3/5/12

Psychological Factors Affecting Physical Conditions

Click to edit Master subtitle style Prepared by: Myrna B. Alarcio

The effect of the psychological on the physical, prior to the arrival on the philosophical front of scientific rationalism, would have been labeled a mind/body problem. Prescientific humanity, led by their philosophers and religious leaders, considered mind and body to be independent entities. dichotomy between the mind and body were elaborated by the philosophy of Thomas Aquinas, Platos rabble of the senses, Berkeleys Mentalism, and Ren Descartes Dualism and Newton provided the kind of early scientific thinking that brought medicine and psychology to their modern interpretation of min/body relationships the mind and body function as a unit.

3/5/12

The

Galileo

Interactions Between Psychological and Physical Functioning

3/5/12

In1883, the publication of Kraeplins textbook on psychiatry gave recognition of the influence of somatic (bodily) changes on mental activities. the acceptance of influence in the opposite direction that is, the mind influencing physical disease was a much later concept. in the 1960s, a much broadened way of thinking developed about the influence of psychic factors on bodily processes. Physiological psychologists, aided by the development of sensitive electronic instruments that could measure physiological responses, (e.g. blood pressure, pulse rate, and bodily temperature) demonstrated that those responses, once thought to be involuntary, could be brought under voluntary control. In 1991, studies conducted in Pittsburgh and in Salisbury, England, led to the conclusion that high levels of

Models of Psychological-Physical Interaction

Diathesis-Stress

3/5/12

Model

- states that human disorders, both physical and mental, result from the presence of a diathesis, or vulnerability, may result from genetics for example, schizophrenia) or from earlier physical disease (e.g. whooping cough in infancy). - that predisposition is provoked by a stressor; that is, a disturbing bodily invader, in the case of a physical disorder, or a disturbing early life emotional experience, in the case of a psychological disorder (e.g. psychophysiological disorders, defined as disorders in which psychological events , such as cognitions and

The General Adaptation Syndrome

- describes the sequential way which the individual psychologically and physically responds to stressful events. Selye identifies 3 stages of the organisms response to a stressor event: alarm phase arouses the individuals defenses resistance stage all the resources of the individual are employed defensively

stage of collapse decompensation, the tensions produced by the stressor cannot be reduced, and there is a likelihood that those tensions will now combine with a vulnerability in the body, and a psychophysiological disorder will develop - once developed, the disorder may remain as a lifetime weakness of the individual that flares up

3/5/12

3/5/12

Psychoneuroimmunology -

The study of how psychological factors affect the nervous systems role in the immune response Research unmistakably indicates that psychological factors directly affect health through changes in the immune system negative mood, hostility, and interpersonal conflict are associated with declines in immune system functioning, while positive mood, optimism, and social support are associated with increases in immune system functioning

The Role of Stress in Psychophysiological Disorders

Autonomic

3/5/12

Reactions and Stress

- Walter Cannon postulated that in order to survive, our primitive ancestors had need of bodily reactions that would respond their lifeand-death struggle (fight-or-flight pattern) and identified the autonomic nervous system as the mechanism that prepared the individual to make either of those responses. - the autonomic system responds to external events that threaten the individual by initiating a whole series of physiological changes

 The

Immune System

3/5/12

- The bodys alarm reaction, in itself, does not cause infection or disease, but over time it reduces the bodys defenses by impairing the functioning of the immune system.

Physical Effects of Psychological Stressors

- one explanation of the way in which psychological tensions cause or contribute to the development of physical disease is that some physiological changes of the psychologically intense alarm reaction may impair the effective working of the immune system.

 Mediating

Stressors

Influences on the Effects of

3/5/12

Lifestyle

- Aspects of how one chooses to live ones life have been related to the development of psychophysiological illnesses. People differ in what they eat, how much they eat, and in their manner of eating. Powerfully,

Explanatory Style

- people differ in the way in which they lifes events explain in and what they expect from life. It has been sorted out by 2 principal types: pessimistic and optimistic.

 Personality

Traits

3/5/12

Hardiness, in a study of a group of executives of high-stress jobs found the 3 aspects of the trait identified stress-resistance individuals, those whom stress produced minimal health changes: openness to change, a sense of involvement or commitment to their jobs; and feelings of being in control of their lives.

Hopelessness,

has been studied extensively as a factor in vulnerability to illness. The persistence and severity of diseases as different as cancer and influenza have been related to depression or feelings of hopelessness.

Psychological Factors in Specific Physical Disorders

Coronary Friedman

3/5/12

Disease

and Rosenman described Type A personalities as aggressive, competitive, hostile, feeling pressured by time, and always striving to succeed. Type B individuals as relaxed and opposite in many ways to Type B. personalities. Diagnoses of the personality types are made either on the basis of a stress-type interview or by a self-administered questionnaire. levels of research have been directed at the Type A concept: prospective studies that predict risk of heart attack from a personality assessment and research that attempts to pinpoint what it is in a Type A personality that increases risk of

However,

Two

 Predicting

Coronary Heart Disease from Personality Assessments

3/5/12

The Western Collaborative Study

Researchers tested first for personality type, and then followed 3,200 males and monitored their medical status for the next 8 years. They found that men with Type A personalities had more than twice as many heart attacks as did those men who had been judged to be Type B.

The Framingham-Massachusetts Study

Researchers studied a population of 1,600 men and women white-collar workers, who had been classified as Types A or B. They found 3 times as many cases of coronary heart disease among Type A men and 2 times as many among Type A women than among Type B men and women.

Characteristics of the Type A Personality that Cause Coronary Heart Disease

3/5/12

Hostility

Several researchers have followed a lead provided in the writings of the psychoanalytically oriented Franz Alexander, who related high blood pressure to the way in which individuals dealt with their aggression. They found that when hostility was felt but not expressed overtly, the frequent results was high blood pressure, inhibited hostility and a Type A personality.

Chronic Negative Emotion

Other research has indicated that negative emotions such as anxiety and depression, not just anger, are the link between Type A personality and heart disease.

Essential Hypertension

3/5/12

- Medical findings indicate that in 90 to 95 percent of hypertensive patients, there is no preexisting physical cause. Thus, almost all patients with high blood pressure are diagnosed with essential hypertension.
-

essential means the absence of known physical causes This is not to say, however, that there is an absence of physical correlates of high blood pressure. The first advice of a doctor to an overweight patient with high blood pressure is, Lose some weight or Let me suggest a diet. Even granted the presence of potentially

Suppressed Rage

3/5/12

Anger is a strong emotion. Its immediate effects on the body are, in time, usually reduced by its open expression, assuming there is no physical violence against others that may produce other negative results. A study by Esler and others reports that individuals with hypertension who also exhibit signs of suppressed hostility frequently have personalities that are overly submissive, overly controlled, and guilt-laden.

Social Support and Negative Emotion

Research has found strong links between a alack of social support, loneliness, depression, and other negative emotions and hypertension. It is theorized that negative emotions might be responsible for the relationship between social support and hypertension. That is, low levels of

Cancer

3/5/12

The possibility of a relationship in cancer is most often greeted with skepticism. This results from the concrete nature of cancers physical growth, increasing in size each day, or spreading in minute cells that travel throughout the body. Another factor may be the well-known emphasis medical science gives to biological treatment and its effectiveness in many cases. When we think of cancer, we think immediately of radiation, chemotherapy, or even surgery. We do not often consider the influence of psychotherapy, although it can indeed be helpful in dealing with the knowledge that one has cancer.

Emotional Inhibition

3/5/12

In 1946, Thomas administered a series of personality tests to a group of medical students. By 1977, 48 of her subjects had developed cancer. Comparing their personality profiles with those participants who had not developed cancer, she noted strong tendencies to repress intense emotions in cancer patients. She described them as having emotionally inhibited personalities. Rogentine and others reported that those cancer patients who freely expressed negative emotions about the illness were more likely to survive than those who were emotionally restrained. Later research indicated that cancer patients who received group psychotherapy lived longer than those receiving similar care but without psychotherapy.

Hopelessness in Cancer

3/5/12

subsequent research has focused on hopelessness as a factor in development of cancer. 51 women who entered a clinic for a cancer test were interviewed after medical exams had revealed suspicious in the cervix that had to be investigated further before a diagnosis of cancer could be made. It revealed that 18 of them had suffered significant losses in the preceding 6 months, to which the interview further revealed, they had responded with feelings of hopelessness and a resultant sense of helplessness. Of the 18, 11 had cancer diagnosis. Among the other 33, with no such preceding life experiences reported, only 8 had cancer. Other research with different types of cancer has confirmed those earlier findings. One study reported that upon the news of a cancer

 AIDS

3/5/12

It affects the immune system, which is greatly affected by psychological factors. Psychosocial support groups for individuals who are HIV positive have been found to be associated with higher immune functioning, slower disease progression, and longer survival times. Subsequent research suggests that the decrease in negative emotions resulting from the support group might be responsible for the improved immune functioning. Other research suggests that positive emotions, rather than simply the absence of negative emotions, are associated with longer life expectancy in individuals who are HIV positive and experiencing the stress of caring for a loved one with a more advanced stage of the disease.

Overview on Causative Factors in Psychologically Affected Physical Disorders

The

3/5/12

Biogenic Perspective

2 principal emphases: genetic influences and involvement of the bodys immune system Current focus: diathesis-stress model, as a way of thinking about the interaction between physical and psychological factors.

Genetics

Family studies, twin studies, and animal breeding research lend strong support to the presence of genetic factors in psychosomatic disorders (e.g. hypertension, heart disease, cancer) Genetic hypothesizing has suggested the somatic weakness theory: genetic factors may create

Immune System

3/5/12

Defends the body against disease-causing foreign agents. Much evidence from animal laboratories demostrates that in animals such psychological tensions as, for example, those created by a condition of helplessness, reduce its effectiveness. In that way, the bodys vulnerability to physical disease is increased. Recent research is beginning to suggest that positive emotions has a boosting effect on the immune system.

 The

Psychodynamic Perspective

3/5/12

Today,

the psychodynamic theorist attributes psychosomatic illness to some aspect of a disturbed parent-child relationship, the same pattern that underlies other anxiety-based disorders. patients were thought to be hardworking, conscientious, or perfectionist while hypertensive patients are believed to be covertly angry. failed to support them since individuals with those psychosomatic ailments could not be grouped into similar personality types. personalities were widely heterogeneous. Nevertheless, the relationship between the Type A personality and risk of heart attack, which fits the earlier psychodynamic conceptualization, suggests the possibility that there may yet be

Migraine

Research

Their

 The

Behavioral Perspective

3/5/12

Until

recently, the rationale for considering psychosomatic symptoms to be the result of conditioning, either respondent or operant, was difficult to establish. For one thing, autonomic responses were considered to beyond voluntary control. They, therefore, would not respond to operant conditioning. Second to hypothesize respondent conditioning as the cause of the illness would require frequent associations between a neutral stimulus to be conditioned and some unconditioned stimulus known to produce the response reflexively. scientists were able to condition a suppression of the immune system. While not under conscious control, it is now understood that learning can result in decrease in immune functioning (e.g. the condition of learned helplessness).

Behavioral

3/5/12

The

Cognitive Perspective

Attempts

at understanding differences in survival rates of individuals who are HIV positive has resulted in investigating coping styles. indicates that using meaning-focused coping results in positive cognitions and increased survival rates. is, individuals who are HIV positive, but choose to focus on obtaining goals, create meaning in light of difficult experiences, and acknowledge even small positive experiences live longer than those who do not engage in such types of cognitions.

Research

That

Treatment Approaches to Physical Diseases Affected by Psychological Factors

Biofeedback

3/5/12

Behavior

Modification

 Relaxation

Therapy

3/5/12

Psychosocial

Support Groups