Introduction to Health Psychology

Posted on May 16, 2024 in Psychology and Sociology

Sleep

Sleep – Periodic, natural loss of consciousness

Stages of Sleep

Brain waves detected by EEG (electroencephalography); Cycle through 4 stages ~ every 90 minutes:

Non-REM 1: slowed breathing, sometimes sensations of floating/falling
Non-REM 2: clearly asleep
Non-REM 3: slower brain waves, harder to waken; sleepwalking, sleep talking can occur
REM – fast eye movements, dreaming

Sleep feeds creative thinking.

How Does Sleep Affect Mental Health?

Lack of sleep can lead to:

Irritability (chronic lack of sleep can result in chronic frustration and irritability)
Poorer emotion regulation – more reactive to emotional stimuli
Perceptual distortions (e.g., mild hallucinations)
Impairs memory, learning, decision-making, creative thinking

What is Insomnia?

Persistent difficulty falling or staying asleep, and/or early wakening with inability to return to sleep

3+ nights per week for 3+ months
Occurs despite adequate opportunity for sleep
Not fully attributable to psychological or medical disorder or substance use
Distress and/or impairment
Prevalence: 10-15%

How is Insomnia Treated?

Medications (e.g., benzodiazepines, Ambien, melatonin)
- Effects only last only as long as the person takes meds
Cognitive behavioral therapy for insomnia (CBT-I)
- Identify what is influencing person’s sleep
- Address behaviors and cognitions that may be negatively influencing sleep

What Influences Sleep? (Factors Affecting Sleep)

Sleep “drive”: Need for sleep (akin to hunger drive).
Circadian rhythm (biological clock): You feel sleepier at certain times of day more than others.
Conditioning: The pairing of sleep with other stimuli.
Hyper arousal: More anxiety/stress → worse sleep.

Health Psychology

What is Health Psychology?

Study of psychological and behavioral factors of physical health, illness, and healthcare

Increasing Relevance of Health Psychology

Chronic illnesses are increasingly common
- People now live longer with illness/ Increased understanding of how important psychological/ behavioral factors are to health

Love Hurts?

Findings:

On average it took a day longer to heal after a conflict conversation compared to the supportive conversation.
Couples with higher hostile behaviors (being critical, insulting, using a harsh tone of voice) during the interactions:
- took on average 2 days longer to heal
- showed larger increases in pro inflammatory cytokines (immune cells that promote inflammation) following conflict conversation

Example of Coronary Heart Disease (CHD)

Substance Use Disorders

What are Substance Use Disorders (SUD)?

DSM-4 distinguishes between abuse and dependence
DSM-5 combined into one disorder with…
- mild (2-3 symptoms)
- moderate (4-5)
- severe (6+)
12-month prevalence of alcohol use disorder (~10%)
12-month prevalence of other SUDs (2-3%)

Impaired Control

Use more than planned
Cravings
Unsuccessful attempts to stop
Much time spent using/recovering

Social Impairment

Not meeting responsibilities
Not doing activities
Social difficulties

Risky Use

Use in dangerous situations
Use despite physical/psychological problems

Withdrawal: going off a substance causes physiological reactions in our body

Categories of Abused Substances

Central nervous system depressants → alcohol, benzodiazepines, barbiturates, inhalants
Central nervous system stimulants → Cocaine, amphetamines, nicotine, caffeine
Opioids → heroin, morphine
Hallucinogens → LSD (acid), psilocybin (mushrooms)

Alcohol

Slows CNS, increased GABA activity

Intoxication:

Low doses: euphoria, confidence, relaxation
High doses: cognitive impairment, depression/ aggression, poor coordination, fatigue
Overdose: respiratory paralysis, death/coma

Long-Term Consequences of Chronic Alcohol Use

Increased risk of heart disease, cancer, and dementia
Thiamine deficiency

Public Health Consequences

Alcohol-related injuries
Alcohol-related car accidents
Violence

Withdrawal

1st stage: “shakes,” weakness, perspiration, headache, nausea
2nd stage: seizures
3rd stage: delirium tremens (DTs)
- Hallucinations and delusions, fever, irregular heartbeat
- Deadly in 10% of cases

Defining “Abnormal” Drinking

Heavy drinking: 14+ drinks/day (men); 7+ drinks/day (women)
Binge drinking: 5+ drinks/few hours (men); 4+ drinks/few hours (women), Should this be diagnosed?

Other CNS Depressants

Prescription pills (benzodiazepines and barbiturates)
Gas, glue, paint thinners, nitrous oxide (inhalants)
Intoxication and withdrawal like alcohol

Cocaine: CNS Stimulant

Activates CNS: blocks dopamine reuptake

Intoxication:

Initial effects: rush of euphoria, high energy, high self-esteem

High/repeated doses: grandiosity, impulsiveness, compulsive behavior, agitations, anxiety, paranoia

Long-Term Consequences

Heart attack, stroke, GI problems
Risky behaviors to obtain substance
HIV from needle-sharing

Withdrawal

Dysphoria, fatigue, sleep problems, increased appetite

Amphetamines: CNS Stimulant

Prescription pills (Ritalin, etc)
- Prescribed for ADHD and other problems
- Diverted for illegal use/abuse
Manufactured illegally
- “Speed,” “meth,” snorted (“crank”), smoked (“crystal meth”)

Other CNS Stimulants

Nicotine
- Chemical in tobacco
- “Fight or flight” response
- Withdrawal: depressed, anxious, restless, hungry
- Fun fact: tobacco use is the biggest drug that acts as a risk factor for death
Caffeine
- High dose: agitation, seizures, respiratory problems
- Withdrawal: flu-like, headache, fatigue, low mood

Opioids: Heroin and Fentanyl

Opioids are the most common cause of drug overdoses

Initial effects: rush of euphoria, followed by lethargy, slurred speech, cognitive slowing
High doses: coma, seizure, respiratory suppression, death
Withdrawal: dysphoria, achiness, nausea, sweating, diarrhea, fever, insomnia

Hallucinogens and PCP

Hallucinogens
- Intoxication: synesthesia, mood shifts, hallucinations
- Bad response: anxiety, paranoia, psychosis, requiring hospitalization
Phencyclidine (PCP)
- Intoxication: similar to hallucinogens
- High dose: violent, amnesia, coma, psychosis

Cannabis

Intoxication:

Low doses: feeling of well-being, relaxation, sleep, forgetfulness, impaired motor functioning
High doses: perceptual distortions, depersonalization, paranoia, anxiety

Long-Term Effects:

cannabis smoke → cancer risk
increased risk of psychotic disorder

Biological Factors of Substance Use

Genetic factors ~50%
- Inherited vulnerability to addiction
- Variations in genes related to
  - Impulsivity
  - The metabolism of different substances
  - Dopamine system functioning → how rewarding/reinforcing a person finds a substance
Brain Functioning Drugs of abuse affect the reward system in the brain and affect dopamine either directly or indirectly
- Ex: amphetamines and cocaine→increase dopamine directly
- Ex: Opioids → indirectly increase dopamine – Inhibiting GABA → less inhibition of dopamine → more dopamine
Chronic use → alters reward pathways → needs more drug to get same effects
- Reduced natural production of dopamine
- Increased tolerance
- Cravings
- Withdrawal
- Low mood

Psychological Factors of Substance Use

Positive & Negative reinforcement
- Start using it with a positive attitude, try it once, and have a rewarding experience
  - Positive reinforcement to gain the reward experience
- Continue to use and it turns into a heavy use → avoiding withdrawal → continue to use
  - Negative reinforcement to take away negative symptoms of withdrawal
Mental Illness
- Correlation between having a mental illness and co-occurring substance use disorder
- Ex: Having traumatic childhood → Using substances to cope with that experience → Drugs become essential in daily functioning
- Ex: Substance use → leads to the development of mental illness
Cognitions
- Positive expectations about the effects of alcohol make it more likely for people to use the drug
  - “Alcohol helps me relax”
  - “Alcohol improves sex”
  - “Alcohol makes it easier to openly express love and reaction”
Culture/age
- Cultures where alcohol use is more accepted
  - The US and Australia use alcohol at high rates
  - Military culture and college campuses have high rates
  - Some cultures don’t use alcohol at all, some religions
- The majority start using before the age of 18
  - The earlier you start using, the greater the likelihood of developing a SAD
Gender
- Males at higher risk compared to females
  - Social message that drinking is masculine
  - Social message that using substances for men is a way to express emotions or build bonds
  - Historical pattern for women being shamed about drinking
- Higher rates among gender minorities
  - Social factors or psychological factors lead people to experiment with substances or use as a coping mechanism

Eating Disorders

What is Anorexia Nervosa (AN)?

Restriction of energy intake relative to requirements leading to significantly low weight (BMI below 18.5)
Intense fear of gaining weight or persistent behaviors to avoid gaining weight
Disturbance in perception of weight or influence of weight on self-evaluation, or persistent lack of recognition of seriousness of low weight

Types:

Restricting type – Restricting food intake
binge/purge type

Lifetime Prevalence in US

Up to 4% of females, ~0.3% of males

Health Complications

Heart failure
Low bone density
Kidney damage
Death (5-9%)

What is Bulimia Nervosa (BN)?

Recurrent episodes of binge eating
Recurrent compensatory behaviors to prevent weight gain – Self-induced vomiting, laxatives, medications, fasting, excessive exercise
binging/purging occurs at least once a week
Self-evaluation unduly influenced by body shape and weight

Lifetime Prevalence in US

Up to 2.6% in females
Up to 1.6% in males

Health Complications

Electrolyte imbalance → heart failure

What is Binge Eating?

Eating an unusually large amount of food (1200-4000 calories in 1-2 hours)
Lack of control
Often foods high in fat or carbs
Often at home, alone, at night, or after unstructured activity
Often accompanied by negative emotions
Not uncommon to move between diagnoses

Other Specified Feeding or Eating Disorders

Symptoms of an eating disorder exist but person does not meet full criteria for a diagnosis
Clinically significant impairment/distress
Atypical anorexia – all criteria are met for AN, except individuals weight is within or above normal weight range
Atypical anorexia – Lack of awareness – Can be difficult to receive diagnosis and treatment – Associated with at least as severe disorder-related cognitions and similar physiological complications

Sociocultural Factors: Culture and Race/Ethnicity

In the US

AN somewhat more common among Asian and White Americans
BN more common among Hispanic and White Americans

Worldwide

Eating disorders are more common among Westernized cultures, but can be found everywhere (America, Europe, Australia)

Sociocultural Factors: Gender

More common among women, however men comprise 10-25% of those with AN or BN
Higher rates in sexual minority men – BN more likely than AN among men, Excessive exercise strategies most common compensatory strategy
Gender minority individuals have elevated rates of eating disorders – Possibly related to gender dysphoria and perceived mismatch between one’s own body and sociocultural ideals

Post Traumatic Stress Disorder (PTSD)

Symptoms – Can develop following extreme stressors

Experience/witness trauma (actual/threatened death, serious injury, or sexual violence)
Learn about trauma to someone close
Repeated or extreme exposure to details of trauma

4 Main Categories of Symptoms

Re-experiencing (ie. intrusive memories, dreams/nightmares)
Avoidance
Altered mood/cognitions (guilt, blame, loss of interest in activities, feeling distant)
arousal/reactivity (panic sensations in response to conditioned stimuli, hypervigilant, intense startle response)

Symptoms all have to be present for more than one month and patient has to have significant distress and/or impairment to meet criteria for diagnosis

Prevalence of PTSD

About 7% lifetime prevalence
70-90% exposed to one or more traumatic events

Somatic Symptom and Related Disorders

Somatic Symptom Disorder

One or more somatic symptoms that cause significant distress and/or impairment
Six months of persistence to be diagnosed

Illness Anxiety Disorder (Formerly Hypochondriasis)

Significant worry about having or developing a serious illness
Six months of persistence to be diagnosed

Conversion Disorder (Functional Neurological Symptom Disorder)

Altered sensory or motor function

Theories of Functional Neurological Symptom Disorder

Freudian, Neurological and Behavioral

Psychogenic Non-Epileptic Seizures (PNES)

Person experiences epileptic-like seizures but no underlying changes in brain electrical activity

Factitious Disorder

deliberate faking of illness to gain medical attention

Factitious Disorder Imposed on Other

Falsifying illness in another person

Depression

Major Depressive Episode (MDE)

5 symptoms, nearly daily for 2 weeks
Depressed mood, or loss of interest in usual activities
Significant change in weight, Difficulty in sleeping, Recurrent thoughts of suicide or death

Major Depressive Disorder (MDD)

One or more major depressive episodes (recurrent)
No history of hypomanic or manic episodes (Bipolar possibly)
Worldwide lifetime prevalence: 16%

Other Types

Premenstrual dysphoric disorder, More common in recent generations, Twice as common in women vs men, More common among gender and sexual minority individuals

Race/Ethnicity

Higher rates among Latinx, White, and Native Americans than Black or Asian American
More common in US born Latinx individuals vs immigrated.

How Does Depression Develop?

Biological, Genetic Heritability

35%
Alterations in serotonin and norepinephrine functioning

Panic Disorder and Agoraphobia

What is a Panic Attack?

Abrupt surge of fear with 4 or more

Panic Disorder Symptoms

Recurrent, unexpected panic attacks
Persistent concern about having another attack
Significant behaviors change related to the attacks

How Does Panic Disorder Develop?

Biological

43-48 Heritability

Agoraphobia

Fear and avoidance of situations because of concerns that escape might be difficult if the person develops panic or other symptoms, Ex. Public transportation, open spaces, enclosed spaces, crowded places, being outside of the home alone
50% of people with agoraphobia have history of panic disorders

Treatments of Panic Disorders and Agoraphobia

CBT is the the most common
Benzodiazepines, SSRIs
Cognitive restructuring (CR) Skill for countering catastrophic, inaccurate, or unhelpful thoughts and Interoceptive Exposure (IE) Learning to cope with sensation differently

Schizophrenia

What is Schizophrenia?

Two or more psychotic symptoms > 1 month:
- Delusions, Hallucinations, Disorganized Speech (positive symptoms: excess/distortion of normal behavior)
- Highly disorganized or catatonic behavior
- Negative Symptoms (loss of certain qualities)
Continuous signs for >6 months
Significant interference in functioning
Lifetime prevalence: 1-2%

What are Delusions?

Fixed beliefs that do not change with conflicting evidence
Highly unlikely or impossible
Content of delusions differs across time and sociocultural context

What are Hallucinations?

Sensory events (auditory, visual, etc) that occur without an external stimulus

Obsessive Compulsive Personality Disorder

What is Obsessive Compulsive PD (OCPD)?

Pervasive preoccupation with orderliness, perfectionism, and control (4+ of below)
Preoccupied with details, rules, lists, order, etc
Perfectionism interferes with task completion
Excessively devoted to work/productivity to the exclusion of leisure activities
Over Conscientiousness and inflexibility about morals/ethics
Unable to discard worthless objects
Rigidity and stubbornness
Lifetime prevalence: ~8%

Body Dysmorphic Disorder

What is Body Dysmorphic Disorder (BDD)?

Preoccupation with one or more perceived defects or flaws in physical appearance
Most to least common: Skin, Hair, Nose, Eyes, Breasts/chest, Stomach
Perceived defects are not observable or only appear slight to others
Individual performs repetitive behaviors or mental act in response to appearance concerns – Mirror checking or avoidance of mirrors
Lifetime prevalence: roughly 2%

Bipolar Disorder

What is Bipolar Disorder?

Bipolar I:
- At least one manic episode
- Usually one or more major depressive episodes
Bipolar II:
- At least one hypomanic episode:
  - Same symptoms but only 4+ days with significant change, not impairment
- One or more major depressive episodes
Lifetime prevalence in US: 4.4%

How Does Bipolar Disorder Develop?

– Biological factors- Genetics – First degree relatives with bipolar disorder (parent or sibling), you are 5-10x more likely to develop disorder- 80-90% heritability

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