Today •PTSD •Being ill •HIV/AIDS •Cancer •Obesity •Gender and health •Quality of Life •Semester wrap-up • > images.jpeg Post-traumatic stress disorder (PTSD) •PTSD versus Post-traumatic Growth (PTG) •PTG •Subjective experience of positive psychological change reported by an individual following a trauma •PTSD •Psychiatric disorder in people who experiences (directly or indirectly) or witnessed a traumatic event •Includes symptoms such as intrusion, avoidance, numbing, and hyper-arousal •PTSS •Post-traumatic stress symptoms – common negative reactions that occur in aftermath of trauma • • > ptsd.jpg 13465257_f520.jpg CoOccurring-Conditions_PTS_640.png 1925_d.jpg HIV / AIDS > Initial viral seroconversion illness Asymptomatic stage Enlargement of lymph nodes, onset of opportunistic infections AIDS-related complex (ARC) AIDS Psychology in HIV / AIDS •Susceptibility to disease •Lifestyle behaviors (unsafe sex, drug abuse) -- exposure comorbid infections (herpes, CMV) •Beliefs impact lifestyle behaviors (much work outdated) •Women are more susceptible to HIV and AIDS •Discuss WHY > tumblr_n6jxi6II9v1qb638eo1_500.jpg Psychology in HIV / AIDS •Progression of disease •Lifestyle •Adherence to medication (only 75% of eligible receive treatment) – AZT, HAART (adverse effects, question efficacy, difficult regimen) •Stress - CBT effective in reducing viral load when added to medication treatment at 15-month follow-up controlling for medication adherence (Antoni et al., 2006) •Cognitive adjustment – having negative expectancies of HIV at baseline predicts faster disease progression (Bower et al., 1998, Reed et al., 1999) •Types C coping style – emotional inexpression, decreased recognition of needs and feelings worsens disease progression (as do high levels of emotional expression) (Solano et al., 2001, 2002) > Psychology in HIV / AIDS •Longevity •Baseline factors such as •Health status •Health behaviors •Hardiness •Social support •Type C coping (self-sacrificing, self-blaming, not emotionally expressive) •Protective factors •Realistic acceptance •Social support •Problem-solving •Help-seeking behavior •Low social desirability •Expression of anger and hostility > Cancer •Initiation and promotion of cancer •Behavioral factors •75% of all cancers attributable to health behaviors (Mokdad et al., 2004; Khaw et al., 2008) •Stress •Experimental animal research studies (uncontrollable stressors linked to tumor growth) •Life events •Inconsistent, methodological problems •Control •Coping styles •Disengagement strategies (smoking, alcohol) •Depression •Personality – “cancer-prone personality” (Eysenck, 1990) – high in helplessness and hopelessness, Type C •Hardiness – control, commitment (meaning in life), challenge • > Cancer •Psychological consequences of cancer •Lowered mood •Body image •Cognitive adaptation •Benefit finding •Interventions for symptom relief & QOL enhanecement •Pain management •Social support management •Treating nausea and vomiting (visual imagery, relaxation, hypnosis…) •Body image counselling •Cognitive adaptation strategies (self-worth, meaning in life, self-transcendence) •Fear reduction > Obesity •Causes •Physiological theories •Genetics •One parent obese – 40%; two parents obese – 80%; non-obese parent only 7% chance of having an obese child •Twin studies (genetics 66-70% of variance in body weight), Adoptee studies (stronger association to biological parents) •Metabolic rate theory •Lower metabolic rate to begin with predicts weight gain •Overweight people have higher metabolic rate – paradox • Weak support •Appetite regulation •Genetics (leptin, grhelin) •Diet may contribute to changes in appetite regulation (artificial sweeteners, high sugar diet, salt intake, fat intake) > Obesity •Causes •Obesogenic environment •What factors outside the individual could explain obesity? •Discuss obesity-evolution.jpg > Obesity •Causes •Behavioral theories •Physical (in)activity •Increase in obesity prevalence at the same rate as decrease in physical activity (or increase TV viewing) •Obese people less active than non-obese •Most evidence correlational – what is cause and effect? •Diet •Increase in obesity unrelated to overall decrease in calorie consumption in the home •Obese do not seem to eat more than non-obese (but most research is self-reported) •Obese may eat proportionately more fat and relatively less carbohydrates •Calories in vs. calories out - ??? > Obesity •Treatments •Behavioral •PA – takes a lot of PA, may be better as prevention strategy •Dieting – restraint eating may promote overeating, weight cycling •Role of cognitive restraint •Drug treatments – side effects •Surgical treatments •Should we treat obesity? •Discuss • > Obesity •Halfron et al. (2013) •Discussion • > Gender and Health •Persistent differences between men and women •Health behaviors •Health outcomes •Longevity, morbidity, mortality •Women’s health •Pregnancy, miscarriage, termination •Menopause •Men’s health •Health behaviors, risk-taking behaviors, help-seeking behaviors •Andropause •Prostate cancer, CHD, suicide • > Menopause •Cessation of menstrual flow lasting at least 12 months •The median age at menopause is 52 •Menopausal transition is a natural, developmental process •Changes health profile of women •Generally neutral or positive effects on wellbeing but impact will vary based on •Premenopausal health •Stress •Menopausal symptoms •Lifestyle • Matthews et al. N Engl J Med. 1989 ;321(10):641–64; Avis & McKinlay. J Am Med Womens Assoc. 1995;50(2):45-50.; Mitchell & Woods. Maturitas. 1996;25(1):1-10.; Grisso et al. J Gen Intern Med. 1999;14(2):98-103. ; Brown et al. Women Health. 1998;28(1):23-40; Sowers et al. Menopause: biology and pathology. 2000:175–188. Dennerstein, et al. Menopause. 2007;14(1):53-62; Netz et al. Climacteric. 2008;11(4):337-344. Article discussion •Lau 2013 •Steel 2017 > Quality of Life • > Quality of Life •QOL rather than longevity is a vital goal in health promotion •Only partially reflected in existing mortality and morbidity indexes – traditional assessment of Q of L • • > What is Quality of Life? •How to define QOL? •What does QOL mean to you? The New Science of Happiness (Seligman, Diener) •Subjective experience that is about 50% determined •Experiencing self versus remembering self •Are we our memories or sum of total experiences? •Keys: pleasure, engagement, meaningfulness •Kindness, gratitude, capacity for life •Gratitude journals/letters > Happiness: Enough Already (Wilson) •Sadness is normal and salutary •Too much happiness can be detrimental •The case of late-stage illness (happiest most likely to die) •Negative emotions needed – make us more analytical, critical, innovative •If you are 100% what happens? •Melancholia fueled many geniuses in history > What is Quality of Life? •How to define QOL? •What does QOL mean to you? •We know it when we see it (David Rowe’s collage….) A married couple in their 90’s Jack LaLanne, 95, and wife Elaine, 83 “Banana” George Blair (95 yr) http://www.bananageorge.com/images/bgcard.jpg photo Boat Guy (George made it into the sexiest man list in SI’s 2002 Swimsuit Issue – at 87!) http://www.bananageorge.com/images/iceboat.gif > C:\Downloads\olderswim4.jpg C:\Downloads\olderswim2.jpg Quality of Life • •Subjective and objective evaluations of the “goodness” of one’s life overall, and the “goodness” of the various domains that make-up one’s life •What are the domains?... > Infinite Dimensions of QOL…. •Symptoms •Mobility •Physical activity •Social activity •Emotions •Relationships/sexuality •General activities •Sleep •Practical problems •Independence •Physical health •Social health •Cognitive health •Role limitations (physical) •Role limitations (emotional) •Pain •Mental health •Vitality, energy •General health •Personal development •Recreation > Defining Quality of Life •Multiple definitions and measures (300+) •Little consistency •Three most common approaches •QOL as absence of disease or life expectancy (mortality, morbidity); quality-adjusted life years (QALY) •QOL as function and well-being – Health-related QOL •QOL as a “cognitive judgment of satisfaction with one’s life” (Pavot & Diener 1993) • > QOL as Function and Well-Being •Function • Physical • Cognitive • Activities •Well-Being •Bodily •Emotions •Self-Concept •Global Perceptions > Quality of Life Measures •Objective Measures??? •Subjective Measures •Aggregated Measures •Single Item Measures •Perceived Change •Multidimensional Measures •Comparative Measures •“Non-Measures” of QOL > One can view QOL measures from several perspectives. For example: Aggregate measures rely on Combining multiple categories to come up with single index (e.g., physical symptoms, physical function, depression, control etc.). Problems of lack of specificity in finding effects that may be specific to PA (i.e., effects are masked) Single item measures Problem of reliability, validity, and sensitivity. Tendency to use these has been reduced but still may take this form in larger epidemiological studies When QOL is measured as Perceived Change,one encounters the problem of response bias. Of ten used to assess benefits of PA at multiple levels. OK if accompanied by objective measures of change Multidimensional measures employ assessments of primary domains of function including physical, mental, social, and spiritual function. The advantages lie in being able to document change in QOL at varying levels that may be more susceptible to change through PA (e.g., SF-36) Comparative Measures are designed to allow respondent to decide which components of one’s life are important in making judgments relative to QOL. SWLS, for example, targets life as a whole rather than identifying particularized facets or domains. So-called Non-Measures of QOL represent constructs like mood, anxiety, depression, etc. All are potentially related to QOL. However, they are theoretically and conceptually distinct from QOL. Yet, they are often assessed and QOL is inferred from their scores. Important to remember that how one defines QOL dictates how it is measured. Sample Measures of QOL •Sickness Impact Profile •physical and psychosocial status; independence •SF-36, SF-12, SF-6 •overall physical and mental health status •Nottingham Health Profile •Emotional reactions, social isolation, physical mobility, pain, energy, sleep •ADLS and IADLS •bathing, transferring, dressing •cooking, laundry, managing money •Satisfaction with Life Scale •Late Life Function and Disability Inventory •Limitations in discrete activities •Performance of socially defined tasks/activities > Psychological approach to QOL •Happiness or satisfaction with life the ultimate outcome •____ In most ways my life is close to my ideal. •____ The conditions of my life are excellent. •____ I am satisfied with my life. •____ So far I have gotten the important things I want in life. •____ If I could live my life over, I would change almost nothing. • > Quality of Life Top-Down Influences (time invariant, individual difference or between-person characteristics) Demographics Personality Functional status Physical activity status Physical & mental health status QOL Mental & physical health Physical function Self-related function Cognitive functions Daily physical activity Bottom-Up Influences (time varying, within-person changes) > Semester Wrap-Up •Health psychology - an interdisciplinary field concerned with the application of psychological knowledge and techniques to health, illness, and health care (Marks et al., 2011) •Health beliefs and behaviors •Health cognitions and the process of behavior change •Illness cognitions and the process of illness •Quality of life •The importance of learning to be critical •Theories, constructs •Finding commonalities and differences in theories •Transtheoretical paradigms •Methods and research designs •Discipline problems – mind-body split; individual within context >