Health Psychology Psychology 46.339 (01) Summer 2007 Instructor: Dr. Fuschia Sirois Wednesday August 8: LAST CLASS! Lecture 9, Prep.
Download ReportTranscript Health Psychology Psychology 46.339 (01) Summer 2007 Instructor: Dr. Fuschia Sirois Wednesday August 8: LAST CLASS! Lecture 9, Prep.
Slide 1
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 2
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 3
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 4
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 5
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 6
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 7
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 8
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 9
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 10
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 11
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 12
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 13
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 14
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 15
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 16
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 17
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 18
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 19
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 20
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 21
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 22
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 23
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 24
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 25
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 26
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 27
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 28
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 29
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 30
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 31
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 32
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 33
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 34
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 35
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 36
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 37
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 38
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 39
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 40
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 41
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 42
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 43
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 44
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 45
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 46
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 47
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 48
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 49
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 50
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 51
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 52
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 53
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 54
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 55
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 2
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 3
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 4
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 5
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 6
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 7
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 8
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 9
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 10
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 11
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 12
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 13
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 14
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 15
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 16
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 17
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 18
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 19
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 20
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 21
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 22
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 23
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 24
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 25
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 26
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 27
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 28
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 29
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 30
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 31
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 32
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 33
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 34
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 35
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 36
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 37
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 38
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 39
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 40
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 41
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 42
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 43
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 44
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 45
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 46
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 47
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 48
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 49
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 50
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 51
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 52
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 53
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 54
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”
Slide 55
Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?
A general term referring to illnesses caused by
atherosclerosis
Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
Caused by temporary shortage of oxygen
Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress
Development of CHD is associated with
Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD
Cardiovascular disease
Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men
Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Type A Behavior Pattern
Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility
Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks
depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important
by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors
Strong Associations between
Depression and heart attack
Hopelessness and heart attack
Anxiety and sudden cardiac death
Recent research
Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
the perception that a patient’s abilities and
capacities are lower than they actually are
both patients and their spouses are
vulnerable to these misperceptions.
Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
relaxation techniques can significantly reduce BP &
the need for medications
Diet changes can help reduce serum cholesterol
levels
Exercise can also help to reduce BP
weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview
Condition that results from a disturbance in blood flow
to the brain
Deaths
Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke
That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview
Prevalence
There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects
Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors
Modifiable risk factors include
High blood pressure
Heart disease
Cigarette smoking
High red blood cell count
Transient ischemic attacks
Psychological distress
Anger expression
Stroke:
Consequences
Stroke affects all aspects of life
Personal
Social
Vocational
Physical
Motor, Cognitive, Emotional, and Relationship
problems
Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.
insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview
Cells of the body need energy to function
Glucose is the primary source of energy
Insulin is a hormone produced by pancreas
Insulin acts as a “key” to permit glucose to
enter cells
Without insulin, cells don’t get the glucose they
need
Glucose stays in the blood: Hyperglycemia
Diabetes: Types
Diabetes mellitus can be Type I or Type II
Type I = Insulin dependent (IDDM)
Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes
Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change
Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change
Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with
Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
Diabetes is a risk factor for cardiovascular
disease
Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes
Heart and blood vessel
disease
Kidney disease
Eye damage
Foot damage
Infections, slow to heal
Gum disease
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive
keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)
The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review
The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
Attack and rid the body of foreign invaders
Distinction between
Natural immunity
Specific immunity
Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence
Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood
Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning
Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence
Immunocompromise
Indicators suggest that immune functioning
• Has been disrupted or reduced
Wound-healing
Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes
Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships
Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
Loneliness
Martial disruption and conflict (including
short-term conflicts)
Providing care for a friend or family
member with a long-term illness
Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells
tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?
All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
Malignant spread much
more threatening
Metastatic cancer cells
move to other parts of
the body
Cancer:
Canadian Cancer Society
A set of >100 diseases
All cancers result from DNA dysfunction
Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.
On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer
Coping with physical limitations
Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview
Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
Arthritis means “inflammation of a joint”
Over 200 forms of arthritis.
About 30% of adults have arthritis.
Three major forms of arthritis
Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis
GENDER
AGE
OBESITY
WORK
FACTORS
Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
Lupus (systemic lupus erythematosus)
Rheumatoid arthritis
Scleroderma
Sjogren’s syndome
Lyme disease
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to
activity, depression, psychosocial costs
Coping & management of arthritis are affected by:
behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis
Crippling form of arthritis believed to result from an
autoimmune process
Primarily affects
Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications
Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis
Treatment includes
Anti-inflammatories to reduce
inflammation and pain
Rest
Supervised exercise
Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
Optimism
Relearning meaning of pain
Osteoarthritis
Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint
May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment
Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)
170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?
anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”