Summary Class notes - Psychology of Illness

Course
- Psychology of Illness
- N/A
- 2017 - 2018
- Durham University
- Psychology
195 Flashcards & Notes
0 Students
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Summary - Class notes - Psychology of Illness

  • 1484521200 Stress & Illness


  • Is there a direct connection between stress (psychological) and a physical illness?
  • Stress can influence health and illness by changing behaviour or by directly impacting an individual's physiology 

    (p. 244 Ogden textbook)
  • What kind of changes does stress involve? (4 points)
    Biochemical, physiological, behavioural and psychological changes
  • What does stress (fight or flight response) activate?

    Stress (fight or flight response) activates various hormonal changes e.g. cortisol is released into the bloodstream, releasing adrenaline --> think HPA axis
    - The release of these biochemicals may have long-term detrimental effects
  • Important things to remember:

    • Difference between short term stress and long term acute stress
    • Type of stressor is important 
    • Some people work well under stress/pressure; some people get ill under a lot of stress 
    • BIS/BAS; anxiety correlates with hippocampus size = individual differences
    • Women – level of stress may correlate with different stages of menstrual cycle
    • People with a certain type of temperament are more prone to stress 
    • Complicated reactions between gender and temperament
    • Support network: people with a stronger support network tend to be less stressed  
  • Research shows that hyper tension rates are more common in those with high-stress jobs such as air traffic controllers than in less stressed occupations e.g. nuns

    Stressful occupations are associated with an increased risk of coronary heart disease

    ---> HOWEVER with these studies, there is a problem of causality - it is unclear whether stress causes the illness or the illness causes stress  

    (p. 239 Ogden textbook)
  • What is the stress-illness indirect pathway?

    Stress might affect people’s smoking/drinking/eating habits which in turn may make people become ill

  • What are the 3 main direct pathways in which stress may increase someone’s risk of disease?
    1. Stress causes increased heart rate and blood pressure = increased risk of disease
    2. Impact of stress hormones on immune processes - corticosteroid suppresses immune system = increased risk of disease
    3. Stress causes disturbance of the digestive system = increased risk of disease
  • Regarding the main direct pathways to in which stress may increase risk of disease, what is the problem with 2: corticosteroid suppresses immune system?

    It is not as simple as that – sometimes stress benefits the individual 
  • What does the release of adrenaline do?

    Raises heart rate and blood pressure
  • What is the fight of flight mechanism?

    The hypothalamus signals the adrenal glands to produce adrenaline when there is a stressor
  • Stress affects adrenaline. What does this then cause?

    Stress effects adrenaline = which effects blood pressure = cardiovascular disease
    --> chain reaction
  • What did Matthews et al. (2004) investigate? What did they find?

    Sample of 4000 people; longitudinal study of 30 years

    Method: Examined how a stressful task affected participants' blood pressure

    Results: found that those people who had a larger change on blood pressure were more likely to have hypertension 30 years later
    i.e. Young adults who show a large BP response to psychological stress may be at risk for hypertension  

    = potential causal chain of effects that may cause a risk of high blood pressure in later life

    (Hypertension = to do with high blood pressure)  

    Paper: http://circ.ahajournals.org/content/110/1/74.full
  • What did Tawakol et al. (2017) investigate? What did they find?

    Looked at relationships between patients and amygdala activity
    – they examined whether amygdala activity had a causal effect on cardiovascular disease
    - Used PET scan
    - Looked at bone marrow, spline activity, inflammation of arteries
    - Follow up 4 years later to see who had developed cardiovascular disease

    Results = link between higher amygdala activity and cardiovascular disease 4 years later = amygdala increases bone marrow and white blood cells

    Conc: emotional stressors can lead to cardiovascular disease through amygdalar activity 


    Amygdala = related to anxiety, fear, and stress response     
  • How can stress affect gastrointestinal disorders?
    • Stress can inhibit gastric emptying (emptying of the stomach) and stimulate colonic motor function (Tache et al., 2001)


    • IBS (irritable bowel syndrome) may be triggered by the immune system which is affected by stress (Giovanni et al., 2011)
    - colonic motor function = links to IBS = may link to stress
  • Stress & Immunity

    The lymphoid organs (thymus, bone marrow, spleen) produce lymphocytes (T cells, B cells, natural killer cells) which recognise harmful substances, destroy harmful cells and produce antibodies
  • What did Segerstrom & Miller (2004) investigate? What did they find?

    Meta-analysis of articles describing a relationship between stress and parameters of the immune system

    (see slide 11 + notes on slide 11)
    READ THIS PAPER: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/
  • What did Kiecolt-Glaser et al. 1984 investigate? What did they find?
    Students facing academic exams 
    = decrease in Th1 type cytokine and increase in Th2 type cytokine (Th1 is related to the cellular response and immunity = people’s response to viruses; suggests people are more likely to get ill during exam periods) (Th2 cells activate blood system immunity – wards off more specific pathogens) = exams have a specific effect on immunity 

    Conclusion: stressful events reliably associated with changes in the immune system
    - Shows potential causal chain but does not explain individual differences

  • The link between stress and illness is not the same for everybody 
  • What are 4 moderators of the stress-illness link?

    1. Social support (Cohen & Mills, 1985; Pressman et al., 2005)
    2. Hardiness (Klag & Bradley, 2004)
    3. Type A personality (Fredrickson et al., 2000)
    4. Exercise/ physical activity (Carmack et al., 1999)
  • What hypothesis did Cohen and Mills (1985) propose?
    Social support and the buffering hypothesis
    --> A support network may inhibit a maladaptive response to stress - look at slide 14 for diagram
  • What did Pressman et al. (2005) investigate? What did they find?
    Participants: US college students (83 freshman)

    Participants kept daily diaries of levels of loneliness - acted as proxy levels of stress
    Results = Higher levels of loneliness = higher psychological levels of stress

    Asked to identify how large their social network
    - The researchers found no relationship between loneliness and support network – limitations of study?

    Measured antibodies in the blood
    Results = social support may provide a buffer to people’s immune function
    --> supports Social Support and buffering Hypothesis

    Paper: http://repository.cmu.edu/cgi/viewcontent.cgi?article=1242&context=psychology 
  • What did Klag & Bradley (2004) investigate? What did they find?

    3 components of hardiness
    Commitment (links to how optimistic about life they are)
    Control (how much control over their lives people feel they have)
    Challenge (some people embrace challenges and respond well to change, some people are more negative) – people who embrace change are more hardi 

    Sample = university staff members
    - Participants identified minor stressors they had in the past week; physical symptoms they experienced 
    - Researchers measured their hardiness levels

    Results
    = the degree of association between stress and health was less the more hardiness people were
    = low levels of hardiness people tended to report more stress
    ---> THESE RESULTS WERE FOUND ONLY FOR THE MALE PARTICIPANTS
    = For females hardiness didn’t moderate this effect


    Limitation: the researchers do not discuss why this sex difference occurs (they do go into the methodology in which the scale was developed and how the scale was more developed towards males)

    Conc: This study suggests hardiness may buffer reactions to stress (only in males)
  • What did Fredrickson et al. (2000) investigate? What did they find?

    Measured hostility and looked at the response to a stressful task and how that effects participants' blood pressure (BP)

    Stressful task = asked Ps to recall an event that made them angry

    Result = the task raises the BP more in high hostility individuals
    - African Americans also showed longer-lasting blood pressure reactivity to anger
    - Stronger connection for people with type A personality

    Paper: https://www.researchgate.net/profile/Michael_Helms3/publication/12454475_Hostility_Predicts_Magnitude_and_Duration_of_Blood_Pressure_Response_to_Anger/links/0deec528a2d1c6f058000000.pdf
  • What did Carmack et al. (1999) find?
    Whether someone had high or low fitness didn’t buffer the reaction to stress BUT participation in exercise was a buffer
    = Interesting, not just about how fit you are – it’s all about participation to buffer the effects of stress

    --> The researchers go into a Distractor Hypothesis to explain why


    ---> Look into whether team sports combat stress better than individual sports
  • What could reduce stress? What result could this have?
    Stress management = reduces stress
    - has some success in reducing coronary heart disease (Johnson 1989, 1992) and in reducing current cold and flu in children (Hewson-Bower and Drummond, 2001)

    (p. 240 Ogden textbook)
  • What did Johnston (2002) argue about how stress causes illness?
    That stress can cause illness through 2 interrelated mechanisms involving chronic and acute processes

    The chronic process
     
    Stress leads to disease due to a prolonged interaction of physiological, behavioural and psychological factors
    - over time could lead to damage to the cardiovascular system (for example)
    - in particular, chronic stress is associated with atherosclerosis - a slow process of arterial damage that limits the supply of blood to the heart
    - parallel to the stress-diathesis model of illness (Levi's, 1974) illustrated p. 240 

    The acute process

    - acute events involve a sudden rupture and thrombogenesis
    - acute stress triggers a sudden cardiac problem --> explains why exercise can be protective in the longer term but a danger for an at-risk individual; also explains when and why a heart attack occurs (e.g. following exercise, following anger)

    Links between chronic and acute processes
    --> both processes highlight the central role for stress-induced changes in behaviour and physiology 

    (p. 240 & 241 Ogden textbook)
  • What are 2 problems with a purely chronic model of the stress-illness link?
    1. Exercise protects against the effects of stress - more active individuals are less likely to die from cardiovascular disease. However, exercise can also immediately precede a heart attack

    2. Stress can explain the accumulative damage to the cardiovascular system. However, this chronic model does not explain why coronary events occur when they do

    (in light of these problems, Johnston (2002) argues for an acute model

    (p. 240 - 41 Ogden textbook)
  • p. 242 - 243 (Ogden textbook) discusses research examining the effect of stress on these health-related behaviours: smoking, alcohol, eating, exercise & accidents
  • Stress may cause behaviour changes
  • Stress causes physiological changes that have implications for promoting both the onset of illness and its progression
  • How does stress cause changes in sympathetic activation?
    Via the production catecholamines 

    --> the prolonged production of adrenalin and noradrenalin can result in:
    • blood clot formation
    • increased blood pressure
    • increased heart rate
    • irregular heart beats  
    • fat deposits
    • plaque formation
    • immunosuppression

    = these changes can increase the chances of heart & kidney disease and leave the body open to infection


    (p. 244 Ogden textbook)
  • How does stress cause changes in hypothalamic-pituitary-adrenocortical activation?
    Via the production of cortisol

    ---> the prolonged production of cortisol can result in:  
    • decreased immune formation
    • damage to neurons in the hippocampus 


    = these changes can increase the chances of infection, psychiatric problems and losses in memory & concentration

    (p. 244 Ogden textbook)
  • What type of stress is more likely to involve HPA activation and the release of cortisol?
    Chronic stress

    ---> this results in the slower process process of atherosclerosis and damage to the cardiovascular system

    (p. 244 Ogden textbook)
  • What type of stress is more likely to involve sympathetic activation?
    Acute stress
    = changes in heart rate and blood pressure

    ---> this contributes to atherosclerosis and kidney disease  

    (p. 244 Ogden textbook)
  • Greater stress reactivity may make people more susceptible to stress-related illnesses
    ---> individual differences
    (p. 245 Ogden textbook)
  • What is a limitation of a cross-sectional design? What design could you use instead?
    It raises the problem of causality 

    Some researchers therefore use a prospective design

    (p. 245 Ogden textbook)
  •  What happens when the body recovers from reacting to stress?
    Levels of sympathetic and HPA activation return to baseline

    (p. 245 Ogden textbook)
  • Take Home Messages:

    •Stress is implicated in the development and exacerbation of physical health problems
    •Not all individuals facing the same levels of stress develop the same physical symptoms
    •Research is starting to provide insights into moderating factors which can exacerbate or buffer the effects of stress
  • Some research indicates that rate of recovery from stress may relate to a susceptibility to stress-related illness. How does cortisol production fit in with this?
    Slower recovery from raised cortisol levels could be related to immune function and a susceptibility to infection and illness e.g. Perna & McDowell, 1995

    (p. 245 Ogden textbook)
  • Who came up with the concept, 'allostatic load'? What is this?
    McEwan and Stellar (1993)

    The allostatic load is "the wear and tear on the body" which grows over time when the individual is exposed to repeated or chronic stress. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response that results from repeated or chronic stress

    (p. 246 Ogden textbook)
  • What is psychoneuroimmunology (PNI)?
    PNI is based on the prediction that an individual's psychology state can influence their immune system via the nervous system
    --> more info p. 246-250 Ogden textbook
  • What are 3 problems with stress and illness research?
    1. Research indicates that stress is linked to illness. However, without some degree of stress we wouldn't get many of life's pleasures. (e.g. rewards from hard work etc.). What differentiates stress that produces illness and that which produces a sense of worth is unclear

    2. Stress is seen to cause illness through either a direct route via physiological shifts or an indirect route via behaviour. Much research consider these two pathways as separate. However, it is likely that they constantly interact and that behaviour and physiology exist in a dynamic relationship  

    3. Factors such as coping, social support and control are considered to mediate the stress-illness link. From this perspective the stress-illness link is seen as occurring first, which in turn can then be influenced by these factors. It is likely, however, that the very indication of a stressor which may or may not lead to illness is determined by the degree of coping, social support or control
    (p. 252 Ogden textbook)
  • What factors moderate the stress-illness link?
    1. Exercise 
    2. Coping styles -> may mediate the stress-illness link and determine the extent of the effect of stress on their health
    3. Social support -> has been related to a decreased stress response and a subsequent reduction in illness
    4. Personality -> this has been studied with a focus on type A personality and the role of hostility
    5. Actual or perceived control -> control over the stressor may decrease the effects of stress on an individual's health status

    (p. 255 Ogden textbook)
  • Different ways of coping are discussed on p. 256-258 Ogden textbook
  • Wills (1985) defined several types of social support, what are they?
    1. Esteem support -> whereby other people increase one's own self-esteem
    2. Support -> whereby other people are available to offer advice
    3. Companionship -> involves support through activities
    4. Instrumental support -> involves physical help

    (p. 259 Ogden textbook)
  • What 2 hypotheses explain the role of social support in health?
    1. Main effect hypothesis
    2. Stress buffering hypothesis

    (p. 260 Ogden textbook)
  • What is the main effect hypothesis?
    Suggests that social support itself is beneficial and that the absence of social support is stressful 
    --> This suggests that social support mediates the stress-illness link, with its presence reducing the effect of the stressor and its absence acting as the stressor

    (p. 260 Ogden textbook)
  • What is the stress buffering hypothesis?
    Suggests that social support helps individuals cope with stress, therefore mediating the stress-illness link by buffering the individual from the stressor. Social support influences the individual's appraisal of the stressor 

    (p. 260 Ogden textbook)
  • Hostile people show greater reactivity to stress (p. 263 Ogden textbook)
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What did Lee and Lin (2010) examine?
Examined whether the effectiveness of patient-centred care is specific to the individual or universal in nature.

Results: autonomy preferences moderate the relationship between consulting style and satisfaction. The researchers indicated that patients with a higher autonomy preference preferred a patient-centred approach compared to those who wanted to be less involved in the treatment decision. 

Limitation: the sample only consisted of older patients. Research has shown that older prefer a more passive role in decision making (Say et al. 2006), therefore the results may differ with a wider range of ages
What did Swenson et al. (2004) argue in terms of individual differences?
Argued that patients’ preferences regarding the degree of involvement in their care are highly variable; some patients prefer active participation while others wish to rely on their physicians to make decisions. 

--> Therefore, doctor flexibility is important in the decision-making process so that individual differences in patient preferences are respected. 
What did Marcatto et al. (2013) argue? Who is this study supported by?
Health professionals are also susceptible to decision biases by finding that physicians would more likely prescribe a treatment when its risk reduction was presented to them in relative rather than in absolute terms, a finding supported by Covey (2007). 
What did Zipkin (2014) find?
That misunderstanding numeric data and statistical concepts of relative risk can mislead the patient’s health decisions.

Conversely, Zipkin (2014) found that people more accurately perceived risk differences when presented with absolute compared to relative risks, and were therefore able to make more informed health decisions. 
What did Covey (2011) find?
That providing health information in relative risk format (as oppose to absolute risk) misled participants into preferring an inferior vaccine. 
What did Swenson et al. (2004) study?
Investigated patient preferences for a patient-centred or doctor-centred communication style

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Results: a significant proportion of patients preferred the doctor-centred communication style.    

Limitation: patients were asked to compare one communication style to another, rather than rate a single style to which they were randomly assigned. When comparing approaches, patients may favour what they are accustomed to. Notably, patients overwhelmingly preferred the video that reflected their own physicians’ communication style. A follow-up study would benefit from avoiding this potential bias by asking patients to react to a single video, without a “benchmark” with which to compare it. 
What did McKinstry (2000) find?
Patient-centred approach are associated with higher levels of social class 
What did Dowsett et al. (2000) find?
Patient-centred approach are associated with higher levels of occupation 
What did Swenson et al. (2004) find that links with Saha and Beachs' (2011) study?
Patient-centred approach are associated with higher levels of education