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In these 2 lectures we will cover..

Psychophysiological disorders • definition of psychophysiological disorder


• definition and measurement of “stress”
• physiological explanations of stress response
Lecture 1 • personaility factors affecting response to stress
• behavioural and cognitive factors affecting
response to stress

DIATHESIS-STRESS PSYCHOPHYSIOLOGICAL disorders

• constitutional predisposition • psychological/emotional factors which predispose


individuals to develop physical illness
triggered by
• environmental stress
• DSM IV-R
Axis I “psychological factors affecting medical
condition”

stress... An exam situation...

• Lazarus 1968 ...stress is produced when


“STRESS OCCURS WHEN A SITUATION IS • She perceives the result as an important
APPRAISED AS EXCEEDING A PERSON’S determinant of her success
ADAPTIVE RESOURCES” • she perceives it as taxing or exceeding her ability
to prepare for and complete it successfully
• perception of the demands in relation to personal
• ... not the situation/environment per se, but the resources – and strategies available to deal with
way the person interprets the experience them
Moderators of stress

• Coping strategies (problem focused, emotion


focused) • Social conflict predicts poor outcome in people
• Social support (structural, functional - critically with coronary heart disease
NONEVALUATIVE) • Social isolation confers heightened risk for
coronary heart disease

Measuring stress Categories of ‘stressor’

• Life Change Units - Combine life event frequency • Life events


and intensity/salience • Holmes & Rahe (1967): SCHEDULE OF
• Life event = something which demands resources RECENT EVENTS
and requires personal or social adjustment
• divorce or vacation +ve or –ve • Daily Hassles?
• LCU calculated for a particular period of time by • ... unwanted visitors, parking tickets, no milk in
adding weighted scores of events experienced the fridge.
• Population specific- daily hassles for college
students (Kohn et al 1990)

Traumatic stress... The “weak link in the chain”

• Higher death rate in • no evidence that different psychological stressors


widowers within 6 months relate to different physical disorders –
of death of spouse
(relative to age-related
norms) • individual’s constitutional vulnerability
• Higher incidence of determines the organ/system ‘reactive’ to stress
hospital visits and 19%
• stomach.. skin ..lungs ..heart
increase in death rate
following Mt St Helens
eruption in 1980….
Explaining psychophysiological
Physiological explanations
responses to stress
• Stress produces specific adverse physiological • emphasis on causal role of constitutional reactivity
reactions and direct damage to the body • stem from evolutionary model –
• response to psychological threat mimics evolutionary response
• Stress damages the body indirectly by increasing to physical threat - increased b/p, muscle tension, respiratory
unhealthy behaviours changes
• These have become automatic responses to psychological
• Stress induces unhealthy cognitions and stress
behaviours in certain personality types, making • often maladaptive – counterproductive – debilitating
them vulnerable to physical illness

Selye (1976) Damage may be caused by different


General Adaptation syndrome routes:

• inherited physiological reactivity in Autonomic


Nervous System
• specific organ vulnerability - inherited
• individual biological reactions - inherited/acquired
• immune system changes

physiological reactivity
Destruction of hippocampal neurons

More Fewer
Prolonged stress cortisol hippocampal
secretion neurons

Decreased ability to shut of cortisol secretion


Immune system changes in animals... Sklar & Anisman (1979)

Psychoneuroimmunology • introduced cancerous growths into 2


identical sets of mice
Studying evidence for stress-related lowering • half exposed to intermittent electric shock
of body’s resistance to infection/virus • Cancerous tumours developed more rapidly
“immunocompetence” = immune system in stressed group
efficiency

in humans... two possible mechanisms

• reduced efficiency of immune system


• Natural killer cell: cytotoxicity significantly
(Kiecolt-Glaser & Glaser, 1970s, 80s, 90s)
diminished by induced negative self evaluations
• colds and stress (Strauman et al 1993)
• depression
• unemployment
• Efficiency of natural DNA repair systems: reduced
• marital disruption
by stress (Glaser et al 1985)
• bereavement

coronary heart disease Coronary heart disease

• ARTERIOSCLEROSIS - thickening and


• Most widely researched stiffening of coronary arteries, often a
psychophysiological disorder consequence of chronic hypertension
• ATHEROSCLEROSIS – thickening of coronary
arteries by deposition of cholesterol
• Consider a) unhealthy behaviours and b)
• MYOCARDIAL INFARCTION - heart attack
personality traits/cognitions in relation to
- death of tissue as a result of lack of oxygen
CHD
following blockage in coronary artery
physiological risk factors for CHD... high blood pressure

• Approximately 25 million individuals have elevated


• Growing old • Having high serum
blood pressure.
• Being male cholesterol
• Smoking cigarettes • Enlarged left ventricle
• Consistent or frequent elevation = HYPERTENSION
• Physical inactivity • Diabetes
• 92-98% of those suffering from hypertension show no
• Having high blood
discernible organic cause
pressure

• ESSENTIAL / PRIMARY HYPERTENSIVES

Personality as a risk factor?

• For this group, environmental stress plays a • first suggested by Friedman (1969) and Friedman
critical role in development of hypertension and Rosenman (1974)

• described individual with a CORONARY-


• high stress jobs + high basal blood pressure PRONE personallity...
and/or cardiovascular reactivity = essential
a TYPE A individual
hypertension risk

typical Type A individual...

• ..is competitive and ambitious


• ..has exaggerated sense of time urgency
“any person who is aggressively involved in a • ..is aggressive and hostile
chronic incessant struggle to achieve more • ..is over-committed to work
and more in less and less time” • (characteristics may emerge as early as 3-4 yrs old)
Type A/B can be differentiated by
questionnaire or interview..

• Structured interview: affective/expressive style


and behaviour
• Others not displaying these characteristics are
classified by default as Type Bs – relaxed, serene, Rosenthan et al (1964)
no sense of time urgency
• Jenkins Activity Survey: self report
Jenkins (1968)

TRAIT vs REPONSE STYLE

• first considered as a fixed set of traits – may • High percentage are white middle income,
be more appropriate to think of it as middle class males
RESPONSE STYLE • embedded within social context of
competitive occupational careers in US and
• not invariant overt behaviour pattern – similar cultures
situational • in this setting may be highly adaptive
• differs between populations - not all response style leading to desired material
environments induce it goals

Situation dependent style –

• Home environment: Participants and


• Ratings drop radically in 50 somethings spouses agreed on all measures.
• Work environment: Participants and work
• Bages et al (1997) – 45 University employees supervisors agreed on Type A assessment
• Asked participants, spouses and work supervisors • Spouses vs Work supervisors: virtually no
to assess Type A behaviour, anger, social support overlap
measures in their respective environments
• situation specific Type A Behaviour Pattern

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