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Chapter 1 What is health Psychology? Health Psychology is understanding psychological influences on: How people stay healthy Why people get ill How they respond to illness What is health organization (who) defines health \ Health is a sate of complete physical mental, and social well - being and not...

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Chapter 1 - What is health Psychology? -

Health Psychology is understanding psychological influences on: How people stay healthy Why people get ill How they respond to illness

- What is health organization (who) defines health \ - Health is a sate of complete physical mental, and social well - being and not merely the absence of disease or infirmity. -

Who has four main functions: To give worldwide guidance in the field of health To set global standards for health To cooperate with governments in strengthening national health programs To develop and transfer appropriate health technology, information and standards.

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Health Psychologist focus on: Health promotion and maintenance Prevention and treatment of illness Etiology and correlation of health, illness, and dysfunction Improving the health care system, and policy Mind - Body Relationship - early times - Over time our views around mind & body in terms of health has changed - Early cultures believed that mind & body were a unit - Disease arose when evil spirits entered - Employed trephination

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Mind - body relationships - the Greeks - The greeks introduced the humoral theory of illness - Four essential fluids: blood, black bile, yellows bile, and phlegm Hot - blood air Fire - yellow bile fire - Dry - black bile earth Cold phlegm water Wet Fire, Earth , Water Mind - Body relationship the Greeks - The greeks introduced the humoral theory of illness - Four essential fluids; blood, black bile, yellow bile, and phlegm - Disease arose when there was imbalance - Personality types were associated with dominant humoral variables - Aligns with mind body unitarys hypothesis 4 main temperaments -

Phlegmatic Choleric Sanguine Melancholic

- Constant flux between temperaments - Today = Temperament psychological disposition Middles Ages - Period of supernatural and mysticism beliefs - Disease was attributed to evil forces - Disease arose when evil spirits entered - Ritualistic tortue was employed - Religion infiltrated medical knowledge - Functions of the physician were absorbed by the prest - Level of health was associated with degree of faith Renaissance

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- Improvements in biotechnology - Microscopy (Leeuwenhoek) - Autopsy (Morgagni) -

Led to the rejection of the humoral theory Supported by cellular pathology Initiated the mind - body dualism movement (Descartes) Physicians associated with the body Philosophers associated with mind

Dualism - The mind, according to descartes, was a “thinking thing” (LAT. RES COGITIANS), and an immaterial substance - The mind can exist apart from its extended body. And therefore, the mind is a substance distinct from the body, a substance whose essence is thought. - How can an immaterial mind causes anything in a material body, and vicre versa? Things Are ]Changing -

Freud introduces conversion hysteria Mind causes deficit in body Pt converts conflict into a symptom Address the psychological issue

Things Are changing -

Views continued to sway towards psychosomatic medicine Bodily disorders cu\aused by psychosomatic issues Ulcers, hypertension, colitis Disease prone individuals?

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1973, Biofeedback: Behavioural medicine defines behavior as: - The interdisciplinary field which integrates behavioral science and biomedical science for understanding physical health - Prevent, diagnose, treat, and rehabilitate Current Views - Physical health is correlated with both the psychological and social environment - Personal control of health factors: - Diet, physical fitness, harmful behaviours - Socially determined factors - Culture - Socio - economic factors - Availability of health resources Biomedical vs, Biopsychosocial model - The biopsychosocial model assumes the coordinated influences of: - Biological factors - Psychological factors - Social factors - The biomedical model assumes that psychological/social factors are independent - Based on biochemical or neurophysiological difference Biopsychosocial Model -

Both macro and mirco- levle processes interact Macro: depression, social support Micro: chemical imbalance cellular disorder A healthy state is not the steady-state Systems theory: all levels of organization (micro/macro) are linked and changes in one will affect the other

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Biopsychosocial Model Clinical implications of the BPS model: All three factors must be considered in diagnosis Treatment can be individualized and allow for “team” therapy Strengthens the patient- practitioner relationships

Biomedical vs. Biopsychosocial model Biomedical model - Reductionist - Single causal factor considered - Assumes mind - body dualism - Emphasizes illness over health Biopsychosocial Model - Macro Level as well micro level - Multiple causal factors considered - Mind and body inseparable - Emphasizes both health and illness

Importance of health psychology - Acute vs. chronic illness in Canada Death rates per 100 000 1921 - 25 221.9 - cardiovascular and renal disease 141.1 influenza, bronchitis, and pneumonia 111.0 Disease of early infancy

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85.1 tuberculosis 75. 9 Cancer 72.2 Gastritis, duodenitis and colites 51.5 accidents 47.1 communicable diseases 2011 72, 476 cancer 47, 627 cardiovascular diseases 13, 283 cerebrovascular diseases (stoke) 11, 184 chronic lower respiratory diseases 10, 716 accidents (unintentional injuries) 7, 194 diabetes 6, 356 alzheimers disease 5, 767 influenza and pneumonia

Chapter 2 - Nervous system - Endocrine system - Cardiovascular system - Respiratory system - Immune system Nervous System - Comprised of a very complex system of nerve fibers - Organized into two main sections: - Central nervous system (CNS) - Peripheral nerous system (PNS

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The Nervous System - CNS - Consists of brain and spinal cord - Brian is contained in the cranial cavity - Sponal cord is contained in the spinal cavity - Brain is protected by skull - Spinal cord is protected by vertebrae The Nervous System - PNS - Consists of the somatic and autonomic nervous system - The somatic nervous system: - Also know as voluntary - Connects brain to voluntary muscles - Provides sensory feedback about voluntary movement - Is less protected than the CNS The Nervous systems - Pns - The autonomic nervous system: - Also known as involuntary - Connectsa brian to internal organs - Further divided into sympathetic and parasympathetic - The sympatheirc dvisions: - Responds to danger and stress - Physiological changes - heart rate, bop - Adrenaline (flight or flight) The Nervous System - flight or fight Acute stress response (general adaption syndrome) The parasympathetic division: - Controls organs at baseline - Antagonistic to the sympathetic ns active when individual feels relaxed - Stimulates digestion (rest & digest)

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The Nervous system The nervous system ---- central nervous system (CNS) (carries voluntary nerve imules to skeletal muscles and skin: carries involuntary implies tom muscles and glands) - BRAIN & SPINAL CORD Peripheral nervous systems (PNS) ---- Somantic nervous system (controls voluntary movement)

Chapter 2 The systems of the Body -

The Nervous System Comprised of a very complex system of nerve fibers Organized into two main sections: Central nervous system (CNS) Peripheral nervous system (PNS)

The nervous consists of the brain and spinal cord Brain is contained in the cranial cavity Spinal cord is contained in the spinal cavity Brain is protected by the skull Spinal cord is protected by vertebrae

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Consists of the somatic and autonomic nervous system. The somatic nervous system Also known as voluntary Connects brain to voluntary muscles Provides sensory feedback about voluntary movement Is less protected than the CNS

The autonomic nervous system: - Also known as involuntary - Connects brain to internal organs - Further divided into sympathetic and parasympathetic - The sympathetic division; - responds to danger and stress - • physiological changes – heart rate, bp - • adrenaline (“fight or flight”) Flight or fight Acute stress response (general adaptation syndrome) The parasympathetic division: • controls organs at baseline • antagonistic to the sympathetic ns • active when individual feels relaxed • stimulates digestion (“rest & digest”) The Brain - The brain consists of three sections: - The hindbrain, midbrain, and forebrain Hindbrain - The medulla: mediates heart rate, blood pressure and CO2 /O2 concentration - The pons: link between hindbrain and midbrain and helps control respiration - The cerebellum: coordinates voluntary muscle movement, balance/equilibrium, muscle tone and posture

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Midbrain - Relay of sensory and motr info between forebrain and hindbrain - visual and auditory reflexes - Production of of DA in substantia nigra Forebrain - The forebrain has two main sections: diencephalon and telencephalon - The diencephalon contains the thalamus and the hypothalamus. - • thalamus: relay sensation, spatial sense, and motor signals to the cerebral cortex, along with the regulation of consciousness, sleep, and alertness

Forebrain (diencephalon) -

Fictions of thalamus: Relay sensation, spatial sense, and motor signal to the cerebral cortex Regulation of consciousness sleep, and alertness Switchboard

Forebrain (diencephalon) - Functions of Hypothalamus: - Regulate parts of medulla that control caradiac function, blood pressure, respiration - Regulation of water balance, appetite, and sexual desire - Link to the endocrine system via pituitary gland Forebrain (telencephalon) - The telencephalon contains the left and right cerebral cortex. - functions of cerebral cortex: - • involved in higher order intelligence, memory, personality - • processing of sensory and motor information - • contains four lobes

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Neurotransmitters - regulate both CNS and PNS function - • Sympathetic nervous system secretes norepinephrine and epinephrine (catecholamines) - • can modulate physiology, alertness - • repeated activation linked to chronic disease

Disorders of the Nervous system - approximately 1 in 3 affected in their lifetime • disorders can include: o Epilepsy o - Parkinson’s disease (PD) o - Alzheimer’s disease (AD) o - Cerebral palsy (CP) o - Multiple sclerosis (MS) o - Huntington disease (HD) The Endocrine System - system of ductless glands which secrete hormones directly in to the blood - • interacts with the nervous system - • slow-acting, long-lasting changes to the body - • regulated by the hypothalamus and the pituitary gland – Pituitary Gland • contains two lobes: anterior and posterior • anterior lobe secretes hormones for growth: • somatotropic hormone (STH) • gonadotropic hormone (GTH) • thyrotropic hormone (TSH) • adrenocorticotropic hormone (ACTH)

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• The posterior lobe produces oxytocin (controls contractions during labor), vasopressin (water absorption in kidneys) Adrenal Glands • two small glands located on top of the kidneys • each adrenal gland consists of: • adrenal medulla (epinephrine, NE • adrenal cortex: stimulated by ACTH from the pituitary gland, than releases hormones (steroids

Disorders of the Endocrine System - disorders can include: - Diabetes (type 1, type 2) - Osteoporosis - Cushing’s syndrome - Menopause - Obesity The Cardiovascular System - composed of the heart, blood vessels and blood. - • blood carries O2 from the lungs to the tissues and CO2 expelled as breath • blood also carries nutrients, waste and hormones The Cardiovascular System - The Heart - Four chambers in the heart - • left side of the heart takes in oxygenated blood from the lungs - • right side sends deoxygenated blood to the lungs - • systole – blood is pumped out of the hear - • diastole– blood is taken into the heart Disorders of the Cardiovascular System - disorders can include: - o atherosclerosis - ▪ angina pectoris

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- ▪ myocardial infarction (heart attack) - arteriosclerosis - aneurysm

The Respiratory System - Respiration has three main functions: - • acquire oxygen into the body - • excrete carbon dioxide out of the body - • regulate the composition of the blood Inspiration of air is an active process: • contraction of muscles - • lungs expand inside thorax Expiration of air is an passive process - Relaxation of the lungs The Respiratory System. - Respiration is controlled by the medulla - chemical composition of the blood can modulate activity - • higher CO2 and respiration increases - • lower CO2 and respiration decreases Disorders of the Respiratory System - disorders can include: - o chronic obstructive pulmonary disease (COPD) o - pneumonia o - tuberculosis o - asthma o - Asphyxia, - anoxia, - Hyperventilation

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The Immune System - The immune system main function is protect the body from foreign substances. - can interact with psychological and neuroendocrine factors to modulate health - Disease can be caused by: - • infection • genetic defects - • hormone imbalances - • nutritional deficiencies The immune System - Infection is transmitted by: - • direct transmission o genital herpes, HPV - • indirect transmission o influenza - • biological transmission o mosquito – yellow fever - • mechanical transmission o hands, rats – H1N1 -

Surveillance system of the body Implicated in: Infection Allergies cancer Autoimmune disorders Determins what “self” and foreign

– Natural Immunity Natural immunity • defence against a variety of pathogens • largest group of cells is granulocytes • this includes neutrophils and macrophages, which are phagocytes

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• neutrophils & macrophages congregate at the site of injury or infection • release toxic substances

macrophages release cytokines which: • lead to inflammation • fever • promote wound healing • natural killer (NK)cells: • recognize viral infections or cancer cells • lyse cells by releasing toxic factors • important in signaling potential malignancies • limits early phases of viral infections Specific immunity - • slower process but more specific - • lymphocytes have very specific receptors for one antigen - • once activated they divide to create a proliferative response - • both types of immunity work together - • natural followed by specific humoral immunity is mediated by B lymphocytes: o provide protection against bacteria o neutralize toxins produced by bacteria o prevent viral infections • cell-mediated immunity: o involves T lymphocytes from the thymus gland o operates at the cellular level o cytotoxic (TC ) cells response to specific antigens o helper T (TH ) cells enhance functioning of TC cells, B cells and macrophages Stress Response - stress has the ability to activate physiological systems - • acute vs. chronic or long-term stress - systems involved in the stress response:

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- sympathetic-adrenomedullary (SAM) o hypothalamic-pituitaryadrenocortical (HPA) axis Stress Response - Sympathetic - cerebral cortex labels events as stressful - • signal is sent to hypothalmus - • activates sympathetic nervous system: - fight-or-flight response acute stress response o Walter Cannon (Cannon’s response) Sympathetic arousal: - stimulates medulla of the adrenal glands - o release of epinephrine and norepinephrine - leads to increased blood pressure, heart rate, sweating, constriction of peripheral blood vessels HPA activation - Hans Selye introduced the general adaptation syndrome (GAS) - • response to stress involves three phases: o alarm o resistance o exhaustion The Stress Response – HPA Activation • HPA activation causes release of: o corticotropin-releasing factor (CRF) o adrenocorticotropic hormone (ACTH) o Glucocorticoids (ie. Cortisol)

Chapters 3 health Behaviours - good health, or wellness, is a personal and collective achievement - • WHO defines health promotion as: “the process of enabling people to increase control over, and to improve, their health” (1986) - • Different perspectives: - • individual vs. - • medical practitioner vs - . • psychologist vs. - • media

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Smart Canadians - Lalonde Reprot (1974) - proposed the concept of the "health field" - • identified two main health principles: - • the health-care system - • prevention of health problems and promotion of good health. - • first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong! What are Health Behaviours? - “behaviours employed by people to enhance or maintain their health” • health behaviours (good or bad) become health habits - • a health habit is a health behaviour that is well established and is performed automatically o if reinforced early → resistant to change Role of Health Behaviour - patterns of disease have shifted over 70 yrs - o acute diseases vs. preventable diseases o - modifying health behaviours can lead to a 50 % reduction in deaths • Benefits of modifying health behaviours: reduction in deaths due to lifestyle-related diseases o increased longevity (life expectancy) o longer disease-free period (quality of life) o reduced overall health care costs (~$200 billion)

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Influential Factors - health behaviours are influenced by several factors including: - o socio-economic factors o - age o gender o - values (culture) o - personal control o - social influence o - personal goals o - perceived symptoms o - access to health-care o - location o - cognitive factors Health Habits in Children & Adolescents - Health habits are strongly affected by: - socialization – parents as role models o - teachable moment– educational opportunity o - closing the window of vulnerability- adolescence Are You At Risk? - benefits of identifying at risk people: - o may eliminate or prevent poor health habits - efficient & effective use of health dollars o - help identify risk factors in this patient population - • problems with identifying at risk people: - hypervigilance – over sensitive to stressors - may become defensive and disregard risk factors Ethical Issues - ethical issues must be considered when identifying at-risk people - • do you identify at-risk people if risk is low? - • identification may initiate symptoms (i.e. depression) - • there might not be a clear intervention • interpersonal issues may arise - Health Habits in Elderly - factors to consider include:

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exercise participation in social activities monitor alcohol consumption o controlled diet Vaccinations

Other Factors to Consider - gender and ethnic differences can influence vulnerability to particular health risks: - alcohol consumption (men vs. women) - o smoking (aboriginals) - drug-use - exercise How Can We Change health behaviours? - our goal is change views and prevent unhealthy behaviours - • different approaches include: educational appeals – credible, colourful, concise - fear appeals – use fear to change behaviour, may be counterproductive, coupled approach o - message framing – messages that stress benefits - ▪ loss-framed works best for high risk behaviours - ▪ gain-framed works best for low risk behaviours Models of Health Behaviour Change - changing beliefs instead of attitudes - • models include: o social cognition model – expectancy-value theory, engage in behaviours that will be successful and they value - health belief model – perception of threat, perceived threat reduction planned behaviour model– health behaviour is a result of a behavioural intention Theory of Planned Behaviour - direct result of behavioural intention • three components: o - attitudes toward the specific action – likeliness and evaluation -subjective norms– what do others think? motivation to comply?

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-perceived behavioural control – capable...