Unit 1 - Introduction

Health psychology is an exciting and relatively new field devoted to understanding psychological
influences on how people stay healthy, why they become ill and how they respond when they do get ill.

WHO (1994) health - health is a complete state of physical, mental and social well being and not merely
the absence of disease or infirmity.

Focus –

- Health promotion and maintenance.

- Prevention and treatment of illness
- Focus on the etiology and correlates of health, illness and dysfunction (Causal factors)
- Analyze and attempt to impose the health care system and the formulation of health.

History

Mind body relationship

- Prehistoric era –
o Mind in body is intertwined – that can’t be separated
o Disease was thought to arise when evil spirit entered the body and treatment would be
exorcism
o Some skulls from the Stone Age – small, symmetrical holes to drive the evil spirits away.
- Ancient Greeks –
o Identify the role of bodily factors in health and illness
o Humoral theory – imbalance in 4 of the bodily fluids causes illness
o Blood – passionate temperament
o Black bile – sadness
o Yellow bile – anger
o Phlegm – laid back approach to life
- Middle age -
o Supernatural explanations for illness
o God’s punishment for evildoing
o Cure often considered for driving out the evil forces by torturing the body
o Later, replaced by penance
- Renaissance until today –
 Major development in medicine
 Humoral theory declined – inventions of the microscope in 1600’s, relied on
cellular pathology and laboratory findings
 Focused on bodily factors than mind
 Resulted in biomedical model
 Development of science of autopsy
2 models –

1. Biomedical model

2. Biopsychosocial model

1. Biomedical model –
- Bodily factors were given more importance
- All illness can be explained on the basis of aberrant somatic bodily processes, such as
biochemical imbalances or neurophysical abnormalities.
- Assumes that psychological and social processes are largely irrelevant to the disease process.

Limitations –
- Reduces illness to low level processes such as disordered cells and chemical imbalances.
- Fails to recognize social and psychological process as powerful influences over bodily influences
over bodily – assumes a mind body dualism
- Focus on illness over health
- Puzzles that practioners face.

2. Biopsychosocial model –
- Rise of modern psychology – Sigmund freud early work on conversion hysteria (unconsciously
converted into physical disturbances)
- According to Freud, this model looks beyond bodily factors, specific unconscious conflicts can
produce physical disturbances that symbolize the 3 factors – bio factors, psychological factors,
social factors.

Psychosomatic medicine –
- Specific illness is produced by people’s intended conflicts.
- Flander Dunbar in 1930’s in Franz Alexander in 1940’s
- Links personality and illness rather than specific conflict to specific illness
- Conflicts produce anxiety, which becomes unconscious and takes a physiological toll on the body
in the autonomic nervous system.
- The continuous physiological changes eventually produce an actual organic disturbance.
- Emotional conflicts leads to disorders of psychosomatic origin –
o Ulcers
o Hyperthyroidism
o Rheumatic arthritis
o Hypertension
o Neurodermatis – kind of skin disease.
o Colitis
o Bronchial asthma
- Focus on several factors working together –
 o A biological pathogen ( viral or bacterial infection)
o Social and psychological factors - high stress, low social support and socioeconomic
status. Mind and body together determine health and illness – biopsychosocial model
o Health and illness are both the consequences of interplay of bio, psy and social factors.
(Keefe, 2011)

Diagnosis and treatment should be based on all the three factors.

Advantages –

- Bio, psy and social factors are important determinants of health and illness.
- Macro level/ major processes and micro level/ minor processes continuously interact to
influence health and illness in their courses.
- Based on the individual factors –
o Emphasizes on both health and illness
o Health = something that one achieves through attention to biological, psychological and
social needs, rather than something that is taken for granted.
o Predominate in an individual cause for illness

Clinical implications –

- Diagnosis and recommendations for treatments can benefit from understanding the instructing
role of the 3 factors in assessing a person health on illness
- An effective patient – practitioner relationship can improve a patient’s use of service, the
efficacy of treatment and the rapidity with which illness is restored.

Milestones –

- 1978 – division of health psychology formed by APA

- Important developments within the field of psychology in the past 50 years.
- From 1980’s forward – gained momentum
- 2001 – apa added “ promoting health” to its minus statement.

Need for Health psychology –

- Changing patterns of illness

Major cause of illness in death was acute disorders – especially, tuberculosis,
pneumonia and other infectious diseases (developed countries)
- Treatment innovations and changes in public health standards, such as improvements in waste
controls and sewage.
- Acute disorders – short term illness often the results of viral or bacterial invader and usually
amendable on cure.
- Chronic illness – especially heart diseases, cancer and respiratory diseases – are the main
contributors to disability and death (industrialized countries) – slowly developing diseases with
which people live for many years and typically can’t be cured.
 Chronic illness = health psy

- Psy and social factors involved

- People may live with chronic illness for many years - Psychological issues would prevail in their
management.
- Helps in self care
- Helps ease the problems in family functioning that may result and management regimens and
self monitoring of symptoms and promote adherence to them.
- Enhance quality of life.

- Expansion of health care services

- Prevention – modifying people’s risky health behavior before they become ill
- Design of user friendly health care system.

Increased acceptance in medical community

- Development of behavioral interventions addresses health related problems including managing
pain, modifying bad health problems such as smoking and managing the side effects of
treatments.
- Informing patients fully about the procedures and sensations involved in unpleasant medical
procedures such as surgery improves their adjustment to those procedures.

Unit 2 – Stress and Coping

Stress – Negative emotional experience accompanied by predictable biochemical, physiological,

cognitive, and behavioral change that are directed either towards altering the stressful event or
altering its effects.

- 2 components – physical and psychological

- Stimulus – environment = stressors
- Response – physiological or psychological = strain
- Process = stressor + strain* + relationship between person and environment^
*(physical/psychological) ^ (transaction)
- Person – environment + interactions = transactions

Stress is not just a stimulus or a response, but rather a process in which the person is an active agent
who can influence the impact of a stressor through behavioral, cognitive, and emotional strategies.
People differ in the amount of strain they experience from the same stressor.

Stress is the circumstance in which transactions lead a person to perceive a discrepancy between the
physical or psychological demands of a situation and the resources of his or her biological, psychological,
or social systems.
Theories of Stress

1. Fight- or- Flight response- Walter Cannon

- When an organism perceives a threat, the body is rapidly aroused and motivated via the
sympathetic nervous system and the endocrine system. This concerted physiological response
mobilizes the organism to attack the threat or to flee; hence, it is called the fight-or-flight
response.
- Fight = aggressive responses to stress

Flight= social withdrawal or withdrawal through substance use or distracting activities.

2. General Adaptation Syndrome (GAS)- Hans Selye

- GAS- People goes through three phases in response to stress.

- In the first phase, alarm, the person becomes mobilized to meet the threat.
- In the second phase, resistance, the person makes efforts to cope with the threat, as through
confrontation.
- The third phase, exhaustion, occurs if the person fails to overcome the threat and depletes its
physiological resources in the process of trying.

3. Cognitive Appraisal theory- Richard Lazarus

- Cognitive appraisal is a mental process by which people assess two factors: (1) whether a
demand threatens their physical or psychological well-being and (2) the resources available for
meeting the demand.
- These are called primary and secondary appraisal.
- Primary appraisal occurs as a person is trying to understand what the event is and what it will
mean. Events may be appraised for their harm, threat, or challenge.
- Secondary appraisals assess whether personal resources are sufficient to meet the demands of
the environment.
- Person- environment fit

4. Tend- and- befriend- S.E. Taylor

- At times of stress, in addition to fight or flight, people and animals respond to stress with social
affiliation and nurturing behavior toward off spring
- Especially true of women
- Men and women faced somewhat different adaptive challenges
- Role of oxytocin and estrogen
Stress and health

4 routes – the important pathways by which stress affects health.

- Biological functioning and genetic predisposition
- Poor health behaviours
- Psychosocial resources
- Use of health services and adherence to treatment recommendations

Physiology of stress

2 Interrelated systems are involved in the stress response:

- Sympathetic- adrenomedullary system (SAM)
- Hypothalamic- pituitary- adrenocortical (HPA) axis

Sympathetic Activation
- When events perceived harmful/ threatening:
- Activate cerebral cortex
- Activate hypothalamus
- Sympathetic nervous system arousal
- Stimulates the adrenal glands
- Secrete catecholamines epinephrine (EP) and norepinephrine (NE)

HPA Activation
- Activates hypothalamus
- Releases corticotrophin releasing hormone (CRH)
- Stimulates pituitary gland
- Secretes Adrenocorticotropic hormone (ACTH)
 - Stimulate adrenal cortex
- Secrete cortisol
Effects of Long term stress
- suppression of immune function
- produce hemodynamic changes such as increased blood pressure and heart rate
- provoke variations in normal heart rhythms, such as ventricular arrhythmias- which can be a
precursor to sudden death and produce neurochemical imbalances that may contribute to
the development of psychiatric disorders.
- The catecholamines may also have effects on lipid levels and free fatty acids which contribute
to the development of atherosclerosis
- Prolonged cortisol secretion has also been related to the destruction of neurons in the
hippocampus, which can lead to problems with verbal functioning, memory, and
concentration
- Pronounced HPA activation is common in
- Depression
- Storage of fat in central visceral areas (i.e., belly fat), rather than in the hips,
- Poor sleep can be a consequence of chronic stress.

Individual differences in stress reactivity

- Reactivity is the degree of change that occurs in autonomic, neuroendocrine, and/or immune
responses as a result of stress.
- Predisposition- genetic makeup, prenatal experiences, and/or early life experiences leads to
more biological reactivity to stress and, consequently, more vulnerable to adverse health
consequences due to stress.
- Slow physiological recovery- cumulative damage of stress

Allostatic Load

- refers to the physiological costs of chronic exposure to the physiological changes that result
from repeated or chronic stress.
- Indicators
- Weight gain
- High BP
- Decreased immunity
- Memory problems etc.
- Many of these changes are response to ageing.
- Accumulating allostatic load can be accelerated ageing in response to stress, leading to
illness and increased risk of death
- Unhealthy behaviors (Ways of coping with stress) adds to the load.
Dimensions of stressful events
- Negative events
 - Uncontrollable events
- Ambiguous events- time consuming and resource sapping
- Overload
- People are more vulnerable to stress in central life domain
- Subjective and objective aspects of stress
- If a stressful event becomes a permanent or chronic part of the environment, will people
eventually habituate to it, or will they develop chronic strain?
- depends on the type of stressor
- the subjective experience of stress, and
- the indicator of stress
- Is environmentral noise and crowding a stressor?
- vulnerable populations, such as children, the elderly, and the poor, show little adaptation to
chronic stressors
- little control over their environments and,
- may already be at high levels of stress; the addition of an environmental stressor may push
their resources to the limits.
- Anticipating stress

Perceived stress scale- Sheldon Cohen

- The questions in this scale ask you about your feelings and thoughts during the last month. In
each case, you will be asked to indicate by circling how often you felt or thought a certain
way.

Sources of Chronic Stress

- Effects of early stressful life events- affect health across the life span.
- Low socioeconomic status
- Exposure to violence
- living in poverty-stricken neighborhoods
- Physical or sexual abuse
- Risky family- high in conflict or abuse and low in warmth and nurturance
- Depression, Lung disease, Cancer, heart disease, diabetes
- Chronic stressful conditions
- Contributes to psychological distress and physical illness
- Stress in marriage
- Parenting
- Household functioning
- Job
- Commuting
- Unlike life events, chronic stress isn't easy to measure
 - Poverty, exposure to crime, neighborhood stress, and other chronic stressors vary with SES
and are all tied to poor health outcomes
- Stress in workplace
- Sedentary lifestyle
- Work overload
- Ambiguity and role conflict
- Social relationships
- Control
- When high demands and low control are combined with little social support at work, in what
has been termed the demand-control support model
- Unemployment
- Multiple/dual roles

Stress related illness

Post traumatic Stress Disorder (PTSD)

- When a person has experienced intense stress, symptoms of the stress experience may
persist long after, the event is over. In the case of major traumas, these stressful aftereffects
may go on intermittently for months or years.
- Any trauma
- Symptoms include psychic numbing, reduced interest in once-enjoyable activities,
detachment from friends, or constriction in emotions.
- The person may relive aspects of the trauma
- Excessive vigilance, sleep disturbances, feelings of guilt, impaired memory and concentration,
an exaggerated startle response to loud noise, and even suicidal behavior.

PTSD can produce temporary and permanent changes in stress regulatory systems. People
with PTSD show cortisol dysregulation, alterations in immune functioning and chronically
higher levels of norepinephrine, and epinephrine.
PTSD leads to poor health, especially cardiovascular and lung disorders and early mortality,
especially from heart disease.
It also is tied to life-threatening health habits such as problem drinking and worsening
symptoms of already existing disorders such as asthma.

Who are vulnerable to PTSD?

- People who have poor cognitive skills or catastrophic thinking about stress,and people who
have a preexisting emotional disorder such as anxiety are vulnerable.
- People who use avoidant coping, have low levels of social support, have a history of chronic
stress, have preexisting heightened reactivity to trauma-related stimuli and general
negativity all have increased risk of developing PTSD in the wake of a traumatic stressor.
 - The more traumas one is exposed to, the greater the risk of PTSD, and the greater the health
risk that may result

Acute stress disorder

- Acute stress disorder is characterized by the development of severe anxiety, dissociation, and

other symptoms that occurs within one month after exposure to an extreme traumatic
stressor.
- Decrease in emotional responsiveness, often finding it difficult or impossible to experience
pleasure in previously enjoyable activities and frequently feel guilty about pursuing usual life
tasks.
- A person with acute stress disorder may experience difficulty concentrating, feel detached
from their body, experience the world as unreal or dreamlike, or have increasing difficulty
recalling specific details of the traumatic event 
- Either during or following the distressing event, the individual has 3 or more of the following
dissociative symptoms:
 A subjective sense of numbing, detachment, or absence of emotional responsiveness
 A reduction in awareness of his or her surroundings (e.g., “being in a daze”)
 Derealization
 Depersonalization
 Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
- Re-experience- recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense
of reliving the experience; or distress when exposed to reminders of the traumatic event.
- Significant avoidance of stimuli that arouse recollections of the trauma
- Anxiety or increased arousal
- The disturbance in an acute stress disorder must last for a minimum of 3 days and a
maximum of 4 weeks, and must occur within 4 weeks of the traumatic event. 
- Clinically significant distress or impairment in social, occupational, or other important areas
of functioning.

Psychophysiological disorders
- Psychosomatic- symptoms or illnesses that are caused or aggravated by psychological
factors, mainly emotional stress.
- Psychophysiological disorders, which refers to physical symptoms or illnesses that result
from the interplay of psychosocial and physiological processes.
- Uses a biopsychosocial perspective.
Digestive system diseases

- Ulcers and inflammatory bowel disease- pain and bleeding in the digestive tract
- Ulcers- stomach, duodenum, upper section of the small intestine
- Inflammatory bowel disease-
- Ulcerative colitis ( increased risk of colon cancer)- rectal bleeding, bloody diarrhoea,
abdominal cramps and pain
- Crohn disease (small intestine)- abdominal pain, diarrhoea, weight loss, anaemia, fatigue (risk
of colorectal cancer)
- Irritable bowel syndrome- abdominal pain, diarrhea, and constipation.
- Mainly adults, similar symptoms occur in childhood
- Most ulcers are produced by a combination of gastric juices eroding the lining of the stomach
and duodenum that has been weakened by bacterial infection. But stress plays a role, too.

Asthma

- Asthma is a respiratory disorder in which inflammation, spasms, and mucous obstruct the
bronchial tubes and lead to difficulty in breathing, with wheezing or coughing.
- Asthma attacks appear to result from some combination of three factors: allergies,
respiratory infections, and biopsychosocial arousal, such as from stress or exercise.
- Mostly physical factors are the cause, incidence of psychosocial factors are also there.
- adversity during childhood and family patterns that involve stress or low social support.
- stress-related psychosocial factors and asthma is bidirectional

Recurrent headache

- Two of the most common are called tension-type and migraine headache.
- Tension-type (or muscle contraction) headache seems to be caused by a combination of a
central nervous system dysfunction and persistent contraction of the head and neck muscles.
- The pain it produces is a dull and steady ache that often feels like a tight band of pressure
around the head. Recurrent tension-type headaches occur twice a week or more, and may
last for hours, days, or weeks.
- Migraine headache seems to result from dilation of blood vessels surrounding the brain and a
dysfunction in the brainstem and trigeminal nerve that extends throughout the front half of
the head.
- The pain often begins on one side of the head near the temple, is sharp and throbbing, and
lasts for hours or, sometimes, days.
- Sometimes migraines begin with or follow an aura, a set of symptoms that signal an
impending headache episode. These symptoms usually include sensory phenomena, such as
seeing lines or shimmering in the visual field. This may be accompanied by dizziness, nausea,
and vomiting.
- Recurrent migraine is marked by periodic unbearable symptoms, which occur about once a
month, with headache-free periods in between.
 - Tension type headaches are common.
- The prevalence of migraine is far greater in females than males, and increases with age from
childhood to middle age, and then declines.

Rheumatoid arthritis- chronic and very painful disease that produces inflammation and stiffness of the
small joints.

Dysmenorrhea- is characterized by painful menstruation, which may be accompanied by nausea,

headache, and dizziness.

Skin disorders- hives, eczema, and psoriasis, in which the skin develops rashes or becomes dry and
flakes or cracks.

Psychoneuroimmunology

- An individual’s psychological state can influence their immune system via the nervous system.
- Essential components: (1) the immune system; (2) conditioning the immune system; (3)
measuring immune changes; and (4) psychological state and immunity.
- The role of the immune system is to distinguish between the body and its invaders (antigens)
and to attack and protect the body from anything that is considered foreign.
- When the immune system works well the body is protected and infections and illnesses are kept
at bay.
- If the immune system overreacts then this can lead to allergies.
- If the immune system mistakes the body itself for an invader then this can form the basis of
autoimmune disorders-Rheumatoid arthritis, Inflammatory bowel disease, Multiple Sclerosis,
Psoriasis
- Lymphoid organs - bone marrow, lymph nodes and vessels, the spleen and thymus.
- Three levels of immune system activity.
- The first two are called specific immune processes and are ‘cell mediated immunity’ and
‘humoral mediated immunity’.
- Cell mediated immunity involves a set of lymphocytes called T cells (killer T cells, memory T
cells, delayed hypersensitivity T cells, helper T cells and suppressor T cells).
- These operate within the cells of the body and are made within the thymus (hence ‘T’).
- Humoral mediated immunity involves B cells and antibodies and takes place in the body’s fluids
before the antigens have entered any cells.
- Third, there is non-specific immunity which involves phagocytes (cells which ingest/digest
foreign substances) which are involved in non-specifically attacking any kind of antigen.
- Immunocompetence is when the immune system is working well.
- Immunocompromise is when the immune system is failing in some way.
- Ader and Cohen (1975, 1981)- applied the basic principles of classical and operant conditioning
in immune system interaction with other systems of the body.
- One’s psychological state can lead/ not lead to immunosupression.
 The four main markers of immune function used to date have been as follows:
- (1) tumour growth, which is mainly used in animal research;
- (2) wound healing, which can be used in human research by way of a removal of a small section
of the skin and can be monitored to follow the healing process
- (3) secretory immunoglobulin A (sIgA), which is found in saliva and can be accessed easily and
without pain or discomfort to the subject
- (4) natural killer cell cytoxicity (NKCC), T lymphocytes and T helper lymphocytes, which are
found in the blood.
- Immediate or delayed effect?
- Taking blood/ saliva lead to changes in immune functioning?
- Accuracy?
- Psychological factors and immune functioning
- the role of mood, beliefs, emotional expression and stress.
- Positive/ negative mood
- Attribution- pessimistic approach
- Seligman et al. (1988) argued that pessimism may be related to health through a decrease in T-
cells and immunosuppression.
- Hopelessness/ fighting spirit
- Expression of emotions, particularly negative emotions in stressful situations, can be harmful for
health.
- Encouraging emotional expression through writing or disclosure groups may be beneficial
(Pennebaker)
- Writing/talking about emotional topics
- Relevant experiences
- 15- 30 mins of writing spreading across few days to weeks to months.
- Men may benefit more from writing than women and those who do not naturally talk openly
about their emotion may benefit more than those who do.
- Individuals high on hostility scores benefited more from writing than those low on hostility.
- Use of language
- Stress and immune system

Moderators of stress experience

- Exercise
- Coping styles
- Social support
- Personality
- Actual or perceived control
 Stress moderators- modify how stress is experienced and the effects it has.

- Have an impact on
- stress itself,
- on the relation between stress and psychological responses,
- on the relation between stress and illness, and
- on the degree to which a stressful experiences intrudes into other aspects of life.

Coping
- the thoughts and behaviors used to manage the internal and external demands of situations
that are appraised as stressful.
- Personality and coping-negative affectivity, a pervasive negative mood marked by anxiety,
depression, and hostility. People high in negative affectivity (also called neuroticism) express
distress, discomfort, and dissatisfaction in many situations.
- Elevated levels of stress indicators such as cortisol, heart rate, inflammation, and risk factors for
coronary heart disease.
- A second link is poor health habits
- Poor response to treatment
- Report physical symptoms like headache and pain when under stress
- Use health services more than people who are positive.
- Positive emotional functioning- low levels of cortisol
- Better immune response
- Positivity promotes psychosocial resources to effectively cope with stress
Psychosocial resources
- Optimism
- Psychological control is the belief that one can determine one’s own behavior, influence one’s
environment, and bring about desired outcomes. The belief that one can exert control over
stressful events has long been known to help people cope with stress.
- Leads to better self- efficacy
- Control-enhancing interventions- these interventions use information, relaxation, and
cognitive-behavioral techniques, such as learning to think differently about the unpleasant
sensations of a procedure, to reduce anxiety, improve coping, and promote recovery
- People who desire control especially benefit from control-based interventions.
- But control may actually be aversive if it gives people more responsibility than they want.
- Self- esteem
- Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or
significant sources of stress — such as family and relationship problems, serious health
problems or workplace and financial stressors. It means "bouncing back" from difficult
experiences. (APA)
- bounce back from bad experiences and adapt flexibly to the changing demands of stressful
situations.
 - A sense of coherence about one’s life, a sense of purpose or meaning in one’s life, a sense of
humor, trust in others, a sense that life is worth living, and religious beliefs are also resources
that promote resilience and effective coping
- Find opportunities for rest and relaxation
- short vacations
- Celebrating positive moments in life
- Being able to feel positive emotions, even when going through intense stressors, is a coping
method that resilient people draw on

Coping styles

- Coping style is a propensity to deal with stressful events in a particular way.

- Approach v/s avoidance coping
 Avoidant- minimizing coping style
 Approach- confrontative, vigilant coping style
 Approach coping style- people may pay a short-term price in anxiety and physiological
reactivity as they confront stressful events, but be better off in the long-term.
 How long term the stressor is?
- Problem- focused and emotion- focused coping
 Problem-focused coping involves attempts to do something constructive about the
stressful conditions that are harming, threatening, or challenging an individual.
 Emotion-focused coping involves efforts to regulate emotions experienced due to the
stressful event.
 Both are equally helpful
 Nature of the event/ type of stressor- determines the coping style used.
 People who are able to shift their coping strategies to meet the demands of a situation
cope better with stress than those who do not.
- Emotional approach coping
 focused on managing the emotions in response to stress.
- Proactive coping
 anticipate potential stressors and act in advance, either to prevent them or to reduce
their impact
 Requires the abilities to anticipate or detect potential stressors
 coping skills for managing them
 self-regulatory skills, which are the ways that people control, direct, and correct their
actions as they attempt to counter potential stressful events.

Coping Interventions

- Mindfulness meditation and acceptance/commitment theory

 Mindfulness meditation teaches people to strive for a state of mind marked by
heightened awareness of the present, focusing on the moment and accepting and
acknowledging it without becoming distracted or distressed by stress.
  Mindfulness-based stress reduction (MBSR) is systematic training in mindfulness to help
people manage their reactions to stress and the negative emotions that may result.
 Mindfulness engages the prefrontal cortical regions of the brain, which regulate affect
and suppress the activity in the limbic areas related to anxiety and other negative
emotions.
- acceptance/commitment theory - CBT technique that incorporates acceptance of a problem,
mindfulness regarding its occurrence and the conditions that elicit it, and commitment to
behavior change.
- Expressive writing - J. W. Pennebaker
- Self- affirmation
 Self-affirmation theory (Claude Steele, 1988) maintains that when people positively
affirm values, they feel better about themselves and show lower physiological activity
and distress.
 When people engage in brief self affirmation exercises, they practice better health
habits
- Relaxation training
 affects the physiological experience of stress by reducing arousal.
 Relaxation therapies include deep breathing, progressive muscle relaxation training,
guided imagery, transcendental meditation (Maharishi Mahesh Yogi- silent mantra
meditation, practiced for 20 minutes twice per day), yoga, and self hypnosis.
- Benefits- reduce heart rate, muscle tension, blood pressure, inflammatory activity, lipid levels,
anxiety, and tension, among other physical and psychological benefits.

Combat Stress Now (CSN)- 3 phases- education, skill acquisition, practice

- Identify stressors
- Monitoring stress
- Identifying stress antecedents
- Avoiding negative self-talk
- Completing take- home assignments
- Acquiring skills
- Setting new goals
- Engaging in positive self talks and self instruction
- Using other CBT techniques- contingency reinforcement
- The person is encouraged to identify the people in their environment who cause them special
stress—called stress carriers— and develop techniques for confronting them.

Unit 3

Pain

- Pain is perceived as a direct consequence of physical injury

- The extent of tissue damage determined to the intensity of pain.
- Strong ( 1895) hypothesized that pain was due to 2 factors –
o The sensation
o The person’s reaction to that sensation.
- Physical injury
- Damage determined according to intensity of pain
- Attention to psychological factors, gave on altered view of pain
- The international association for the study of pain (IASP) subcommittee on Taxonomy defined
pain as - “an unpleasant sensory and emotional experience associated with actual or potential
tissue damage, or described in terms of such damage.”
- Provides constant feedback about the body
- Warning sign
- Triggers help- seeking behaviour
- Acute pain- pain that lasts for six months or less. It usually has a definable cause and is mostly
treated with painkillers
- Chronic pain- lasts for longer than six months and can be either benign in that it varies in
severity or progressive in that it gets gradually worse.
- Pre-chronic pain- comes between acute and chronic pain
- Chronic recurrent pain- pain marked by alternating episodes of intense pain and no pain.
- Complaints of pain often accompany mental and physical disorders, and this comorbidity further
complicates diagnosis and treatment
- The relationship between pain and the underlying problem can be weak
- Pain is medically significant because it can be a source of misunderstanding between a patient
and the medical provider.
- Patients may choose not to comply with their physician’s recommendations if they think they
have been misdiagnosed or if their chief symptoms have been ignored
- Role of depression, anxiety, anger
- Social support for pain can inadvertently act as reinforcement of pain behaviors which then
become part of the pain problem
- Social pain- social rejection or loss

Pain theories

- Earlier models focused on biomedical framework

- Descartes- pain as a response to painful stimulus
- There exists a direct pathway from the source of pain to an area of the brain that detected the
painful sensation

Von Frey- specificity theory of pain

- Reflects on stimulus- response model

- 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
- There were specific sensory receptors which transmit touch, warmth and pain, and that each
receptor was sensitive to specific stimulation

Goldschneider (1920) - pattern theory- suggested that nerve impulse patterns determined the
degree of pain and that messages from the damaged area were sent directly to the brain via these
nerve impulses.

- Conclusion from the models

- Tissue damage causes the sensation of pain.
- Psychology is involved in these models of pain only as a consequence of pain (e.g. anxiety, fear,
depression). Psychology has no causal influence.
- Pain is an automatic response to an external stimulus. There is no place for interpretation or
moderation.
- The pain sensation has a single cause.
- Pain was categorized into being either psychogenic (psychosomatic) pain or organic pain.

Inclusion of psychology in understanding pain

- Medical treatments for pain (e.g. drugs, surgery) were (mostly) only useful for treating acute
pain
- People with same degree of tissue damage had varied response to pain
- Meaning associated to pain mediates the pain experience
- Phantom limb pain- pain the majority of amputees tend to feel in an absent limb
- Three kinds of pain perception- nociception (sensory nervous system’s response to harmful or
potentially harmful stimuli).
- Mechanical nociception—pain perception that results from mechanical damage to the tissues of
the body.
- Thermal damage- the experience of pain due to temperature exposure.
- Polymodal nociception, a general category referring to pain that triggers chemical reactions
from tissue damage
- TED video on nociception

Gate- control theory of pain

- Ronald Melzack and Patrick Wall (1965)

- Nociceptors- peripheral nerves- sense injury
- Release chemical messengers (endorphins)
- Spinal cord contains a neurological "gate" that either blocks pain signals or allows them to
continue on to the brain
- Thoughts, emotions, expectations can influence the perception of pain
- Before the information (pain signals) is transmitted to the brain, they encounter ‘nerve gates’
- Sometimes passed on, otherwise prevented
- Dorsal horn of the body's spinal cord.
- Both small nerve fibers (pain fibers) and large nerve fibers (normal fibers for touch, pressure,
and other skin senses) carry information to the two areas of the dorsal horn
- Large fiber activity, however, excites the inhibitory neurons, which diminishes the transmission
of pain information.
- When there is more large fiber activity in comparison to pain fiber activity, people tend to
experience less pain. This means that the pain gates are closed.
- Why do we rub injuries after they happen?
- The increase in normal touch sensory information helps inhibit pain fiber activity, therefore
reducing the perception of pain

Types of pain

- Acute pain and Chronic pain

- Acute pain- results from specific injury that produces tissue damage
- It disappears when the tissue damage is repaired
- Short duration- 6 months or less
- Induces anxiety, role of painkillers
- Chronic pain- begins with an acute episode, but unlike acute pain, it does not decrease with
treatment and the passage of time.
o Types of Chronic pain
- Chronic benign pain - persists for 6 months or longer and is relatively unresponsive to
treatment.
The pain varies in severity and may involve any of several muscle groups.
Example- Chronic low back pain
- Recurrent acute pain - intermittent episodes of pain that are acute in character but chronic in as
much as the condition recurs for more than 6 months.
- Example- Migraine headaches
- Chronic progressive pain- longer than 6 months and increases in severity over time.
- Typically, it is associated with malignancies or degenerative disorders, such as cancer or
rheumatoid arthritis.
Psychological factors and pain perception
- The components of pain perception reflect a three- process model of pain
- physiological processes- tissue damage, release of endorphin, changes in heart rate, breathing
rate etc.
- Subjective–affective–cognitive processes

Behavioral processes

o Classical conditioning
- Associative learning- associate a particular environment with the experience of pain.
- Expectation- anxiety- pain
o Operant conditioning
- Individuals may respond to pain by showing pain behaviour
- Such pain behaviour may be positively reinforced - increase pain perception- become part of
lifestyle
- Secondary gains of pain
Learning and pain-
- associate pain with antecedent cues and its consequences, especially if the pain is severe and
repeated, as it usually is with chronic pain
- Eg: Migraine
- Words or stimuli that relate to the pain we have experienced can also become conditioned
stimuli and produce conditioned responses
- Research findings- physiological arousal in response to pain- related words (Jamner and Tursky,
1987)
- (Excruciating, squeezing, throbbing etc. )

Pain behaviors- characteristics ways people with pain behave

- 4 types (Turk , Wack, & Kerns, 1985)

- Facial or audible expression of distress- as when people clench their teeth, moan, or grimace.
- Distorted ambulation or posture- such as moving in a guarded or protective fashion, stooping
while walking, or rubbing or holding the painful area.
- Negative affect- such as being irritable.
- Avoidance of activity- as when people lie down frequently during the day, stay home from
work, or refrain from motor or strenuous behavior.
The role of affect
- Anxiety can increase pain perception
- Differs with respect to acute and chronic pain
- Distraction and low anxiety can reduce pain experience
- Fear of increased pain or pain reoccurring can result in avoiding a whole range of activities that
they perceive to be high risk
- Fear of pain and fear avoidance beliefs have been shown to be linked with the pain experience
in terms of triggering pain in the first place
- fear may also be involved in exacerbating existing pain and turning acute pain into chronic pain.

The role of cognition

- Catastrophizing
- Three components: (1) rumination – a focus on threatening information, both internal and
external (‘I can feel my neck click whenever I move’)
- (2) magnification – overestimating the extent of the threat (‘The bones are crumbling and I will
become paralysed’)
- (3) helplessness – underestimating personal and broader resources that might mitigate the
danger and disastrous consequences (‘Nobody understands how to fix the problem and I just
can’t bear any more pain’)
- Leads to longer term pain problems
- Meaning associated to pain
- Self- efficacy
- Attention can increase pain and distraction can reduce pain experience
- Behavioral processes

Pain and secondary gains

- Pain behaviours are reinforced through attention, the acknowledgement they receive,
and through secondary gains
- Pain behaviour can also cause a lack of activity and muscle wastage, no social contact and no
distraction leading to a sick role, which can also increase pain perception
- Research- people often assume that individuals have more control over the extent of their pain-
induced facial expressions than they actually do and are more likely to offer help or sympathy
when expressions are mild.
- Stronger forms of expressions are interpreted as amplified and as indications of malingering.
- Gender, sociocultural factors and pain?
- Organic and Psychogenic pain
- The processes though distinct in itself, interact with one another
- Acute v/s chronic pain
1. Present different psychological profiles
- Chronic pain- psychological distress- complicates diagnosis and treatment
- Depression, anxiety, anger
- Maladaptive coping strategies- catastrophizing, wishful thinking, social withdrawal
- Beliefs that magnify the distress of chronic pain and feedback into the pain itself
2. Most pain control techniques work for acute pain, hence individualised techniques for chronic
pain management is required
3. Complex interaction of physiological, psychological, social, and behavioural components in
chronic pain
- Inappropriate prior treatments by misdiagnosis, and/or by inappropriate prescriptions of
medications; biopsychosocial factors
- Chronic pain and lifestyle?
- Work related- leave the job, financial issues, compensation
- Social life- withdrawal from family and social circles, lack of interest in leisure activities
- Personal life- low self- esteem
- Chronic pain and relationships- poor communication, deterioration in sexual relationships,
though spouses are supportive, it may maintain the pain and disability.
- Pain behaviors- knowing whether they persist after the treatment of pain is important in
treating the total pain experience
- Personality and pain?
- Pain- prone personality- a constellation of personality traits that predispose a person to
experience chronic pain (Ramirez-Maestre, Lopez-Martinez, & Zarazaga, 2004).
- But, pain itself can produce alterations in personality that are consequences, not causes, of the
pain experience.
- Individual experiences of pain are too varied and complex to be explained by a single personality
profile.
- Certain personality attributes are reliably associated with chronic pain, including neuroticism,
introversion, and the use of passive coping strategies
- Pain profiles- MMPI, Johansson & Lindberg, 2000
- Chronic patients high on three subscales- hypochondriasis, hysteria and depression- “neurotic
triad”
- Depression increases pain perception- hence treat depression and pain
- Suppression of anger and pain- dysfunction in the opioid system that controls pain or to
psychological processes involving hypervigilance.
- Anxiety disorders, substance abuse disorders, other psychiatric problems
- Possibility- chronic pain activates latent psychological vulnerabilities (Dersh, Polatin,& Gatchel,
2002).

Assessment of pain

- Self report methods

- Behavioral assessment approaches
- Psychophysiological measures
- Self report method-
- Describe their discomfort- rating scale or questionnaire
- Interviews with family members, coworkers
- (History, emotional adjustment, lifestyle, impact on current lifestyle, interpersonal relations and
work, response of family, factors that trigger pain or make them worse, coping style)
- Three scales for measuring pain intensity-
- Visual analog scale-people rate their pain by marking a point on a line that has labels only at
each end. This type of scale is very easy for people to use and can be used with children as
young as 5 years of age
- The box scale has individuals choose one number from a series of numbers that represent levels
of pain within a specified range
- The verbal rating scale has people describe their pain by choosing a word or phrase from several
that are given
Use pain diaries
- Pain Questionnaires- considering the multidimensional nature of pain
- Melzack determined that pain involves three broad dimensions—
- affective (emotional-motivational), sensory, and evaluative—by conducting a study in which
subjects sorted over 100 pain-related words into separate groups of their own making
 - By determining the degree of pain reflected by each word, Melzack (1975) constructed an
instrument to measure pain- MPQ (McGill Pain Questionnaire)
- 20 subclasses of descriptive words- choose the word best fitting the pain experienced- assigned
value- pain rating index
- Present pain intensity- verbal rating scale
- Advantages
- Useful for assessing pain in research and clinical purposes
- Individuals with similar pain syndromes tend to choose the same patterns of words to describe
their pain. But people suffering from very different types of pain—for example, toothache,
arthritis, cancer, and phantom limb pain—choose different patterns of words in the MPQ to
describe their different pain experiences.
- Disadvantages
- It requires a fairly strong English vocabulary
- Not useful for children below 12 years of age
- (Sarafino- Page 301)
Multidimensional Pain Inventory

Behavioral assessment approaches-

- Considering two types of situations- everyday activities and structured clinical sessions
- Stuctured clinical sessions- specific pain behaviors to be assessed and tasks the patient is asked
to perform
- UAB pain Behavior Scale- used by nurses during early morning rounds
- Ask patients to perform several activities and rates each of 10 behaviors, such as the patient’s
mobility and use of medication, on a 3-point scale: ‘‘none,’’ ‘‘occasional,’’ and ‘‘frequent.’’ These
ratings are converted into numerical values and summed for a total score.
- Assessing pain in everyday activities- Does the person spend much time in bed, complain of
discomfort a lot, seek help frequently in moving, or walk with a limp most of the time? How
much of these behaviors does the person exhibit?
- Help by family members
- Get an idea of the impact in his or life and the social context that maintain pain behaviors-
assessor maintain a pain diary

Psychophysiological measures-

- EMG- electromyograph to measure the electrical activity in muscles, which reflects their
tension.
- Muscle tension is associated with various pain states
- Assessments need to be taken over an extended period of time
- Measure of autonomic activity- heart rate, skin conductance- but not very useful
- Because changes in autonomic activity are more strongly related to people’s ratings of pain than
to the strength of the pain stimulus, are inconsistently associated with chronic pain, and readily
occur in the absence of the sensation of pain, such as when people feel stressed.
 - EEG- electroencephalograph to measure electrical activity of the brain
- Pain stimuli produce evoked potentials (electrical changes produced by stimuli) that vary in
magnitude—the amplitudes of the surges increase with the intensity of the stimuli, decrease
when subjects take analgesics, and correlate with people’s subjective reports of pain.
- Affected by other factors, such as attention, diet, and stress
Role of Psychology in pain treatment
- Acute pain- Pharmacological interventions
- Chronic pain- multidisciplinary approach
- Improving physical and lifestyle functioning
- Decreasing reliance on drugs and medical services
- Increasing social support and family life
- Early intervention to prevent transition from acute to chronic pain
- Methods of pain intervention need to focus on psychology and physiological factors
- Respondent methods- designed to modify the physiological system directly by reducing
muscular tension.
Examples are relaxation methods , biofeedback , hypnosis (acute pain and repeated painful
procedures)
- Cognitive methods- focuses on the individuals’thoughts about pain and aims to modify
cognitions that may be exacerbating their pain experience.
Examples- attention diversion, imagery, Socratic questioning (to modify maladaptive thoughts
by challenging their automatic thoughts- use role play and role reversal)
- Behavioral methods- use the basic principles of operant conditioning and use reinforcement to
encourage the individual to change their behaviour.

Pain control techniques –

- What are the possible techniques to control pain?

- Pain control can mean that a patient no longer feels anything in an area that once hurt.
- Feels sensation but no pain.
- Feels pain but not concerned about it.
- Still hurting but can tolerate the pain.

Pharmacological control of pain

- Administration of drugs – morphine

- Addiction, tolerance
- Neural transmission is affected
- Local anesthetics can affect the transmission of pain impulses from the peripheral receptors to
the spinal cord. Eg – analgesic
- Videos -How does anesthesia work?
How aspirin was discovered? – TED ED
- The injection of drugs – spinal blocking agents.
 - Drugs that act directly on higher brain regions – antidepressants, for Eg, combat pain not only by
reducing anxiety and improving mood but also affecting the downward pathways from the brain
that modulate pain.
- Undesirable side effects – limb paralysis, loss of bladder control.
- Research – addiction often exaggerated.

Surgical control of pain

- Cutting or creating lesions in the pain at the various points in the body so that pain sensations
can no longer be conducted.
- Some techniques attempt to disrupt the conduct of pain from the periphery to the spinal cord:
others are designed to interrupt the flow of pain sensations from the spinal cord upward to the
brain
- Temporary, side effects, expensive
- The nervous system has substantial regenerative powers and that blocked pain impulses find
new neural pathways.
- Damage the nervous system
- May be considered as a last resort.

Sensory Control of Pain

- Counterirritation – inhibiting pain in one pain of the body by stimulating or mildly irritating
another area.
- Eg – spinal cord stimulation.
- A set of small electrodes is placed or implanted near the point at the nerve fibres from the
painful area enter the spinal cord.
- When the patient experiences pain, he / she activate a radio signal, which delivers a mild
electrical stimulus to the area of the spine, thus inhibiting pain.
- Temp relief
- Restrict movement for healing v/s staying active to maintain functioning.

Psychological control of pain

- CBT – it changes our perception – focus on cognitions – managing healthy and unhealthy
thinking
Positive and negative self talk – restructuring thoughts and
- Relaxation exercises – Jacobson progressive muscle relaxation, bio feedback, mediation,
distraction - some control of pain can be taken for one level

Psychological techniques

- Require active participation and learning from the patient

- More effective for managing slow-rising pains

Biofeedback

- Achieving control over the bodily processes

- Biophysiological feedback to a patient about some bodily process of which the patient is usually
unaware.

- Operant learning process

- Identify the target function

- Tracked by machine which gives feedback

- Through trial and error and continuous feedback from the machine, the patient learns what
thoughts or behaviors will modify the bodily function

- Used for treating headaches, Raynaud’s disease (disorder in which small arteries in the
extremities constrict, limiting blood flow and producing a cold, numb aching),
temporomandibular joint pain, pelvic pain

- Moderate evidence on reducing pain

Relaxation techniques

- Used alone or along with other techniques

- Enables them to cope more successfully with stress and anxiety

- Relaxation may also affect pain directly- the reduction of muscle tension or the diversion of
blood flow induced by relaxation may reduce pains that are tied to these physiological processes

- Progressively relax different parts of the body- state of low arousal.

- Controlled breathing- breathing shifts from relatively short, shallow breaths to deeper, longer
breaths

- Meditation, slow breathing, and mindfulness also reduce pain sensitivity and can produce
analgesic effects, possibly through a combination of relaxation and self-regulatory skills

- Activation of opioid mechanisms-endorphins

Distraction

- By focusing attention on an irrelevant and attention- getting stimulus or by distracting oneself

with a high level of activity, one can turn attention away from pain

- Reinterpret the experience

- Effective for low level pain

 - Not possible to distract indefinitely- hence may not be quite useful for chronic pain patients

Coping skills training

- Avoidant v/s attentive

Cognitive- behavioural therapy

- Encourage patients to reconceptualize the problem from overwhelming to manageable

- Clients must be convinced that the skills necessary to control the pain can and will be taught to
them, thereby enhancing their expectations that the outcome of this training will be successful

- Clients are encouraged to reconceptualize their own role in the pain management process, from
being passive recipients of pain to being active, resourceful, and competent individuals who can
aid in the control of pain- promote self-efficacy

- Clients learn how to monitor their thoughts, feelings, and behaviors to break up maladaptive
behavioral syndromes that accompany chronic pain

Negative self-talk v/s positive self- talk

- Patients are taught how and when to employ overt and covert behaviors in order to make
adaptive responses to the pain problem

- Clients are encouraged to attribute their success to their own efforts

- Relapse prevention

- Trained to control their emotional responses to pain- acceptance

- Self-determination theory also provides guidelines for intervening with chronic pain patients as
by increasing autonomy, feelings of competence, and the experience of support.

- Mindfulness interventions have also shown success for some chronic pain patient groups

- Hypnosis

- Acupuncture

- Guided imagery

Unit 4

Chronic Illness – from a health psychology perspective

- Caretaker’s aspect to the chronic illness

 - Connection to body and mind
- Holding
- After Diagnosis, life becomes it more difficult for the patient.
1. Cancer – not able to find direct links to find out what causes cancer – higher chances of genetic link

- Cancer is defined as an uncontrolled growth of abnormal cells, which produces tumours called
neoplasms.

- There are two types of tumour: benign tumours, and malignant tumours

- There are three types of cancer cell: carcinomas, which constitute 90 per cent of all cancer cells
and which originate in tissue cells; sarcomas, which originate in connective tissue; and
leukaemias, which originate in the blood.

Lung Cancer (damaging the lungs)

Symptoms –

- Not many signs and symptoms in the earliest stages

- A new cough that doesn’t go away
- Coughing up blood, a small amt
- Shortness of breath
- Bone pain
- Chest Pain
- Hoarseness
- Losing weight without trying
- Headache
Risk Factors
- Smoking
- Exposure to secondhand smoke
- Exposure to radon gas
- Exposure to asbestos, arsenic, chromium, nickel
- Family history

Colon cancer/colorectal cancer

- In the large intestine

- In older adults
- Begins as small noncancerous clumps of cells called polyps that develop in the colon which over
time becomes cancerous

Symptoms

- A persistent change in bowel movements – diarrhea or constipation

- Rectal bleeding
 - Persistent abdominal discomfort – cramps, gas or pain
- A feeling that your bowel doesn't empty completely
- Weakness or fatigue
- Unexplained weight loss
- No symptoms in the early stages of the disease. When symptoms appear, they'll likely vary,
depending on the cancer's size and location in your large intestine.

Risk factors –
- Age 50 above
- Personal history
- Inflammatory intestinal conditions
- Inherited – familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer
(HNPCC) – lynch syndrome
- Family history
- Low fiber high fat diet
- Sedentary lifestyle
- Smoking, Obesity
- Diabetes, Alcohol, Radiation therapy directed at the abdomen

Liver Cancer

- Cells in the liver

- Upper right portion of the abdomen, beneath the diaphragm and above the stomach
- Metastatic – Cancer that spreads to the liver is more common than cancer that begins in the
liver cells

Symptoms –

- Losing weight
- Loss of appetite
- Upper abdominal pain
- Nausea and vomiting
- General weakness and fatigue
- Abdominal Swelling
- Yellow discoloration of your skin and whites of your eyes
- White, chalky stools

Causes/ risk factors-

- Chronic infection with Hepatitis B or C virus

- Cirrhosis
- Inherited liver diseases – hemochromatosis and Wilson’s disease (excessive copper absorption)
- Diabetes
- Nonalcoholic fatty liver disease
 - Exposure to aflatoxins
- Excessive alcohol consumption

Pancreatic cancer –

- Tissues of your pancreas – cells that lines the ducts that carry digestive enzymes out of the
pancreas
- Pancreas – enzymes that aid digestion
- The most common type of cancer - begins in the cells that line the ducts that carry digestive
enzymes out of the pancreas

Symptoms –
- Abdominal pain that radiates to your back
- Loss of appetite or unintended weight loss
- Yellowing of your skin and the whites of your eyes (jaundice)
- Light colored stools
- Dark colored urine
- Itchy skin
- New diagnosis of diabetes or existing diabetes that's becoming more difficult to control
- Blood clots
- Fatigue

Risk Factors

- Smoking
- Diabetes
- Chronic inflammation of the pancreas
- Family history of genetic conditions – BRCA2, Lynch syndrome, familial atypical mole –
malignant melanoma (FAMMM)
- Family history
- Obesity
- Older age – after 65 years

Mouth Cancer

- Cancer that develops in any of the parts that make up the mouth (oral cavity)
- Lips
- Gums
- Tongue
- Inner lining of the cheeks
- Roof of the mouth
- Floor of the mouth
- Oral cancer/oral cavity cancer
- Category of head and neck cancer
 Symptoms –

- A lip or mouth sore that doesn’t heal

- A white or reddish patch on the inside of your mouth
- Loose teeth
- A growth or lump inside your mouth
- Mouth pain
- Ear pain
- Difficult or painful swallowing

Risk factors
- Tobacco use – cigarettes, cigars, pipes, chewing tobacco and snuff
- Heavy alcohol use
- Excessive sun exposure to lips
- HPV – sexually transmitted virus
- A weakened immune system

Throat cancer

- Cancerous tumors that develop in your throat, voice box or tonsils

Symptoms
- A cough
- Changes in your voice
- Difficulty swallowing
- Ear pain
- A lump or sore in throat
- A sore throat
- Weight loss

Risk factors

- Tobacco use
- Excessive alcohol use
- HPV
- A diet lacking fruits and vegetables
- GERD – Gastroesophageal reflux disease

Biological factors –

- Genes/Heredity
- Viruses
- Age
Psycho factors –

- Type c personality
- Addiction
- Stress
- Unhealthy coping mechanism
- Eating disorders

Social/lifestyle factors –

- Diet/eating habits
- Smoking
- Sedentary lifestyle
- Environmental factors – radiation, emission of gases, pollution
- Alcohol
2. Cardiovascular diseases( any with the disturbance to the functioning of the heart) – coronary heart
attacks, - cause wise (higher chances of genetic link) – moderate level of exercise (even at tests,
there is proper caution taken)

The Cardiovascular system

 comprises the heart, blood vessels, and blood

 acts as the transport system of the body

 Blood carries oxygen from the lungs to the tissues and carbon dioxide from the tissues to the
lungs

 Blood also carries nutrients from the digestive tract to the individual cells for growth and energy

 The blood carries waste products from the cells to the kidneys, from which the waste is excreted
in the urine

 Carries hormones from the endocrine glands to other organs of the body and transports heat to
the surface of the skin to control body temperature

Cardiovascular disease (CVD)

 Congenital defects

 Infection

Major threats- lifestyle factors=

 stress,

 Diet
  Exercise

 smoking

Atherosclerosis

 Worsens with age

 Caused by deposits of cholesterol and other substances on the arterial walls, which form
plaques that narrow the arteries

 These plaques reduce the flow of blood through the arteries and interfere with the passage of
nutrients- leading to tissue damage

 Damaged arterial walls are potential sites for formation of blood clots

Associated with many primary clinical manifestations:

 Angina pectoris- (chest pain) due to insufficient blood flow. Feels like squeezing, pressure,
heaviness, tightness, or pain in the chest. Can be sudden or recur over time

 Myocardial infarction (MI)- (heart attack)- results when a clot has developed in a coronary vessel
and blocks the flow of blood to the heart

 Ischemia- characterized by lack of blood flow and oxygen to the heart muscle

 Congestive heart failure (CHF), which occurs when the heart’s delivery of oxygen-rich blood is
inadequate to meet the body’s needs.

 Arrhythmia, irregular beatings of the heart, which, at its most severe, can lead to loss of
consciousness and sudden death.

Rheumatic fever- bacterial infection that originates in the connective tissue and can spread to the heart,
potentially affecting the functioning of the heart valves

 Vulnerable to endocarditis, the inflammation of the membrane that lines the cavities of the
heart

Blood pressure

 the force that blood exerts against the blood vessel walls

 Systole and diastole

Influenced by several factors:

 Cardiac output- the volume of blood being pumped.

pressure against the arterial wall is greater as the volume of blood flow increases
  Peripheral resistance- the resistance of the arteries to the blood flow.

Affected by the number of red blood cells and the amount of plasma the blood contains

As the arteries constrict, the resistance increases and as they dilate, resistance decreases

Structure of the arterial walls-If the walls have been damaged, if they are clogged by deposits of waste,
or if they have lost their elasticity, blood pressure will be higher

The blood

 Approx. 4.5 – 5.5 litres blood

 Plasma- fluid portion- approx. 55% of blood volume

 45%- RBC and WBC

 Contains oxygen and nutrients or carbon dioxide and waste materials

 Regulates skin temperature

 WBC- role in healing by absorbing and removing foreign substances from the body.

 Lymphocytes produce antibodies. Fights infection and disease

 RBC- contain hemoglobin needed to carry oxygen and carbon dioxide throughout the body.

 Anemia

 Platelets enable blood clotting

Clotting disorders

 Clots or thromboses can develop in blood vessels

 Mostly occurs when arterial or venous walls have been damaged or roughened because of the
buildup of cholesterol.

 Platelets then adhere to the roughened area, leading to the formation of a clot.

 Leads to coronary thrombosis or cerebral thrombosis (clot in blood vessels)

 Clot in veins- embolus – causes pulmonary obstruction

Stroke-occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a
clot or bursts (or ruptures)

3. AIDS – genetic + stigma – transmission through various modes – check of cures still on
- The HIV virus is a retrovirus
 - There are three types of retrovirus: oncogenic retroviruses which cause cancer, foamy
retroviruses which have no effect at all on the health status of the individual, and lentiviruses,
or slow viruses, which have slow longterm effects.
- HIV (Human Immunodeficiency Virus) is a lentivirus.
- It attacks the helper T cells and macrophages of the immune system.
- The virus appears to be transmitted exclusively by the exchange of cell-containing bodily fluids,
especially semen and blood.
- The period between contracting the virus and development of symptoms of AIDS is variable
- During the asymptomatic period can pass on the virus to other people.
- Transmission- needle exchanges among drug users, anal- receptive sex without condom, vaginal
intercourse without condom, number of sexual partners, number of anonymous sexual
partners, breast milk
- HIV grows rapidly during the first few weeks of infection- swollen glands and mild, flulike
symptoms predominating.
- After 3-6 weeks symptoms may decline- asymptomatic period- viral growth is slow and gradual,
eventually severely compromising the immune system by killing the helper T cells and producing
a vulnerability to opportunistic infections ( people with weak immune systems) that leads to the
diagnosis of AIDS.
- Symptoms- rapid weight loss, recurring fever and night sweats, extreme unexplained tiredness,
swollen lymph glands, Diarrhoea etc.
- Opportunistic infections- pneumonia, Kaposi,s sarcoma or non- Hodgkin’s lymphoma.

Quality of life –

- Well – being, satisfaction, lifestyle, nutrition, infrastructure, resources – physical health,

psychological state, social life, occupation, environment, spiritual +personal beliefs
- WHO – individual’s perception of your possession of life in the context of the culture and value
systems in which they live and in relation to their goals, expectations, standards and concerns.
- The quality of life that you hold of your expectations and ideas in life
- How do these factors help? = treatments which can help but affect the qol,

Emotional Responses –

- Denial, Anxiety, Anger/ frustration, Bargaining, Overindulgence, Hopelessness, depression,

- Diagnosis –crisis situation – dilemma – something attention seeking –
- 1st – have a idea of the person’ s coping mechanisms – how the person will take the news
- 2nd –
- 3rd – news and self blame
- Explaining something with regard to the emotions – anxiety and depression symptoms can
overlap sometimes – regressive and repetitive
- Anxiety– vulnerable to diabetes, irritable bowel movement, coronary issues, pulmonary
disorders
- Depression – vulnerable to cancer, stroke, heart diseases, astriopariosis, dementia at a young
age

How does illness affect self concept and self esteem?

- Self concept
Self Esteem
- How well do I compete with these illnesses? - different ways and
- Rehabilitation – restoring a balance – no of activities and action which helps a person to restore
a state of health through therapy and training.
- Physical rehabilitation – chronic illness and physical disabilities – to help people use their body
as much as possible – to sense changes in the environment and make physical accommodation –
teaching new physical management skills – teaching a necessary exercise regiment – teaching
how to control energy expenditure for people with physical disabilities

Psychosocial interventions -
Apart from Pharmacological interventions,
- Individual therapy – individual psychotherapy – with psychological problems and for people who
need psychological help – not continuous help – collaboration b/w physician and family and
therapist ( physician – necessary meds ~ family – emotional support ~ therapist – working on the
issues based on the info collected) – therapist challenging the defence mechanisms of the
patient for to show how it can be harmful but specially for chronic patients, wishes should be
respected and the stalling should be shown
- Part of Indi therapy - CBT techniques – fatigue, functional impairments, stress, and mood swings
– thoughts enacted in behr – positive thoughts influencing the behr.
- Relaxation therapy – anxiety and stress related issues – mediation, guided imagery, mindful
mediation
- Coping skills training – to provide / to increase the knowledge of the disease ( info on how the
disease has a effect on the quality of life of a patient) - to reduce anxiety and pain/ to increase
pain management
- Expressive therapy – writing, dance, art, music, - helpful for stress related symptoms
- Positive side of internet – support groups, info on the illness – but multiple sources,
- Telephone interventions
- Relaxation –
- Stress management – mindfulness based stress reduction + acceptance and commitment
therapy ( make the individuals aware and focusing on the present / accept the thoughts and
conditions and try to modify behavior helping the person)
- Social support interventions – family therapy ( informing the family – unconditional acceptance
and support)
- Support groups
- Preventive actions
 For chronic – Cardiac, AIDS, Cancer –
- Heart – relaxation training, stress management, self monitoring strategies, cognitive
restructuring, diet + exercise changes
- Cancer – relaxation and systematic desensitization, CBT (Physical), stress management,
mindfulness program, improve the emotional adjustment and quality of life – family therapy and
support groups
- AIDS - counseling, same including Heart and Cancer

Unit 5 (Shelly and Taylor)

The different types of health compromising and health enhancing behaviors –

Factors determining development of health behaviour –

A. Genetics
B. Learning – conditioning, reinforcement, observation, punishment – age group of 10 to 18
years – use to acquire many habits, observe and learn from parents {modeling}, parental
approval – major reinforcement in childhood – as we grow, peer validation.
C. Social factors – family, friends – direct, indirect; media – celebrities; religion, society, culture,
community we live in, ecological perspective.
D. Personality
E. Perception and cognition – superstitions and beliefs, how we perceive a threat – people have
personal beliefs – health belief model – whether or not we take preventive action + what
determines whether a person will engage in prevention action or not.
Aspects/ factors –
1. Threat – whether you perceive the situation as threat or not.
2. The perceived benefits and the barriers of taking action.

How do we identify the health behaviour or a threat?

Eg. I sleep for only 4 hours, have some issues but still don’t perceive it as
a threat.

Significantly, affecting work, lack of concentration, memory etc. that is

when you see it as a threat to functioning.

- Perceived threat depends on 3 factors (based on how serious are we about of our health
problems)
- 1. Perceived seriousness – medical or organic disturbances, physical functioning and
psychological functioning.
- 2. Perceived susceptibility – How vulnerable I am to an actual physical problem – depends on
subjective factors on how we see it.
- 3. Cues to action – external signals, reminders and alert. Eg – articles in the newspaper regarding
on illness, people suffering, symptoms, precautions, how people around you talk about the
disease.

Perceived benefits or barriers for taking action

- If we see long term benefits, we would take it seriously and get into action.
- 1. Alcoholism and Problem Drinking substance dependence – substance dependence, physical
and psychological problems, develop tolerance, regulating greater and larger doses of the
substances and intoxication concepts.
- A. Problem drinking – (can decide after knowing the consequence) – not dependent ~ when we
drink, , we drink in large quantities - causing oneself and others trouble physically or
psychologically – social drinkers not a drinking problem – (drink occasionally only in 3 months –
people around you are affected.
- B. Substance dependent – repeated self – administration resulting in tolerance, withdrawal and
compulsive behavior. – include physical dependence
- C. Physical dependence – when the body heat adjusted to the substance and incorporates the
cue of that substance and incorporates the cue of that substance into the normal functioning of
the body’s tissues.
- D. Tolerance – The process by which the body increasingly adapts to the use of a substance
requiring large doses of it to obtain the same affects and eventually reaching a plateau.
- E. Craving – intense desire to consume a substance. A strong desire to engage in a behavior or
consume a substance. It results from physical dependence and conditioning process.
- F. Addiction – physically or psychologically dependent on a substance following repeated use
over time.
- G. Withdrawal - Any unpleasant symptoms both physical and psychological that people
experience when they stop using a substance which they have become dependent on. Eg –
headache, nausea, veritable short tempered, tremors, hallunications, being impulsive,
impatient, reduced inhibitions, anxiety.
Treatments
- Detoxification –
- Focus on CBT – to decrease the reinforcing properties of alcohol – to teach new behaviors
inconsistent with alcohol abuse – be assertive and tell what you/ the person need.
- Stress management programs
- Relapse prevention skills – Relapse prevention method – G.Alan Marlatt – cognitive events and
different thoughts that occurs during the relapse period – essence of self efficacy ( the capacity
to take control of your life) –therapist supervised self management program – 3 steps –
1. Learn to identify high risk situations- something that can trigger the person + social
events
2. Acquire competent and specific coping skills
3. Practice effective coping skills in high risk situations
 - Self monitoring techniques – ask the person to maintain a record of unhealthy behaviors
- Motivation enhancement techniques – build self esteem, self efficacy and motivate the person.
- Substitution of beverages in place of alcohol
- Family support
- Counselling
- Group therapy
- Relapse – spontaueous recovery of that involves recurrence of pathological drug are after a
period of abstenance. The changes of relapse- high chances in the foirst 3 months – more than
50% chance
- Psychological dependence –
- Stages of substance use – Jane Oqden –
1st stage – Initiation – beliefs and psychosocial factors
2nd stage – Maintainance
3th stage – Cessation –Self help, medicine and psychosocial interventions –
5 steps/ change model – Pre contemplation
Contemplation – thinking about the behavior
Preparation – finding methods to cure or reduce the behr
Action
Maintainance
( even for smoking intervention program)
4th stage – relapse

Smoking

- Second hand smoking

- Consequences – different types of cancer
- Research – when you smoke
- Smoking in women - breast cancer – studies prove but prove to be a unknown cause.
- Smoking – 20’s – 53% which leads to death
- Smoking in India – 13% in India
- ¾ of the menopause women leads to breast cancer
- Chronic bronchitis, emphysema, respiratory diseases in general, reproductive diseases in males
– erectile dysfunction
- Pre and Post menopause women – higher risk of getting breast cancer
- Heart diseases – high cholesterol levels leading to heart attack
- Body weight – thin people who smoke – greater chance of mortality
- Lack of physical activities, get tired easily , fatigue
- Drinking and smoking
- Smokers gets impulsive and risk taking behaviors are common
- Gets influenced by others – someone close to you smoke – influences
- Oral gratification.

Interventions –
 - Nicotine replacement therapy
- CBT
- Psychological programs
- Role of media
- Relapse prevention similar to alcohol relapse program
- Withdrawal symptoms
1. Increase in appetite
2. Increase in phlegm
3. Increased irritability and variations in the urge to smoke
- Social support and group therapy
- Contingency contracting – according to research, it is effective – a contract made where the
person is awarded with reinforcement for positive behavior
- Self determination theory
- Abstinence violation effect – occurs when the person has a relapse – to what extent does the
person have some control
- Social influence intervention – depends on 3 factors
1. Information for fear appeals
2. Conveying a positive message on the non smoker– how to deal with the behavior that is
connected to the habit
3. Influence of peer groups – done as a social activity

Health compromising behaviors (shelly and taylor)

Health enhancing programs –

Diet and weight control

Exercise and yoga

Stages of change model – Transtheoretical model of change

Antioxidants - fruits and vegetables

Set point theory – related to body rate – when you diet to reduce weight, you might reduce the weight
but after a while, your body weight gradually increases.

Ted video – mental habits – the secret of becoming mentally strong