Health Psychology Review

Lecture
25th April, 2022
 Nutrition, Weight Control and Diet, Exercise and Safety

• Weight = energy you get from food - energy you use.

• If calories consumed are more than the energy used,

the body stores the extra calories

in fat cells (lipocytes)

• When a person burns up more calories than they consume,

they will lose weight.

• Fat cells grow or shrink depending on how people use

energy.
 Measurement of Obesity
• Obesity is determined by measuring body fat, not just body
weight.

• You can be overweight but not obese, and can have normal
or under-weight, but obese ((have excessive body fat))

The Body Mass Index (BMI)

• It is the current standard measurement for obesity

• BMI is calculated to evaluate your body fat using your height

and weight.

Bodyweight in Kilograms
BMI =
Height x Height
 Waist Circumference

• Extra weight around the mid-

section or stomach area
increases the risk for type 2
diabetes, heart disease, and
stroke

• Waistlines over:

‒ 31.5 inches ----- Women

‒ 37.0 inches ----- Men } watch weight

‒ 35 inches ----- Women

‒ 40 inches ----- Men } Risk for diseases
Apple shape ---- is a more important predictor of heart disease
and other health problems than BMI
 Waist-Hip Ratio

• The distribution of fat can be evaluated by

dividing waist size by hip size.

Waist Size
Waist-Hip Ratio =
Hip Size

• The lower the ratio the better

• Ratios above:

‒ 0.8 ----- Women

‒ 1.0 ----- Men } Risk for diseases
 Obesity & Health Risks

• Obesity is a medical condition in which a high amount of

body fat makes it hard for a person's internal organs to
work well.

• People with obesity are at risk for developing a number of

health problems such as:
‒ heart disease,
‒ stroke,
‒ high blood pressure,
‒ type 2 diabetes,
‒ sleep apnea,
‒ arthritis,
‒ gallstones,
‒ stroke, and
‒ various cancers.
 Causes of Obesity
• The Biological Pathway to Appetite
 Causes of Obesity
• The primary known feedback signal that regulates body
fatness is leptin- Insulin plays a role as well, acting directly
on the brain in a manner similar to leptin, although much
less powerfully.
 Causes of Obesity
• Specific genetic factors
• Learned Behaviors and Habits
• Television and Sedentary Habits
• Modern Diet and Eating Habits
• Medical or Physical Causes of Obesity
• Effects of Certain Medications

Risk Factors for Obesity

• Gender
• Age
• Socio-economic status
• Ethnicity
 Causes of Obesity
• Specific genetic factors
• Learned Behaviors and Habits
• Television and Sedentary Habits
• Modern Diet and Eating Habits
• Medical or Physical Causes of Obesity
• Effects of Certain Medications

Risk Factors for Obesity

• Gender
• Age
• Socio-economic status
• Ethnicity
 People at Risk of Obesity

• Ex-smokers
• Sedentary
• Disabled
• Mentally ill
 Strategies to Promote Exercising
1) Pre-assessment - purpose & expected benefits

2) Exercise selection - tailored to meet the health needs

3) Exercise selection - when, where, & what conditions,

equipment

4) Goals - behavioral contract, measurable goals

6) Consequences - tangible reinforcers to maintain exercise

behavior
7) Social influence - support and encouragement

8) Record Keeping - weight and performance

 Eating Disorders
• Abnormal eating habits that negatively affect a person's
physical or mental health

a) Binge eating disorder - too much food in a short time

b) Anorexia nervosa - refuse to eat due to intense and

irrational fear of becoming fat
c) Bulimia nervosa - overeat (binging) and then purge the
food to prevent weight gain
d) Pica - eat non-food items (that have no nutritional value)

e) Rumination disorder - food is regurgitation and re-chewed

f) Avoidant/restrictive food intake disorder (selective eating

disorder, SED)
 Personality, Disease, and Self-Healing

• There are disease-prone personalities and self-healing

personalities.
E.g. Type A personality

The Causal link between Personality Traits and Disease

• Personality ------- unhealthy behaviors -------- diseases

• Disease-caused personality changes

• Individual differences in gravitating towards or choosing

unhealthy situations
 The Causal link between Personality Traits and Disease

• The psychophysiological model, ----- stress ----- coping ------

---- effect on physiology

Models of Personality and Disease

 Depression and risk of heart disease

• Depression predicts heart disease and why only in some

people

• Depressed people have 64% greater risk of developing

coronary artery disease (CAD)

• Depressed CAD patients are 59% more likely to have a

future adverse cardiovascular event, such as a heart attack
or cardiac death.

• Conversely, people who are diagnosed with heart disease

have an increased risk of developing depression

Depression ---------- Heart Disease

 Depression and risk of heart disease

• 20 – 30% of cardiac patients suffer from depression

• Heart disease patients are twice as likely to die if they

develop depression

• Depression is the strongest predictor of death in the first

decade after a heart disease diagnosis

• Depression is also associated with other risk factors,

E.g. smoking
• The pathways are not completely understood, there are
many likely explanations

Depression ---------- Heart Disease

Depression  --- risk factors --- Heart Disease

SNS  --- risk factors --- Heart Disease

Depression Heart Disease

Behavior

‒ poor diet
‒ lack of exercise,
‒ Smoking
‒ Drinking
‒ non-adherence to medications,
• The biology of depression may be the explanation
 Self-Healing Personality

• Disease-prone personality is characterized by:

‒ negative mood,
‒ depression,
‒ anxiety, and
‒ irritability

• They tend to dwell on the negatives of life and are often

dissatisfied.

• Thus, they are more prone to stress-related illnesses, such

as heart disease
 Self-Healing Personality

• Self-healing personality is associated with being:

‒ conscientious,
‒ emotionally secure,
‒ enthusiastic about life, and
‒ have strong social relationships

• These characteristics lead to more health-promoting

behaviors—avoiding smoking, better adherence to exercise programs and
maintaining a healthy diet.

• This leads to greater resistance to stress-related illnesses.

 Mind-Body Interactions in Health and Illness

Psychoneuroimmunology (PNI)
• Psychological state -- nervous system -- the immune
system ---- disease and healing

• The brain (central nervous system) directly influences the

immune system

• Robert Ader (1974) Exp’t ---- classical conditioning in rats.

‒ inert (inactive) substance such as sugar (CS)

‒ immunosuppressive substance (US)
e.g. a cancer medication, cyclophosphamide --- reduces number of
T cells

‒ The CS caused immunosuppression and rats died.

 Innate Immunity

• Inborn; present at birth, and generally inherited from

parents and passed to offspring

• The innate immune system provides an immediate

response to pathogens, with responses typically within
minutes to hours.

• It is composed of physical and chemical barriers,

phagocytic leukocytes (macrophages), dendritic cells,
natural killer cells, and plasma proteins.

• Fights any foreign invader/pathogen (non-specific)

- bacteria, viruses, fungi, and parasites

 Innate Immunity

• Rapid, but not very effective

• Once activated against a specific type of antigen, the

immunity remains throughout the life.

But

• Has no memory and cannot react with equal potency upon

repeated exposure to the same pathogen.
 The Adaptive Immune System

• The adaptive or acquired immune system save us from

death by infection

• Defends body from harmful invaders, collectively called

pathogens
- bacteria, viruses, fungi, and parasites

• Unlike innate immune responses, the adaptive responses

are highly specific to the particular pathogen that induced
them.

• The innate responses call the adaptive immune responses

into play, and both work together to eliminate the
pathogens
• It is slow (1-2 weeks) and can only fight against a specific
infection

• A person who recovers from measles

- is protected for life against measles

but not against

- other common viruses, such as those that cause

mumps or chickenpox.

• Adaptive immunity can provide long-lasting or short-lived

protection.
• The adaptive immune system consists of antibodies, B
cells, and CD4 + and CD8 + T cells, and these enable a
highly specific response against a particular target

• Natural killer T cells and γδ T cells are cytotoxic

lymphocytes that overlap both innate and adaptive
immunity.

• Adaptive immunity can provide long-lasting or short-lived

protection.
• The function of adaptive immune responses is to destroy
invading pathogens and any toxic molecules they produce

• The ability to distinguish what is foreign from what is self in

this way is a fundamental feature of the adaptive immune
system.

• Sometimes, the system fails to make this distinction and

reacts destructively against the host's own molecules.

-- Such autoimmune diseases can be fatal.

• Allergic conditions such as hayfever and asthma are
examples of deleterious adaptive immune responses
against apparently harmless foreign molecules.

• Any substance capable of eliciting an adaptive immune

response is referred to as an antigen (antibody generator).

• The immune system can be tricked by injecting a

harmless molecule together with immunostimulants
(usually microbial in origin) called adjuvants, which
activate the innate immune system. This process is called
immunization.
• Natural killer T cells and γδT cells are cytotoxic lymphocytes
that overlap the interface of innate and adaptive immunity.
Immune Cells
• The different types of white blood cells (leukocytes)
include:
‒ Granulocytes (neutrophils, eosinophils, and
basophils),

‒ Lymphocytes (T cells and B cells), and

‒ Phagocytes (monocytes, and macrophages)

• These immune cells defend the body against foreign

pathogens (antigens), such as bacteria, viruses and
cancerous cells.
Phagocytes
• Engulf foreign particles, including infectious agents, such
as bacteria

• They swallow and digest disease causing bacteria and

other foreign particles.
Lymphocytes
• Lymphocytes include natural killer cells (NK cells), T cells,
and B cells.

• NK cells function in cell-mediated, cytotoxic innate

immunity---killing of tumors and virally infected cells.
• B cells produce antibodies

• An antibody matches an antigen (e.g. protein on a foreign

cell or virus).
• T cells - (for cell-mediated, cytotoxic adaptive immunity---
response to specific pathogens).

• If the pathogen (e.g. virus) gets inside a cell, the T cells

lock on to the infected cell, multiply and destroy it.
• T cells recognize and destroy virus-infected cells and
tumor cells, and are also implicated in transplant rejection.

• Memory T cells (CD8+ T cells and CD4+ T cells) are a

subset of antigen-specific T cells that persist long-term
after an infection has been resolved.

• T-cells are mobilized when they encounter a cell such as a

dendritic cell, a macrophage, or a B cell that has digested
an antigen

• The MHC–antigen complex activates the T cell receptor

and the T cell secretes cytokines.
 • Helper T-cells direct and regulate the immune responses,
while the cytotoxic T-cells (killer T-cells) attack and destroy
cells, which are infected or cancerous.

• Basophils are white blood cells, which secrete inflammatory

mediators which attract other leukocytes (white blood cells)
to the point of infection or allergic reaction.
 Stress, Immunity, and Susceptibility to Disease

• There are two main ways that stress has a direct, negative
effect on the immune system:

1. It creates chronic inflammatory conditions

2. It lowers the immunity of people who would

otherwise have a healthy immune system.
For example;
• The stress hormones can suppress the effectiveness of
the immune system (e.g. by lowering the number of
immune cells, interfering with antibody production, etc.)

• Stress leads to frequent illness and infections.

• Leukocytes (immune cells) have receptors for stress hormones
and can be modulated by the binding of these hormones to
their respective receptors.
• For instance, when stress hormones bind the immune cells,
they can:-
‒ downregulate (reduce) antibody production

‒ inhibit inflammation and production of certain

cytokines e.g. IL12

‒ reduce trafficking of immune cells

‒ induce the release of pro-inflammatory cytokines,

which if persistent can hamper the body's ability to fight infection
and heal wounds, and chronic inflammation also increases the
risk of heart disease, osteoporosis, allergies, and autoimmune
diseases including type 2 diabetes.
Research on the link between Stress and Immune Function
Kiecolt-Glaser et al., (1984) study

Blood samples were taken:

1. one month before their final examinations
(relatively low stress),

and

2. during the examinations (high stress).

Findings: ‒ The blood sample contained less T-cells

during the exams.

‒ Especially for lonely, stressed, depressed,

anxious students
Research on the link between Stress and Immune Function
Stress and Illness
 Stress and Vaccines
• Stress can lessen the effectiveness of certain vaccines.
For example,
• Hepatitis B & influenza vaccines

• Stress can:
‒ suppress T-cell responses
‒ lower antibody levels
Experiment
• Kiecolt-Glaser et al. administered flu vaccines to caregivers and control subjects.

Results
‒ Only 38 percent of the caregivers produced an adequate antibody response
compared to 66 percent of controls (with no stress).
‒ Implying that --- the stress of caregiving suppressed the caregivers' immune systems
and put them at an increased risk of infection.
Stress and Research on illnesses that affect the Immune System
• Stress can confound some studies of certain illnesses that affect
the immune system, such as AIDS and autoimmune diseases.

• The stress hormones (corticosteroids) can:

‒ suppress the effectiveness of the immune
system (e.g. lowers the number of lymphocytes,
and other immune cells).

‒ alter the synthesis and the release of the

cytokines, involved in immune function.

• Stress can also have an indirect effect on the immune

system -------- unhealthy behavioral coping strategies ----
-------- e.g. drinking and smoking
The Hypothalamo-Pituitary-Adrenal Axis (HPA Axis)
• The HPA Axis controls reactions to stress and regulates various
body processes such as digestion, the immune system, mood and
sexuality, energy usage, and neuropsychiatric function.
Stress and Illnesses
• Negative emotions induced by stress also impact the immune
system.
For example,
• Depression
‒ Cancer patients who are depressed have lower
natural killer (NK) cell activity in comparison to
their non-depressed counterparts

‒ individuals who are ill are 3 times more likely to

die if they are depressed, in comparison to those
who are ill but not depressed.
Stress and Cancer
Stress and Cancer
Stress and Cancer
• Immune Response
Stress and cancer

• Stress can suppress the immune system

‒ thus inhibiting the body’s natural

defenses against cancer

• Stress also leads to hormonal imbalances

‒ increase the production of abnormal cells

some of which can be cancerous
Stress and cancer

• Kiecolt-Glaser and Glaser (1986)

• Stress causes a decrease in the hormones produced to

repair DNA and fight cancer

• Cortisol decreases the number of active T cells, which can

increase the rate of tumor (cancer) development

• Thus, stress whilst ill can worsen the illness

Stress and cancer

• Experiments

• Mice bearing human tumors were kept in stressful

conditions ------- their tumors were more likely to grow and
spread (metastasize)

• Norepinephrine (a stress hormone) seems to promote

angiogenesis (growth of new blood vessels) and metastasis

• Women who reported using beta-blockers (drugs that block

the effects of stress hormones) had a better chance of
surviving their cancer treatment without a relapse
Cardiovascular Disorders/Heart Disease

• Stress   increased heart rate etc.   strain upon

circulatory system

  risk of developing disorders of the heart and circulation

e.g. coronary heart disease (CHD).
Cardiovascular Disorders/Heart Disease
 Pain and Discomfort

• Pain
• distressing feeling   injury or medical condition

• It’s "an unpleasant sensory and

emotional experience associated
with actual or potential tissue
damage, or described in terms of
such damage"
 Pain and Discomfort
• Pain
• has biological, psychological and
emotional factors

• It is worsened by feelings such as

anger, hopelessness, sadness and
anxiety

• Emotional aspects are most

prominent in chronic pain
patients, but can also influence
acute pain.
 Pain and its perception
• Pain perception threshold
• the point at which the stimulus begins to hurt
 Pain and its perception
• Pain tolerance threshold
• the point at which pain
becomes unbearable
and the person acts to
stop the pain.
 Psychology of Pain
• Factors such as expectations, beliefs, attention,
emotions, and context:

 differences in pain perception and

tolerance thresholds.
Expectations
 Psychology of Pain
Beliefs

• A saline or water injection ---- believed to be morphine

  about 35% of people report marked

relief after receiving
 Psychology of Pain
Attention
• Focusing one’s attention on pain
  makes the pain worse
 Psychology of Pain
Attention
• Distracting patients (e.g. making them so absorbed in an activity or
entertainment )
  highly effective in reducing their
pain
 Psychology of Pain
Emotions

• Depression, anxiety, stress, etc.   worsen pain

 Psychology of Pain
Emotions and Pain
 Psychology of Pain

Context
  greatly influences pain perception
Pain and its perception
 Psychology of Pain
• Treating anxiety, depression, & providing psychological
support
  improves pain and reduce
analgesic (pain medication) use.
 Psychology of Pain
• Pain can be a learned response, rather than a purely physical
problem

• Pain can be entirely ‘‘in the mind” and patients can learn to feel
different amounts of pain just by viewing other people.

Laboratory subjects:
• Witnessed models with high pain tolerance
– required 3.48 times greater stimulus before
they rated it as painful

• Observed models with poor pain tolerance

– 77% reported “tingling” stimulus as painful
compared to 3% of those who witnessed
models with high pain tolerance
 Psychology of Pain

• Preexisting psychological factors

  chronic pain after surgery or injury.

• Pain can be a condition response

• Some chronic pain patients

  demonstrate pain behavior only

when around other people .

  decrease this behavior when they

think no one is watching.
 Psychology of Pain

• Reinforcing pain behavior   more pain.

(rewards (the attention and/or concern by others)

E.g. 10-year-old girl who had chronic daily abdominal pain

 Psychology of Pain

• Depression and Pain

Pain  Depression

• E.g. in one study 61% of patients on pain medication had

depression

Depression = Worse Pain during childbirth, after

surgery, injury, etc.

Antidepressant medication = Pain Relief

 Psychology of Pain

• Stress and chronic pain

Pain  stress

Stress = Worse Pain during childbirth, after surgery, injury, etc.

Stress  muscle tension/spasms   increase pain.

Managing stress   lessened pain.

 Psychology of Pain

Managing and Controlling Clinical Pain

• Medical treatments (medication, surgery, rehabilitation and physical therapy)

• Psychological treatments

Managing the thoughts, emotions and behaviors

e.g. challenging thoughts, distracting a patient from pain,

removing reinforcement/rewards, etc.

- Psychological treatment can alter how your brain

processes pain sensations
- Can be as effective as surgery in alleviating pain
 Chronic and Life-Threatening Health Problems

• Chronic illnesses such as asthma, AIDS, cancer, coronary heart disease

and multiple sclerosis

Coronary Heart Disease (CHD)

 one of the leading causes of

death

- caused by hardening of the arteries (atherosclerosis), which

are narrowed by fatty deposits
Coronary Heart Disease (CHD)

- can result in angina (pain) or a heart attack

(myocardial infarction)

- Risk factors - - smoking behavior, obesity, sedentary lifestyle,

perceived work stress, family history, and type A behavior.
• Psychology has a role to play at all stages of CHD
• Psychology has a role to play at all stages of CHD
 Doctor-Patient Communication
• Lack of knowledge about the disease make patients worry,
nervous, afraid, powerless about their body and health,
frightened and upset

• Patients expect/desire the doctor to:

• communicate about their health condition

• provide care and support

• But doctor tend to mainly care the disease and ignore what is
needed most by the patient
 Doctor-Patient Communication
• Doctors have little time to communicate with the patients

• They are not interested in what patients say and often interrupt
rudely or act impatiently.

  the patients feel guilty and avoid questions

• Some doctors only ask about the disease, and focus writing
diagnosis notes

  patients feel ignored and develop doubts

about the diagnosis and treatment.
 Doctor-Patient Communication
• Due to poor (or lack of) Doctor-Patient communication

  the doctor may give a diagnosis without understanding

patients’ pains or symptoms

  the patients may belief that the discomfort associated

with the disease is caused by the incompetency or mistake of
the hospital

  the diagnosis may not be accurate, or the treatment

prescribed may not be adequate

  the doctor may not get to know about the adverse side
effects of the medication, ----- failing to change it, and the
patient may not adhere   Treatment will not be effective
 Doctor-Patient Communication
• Good Doctor-Patient communication

  produces a therapeutic effect for the patient

  can improve a patient's health as quantifiably as

many drugs ((placebo effect))

  can result in patients being more likely to

acknowledge health problems, understand their
treatment options, modify their behavior, and follow
medical advice.
 Doctor-Patient Communication

• Health psychologists offer guidance to doctors on how to

become competent in key communication skills such as:

• listening effectively;
• eliciting information using effective questioning
skills;
• providing information using effective explanatory
skills;
• counseling and educating patients; and
• making informed decisions based on patient
information and preference.
 Patient Adherence to Treatment Regimen

Adherence,
  refers to the degree to which a patient correctly
follows medical advice.

• medication or drug adherence,

• medical device use,
• self-care,
• self-directed exercises, or
• therapy sessions.

Non-adherence   major barrier to effective treatment

 Patient Adherence to Treatment Regimen
• The major factors that hinder adherence include:
• the complexity of medication regimens,

• poor "health literacy" and lack of comprehension of

treatment benefits,

• the occurrence of undiscussed side effects,

• the cost of prescription medicine, and

• poor communication or lack of trust between the patient

and his or her health-care provider

• Negative emotions such as fear and concerns about the treatment,

anger, denial, apathy, depression, stress and anxiety

• preconceptions about treatment

 Patient Adherence to Treatment Regimen

• Non-adherence to treatment is a complex behavior, often fueled

by a combination of factors.

• Health psychologists design and implement interventions that

promote treatment adherence through targeting

  the psychological, social, behavioral, and contextual

barriers.
 Patient Adherence to Treatment Regimen

• Adherence may for example, be improved through:

• simplifying medication packaging,

• providing effective medication reminders,

• improving patient education,

• minimizing the side effects,

• limiting the number of medications prescribed

simultaneously, and

• dealing with patient’s' attitudes, beliefs,

depression, denial, and other psychological
factors hindering adherence
 The Placebo effect

Placebo,
  refers to medicineless pill or substance.

Placebo effect,
• refers to any treatment that improves a symptom or disease but
lacks specific effectiveness for the condition being treated

• A doctor may give a placebo (medicineless pill or substance)

either because medicine is not required or because an
appropriate treatment is not available and the doctor does not
want the patient to feel abandoned.
 The Placebo effect

Placebo,
  refers to medicineless pill or substance.

Placebo effect,
• refers to any treatment that improves a symptom or disease but
lacks specific effectiveness for the condition being treated

• A doctor may give a placebo (medicineless pill or substance)

either because medicine is not required or because an
appropriate treatment is not available and the doctor does not
want the patient to feel abandoned.
 The Placebo effect

• The placebo has no medicinal effect but the patients’ belief in

it as a cure for the illness makes him/her recover.

• In many cases, the placebo proves to be very effective in

reducing or eliminating the physical complaints such as pain,
and even for illnesses for which there is no known cure.
 The Placebo effect
• Although the placebo may be chemically inactive, its effects
are evident beyond the psyche (mind).
1) Through the patient’s confidence in a treatment,
placebos have been shown to reduce stress, anxiety,
and depression, all which have been reviewed to
associate with illness.
2) Placebo treatments may also work as conditioned
stimuli, like Ader’s experiments with saccharine
(sugar) in rats.
3) The placebo response may also act directly on the
CNS with the release of the body’s natural pain
killers and narcotics (e.g. endorphins and
enkephalins).
 The Placebo effect

• Thus, although the beliefs may be ‘all in the mind’, the effects
of this belief (in the placebo) alter an individual’s biochemistry
to mimic the effects of an active drug.