PSYU/X1105: Health Psychology 2

DR ALISSA BEATH
Lecture Outline

Part 2 (week 4):

• Psychology of pain
• Placebo effect
• Brain-gut connections
― Brain-gut connections
― Functional gastrointestinal disorders
― Psychological treatment for GI disorders
― GI treatment for psychological disorders

Textbook Reading: Chapter 12 Stress, Coping and Health

2
Stress and Illness
STRESS AND COPING

HOW does stress affect health??

Physiologically:
― Increases blood pressure
― Changes blood composition
― Release of stress hormones
― Suppression of immune system
Behaviourally:
― Less sleep / rest
― Less exercise
― Less healthy food eaten
― Increased physical tension
― Less social support

McEwan, 1998: Stress, Adaptation, and

Disease: Allostasis and Allostatic Load

3
Example: Religiosity and Health
STRESS AND COPING

• Demonstrates the importance of good research methods

• Compared to non-religious people, religious people have:

― Longer life expectancy
― Improved immune system functioning
― Lower blood pressure
― Faster illness recovery
(Koenig, McCollough, & Larson, 2001; Levin, 2001; Matthews, Larson & Barry, 2003)

• But, observational research methods

― Correlation or causation?
― Mechanism of action?

• Restriction of risky health behaviours?

• Increased social support?
• Better coping styles?

4
Psychology of Pain
What is Pain?
PSYCHOLOGY OF PAIN

“unpleasant sensory and emotional experience associated with actual or

potential tissue damage, or described in terms of such damage”
- International Association for the Study of Pain

• Sensory and emotional discomfort

• Usually associated with tissue damage (bodily harm)
• PSYCHOLOGICAL PHENOMENON

6
Process of Pain
PSYCHOLOGY OF PAIN

• Process of (most) pain:

― Stimulation at local tissue site (noxious stimulation)
― Chemicals released -> inflammation and activation of nerve endings
Nerves transmit message to spinal cord (via nociceptors), then to brain
― Travels through many brain regions

• Pain is a construct of the brain!

http://science.howstuffworks.com/life/inside-the-mind/human-brain/pain.htm
7
Pain is Psychological
PSYCHOLOGY OF PAIN

Pain is psychological:
― The same nociceptive input can be manipulated to create more or less pain
― Negative mood causes same input to be more ‘painful’ (and positive mood can buffer)
― Pain can be generated WITHOUT nociceptive input! e.g. Rubber Hand Illusion:
https://www.youtube.com/watch?v=DphlhmtGRqI

8
Pain is Psychological
PSYCHOLOGY OF PAIN

Pain is psychological:
― The same nociceptive input can be manipulated to create more or less pain
― Negative mood causes same input to be more ‘painful’ (and positive mood can buffer)
― Pain can be generated WITHOUT nociceptive input!

• Prof. Lorimer Mosely, University of South Australia, Body in Mind: watch this yourself!!
https://www.youtube.com/watch?v=gwd-wLdIHjs

• Implications: think treatment of chronic health conditions: targeting psychological (vs

physical) processes

9
Placebo Effect
Placebo Effect
PLACEBO EFFECT

• If pain can be created in the mind, can the treatment of pain occur in the mind?
• Placebo effect: positive effect results not from any active treatment, but purely from patient’s
belief in or expectations of treatment
• Sugar pills/capsules, injections, surgery! https://youtu.be/yfRVCaA5o18

11
Placebo Effect
PLACEBO EFFECT

• Fundamental to clinical trials: Common “control group” treatment (match type to the active
therapy)

• e.g. VR for pain management https://www.youtube.com/watch?v=jNIqyyypojg

• Placebo vs nocebo effect

12
Mechanisms of Placebo
PLACEBO EFFECT

• WHY does it work?

― Expectancy theory
― Conditioning

• HOW does it work?

― Endogenous opiods and neurotransmitters (dopamine and seratonin)

• Mechanisms disrupted in Alzheimer’s (Benedetti et al., 2006)

13
Ethics of Placebo?
PLACEBO EFFECT

• Deception

• Clinical trials: participants informed of chance of placebo

• Many therapies, not based in scientific or clinical evidence, ‘work’ via the
placebo effect

14
Brain-Gut Connections
Brain-Gut in the news

16
Brain and Gut

https://www.youtube.com/watch?v=T3Ftj5E90tY
17
Brain and Gut

• Gut microbiota = colonies of bugs

• Gut-brain axis (microbiome-gut-brain axis):

communication between gut microbiota, immune system,
metabolism, and central nervous system

• Gut microbiota can (via a complex pathway) stimulate the

body’s immune response; activate the HPA
(hypothalamus-pituitary-adrenal) axis (AKA stress
response)

18
Brain and Gut

• In sum: the gut and brain talk!

• Gut health can impact our mental health (and vice versa)
• Currently on the cusp of major breakthroughs

19
FGIDs

• Functional GastroIntestinal Disorders (FGIDs): neurogastroenterology

• “Disorders of brain-gut interaction” (Drossman, 2016)

• 32 individual diseases: Irritable bowel syndrome (IBS) most common

• High comorbidity with mental health disorders

20
Development of FGIDs

• Psychological distress causing GI symptoms?

• GI symptoms causing psychological distress?

• Anxiety/depression can predict diagnosis of FGID in 12 years

• FGID can predict elevated anxiety/depression in 12 years
(Koloski et al., 2012)

• Mental health problems preceding GI problems more often than GI preceding mental health
(Sykes et al., 2003; Jones et al., 2017)

21
Biopsychosocial Model

Van Oudenhove et al., 2016

22
Visceral Hypersensitivity

Mertz et al., 2000

23
Psychological Treatment of GI

• Psychological therapies (e.g. Cognitive behavoural therapy, Hypnosis, Mindfulness,

Relaxation therapy, Psychodynamic therapy…)

• Reliable, moderate effect on GI symptoms and associated psychological

distress (Ford, 2009)

• Benefits last up to 1 year post therapy (Laird et al., 2016)

24
Mechanisms of Psychotherapy?

• Psychological therapy also decreases:

― Catastrophizing
― GI-specific anxiety
― Visceral hypersensitivity
― Negative appraisal
― External locus of control
• And increases:
― Reinterpretation of pain symptoms
― Non-reactivity (mindful mindset)
― Brain activity in pain processing centres
Boyce et al., 2003; Garland et al., 2012; Gonsalkorale et al., 2004; Hyphantis et al., 2009; Lowen
et al., 2013; Oerlemans et al., 2011
• Correlation or causation??
25
GI Treatment for Mental Health

• Because of brain-gut (microbiome-brain-gut) connections,

changing gut could directly impact mental health
• Probiotics, dietary changes, faecal microbiota transplants…
• Need experimental work to differentiate between correlation and
causation, and understand mechanisms of action
― Randomised control trials
― Human (vs. animal) studies

26
27
Caveat

• We need scientific evidence to show efficacy of any treatment

• This is in EARLY STAGES!
• Don’t want to increase stigma around mental health issues (or physical health issues)
• Need more (good quality) scientific research, and understanding of mechanisms of action

http://www.robot-hugs.com/helpful-advice/

28
Summary 1
HEALTH PSYCHOLOGY

• Evolution of “Health” and “illness” throughout history

• The fundamental role psychology plays in all aspects of health
• The need for good research methods!
• Biomedical vs biopsychosocial model
• Different definitions of stress and mechanisms through which it affects
illness
• Appraisal and coping
• The psychology of pain: how is pain processed?
• How can we learn from the psychological aspects of pain to inform
treatment?
• Placebo effect: Why should we care? Why does it work? Ethics?

Health Psychology 1 29
Summary 2
HEALTH PSYCHOLOGY

• Brain and gut are connected

• Functional gastrointestinal disorders = disorders of brain-gut connections
• There might be common developmental pathways in mental health conditions
and gastrointestinal conditions
― Lead to better understanding of both!
• Psych treatment can help GI conditions
• GI treatment can help mental health conditions
• We DO NOT know all the answers yet!!

30
31
https://www.theguardian.com/world/
2020/jun/07/health-experts-on-the-
psychological-cost-of-covid-19

32
“Efforts to control and reduce coronavirus transmission rely on behavioural change and maintenance… Beyond
behaviour change, health psychology also has a role in understanding how people might respond to and cope
with the threat of a global pandemic and changes to their lives that are made in an effort to reduce that threat.”

33
MORE Health Psychology??

• PSYU2224: Psychology, Health + Wellbeing

• PSYH4466: Advanced Issues in Health Psychology

• Health Psychology as an applied field: learn from personality, social psych, biopsychology, perception,
cognitive psych…

• Reach out to lecturers or other staff and have a chat!

https://www.mq.edu.au/about/about-the-university/faculties-and-
departments/medicine-and-health-sciences/departments-and-centres/department-of-
psychology/our-people

• Get involved: work as a research assistant,

volunteer, take part in groups,
conferences, etc.
https://www.psychology.org.au/public/health/
https://groups.psychology.org.au/chp/ 34
Some optional extra readings

• Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on
coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591-612.

• McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the
New York academy of sciences, 840(1), 33-44.

• Ongaro, G., & Kaptchuk, T. J. (2019). Symptom perception, placebo effects, and the Bayesian brain.
Pain, 160(1), 1.

• Wiech, K. (2016). Deconstructing the sensation of pain: the influence of cognitive processes on pain
perception. Science, 354(6312), 584-587.

• https://noijam.com/2019/02/27/predictive-processing-a-potential-theory-for-persistent-pain-and-the-
power-of-discrepancy-in-facilitating-change/

Health Psychology 1 35
Some optional extra readings

• Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., ... & Brazionis, L. (2017). A
randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC
Medicine, 15, 23.
• Jones, M. P., Tack, J., Van Oudenhove, L., Walker, M. M., Holtmann, G., Koloski, N. A., & Talley, N. J. (2017).
Mood and anxiety disorders precede development of functional gastrointestinal disorders in patients but not
in the population. Clinical Gastroenterology and Hepatology, 15(7), 1014-1020.
• Koloski, N. A., Jones, M., Kalantar, J., Weltman, M., Zaguirre, J., & Talley, N. J. (2012). The brain–gut
pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based
study. Gut, 61(9), 1284-1290.
• Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D., & Walker, L. S. (2017). Comparative efficacy of
psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A
systematic review and meta-analysis. Clinical Psychology Review, 51, 142-152.
• Taylor, A. M., & Holscher, H. D. (2018). A review of dietary and microbial connections to depression, anxiety,
and stress. Nutritional Neuroscience, 1-14.
• Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., ... & Naliboff, B.
D. (2016). Biopsychosocial aspects of functional gastrointestinal disorders: How central and environmental
processes contribute to the development and expression of functional gastrointestinal
disorders. Gastroenterology, 150(6), 1355-1367.

36