CAS PS 371 18 - Lecture notes 18 PDF

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Lecture 18...

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Substance Use Treatment: Motivational Interviewing

Lecture 21 Notes: Behavioral Medicine  Knowledge from Behavioral Science applied to… o Developmental o Diagnosis o Prevention o Treatment of Medical Problems  Interdisciplinary o An interdisciplinary field working together to develop prevention and treatment to a wide variety of medical problems Health Psychology  Subfield of Behavioral Medicine  Focus: Factors that Promote and Maintain Health  Assist Formation of… o Improvements to Health Care Systems o Improvements to Health Care Policy  Important in Promoting and Maintaining Health Psychological and Social Impact On Health  May Adversely Impact Health: o Chronic exposure to high levels of occupational stress, may lead to chronic elevated blood pressure, then heart disease.  Psychological Factors -> Biological Processes -> Illness and Disease  Long-Standing Behavioral Patterns INCREASE Risk For Physical Disorders  May also POSITIVELY Impact Health o Examples:  Exercise  Yoga  Relaxation Training  Beneficial when paired with other treatments for anxiety, depression, and mood disorders

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Effects of Acute or Prolonged Stress is a Primary Interest/Focus Other Potential Factors/Focal Interests Include: o Inequity in Healthcare Decisions o Risk Factors for Significant Medical Conditions o Interpersonal Factors Affecting Prevention, Treatment, and Outcome Psychophysiological Disorders  Biological Factors can contribute to development and miniatous of conditions  Psychological Factors are the leading determinant of severity of conditions  Best Known/Most Common o Ulcers o Asthma o Insomnia o Headache o Coronary Heart Disease o Hypertension  To This List You May Add o Ulcerative Colitis o Fibromyalgia o Irritable Bowel Syndrome o Chronic Fatigue Syndrome (Among Others) Stress  How do YOU define "Stress?"  Hans Selye o Study of effects of chemicals on health of lab rats o Test rats injected with chemical extracts o "Control" rats injected with saline o Test Animals developed Ulcers and Other Physiological Problems  BUT so did Animals injected with Saline!  Selye concluded that Experimental Procedures and Conditions -> Adverse Outcomes  Underlying Cause … Stress  Not what was being Injected, but the Injections themselves and the Changes in being Handled in the Lab Environment o Defined "Stress" as…  Biological Syndrome  Reaction to Shock to Organism's System  Disruption of Stable and Internal Balance  Organismic Homeostasis o Body goes through Several Stages in Response to Chronic Stress  General Adaptation Syndrome  Alarm Reaction Phase  Body physiological arousal prepares for Fight or Flight - Fight or Flee  If Successful - Restoration to Balanced Homeostasis State  If Not - Followed by a Second Phase

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Resistance (Adaptation) Phase  Mobilize Coping Mechanism  If Stressor Persists …  Exhaustion Phase (This Occurs)  Resulting in Illness, or even Death  Brief Exposure to Stressors may Enhance Functioning  Long-Lasting Exposure -> Deterioration  Biological, Psychological, and Social Stressors may have SIMILAR Effects o Sustained Stress via Psychological or Social Issues make a person MORE Susceptible to Illness, and may alter the Course of the Disease  More recent Definitions Include: o Condition where expectations do not match perceptions of Internal or External Environment(s)  Stress  Operates at an unconscious level  Subjective Manifestation - Our Realization of Stress  Distress  Conscious awareness of impact  Not necessarily resulting in Pathological Outcome  Biological Cost of Adapting to Stress - Allostatic Load o Represents the Wear and Tear of the Body Growing Over Time as Repeated or Chronic Stress Occurs o Represents Physiological Consequences of Chronic Exposure or Fluctuating Neural Responses o May have implications for Physical or Mental Health Functioning o Relaxed  Allostatic Load is LOW o Stressed  Allostatic Load is HIGH Physiological Response To Stress  Sympathetic Nervous System o Mobilizes Resources during times of Threat and Danger by Activating Organs that Prepare the Body for Action o Ready to Respond to Stress  With Activation  Heart Beats Faster  Blood Flow Increases  Respiration Increases  Adrenal Glands Stimulated  Hypothalamic Pituitary Adrenal Axis (HPA Axis) o Hypothalamus -> Pituitary  Stimulate Adrenal Glands  Produce Surge of Epinephrine and Cortisol  Hypothalamus and Hippocampus are SENSITIVE to Cortisol ???  Helps turn off Stress Response (Completes Feedback Loops Between HPA Axis and Limbic System)

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Higher Cortisol Levels may harm Hippocampus and have Adverse Effects on Cognitive Abilities  May KILL Nerve Cells

Cardiovascular Disease  Hypertension (HTN) o Secondary (High Blood Pressure) from …  Known Causes related to POOR Food Consumption  Example: Excess Dietary Salt o Essential (Primary) from …  NO Verifiable Physiological Cause; Assumed due to Physiological AND Psychological Factors  More than 33% of the population  Common in those of 20 years of age or older are diagnosed with HTN  Majority (~90%) have NO Verifiable Physiological Cause  20-65 Years Old - Males more than Females  65 Years and Older - Females more than Males  Psychosocial Factors o Association with Personality Factors o High Blood Pressure is often related to Negative Emotions, and the Suppression of Them  Negative Emotions - Suppression  Examples: Anger and Hostility  Tends to be HIGHER when people are Angry or Anxious then when they're Relaxed  More Likely in African Americans (Culturally Mediated)  Influence of Personality Association Stronger with Increasing Age Racial / Ethnic Group

Men

Women

African American

43.0%

47.5%

Mexican American

27.8%

28.9%

White

33.9%

31.3%

All

34.1%

32.7%

Source: Mozzafarian, Benjamin, Go, et al (2015) Update: a report from the American Heart Association

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Association with Social Factors  Loneliness  Depression  Uncontrollability Genetics o HTN runs in Families  Those with Family History show Greater Reactivity  Offspring are TWICE as likely to Develop HTN  Elevated BP evident during First Weeks of Life Stress o Stress Association and Heart Attack/with Cardiovascular Challenges  Stress and Heart Attack  Long-Term Survival related to Subsequent Stress Levels

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High Stress Levels without Treatment -> Higher Risk for Later Heart Attack  THREE TIMES More Likely to Die During 5 Year Follow Up

Treatment o Impact of Cognitive-Behavioral Therapy and Other Non-Drug Therapies are CONSISTENT with Drug Treatment Effects  CBT and Other Non-Drug Therapies (Meditation, Weight Reduction, and Others) are AT LEAST AS Effective as Drug Treatment for Treating Hypertension  In SOME Cases even Better  Generally Treated as Medical Disease even if Biological Cause was NEVER Identified Psychological Treatment Of Physical Disorders  Unlike with Exposure Therapy (for Specific Phobias), one may not want to use such techniques when being treated  Relaxation Training, Biofeedback, Meditation, Hypnosis, and Others are Beneficial against Hypertension  Along and in Combination, these may also help with o Headaches, Insomnia, Asthma, Diabetes, Chronic Pain, Irregular Heartbeat, and Others HIV+  Prevalence o ~38 Million Positive HIV+ Cases Worldwide o ~1.2 Million Positive HIV+ Cases in the United States  ~14% are UNAWARE of Infection Status o In the United States  Majority (~78%) are Males  African American and Hispanic Americans are over-represented among Newly Infected o Globally  47% living with HIV+/AIDS are Males  HIV/AIDS is the Leading Cause of Death among Women of Reproductive Age  Population Factors o Initial Impact in the United States is most significant among Gay Males and Intravenous Drug Users o Increasing Impact among Women, Minorities, and Heterosexuals  Can be Transmitted through Sexual Intercourse, Pregnancy, and Needle Sharing o Worldwide  Unprotected Heterosexual Contact is the PRIMARY Mode of Exposure o Leading Cause of Death for 25 to 44 year old Age Group  New Infections by Race and Transmission Group - U.S. (2014-2018)

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Co-Factors and Consequences o Substance Use Disorder - Risk Factor AND also a Consequence  Sharing Needles and Risky Sexual Behaviors while High on Substances  Develop Substance Disorder in part as a Consequence of Learning about the Infection  Self Medicating o Those with Mood and Anxiety Disorders are THREE to FIVE TIMES Higher than the General Population  Living with Serious and Persistent Mental Illnesses appear to be at an Elevated Risk of Exposure or Risk of Infection, particularly when Abusing Other Drugs o Cognitive-Motor Effects  Subcortical  Reduced Speed of Motor Functioning, Reaction Time, and Informational Processing  Affective Changes  Examples: Anxiety, Depression, and Apathy  Look like Accelerated Normal Cognitive Aging Patterns  Major Cognitive Disorder Symptoms are unlikely to show until VERY Advanced Stages of AIDS  Appear to Reflect HIV+ Effects on Mid-Brain Regions Reducing Disease Progression o Stress-Reduction Treatment before Receipt of HIV+ Antibody Results  Use to have to wait 2-3 Weeks  Usually was a LARGE Increase in Stress and Anxiety Symptoms o Upon Receipt of Test Results,  Treatment Groups are …  Less Likely to Show Substantial Increase in Anxiety and Depression  Showed Increases in Immune System Function

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Reduced Disease Progression among Positive HIV+ Subjects at 2 Year Follow-Up o Integrated Medical/Psychological Treatment is Beneficial  Kane et al. (2007) Prevention o Best to Change High-Risk Behavior o Needle Exchange Programs and Prophylaxis are also Beneficial  Reduction in Patterns of Use - Given Access to Available Services  Post-Exposure Prophylaxis (PEP)  HIV+ Medications used to REDUCE Possibility After Possible/Potential Infection  Sex W/O Protection - Condom  Exposure of Healthcare Worker  MUST START WITHIN THREE DAYS AFTER EXPOSURE - Lasts up to a MONTH of Medication  Pre-Exposure Prophylaxis (PrEP)  At High Risk for HIV+  Take Medications DAILY to Lower Chances of Infection  Can Stop HIV+ from SPREADING Throughout the Body  VERY Effective when CONSISTENTLY Taken  Reduces Sexual Risk by MORE than 90% and Injection for 70% o Effects of Educational Programs are often Short-Lived o Behavioral Approaches that instill Self-Efficacy and Control appear to be MOST Effective o Mild to Moderate Effectiveness o Behavioral Interventions are at least MODERATELY Effective in Producing the following…  Changes about Knowledge of HIV+ and Risky Behavior, even among High-Risk Groups such as those with Severe Mental Health Disorder - Brady et al. (2008) and those who Abuse Club Drugs - Mimiaga et al. (2014) o Provide NEW Information about HIV+  How it's Spread, and Appropriate Responses to High-Risk Situations o May be MOST Effective among the HIGHEST Risk Population...