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Psychology

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CHAPTER 1

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What is Health Psychology?

© 2020 McGraw-Hill Education Limited
Slides prepared by Krista K. Trobst, Ph.D
York University

Class Activity 1A –Vocabulary parking Lot Activity
(This activity is graded)
Find out the meanings for the terms used in today’s lesson
1. Psychology
2. Health Psychology
3. Conversion hysteria
4. Etiology
5. Psychoanalytic
6. Psychosomatic Medicine
7. Behavioral Medicine
8. Biopsychosocial Model

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Class Activity 1 B
Define what is Health psychology
Why is it important to learn?
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Learning Objectives
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Describe and define health psychology.
Understand how our view of the mind-body relationship has changed over time.
Explain the biopsychosocial model of health.
Identify why the field of health psychology is needed.
Relate the purpose of health psychology training.

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Health Psychology Defined
Health psychology is a relatively new field devoted to understanding psychological influences on how people stay healthy, why people become ill, and how they respond when they do get ill.

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Health Psychology Introduction Flowchart

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What is Health?
The World Health Organization (WHO) has formally defined health as:
“a state of complete physical, mental and social well‐being and not merely the absence of disease or infirmity” (1948)

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Health Psychology Focus
Health Psychologists focus on:
health promotion and maintenance
prevention and treatment of illness
etiology and correlates of health, illness and dysfunction
studying of the impact of health institutions and health professionals on people’s behaviour
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Health Psychology Roles
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the educational, scientific and professional contributions of psychology to the promotion and maintenance of health
the prevention and treatment of illness
the identification of the causes and correlates of health and illness

the improvement of the health care system and the formulation of health policy

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Timeline graphic

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Early Views of
Mind-Body Relationship

Imbalance of blood, black bile, yellow bile, and phlegm
God’s punishment
Evil spirits entering the body
Disease

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The Mind-Body Relationship: Psychoanalytic
Psychoanalytic Contributions:
Freud’s early work on conversion hysteria:
unconscious conflicts produce physical disturbances that symbolize the repressed psychological conflicts
patient converts conflict into a nervous system disturbance and becomes relatively free of anxiety

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The Mind-Body Relationship: Psychoanalytic
Psychoanalytic Contributions:
Freud’s early work on conversion hysteria:
unconscious conflicts produce physical disturbances that symbolize the repressed psychological conflicts
patient converts conflict into a nervous system disturbance and becomes relatively free of anxiety

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The Mind-Body Relationship: Psychosomatic Medicine
Psychosomatic Medicine:
Dunbar and Alexander
profiles of disorders thought to be psychosomatic in origin (e.g., anxiety and stress causing ulcers)
helped shape belief that bodily disorders are caused by emotional conflicts
criticized that a particular conflict or personality style is not sufficient to produce illness

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The Mind-Body Relationship: Behavioural Medicine
Behavioral Medicine:
focus on objective and clinically relevant interventions that demonstrate the connections between body and mind
Interdisciplinary field concerned with integrating behavioural science and biomedical science for understanding physical health and illness and to prevent, diagnose, treat, and rehabilitate

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Current Views of the Mind-Body Relationship
We now know that physical health is inextricably interwoven with the psychological and social environment.
With an expanded perspective there is growing interest in more holistic approaches to health and healing.
Increase in use of alternative and complementary therapies.
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What is the Biopsychosocial Model of Health?
Biomedical model:
All illness can be explained on the basis of aberrant somatic bodily processes; psychological and social processes are irrelevant to disease process.
Biopsychosocial model:
Health and illness are consequences of the interplay of biological, psychological and social factors.
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A Comparison of the Biomedical and Biopsychosocial Models
Biomedical Model Biopsychosocial Model
Reductionistic Macrolevel as well as microlevel
Single causal factor considered Multiple causal factors considered
Assumes mind-body dualism Mind and body inseparable
Emphasizes illness over health Emphasizes both health and illness

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Biopsychosocial Model

WELLBEING
BIOLOGICAL
PSYCHOLOGICAL
SOCIAL

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The Biopsychosocial Model: Advantages I
Advantages of the Biopsychosocial Model:
macrolevel processes and microlevel processes interact to produce a state of health or illness
the mind and body cannot be distinguished in matters of health and illness because they are intertwined
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The Biopsychosocial Model: Advantages I
Advantages of the Biopsychosocial Model:
macrolevel processes and microlevel processes interact to produce a state of health or illness
the mind and body cannot be distinguished in matters of health and illness because they are intertwined
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The Biopsychosocial Model: Advantages II
Advantages of the Biopsychosocial Model:
researchers have adopted a systems theory approach to health and illness
All levels in an entity are linked hierarchically and a change on one level will effect change in all the other levels
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The Biopsychosocial Model: Clinical Implications I
Clinical Implications:
diagnosis should always consider biological, psychological and social factors in assessing an individual’s health or illness
recommendations for treatment must examine all three sets of factors
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The Biopsychosocial Model: Clinical Implications II
Clinical Implications:
becomes possible to target treatment uniquely to a particular individual
the relationship between the patient and the practitioner matters
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Why is the Field of Health Psychology Needed?: Part I
only way to develop an adequate understanding of health and illness
changing patterns of illness and causes of death have created a need for understanding and affecting lifestyle factors
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Fig. 1.2 Death rates for the leading causes of death in Canada,

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Why is the Field of Health Psychology Needed?: Part II
only way to develop an adequate understanding of health and illness
changing patterns of illness and causes of death have created a need for affecting lifestyle patterns
advances in technology and research
role of epidemiology in Health Psychology
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Why is the Field of Health Psychology Needed?: Part III
morbidity and mortality
health-related quality of life and symptomatic complaints
increased medical acceptance
demonstrated contributions to health
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What is the Purpose of Health Psychology Training?: Careers I
Careers in practice:
physicians, nurses and allied health professionals better able to understand and manage the psychological and social aspects of health than if had traditional background
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What is the Purpose of Health Psychology Training?: Careers II
Careers in research:
conduct research in public health, psychology and medicine in a variety of settings such as academia, public health departments and Health Canada
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Summary: Part I
Describe and define health psychology.
devoted to understanding psychological influences on people’s health and illness
Understand how our view of the mind-body relationship has changed over time.
different models of the mind-body relationship have predominated but current emphasis is on the inextricable unity of the two
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Summary: Part II
Explain the biopsychosocial model of health.
health or illness a complex interplay of biological, psychological, and social factors

Identify why the field of health psychology is needed.
increase in lifestyle-related illness, burden of health care costs, methodological contribution of researchers
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Summary: Part III
Relate the purpose of health psychology training.
Health psychologists:
research biopsychosocial factors in health and illness
treat patients and conduct counselling
develop interventions
act as consultants to improve health and health care delivery

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CHAPTER 3

Health Behaviours

© 2020 McGraw-Hill Education Limited
Slides prepared by Krista K. Trobst, Ph.D
York University

Slides prepared by Krista K. Trobst, Ph.D.
York University

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Class activity -3A
Describe and define health promotion.
Explain why health behaviors are important.

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Learning Objectives
Describe and define health promotion.
Explain why health behaviours are important.
Know the theories and models used for understanding health behaviour change.
Describe how cognitive-behavioural approaches are used to change health behaviours.
Understand other methods for changing health behaviours.
© 2020 McGraw-Hill Education Limited
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Class Activity 5
Voculabulary parking-lot –Chapter 3
Health promotion
Self-efficacy
Methods for changing health behaviour
1. Classical conditioning – Ivan pavlov
2. Operant conditioning : Positive reinforcement , negative reinforment – Rewards and punishment – Reward Strengths the behaviour, Punishment weakens the behaviour.
3. Modelling
4. Cognitive-Behavioural Therapy – Cognition – mental abilities – thinking, problem solving, memory
5. self-observation and self-monitoring
Transtheoretical Model of Behaviour Change
s.
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Health Promotion and Maintenance Graphic

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What is Health Promotion?
the idea that good health, or wellness, is a personal and collective achievement
In 1986 the World Health Organization defined health promotion as:
“the process of enabling people to increase control over, and to improve, their health”
Ottawa Charter for Health Promotion (1986)

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What is Health Promotion?
For the individual, health promotion involves developing a program of good health habits early in life.
For the psychologist, health promotion involves the development of interventions.
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What is Health Promotion?
For policymakers, health promotion involves an emphasis on good health, the availability of information to help people develop and maintain healthy lifestyles and ensuring the availability of resources.
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What is Health Promotion?
Different from disease prevention which views health as simply the absence of disease.
In recent decades, many health promotion initiatives have been successfully launched.
Understanding health-promoting behaviours and finding effective approaches to improving health behaviours is the goal.
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What are Health Behaviours?
Health behaviours are behaviours used to enhance and maintain health.
A health habit is a behaviour that is firmly established and usually performed without awareness.
Primary prevention involves taking measures to combat risk factors for illness before it has a chance to develop.
Behaviour change
Prevent development of poor health habits
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Role of Behavioural Factors in
Disease and Disorder
Patterns of disease have changed substantially
Today, fewer people die of acute infectious diseases. At the same time, “preventable” disorders (e.g., cancer, heart disease, substance abuse) have increased.
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Table 3.1 Risk Factors for Leading Causes of Death in Canada
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Role of Behavioural Factors in
Disease and Disorder
Successful modification of health behaviours can:
reduce deaths due to lifestyle-related illnesses
delay time of death, increasing longevity
expand years of life free from chronic disease complications
decrease health expenditures required
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What Factors Influence the Practice of Health Behaviours?
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Socio-Economic Factors

Age

Gender

Values

Personal Control

Social Influence

Personal Goals

Perceived Symptoms

Access to Health Care Services

Place

Supportive Environments

Cognitive Factors

Barriers to Modifying Poor Health Behaviours: Part I
Not knowing when to intervene to change health habits
Instability of health habits
Different health habits are controlled by different factors.
Different factors may control the same health behaviour for different people.
Factors controlling a health behaviour may change over the history of the behaviour.

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Barriers to Modifying Poor Health Behaviours: Part II
Instability of health habits (continued)
Factors controlling the health behaviour may change across a person’s lifetime
Health behaviours are elicited and maintained by different factors for different people
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Intervening with Children and Adolescents: Part I
Socialization is important, especially the influence of parents as role models
As move into adolescence, children often backslide or ignore the early training they received from parents
Important to use teachable moments—certain times are better than others for teaching particular health practices
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Intervening with Children and Adolescents: Part II
Need to attend to the window of vulnerability for substance use in adolescence.
Adolescent health behaviours influence adult health.
For adults who choose to make changes in their lifestyle, it may already be too late.
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Interventions with At-Risk People: Part I
Children and adolescents are especially vulnerable
Also vulnerable are people who are at risk for a particular health problem
Benefits of focusing on at-risk people:
may prevent or eliminate poor health habits
an efficient and effective use of health promotion dollars
makes it easier to identify other risk factors
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Interventions with At-Risk People: Part II
Problems with focusing on at-risk people:
People do not always perceive their risks correctly
Testing positive for a risk factor can lead people into needlessly hypervigilant and restrictive behaviour
People may become defensive and minimize the significance of their risk factor and avoid changing their behaviour
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Interventions with At-Risk People:
Part III
Ethical issues also arise:
When is it appropriate to alarm at-risk people?
some may react defensively
sometimes there is no successful intervention
emphasizing risks can raise complicated issues of family dynamics

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Health Promotion and the Elderly
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maintaining a healthy, balanced diet

developing a regular exercise regimen

taking steps to reduce accidents

controlling alcohol consumption

eliminating smoking

reducing the inappropriate use of prescription drugs

vaccinating against influenza

Ethnic and Gender Differences in Health Risk and Habits: Part I
There are important ethnic and gender differences that need to be taken into account.
Socioeconomic status and biological predispositions to particular illnesses put certain groups at greater risk
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Ethnic and Gender Differences in Health Risk and Habits: Part II
Alcohol consumption greater in men
Indigenous individuals have several vulnerabilities including smoking, lack of exercise, overweight, and epidemic levels of diabetes
South Asians and Chinese have more dangerous abdominal fat
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Attitude Change and Health Behaviour: Part I

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Educational appeals:

vivid communications

expert communicator

strong arguments at beginning and end

short, clear, direct messages

messages should state conclusions explicitly

caution with extreme messages

depending on the audience, communication should include favourable and/or non-favourable points

Attitude Change and Health Behaviour: Part II
Attempts at changing health behaviours often make use of fear appeals.
Messages that elicit too much fear often backfire and trigger avoidance.
Fear itself would also not be useful without recommendations for action.
Appropriate message framing also influences effectiveness.
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Social Cognition Models of Health Behaviour Change: Part I
Social cognition models suggest people are motivated to change behaviours based on their beliefs about that behaviour.
Expectancy-value theory suggests that people will engage in behaviours they value and expect to succeed in.
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Social Cognition Models of Health Behaviour Change: Part II
Self-efficacy is the belief in the ability to control one’s practice of behaviours.
It is a powerful determinant of behaviour, especially in the face of difficulties.

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Social Cognition Models of Health Behaviour Change: Part III
Health Belief Model
Whether a person practices a health behaviour depends on :
Perception of health threat
Perception of threat reduction
Cues to action and self-efficacy
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Social Cognition Models of Health Behaviour Change: Part IV
Theory of Planned Behaviour suggests that a health behaviour is the direct result of a behavioural intention which is made up of three components:
attitude toward the specific action
subjective norms regarding the action
perceived behavioural control
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Figure 3.1 The Health Belief Model Applied to the Health Behaviour of Stopping Smoking

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Social Cognition Models of Health Behaviour Change: Part V
Benefits of Theory of Planned Behaviour
links beliefs directly to behaviour
provides a fine-grained picture of people’s intentions
Evidence that the theory predicts many health behaviours such as use of condoms and oral contraceptives, sunscreen use, exercise, healthy eating, etc.

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Social Cognition Models of Health Behaviour Change: Part VI
Having good intentions is often not enough to ensure changes.
Implementation intentions bridge the intention-behaviour gap.
It is a specific behavioural intention that highlights the how, when, and where of a behaviour.
Includes “if-then” contingency plans
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Attitudes, Social Cognition, and Changing Health Behaviours: Some Caveats
attitudinal approaches not very successful for explaining spontaneous or long-term behaviour change
communications can provoke irrational, defensive reactions
some people hold irrational beliefs about health
thinking about disease may produce a negative mood
attitude change may not alter behaviour and maintain behaviour change
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Transtheoretical Model of Behaviour Change
Pre-comtemplation
Contemplation
Preparation
Action
Maintenance
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Pre-contemplation

Contemplation

Preparation

Action

Maintenance

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Figure 3.3 The Relationship between Stage and Both Self-Efficacy and Temptation

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Importance of the Stages of Change Model
Captures the processes that people actually go through
Illustrates that successful change may not occur on the first try
Explains why many people are not successful in changing their behaviour
Use of the model has shown mixed success
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How are Cognitive-Behavioural Approaches Used to Change Health Behaviours?: Part I
Cognitive-Behavioural Therapy (CBT) approaches to health habit modification change the focus to the target behaviour itself.
Looks at the conditions that elicit and maintain it as well as those that reinforce it
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How are Cognitive-Behavioural Approaches Used to Change Health Behaviours?: Part II
Focuses heavily on the beliefs that people have about their health habits and may be an effective way to support health behaviour change.
Have realized the importance of involving the patient as a co-therapist.
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Self-Observation and Self-Monitoring: Part I
CBT often uses self-observation and self-monitoring as the first steps in behaviour change.
Person must understand the dimensions of the target behaviour before change can be initiated.
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Self-Observation and Self-Monitoring: Part II
The frequency of the behaviour and the antecedents and consequences are examined.
Discriminate the behaviour
Record the behaviour
Can have an “ostrich problem” where people are resistant to tracking their behaviour
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Classical Conditioning
Classical conditioning was one of the earliest principles of behaviour change.
An unconditioned reflex is paired with a new stimulus creating a conditioned reflex.
One of the first methods used for behaviour change.
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Classical Conditioning
An example of the use of classical conditioning in behaviour change is demonstrated with the treatment of alcoholism.
Antabuse (unconditioned stimulus) is a drug that produces extreme nausea and vomiting (unconditioned response) when taken with alcohol.
Over time, the alcohol becomes associated with the nausea and vomiting (conditioned response).
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Figure 3.4 A Classical Conditioning Approach to the Treatment of Alcoholism
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Operant Conditioning: Part I
Operant conditioning pairs a voluntary behaviour with systematic consequences.
Reinforcement is the key.
Positive reinforcement makes the behaviour more likely
Negative reinforcement is the removal of something positive and it makes the behaviour less likely
Punishment also makes the behaviour less likely
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Operant Conditioning: Part II
Operant conditioning is often used to modify health behaviours.
People are positively reinforced for efforts to change a faulty health habit.
As progress is made, a greater amount of behaviour change may be required for the same reinforcement.
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Modelling: Part I
Modelling can be important in long-term behaviour change and is a component in some self-help programs such as Alcoholics Anonymous.
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Modelling: Part II
Modelling can also be used as a technique for reducing the anxiety that gives rise to some bad habits or develops when going through health behaviour change.
Modelling may be most effective when it shows the realistic difficulties people have when undergoing behaviour change.
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Stimulus Control: Part I
Successful behavioural modification requires an understanding of the antecedents and consequences of the target behaviour.
For some health behaviours, associations develop between the behaviour and aspects of the social environment and these come to act as discriminative stimuli that can elicit the behaviour.
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Stimulus Control: Part II
Stimulus control interventions take two approaches:
rid the environment of the stimuli
creating new discriminative stimuli signaling behaviour change will be reinforced
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The Self-Control of Behaviour: Part I
CBT often utilizes techniques that emphasize self-control
Self-reinforcement involves rewarding the self for desired behaviour.
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The Self-Control of Behaviour: Part II
Positive self-reward involves something desirable where negative self-reward is the removal of something aversive.
Positive self-punishment involves something unpleasant as consequence and negative self-punishment is withdrawing something undesirable.
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The Self-Control of Behaviour: Part III
Contingency contracting involves making a “contract” with another person regarding what rewards or punishments will occur for particular behaviours.
Covert self-control teaches individuals to recognize and modify their internal monologues to support behaviour change.
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The Self-Control of Behaviour: Part IV
Cognitive restructuring targets thoughts for modification, often involving self-talk.
Some poor health habits are associated with interpersonal anxieties for which social skills training or assertiveness training may be helpful.
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The Self-Control of Behaviour: Part V
Motivational interviewing is becoming increasingly popular.
A variety of psychotherapy and behaviour-change techniques are used to work through any ambivalence about the behaviour change.
Relaxation training, often in the form of progressive muscle relaxation, involves learning breathing techniques that are paired with tension and relaxation exercises of muscle groups.
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Relapse: Part I
Relapse is an especially difficult aspect of health behaviour change.
Relapse rates are about 50% for the first year and then drop dramatically but never goes away completely.
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Why do people relapse?

This is an example text.
RELAPSE

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Withdrawal Effects
Conditioned Associations
Depressed, Anxious
Lacks Social Support
Abstinence Violation Effect
Stress
Why do people relapse
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Figure 3.5 A cognitive-behavioural model of the relapse process
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Relapse: Part II
Consequences of relapse?
Negative emotions like disappointment and frustration.
Hopelessness
Paradoxical effect that often change after multiple attempts so earlier attempts may prepare one for later success.
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Relapse: Part III
Reducing relapse:
Because of high probability of relapse, behavioural interventions build in techniques to reduce its likelihood.
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Relapse: Part IV
Booster sessions
Consider abstinence as a lifelong treatment process. Downside is it may make people feel they are always vulnerable and not in control and decrease feelings of self-efficacy.
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How Can Other Methods be Used to Change Health Behaviours?
Social Engineering:
Modifying the environment in ways that affect people’s ability to practice a particular health behaviour
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Venues for Social Engineering
Health Practitioner’s Office
Family
Self-Help Groups
Schools
Work-site interventions
Community-based interventions
Mass media
Internet
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Summary: Part I
Describe and define health promotion.
The process of enabling people to increase control over and improve their health.
Explain why health behaviours are important.
Health behaviours determined by socio-economic factors, social factors, gender, values and cultural background, perceived symptoms, access to medical care, place, and cognitive factors.
© 2020 McGraw-Hill Education Limited
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Summary: Part II
Know the theories and models used for understanding health behaviour change.
The belief that a threat to health is severe, one is personally vulnerable to the threat, self-efficacy, response efficacy, and that social norms support one’s practice of the behaviour are attitudes related to behavioural change.
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Summary: Part III
Describe how cognitive-behavioural approaches are used to change health behaviours
Cognitive-behavioural approaches, social skills training and relaxation are used to change health behaviours. Focus is also on relapse prevention.
Understand other methods for changing behaviours
Social engineering can be used to change health behaviours through various venues.
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Related Videos
The difference between classical and operant conditioning

What is cognitive behavioural therapy?

Approaches to behaviour change

Transtheoretical model of behavior change

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CHAPTER 2

The Systems of the Body

© 2020 McGraw-Hill Education Limited
Slides prepared by Krista K. Trobst, Ph.D
York University

Slides prepared by Krista K. Trobst, Ph.D.
York University

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© 2020 McGraw-Hill Education Limited
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Learning Objectives
Describe the function of the nervous system.
Explain how the endocrine system operates.
Identify how the cardiovascular system works.
Describe the function of the immune system.
Understand the physiological systems involved in the stress response.

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Etiology and Correlates Graphic

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The Nervous System
Overview: Part I
The nervous system (NS) is made up of the central nervous system and the peripheral nervous system
The central nervous system (CNS) is made up of the brain and the spinal cord
The peripheral nervous system (PNS) is made up of the somatic and autonomic nervous systems

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Figure 2.1 Components of the nervous system
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Figure 2.3 The Brain
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The Nervous System
Overview: Part II
The Brain
hindbrain:
medulla – receives sensory information from heart
pons – links hindbrain and midbrain
cerebellum – coordinates voluntary muscle movement
midbrain:
major pathway for sensory and motor impulses moving between forebrain and hindbrain

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The Nervous System
Overview: Part III
The Brain
The forebrain has two main sections:
diencephalon
– thalamus – recognition and relay of sensory stimuli
– hypothalamus – helps regulate heart and blood pressure
telecephalon:
– the two hemispheres (right and left) of our cerebral cortex
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The Nervous System
Overview: Part IV
The Brain
Limbic system:
Amygdala:
-detection of threat
Hippocampus:
– emotional memories
Cingulate gyrus, septum, areas of the hypothalamus:
– emotional functioning

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The Nervous System
Overview: Part V
Neurotransmitters:
chemicals that regulate nervous system functioning
Catecholamines:
epinephrine and norepinephrine
– promote sympathetic NS activity – released during stressful times

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The Nervous System
Disorders
Disorders of the Nervous System:
Epilepsy
Parkinson’s disease
Cerebral palsy
Alzheimer’s disease
Multiple sclerosis
Huntington’s disease
Paraplegia, quadriplegia

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The Endocrine System
Overview
Complements the nervous system in controlling bodily activities.
Regulated by the hypothalamus and pituitary gland.

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Hypothalamus
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The Endocrine System
Overview (cont….)
Adrenal Glands:
small glands at the top of each kidney
each gland composed of adrenal medulla and adrenal cortex
produces epinephrine and norepinephrine

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Figure 2.3
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The Endocrine System
Disorders
Diabetes:
body cannot manufacture or properly use insulin
– Type I: insulin-dependent diabetes
– Type II: insufficient insulin or insensitivity to it

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The Cardiovascular System
Overview: Part I
Is comprised of our heart, blood vessels and blood
Is the transport system of the body
The arteries carry blood from the heart to other organs and tissues, delivering oxygen and nutrients
The veins return blood to the heart after the oxygen and nutrients have been absorbed

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The Cardiovascular System
Overview: Part II
The Heart:
Functions as a pump
Left side takes in blood with oxygen from the lungs
Blood is pumped into the aorta and then passes into smaller vessels to reach cells
Oxygen and nutrients are exchanged for waste material

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Figure 2.4 The Heart
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The Cardiovascular System
Disorders: Part I

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Atherosclerosis:
Caused by deposits of cholesterol and other substances on the arterial walls that form plaques and narrow the arteries
It is in part a lifestyle disease because of its association with poor health habits

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The Cardiovascular System
Disorders: Part II

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Two primary clinical manifestations of atherosclerosis:
Angina pectoris — chest pain
Myocardial infarction — heart attack
Arteriosclerosis (hardening of the arteries) may also occur:
Over time, plaques harden and blood vessels lose their elasticity which causes increases in blood pressure
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The Cardiovascular System
Blood Pressure
Blood pressure:
Pressure on arterial walls is high when heart contracts and pushes blood out (systolic)
Pressure is lower when heart rests, between beats (diastolic)
Chronically high blood pressure is called hypertension and it increases the risk of heart disease and stroke

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The Cardiovascular System
Blood: Part I
Adult body contains approximately 5 litres of blood
Plasma is the fluid portion and it makes up about 55% of the volume
The remaining 45% of the blood comprises substances such as red and white blood cells, proteins, electrolytes, platelets, oxygen, nutrients, and waste

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The Cardiovascular System
Blood: Part II
Red blood cells primarily carry oxygen and nutrients
White blood cells are primarily involved in immune functions
Platelets are used in clotting blood and forming scabs
Blood cells are manufactured in bone marrow

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White cell
Red cell
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Disorders Related to White Cell Production
Leukemia: disease of bone marrow – common form of cancer
Leukopenia: deficiency of white blood cells – may accompany other diseases like TB, measles, and pneumonia
Leukocytosis: excessive white blood cells – often response to infections like appendicitis and mononucleosis

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Disorders Related to Red Cell
Production: Part I
Anemia
When insufficient red blood cells or hemoglobin impair transport of oxygen to cells
Menstruating women may experience anemia due to loss of iron and may be helped by iron supplementation
Anemia also occurs when bone marrow doesn’t producing enough red blood cells, potentially causing nervous system damage and chronic weakness

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Disorders Related to Red Cell
Production: Part II
Sickle-Cell Anemia
Sickle-cell anemia is a genetically transmitted inability to produce sufficient red blood cells and is found primarily in African, Middle Eastern, Caribbean, and South and Central Americans.

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Disorders Related to Red Cell
Production: Part III
Sickle-Cell Anemia
Cells are sickle-shaped rather than flattened spheres, believed to have developed to improve resistance to malaria but having potentially fatal consequences over the long term.

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Disorders Related to Clotting: Part I
Platelets
Used for creating clots like scabs
Clots (thromboses) that form in vessels however can have serious consequences

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Platelets
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Disorders Related to Clotting: Part II
Platelets
Coronary and cerebral thromboses and embolus (detached clot that lodges in lung) can be fatal
Hemophilia results from lack of platelets, where individuals can bleed to death from an injury

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Platelets
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The Immune System: Part I
Surveillance system of the body
Impacts infection, allergies, cancer, and autoimmune diseases
Primary function to distinguish between “self” and “foreign” and to attack what is considered foreign
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B cell

The Immune System: Part II
Infection:
one path to illness is the invasion of microbes and their growth in the body
Four means of infection:
direct transmission
indirect transmission
biological transmission
mechanical transmission
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The Immune System: Part III
The course of infection:
incubation period
period of nonspecific symptoms
acute phase (disease is at its height)
fatality or a period of decline during which invading organisms are expelled
Infections may be localized, focal, or systemic
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The Immune System: Part IV
Immunity:
body’s resistance to injury from invading organisms
develops naturally or artificially through vaccines
occurs through either nonspecific immune mechanisms (fights any infection) or specific immune mechanisms (fights particular microorganisms)
phagocytosis is when certain white blood cells ingest microbes
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Lymphocytes
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The Immune System: Part V
Humoral immunity:
mediated by B lymphocytes
best against bacterial and viral infection
Cell-mediated immunity:
involving T lymphocytes
best against fungi, parasites, foreign tissue, cancer
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Figure 2.6 Components of the Immune System

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The Immune System: Part VI
Lymphatic System’s role in immunity:
drainage system of the body
water, proteins, microbes and foreign materials drain into lymph vessels from between cells
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The Immune System: Part VII
Lymphatic organs:
spleen – production of B and T cells; removes old red blood cells
tonsils – filter microorganisms that get into respiratory tract
thymus – helps T cells mature; produces hormone important for antibodies
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The Immune System: Part VIII
Disorders related to the Immune System:
AIDS
Cancer
Infectious disorders:
splenomegaly – infection of spleen
tonsillitis – inflammation impedes filter function
mononucleosis – enlargement in lymph system
lymphoma – tumor in lymphatic system

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The Immune System: Part IX
Autoimmunity
Learning that inflammatory response that protects us in some circumstances is a cause or contributor to a great many of our chronic diseases
Many diseases we believed had other causes are actually autoimmune in nature, in which the body attacks its own tissue

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Figure 2.7 The Body’s Stress System

Physiological Systems in Stress Response
Sympathetic Activation
Events perceived to be stressful create sympathetic nervous system arousal
Triggers adrenal glands to release catecholamines epinephrine and norepinephrine
Blood pressure, heart rate increase (and many other changes)
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Physiological Systems in Stress Response
HPA Activation
hypothalamic-pituitary-adrenocortical (HPA) axis
pituitary gland releases hormone ACTH, triggering adrenal release of glucocorticoids, especially cortisol
recurring activation compromises functioning, creating allostatic load
hampers immune functioning
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Summary: Part I
Describe the function of the nervous system
NS and endocrine system control the system of the body and mobilize it when under threat.
Exchange of nerve impulses between body and brain integrate as needed for voluntary and involuntary movement.
Explain how the endocrine system operates
operates chemically via hormones to control growth and help the nervous system

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Summary: Part II
Identify how the cardiovascular system works
Transport system that delivers oxygen and nutrients throughout the body.
Heart pumps to keep circulation going.
Vulnerable to stress and a major cause of death.
Describe the function of the immune system
Wards off disease by creating special cells to attack foreign invaders to the body.

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Summary: Part III
Understand the physiological systems involved in the stress response
Activation of SAM system and HPA axis
Physiological changes are harmful to the body long term
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Slides prepared by Krista K. Trobst, Ph.D.
York University
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CHAPTER 4
Preventative and Health-Promoting Behaviour

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Learning Objectives
Identify preventable injuries.
Describe cancer-related health behaviours.
Understand how exercise enhances health.
Explain why maintaining a healthy weight is important.
Describe how sleep is related to health.
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Class Activity 5
1) Identify preventable injuries
2) What is cancer and how can it be prevented
3) Importance of exercise
4) How sleep is related to health?
5) How many hours of sleep is considered to be health.
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Preventive and Health-Promoting Behaviour
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No wonder that so many cars collide;
Their drivers are accident prone,
When one hand is holding a coffee cup,
And the other a cellular phone.
Art Buck

Accidents Verse

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What Are Preventable Injuries?: Part I
You know what I call a motorcyclist who doesn’t wear a helmet? An organ donor.
Emergency Room Physician
Unintentional injuries are a major cause of death and the primary cause of death for children under the age of five (e.g., poisoning, falls).

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What Are Preventable Injuries?: Part II
Motorcycle and automobile accidents are the major cause of death for children, adults, and young adults.
Social engineering techniques are used to decrease accidents and injuries (e.g., speed limits, seatbelts).

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Figure 4.1
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What Are Cancer-Related Health Behaviours?
Approximately 1 in 4 of Canadians will die of cancer
Breast Cancer Screening
prevalence of breast cancer in this country remains high
majority detected in women over 40
early detection through mammograms improves survival rates
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What Are Cancer-Related Health Behaviours? Breast cancer
Getting Women to Obtain Mammograms:
25% decrease in breast cancer deaths since screening initiated
breast cancer brochures, counselling, mailed materials
changing attitudes
theory of planned behavior used to predict mammogram compliance
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What Are Cancer-Related Health Behaviours? Prostate cancer
Prostate cancer is the most common cancer among men
Third leading cause of cancer deaths in Canada
Risk increases with age
Screening is important, particularly after age 50
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What Are Cancer-Related Health Behaviours? Colorectal cancer
Colorectal cancer:
second highest cause of cancer deaths in Canada
Colorectal cancer screening:
screening is distinctive; people may learn they have polyps that would become cancerous if not removed and can thereby prevent cancer development
participation predicted by self-efficacy, perceived benefits, physician’s recommendation, lack of barriers
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Figure 4.2
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What Are Cancer-Related Health Behaviours? Skin cancer
Skin cancer:
Among the most preventable cancers
Several varieties—some are relatively benign but others can be deadly
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What Are Cancer-Related Health Behaviours? Sunscreen Use
Problem with increasing sunscreen use:
tans are perceived as attractive, particularly among teens and young adults
Approximately ½ of all Canadians report having had a sunburn each year
Use increases with age and is predicted by the same factors as other health behaviours.
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How Does Exercise Enhance Health?
Aerobic exercise:
Sustained exercise that stimulates/strengthens heart and lungs
Improves body’s utilization of oxygen
High-intensity, long-duration and requisite high endurance:
– jogging
– bicycling
– jumping rope
– running
– swimming
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How Does Exercise Enhance Health?
Benefits
Benefits of exercise:
decreased risk of chronic disease and some cancers
decreased risk of Type II diabetes in high-risk adults
accelerated wound healing
increases in cardiovascular fitness and endurance
increased longevity
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Table 4.1
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How Does Exercise Enhance Health?
Benefits (cont…..)
Benefits of exercise (cont.):
aim for 150 minutes per week of moderate-to-vigorous exercise
positive effects on psychological health
exercise is effective as stress management
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How Does Exercise Enhance Health?
Determinants
Determinants of Regular Exercise
Individual characteristics:
positive attitude, sense of athleticism, gender, a sense of self-efficacy, and social support
Characteristics of the setting:
convenient, easily accessible, and available resources
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How Does Exercise Enhance Health? Interventions
Characteristics of interventions
Strategies:
Theory of Planned Behaviour can help explain participation
Cognitive-behavioural strategies can promote adherence
Self-monitoring
Goal-setting
Contingency contracting
Self-reinforcement
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How Does Exercise Enhance Health? Interventions (continued….)
Characteristics of interventions
relapse prevention techniques
Transtheoretical model of behavioural change suggests that interventions should be targeted to the individual’s stage.
Individualized Exercise Programs
understanding motivation and attitudes to design interventions that fit the person well
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Why is Maintaining a Healthy Weight Important?
Why diet is important:
dietary factors contribute to a broad array of diseases
dietary habits have also been implicated in the development of several cancers and diet contributes about 20% to incidence of cancer
changing one’s diet improves health
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Resistance to Modifying Diet
problem of maintaining change
some dietary recommendations are restrictive, monotonous, expensive and hard to find/prepare
stress has a direct effect on eating
some dietary changes may alter mood and personality
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Interventions to Modify Diet
most interventions done on an individual basis in response to a specific health problem or health risk
motivation and commitment are essential
begin with education and self-monitoring
cognitive-behavioural interventions
Adopting the stages of change model:
family interventions
community interventions

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Summary of the Transtheoretical Model of Change from Chapter 3:
Precontemplation
In this stage the person is not aware of a problem
Family and friends may be aware and push for treatment.
The individual often reverts to old behaviours if treatment does occur.
Contemplation
The person is aware that a problem exists
No commitment to take action
Weighing the pros and cons of action
If a decision for change is made, then there are favorable expectations
Preparation
The intention to change a behaviour has been made
The person may not have begun to change the behaviour or may have modified the target behaviour somewhat (for example, smoking fewer cigarettes each day).
Action
Commitment of time and energy
Stopping the behaviour
Modifying lifestyle and environment to get rid of cues associated with the behaviour
Maintenance
Works toward preventing relapse
Consolidating gains that have been made
Has been free of the addictive behaviour for more than 6 months.
Relapse may occur causes the cycle to repeat before the behaviour is successfully eliminated.
Summary of the Importance of this Model
Captures the process that people actually go through.
Illustrates that change doesn’t happen all at once.
Illustrates that change may not occur on the first try.
Explains why many interventions aren’t successful – people are not in the “action” phase.

The Importance of Weight Control:
Regulation of eating
leptin and insulin are important hormones that control eating
ghrelin may explain why dieters gain their lost weight back
Leptin signals hypothalamus as to whether the body has sufficient energy stores
a malfunctioning ventromedial hypothalamus interferes with normal eating habits
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hypothalamus

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The Importance of Weight Control:
Obesity
Obesity:
– an excessive accumulation of body fat
– health risk
– one of the most serious problems in Canada
Risks of obesity
– risk factor for many disorders
– one of the chief causes of disability
– associated with early mortality
– can cause psychological distress
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Fig. 4.1 BMI Chart

Obesity as a Health Risk
World Health Organization states obesity rates have more than doubled since 1980
One in five Canadians is obese (more men than women)
Portion sizes have increased and we eat more processed food
Fat and sugar consumption contribute greatly
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Fig. 4.5

Where the Fat Is
Where the fat is:
abdominally localized fat is especially potent as a risk factor
excessive central weight, sometimes called “stress weight”
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Obesity in Childhood
approximately 23% of children are overweight or obese in Canada (more boys than girls)
genes contribute to risk of obesity
sedentary lifestyles
early eating habits contribute to obesity
negative impact on self-esteem
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Risks of Obesity
Obesity is a risk factor in its own right and because it influences other risk factors (e.g., blood pressure, cholesterol)
Accounts for over 4,000 deaths in Canada each year
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Risks of Obesity
Increases death rates for all cancers
Increases risks in surgery and child-bearing
It’s links to chronic diseases results in early mortality
Psychological stress of obesity stigma
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Fig. 4.6

Factors Associated with Obesity
number and size of individual fat cells
fat cells in childhood increase fat storage later
style of eating
family history and obesity
SES, culture and obesity
obesity and dieting as risk factors for obesity
set point theory of weight
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Stress and Eating
stress affects eating differently among people (e.g., about half of people eat more, and half eat less)
stress influences what food is consumed—move toward high-calorie/high-fat foods
anxiety and depression figure into stress eating

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Weight Loss Strategies and Treatment
Motivations to lose weight include health concerns, and eliminating food bingeing, but most are motivated by a desire to be more attractive.
– dieting – most common approach
– surgery – stomach stapling, gastric bypass
– appetite-suppressing drugs – Rx and OTC
– screening – determine who is ready
– self-monitoring – enhances awareness
– control overeating – multimodal behavioural intervention

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Weight Loss Strategies and Treatment (cont.)
– adding exercise
– controlling self-talk
– social support
– relapse prevention

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Evaluation of Cognitive-Behavioural Weight-Loss Techniques
newer programs are longer, emphasize self-direction and exercise and include relapse prevention
efforts have been only somewhat successful
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Table 4.2 Eight things to consider when you want to lose weight

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Taking a Public Health Approach
shift from a treatment model to a public health model
prevention with families at risk is one strategy
behavioural treatment of childhood obesity has been successful
weight-gain prevention programs for normal-weight adults
social engineering strategies—better labeling, “junk food tax,” limit advertising, etc.
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How is Sleep Related to Health?
Stages of Sleep:

Stage 1:
– Theta waves, lightest stage of sleep
Stage 2:
– sleep spindles, large K-complex waves
– body temperature drops, breathing & heart rate even out

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How is Sleep Related to Health? (cont…)
Stages of Sleep:

Stages 3 and 4:
– deep sleep, Delta waves, blood pressure falls, strengthening immune system

REM sleep:
– Beta waves, vivid dreams, consolidating memories

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Sleep and Health
fewer than 7 hours of sleep a night affects cognition, mood, performance in work, and quality of life
emotional arousal and neuroendocrine activation from chronic stress may underlie chronic insomnia
sleep deprivation affects immune functioning
too much sleep may also be tied to psychopathology and chronic worrying
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Table 4.3A Good Night’s Sleep
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Summary: Part I
Identify preventable injuries.
Unintentional injuries are a major cause of preventable death, despite increased use of accident prevention measures.
Describe cancer-related health behaviours.
Many women do not get breast cancer screening, and screening for colorectal cancer is also low. Many do not use safe sun practices.

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Summary: Part II
Understand how exercise enhances health.
Aerobic exercise is very good for overall health but few adhere to the minimum 30 minutes per day, three times per week. Cognitive-behavioural interventions can be successful.
Explain why maintaining a healthy weight is important.
Obesity is a major health risk linked to many chronic health conditions. Intervention through mass media and the community can be helpful.
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Summary: Part III
Describe how sleep is related to health.
Inadequate sleep is related to poor health. Bedtime procrastination is one cause of inadequate sleep.

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Health Psychology, 6th edition
Shelley E. Taylor
Chapter Four:
Health-Enhancing Behaviors

Exercise: Overview
Aerobic exercise is sustained exercise that
stimulates/strengthens heart and lungs
improves body’s utilization of oxygen
High-intensity, long-duration
Bicycling
Jogging, running
Jumping rope
Swimming

Exercise: Benefits
Increases in cardiovascular fitness and endurance
30-minute/day decreases the risk of chronic disease
Increased longevity
by age 80, the amount of additional life attributable to aerobic exercise is between 1 and 2 years
Yet, 1/4 of Americans do not engage in any leisure-time physical activity
2/3 of Americans don’t meet recommended levels of physical activity

“You’re It! Get Fit” (Slogan from the Healthier U.S. Website: Brought to you by the Executive Office of the President and the Department of Health and Human Services)
Our textbook noted that according to the Center for the Advancement of Health (2002) 1/4 of Americans do not engage in any leisure-time physical activity. President Bush has been trying to encourage more Americans to engage in physical activity. Go to this website to find out more about the President’s Challenge: http://www.healthierus.gov/ Several suggestions have been given to encourage the public to become more active. “There are 1440 minutes in every day… Schedule 30 of them for physical activity. Adults need recess too! With a little creativity and planning, even the person with the busiest schedule can make room for physical activity. For many folks, before or after work or meals is often an available time to cycle, walk, or play. Think about your weekly or daily schedule and look for or make opportunities to be more active. Every little bit helps. Consider the following suggestions:
Walk, cycle, jog, skate, etc., to work, school, the store, or place of worship.
Park the car farther away from your destination.
Get on or off the bus several blocks away.
Take the stairs instead of the elevator or escalator.
Play with children or pets. Everybody wins. If you find it too difficult to be active after work, try it before work. 
Take fitness breaks-walking or doing desk exercises-instead of taking cigarette or coffee breaks.
Perform gardening or home repair activities.
Avoid labor-saving devices-turn off the self-propel option on your lawn mower or vacuum cleaner.”
To get a peek at the methods that have been successful for President Bush see: The White House Workout: The Fitness Plan Inspired by President George W. Bush’s Healthier US Initiative by Andrew Flach, RoseMarie Alfieri Publisher: Hatherleigh Pr; (May 17, 2003) ISBN: 1578261333
Among the activities that Bush engages in:
► running for three miles, three times per week.
► water jogging in a pool once a week.
► elliptical trainer three times per week.
► weight lifting two times a week
Exercises are reported in Declared ‘Fit for Duty,’ President Heads to Texas for Yearly Vacation by Vicki Kemper, Los Angeles Times, August 3, 2003

Exercise: Determinants of Regular Exercise
Exercise schedules are usually erratic
Lack of time and stress undermine good intentions
About 50% of people who initiate a voluntary exercise program are still doing it after 6 months
Individual Characteristics
Gender, weight, social support, self-efficacy predict exercise adherence
Characteristics of the Setting
Convenient and accessible settings predict adherence

Exercise: Characteristics of Interventions
Strategies
Cognitive-behavioral strategies promote adherence
Telephone and mail reminders are effective in relapse prevention
Individualized Exercise Programs
Understanding motivation and attitudes aids in development of a program of activities that are liked and are convenient

Accident Prevention:
Overview
Accidents
Major cause of preventable death in U.S.
Worldwide
1.26 million people died of road-traffic injuries in 2000
Economic cost of accidents is $518 billion per year
Strategies to reduce accidents
Focus of health psychology research and intervention

Accident Prevention:
Home and Workplace
Accidents in the home
Most common cause of death and disability in children under 5
Pediatricians and parenting classes
Provide information to new parents about “childproofing” the home
Social engineering solutions are effective in reducing injury and mortality
Safety caps on medication
Guidelines regarding occupational safety

Accident Prevention: Motorcycle and Automobile Accidents
Single greatest cause of accidental death
Little psychological research helping people avoid vehicular accidents
Safety measures do reduce mortality
Wearing seat belts
Highway speeds of 55 mph
Infants/children in car safety seats
Reflective clothing among bike/motorcycle riders
BUT many people don’t follow these measures
Examples: Seat belts, especially among adolescents

Why don’t people engage in health-enhancing behaviors? Sometimes the engineering isn’t user-friendly. Wearing a seat belt might seem like a simple task to a 35-year-old engineer who is involved in vehicle design. But what about older adults? Or pregnant women? In order to help make these safety measure easier for individuals to use, a team at the Ergonomics Centre at ICE Ergonomics, part of Loughborough University’s Research School in Ergonomics and Human Factors developed a “Third Age Suit”. This suit is designed to simulate some of the effects of aging. From the program abstract from An international conference on inclusive design and communications Organized by The Helen Hamlyn Research Centre and The Contemporary Trends Institute April 2001 Royal College of Art, London, UK
URL: http://www.hhrc.rca.ac.uk/programmes/include/2001/includebook

“Although people are living longer and healthier lives, most of us will experience some degree of disability as we get older. Such disabilities are frequently exacerbated by poor design. TAURUS aims to promote awareness of ‘disabling’ designs and work towards the ‘inclusive’ design of products and the built environment. The interactive ‘Third Age workshop’ was presented at the HF2K Symposium held at Loughborough University in September 2000. It aims to introduce delegates to some of the problems faced by the ageing population and how consideration of the design process can help alleviate these problems, leading to products which are easier to use by everybody.”
The conference presenters, Suzanne Lockyer and David Hitchcock, from the University of Loughborough presented information on the Third Age Suit in a workshop on user-centered design. When engineers put on this suit they find themselves with restricted mobility in their knees and elbows. They have less flexibility in their stomach and backs. Goggles help the engineers drive a car with the eyesight of an individual who is beginning to develop cataracts. Rubber gloves reduce the sensitivity of touch. The concept behind this suit is that making a car safer for one segment of the population will improve the vehicle for all drivers.
A new type of suit was designed, this one with an “empathy belly”. Details of the suit were described by Jim Mateja of the Chicago Tribune (August 6, 2003). The suit is designed to simulate the last month of pregnancy. An engineer working at Ford attended a Lamaze class with his pregnant wife and thought it would be useful in car design. Ford purchased two of the suits and the engineers were able to assess their designs from the perspective of a pregnant woman. Mateja explains the experience he had when he tried on the suit: “To understand what the engineers go through, I submitted to the suit. The suit is a vest with built-in breasts, a slide-in 13-pound water bladder in the stomach pouch to simulate a fetus and two 7-pound lead weights to torture the bladder. Before strapping it on, you must have your rib cage wrapped in a wide strip of Velcro cloth to ensure that if the 13-pound water bladder and 14 pounds of lead weights don’t get you thinking of the plight of the pregnant woman, the lack of oxygen will. … It takes the suit about five seconds before the weight brings on back pains, about six seconds before the Velcro corset has you gasping for breath, about seven seconds before you waddle rather than walk and about eight seconds before celibacy starts to sound good.” One of the Ford Motor Company engineers, Fred Lupton, said that, “the pregnancy suit is going to be used ‘in designing our family haulers — vans, SUVs and, now, with the refocus on cars, our sedans,’ including the Ford Five Hundred and Mercury Montego for ’05 and the Ford Futura replacement for the Taurus for ’06.” Ford engineers design with comfort in mind: Ergonomics team members don suits that simulate the ninth month of pregnancy to get ideas on how to make vehicles easier to operate. By Jim Mateja, Chicago Tribune, August 6, 2003

Cancer-Related Health Behaviors:
Breast Self-Examination
Breast cancer
On decline, remains leading cause of cancer death
Strikes 1 in 8 U.S. women
90% detected through BSE
BSE
Palpitating breasts to detect alterations in underlying tissue
Once per month, day 10 of menstrual cycle
Check while standing up and lying down
Relatively few women practice BSE
Few women practicing BSE correctly

Cancer-Related Health Behaviors:
Breast Self-Examination (BSE)
Theory of Planned Behavior predicts BSE
Health locus of control beliefs predict BSE
Barriers to BSE
Not knowing exactly how to do it
Breast tissue tends to be lumpy, beginners find lumps frequently
Fear may act as a deterrent
Synthetic models help accuracy and confidence
Teaching BSE

Theory of Planned Behavior, Review From Chapter 3
Theory of Planned Behavior – links health attitudes and behavior
A health behavior is the direct result of a behavioral intention.
Behavioral intentions are made up of
Attitude toward the action
Subjective norms about the actions
Perceived behavioral control

Health locus of control beliefs, Review from Chapter 3
The perception that one’s behavior is
► under personal control, OR
► under the control of powerful others, such as physicians, OR
► determined by external factors, such as chance.

Cancer-Related Health Behaviors:
Mammograms
Women aged 50 and older
Mammograms every year suggested
Why are mammograms important?
Prevalence of breast cancer remains high
Majority of breast cancers are detected in women over age 40
Early detection improves survival rates

Cancer-Related Health Behaviors:
Mammograms
Compliance is low
27% of women had the age appropriate number of repeat screening mammograms
Deterrents include
Fear of radiation
Embarrassment over procedure
Anticipated pain
Concern about cost, especially among poor women
Lack of awareness, time, incentive, availability

Cancer-Related Health Behaviors:
Testicular Self-Examination
Most common cancer in men 15 to 35 years
A leading cause of death for men 15 to 35
Incidence is increasing
With early detection, cure rate is high
Symptoms include
Small, painless lump on front or side of testicle
Feeling of heaviness in the testes
Dragging sensation in the groin
Fluid or blood in scrotal sac

The American Cancer Society has a web page that provides information about the different types of testicular cancer. The URL is:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_testicular_cancer_41.asp
This website has specific information about many topics important to those seeking information on this subject. For example, the prognosis for one particular type of testicular cancer varies from that of another. It also points out the need to have an examination by a physician as part of a regular examination. At this time the ACS does not recommend TSE on a regular basis because research has not yet shown that it reduces mortality. They do note that many physicians recommend monthly testicular exams and they provide instructions on their site. In describing TSE the site points out the need to have a physician check out suspicions that a man might have; many of them will turn out to be ordinary and not indications of any abnormalities. For example, a man might be concerned about a lump that he feels, not knowing that it is the epididymis.

Cancer-Related Health Behaviors:
Testicular Self-Examination (TSE)
TSE Exam
Become familiar with surface, texture, consistency or testicles
Examination during warm bath/shower
Rotate testicle between thumb and forefinger to detect lumps
Educational interventions increases
Frequency of TSE
Proficiency in TSE
No documented relation of TSE to reduction in advanced testicular cancer at this point

Cancer-Related Health Behaviors:
Colorectal Cancer Screening
Colorectal cancer
Western countries, 2nd highest cause of cancerous deaths
Screening
People often learn they have polyps rather than malignancies
Participation predicted by
Self-efficacy, perceived benefits, physician’s recommendation, lack of barriers

Cancer-Related Health Behaviors:
Sunscreen Use
Skin Cancer
Fourfold increase in 30 years
Melanoma incidence risen 155% in 20 years
Excessive exposure to ultraviolet radiation
Vacations in southern latitudes
Participation in outdoor activities
Use of tanning salons
Problem with Sunscreen Use
Tans are perceived as attractive
Young adults – especially concerned with appearance

Look at Article 37 in Annual Editions: Health 05/06 Edited by Eileen L. Daniel.
Dubuque, Iowa: McGraw-Hill/Dushkin
It is called, A Killer Tan, by Hallie Levine and it was originally published in May, 2004.
Levine points out that the tanning industry is a $5 billion dollar industry that tells its customers that it is safe to tan. In fact, the article opens with a horrifying story. Michele, a woman who has survived malignant melanoma, enters a salon that offers a spray on tanning solution. The employee encourages her to enter a room with a tanning bed instead, insisting that it would be safe because the beds have “UVA rays” that lessen her chances of developing cancer. Imagine saying that to someone with melanoma!
The article highlights the point made in the textbook that young adults are primarily concerned with appearance. A 23-year-old, Melanie Mahaffey, is interviewed for the story after her mother has had a small skin cancer removed. But it has little effect on Melanie who says, “But I figure I’m still so young that my skin will automatically rejuvenate itself.” The article then cites a doctor who explains why this isn’t true.

Cancer-Related Health Behaviors:
Sunscreen Use
Best predictor of sunscreen use is type of skin
burn only, burn then tan, tan without burning
Factors influencing sunscreen use
Perceived need for sunscreen
Perceived efficacy of sunscreen (prevent cancer)
Social norms
Most effective educational intervention
Short-term negative effects of tanning on appearance rather than long-term effects on health
UV photo with aging information led to less sunbathing

UV photo with aging information led to less sunbathing: This relates to the Mahler, Kulick, Gibbons, Gerrard, & Harrell, 2003 study cited in the textbook showing how the immediate concerns of the beachgoers were salient.
Although President Bush is known for his emphasis on fitness, one can see the effects of this earlier “window of vulnerability” in regard to his 2003 physical exam:
Each year President Bush has a physical exam at Bethesda Naval Hospital in Maryland. The results of the 2003 exam were made public in August, 2003 and indicated that the president was in superior health. However there were some skin abnormalities due to sun exposure:
“As a preventive measure, doctors treated several small skin abnormalities on Bush’s nose, cheeks and left arm. Such skin lesions and swollen blood vessels are common symptoms of sun exposure.”
Declared ‘Fit for Duty,’ President Heads to Texas for Yearly Vacation by Vicki Kemper, Los Angeles Times, August 3, 2003

Maintaining a Healthy Diet:
Overview
Controllable risk for many causes of death
35% of U.S. population gets 5 servings of fruit and vegetables each day
Unhealthy eating contributes to 300,000+ deaths per year
Dietary change is critical for those at risk for
Coronary artery disease, hypertension
Diabetes
Cancer

Maintaining a Healthy Diet:
Why is Diet Important?
Dietary factors contribute to broad array of diseases
Example: relation of dietary factors to total serum cholesterol level
Estimates of degree to which diet contributes to incidence of cancer exceed 40%
Poor diets are problems in conjunction with other risk factors, such as stress
Good News!
Changing one’s diet improves health
Controversy
Will reducing calories increase the life span?

Maintaining a Healthy Diet:
Resistance to Modifying Diet
People switch to healthier diets more often to improve appearance than to improve health!
Maintaining change is difficult
Long-term monitoring, relapse prevention is critical
Tastes are difficult to alter
Dietary changes may affect mood and personality
Helpful factors
Strong sense of self-efficacy
Family support
Perception that dietary change has important benefits

Maintaining a Healthy Diet:
Resistance to Modifying Diet
Stress has a direct effect on eating
Especially true for adolescents
Greater stress tied to
Eating more fatty foods
Eating less fruit and vegetables
Skipping breakfast
More between-meals snacks

Maintaining a Healthy Diet:
Interventions to Modify Diet
Individual interventions
In response to specific health risk
Education and self-monitoring are key
Cognitive-behavioral interventions
Transtheoretical Model of Change – Different interventions are required for each stage
Precontemplation
Contemplation
Preparation
Action
Maintenance

Summary of the Transtheoretical Model of Change from Chapter 3:
Precontemplation
In this stage the person is not aware of a problem
Family and friends may be aware and push for treatment.
The individual often reverts to old behaviors if treatment does occur.
Contemplation
The person is aware that a problem exists
No commitment to take action
Weighing the pros and cons of action
If a decision for change is made, then there are favorable expectations
Preparation
The intention to change a behavior has been made
The person may not have begun to change the behavior or may have modified the target behavior somewhat (for example, smoking fewer cigarettes each day).
Action
Commitment of time and energy
Stopping the behavior
Modifying lifestyle and environment to get rid of cues associated with the behavior
Maintenance
Works toward preventing relapse
Consolidating gains that have been made
Has been free of the addictive behavior for more than 6 months.
Relapse may occur causes the cycle to repeat before the behavior is successfully eliminated.
Summary of the Importance of this Model
Captures the process that people actually go through.
Illustrates that change doesn’t happen all at once.
Illustrates that change may not occur on the first try.
Explains why many interventions aren’t successful – people are not in the “action” phase.

Maintaining a Healthy Diet:
Interventions to Modify Diet
Family interventions
Easier for target member to change when other family members change also
Wives usually shop and prepare food
Husband’s food preferences likely to determine what the family actually eats
Meet with a dietary counselor
Discuss ways to change the family’s diet
Family members decide on specific changes

Maintaining a Healthy Diet:
Interventions to Modify Diet
Community interventions
Initial success rates, but not impressive long term change
More effective – intervention directed toward particular at-risk groups (Hispanic dietary study)
Social engineering possibilities
Banning snack foods from schools
Making snack foods expensive; healthy foods less

Weight Control:
Regulation of Eating
Taste
The chemical gatekeeper
Most ancient of the senses
Important in selection and rejection of foods
Leptin
Protein secreted by fat cells
Signals hypothalamus about stores of fat
Inhibits neurons that stimulate appetite
Activates neurons that suppress appetite

Weight Control:
Regulation of Eating
Ghrelin
Secreted by cells in the stomach
Spikes just before meals, drops afterwards
When given ghrelin injections, people feel extremely hungry
Ventromedial hypothalamus
When damaged, rats eat excessively
May play a role in some cases of human obesity

Weight Control:
Why Obesity is a Health Risk
Obesity – excessive body fat
Women: fat should be 20% to 27% of body tissue
Men: fat should be 15% to 22% of body tissue
Global epidemic of obesity
300 million worldwide are obese
Americans are fattest in the world
Epidemic stems from
Genetic susceptibility
Increasing availability of high-fat, high-energy foods
Low levels of physical activity

Weight Control:
Why Obesity is a Health Risk

Then Now
Average American’s Calories/Day 1,826 in the 1970s 2,000 in the mid 1990s
Soda Consumption 22.2 Gallons per year 56 Gallons
per year
McDonald’s French Fries Original Size was 200 Calories Supersize is 610 Calories

Weight Control:
Why Obesity is a Health Risk
Links with other risk factors, i.e., blood pressure
Increases risks during surgery, anesthesia administration, and childbearing
Chief cause of disability
number of people aged 30-49 who cannot care for themselves has jumped by 50%
Problems with health care
May not fit in standard wheelchairs
X-rays may not penetrate far enough
Blood pressure cuffs may not fit

Weight Control:
Obesity in Childhood
Prevalence of overweight children in the past 20 years
Doubled among those 6 to 11 years
Tripled among those 12 to 17 years
Why?
Sedentary lifestyles
TV, videogames
Early eating habits
80% of all people who were overweight as children go on to be overweight as adults

http://www.girlpower.gov/girlarea/bodywise/Index.htm

Girl power is a government website designed to encourage healthy development among young girls. One of the aspects concerns body image.
According to this site:
“Getting BodyWise is all about learning to love and take care of your body—it’s the only one you’ve got! That means knowing how to choose nutritious foods, eat smart, and stay fit. It’s important to learn about the vitamins and nutrients your body needs to keep you going. It’s also important to get the facts about serious health problems like eating disorders.”

Weight Control:
Where the Fat is
Particular risk to “apples” rather than “pears” (fat localized in abdomen)
More psychologically reactive to stress
Greater cardiovascular reactivity
Yo-Yo dieting
Loss and regain
Affects abdominal fat

Weight Control:
Factors Associated with Obesity
Childhood: Window of vulnerability
Number of fat cells determined early in life by genetic factors or early eating habits.

The concept of Window of vulnerability may be reviewed at this point:
“The fact that, at certain times, people are more vulnerable to particular health problems.”
The picture is found at http://www.girlpower.gov
[If you would like to include other pictures or information in your presentation they are in the public domain (this information can be verified at 1-800-729-6686 SAMHSA’s NCADI . This number also has a staff of trained information specialists who can answer your questions 24 hours a day regarding pamphlets and information available on various topics.]
This is a “Girl Power” website to encourage health nutrition in young girls.
There are interactive quizzes to help figure out the healthiest food based on nutrition labels. For example, which muffin would be the better choice in order to increase fiber in your diet? The girl just study each label and then make a choice.
“Which of these muffins would you choose to maximize your fiber intake:
The oat bran muffins OR the honey wheat muffins?
You’re Right!!!
One honey wheat muffin has more fiber than one oat bran muffin!
Each oat bran muffin has only 2g of fiber (8% of the Daily Value).
Each honey wheat muffin has 3g of fiber (12% of the Daily Value).
Note: To compare fiber, look at the Nutrition Facts panel and compare
the % Daily Value of Dietary Fiber on each package.”
http://www.cfsan.fda.gov/~dms/flquiz1d.html
The site also contains other activities, such as the “Calcium Word Search” shown in the slide above. The girls try to find the following words:
Beans Bread Broccoli Burrito Cocoa Fortified Juice
Hot Cereal Ice Cream Lasagna Macaroni Cheese Milk
Milkshake Nachos Pizza Pudding Waffle Yogurt

Weight Control:
Factors Associated with Obesity

This is a slide of the food label that replaced the ones that had been in use for many years. Note the addition of “Trans Fat” as well as the changes to enhance the ability of individuals to read the labels.
SUMMARY: The Food and Drug Administration (FDA) is amending its regulations on nutrition labeling to require that trans fatty acids be declared in the nutrition label of conventional foods and dietary supplements on a separate line immediately under the line for the declaration of saturated fatty acids. This action responds, in part, to a citizen petition from the Center for Science in the Public Interest (CSPI). This rule is intended to provide information to assist consumers in maintaining healthy dietary practices. Those sections of the proposed rule pertaining to the definition of nutrient content claims for the ‘‘free’’ level of trans fatty acids and to limits on the amounts of trans fatty acids wherever saturated fatty acid limits are placed on nutrient content claims, health claims, and disclosure and disqualifying levels are being withdrawn. Further, the agency is withdrawing the proposed requirement to include a footnote stating: ‘‘Intake of trans fat should be as low as possible.’’
41434 Federal Register / Vol. 68, No. 133 / Friday, July 11, 2003 / Rules and Regulations
For a PDF file of this 74-page document go to :http://www.cfsan.fda.gov/~acrobat/fr03711a

Weight Control:
Factors Associated with Obesity
Family History and Obesity
Relationship is due to genetic and dietary factors
SES, Culture and Obesity
Low SES women are heavier than high SES women
SES not associated with obesity for men or children
Thinness is valued in women from developed countries

Weight Control:
Factors Associated with Obesity
Obesity and Dieting as Risk Factors
Obesity is a risk factor for obesity
High basal insulin levels prompt overeating due to increased hunger
Obese have larger fat cells
Cycles of dieting lower metabolic rate
Set Point Theory
Each person has ideal biological weight

Weight Control:
Stress and Eating
50% eat more when under stress
Women more likely to eat more under stress
Stress removes self-control in dieters/obese
Choose foods containing more water, “chewier”
Choose salty, low calorie foods
Negative emotions – sweet, high-fat foods
50% eat less when under stress
Men, compared to women, eat less under stress
Non-dieting, non-obese suppress hunger cues

Weight Control:
Treatment of Obesity
Amazon.com has 140,000 titles about dieting
Obese individuals attempt to lose weight because
It is considered unattractive (a primary reason)
It carries a social stigma (a primary reason)
They perceive that it is a health risk
It is coupled with psychological distress
Obese – often blamed for their weight
Few health practitioners advise losing weight

Weight Control:
Treatment of Obesity
Dieting
Small losses, rarely maintained for long
Risk of yo-yo dieting to CHD > than risk of obesity alone
Formal investigation of low-carb diets does not suggest they are more effective than other kinds of diets
Fasting – usually employed with other techniques
Surgery – stomach stapled to reduce capacity
Appetite-Suppressing drugs
The multimodal approach
Screening, self-monitoring, control over eating, exercise
Controlling self-talk, social support, relapse prevention

Weight Control: Where are Weight Loss Programs Implemented?
Work Site Interventions
Team competitions are effective
in the short term
Controversy
Are weight losses maintained over time?
Commercial Programs
TOPS (Taking Pounds Off Sensibly)
Weight Watchers
Jenny Craig

Weight Control: Evaluation of Cognitive-Behavioral Techniques
Efforts are somewhat successful
Losing 2 pounds/ week for 20 weeks
Maintenance for 2 years
Programs emphasize self-direction, exercise, and relapse prevention
Health psychologists suggest
Sensible eating and exercise
Rather than specific weight reduction techniques

Weight Control:
Taking a Public Health Approach
Prevention with families at risk
Training: Sensible meal planning
Training: Helping children develop healthy eating habits
Behavioral treatment
Adult obesity – difficult to modify
Childhood obesity – impressive successes
Reinforcement for exercise is effective
Reduced TV watching is effective

Weight Control:
Taking a Public Health Approach
Weight- Gain Prevention
Women at menopause: exercise and good eating habits may prevent the weight gain that is very common
Special “junk food tax” on foods high in sugars and fats
Restriction of advertising to children
Health warnings regarding foods high in sugars and fats

Eating Disorders:
Anorexia Nervosa
An obsessive disorder amounting to self- starvation
Dieting and exercising till body weight is grossly below optimum level
Most sufferers are adolescent females
Disproportionate number from upper social classes

Eating Disorders: Factors in developing Anorexia Nervosa
Physiological
Amenorrhea, abnormal levels of neuroactive steroids, Turner’s syndrome, hypothalamic abnormalities, chronically overreact to stress
Profiles show
Depression, anxiety, low self-esteem, poor sense of mastery
Genetic contributions – runs in families
Family interaction patterns –lack of control, need for approval
First treatment step: bring weight up to safe level

Eating Disorders: Bulimia
An eating syndrome characterized by alternating cycles of binge eating and purging through such techniques as
Vomiting
Laxative abuse
Extreme dieting
Drug or alcohol abuse
Binge eating
Usually the person is alone and feels out of control

Eating Disorders: Bulimia
Bulimics
Typically normal or overweight
Issues of control
Binge phase – out of control
Purge phase – attempt to regain control
Control of eating shifts from internal sensations to cognitively based decisions
Families placing high value on thinness
produce bulimic daughters
Genetic basis: bulimia runs in families
First step to help: Get treatment

Sleep: What is Sleep?
Stage 1
Theta waves, lightest stage of sleep
Stage 2
Sleep spindles, large K-complex waves
Body temperature drops, breathing and HR even out
Stages 3 and 4
Deep sleep, Delta waves, blood pressure falls, strengthening immune system
REM sleep
Beta waves, vivid dreams, consolidating memories

Sleep: Sleep and Health
Major sleep disorders
More than 14 million Americans have them
May be tied to hormonal levels at menopause
Most common sleep disorder is insomnia
Chronic insomnia
Reduces the ability to respond to insulin
Increases the risk of CHD
Reduces the efficacy of flu shots

Sleep: Apnea
Quality of sleep compromises health
Apnea
Air pipe blockage leads the sleeper to stop breathing, for as long as three minutes
S/he wakes up gasping for air
People can awaken dozens of times each night without realizing it
Sleep apnea triggers thousands of nighttime deaths
Surgery or special machines are used to treat this condition

A Good Night’s Sleep: Table 4.5

Health-Enhancing Behaviors: Rest, Renewal, Savoring
Understanding health-enhancing behaviors is a work in progress
Health behaviors needing research
Processes of relaxation and renewal
Restorative activities to reduce stress
Intuition, rather than a strong body of research, guides our thinking about restorative processes

“You’re It! Get Fit” (Slogan from the Healthier U.S. Website: Brought to you by the Executive Office of the President and the Department of Health and Human Services)
Our textbook noted that according to the Center for the Advancement of Health (2002) 1/4 of Americans do not engage in any leisure-time physical activity. President Bush has been trying to encourage more Americans to engage in physical activity. Go to this website to find out more about the President’s Challenge: http://www.healthierus.gov/ Several suggestions have been given to encourage the public to become more active. “There are 1440 minutes in every day… Schedule 30 of them for physical activity. Adults need recess too! With a little creativity and planning, even the person with the busiest schedule can make room for physical activity. For many folks, before or after work or meals is often an available time to cycle, walk, or play. Think about your weekly or daily schedule and look for or make opportunities to be more active. Every little bit helps. Consider the following suggestions:
Walk, cycle, jog, skate, etc., to work, school, the store, or place of worship.
Park the car farther away from your destination.
Get on or off the bus several blocks away.
Take the stairs instead of the elevator or escalator.
Play with children or pets. Everybody wins. If you find it too difficult to be active after work, try it before work. 
Take fitness breaks-walking or doing desk exercises-instead of taking cigarette or coffee breaks.
Perform gardening or home repair activities.
Avoid labor-saving devices-turn off the self-propel option on your lawn mower or vacuum cleaner.”
To get a peek at the methods that have been successful for President Bush see: The White House Workout: The Fitness Plan Inspired by President George W. Bush’s Healthier US Initiative by Andrew Flach, RoseMarie Alfieri Publisher: Hatherleigh Pr; (May 17, 2003) ISBN: 1578261333
Among the activities that Bush engages in:
► running for three miles, three times per week.
► water jogging in a pool once a week.
► elliptical trainer three times per week.
► weight lifting two times a week
Exercises are reported in Declared ‘Fit for Duty,’ President Heads to Texas for Yearly Vacation by Vicki Kemper, Los Angeles Times, August 3, 2003
Why don’t people engage in health-enhancing behaviors? Sometimes the engineering isn’t user-friendly. Wearing a seat belt might seem like a simple task to a 35-year-old engineer who is involved in vehicle design. But what about older adults? Or pregnant women? In order to help make these safety measure easier for individuals to use, a team at the Ergonomics Centre at ICE Ergonomics, part of Loughborough University’s Research School in Ergonomics and Human Factors developed a “Third Age Suit”. This suit is designed to simulate some of the effects of aging. From the program abstract from An international conference on inclusive design and communications Organized by The Helen Hamlyn Research Centre and The Contemporary Trends Institute April 2001 Royal College of Art, London, UK
URL: http://www.hhrc.rca.ac.uk/programmes/include/2001/includebook

“Although people are living longer and healthier lives, most of us will experience some degree of disability as we get older. Such disabilities are frequently exacerbated by poor design. TAURUS aims to promote awareness of ‘disabling’ designs and work towards the ‘inclusive’ design of products and the built environment. The interactive ‘Third Age workshop’ was presented at the HF2K Symposium held at Loughborough University in September 2000. It aims to introduce delegates to some of the problems faced by the ageing population and how consideration of the design process can help alleviate these problems, leading to products which are easier to use by everybody.”
The conference presenters, Suzanne Lockyer and David Hitchcock, from the University of Loughborough presented information on the Third Age Suit in a workshop on user-centered design. When engineers put on this suit they find themselves with restricted mobility in their knees and elbows. They have less flexibility in their stomach and backs. Goggles help the engineers drive a car with the eyesight of an individual who is beginning to develop cataracts. Rubber gloves reduce the sensitivity of touch. The concept behind this suit is that making a car safer for one segment of the population will improve the vehicle for all drivers.
A new type of suit was designed, this one with an “empathy belly”. Details of the suit were described by Jim Mateja of the Chicago Tribune (August 6, 2003). The suit is designed to simulate the last month of pregnancy. An engineer working at Ford attended a Lamaze class with his pregnant wife and thought it would be useful in car design. Ford purchased two of the suits and the engineers were able to assess their designs from the perspective of a pregnant woman. Mateja explains the experience he had when he tried on the suit: “To understand what the engineers go through, I submitted to the suit. The suit is a vest with built-in breasts, a slide-in 13-pound water bladder in the stomach pouch to simulate a fetus and two 7-pound lead weights to torture the bladder. Before strapping it on, you must have your rib cage wrapped in a wide strip of Velcro cloth to ensure that if the 13-pound water bladder and 14 pounds of lead weights don’t get you thinking of the plight of the pregnant woman, the lack of oxygen will. … It takes the suit about five seconds before the weight brings on back pains, about six seconds before the Velcro corset has you gasping for breath, about seven seconds before you waddle rather than walk and about eight seconds before celibacy starts to sound good.” One of the Ford Motor Company engineers, Fred Lupton, said that, “the pregnancy suit is going to be used ‘in designing our family haulers — vans, SUVs and, now, with the refocus on cars, our sedans,’ including the Ford Five Hundred and Mercury Montego for ’05 and the Ford Futura replacement for the Taurus for ’06.” Ford engineers design with comfort in mind: Ergonomics team members don suits that simulate the ninth month of pregnancy to get ideas on how to make vehicles easier to operate. By Jim Mateja, Chicago Tribune, August 6, 2003

Theory of Planned Behavior, Review From Chapter 3
Theory of Planned Behavior – links health attitudes and behavior
A health behavior is the direct result of a behavioral intention.
Behavioral intentions are made up of
Attitude toward the action
Subjective norms about the actions
Perceived behavioral control

Health locus of control beliefs, Review from Chapter 3
The perception that one’s behavior is
► under personal control, OR
► under the control of powerful others, such as physicians, OR
► determined by external factors, such as chance.
The American Cancer Society has a web page that provides information about the different types of testicular cancer. The URL is:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_testicular_cancer_41.asp
This website has specific information about many topics important to those seeking information on this subject. For example, the prognosis for one particular type of testicular cancer varies from that of another. It also points out the need to have an examination by a physician as part of a regular examination. At this time the ACS does not recommend TSE on a regular basis because research has not yet shown that it reduces mortality. They do note that many physicians recommend monthly testicular exams and they provide instructions on their site. In describing TSE the site points out the need to have a physician check out suspicions that a man might have; many of them will turn out to be ordinary and not indications of any abnormalities. For example, a man might be concerned about a lump that he feels, not knowing that it is the epididymis.
Look at Article 37 in Annual Editions: Health 05/06 Edited by Eileen L. Daniel.
Dubuque, Iowa: McGraw-Hill/Dushkin
It is called, A Killer Tan, by Hallie Levine and it was originally published in May, 2004.
Levine points out that the tanning industry is a $5 billion dollar industry that tells its customers that it is safe to tan. In fact, the article opens with a horrifying story. Michele, a woman who has survived malignant melanoma, enters a salon that offers a spray on tanning solution. The employee encourages her to enter a room with a tanning bed instead, insisting that it would be safe because the beds have “UVA rays” that lessen her chances of developing cancer. Imagine saying that to someone with melanoma!
The article highlights the point made in the textbook that young adults are primarily concerned with appearance. A 23-year-old, Melanie Mahaffey, is interviewed for the story after her mother has had a small skin cancer removed. But it has little effect on Melanie who says, “But I figure I’m still so young that my skin will automatically rejuvenate itself.” The article then cites a doctor who explains why this isn’t true.
UV photo with aging information led to less sunbathing: This relates to the Mahler, Kulick, Gibbons, Gerrard, & Harrell, 2003 study cited in the textbook showing how the immediate concerns of the beachgoers were salient.
Although President Bush is known for his emphasis on fitness, one can see the effects of this earlier “window of vulnerability” in regard to his 2003 physical exam:
Each year President Bush has a physical exam at Bethesda Naval Hospital in Maryland. The results of the 2003 exam were made public in August, 2003 and indicated that the president was in superior health. However there were some skin abnormalities due to sun exposure:
“As a preventive measure, doctors treated several small skin abnormalities on Bush’s nose, cheeks and left arm. Such skin lesions and swollen blood vessels are common symptoms of sun exposure.”
Declared ‘Fit for Duty,’ President Heads to Texas for Yearly Vacation by Vicki Kemper, Los Angeles Times, August 3, 2003
Summary of the Transtheoretical Model of Change from Chapter 3:
Precontemplation
In this stage the person is not aware of a problem
Family and friends may be aware and push for treatment.
The individual often reverts to old behaviors if treatment does occur.
Contemplation
The person is aware that a problem exists
No commitment to take action
Weighing the pros and cons of action
If a decision for change is made, then there are favorable expectations
Preparation
The intention to change a behavior has been made
The person may not have begun to change the behavior or may have modified the target behavior somewhat (for example, smoking fewer cigarettes each day).
Action
Commitment of time and energy
Stopping the behavior
Modifying lifestyle and environment to get rid of cues associated with the behavior
Maintenance
Works toward preventing relapse
Consolidating gains that have been made
Has been free of the addictive behavior for more than 6 months.
Relapse may occur causes the cycle to repeat before the behavior is successfully eliminated.
Summary of the Importance of this Model
Captures the process that people actually go through.
Illustrates that change doesn’t happen all at once.
Illustrates that change may not occur on the first try.
Explains why many interventions aren’t successful – people are not in the “action” phase.
Girl power is a government website designed to encourage healthy development among young girls. One of the aspects concerns body image.
According to this site:
“Getting BodyWise is all about learning to love and take care of your body—it’s the only one you’ve got! That means knowing how to choose nutritious foods, eat smart, and stay fit. It’s important to learn about the vitamins and nutrients your body needs to keep you going. It’s also important to get the facts about serious health problems like eating disorders.”

The concept of Window of vulnerability may be reviewed at this point:
“The fact that, at certain times, people are more vulnerable to particular health problems.”
The picture is found at http://www.girlpower.gov
[If you would like to include other pictures or information in your presentation they are in the public domain (this information can be verified at 1-800-729-6686 SAMHSA’s NCADI . This number also has a staff of trained information specialists who can answer your questions 24 hours a day regarding pamphlets and information available on various topics.]
This is a “Girl Power” website to encourage health nutrition in young girls.
There are interactive quizzes to help figure out the healthiest food based on nutrition labels. For example, which muffin would be the better choice in order to increase fiber in your diet? The girl just study each label and then make a choice.
“Which of these muffins would you choose to maximize your fiber intake:
The oat bran muffins OR the honey wheat muffins?
You’re Right!!!
One honey wheat muffin has more fiber than one oat bran muffin!
Each oat bran muffin has only 2g of fiber (8% of the Daily Value).
Each honey wheat muffin has 3g of fiber (12% of the Daily Value).
Note: To compare fiber, look at the Nutrition Facts panel and compare
the % Daily Value of Dietary Fiber on each package.”
http://www.cfsan.fda.gov/~dms/flquiz1d.html
The site also contains other activities, such as the “Calcium Word Search” shown in the slide above. The girls try to find the following words:
Beans Bread Broccoli Burrito Cocoa Fortified Juice
Hot Cereal Ice Cream Lasagna Macaroni Cheese Milk
Milkshake Nachos Pizza Pudding Waffle Yogurt

This is a slide of the food label that replaced the ones that had been in use for many years. Note the addition of “Trans Fat” as well as the changes to enhance the ability of individuals to read the labels.
SUMMARY: The Food and Drug Administration (FDA) is amending its regulations on nutrition labeling to require that trans fatty acids be declared in the nutrition label of conventional foods and dietary supplements on a separate line immediately under the line for the declaration of saturated fatty acids. This action responds, in part, to a citizen petition from the Center for Science in the Public Interest (CSPI). This rule is intended to provide information to assist consumers in maintaining healthy dietary practices. Those sections of the proposed rule pertaining to the definition of nutrient content claims for the ‘‘free’’ level of trans fatty acids and to limits on the amounts of trans fatty acids wherever saturated fatty acid limits are placed on nutrient content claims, health claims, and disclosure and disqualifying levels are being withdrawn. Further, the agency is withdrawing the proposed requirement to include a footnote stating: ‘‘Intake of trans fat should be as low as possible.’’
41434 Federal Register / Vol. 68, No. 133 / Friday, July 11, 2003 / Rules and Regulations
For a PDF file of this 74-page document go to :http://www.cfsan.fda.gov/~acrobat/fr03711a

Slides prepared by Krista K. Trobst, Ph.D.
York University
© 2020 McGraw-Hill Education Limited
CHAPTER 6
Stress

1

Learning Objectives
© 2020 McGraw-Hill Education Limited
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Describe and define stress.
Know the theories and models used to study stress.
Understand what makes events stressful.
Explain how stress is assessed.
Describe the sources of chronic stress.
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3
4
5

2

Vocabulary Parking Lot Activity
Find out the meanings for the following
Stress
Stressor
Fight of flight response
Selye’s General Adaptation Syndrome
Tend-and-Befriend
Psychological appraisal

© 2020 McGraw-Hill Education Limited
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What is Stress?
Stress:
a negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioural changes, directed either toward altering the stressful event or accommodating to its effects
© 2020 McGraw-Hill Education Limited
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4
This is a good time to review Chapter Two. Students read about the limbic system and how the amygdala and the hippocampus play a role in stress and emotion.
In the lecture notes, it was suggested that students develop their own memory device to remember the parts of the brain that are involved in stress, the amygdala and hippocampus. It was right after the example about the test:
Example: You walk into the classroom and turn to a classmate saying, “Do you think you’ll be ready for the test by next week?” The person looks at you in astonishment, “What do you mean? That test is today!”
See how many students can recall the parts of the brain as an opportunity to review!

© 2020 McGraw-Hill Education Limited
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What is Stress? (cont….)
Stressor:
a stressful event such as noise or the commute to work
Person-environment fit:
personal resources sufficient to meet the demands of the environment

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Chapter 6 Flowchart
© 2020 McGraw-Hill Education Limited
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© 2020 McGraw-Hill Education Limited
Figure 6.1 Routes by Which Stress May Produce Disease

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What Theories and Models Are Used to Study Stress?: Part I
Fight or Flight:
Walter Cannon (1932) – physiological response mobilizes the organism to attack the threat or to flee
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What Theories and Models Are Used to Study Stress?: Part II
Selye’s General Adaptation Syndrome:
alarm
resistance
exhaustion
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© 2020 McGraw-Hill Education Limited

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Figure 6.2 The Three Phases of Selye’s (1974) General Adaptation Syndrome
© 2020 McGraw-Hill Education Limited
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What Theories and Models Are Used to Study Stress?: Part III
Tend-and-Befriend
Taylor and colleagues:
in addition to fight-or-flight, humans respond to stress with social affiliation and nurturing behaviour
may depend on underlying biological mechanisms
theory supported by women who respond to stress by turning to others
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What Theories and Models Are Used to Study Stress?: Part IV
Psychological appraisal and the experience of stress:
Primary appraisal processes
events may be perceived as positive, neutral or negative in their consequences
negative events further appraised for possible harm, threat or challenge
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What Theories and Models Are Used to Study Stress?: Part V
Psychological appraisal and the experience of stress (cont.):
Secondary appraisal processes:
assessment of one’s coping abilities and whether
they are sufficient to meet the harm, threat and challenge of an event
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© 2020 McGraw-Hill Education Limited

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© 2020 McGraw-Hill Education Limited
Figure 6.3 The Experience of Stress

What Makes Events Stressful?: Part I
Dimensions of stressful events:
Negative events:
More stressful than positive events
Uncontrollable events:
more stressful than predictable events
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What Makes Events Stressful?: Part II
Dimensions of stressful events (cont.):
Ambiguous events:
more stressful because person has no
opportunity to take action
Overload:
overloaded people are more stressed than people with fewer tasks to perform

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© 2020 McGraw-Hill Education Limited

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What Makes Events Stressful?: Part III
Must stress be perceived as such to be stressful?
subjective and objective measures of stress predict psychological distress and health complaints
perceiving stress as harmful to one’s health can increase health problems
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What Makes Events Stressful?: Part IV
Can people adapt to stress?
Psychological adaptation
Physiological adaptation
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What Makes Events Stressful?: Part IV
Can people adapt to stress?
Psychological adaptation:
most people can adapt to moderate stress, but children, elderly and the poor are more adversely affected by chronic stressors
Physiological adaptation:
low-level stress produces habituation in most people, whereas chronic stress can accumulate across multiple organ systems
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What Makes Events Stressful?: Part V
Must a stressor be ongoing to be stressful?
anticipating stress can be as stressful as its actual occurrence, and sometimes more so
adverse after-effects of stress, such as decreases in performance and attention span, and issues with cognition, learning, and memory are well documented
LO3
© 2020 McGraw-Hill Education Limited

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How Stress Has Been Assessed?: Part I
In the laboratory:
Acute Stress Paradigm:
short-term stressful events impact physiological, neuroendocrine and psychological responses
has shown how individual differences contribute to stress and what factors ameliorate the
experience of stress
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© 2020 McGraw-Hill Education Limited

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How Stress Has Been Assessed?: Part II
Inducing disease:
intentionally exposing people to viruses
Stressful Life Events (SLE):
substantial adjustment to the environment leads to high stress
SLE predicts illness
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Items and Instructions for Perceived Stress Scale
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Measurement of Daily Hassles
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How Stress Has Been Assessed?: Part III
Daily stress:
minor stressful events (daily hassles), produce psychological distress and aggravate
physical and psychological health
difficult to measure daily hassles
© 2020 McGraw-Hill Education Limited
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What are the Sources of Chronic Stress?: Part I
Stressful life events is one form of stress but also have chronic stressors that are part of our day-to-day lives.
Increasingly, research is suggesting that these chronic stressors may have a greater effect on health outcomes than do major life events.
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What are the Sources of Chronic Stress?: Part II
Post-traumatic stress disorder (PTSD)
produces chronic mental health and physical health effects
cognitive-behavioural therapies are often used to treat PTSD
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Figure 6.4 Stress can Compromise Both Mental and Physical Health
© 2020 McGraw-Hill Education Limited
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What are the Sources of Chronic Stress?: Part III
Effects of early stressful life experiences:
chronic physical or sexual abuse in childhood or adulthood increases health risks
stress early in life causes developing stress
systems to become dysregulated
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What are the Sources of Chronic Stress?: Part IV
Chronic stressful conditions:
chronic stress, such as living in poverty,
or remaining in a high-stress job, contribute to psychological stress and physical illness
© 2020 McGraw-Hill Education Limited
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What are the Sources of Chronic Stress?: Part V
Bullying and stress:
Cyberbullying
Chronic stress and health:
chronic stress is related to illness
low SES produces more stress-related
outcomes than higher SES
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© 2020 McGraw-Hill Education Limited

What are the Sources of Chronic Stress?: Part VI
Stress in the workplace:
Studies of occupational stress:
help identify common, everyday stressors
Some have physical, chemical, or biological hazards
provide evidence for stress-illness relationship
work stress may be preventable with intervention
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What are the Sources of Chronic Stress?: Part VII
Stress in the workplace (cont.):
Overload:
chief cause of occupational stress
perception of work overload produces physical health complaints and psychological distress
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What are the Sources of Chronic Stress?: Part VIII
Stress in the workplace (cont.):
Causes of stress:
– ambiguity and role conflict
– social relationships
– control/lack of control
– job insecurity
– unemployment
– other occupational outcomes
© 2020 McGraw-Hill Education Limited
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What are the Sources of Chronic Stress?: Part IX
Combining work and family roles:
work-life balance
women and multiple roles:
home and work responsibilities may conflict with one another, enhancing stress
© 2020 McGraw-Hill Education Limited
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What are the Sources of Chronic Stress?: Part X
Combining work and family roles
Protective effects of multiple roles:
some positive effects of combining home and work responsibilities
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Summary: Part I
Describe and define stress.
Events are perceived as stressful when people believe their resources are not sufficient to meet the harm, threat, or challenge.
Know the theories and models used to study stress.
Fight-or-flight, General Adaptation Syndrome, and the neuroendocrine bases of social response recent theories. Allostatic load impacts premature aging.
37
© 2020 McGraw-Hill Education Limited
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2

Summary: Part II
Understand what makes events stressful.
Cognitive appraisals impact perceived threat. Severe stressors may cause chronic problems.
Explain how stress is assessed.
Stressful life events, daily hassles, and chronic stress impact stress and health.
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© 2020 McGraw-Hill Education Limited
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Summary: Part III
Describe the sources of chronic stress.
Chronic stressors may have more impact on development of illness than major life events. Occupational stress and managing multiple roles are chronic stressors that increase chance of illness.
39
© 2020 McGraw-Hill Education Limited
5

Slides prepared by Krista K. Trobst, Ph.D.
York University
© 2020 McGraw-Hill Education Limited
CHAPTER 9

Patient-Provider Relations

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Learning Objectives
© 2020 McGraw-Hill Education Limited
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5
Define health care provider.
Explain why patient-provider communication is important.
Describe how to improve patient-provider communication.
Understand non-adherence and explain how it can be reduced.
Understand the placebo effect.

2

© 2020 McGraw-Hill Education Limited
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Vocabulary Parking lot
health care provider
Patient consumerism
Holistic health care
Patient-Centred Communication
Advanced-practice nurses:
RN
nurse-practitioners RN+
Telehealth (broad services)
Placebo Effect
Non- adherence
Complementary and alternative medicine (CAM)

Class Activity – 10 B
Define health care provider?
Explain why patient-provider communication is important?
– Understanding interaction patient- provider
– Detail information about patient situation
– Patient can detail of symtoms

4
© 2020 McGraw-Hill Education Limited
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Chapter 9 Flowchart
© 2020 McGraw-Hill Education Limited
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What is a Health Care Provider?
Not only physicians.
Advanced-practice nurses:
RN
nurse-practitioners RN+
Telehealth (broad services)
Physicians’ Assistants as providers:
perform a wide range of medical services
CAM Practitioners
© 2020 McGraw-Hill Education Limited
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Explain Why Patient-Provider Communication is Important: Part I
Judging quality of care:
we complain most about jargon, little feedback, and depersonalized care
most of us can’t judge the quality of our care based on its technical merits
instead we use the manner in which care is delivered as the criteria
empathic and caring delivery is judged as competent
7
© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part II
Patient consumerism:
patients have a desire to be involved in decisions that affect their health
increasing interest in establishing and maintaining good health
to convince a patient to follow a treatment plan requires the patient’s cooperation
patients often have considerable expertise about their health problems
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© 2020 McGraw-Hill Education Limited

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© 2020 McGraw-Hill Education Limited
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Patient consumerism—the practice, broadly speaking, of bypassing physicians when obtaining medical information, goods, and services—has been gaining ground for decades, with a giant boost from the Internet. The trend has advantages and challenges.

The goal of consumerism in healthcare is to lower costs and improve care quality; the theory is that if patients shop around for services they’ll …

Explain Why Patient-Provider Communication is Important: Part III
The Setting:
physician visits average 12-15 minutes
patient likely to be interrupted in first 23 seconds of dialogue
often poor correspondence between symptoms reported by patient and those recorded by the physician
things like pain and fever may present difficulties in clear communication and these difficulties in communicating are often enhanced due to anxiety or embarrassment
10
© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part IV
Structure of Health Care Delivery System:
primary health care providers, including physicians, are usually the first point of entry for individuals into our publicly funded health care system
primary health care facilitates and coordinates the provision of the services

© 2020 McGraw-Hill Education Limited
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Explain Why Patient-Provider Communication is Important: Part V
Structure of Health Care Delivery System (cont…):
many do not have a family physician
getting needed referrals to specialists difficult without family physician
many cannot see their doctor on the day they are sick or need medical care
some dissatisfaction with health care system drives people to use Complementary and Alternative Medicine
12
© 2020 McGraw-Hill Education Limited

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Figure 9.1 Access to Health Care in Canada and other Developed Countries, 2015
© 2020 McGraw-Hill Education Limited
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Explain Why Patient-Provider Communication is Important: Part IV
Changes in the philosophy of health care delivery:
physician’s role is changing
patients must assume more responsibility
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© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part V
Holistic health movement and health care:
health is a positive state to be actively achieved
Western medicine incorporating Eastern approaches
greater emotional contact between patient and provider
15
© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part VI
Provider behaviours that contribute to faulty communication: Barriers
– not listening
– use of jargon (professional word)
– baby talk
– elder-speak
– stereotypes of patients
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© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part VII
Patient contributions to faulty communication:
patient characteristics (e.g., anxiety, neuroticism)
patient knowledge
patient attitudes toward symptoms
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Explain Why Patient-Provider Communication is Important: Part VIII
Interactive aspects of the communication problem:
providers rarely receive feedback
when a patient doesn’t return for treatment:
the treatment may have led to a cure
the patient may have gotten worse and gone elsewhere
the treatment may have failed, but the patient got better anyway
the patient may have died
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© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part IX
Consequences of Poor Patient-Provider Communication:
patients with communication problems in delivery of their care at greater risk for experiencing multiple preventable adverse events
dissatisfied patients less likely to use medical services in the future and more likely to turn to CAM
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© 2020 McGraw-Hill Education Limited

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Explain Why Patient-Provider Communication is Important: Part X
Patient-Provider Communication and CAM use:
people using CAM expect collaborative and caring interaction and expect treatment to be delivered in a caring and empathic manner

© 2020 McGraw-Hill Education Limited
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Explain Why Patient-Provider Communication is Important: Part XI
Non-Disclosure of CAM use:
poor patient-provider communication may lead to non-disclosure of CAM use
disclosure of CAM critical for preventing harmful treatment and drug interactions
people do not disclose because they expect a negative reaction from the physician

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How Can We Improve Patient-Provider Communication
Patient-Centred Communication:
Training providers using the following interventions:
cognitive (teach effective communication)
behavioural (bedside practices)
psychological (provide individual feedback)
22
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Practitioner guidelines: How to improve adherence to treatment: Part I
© 2020 McGraw-Hill Education Limited
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Listen to the patient.
Repeat things, where feasible, and ask the patient to repeat what has to be done.
Give clear instructions on the exact treatment regimen, preferably in writing.
Make use of special reminder pill containers and calendars.
Call the patient if an appointment is missed.
Prescribe a self-care regimen in concert with the patient’s daily schedule.

Practitioner guidelines: How to improve adherence to treatment: Part II
© 2020 McGraw-Hill Education Limited
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Emphasize at each visit the importance of adherence, and acknowledge the patient’s efforts to adhere.
Involve the patient’s spouse or other partner.
Whenever possible, provide patients with instructions and advice at the start of the information to be presented, and stress how important they are.
Use short words and short sentences, and avoid medical jargon.
Use explicit categorization where possible (e.g., divide information clearly into categories of etiology, treatment, or prognosis).
When giving advice, make it as specific, detailed, and concrete as possible.

Practitioner guidelines: How to improve adherence to treatment: Part III
© 2020 McGraw-Hill Education Limited
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Find out what the patient’s worries are. Do not confine yourself merely to gathering objective medical information.
Find out what the patient’s expectations are. If they cannot be met, explain why.
Provide information about the diagnosis and the cause of the illness.
Adopt a friendly rather than a businesslike attitude.
Spend some time in conversation about non-medical topics.

Table 9.2 Why the Health Practitioner Can Be an Effective Agent of Behaviour Change
The health practitioner is a highly credible source with knowledge of medical issues. The health practitioner can make health messages simple and tailor them to the individual needs and vulnerabilities of each patient. The practitioner can help the patient decide to adhere by highlighting the advantages of treatment and the disadvantages of non-adherence.
The private face-to-face nature of the interaction provides an effective setting for holding attention, repeating and clarifying instructions, extracting commitments from a patient, and assessing sources of resistance to adherence.
The personal nature of the interaction enables a practitioner to establish referent power by communicating warmth and caring.
The health practitioner can enlist the cooperation of other family members in promoting adherence.
The health practitioner has the patient under at least partial surveillance and can monitor progress during subsequent visits.
© 2020 McGraw-Hill Education Limited
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How Can We Improve Patient-Provider Communication (cont.)
Patient-Centred Communication:
Training patients:
teaching patients skills for eliciting information from physicians
skills training

27
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Understand Non-Adherence and Explain How it Can Be Reduced: Part I
Nonadherence to treatment regimens:
patients do not adopt the behaviours and treatments their providers recommend
estimates range from 15% to 93% of patients do not heed their physician’s advice
52% don’t adhere with medications – nearly 10% don’t fill the prescription
© 2020 McGraw-Hill Education Limited
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© 2020 McGraw-Hill Education Limited
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Understand Non-Adherence and Explain How it Can Be Reduced: Part II
Measuring adherence to treatment regimens:
relies on retrospective recall and yields unreliable and artificially high estimates
creative non-adherence
Causes of adherence:
good communication
treatment regimen
30
© 2020 McGraw-Hill Education Limited

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Understand Non-Adherence and Explain How it Can Be Reduced: Part III
Reducing Non-Adherence:
use technical interventions such as simplifying the treatment regimen
break down advice into manageable subgoals

© 2020 McGraw-Hill Education Limited
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Table 9.3 Medical Outcomes Survey General Adherence Items
© 2020 McGraw-Hill Education Limited
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What is the Placebo Effect: Part I
Consider the following:
Inhaling a useless drug improved lung function in children with asthma by 33 percent.
People exposed to fake poison ivy developed rashes.
Forty-two percent of balding men taking a placebo maintained or increased their hair growth.
Sham knee surgery reduced pain as much as real surgery (Blakeslee, 1998).
© 2020 McGraw-Hill Education Limited
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What is the Placebo Effect?: Part II
Historical Perspective
In early medicine, treatments were often bizarre (many dangerous) and ineffective so any benefit or relief was inexplicable.
Placebo effect – the belief brings real change
© 2020 McGraw-Hill Education Limited
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What is the Placebo Effect?: Part III
What is a placebo?
Placebo – any medical procedure that produces an effect in a patient because of it’s therapeutic intent and not its specific nature, whether chemical or physical
Active treatments that produce “real” effects also have a placebo component
35
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part IV
What is a placebo?
Mechanism is not purely psychological (as stereotyped) but also expectation of success and hope
If real medication labelled “placebo” patients may also report less symptom relief
36
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part V
Provider behaviour and placebo effects:
Effectiveness of the placebo depends on how much the provider communicates believing in the curative effects
A provider voicing doubt can significantly decrease the placebo effect
© 2020 McGraw-Hill Education Limited
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What is the Placebo Effect?: Part VI
Patient-provider communication and placebo effects:
Good communication between patient and provider is as essential for placebo effects are for adherence
Also, when the provider explains the illness in a way that is understandable and satisfying and shows support and concern for the patient, this may restore the patient’s sense of control over the symptoms and facilitate healing (and the placebo effect)
38
© 2020 McGraw-Hill Education Limited

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What is the Placebo Effect?: Part VII
Patient characteristics and placebo effects:
There isn’t a placebo-prone personality, rather certain people may show stronger or weaker placebo effects in some situations but not others
When characteristics of treatment match patient’s disposition (e.g., spirituality)
When expectation of placebo response matches patient’s personality (e.g., optimism)
Anxious people experience stronger placebo effects but not so much about personality as due to the fact that they have greater anxiety symptoms to potentially be relieved
39
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part VIII
Contextual determinants of placebo effects:
The characteristics of the placebo and the setting also important
Medically formal settings show stronger effects
Provider expression of faith in treatment enhances placebo
Shape, size, colour, and taste of placebo “medication” have an effect such that the more it resembles actual medication the better
40
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part IX
Social norms and placebo effects:
Placebo effect facilitated by norms that surround treatment regimens – the expected way treatment will be enacted (e.g., faith in medications)
41
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part X
Generalizability of placebo effects:
Virtually any medical procedure can have placebo effects (e.g., medication, surgery, psychiatry)
Should not be thought of as a medical trick or psychological factor
42
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part XI
Respect the placebo effect:
Achieves success with otherwise ineffective treatments
Enhances the efficacy of treatments
Reduces pain and discomfort
So effective some suggest it be used instead of actual medication in some instances—shows some efficacy even when patients know it is a placebo
43
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part XII
Placebo as a methodological tool:
Placebo effect is so powerful that no drug can be marketed unless it has been evaluated against a placebo
44
© 2020 McGraw-Hill Education Limited

What is the Placebo Effect?: Part XIII
Standard method is double-blind experiment:
half of the patients are given medication and half are given a placebo
double-blind because neither the patient nor the researcher knows which the patient is receiving
difference between efficacy of drug over placebo is a measure of the drug’s effectiveness
45
© 2020 McGraw-Hill Education Limited

Summary: Part I
Define health care provider?
Canadians increasingly receiving health care from other types of health care providers such as nurse practitioners and CAM.
Explain why patient-provider communication is important?
Many factors impede patient-provider communication, and both provider and patient contribute to this. Lack of communication can lead to non-adherence and failure to disclose.

46
© 2020 McGraw-Hill Education Limited
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2

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Summary: Part II
Describe how to improve patient-provider communication.
Training in communication skills (patient-centred communication) are useful.
Understand non-adherence and explain how it can be reduced.
Many variables contribute to non-adherence but this can be improved when the patient feels cared for and receives clear, written instructions.

47
© 2020 McGraw-Hill Education Limited
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4

47

Summary: Part III
Understand the placebo effect.
Placebo effects are common and are enhanced when the physician endorses the treatment and the patient believes it will work.
48
© 2020 McGraw-Hill Education Limited
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48

Related Video
Placebo effect:

© 2020 McGraw-Hill Education Limited
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Slides prepared by Krista K. Trobst, Ph.D.
York University
© 2020 McGraw-Hill Education Limited
1
CHAPTER 10

Pain and its Management

1

Learning Objectives
Understand the significance of pain.
Explain why pain is difficult to study.
Identify the clinical issues in pain management.
Describe the techniques used to control pain.
Explain how chronic pain is managed.
© 2020 McGraw-Hill Education Limited
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1
2
3
4
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2

© 2020 McGraw-Hill Education Limited
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Learning Activity 11
Vocabulary parking-lot
Hypnosis
Hypnotherapy
Acupuncture
Biofeedback
Gate control theory of pain
Body-self neuromatrix
Polynorphins
Three kinds of pain perception:
mechanical nociception
thermal damage
polymodal nociception

© 2020 McGraw-Hill Education Limited
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Learning Activity 11
Vocabulary parking-lot
Chronic pain
Acute pain
Physiology of pain
A-delta fibers
A-beta fibres
C-fibers
Phantom Limb Pain
Beta-endorphins
Proenkephalin
Gate control theory of pain
body-self neuromatrix
Polynorphins
Three kinds of pain perception:
mechanical nociception
thermal damage
polymodal nociception

4

© 2020 McGraw-Hill Education Limited
5

Chapter 10 Flowchart
© 2020 McGraw-Hill Education Limited
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Introduction
Chronic pain is an epidemic burden
Approximately 20% of Canadians have chronic pain with higher rates after age 65
Back pain, migraines, and arthritis most common
Costs in health care utilization and lost productivity are approximately $10 billion/year
Pain management efforts have created an opioid epidemic
© 2020 McGraw-Hill Education Limited
7

What is the Significance of Pain?
Some pain is critical for survival as it provides feedback about the functioning of our bodies
Medical consequences:
pain is the symptom most likely to lead an individual to seek treatment and it often interferes with functioning.
pain has psychological significance, increasing depression and anxiety
chronic pain patients are at significantly higher risk of suicide
© 2020 McGraw-Hill Education Limited
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8

Why is Pain Difficult to Study?: Part I
pain is a psychological experience
pain is influenced by the context in which it is experienced
pain has a cultural component
there are gender differences in pain
ways of coping influence pain
© 2020 McGraw-Hill Education Limited
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9

Why is Pain Difficult to Study?: Part II
Measuring pain:
verbal reports
pain behaviour:
behaviour that arises as a manifestation of chronic pain
assesses how pain has disrupted the lives of patients
© 2020 McGraw-Hill Education Limited
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10

© 2020 McGraw-Hill Education Limited
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McGill Pain Questionnaire

Why is Pain Difficult to Study?: Part III
Physiology of pain:
pain and emotions greatly intertwined
pain is a protective mechanism
pain is accompanied by motivational and behavioural responses
© 2020 McGraw-Hill Education Limited
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Why is Pain Difficult to Study?: Part IV
Physiology of pain (cont.):
Three kinds of pain perception:
mechanical nociception: mechanical damage to body tissue
thermal damage: damage due to temperature exposure
polymodal nociception: pain triggers chemical reactions from tissue damage
© 2020 McGraw-Hill Education Limited
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Why is Pain Difficult to Study?: Part V
Physiology of pain (cont.):
Two major types of peripheral nerve fibers involved in pain:
A-delta fibers:
small, myelinated fibers that transmit sharp pain
C-fibers:
unmyelinated fibers that transmit dull, aching pain

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Table 10.1 Summary of Peripheral Nerve Fibres Involved in Nociception and Their Function in the Experience of Pain
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Peripheral Nerve Fibre Description Type of Pain Function Pain Gate Modulation
A-delta fibres Small, myelinated fibres Transmit first pain and sharp pain rapidly Affects sensory aspects of pain Opens gate
C-fibres Unmyelinated fibres Transmit secondary dull or aching pain Affects motivational and affective elements of pain Opens gate
A-beta fibres Large-diameter myelinated fibres Transmit information about vibration and position Concurrent stimulation can suppress pain transmitted by C-fibres Closes gate

Why is Pain Difficult to Study?: Part VI
Theories of Pain
Gate control theory:
neural “pain gate” that can open and close to modulate pain signals to the brain
physical, emotional, and cognitive factors contribute to the experience of pain by opening or closing the gate
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Table 10.2 Factors That Open or Close the Pain Gate
Type of Factor  Factors That Open the Gate Factors That Close the Gate
Physical Extent of injury
Inappropriate activity level Medications
Counter stimulation (e.g., massage, heat)
Emotional Anxiety or worry
Tension
Depression Positive emotions (e.g., joy, interest)
Relaxation
Cognitive Focusing on pain
Boredom Distraction or intense concentration on other things
Involvement and interest in life activities

Why is Pain Difficult to Study?: Part VII
Phantom Limb Pain
Immersive Virtual Reality: enables the viewer to see a complete representation of the body and movement engaging in several virtual tasks
Mirror box: which creates an illusion of the arm that is missing- increasing control over the phantom limb that is missing
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Why is Pain Difficult to Study?: Part VIII
Neuromatrix Theory of Pain
The body-self neuromatrix generates nerve impulses that are synthesized into a characterise pattern called neurosignature.
Each pain experience results in an experience that reflects a multitudes of sensory, emotional, cognitive factors
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The Neuromatrix Theory of Pain
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Why is Pain Difficult to Study?: Part IX
Neurochemical bases of pain and its inhibition:
Landmark study: D. V. Reynolds 1969 was able to demonstrate by stimulating an area of a rat’s brain that the brain can modulate the experience of pain by sending blocking messages through the spinal cord.
SPA: Stimulation-Produced Analgesia
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Why is Pain Difficult to Study?: Part X
Neurochemical bases of pain and its inhibition:
Akil, Mayer, and Liebeskind (1972, 1976) determined that the neurochemical basis of this effect is endogenous opioids:
Three types:
Beta-endorphins
Proenkephalin,
Polynorphins
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What are the Clinical Issues in Pain Management? Part I
Acute and chronic pain:
acute pain usually results from injury
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What are the Clinical Issues in Pain Management?: Part II
Chronic pain usually begins as an acute episode but does not decrease with the passage of time
Three types of chronic pain:
chronic benign pain
recurrent acute pain
chronic progressive pain

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What are the Clinical Issues in Pain Management?: Part III
Acute vs. chronic pain:
present different psychological profiles as chronic pain often brings psychological distress and depression
chronic pain patients develop maladaptive coping strategies (e.g., wishful thinking, social withdrawal)
pain techniques work with acute but not chronic pain
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What are the Clinical Issues in Pain Management?: Part IV
Acute vs. chronic pain:
chronic pain involves a complex interaction of physiological, psychological, social and behavioural components
chronic pain also often has widespread effects on not only the individual but also their families and society
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What are the Clinical Issues in Pain Management?: Part V
Who becomes a chronic pain patient?
acute pain patients and patients for whom pain interferes with life activities
Lifestyle of chronic pain:
disruption of a person’s life
some receive compensation for their pain
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What are the Clinical Issues in Pain Management?: Part VI
The toll of pain on relationships:
affects marriage and other family relationships
social relationships can be threatened
many patients are clinically depressed and contemplate suicide
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What are the Clinical Issues in Pain Management?: Part VII
Pain and personality:
pain-prone personality:
a constellation of personality traits that predispose a person to experience chronic pain
anxiety disorders, substance use disorders and other psychiatric problems often co-occur with chronic pain
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What are the Clinical Issues in Pain Management?: Part VIII
Pain profiles:
the “neurotic triad”: MMPI profiles in which the first three scales are all elevated (Depression, Hysteria, and Hypochondriasis). Seen in highly neurotic individuals.
This is a common profile among individuals with chronic pain which historically was taken as evidence that it is neurotic individuals who develop chronic pain.
We now know that these elevations often develop after the onset of chronic pain rather than being precursors.
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What Techniques Are Used to Control Pain?: Part I
Pharmacological control of pain:
NSAIDS
opioids (e.g., OxyContin)
local anesthetics
spinal blocking agents
antidepressants
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What Techniques Are Used to Control Pain?: Part II
Surgical control of pain:
cutting or creating lesions in the so-called pain fibers at various points in the body
Sensory control of pain:
counterirritation:
inhibiting pain in one part of the body by stimulating or mildly irritating another area
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What Techniques Are Used to Control Pain?: Part III
Biofeedback:
a method of achieving control over bodily processes
used to treat chronic disorders such as, temporomandibular joint pain, hypertension and a broad array of pains
Does Biofeedback work?
only modest efficacy in reducing pain
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What Techniques Are Used to Control Pain?: Part IV
Relaxation techniques:
enable patients to cope with stress, anxiety, reducing pain
What is relaxation?
shifting the body into a state of low arousal
controlled breathing and meditation
Does relaxation work?
distinct from placebos and activate higher-order brain regions
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What Techniques Are Used to Control Pain? Part V
Hypnosis:
one of the oldest techniques for pain
How does hypnosis work?
relaxation and suggestion
Hypnotherapy has successfully controlled:
irritable bowel syndrome, acute pain due to surgery, childbirth, dental procedures, burns, headaches and medical procedures
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What Techniques Are Used to Control Pain?: Part VI
Acupuncture:
– developed in China over 2,000 years ago
– long, thin needles are inserted into designated areas of the body
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What Techniques Are Used to Control Pain?: Part VII
Acupuncture:
How does acupuncture work?
not really known, although may be due to:
counterirritation
preparation reduces fear and increases tolerance of pain
release of endorphins
reduces post-operative knee pain and cancer pain
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What Techniques Are Used to Control Pain?: Part VIII
Distraction:
focusing attention on an irrelevant and attention-getting stimulus in order to reduce pain
focus directly on the events but reinterpret the experience
Does distraction work?
is effective but most useful in conjunction with other techniques
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What Techniques Are Used to Control Pain?: Part IX
Coping techniques:
increasingly used to help chronic pain patients manage pain
e.g., some CBT techniques, focus on sensory aspects of the pain sensation and not the pain itself, active coping skills, expressive writing
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What Techniques Are Used to Control Pain?: Part X
Guided imagery:
imagine a picture that brings one happiness during the painful experience
induced relaxation can control slow-rising pains
some patients rouse themselves by imagining a combative, action-filled scene
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What Techniques Are Used to Control Pain?: Part XI
Cognitive-Behavioural Therapy:
– re-conceptualize the problem
– expect that this training will be successful
– re-conceptualize patient’s own role
– monitor thoughts, feeling and behaviors
– teach adaptive responses
– attribute success to patient’s own efforts
– prevent relapse
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How is Chronic Pain Managed?: Part I
Pain management programs:
Initial evaluation:
perform a qualitative and quantitative assessment of pain
explore how the patient has coped with the pain in the past
evaluate patient for emotional and mental functioning
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How is Chronic Pain Managed?: Part II
Individualized treatment:
use profile of patient pain
Components of chronic pain management programs :
education, training and group therapy
involvement of family
evaluation of pain management program
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Summary: Part I
Understand the significance of pain.
Pain leads people to seek medical attention.
Explain why pain is difficult to study.
Subjective, and results from physical, emotional, and cognitive factors.
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Summary: Part II
Identify the clinical issues in pain management.
1.5 million Canadians suffer from chronic pain that disrupts their lives. Psychological pain profiles can be helpful in determining management.
Describe the techniques used to control pain.
Pharmacologic, surgical, and sensory stimulation techniques used most often. Psychological techniques also successfully used (biofeedback, relaxation, hypnosis, etc.)
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Summary: Part III
Explain how chronic pain is managed.
Coordinated pain management programs used to create a biopsychosocial approach to pain.
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Related Videos
Phantom limb pain
https
://
www.youtube.com/watch?v=2ojt26LFL_o

Neuromatrix Theory of Pain
https
://www.youtube.com/watch?v=oQLFfvGM7nI
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Slides prepared by Krista K. Trobst, Ph.D.
York University
© 2020 McGraw-Hill Education Limited
CHAPTER 5
Health-Compromising
Behaviours

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Learning Objectives
Identify the characteristics of health-compromising behaviours.
Describe and define substance use disorder.
Understand how alcohol use disorder and problem drinking compromise health.
Explain how smoking is harmful for health and what factors influence smoking.
Describe eating disorders.
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Introduction Chapter Flowchart
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What are the Characteristics of Health-Compromising Behaviours?: Part I

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What are the Characteristics of Health-Compromising Behaviours?: Part I
Many of these behaviours share a window of vulnerability in adolescence:
drinking to excess
smoking
using illicit drugs
having unsafe sex
engaging in risk-taking behaviours
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What are the Characteristics of Health-Compromising Behaviours?: Part II
behaviours are tied to the peer culture
image of these behaviours as “cool”
behaviours, though dangerous, are pleasurable
problem develops gradually
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Remember in Chapter 4 the discussion of tanning.
Problem with the lack of sunscreen Use: Tans are perceived as attractive and adolescents and young adults are especially concerned with appearance. For this reason, they will engage in health-compromising behaviours.

What are the Characteristics of Health-Compromising Behaviours?: Part III
substance abuse of all kinds is predicted by some of the same factors
most problem behaviours more common in lower social-class individuals, associated with health attitudes
development of eating disorders
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Remember in Chapter 4 the discussion of tanning.
Problem with the lack of sunscreen Use: Tans are perceived as attractive and adolescents and young adults are especially concerned with appearance. For this reason, they will engage in health-compromising behaviours.

What is Substance Use Disorder?: Part I
Arises when a substance is used repeatedly and causes functional or clinical impairment
Three criteria:
Risky use refers to continuing to use a substance despite experiencing problems associated with it
Impaired control involves using a substance in greater quantities or more frequently than intended—associated with craving – a powerful urge to use a substance
Social impairments involve failure to meet obligations (social, recreational, or occupational)
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What is Substance Use Disorder?: Part II
Pharmacological Effects Criteria
Physical dependence:
Tolerance
Addiction:
Withdrawal
Psychoactive substances
Illicit Drug Use
DSM-5

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What is Substance Use Disorder?: Part II
Pharmacological Effects Criteria:
Physical dependence:
body adjusts to substance and incorporates its use into normal functioning of the body’s tissues
Tolerance:
larger doses needed to produce same effects

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What is Substance Use Disorder?: Part III
Pharmacological Effects Criteria (cont…):
Addiction:
person has become physically or psychologically dependent on a substance following use over a period of time
Withdrawal:
unpleasant symptoms, both physical and psychological, that people experience when they stop using a substance on which they have become dependent
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What is Substance Use Disorder?: Part IV
Costs of substance use disorder are substantial:
Health care resources
Law enforcement
Loss of productivity at work and home
Death
Disability
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What is Substance Use Disorder?: Part V
Harm-Reduction:
Public health response to substance misuse that focuses on the risks and consequences rather than the use itself
Model guiding Canada’s national drug strategy
Philosophy that completely eliminating substance use in society is unrealistic
Promotes safe substance use
Methadone maintenance
Needle exchange programs
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Figure 5.1 Percentage of people reporting cannabis use aged 15 years or older in Canada, first quarter 2018 and first quarter 2019
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What is Substance Use Disorder?: Part VI
Illicit Drug Use:
In Canada, 15% of population used illicit drug at least once in 2016
Three classes of illicit drugs:
Opiates (e.g., oxycontin, heroin)
Cocaine
Amphetamines (e.g., meth, ecstasy)
Psychoactive substances – affect cognitive and affective processes and change how a person behaves.
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What is Substance Use Disorder?: Part VII
Illicit Drug Use (cont…):
misuse of prescription opioids a public health crisis
Canada second only to US in scope of the problem
Use increased > 200% between 2000 and 2010 as has emergency room visits related to their use
Over 3000 Canadians died of opioid overdose between January and September 2018
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What is Substance Use Disorder?: Part VII
Consequences of Illicit Drug Use:
Legal and economic issues
Physical problems (e.g., lung damage, nasal damage, infection, HIV)
Stimulants increase heart rate and blood pressure and increase risk for heart attack and stroke
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What is Substance Use Disorder?: Part VIII
Consequences of Illicit Drug Use:
Short-term mental health problems such as anxiety and confusion
Long-term mental health problems such as personality and memory changes
Lowers inhibitions and increases engagement in risky behaviours
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Figure 5.2 Percentage Distribution of People in Treatment by Primary Drug Type, by Region and Share of First-Time Entrants for Each Drug Type

How does Alcohol Use Disorder Compromise Health?: Part I
Scope of the problem:
third leading cause of preventable death
alcohol consumption is linked to more than 200 diseases, including high blood pressure, stroke, cirrhosis of the liver, fetal alcohol syndrome and some cancers
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How does Alcohol Use Disorder Compromise Health?: Part II
Scope of the problem:
A large proportion of traffic-related deaths are related to alcohol
Through disinhibition alcohol use is also associated with many homicides, suicides, and assaults
many drinkers keep their problem hidden
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How does Alcohol Use Disorder Compromise Health?: Part III
Medical diagnosis of Alcohol Use Disorder (AUD) when problem drinking becomes severe but not related to use alone.
Four categories of criteria in DSM-5:
Risky drinking
Impaired control
Social impairment
Pharmacological effects
Total of 11 criteria, only need 2 to meet AUD criteria

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How does Alcohol Use Disorder Compromise Health?: Part IV
Origins of alcoholism and problem drinking:
genetic (50% of vulnerabilities)
gender – more men but gender gap is narrowing
physiological, behavioural and sociocultural factors are involved
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At this point, it is possible to preview Chapter 7, Moderators of the Stress Experience. In the discussion of Coping with Stress, Taylor et al. brings up the topic of Personality and Coping. One of the topics described is that of Psychological Control. Perceived control is the belief that one can determine one’s own behaviour, influence one’s environment, and bring about desired outcomes. It is closely related to self-efficacy. The East German migrants who found that they could not find work in West Germany often turned to alcohol for solace unless they had high feelings of self-efficacy. This is discussed in Chapter 7.

How does Alcohol Use Disorder Compromise Health?: Part V
Drinking and stress:
drinking buffers stress
many start drinking to enhance positive emotions and decrease negative ones
Individuals with more stress and less social support are more likely to become problem drinkers
AUD typically co-occurs with anxiety and/or depression
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At this point, it is possible to preview Chapter 7, Moderators of the Stress Experience. In the discussion of Coping with Stress, Taylor et al. brings up the topic of Personality and Coping. One of the topics described is that of Psychological Control. Perceived control is the belief that one can determine one’s own behaviour, influence one’s environment, and bring about desired outcomes. It is closely related to self-efficacy. The East German migrants who found that they could not find work in West Germany often turned to alcohol for solace unless they had high feelings of self-efficacy. This is discussed in Chapter 7.

How does Alcohol Use Disorder Compromise Health?: Part VI
Social origins of drinking:
AUD tied to social and cultural environment
Two periods of enhanced vulnerability:
dependence starting in adolescence when brain is more vulnerable to reward circuitry which can diminish the ability to control alcohol use
late middle age to cope with stress
Depression and alcohol use linked and likely bidirectional
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At this point, it is possible to preview Chapter 7, Moderators of the Stress Experience. In the discussion of Coping with Stress, Taylor et al. brings up the topic of Personality and Coping. One of the topics described is that of Psychological Control. Perceived control is the belief that one can determine one’s own behaviour, influence one’s environment, and bring about desired outcomes. It is closely related to self-efficacy. The East German migrants who found that they could not find work in West Germany often turned to alcohol for solace unless they had high feelings of self-efficacy. This is discussed in Chapter 7.

How does Alcohol Use Disorder Compromise Health?: Part VII
Treatment of alcohol abuse:
was once seen as intractable problem
alcohol abuse can be modified successfully
some use of cognitive-behavioural modification
preliminary evidence online CBT may have efficacy
without employment or social support, prospects for recovery are dim
some “age out” and stop drinking in later life
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How does Alcohol Use Disorder Compromise Health?: Part VIII
Treatment programs:
self-help groups such as AA (Alcoholics Anonymous)
inpatient/outpatient programs
detoxification – requires medical supervision
short-term, inpatient therapy
continuing outpatient treatment
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How does Alcohol Use Disorder Compromise Health?: Part IX
Treatment programs (cont.):
Cognitive-behavioural treatments:
self-monitoring, contingency contracting
motivational enhancement
medications
stress management techniques
family therapy and group counseling
Relapse prevention a major difficulty
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© 2020 McGraw-Hill Education Limited
Table 5.1 Patterns of Hazardous or Harmful Drinking among Canadian Undergraduates
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© 2020 McGraw-Hill Education Limited
Table 5.2 Percentage of Students Who Reported Binge Drinking at a Campus Event During a One-Month Period
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© 2020 McGraw-Hill Education Limited
Table 5.3 Alcohol-Related Problems of University Students Who Had a Drink During a One-Year Period
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How does Alcohol Use Disorder Compromise Health?: Part X
Evaluation of alcohol treatment programs:
success involves environmental factors, outpatient services, family/social support
Minimal interventions:
can make a dent in drinking-related problems
social engineering
banning alcohol advertising
raising the legal drinking age
strictly penalizing drunk driving
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How does Alcohol Use Disorder Compromise Health?: Part XI
Can recovered alcoholics ever drink again?
Alcoholics Anonymous philosophy:
An alcoholic is an alcoholic for life
Moderation Management (MM):
goal setting, self-monitoring, and self-control of drinking
most effective with less heavy drinkers
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How does Alcohol Use Disorder Compromise Health?: Part XII
Preventive approaches to alcohol abuse:
appealing to adolescents to avoid drinking
social engineering programs (increase taxes, restrict advertising, educational programs)
beundrunk.com promotes responsible drinking by Manitoba Liquor Control Commission
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How does Alcohol Use Disorder Compromise Health?: Part XIII
Drinking and driving:
pressure municipal and provincial governments for tougher alcohol control measures
hosts/hostesses/friends intervening to recognize those too drunk to drive
need for stiffer penalties
designated drivers
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How does Alcohol Use Disorder Compromise Health?: Part XIV
Modest alcohol intake adds to a long life:
reduced risk of heart attack
lower blood pressure
increase in HDL (“good” cholesterol)
fewer strokes
Moderate drinking among younger adults may enhance risks of death, probably due to alcohol-related injuries
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How is Smoking Harmful for Health and What Factors Influence Smoking?: Part I
leading cause of premature death in Canada
increases the risk of many diseases and disorders
smokers are generally less health-conscious than non-smokers
dangers not confined to the smoker; hazards of secondhand smoke
may lower cognitive performance in adolescents
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Table 5.4 Premature deaths caused by smoking and exposure to secondhand smoke, 1965-2014

How is Smoking Harmful for Health and What Factors Influence Smoking?: Part II
Synergistic effects of smoking:
smoking enhances the impact of other risk factors in compromising health:
smoking and stress, increased weight and less exercise, breast cancer, depression, and anxiety
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© 2020 McGraw-Hill Education Limited
Figure 5.3 Percentage of Never and Ever Smokers, Aged 15+, Canada (1999 – 2012)
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A Brief History of the Smoking Problem
For years, smoking was considered to be a sophisticated and manly habit
19th & 20th century often depicted men retiring to the drawing room after dinner for cigars
20th century – advertisement built on this image
By 1965, 61% of the adult male population in Canada was smoking
© 2020 McGraw-Hill Education Limited
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A Brief History of the Smoking Problem (cont….)
1962 – report of the Royal College of Physicians of the UK concluded that cigarette smoke may be an important cause of lung cancer
1963 – Minister of Heath in the Canadian House of Commons announced smoking was linked to cancer
1964 – surgeon general’s warning included extensive publicity campaign to high light the dangers of smoking
© 2020 McGraw-Hill Education Limited
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© 2020 McGraw-Hill Education Limited
Table 5.5 Smoking Status by Age Group and Sex, Aged 15+ Years, Canada (2012)
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Why do people smoke?

How can you prevent smoking
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Why do people smoke?
Genetics: smoking runs in families
Factors associated with smoking in adolescents:
peer and family influences
weight control
self-image
mood
nicotine addiction
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© 2020 McGraw-Hill Education Limited
Table 5.6 Health Beliefs and Attitudes by Smoking Status, Youth Grades 5 to 9, Canada (2004 – 2005)
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© 2020 McGraw-Hill Education Limited
Figure 5.4 Teenage Smoking
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Interventions to Reduce Smoking
Changing attitudes toward smoking
the therapeutic approach to the smoking problem:
nicotine replacement therapy
multimodal interventions
social support and stress management
maintenance
relapse prevention
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Harm-Reduction Approaches to Smoking
nicotine replacement (patch, gum)
pharmaceutical nicotine
smokeless cigarettes
electronic cigarettes (vaping)

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Smoking Prevention: Part I
Advantages of smoking prevention programs:
potentially effective, cost-effective and easily implemented
Social influence interventions:
modelling
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Smoking Prevention: Part II
Social Influence Interventions
Three components:
Information about the negative effects of smoking constructed to appeal to adolescents.
Materials are developed to convey a positive image of the non-smoker as independent and self-reliant.
The peer group is used to reinforce not smoking rather than smoking.
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Smoking Prevention: Part III
Social Influence Interventions
Hard to know if these programs work:
Learn to turn down cigarettes but may not do so
Might delay smoking without reducing overall rates
Difficult to validate self-reports of smoking
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Smoking Prevention: Part IV
The life-skills training approach:
encourage self-esteem and coping enhancement as well as social skills in adolescents
has shown success in the reduction of smoking onset over time but the data is mixed
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Social Engineering and Smoking
restrict smoking to particular places
regulation of access of tobacco by the Food and Drug Administration
heavy taxation

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Figure 5.5 Percentage of Non-Smokers Exposed to Second-Hand Smoke at Home by Age (2011)
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What are Eating Disorders?: Part I
Anorexia Nervosa:
an obsessive disorder amounting to self-starvation
dieting and exercising to the point that body weight is grossly below optimum level
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What are Eating Disorders?: Part II
Developing Anorexia Nervosa:
genes
disruption in serotonin, dopamine and estrogen systems which are implicated in both anxiety and food intake
environmental risks (e.g., stress)
behavioural manifestations

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What are Eating Disorders?: Part III
Anorexia Nervosa (cont.):
Treating Anorexia:
bring weight to safe level
family therapy
prevention
stressing the health risks of eating disorders
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What are Eating Disorders?: Part IV
Bulimia:
an eating syndrome characterized by alternating cycles of binge eating and purging through such techniques as vomiting, laxative abuse, extreme dieting and drug or alcohol abuse
Developing Bulimia?
food becomes a constant thought
overvaluing body appearance
symptoms of depression
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What are Eating Disorders?: Part V
Treating Bulimia:
convince bulimics that the disorder threatens their health and that psychological interventions can help
combine medication and cognitive-behavioural therapy
use other behavioural treatments
use relapse prevention techniques
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Summary: Part I
Identify characteristics of health-compromising behaviours.
Those that threaten or undermine good health in present or the future. Many of these behaviours begin in adolescence.
Describe and define substance use disorder.
It occurs when an individual’s recurrent use of a substance causes clinically and/or functionally significant impairment or psychological distress.
© 2020 McGraw-Hill Education Limited
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2
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Summary: Part II
Understand how alcohol use disorder and problem drinking compromise health.
Accounts for multiple deaths
Has a genetic component
Creates a range of behaviour problems
Tied to socio-economic status
Buffers stress
Treatment efficacy for cognitive behavioural approaches.
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Summary: Part III
Explain how smoking is harmful for health and what factors influence smoking.
Account for more than 45000 deaths in Canada, although attitudes are changing, smoking highly resistant to change.
Describe eating disorders.
Anorexia and bulimia involve an obsession with weight control.
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Slides prepared by Krista K. Trobst, Ph.D.
York University
© 2020 McGraw-Hill Education Limited
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CHAPTER 12

PSYCHOLOGICAL ISSUES IN ADVANCING AND TERMINAL ILLNESS

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Learning Objectives
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Describe how death differs across the lifespan.
Know the psychological issues in advancing illness.
Identify the stages in adjustment to dying.
Understand the concerns in the psychological management of the terminally ill.
Describe the alternatives to hospital care for the terminally ill.
© 2020 McGraw-Hill Education Limited
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Learning Activity 12 B
Vocabulary Parking-Lot
Terminal illness
Thanatologists
Life expectancy – Canada – 78 -80 yrs China – 76 yrs, Japan – 84yr, India – 69, Korea – 83, Africa – 75yrs, Europe – 79, Abrabian – 75yrs, USA – 79
Sudden Infant Death Syndrome (SIDS):
Euthanasia
Kϋbler-Ross’s 5 stages of adjustment to death
Palliative care
Hospice care
Home care

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Chapter 12 Flowchart
© 2020 McGraw-Hill Education Limited
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How Does Death Differ Across the Lifespan?: Part I
100 years ago people died primarily of infectious diseases like pneumonia, influenza, and tuberculosis
Now most die from chronic or terminal illness
Life extectancy in Canada is 84 for women and 80 for men—longer than for most other developed countries
© 2020 McGraw-Hill Education Limited
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© 2020 McGraw-Hill Education Limited
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Rank and Cause Number of Deaths
Malignant neoplasms (cancer) 79 084
Diseases of heart (heart disease) 51 396
Cerebrovascular diseases (stroke) 13 551
Accidents (unintentional injuries) 12 524
Chronic lower respiratory diseases  12 293
Diabetes mellitus (diabetes) 6838
Alzheimer’s disease 6521
Influenza and pneumonia 6235
Intentional self-harm (suicide) 3978
Chronic liver disease and cirrhosis 3385

Deaths: Ten Leading Causes in Canada, All Ages, 2016

How Does Death Differ Across the Lifespan?: Part II
Death in infancy or childhood:
Canada infant mortality rate is high (4.5 per 1,000) compared to many developed countries
Mortality rate associated with socio-economic status
1996 the rates of infant mortality in Canada were close to Sweden rates 4.0 per 1,000
© 2020 McGraw-Hill Education Limited
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How Does Death Differ Across the Lifespan?: Part III
Sudden Infant (0-2yrs) Death Syndrome (SIDS):
causes are not entirely known
infant simply stops breathing
gentle death for child
enormous psychological toll for parents
sleeping position has been reliably related to SIDS
© 2020 McGraw-Hill Education Limited
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How Does Death Differ Across the Lifespan?: Part IV
Causes of death:
Death between ages 1 to 15 years
#1 cause of death is accidents, drowning, poisoning, injuries, falls, and motor vehicle accidents (42% of deaths)
#2 cause of death is cancer (especially leukemia)
Both of these causes are on the decline
© 2020 McGraw-Hill Education Limited
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How Does Death Differ Across the Lifespan?: Part V
Children’s understanding of death:
young children (< 5 years) associate death with sleep, not as something final and irreversible children 5-9 years understand it’s final, but do not understand biological death at ages 9 or 10, death is seen as universal and inevitable © 2020 McGraw-Hill Education Limited 10 10 How Does Death Differ Across the Lifespan?: Part VI Death in young adulthood: For those aged 15 to 24, death is due to: #1 unintentional injury (car accidents) #2 suicide #3 cancer #4 homicide © 2020 McGraw-Hill Education Limited 11 11 How Does Death Differ Across the Lifespan?: Part VII Reactions to young adult death: death of a young adult is considered tragic young adults feel shock, outrage and an acute sense of injustice medical staff often find this group difficult to work with © 2020 McGraw-Hill Education Limited 12 12 How Does Death Differ Across the Lifespan?: Part VIII Death in middle age: death becomes more common and often more fearful as mortality becomes more feasible people develop chronic illnesses that ultimately kill them © 2020 McGraw-Hill Education Limited 13 13 How Does Death Differ Across the Lifespan?: Part IX Premature death: death before the projected age of 81 usually occurs due to heart attack or stroke lifestyle issues often contribute most people say they would prefer a sudden, painless, non-mutilating death © 2020 McGraw-Hill Education Limited 14 14 How Does Death Differ Across the Lifespan?: Part X Death in old age: dying is not easy, but it may be easier in old age initial preparations may have been made some friends and relatives have died may have come to terms with issues typically die of degenerative diseases psychosocial factors predict declines in health © 2020 McGraw-Hill Education Limited 15 15 What Are the Psychological Issues in Advancing Illness?: Part I Continued treatment and advancing illness: treatments may have debilitating side effects patients find themselves repeated objects of surgical or chemical therapy © 2020 McGraw-Hill Education Limited 16 16 What Are the Psychological Issues in Advancing Illness?: Part II What is a Good Death?: free from avoidable suffering Ten core themes: © 2020 McGraw-Hill Education Limited 17 Pain free Positive relationship with provider Religiosity/spirituality Quality of life Treatment preferences Emotional wellbeing Dignity Sense of life completion Family Preferences for the dying process 17 What are the Psychological Issues in Advancing Illness? Part III Continued treatment and advancing illness: Is there a right to die? Historically tremendously controversial and largely illegal (for patient, but more importantly for whomever assisted) 2015 Supreme Court of Canada ruled that physicians may aid competent patients with grievous, enduring, and terminal pain in ending their lives Still illegal in most countries © 2020 McGraw-Hill Education Limited 18 18 What Are the Psychological Issues in Advancing Illness?: Part IV Moral and legal issues: Euthanasia: assist death Ending the life of a person with a painful terminal illness Advance care directives (living will): A request that extraordinary life-sustaining procedures not be used if person is unable to make this decision on his/her own © 2020 McGraw-Hill Education Limited 19 Gloria Taylor, first to win legal right to die 19 © 2020 McGraw-Hill Education Limited 20 A Letter to My Physician Concerning my Decision about Physician Aid-in-Dying What Are the Psychological Issues in Advancing Illness?: Part V Psychological and social issues related to dying: Changes in the patient’s self-concept: difficulty maintaining control of biological functions mental regression, inability to concentrate Issues of social interaction: fear that their condition will upset visitors withdrawal for fear of depressing others and fear of becoming an emotional burden © 2020 McGraw-Hill Education Limited 21 21 What Are the Psychological Issues in Advancing Illness?: Part VI Communication issues: many people feel it is proper to avoid the topic medical staff, family and patient may believe that others don’t want to discuss death © 2020 McGraw-Hill Education Limited 22 22 Are There Stages in Adjustment to Dying?: Part I Kϋbler-Ross’s 5 stages of adjustment to death: Denial: a mistake must have been made; test results were mixed up Anger: Why me? Why not him? Or her? Bargaining: a pact with God, good works for more time or for health Depression: a time of “anticipatory grief” Acceptance: tired, peaceful (not always pleasant), calm descends © 2020 McGraw-Hill Education Limited 23 23 Are There Stages in Adjustment to Dying?: Part II Differing evaluations of Kϋbler-Ross’s theory: her work is invaluable her work has not identified stages of dying: there is not a predetermined order some patients never go through a particular “stage” her work does not fully acknowledge the importance of anxiety © 2020 McGraw-Hill Education Limited 24 24 What are the Concerns in the Psychological Management of the Terminally Ill?: Part I Medical staff and the terminally ill patient: The significance of hospital staff to the patient: dying need help for simple things, such as brushing teeth or turning over they assist with pain management they are the patient’s source of realistic information they are privy to a most personal and private act—dying © 2020 McGraw-Hill Education Limited 25 25 What are the Concerns in the Psychological Management of the Terminally Ill?: Part II Risks of terminal care for staff: emotionally and physically draining for hospital staff they provide palliative care, care designed to make the patient comfortable, rather than curative care, care designed to cure the patient’s disease © 2020 McGraw-Hill Education Limited 26 26 What are the Concerns in the Psychological Management of the Terminally Ill?: Part III Achieving an appropriate death: Avery Weisman’s goals for the staff caring for the dying: informed consent safe conduct significant survival anticipatory grief timely and appropriate death © 2020 McGraw-Hill Education Limited 27 27 What are the Concerns in the Psychological Management of the Terminally Ill?: Part IV Individual counseling with the terminally ill: therapy for dying patients is becoming an increasingly available and utilized option thanatologists, those who study death and dying, suggest behavioural and cognitive-behavioural therapies - clinical thanatology involves symbolic immortality © 2020 McGraw-Hill Education Limited 28 28 What are the Concerns in the Psychological Management of the Terminally Ill? Part V Family therapy with the terminally ill: family and patient may have different ways of adjusting to the illness The management of terminal illness in children: most stressful of all terminal care hardest to accept and psychologically painful family may need counselling as well © 2020 McGraw-Hill Education Limited 29 29 What are the Concerns in the Psychological Management of the Terminally Ill? Part VI The adult survivor—little to do but grieve. grief: psychological response to bereavement feeling of hollowness preoccupation with image of deceased person expressions of hostility towards others guilt over death Most widows and widowers are resilient to their loss. © 2020 McGraw-Hill Education Limited 30 30 What are the Concerns in the Psychological Management of the Terminally Ill? Part VII The child survivor: may expect the dead person to return may believe a parent left because the child was “bad” may feel “responsible” for a sibling’s death © 2020 McGraw-Hill Education Limited 31 31 What Are the Alternatives to Hospital Care for the Terminally Ill? Part I Hospice care: designed to provide palliative care and emotional support to dying patients and their families may be provided in the home, but commonly provided in free-standing or hospital-affiliated units called hospices oriented toward improving a patient’s social support system © 2020 McGraw-Hill Education Limited 32 32 The role of Hospice Palliative Care in End-of-Life Care © 2020 McGraw-Hill Education Limited 33 What Are the Alternatives to Hospital Care for the Terminally Ill?: Part II Home care: care for dying patients in the home choice of care for many terminally ill patients psychological factors are legitimate reasons for home care very stressful for family members, especially primary caregiver © 2020 McGraw-Hill Education Limited 34 34 Summary: Part I Describe how death differs across the lifespan. Causes differ over the life cycle and concepts of death change over the life cycle. Know the psychological issues in advancing illness. Treatment-related discomfort and decisions to continue treatment; advanced care directives. Patients’ self-concept continually changing. © 2020 McGraw-Hill Education Limited 35 1 2 Summary: Part II Identify the stages in adjustment to dying. Kϋbler-Ross’s theory of dying suggest 5 stages but not all go through these in sequence. Understand the concerns in the psychological management of the terminally ill. Medical staff responsible for most care. Psychological counselling needed for patient and family members, especially children. © 2020 McGraw-Hill Education Limited 36 3 4 Summary: Part III Describe the alternatives to hospital care for the terminally ill. Hospice care and home care alternatives have beneficial psychological effects on dying patients and their survivors. © 2020 McGraw-Hill Education Limited 37 5 Slides prepared by Krista K. Trobst, Ph.D. York University © 2020 McGraw-Hill Education Limited 1 CHAPTER 12 PSYCHOLOGICAL ISSUES IN ADVANCING AND TERMINAL ILLNESS 1 Learning Objectives 1 2 3 4 5 Describe how death differs across the lifespan. Know the psychological issues in advancing illness. Identify the stages in adjustment to dying. Understand the concerns in the psychological management of the terminally ill. Describe the alternatives to hospital care for the terminally ill. © 2020 McGraw-Hill Education Limited 2 2 Learning Activity 12 B Vocabulary Parking-Lot Terminal illness Thanatologists Life expectancy – Canada – 78 -80 yrs China – 76 yrs, Japan – 84yr, India – 69, Korea – 83, Africa – 75yrs, Europe – 79, Abrabian – 75yrs, USA – 79 Sudden Infant Death Syndrome (SIDS): Euthanasia Kϋbler-Ross’s 5 stages of adjustment to death Palliative care Hospice care Home care © 2020 McGraw-Hill Education Limited 3 Chapter 12 Flowchart © 2020 McGraw-Hill Education Limited 4 How Does Death Differ Across the Lifespan?: Part I 100 years ago people died primarily of infectious diseases like pneumonia, influenza, and tuberculosis Now most die from chronic or terminal illness Life extectancy in Canada is 84 for women and 80 for men—longer than for most other developed countries © 2020 McGraw-Hill Education Limited 5 © 2020 McGraw-Hill Education Limited 6 Rank and Cause Number of Deaths Malignant neoplasms (cancer) 79 084 Diseases of heart (heart disease) 51 396 Cerebrovascular diseases (stroke) 13 551 Accidents (unintentional injuries) 12 524 Chronic lower respiratory diseases  12 293 Diabetes mellitus (diabetes) 6838 Alzheimer’s disease 6521 Influenza and pneumonia 6235 Intentional self-harm (suicide) 3978 Chronic liver disease and cirrhosis 3385 Deaths: Ten Leading Causes in Canada, All Ages, 2016 How Does Death Differ Across the Lifespan?: Part II Death in infancy or childhood: Canada infant mortality rate is high (4.5 per 1,000) compared to many developed countries Mortality rate associated with socio-economic status 1996 the rates of infant mortality in Canada were close to Sweden rates 4.0 per 1,000 © 2020 McGraw-Hill Education Limited 7 7 How Does Death Differ Across the Lifespan?: Part III Sudden Infant (0-2yrs) Death Syndrome (SIDS): causes are not entirely known infant simply stops breathing gentle death for child enormous psychological toll for parents sleeping position has been reliably related to SIDS © 2020 McGraw-Hill Education Limited 8 8 How Does Death Differ Across the Lifespan?: Part IV Causes of death: Death between ages 1 to 15 years #1 cause of death is accidents, drowning, poisoning, injuries, falls, and motor vehicle accidents (42% of deaths) #2 cause of death is cancer (especially leukemia) Both of these causes are on the decline © 2020 McGraw-Hill Education Limited 9 9 How Does Death Differ Across the Lifespan?: Part V Children’s understanding of death: young children (< 5 years) associate death with sleep, not as something final and irreversible children 5-9 years understand it’s final, but do not understand biological death at ages 9 or 10, death is seen as universal and inevitable © 2020 McGraw-Hill Education Limited 10 10 How Does Death Differ Across the Lifespan?: Part VI Death in young adulthood: For those aged 15 to 24, death is due to: #1 unintentional injury (car accidents) #2 suicide #3 cancer #4 homicide © 2020 McGraw-Hill Education Limited 11 11 How Does Death Differ Across the Lifespan?: Part VII Reactions to young adult death: death of a young adult is considered tragic young adults feel shock, outrage and an acute sense of injustice medical staff often find this group difficult to work with © 2020 McGraw-Hill Education Limited 12 12 How Does Death Differ Across the Lifespan?: Part VIII Death in middle age: death becomes more common and often more fearful as mortality becomes more feasible people develop chronic illnesses that ultimately kill them © 2020 McGraw-Hill Education Limited 13 13 How Does Death Differ Across the Lifespan?: Part IX Premature death: death before the projected age of 81 usually occurs due to heart attack or stroke lifestyle issues often contribute most people say they would prefer a sudden, painless, non-mutilating death © 2020 McGraw-Hill Education Limited 14 14 How Does Death Differ Across the Lifespan?: Part X Death in old age: dying is not easy, but it may be easier in old age initial preparations may have been made some friends and relatives have died may have come to terms with issues typically die of degenerative diseases psychosocial factors predict declines in health © 2020 McGraw-Hill Education Limited 15 15 What Are the Psychological Issues in Advancing Illness?: Part I Continued treatment and advancing illness: treatments may have debilitating side effects patients find themselves repeated objects of surgical or chemical therapy © 2020 McGraw-Hill Education Limited 16 16 What Are the Psychological Issues in Advancing Illness?: Part II What is a Good Death?: free from avoidable suffering Ten core themes: © 2020 McGraw-Hill Education Limited 17 Pain free Positive relationship with provider Religiosity/spirituality Quality of life Treatment preferences Emotional wellbeing Dignity Sense of life completion Family Preferences for the dying process 17 What are the Psychological Issues in Advancing Illness? Part III Continued treatment and advancing illness: Is there a right to die? Historically tremendously controversial and largely illegal (for patient, but more importantly for whomever assisted) 2015 Supreme Court of Canada ruled that physicians may aid competent patients with grievous, enduring, and terminal pain in ending their lives Still illegal in most countries © 2020 McGraw-Hill Education Limited 18 18 What Are the Psychological Issues in Advancing Illness?: Part IV Moral and legal issues: Euthanasia: assist death Ending the life of a person with a painful terminal illness Advance care directives (living will): A request that extraordinary life-sustaining procedures not be used if person is unable to make this decision on his/her own © 2020 McGraw-Hill Education Limited 19 Gloria Taylor, first to win legal right to die 19 © 2020 McGraw-Hill Education Limited 20 A Letter to My Physician Concerning my Decision about Physician Aid-in-Dying What Are the Psychological Issues in Advancing Illness?: Part V Psychological and social issues related to dying: Changes in the patient’s self-concept: difficulty maintaining control of biological functions mental regression, inability to concentrate Issues of social interaction: fear that their condition will upset visitors withdrawal for fear of depressing others and fear of becoming an emotional burden © 2020 McGraw-Hill Education Limited 21 21 What Are the Psychological Issues in Advancing Illness?: Part VI Communication issues: many people feel it is proper to avoid the topic medical staff, family and patient may believe that others don’t want to discuss death © 2020 McGraw-Hill Education Limited 22 22 Are There Stages in Adjustment to Dying?: Part I Kϋbler-Ross’s 5 stages of adjustment to death: Denial: a mistake must have been made; test results were mixed up Anger: Why me? Why not him? Or her? Bargaining: a pact with God, good works for more time or for health Depression: a time of “anticipatory grief” Acceptance: tired, peaceful (not always pleasant), calm descends © 2020 McGraw-Hill Education Limited 23 23 Are There Stages in Adjustment to Dying?: Part II Differing evaluations of Kϋbler-Ross’s theory: her work is invaluable her work has not identified stages of dying: there is not a predetermined order some patients never go through a particular “stage” her work does not fully acknowledge the importance of anxiety © 2020 McGraw-Hill Education Limited 24 24 What are the Concerns in the Psychological Management of the Terminally Ill?: Part I Medical staff and the terminally ill patient: The significance of hospital staff to the patient: dying need help for simple things, such as brushing teeth or turning over they assist with pain management they are the patient’s source of realistic information they are privy to a most personal and private act—dying © 2020 McGraw-Hill Education Limited 25 25 What are the Concerns in the Psychological Management of the Terminally Ill?: Part II Risks of terminal care for staff: emotionally and physically draining for hospital staff they provide palliative care, care designed to make the patient comfortable, rather than curative care, care designed to cure the patient’s disease © 2020 McGraw-Hill Education Limited 26 26 What are the Concerns in the Psychological Management of the Terminally Ill?: Part III Achieving an appropriate death: Avery Weisman’s goals for the staff caring for the dying: informed consent safe conduct significant survival anticipatory grief timely and appropriate death © 2020 McGraw-Hill Education Limited 27 27 What are the Concerns in the Psychological Management of the Terminally Ill?: Part IV Individual counseling with the terminally ill: therapy for dying patients is becoming an increasingly available and utilized option thanatologists, those who study death and dying, suggest behavioural and cognitive-behavioural therapies - clinical thanatology involves symbolic immortality © 2020 McGraw-Hill Education Limited 28 28 What are the Concerns in the Psychological Management of the Terminally Ill? Part V Family therapy with the terminally ill: family and patient may have different ways of adjusting to the illness The management of terminal illness in children: most stressful of all terminal care hardest to accept and psychologically painful family may need counselling as well © 2020 McGraw-Hill Education Limited 29 29 What are the Concerns in the Psychological Management of the Terminally Ill? Part VI The adult survivor—little to do but grieve. grief: psychological response to bereavement feeling of hollowness preoccupation with image of deceased person expressions of hostility towards others guilt over death Most widows and widowers are resilient to their loss. © 2020 McGraw-Hill Education Limited 30 30 What are the Concerns in the Psychological Management of the Terminally Ill? Part VII The child survivor: may expect the dead person to return may believe a parent left because the child was “bad” may feel “responsible” for a sibling’s death © 2020 McGraw-Hill Education Limited 31 31 What Are the Alternatives to Hospital Care for the Terminally Ill? Part I Hospice care: designed to provide palliative care and emotional support to dying patients and their families may be provided in the home, but commonly provided in free-standing or hospital-affiliated units called hospices oriented toward improving a patient’s social support system © 2020 McGraw-Hill Education Limited 32 32 The role of Hospice Palliative Care in End-of-Life Care © 2020 McGraw-Hill Education Limited 33 What Are the Alternatives to Hospital Care for the Terminally Ill?: Part II Home care: care for dying patients in the home choice of care for many terminally ill patients psychological factors are legitimate reasons for home care very stressful for family members, especially primary caregiver © 2020 McGraw-Hill Education Limited 34 34 Summary: Part I Describe how death differs across the lifespan. Causes differ over the life cycle and concepts of death change over the life cycle. Know the psychological issues in advancing illness. Treatment-related discomfort and decisions to continue treatment; advanced care directives. Patients’ self-concept continually changing. © 2020 McGraw-Hill Education Limited 35 1 2 Summary: Part II Identify the stages in adjustment to dying. Kϋbler-Ross’s theory of dying suggest 5 stages but not all go through these in sequence. Understand the concerns in the psychological management of the terminally ill. Medical staff responsible for most care. Psychological counselling needed for patient and family members, especially children. © 2020 McGraw-Hill Education Limited 36 3 4 Summary: Part III Describe the alternatives to hospital care for the terminally ill. Hospice care and home care alternatives have beneficial psychological effects on dying patients and their survivors. © 2020 McGraw-Hill Education Limited 37 5

CHAPTER 13

Heart Disease, Hypertension, Stroke, and Diabetes

Slides prepared by Krista K. Trobst, Ph.D.
York University
© 2020 McGraw-Hill Education Limited
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Learning Objectives
1
2
3
4
Describe coronary heart disease.
Explain hypertension.
Understand stroke.
Describe diabetes.
© 2020 McGraw-Hill Education Limited
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© 2020 McGraw-Hill Education Limited
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Coronary heart disease
Atherosclerosis
Cholesterol level
Cardiac rehabilitation
C-reactive protein
List causes and treatments of Coronary heart disease
Hypertension
systolic and diastolic
Sphygmomanometer
Acculturation
List causes and treatments of hypertension
Learning Activity 13 A

© 2020 McGraw-Hill Education Limited
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Stroke
Stroke warning signs (symptoms)
Causes and treatments

Diabetes
Insulin
Symptoms and cause of diabetes
Types of Diabetes and its differences
Treatments
Learning Activity 13 A

Chapter 13 Flowchart
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease (CHD)?: Part I
Second leading cause of death
Disease of modernization—tied to current lifestyles
Inflammatory processes implicated
Risk factors include high blood pressure, diabetes, stress, inactivity, high cholesterol
Family history component
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease (CHD)?: Part II
a general term referring to illnesses caused by atherosclerosis, the narrowing of coronary arteries, the vessels that supply the heart with blood
may be caused by inflammatory processes, high blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level and low levels of physical activity
© 2020 McGraw-Hill Education Limited
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Figure 13.1 Age-standardized all-cause mortality rates and number of deaths among Canadians aged 20 years and older with diagnosed ischemic heart disease (HD) and those who had an acute myocardial infarction (AMI), Canada, 2000-2001 to 2012-2013

© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part III
Role of stress:
chronic and acute stress have been linked to CHD
CHD more common in individuals low in socioeconomic status (SES)
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part IV
Role of stress:
job factors linked to CHD
balance of demand and control in daily life is associated with CHD
social instability tied to higher rates of CHD
Tension, psychological stress, and negative affectivity
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part V
Women and CHD:
leading killer of women in the Canada and most developed countries
women seem to be protected at younger ages relative to men
higher levels of HDL
estrogen diminishes sympathetic nervous system arousal
higher risk of cardiovascular disease after menopause
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part VI
Cardiovascular reactivity, hostility and CHD:
anger and hostility are risk factors for CHD and is a predictor of survival
Hostile people often have:
developmental antecedents
difficulty expressing vs. harbouring hostility
hostility within social relationships
mechanisms linking reactivity and psychological factors
© 2020 McGraw-Hill Education Limited
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Hostility and Cardiovascular Disease
Research has implicated cynical hostility as a psychological culprit in the development of cardiovascular disease. Many studies have employed measures of hostility to look at this association. Some sample items are below:
I don’t matter much to other people.
People in charge often don’t really know what they are doing.
Most people lie to get ahead in life.
People look at me like I’m incompetent.
Many of my friends irritate me with the things they do.
People who tell me what to do frequently know less than I do.
I trust no one; life is easier that way.
People who are happy most of the time rub me the wrong way.
I am often dissatisfied with others.
People often misinterpret my actions.
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part VII
Depression and CHD:
depression is a significant risk factor that can lead to development and progression of CHD
there is a link between depression and metabolic syndrome
depression is tied to elevated C-reactive protein, a marker of inflammation
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part VIII
Other psychosocial risk factors and CHD:
vigilant coping
anxiety (implicated in sudden cardiac death)
helplessness, pessimism and a tendency to ruminate over problems
attempting to dominate social interactions
loneliness
vital exhaustion
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What is Coronary Heart Disease?: Part IX
Modification of CHD risk-related behaviour:
dietary intervention
programs to stop smoking
aerobic exercise in particular
Modifying hostility:
relaxation training
speech style interventions
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part X
Management of heart disease:
patients often delay before seeking treatment
about 10% of physician visits are CHD related
Initial treatment
cardiac rehabilitation:
process by which patients attain their optimal physical, medical, psychological, social, emotional, vocational and economic status
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part XI
Management of heart disease:
Treatment by medication:
Beta-adrenergic blocking agents—resist NS activation
Aspirin is commonly prescribed—thins blood, decreases clots
Statins—for cholesterol
© 2020 McGraw-Hill Education Limited
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What is Coronary Heart Disease?: Part XII
Management of heart disease:
diet and activity level
stress management
targeting depression
evaluation of cardiac rehabilitation
problems of social support
cardiac invalidism
© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part I
Hypertension:
high blood pressure
How is hypertension measured?
levels of systolic and diastolic pressure are measured by a sphygmomanometer
© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part II
What causes hypertension?
90% is essential (unknown)
5% is caused by failure of the kidneys
Genetic and emotional factors
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What is Hypertension?: Part III
How is Hypertension Measured?
Systolic and diastolic pressure measured by sphygmomanometer
Systolic blood pressure is the greatest force developed during contraction of the heart
Diastolic: is the pressure in arteries when the heart is relaxed

© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part IV
How is Hypertension Measured?
Systolic has a greater value in diagnosing hypertension
Mild hypertension- systolic -140-159
Moderate hypertension- systolic 160-179
Severe hypertension- systolic above 180

© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part V
What Causes Hypertension?
early blood pressure reactivity is a predictor of hypertension as an adult
lifestyle
genetic factors
emotional factors
© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part VI
Relationship Between Stress and Hypertension:
Repeated stressful events
Combination of high demand/low control
chronic social conflict
job strain
associated with:
crowded, noisy locales
migration from rural to urban areas
women – extensive family responsibilities
© 2020 McGraw-Hill Education Limited
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Figure 13.2 Factors That Contribute to the Development of Hypertension and its Complications
© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part VII
How do we study stress and hypertension?
bring people with hypertension into labs to respond to stressful tasks
identify stressful circumstances (such as high pressure jobs) and examine rates of hypertension
ambulatory monitoring
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What is Hypertension?: Part VIII
Psychosocial factors and hypertension:
originally thought that a constellation of personality factors made one susceptible to hypertension with suppressed anger thought to be the dominant characteristic
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What is Hypertension?: Part IX
Current Views Regarding Personality and Hypertension:
personality factors alone are insufficient for developing hypertension but may still play a role
expressed anger and the potential for hostility
number of conflict-ridden interactions in daily life
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What is Hypertension?: Part X
Acculturation and Hypertension among Asian Canadians:
acculturation is the adjustment to a new culture
hypertension associated with acculturation in Asian Canadians because their traditional lifestyle harder to maintain

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What is Hypertension?: Part XI
Treatment of hypertension:
low-sodium diet
reduction of alcohol
weight-reduction in overweight patients
exercise
caffeine restriction
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What is Hypertension?: Part XII
Treatment of Hypertension:
Drug treatments:
Diuretics – decrease volume of blood
Beta-adrenergic blockers & vasodilators
central adrenergic inhibitors
Statins
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What is Hypertension?: Part XIII
Treatment of Hypertension:
Cognitive-behavioural treatments:
relaxation
stress management
exercise
anger management
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What is Hypertension?: Part XIV
Evaluation of cognitive-behavioural interventions:
seem to be very successful
reduce drug requirements
sometimes the combination of cognitive- behavioural techniques and medications appears to be the best approach
© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part XV
Problems in treating hypertension:
“The hidden disease”
often symptomless, so diagnosis occurs during standard medical examinations
early detection is important

© 2020 McGraw-Hill Education Limited
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What is Hypertension?: Part XVI
Problems in treating hypertension:
Untreated hypertension:
lowers quality of life
compromises cognitive functions
related to fewer social activities
Adherence to all aspects of treatment is essential but rates tend to be low.
© 2020 McGraw-Hill Education Limited
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What is a Stroke?: Part I
3rd leading cause of death in Canada
Disturbance in blood flow to the brain and is responsible for nearly 14,000 Canadian deaths each years.
Some strokes occur when blood flow to localized areas in the brain is interrupted due to arteriosclerosis or hypertension
© 2020 McGraw-Hill Education Limited
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Stroke Warning Signs
© 2020 McGraw-Hill Education Limited
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The Centers for Disease Control and Prevention says these are the five warning signs of stroke:
Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
Sudden confusion, trouble speaking, or difficulty understanding speech
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance, or lack of coordination
Sudden severe headache with no known cause

What is a Stroke?: Part II
Risk factors for stroke:
overlap with those for heart disease
high blood pressure, heart disease, cigarette smoking, high red blood cell count and transient ischemic attacks
negative emotions, sudden change in posture to a startling event and psychological distress
© 2020 McGraw-Hill Education Limited
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What is a Stroke?: Part III
Consequences of stroke:
stroke affects all aspects of life—personal, social, vocational and physical:
motor problems
cognitive problems
emotional problems
relationship problems

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What is a Stroke?: Part IV
Types of rehabilitative interventions:
psychotherapy and treatment of depression
cognitive-remedial training
movement therapies
use of structured, stimulating environments to challenge capabilities
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Figure 13.3 All-cause mortality rates and number of deaths among people aged 20 years and older with a stroke occurrence
© 2020 McGraw-Hill Education Limited
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What is Diabetes?: Part I
Diabetes is a chronic condition of impaired carbohydrates, protein, and fat metabolism that results from insufficient secretion of insulin or from insulin resistance
One of the most common chronic diseases in the country and spreading across the world
Many individuals who have diabetes remain undiagnosed
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Figure 13.4 The Potential Health Complications of Diabetes are Extensive, Life-Threatening, and Costly

Risk Factors for Type II Diabetes
You are at risk if
You are overweight.
You are over age 65.
You have an apple-shaped figure.
You get little exercise.
You have high blood pressure.
You have a sibling or parent with diabetes.
You had a baby weighing over 9 pounds at birth.
You are a member of a high-risk ethnic group, which includes Indigenous, Black Canadians, Latin American, Asian, and Pacific Islanders.
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What is Diabetes?: Part II
Type I Diabetes
insulin-dependent
abrupt onset of symptoms resulting from lack of insulin production by the beta cells of the pancreas
result of viral infection, autoimmune reactions, and genetics
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What is Diabetes?: Part III
Type II Diabetes
Non-insulin dependent
A disorder of middle-age, striking those over age 40
Obesity major contributor
Increasingly common in children and adolescents
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What is Diabetes?: Part IV
Type II Diabetes:
Health implications of diabetes:
leading cause of blindness among adults
kidney failure
foot ulcers
eating disorders
nervous system damage
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What is Diabetes?: Part V
Type II Diabetes:
Stress and Diabetes:
Type II diabetics are sensitive to stress
Lack of social support even more problematic
Stress may play a role in onset
Anger and hostility are associated
Sympathetic nervous system reactivity
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What is Diabetes?: Part VI
Type II Diabetes:
Managing Type II Diabetes:
often unaware of health risks they face
must reduce sugar and carbohydrate intake
encouraged to achieve normal weight
encouraged to exercise
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What is Diabetes?: Part VII
Type II Diabetes:
Interventions with Diabetics:
cognitive-behavioural interventions to improve adherence to their regimen
weight control improves glycemic control
self-management and problem-solving skills
social skills training
behaviour modification
pharmacological therapy
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What is Diabetes?: Part VIII
Type II Diabetes:
Diabetes prevention:
diabetes is a major public health problem
lifestyle intervention and medication can greatly reduce the incidence of diabetes
control obesity
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What is Diabetes?: Part IX
Special Problems of Adolescents with Diabetes
often have Type 1 so their disease is severe
developing years; independence, and self-concept
struggles with adherence
may rebel against diet and authority
emotionally stable conscientious adolescents are more likely to follow the complex regimen
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Summary: Part I
Describe coronary heart disease.
Number two killer in Canada, a disease of lifestyle and associated with hostility and stress.
Explain hypertension.
High blood-pressure, related to genetics, sodium intake, low SES, stress and hostility.
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2
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Summary: Part II
Understand stroke.
Results from a disturbance in blood flow to the brain.
Describe diabetes.
Type I develops in childhood and Type II develops over 40, related to glycemic control. Epidemic in Indigenous peoples.
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CHAPTER 14

Psychoneuro-immunology, AIDS, Cancer, and Arthritis

Slides prepared by Krista K. Trobst, Ph.D.
York University
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Learning Objectives
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Explain psychoneuroimmunology.
Understand AIDS and its consequences.
Describe cancer and the psychosocial factors involved.
Define and understand arthritis.
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Chapter 14 Flowchart
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What is Psychoneuroimmunology?: Part I
Interactions among behavioural neuroendocrine, and immunological process of adaptation
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Learning Activity 15 A – Vocabulary Parking-Lot
Psychoneuroimmunology.
Immunocompetence
AIDS and its consequences.
Cancer and the psychosocial factors involved
Arthritis.
Autoimmune Disorders

What is Psychoneuroimmunology?: Part II
Assessing Immunocompetence:
Indicators of immune functioning:
cells and antibodies
A state of Immunocompetence – immune system is working effectively
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What is Psychoneuroimmunology?: Part III
The immune system:
the surveillance system of the body
profile of the immune system:
natural:
defence against a variety of pathogens
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What is Psychoneuroimmunology?: Part IV
The immune system:
Profile of the immune system (cont…):
specific:
lymphocytes have receptor sites on their cell surfaces that fit with only one antigen and respond to only one kind of invader
humoral and cell-mediated immunity
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What is Psychoneuroimmunology?: Part V
Stress and immune functioning:
commonplace stressors can adversely affect the immune system
Stress and immunity in humans:
more than 300 studies examining the relationship
different stressors create different demands on the body and immune system

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What is Psychoneuroimmunology?: Part VI
Interventions to enhance immune functioning:
Relaxation:
mutes effects of stress on the immune system
research shows higher NK cell activity after relaxation intervention
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What is Psychoneuroimmunology?: Part VII
Stress and the developing immune system:
may be vulnerable to stress, depression and grief
these experiences may permanently affect the immune system in ways that persist into adulthood
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Psychoneuroimmunology

DRUGS.
PSYCHOLOGY
GENETICS.
GUT MICROBIOME
STRESS
PERIPHERAL NERVOUS SYSTEM
PsychoNeuro-
immunology

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Endocrine
System

NUTRITION
Environmental Exposures

SOCIAL SUPPORT
Figure of Factors that Influence Psychoneuroimmunology

SLEEP.

What is Psychoneuroimmunology?: Part VIII
Health Risks:
Psychological stressors leads to health risks
Both children and adults are affected by stress
Vulnerable to infectious disease such as colds, flues, herpes virus infections such as, cold sores, genital lesions, chicken pox, mononucleosis
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What is Psychoneuroimmunology?: Part IX
Autoimmune Disorders
Immune system attacks body
Grave’s disease, chronic active hepatitis, inflammation of the liver, lupus, inflammation of connective tissue, M.S. destruction of myelin sheath, rheumatoid arthritis, IBD, such as Cohen’s or ulcerative colitis and Type 1 diabetes
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What is Psychoneuroimmunology?: Part X
Health Psychology in Action: Academic Stress and Immune Functioning
School-related stress
Elevation in cortisol before exams
Hormone variable in women
Genetics and autoimmunity

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What is Psychoneuroimmunology?: Part XI
Health Risks
immune modulation produced by psychological stressors leads to actual effects on health
Negative affect and immune functioning:
depression is a culprit in the stress-immune relationship

© 2020 McGraw-Hill Education Limited
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What is Psychoneuroimmunology?: Part XII
Stress, immune functioning and interpersonal relationships:
marital disruption and conflict
care giving
loneliness
protective effects of social support
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What is Psychoneuroimmunology?: Part XIII
Coping and coping resources:
Optimism:
active coping strategies are protective against stress
Personal control/benefit finding:
finding benefits in stressful events may improve immune functioning
other coping styles (like exercise) may be related to the stress-immune functioning relationship
Stress management
© 2020 McGraw-Hill Education Limited
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What is AIDS?: Part I
History of HIV Infection and AIDS:
Acquired Immune Deficiency Syndrome (AIDS)
first appearance is unknown
began in Central Africa, 1970s
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What is AIDS?: Part II
History of HIV Infection and AIDS:
In Africa, spread rapidly through heterosexual population:
high rate of extra-marital sex
low rate of condom use
high rate of gonorrhea
medical clinics reused needles to promote vaccinations
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What is AIDS?: Part III
AIDS and HIV infection in Canada:
first diagnosed case: 1982
by 2000, 16,000 people in Canada had AIDS
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What is AIDS?: Part IV
Viral agent is a retrovirus:
human immunodeficiency virus (HIV)
attacks immune system, especially the helper T-cells and macrophages
transmitted by exchange of cell-containing bodily fluids, such as semen and blood
highly variable time between contracting virus and developing AIDS symptoms
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What is AIDS?: Part V
HIV is transmitted by:
drug users:
needle sharing exchanges fluids
homosexual men:
anal-receptive sex (exchange of semen)
heterosexual population:
vaginal intercourse, women more at risk than men
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HIV??AIDS Exposure categories
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What is AIDS?: Part VI
How HIV infection progresses:
mild early symptoms:
swollen glands, flu-like symptoms
3 to 6 weeks:
infection abates, asymptomatic period (can be many years)
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What is AIDS?: Part VII
How HIV infection progresses (cont…):
amount of virus gradually rises
immune system increasingly compromised
opportunistic infections, such as Kaposi’s sarcoma, occur
common symptom for women: gynecologic infection
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What is AIDS?: Part VIII
Antiretroviral therapy:
highly active antiretroviral therapy (HAART)
treatments are complex, adherence variable
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What is AIDS?: Part IX
Who is at risk for getting AIDS?
AIDS growing fastest among Indigenous peoples and other minorities
adolescents and young adults (multiple partners)
child and adolescent runaways
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What is AIDS?: Part X
Psychosocial Impact of HIV infection:
depression and thoughts of suicide
stigma associated with AIDS
people react negatively toward people with AIDS
initial response produces positive changes in health
interventions that reduce depression are valuable
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What is AIDS?: Part XI
Disclosure:
major barrier to controlling spread of HIV:
– not disclosing HIV status
those who don’t disclose:
– less likely to use condoms
benefits of disclosure:
– positive health consequences
– more CD4 cells than non-disclosers
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What is AIDS?: Part XII
Women and HIV:
lives are often chaotic and unstable
getting food and shelter for families often more salient than HIV status
depression likely
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What is AIDS?: Part XIII
Employment and HIV
Factors that effect women who are seropositive
They are often older and struggle to adjust to the disease
Higher education, those with better self-rated health and have AIDS for a short period of time remain employed
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What is AIDS?: Part XIV
Interventions to reduce the spread of AIDS:
Education:
provide knowledge to target populations
Health beliefs and AIDS risk-related behaviour:
perceptions of self-efficacy are critical
Targeting sexual activity:
interventions have focused on communication
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This provides the opportunity to review the Health Belief Model introduced in Chapter 3.
Health belief model   A theory of health behaviours; the model predicts that whether a person practices a particular health habit can be understood by knowing the degree to which the person perceives a personal health threat and the perception that a particular health practice will be effective in reducing that threat.

What is AIDS?: Part XV
Interventions to reduce the spread of AIDS (cont…):
cognitive-behavioural interventions:
– stress management techniques
– reducing sexual activity
– improving ability to negotiate condom use with partners
targeting IV drug use
HIV prevention programs
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What is AIDS?: Part XVI
Coping with HIV+ status and AIDS:
– AIDS is now a chronic disease
– employment:
– men with HIV usually continue working
– unemployed may not return to work
Coping skills:
– coping effectiveness training is successful
– social support
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Spotlight on Canadian Research
HIV Canadian women-heterosexuals contact
Sex education and condom use
HIV prevent programs
Behavioural intervention indicate adolescents, bisexual men, inner-city women, college students, and mentally ill adults are at risk for AIDS
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What is AIDS?: Part XVII
Psychosocial factors that affect the course of AIDS:
negative beliefs about self:
– correlated with decline in helper T cells
psychological inhibition accounts for differences in physical health
depression and bereavement of a partner can have adverse effects on the immune systems of HIV+ men
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What is AIDS?: Part XVIII
Psychosocial Factors that Affect the Course of AIDS (cont…)
Stress increases illness rate of immune decline
Traits such as hope, self-compassion and optimism help aid adjustment
Self compassion correlated with lower stress, anxiety, and shame, and greater likelihood of disclosing HIV to others
© 2020 McGraw-Hill Education Limited
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What is Cancer?: Part I
What is Cancer?
Dysfunction of DNA-part of the cellular programming that controls cell growth and reproduction
Cancer is the leading cause of death
1998-2007, incidences of certain cancers-(thyroid and liver) increased risk of death in Canada
© 2020 McGraw-Hill Education Limited
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Figure 14.5

What is Cancer?: Part II

Why is cancer hard to study?
many cancers are species-specific; some species are more vulnerable to cancer
mice contract many cancers
monkeys get few
develop in different ways in different species
many cancers have long/irregular growth cycles
high within-species variability
© 2020 McGraw-Hill Education Limited
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What is Cancer?: Part III
Who gets cancer?
many cancers have a genetic basis
some cancers are ethnically linked
some cancers are culturally linked through lifestyle
risk for developing some cancers changes with SES
single people have more cancers than married people
cancers more common in chronically malnourished
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What is Cancer?: Part IV
Psychosocial factors and cancer:
positive association between depression and cancer
relationship between cancer development and use of denial or repressive coping
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What is Cancer?: Part V
Mechanisms linking stress, coping and cancer:
Psychological stress:
adversely affects ability of NK cells to destroy tumours
NK cell activity is important in survival rates for certain cancers, such as breast cancer
alterations in biological stress regulatory pathways may affect course of cancer
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What is Cancer?: Part VI
Adjusting to cancer:
Coping with physical limitations:
pain and discomfort
down-regulation of immune system
fatigue

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What is Cancer?: Part VII
Adjusting to cancer:
Treatment-related problems:
cosmetic problems
surgical removal of organs
body image concerns
use of prosthesis
conditioned nausea and vomiting
conditioned immune suppression
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What is Cancer?: Part VIII
Psychosocial issues and cancer:
intermittent and long-term depression
Issues involving social support:
social support can be problematic
may improve immunologic responses to cancer
married patients have better survival rates
young children may show fear/distress
older children have new responsibilities
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Figure 14.6 The impact of psychosocial stress and stress management on immune responses in people with cancer
© 2020 McGraw-Hill Education Limited
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What is Cancer?: Part IX
Life partner and sexual relationships:
strong life partner relationship is important
sexual functioning is particularly vulnerable
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What is Cancer?: Part X
Psychological adjustment and treatment:
post traumatic stress disorder in survivors of childhood leukemia
level of psychological distress important for maintaining quality of life
Self-presentation of cancer patients:
vocational disruption and job discrimination
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What is Cancer?: Part XI
Coping with cancer:
– patterns of coping:
– seeking or using social support
– focusing on the positive
– distancing
– cognitive escaping-avoiding
– behavioural escaping-avoiding
Finding meaning in cancer:
– growth in personal relationships
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What is Cancer?: Part XII
Interventions:
cognitive-behavioural approaches
mindfulness-based stress reduction
exercise
writing
psychotherapeutic interventions
individual therapy
family therapy
group interventions
support groups
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What is Arthritis?: Part I
100 different diseases known as autoimmune disease (body falsely identifies its own tissue as foreign matter and attacks)
Aboriginal people with arthritis more likely to have other risk factors for poor health
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What is Arthritis? Part II
Rheumatoid Arthritis (RA):
crippling form of arthritis believed to result from an autoimmune process:
affects small joints of hands, feet, wrists, knees, ankles and neck
main complications:
pain, limitations in activities and need to be dependent on others

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Stress may play a role: in particular, disturbances in interpersonal relationships.

Figure 14.7 Proportion of total number of individuals with arthritis by age group, household population, Aged 18 Years and Older
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What is Arthritis?: Part III
Stress and RA:
stress may aggravate RA
Treatment of RA:
aspirin, rest, supervised exercise
cognitive-behavioural interventions
enhancement of perceived self-efficacy
Juvenile RA:
onset between 2 and 5 years
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What is Arthritis?: Part IV
Osteoarthritis:
Most common form of arthritis in Canada
4.4 million Canadians in 2010 and double by 2040
Onset usually after 45
2040, over 70% of seniors will be living with osteoarthritis
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What is Arthritis?: Part V
Osteoarthritis:
obesity is the only modifiable risk factor
the articular cartilage (smooth lining of a joint) begins to crack or wear away because of overuse
affects weight-bearing joints
treatment involves keeping weight down, exercise, aspirin

© 2020 McGraw-Hill Education Limited
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Figure 14.8 Prevalence of osteoarthritis by age structure, 2010-20140
© 2020 McGraw-Hill Education Limited
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What is Arthritis?: Part VI
Other forms of arthritis:
Gout:
build-up of uric acid crystals
treated by diet, fluid intake and exercise
leads to life-threatening consequences only if left untreated
Lupus:
skin rash can appear on the face, leading to chronic inflammation, pain, heat, redness and swelling
can be life-threatening
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Summary: Part I
Explain psychoneuroimmunology.
Stressors, depression and anxiety compromise immune functioning. Coping, relaxation, and stress management may buffer this.
Understand AIDS and its consequences.
AIDS results from HIV and is marked by the presence of infectious diseases when immune system compromised. Higher risk for men who have sex with men, needle-sharing, and Aboriginal peoples.
© 2020 McGraw-Hill Education Limited
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Summary: Part II
Describe cancer and the psychosocial factors Involved.
A set of more than 100 diseases marked by malfunctioning DNA and rapid cell growth and proliferation. Related to depression.
Define and understand arthritis
An autoimmune disease involving inflammation of the joints, includes more than 100 diseases.

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Related Videos
AIDS
https
://
www.youtube.com/watch?v=FDVNdn0CvKI

Cancer

Arthristic
https://www.youtube.com/watch?v=Yc-9dfem3lM
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