abnormal psychology third canadian edition - wiley …_33793：异常心理学第三加拿大版-威利……_33793

abnormal PSYCHOLOGYFourth Canadian Edition,Chapter 9Psychophysiological Disorders and Health Psychology,Prepared by: Tracy Vaillancourt, Ph.D.Modified by: Rjeanne Dupuis, M.A.,Chapter Outline,Stress and Health Theories of the Stress-Illness LinkCardiovascular Disorders Socio-Economic Status, Ethnicity, and HealthTherapies for Psychophysiological Disorders,Psychophysiological Disorders,Psychophysiological Disorders characterized by genuine physical symptoms caused by or worsened by emotional factors Examples: asthma, hypertension, headache, and gastritisUsed to be termed psychosomatic disordersDSM-IV requires diagnostic judgment to indicate presence of psychological factors affecting medical conditionCoded in DSM-IV as “other conditions that may be a focus of clinical attention” Diagnosis is applicable to any diseaseThe field is called Health Psychology and Behavioural Medicine,Psychophysiological vs. Conversion Disorders,Stress,Stress environmental condition that triggers psychopathologyTerm “stress” was created by Hans Selye General Adaptation Syndrome (GAS),Nervous System,1. Autonomic Nervous System Stimulates endocrine glands, heart, and smooth muscles found in the walls of the blood vessels, stomach, intestines, kidneys, and other organs ANS is divided into 2 parts:Sympathetic nervous systemParasympathetic nervous system 2. Somatic Nervous SystemVoluntary nervous system,Nervous System and Health,Growing evidence that chronic activation of the sympathetic NS is directly linked to health problemsFocus is on stress as a stimulus (referred to as stressor)Examples:Electric shock, boredom, uncontrollable stimuli, catastrophic life events, daily hassles, and sleep deprivationStressors distinguished in terms of whether they are psychogenic (from psychological factors) or neurogenic (from physical stimulus)Allostatic load,Coping,Problem-focused coping Taking direct action to solve the problem or seeking information that will be relevant to the solution; most adaptive when the individual can do something about the situation Emotion-focused copingEfforts to reduce the negative emotional reactions to stress; most adaptive when the situation is uncontrollable Goodness of fit hypothesis The adaptivity of a particular coping response depends on the match between the coping response and what is called for ideally by the problem situation,Measuring Stress,The Social Readjustment Rating ScaleAssessment of Daily ExperiencesDaily hasslesStress in Specific ContextsJob stressJob spilloverJob burnoutVital exhaustion,Assessing Coping,Health Status of Students,Little evidence showing that college/ university students have comparative health status as other populations Predictors of less positive health status in students:In Canada: Poorer child-parent relationship; Low interest and achievement in school; Lower self-esteem and being a femaleIn Europe: Best predictors of negative self-rating in European students were psychosomatic symptoms Top health problems in students: Allergy (47.9%), back pain (41.6%), sinus infection (30.7%), depression (17.0%), strep throat (13.8%)Top 5 factors interfering with academic performance: Stress (33.9%), cold/flu/sore throat (28.2%), sleep difficulties (25.6%), concern for troubled friend/family member (18.8%), Internet use/computer games (16.9%),Interactional Model of Anxiety, Stress, and Coping,Essence: Personality traits (trait anxiety) interact with situational factors to produce behaviours (state anxiety) The Coping Inventory for Stressful Situations (CISS)1. Emotion-oriented 2. Task-oriented 3. Avoidance-oriented Coping with Health Injury Problems (CHIP)1. Emotional preoccupation 2. Distraction 3. Instrumental coping (task-oriented) 4. Palliative coping (attempts to feel better via self-soothing and self-help by doing things such as staying in bed or resting when tired),Moderators of Stress-Illness Link,Social SupportStructural social support Persons basic network of social relationships Functional social support Quality of a persons relationships Emotional support Provides the recipient with a sense of being cared for by warm and sensitive others Instrumental support Provides the recipient with more tangible forms of assistance Social support linked to healthPeople with few friends or relatives tend to have a mortality rate levels of functional support linked to atherosclerosis and ability of women to adjust to chronic rheumatoid arthritis,Theories of Stress-Illness Link,In considering the etiology of psychophysiological disorders 3 important questions are raised:1. Why does stress produce illness in only some people who are exposed to it?2. Why does stress sometimes cause an illness and not a psychological disorder?3. When stress produces a psychophysiological disorder, what determines which one of the many disorders will be produced?,Biological Theories,Somatic-Weakness TheoryWeakness in a specific body organ Example: congenitally weak respiratory system might predispose the individual to asthmaSpecific-Reaction TheoryIndividuals response to stress is idiosyncraticProlonged Exposure to Stress HormonesActivation of SNS and HPA axis (see Figure 9.5)Stress and the Immune System Stress impact the ANS, hormone levels, brain activity (see Figure 9.6),HPA Axis,Stress and the Immune System,Psychological Theories,Psychoanalytic TheoryAnger-in theory,Gender and Health,Women live longer but report being less healthy than menWomen have lower rates of obesity and being overweight (39% in women and 59% in men) Women experience more disabilities as compared to men due to poor health Greater morbidity among women than men Hormone replacement therapies appear to protect women from mortality Critical determinants of health status in men: smoking an alcohol consumption; in women: caring for a family, social support, being in the highest incomeMortality rates gap is decreasing in women and men,Cardiovascular Disorders,Diseases involving heart and blood-circulation system Hypertension Coronary heart diseaseEssential HypertensionHypertension without evident biological cause Primary hypertensionKnown as the silent killerMeasurement of blood pressure (BP)Systolic pressureAmount of arterial pressure when ventricles contract and heart is pumpingDiastolic pressureDegree of arterial pressure when ventricles relax and heart is restingNormal blood pressure in a young adult is 120/ 80,Risk Factors for High BP,Predisposing Factors of CVDs,Blood pressure and hypertension considered as highly heritable (potentially 13 gene regions)Cardiovascular reactivity and coronary heart disease as predispositions1. Reactivity must have predictive power 2. Laboratory measures must correspond to daily activities (thus eliminating lab-coat hypertension) Results: Hypertension is related to race and social class, obesity, excessive alcohol, family history of hypertension,Coronary Heart Disease (CHD),CHD takes 2 principal forms:Angina pectoris Periodic chest pains Cause of paininsufficient supply of oxygen to heart (ischemia) due to coronary atherosclerosisMyocardial infarction (heart attack)Much more serious disorderLike angina pectoris BUT usually results in permanent damage to the heart,Risk Factors of CHD, Age Sex (males are at greater risk)Cigarette smoking Elevated blood pressure Elevated serum cholesterol, size of the left ventricle in heart Obesity Long-standing pattern of physical inactivity Excessive use of alcohol Diabetes,Stress and Myocardial Infarction,One current theory Chronic stress activates immune system and contributes to inflammation, which, in turn, produces CHD Diatheses for CHDTraditional risk factors (see previous slide)Psychological Diatheses Type A behaviour patternIntense and competitive drive for achievement and advancement; Exaggerated sense of the urgency; Aggressiveness and hostility toward othersType D (distressed) personality Negative affectivity + social inhibition, including the inhibition of anger, anxiety and depressionBiological Diatheses Heart-rate reactivity,SES, Ethnicity, and Health,SES and HealthLow socio-economic status (SES) is associated with rates of mortality from all causes SES more likely to engage in behaviours that risk for diseaseSmoking, eating a high-fat diet, and drinking excessive amounts of alcohol Social gradient of healthInequalities in SES reflect inequalities in health status SES also confers health disadvantages because linked with sense of perceived controllability,Therapies,Treating hypertension and CHD risk anxiety, depression, or anger best way to psychophysiological disordersAlso smoking, obesity, alcohol consumption, salt intake, exercise, etc. Drugs can be used to cholesterol levelsLovastatin (trade name Mevacor) lowers low-density lipid cholesterol BiofeedbackEffectiveness of biofeedback is not supported Cardiac Rehabilitation EffortsEffectiveness studies show mitigated results,Stress Management,Arousal ReductionPerson trained in muscle relaxation, sometimes assisted by biofeedbackCognitive RestructuringSee approaches by Ellis (1962) and Beck (1976)Focus is on altering belief systems and improving the clarity of logical interpretations of experienceMindfulnessA manualized 10-week group approach to develop mindful awareness of perceptible experiences in a way that is non-evaluative and emotionally non-reactive Behavioural Skills TrainingLearning and practicing required skills, including assertion skills,Pain Management,How common are problems with pain? 3.6 million Canadians perceived activities restricted by physical