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Health Psychology
Psychology 46.339 (01)
Summer 2007
Instructor: Dr. Fuschia Sirois
Wednesday August 8: LAST CLASS!
Lecture 9, Prep. Guides 9, 10
Chapter 13: Heart Disease, Hypertension,
Stroke, and Diabetes
Chapter 14: Psychoneuroimmunology, AIDS,
Cancer, and Arthritis
Coronary Heart Disease:
What Is CHD?

A general term referring to illnesses caused by
atherosclerosis


Narrowing of coronary arteries, the vessels that
supply the heart with blood
Angina pectoris
Pain that radiates across the chest and arms
 Caused by temporary shortage of oxygen


Myocardial infarction – heart attack
Coronary Heart Disease (CHD):
Role of Stress

Development of CHD is associated with


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


Hostility
Depression
Cardiovascular reactivity to stress
Acute stress can precipitate sudden clinical events
Balance of control and demand in daily life is
associated with CHD
Heart disease is more common in low SES
individuals –WHY?
Coronary Heart Disease:
Women and CHD

Cardiovascular disease




Leading killer of women in Canada
Women have 50% chance of dying from 1st
heart attack (30% for men)
Recall that symptoms of a female heart
attack are different from those for men
Women seem to be protected at younger
ages relative to men


Higher levels of HDL premenopausal
Estrogen diminishes sympathetic nervous
system arousal
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility

Type A Behavior Pattern



Behavioral and emotional style
marked by an aggressive,
unceasing struggle to achieve
more and more in less time
Often in hostile competition with
other individuals or forces
Risk factor for coronary artery
disease
Anger and
Hostility
appear to be
especially
implicated as
risk factors
Coronary Heart Disease:
Cardiovascular Reactivity and
Hostility
Cynical Hostility





Particularly lethal type of hostility
Characterized by suspiciousness, resentment,
frequent anger, antagonism, distrust of others
Have difficulty extracting social support from
others
Fail to make effective use of available social
support
Hostility combined with defensiveness is particular
problematic
Coronary Heart Disease:
Recovery
Research suggests that social support decreases
recovery time after heart surgery, heart attacks

depressed cardiac patients have higher mortality rate than
non-depressed patients (7.5% vs 2.5%, in 1 study)
Quality of Social Support is important

by-pass surgery patients feel highly supported if
partners express low fatigue, low displeasure, & low
sadness - i.e. if partners are well adjusted to the
situation (Schroeder & Swartzer, 1998)
CHD: Negative Emotions and
Risk Factors

Strong Associations between
Depression and heart attack
 Hopelessness and heart attack
 Anxiety and sudden cardiac death


Recent research


Social dominance may be related to allcause mortality
Vital exhaustion predicts the likelihood of a
heart attack
Management of Heart Disease
– Cardiac Rehabilitation
Cardiac invalidism
psychological state that can result after a
myocardial infarction or diagnosis of
coronary heart disease
 the perception that a patient’s abilities and
capacities are lower than they actually are
 both patients and their spouses are
vulnerable to these misperceptions.

Coronary Heart Disease:
Interventions - Interventions
Behavioral Interventions can help reduce the risk of
CD and also aid in the treatment of CD
 relaxation techniques can significantly reduce BP & 
the need for medications
 Diet changes can help reduce serum cholesterol
levels
 Exercise can also help to reduce BP
 weight loss is the most frequently prescribed
behavioral change - reduces BP
Anger management training, stress coping strategies
can help to reduce reactivity of Type A behavior
Stroke:
Overview

Condition that results from a disturbance in blood flow
to the brain


Deaths




Often marked by resulting physical or cognitive
impairments and, in the extreme, death.
Stroke is the fourth leading cause of death in Canada.
Each year, about 16,000 Canadians die from stroke.
Each year, more women than men die from stroke.
A chief risk of stroke


That more strokes will follow in its wake
Aspirin reduces the risk of recurrent strokes
Stroke:
Overview

Prevalence




There are between 40,000 to 50,000 strokes in Canada
each year.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another
stroke within 2 years.
Effects


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Of every 100 people who are hospitalized for stroke:
20 die before leaving the hospital
50 return home
10 go to an inpatient rehabilitation program
15 require long-term care
Stroke: Warning Signs
Learn to recognize the warning signs of a stroke.
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Weakness - Sudden weakness, numbness or tingling in the face,
arm or leg.
Trouble Speaking - Sudden temporary loss of speech or trouble
understanding speech.
Vision Problems - Sudden loss of vision, particularly in one eye,
or double vision.
Headache - Sudden severe and unusual headache.
Dizziness - Sudden loss of balance, especially with any of the
above signs.
Stroke:
Risk Factors

Modifiable risk factors include
High blood pressure
 Heart disease
 Cigarette smoking
 High red blood cell count
 Transient ischemic attacks
 Psychological distress
 Anger expression

Stroke:
Consequences

Stroke affects all aspects of life
Personal
 Social
 Vocational
 Physical


Motor, Cognitive, Emotional, and Relationship
problems

Symptoms and problems differ depending on
which side of the brain was damaged
Chronic Illness - Diabetes
Diabetes is a chronic blood sugar
regulation disorder in which the
body is not able to manufacture
or utilize insulin properly.





insulin is a hormone produced by the pancreas that
regulates blood sugar
Diabetics have defective insulin production/use
when blood sugar levels are out of balance
hyperglycemia and hypoglycemia can result
Approximately 2 million Canadians have diabetes.
The rate is three to five times higher among Aboriginal
people.
Prevalence of Diabetes in
Canada by age group
Diabetes:
Overview

Cells of the body need energy to function
Glucose is the primary source of energy
 Insulin is a hormone produced by pancreas
 Insulin acts as a “key” to permit glucose to
enter cells
 Without insulin, cells don’t get the glucose they
need
 Glucose stays in the blood: Hyperglycemia

Diabetes: Types
Diabetes mellitus can be Type I or Type II
 Type I = Insulin dependent (IDDM)
 Type II = Non-insulin dependent (NIDDM)
Also gestational diabetes
Type I Diabetes (10% of all diabetes)

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
Abrupt onset of symptoms
Immune system falsely identifies cells in the pancreas
as invaders and destroys them
Pancreas doesn’t produce insulin
Develops relatively early in life
most prevalent type of diabetes in children and
adolescents
Types of Diabetes
Type II Diabetes


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

Cells lose ability to respond fully to insulin (known as
insulin resistance)
Pancreas temporarily increases insulin production
Insulin-producing cells may give out
Most common in adults
Increasingly common in children
Gestational diabetes
A temporary condition that occurs during pregnancy. It
affects two to four percent of all pregnancies with an
increased risk of developing diabetes for both mother and
child.
Risk factors you cannot change

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Increasing age
Family history of
disease
Race or ethnicity
Gestational diabetes or
having a baby weighing
9+ lbs at birth
Risk factors you can change


Inactive lifestyle
Overweight
Diabetes: Health
Implications
Diabetes is associated with


Thickening of the arteries due to buildup of
wastes in the blood
High rates of CHD
 Diabetes is a risk factor for cardiovascular
disease
 Cardiovascular disease is the main cause of
death in diabetics (55%), particularly in Type 2
diabetics
 Diabetics are 2 to 4 times more likely to have,
and to die from, cardiovascular disease than
non-diabetics
Complications of diabetes

Heart and blood vessel
disease
Kidney disease
Eye damage

Foot damage

Infections, slow to heal

Gum disease
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Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
BG
Diabetes Management
Proactive
Reactive

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

keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
Chronic Illness - Diabetes
Psychoneuroimmunology
(PNI)

The study of the inter-relationships between
psychosocial factors, and the immune,
nervous, and endocrine systems
The Immune System is comprised of tissues,
organs, and processes that protect the body
from invasion by foreign material
Immunocompetence: The extent to which the
immune system is able to fight off invading
microorganisms
Psychoneuroimmunology:
The Immune System - Review

The surveillance system of the body:
Primary function
Distinguish between what is “self” and
what is foreign
 Attack and rid the body of foreign invaders


Distinction between
Natural immunity
 Specific immunity

Figure 14.1: Interaction
between Lymphocytes and
Phagocytes
PNI: Assessing Immunocompetence &
Effects of Stress
Two general indicators of Immunocompetence

Measuring the amount of various components of
the immune system in the blood
• Example: counting T, B, NK cells in the blood

Assessing the functioning of immune cells
• Example: ability of certain white blood cells to ingest
foreign particles
Activation of the HPAC Axis affects immune functioning


Corticosteroids have an immunosuppressive effect
Sympathetic activation can enhance or suppress immune
functions under different conditions
Psychoneuroimmunology:
Assessing Immunocompetence

Immunocompromise

Indicators suggest that immune functioning
• Has been disrupted or reduced

Wound-healing

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Psychological distress impairs inflammatory
responses that initiate wound repair
Immunocompromise relates to health
outcomes

Those under stress have lower levels of
antibody titres after vaccination
PNI: Stress and Interpersonal
Relationships

Adverse changes in immunity are
associated with
Bereavement (especially those who have
become depressed)
 Loneliness
 Martial disruption and conflict (including
short-term conflicts)
 Providing care for a friend or family
member with a long-term illness

Mood and the Immune
System
Kiecolt-Glaser, et al. (1993) looked at effects of marital
conflict on immune system functioning
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Newlyweds isolated for 24 hours --> 4 immune assays,
observation of behaviors during discussion of marital
problems, social support & mood questionnaires
Those who were more hostile or negative showed more
negative immune system responses over 24 hrs than did
those who were low on negativity/hostility; avoidant, positive
or problems solving behaviors were not sig. related to these
changes
Women showed more negative changes than men, even
though both groups were high on marital satisfaction
Chronic Illness - Cancer
Cancer - uncontrolled growth of abnormal cells


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tumors can be benign or malignant, localized or
metastasized (spread to other parts)
Most types of cancer cells form a lump or mass
called a tumor.
Tumor cells can break away and travel to other
parts of the body where they can continue to grow.
This process is called metastasis.
What is Cancer?

All cancers have
neoplastic growth,
altered cells with nearly
unlimited growth.
Benign localized
 Malignant spread much
more threatening
 Metastatic cancer cells
move to other parts of
the body

Cancer:
Canadian Cancer Society


A set of >100 diseases
All cancers result from DNA dysfunction

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Rapid cell growth and proliferation
Cancerous cells provide no benefits to body
Cancerous cells sap the body’s resources
An estimated 149,000 new cases of cancer
and 69,500 deaths occured in Canada in 2005.


On average, 2,865 Canadians will be diagnosed with cancer
every week.
On average, 1,337 Canadians will die of cancer every week.
Chronic Illness - Cancer
Often called a lifestyle disease
~ 2/3 of Cancer deaths associated with lifestyle
factors
Psychosocial factors implicated in the onset of Cancer
include personality, stress, coping style, smoking habits
(~30% of cancer deaths), diet, occupation (~4% of
cancer), & UV exposure (~90% of skin cancers)
 Smoking and diet are the 2 leading behavioral risk
factors for cancer
Adjusting to Cancer

Coping with physical limitations
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Pain and discomfort
Downregulation of immune system,
vulnerability to other disorders
Fatigue
Treatment-related problems
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Cosmetic problems:
Surgical removal of organs
Body image concerns
Use of prosthesis
Conditioned nausea and immune
suppression
More than
one-third of
cancer victims
live at least
5 years
after their
diagnosis
Social Support & Cancer
Research suggests that cancer patients who are married
survive longer than unmarried patients (Goodwin et al., 1987)
WHY?
Support groups also give SS
opportunity for downward comparisons (w/worse off
patients) & upward comparisons (w/patients
successfully coping)
Speigel et al. (1993) randomly assigned breast cancer
patients to reg. Tx or Tx + support group
Arthritis:
Overview

Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
Most prevalent autoimmune disorder:
ARTHRITIS
 Arthritis means “inflammation of a joint”

Over 200 forms of arthritis.
 About 30% of adults have arthritis.
 Three major forms of arthritis
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Rheumatoid, osteoarthritis, gout
Arthritis
Risk Factors - Arthritis

GENDER
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AGE
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OBESITY

WORK

FACTORS

Arthritis occurs more frequently in women
than in men.
Anybody can be at risk of developing
arthritis, but in children is called Juvenile
Rheumatoid arthritis
Obesity increases the chances of getting
arthritis particularly in women
If you have a strenuous job that requires
repetitive bending, kneeing, or
squatting,you are at higher risk of getting
arthritis.
Serious types of arthritis
 Lupus (systemic lupus erythematosus)
 Rheumatoid arthritis
 Scleroderma
 Sjogren’s syndome
 Lyme disease
 Ankylosing spondylitis
 Psoriatic arthritis
 Reactive arthritis –aka Reiter’s Syndrome
Chronic Illness - Arthritis
Major symptom of Arthritis is pain - can lead to 
activity,  depression, psychosocial costs
Coping & management of arthritis are affected by:
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behavioral pain coping
stressful events
social support
culture specific coping strategies
severity of pain
level of functional impairment
Rheumatoid Arthritis

Crippling form of arthritis believed to result from an
autoimmune process

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Primarily affects

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Usually attacking small joints of hands, feet, wrists,
knees, ankles, and neck
40-60 age group
Women
Main complications

Pain, limitations in activities, need to be dependent on
others
Rheumatoid Arthritis

Treatment includes
Anti-inflammatories to reduce
inflammation and pain
 Rest
 Supervised exercise


Cognitive-behavioral interventions
Enhancement of perceived self-efficacy
 Optimism
 Relearning meaning of pain

Osteoarthritis

Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to crack
or wear away because of overuse of a particular
joint

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
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May also result from injury or other causes
Usually affects weight-bearing joints
Common among athletes and the elderly
Treatment

Keeping weight down, exercise, aspirin,
joint replacement, prescription medications, joint
injections
Inflammatory Bowel Disease
(IBD)

170,000 Canadian men and women suffer
from IBD
10,000 new cases of IBD diagnosed each year in
Canada
Canada has the highest rates of IBD in the world
frequently diagnosed between the ages of 15-25,
or 45-55.
Crohn’s disease and ulcerative colitis
Inflammation of the intestines
Difference is which part of the intestines are
affected
Inflammatory Bowel Disease
(IBD)
Crohn's disease can affect any part of the
gastrointestinal tract, from the mouth to the anus.
Ulcerative colitis affects only the inner layer of the
colon, or large bowel.
Symptoms: diarrhea, abdominal pain, blood loss,
diminished appetite, weight loss, weakness, fatigue,
nausea and vomiting, fever, and anemia
Symptoms are often unpredictable and uncontrollable
Known to be triggered/exacerbated by stress
How Is It Treated?



anti-inflammatory drugs
immunosuppressive agents
surgically removing the colon (UC) –”ostomy”
Inflammatory Bowel Disease
(IBD)
Psychosocial impact
patients who suffer from IBD have described the
disorder as “painful and embarrassing”, restricting
freedom, and affecting all aspects of daily life
Embarrassment, stigma, social isolation
Bowel sounds, smelly stools
Need to be close to the bathroom at all times
affects a person's self-concept, body image,
sexuality, and lifestyle
particularly difficult for children and young adults
WHY?
Coping with IBD and Arthritis
Internet and mail survey of individuals with arthritis and
Inflammatory bowel disease (IBD)
Arthritis N = 336; 81.3% female; mean age = 43.45
IBD N = 290; 75.2% female; mean age = 36.20
Influence of disease on daily activity (1 - 4)
Arthritis: 3.43 (.78)
IBD: 3.13 (.93)
Different people have different things that they do to
cope with their IBD/Arthritis when it is most
bothersome. What do you do to cope with it?
Coping with Arthritis
Arthritis
“I take a weekend off. I sit on my butt all weekend. I read. I take bubble
baths. I take naps. “
“I try my best not to ask for help. Hide that I'm experiencing pain. Try to
keep an optimistic view, But I get into a depression”
“ignore it as much as possible and focus on something else”
“Slow down and pace myself.”
“I have not really learned to cope very well yet. I have only had it for about 9
months. “
“Lay down; take medicine; cry; vent to my partner; Pray. “
“I just try to accept what I can and can't do. I'm learning to accept my
limitations.”
“I use visualization. I picture myself on a warm beach swimming in the
water and take myself there mentally “
“I retreat into a shell - I hurt and I know that I treat people like crap (and I
don't want to do that) when I feel that”
“I talk about it to family and friends. Or I just get real quiet and need to be
left alone…”
Coping with IBD
IBD
“Talk to my friend whose husband has Crohn's disease. Read up on the
disease to find ways to cope. “
“Pamper myself, read a good book, use a heating pad or soak in a hot
tub.”
“Watch a movie, have a nap, take various narcotics”
“Try to keep a positive attitude, there are people far worse off…”
“I haven't figured out how to cope with it yet. Mostly it just depresses
me.”
“Talk to my husband, friends. Use the internet for support.”
“I use drugs ! Cannabis.”
“I write my thoughts and feelings down in different forms. I keep a
journal and also write poetry and songs ….”
“I try very hard to ignore it, living as far as possible into the center of
denial.”
“I always try to have a sense of humour, and to stay positive. If I didn't
do that I would be depressed and crusty all the time.”
“I pray and meditate a good bit”