate” rat Control rat

Poverty and Inequality

Poorer people are more at risk for premature death.

People also tend to die younger in areas where there is greater income inequality.

People at every income level are at greater risk of death if they live in a community with great income inequality.

Stress and the Heart

Stress that leads to elevated blood pressure may result in Coronary Heart Disease, a clogging of

the vessels that nourish the heart muscle.

Plaque incoronary artery

Arteryclogged

Stress, Personality, & Heart Disease

Coronary heart disease is North America’s leading cause of death

Habitually grouchy people tend to have poorer health outcomes

Chronic negative emotions have negative effect on immune system

6 factors that increase the risk of heart disease:

1. Smoking

2. Obesity

3. High fat diet

4. Physical Inactivity

5. Elevated blood pressure

6. Elevated Cholesterol + stress and personality

Stress and the Heart

Hopelessnessscores

3.5

3

2.5

2

1.5

1

0.5

0 Heart attack DeathLow risk Moderate risk High risk

Men who feel extreme hopelessnessare at greater risk for heart attacksand early death

Stress and the Heart

Type A Friedman and Rosenman’s term for competitive,

hard-driving, impatient, verbally aggressive, and anger-prone people. Type A personalities are more likely to develop coronary heart disease.

Type B Friedman and

Rosenman’s term

for easygoing, relaxed people

Type A Personality

Type B Personality

Research on type A Personality

Time urgency & competitiveness not associated with poor health outcomes

Negative emotions, anger, aggressive reactivity

High levels of hostility increase chance of all disease (e.g., cancer)

Explanatory style

Optimism use external, unstable, & specific

explanations for negative eventspredicts better health outcomes

Pessimismuse internal, stable, & global explanations

for negative eventspredicts worse health outcomes

Stress and the Heart

Stress and Disease

Psychophysiological Illness “mind-body” illness any stress-related physical illness

some forms of hypertension some headaches

distinct from hypochondriasis-- misinterpreting normal physical sensations as symptoms of a disease

Stress and Disease

Lymphocytes two types of white blood cells that are

part of the body’s immune system B lymphocytes form in the bone marrow

and release antibodies that fight bacterial infections

T lymphocytes form in the thymus and, among other duties, attack cancer cells, viruses, and foreign substances

Stress and the Immune System

B lymphocytes fight bacterial infections, T lymphocytes attack cancer cells and viruses, and microphages ingest foreign substances.

During stress, energy is mobilized away from the immune system making it vulnerable.

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Your immune system battles bacteria, viruses, and other foreign invaders that try to set up housekeeping in your body. The specialized white blood cells that fight infection are manufactured in the bone marrow and are stored in the thymus, spleen, and lymph nodes until needed.

Stress and AIDS

Stress and negative emotions may accelerate the progression from human immunodeficiency virus (HIV) to acquired immune deficiency syndrome

(AIDS).

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Stress and Cancer

Stress does not create cancer cells.

Researchers disagree on whether stress

influences the progression of cancer.

However, they do agree that avoiding stress

and having a hopeful attitude

cannot reverse advanced cancer.

Stress and Immune Conditioning

If the immune system can be suppressed through conditioning, researchers believe that immune-

enhancing responses can be inculcated to combat viral diseases.

Conflict

Conflict arises when a person needs to decide between two alternatives.

Types of conflict:

Approach-Approach

The person is attracted to two

goals.

The approach - approach conflict is not all bad. You have to decide between two attractive choices.

Avoidance - Avoidance

The person has to choose between

them.

The avoidance - avoidance conflict presents two undesirable goals.

Approach - Avoidance

The person is attracted to one goal but it comes

with a negative aspect.

The approach - avoidance conflict can be distressing.

Double Approach - Avoidance

The person has two goals, each has both

good and bad characteristics.

The double approach - avoidance conflict is the most common.

Stress and Disease

Negative emotions and health-related consequences

Unhealthy behaviors(smoking, drinking,

poor nutrition and sleep)

Persistent stressorsand negative

emotions

Release of stresshormones

Heartdisease

Immunesuppression

Autonomic nervoussystem effects

(headaches,hypertension)

Promoting Health

Promoting health is generally defined as the absence of disease. We only think of health when we are diseased. However, health psychologists say that promoting health begins by preventing illness and enhancing well-being, which is a constant endeavor.

Coping with Stress

Reducing stress by changing events that cause stress or by changing how we react to stress is

called problem-focused coping.

Emotion-focused coping is when we cannot change a stressful situation, and we respond by

attending to our own emotional needs.

Explanatory Style

People with an optimistic (instead of pessimistic) explanatory style tend to have more control over stressors, cope better with stressful events, have better moods, and have a stronger

immune system.

Promoting Health

Aerobic Exercise sustained

exercise that increases heart and lung fitness

Depressionscore

14

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10

9

8

7

6

5

4

3 Before treatmentevaluation

After treatmentevaluation

No-treatmentgroup

Aerobicexercise

group

Relaxationtreatment

group

Why Does Exercise Work?

Exercise and MoodReleases chemicals

-- norepinephrine

-- serotonin

-- endorphins

Sense of accomplishment

Improved physique

Why Does Exercise Work?

Exercise and Health

Strengthens heart

Lowers blood pressure

Lowers blood pressure reactivity to stress

Moderate exercise adds two years to one’s expected life.

Promoting Health

Biofeedback system for

electronically recording, amplifying, and feeding back information regarding a subtle physiological state

blood pressure muscle tension

Biofeedback

Feedback about subtle bodily responses e.g., tension in forehead

Not controlling body’s responsesPeople can influence some of these responses

finger temperature forehead tension

Reduce intensity of migrainesHelp with some chronic painRelaxation crucial to biofeedback success

Life-Style

Modifying a Type-A lifestyle may reduce the recurrence of heart attacks.

Relaxation

Meditation can lower blood pressure, heart rate, oxygen consumption

Can it help with stress-related disease?

Social Support

Supportive family members, marriage partners, and close friends help people cope with stress.

Their immune functioning calms the cardiovascular system and lowers blood pressure.

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Managing Stress

Having a sense of control, an optimistic explanatory style, and social support can reduce

stress and improve health.

Spirituality & Faith Communities

Personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment.

Those who attend religious services experience lower death rates from coronary heart disease.

Spirituality & Faith Communities

Regular religious attendance has been a reliable predictor of a longer life span

with a reduced risk of dying.

Intervening Factors

Investigators suggest there are three factors that connect religious involvement and better health.

Managing Stress: Summary

How can stress be managed?

Promoting Health

Complementary and Alternative Medicine unproven health care treatments not

taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies

Alternative systems ofmedical practice

Bioelectromagneticapplications

Diet, nutrition,life-style changes

Herbal medicine

Manual healing

Mind-body control

Pharmacological and biological treatments

Subfields of Alternative MedicineHealth care ranging from self-care according to folk principles,to care rendered in an organized health care system based onalternative traditions or practices

The study of how living organisms interact with electromagnetic (EM) fields

The knowledge of how to prevent illness, maintain health, and reverse the effects of chronic disease through dietary or nutritional intervention

Employing plan and plant products from folk medicine traditionsfor pharmacological use

Using touch and manipulation with the hands as a diagnosticand therapeutic tool

Exploring the mind’s capacity to affect the body, based on traditional medical systems that make use of the interconnected-ness of mind and body

Drugs and vaccines not yet accepted by mainstream medicine

Promoting Health Smoking-related early deaths

40,000

30,000

20,000

10,000

0

33,348

1,686 1,135 556 202

Smoking Suicide Vehicle HIV/ Homicide crash AIDS

Cause of death

Numberof deaths

per 100,000

Why Do People Smoke?

The elimination of smoking would increase life expectancy more than any other preventive measure.

1. People smoke because it is socially rewarding.

2. Smoking is also a result of genetic factors.

Why Do People Smoke?

3. Nicotine takes away unpleasant cravings (negative reinforcement) by triggering epinephrine, norepinephrine, dopamine, and endorphins.

4. Nicotine itself is rewarding (positive reinforcement).

Helping Smokers Quit

Smoking decreased in Western countries, especially in higher socioeconomic groups

and more educated groups.

Ways to Quit Smoking

1. Set a quit date.

2. Inform family and friends.

3. Throw away all cigarettes.

4. Review successful strategies.

5. Use a nicotine patch or gum.

6. Abstain from alcohol.

7. Exercise.

Here are a few pointers on how to quit smoking:

Do Programs Work?

Prevention programs do have an effect on smoking.

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Smoking Abstinence Programs

Smoking abstinence programs for teens provide:

1. Information about the effects of smoking

2. Information about peer, parent & media influence

3. Ways to refuse cigarettes

Biopsychosocial Factors: Smoking

Obesity and Weight Control

Fat is an ideal form of stored energy and is readily available. In times of famine, an

overweight body was a sign of affluence.

“You are what you eat”. Eating foods that provide the

biochemical building blocks for those neurotransmitters affect our mood and behavior.

People feeling tense or in a bad mood, often snack on carbohydrate-rich foods for a mood lift.

Nutrition

Body Mass Index (BMI)

Obesity in children increases their risk of diabetes, high blood

pressure, heart disease, gallstones, arthritis, and certain types of cancer,

thus shortening their life-expectancy.

Obesity and Mortality

The death rate is high among very overweight men.

The Physiology of Obesity Fat Cells

A fat cell can vary from relatively empty, like a deflated balloon, to overly full. In an obese person, fat cells may swell to two or three times their normal size and then divide. Once the number of fat cells increases– due to genetic predisposition, early childhood eating patterns, or adult overeating– it never decreases. Fat cells may shrink on a diet, but they never disappear.

Physiology of Obesity

Fat Cells: There are 30-40 million fat cells in the body. These cells can increase in size or increase in

number (75 million) in an obese individual (Sjöstrum, 1980).

Weight Discrimination

When women applicants were made to look overweight, subjects were less willing to hire

Willingnessto hire scale

(from1:definitely

not hire to7: definitely

hire)

0

1

2

3

4

5

6

7

Women Men

Normal Overweight

Set points and Metabolism

Set point is their “weight thermostats” that are set to maintain body weight within a higher-than-average range. Then their weight drops below the set-point range, their hunger increases and metabolism decreases. The body adapts to starvation by burning off fewer calories.

Metabolism is the rate at which we burn calories.

Set Points and Metabolism

When reduced from 3,500 calories to 450 calories, weight loss was a minimal 6% and the metabolic rate

a mere 15%.

The obese defend their weight by conserving energy.

Losing Weight

Fat cells, set points, metabolism, and genetic factors all conspire to make losing weight a big problem.

Obese people find it difficult to lose weight permanently because the number of fat cells is not reduced by dieting, because the energy expenditure necessary for tissue maintenance is lower in fat than in other tissues, and because overall metabolic rate decreases when body weight drops below the set point.

The Genetic Factor

There is a genetic influence on body weight. The body weights of adoptive siblings are uncorrelated with one another and with those of their adoptive parents.

Rather, people’s weights resemble those of their biological parents.

Identical twins have closely similar weights, even when reared apart.

The Genetic Factor

Identical twin studies reveal that body weight has a genetic basis.

The obese mouse on the left has a defective gene for the hormone leptin. The mouse on the right sheds 40%

of its weight when injected with leptin.

Activity

Lack of exercise is a major contributor to obesity. Just watching TV for two hours resulted in a 23%

increase of weight when other factors were controlled.

Food Consumption

Over the past 40 years average weight gain has increased. Health professionals are pleading with US

citizens to limit their food intake.

Plan to Lose Weight

When you are motivated to lose weight, begin a weight-loss program, minimize your exposure to tempting

foods, exercise, and forgive yourself for lapses.

Trading Risks

Although cigarette smoking has declined over the years in the Americas, obesity is on the rise.

Weight Control Thinning of Miss America

Weight Control

Most lost weight is regained

-20

-15

-10

-5

0

5

10

1 2 3 4 5

Weightchange

in pounds

Posttreatment

Years of follow-up

Startingpoint

Normal trend for untreated obesepeople: Gradually rising weight

After participation in behavioralProgram: Much of initial weight

loss regained

Weight Control

Obesity was more common among those who watched the most television

<2 2-3 >4Hours of television watched per day

in 1990s study

Boys Girls

32

30

28

26

24

22

20

Skinfold fatmeasure (mm)

HELPFUL HINTS FOR LOSING WEIGHT

• Minimize exposure to tempting food cues• Take steps to boost your metabolism• Be Realistic and Moderate• Modify both your metabolic rate and your

hunger by changing the food you eat.• Don’t starve all day and eat one big meal at

night.• Beware of the binge.• Set realistic goals.