Class 7: End of Pain, Start of Stress

Class 7: End of Pain, Start of Stress

Class 7: End of Pain, Start of Stress Quiz 1: Oct 4 Covers everything up to Oct. 4 If not covered in class, not on quiz Reader: Recommend you get the reader. Pain and Depression Wrong model: Pain Depression --- Whats missing?

Correct model: Pain activity mastery control Depression MECHANICAL PAIN REDUCTION TECHNIQUES Drugs Surgery Sensory Control: Counter-irritation Counter-irritation stimulates Dorsal horn cells inhibit pain-transmitting cells. PSYCHOSOCIAL PAIN REDUCTION

TECHNIQUES Biofeedback Relaxation Hypnosis Acupuncture Distraction Guided Imagery Cognitive Reframing Pain Management Programs Summary Benefits of Psychosocial Approaches Change meaning of experience Provides skill set, reduces helplessness

Gives patients an active role in pain management Success with techniques increases self-efficacy Changes ways of thinking Pain Relief Through Virtual Reality Severe burns one of most painful conditions to treat: cleaning, re-bandaging excruciating. Pennebaker symptom research suggests that distraction should do what to pain? Reduce it. Why?

Competition of cues. SnowWorld: Virtual Reality program designed for pain relief. Patients enter SnowWorld during procedures Shoot snowballs at snowmen, penguins Report pain reductions 30%-50% Note SnowWorld colors. Why? Pain Management Programs 1. Evaluation a. pain b. functional status: life style changes, limitations

c. Emotional and mental functioning 2. Treatment plan a. Pre-set time. Not indefinite. b. Specific goals. c. Contract 3. Program a. Education 1. Nature of pain: physio, psychological 2. Pain reduction techniques b. Therapy 1. Psycho therapy 2. Cognitive therapy: c. Family therapy

d. Relapse prevention Why Do We Engage in Group Pain? Pain and Bonding Study Bastian, Jetten, Ferris, 2014 Study 1: Pain and Social Bonding Non-Pain Group Pain Group I feel part of this group I feel loyalty to this group

Studies 2, 3: Pain and cooperation Pick number that helps self Pick number that helps group Why Would Pain Improve Group Cohesion? Misattribution Hypothesis Pain endorphins (endogenous opioids) Endorphins elevate or depress mood? Positive mood applied to others increased liking Empathy Hypothesis

Personal Pain increased empathy Empathy helping Attunement Hypothesis (reverse empathy) Personal Pain isolation, do others understand my situation? Shared pain others understand me liking, cooperation Class 7: Stress I Emperor Stress Affects the Entire Person Mental Health Body States

Thinking Feeling Environment Development Stress Personality Social Relations Stress:

Health Psych Bullseye Integrates mental states, bodily states, environmental conditions Window to core psych processes: * How we make sense of events, and how interpretations affect health. Emotions, emotions & thinking, emotional control Social relations in coping and in failed coping Stress is where psych can do most for health. Causes of illness, Treatment of illness, illness prevention Stress Defined

Stress is a negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects. Taylor, p 168. What Are Stressful Events? Broken Heart Syndrome Takotsubo Syndrome: Heart is enlarged, looks like Japanese Octopus Trap. AKA: Stress cardiomyopathy Temporary heart condition due to loss-related stress

Symptoms: Chest pain, due to surge of stress hormones. Loss-related stress: Examples? Break-up Death Departure Duration: Typically 1 week, then better, but: Can lead to heart failures, arrhythmias, death. Cannon Model of Stress Walter Cannon, 1932 Fight or Flight response

SNS activity + endocrine system mobilizes body for fight or flight Stressful events _____You can fight: ..... _____You can flee ... X _____You can neither fight nor flee, "traps" Which are the most stressful? General Adaptation Syndrome (GAS) Hans Selye (1956) All stressors produce same pattern:

Per Selye: Prolonged stress --> Enlarged adrenals cardiovascular disease Shrunken thymus arthritis Shrunken lymph

hypertension Ulcerated stomach compromised immune system Phase 1 Phase 2 Phase 3 X Duration of Stress

What Matters? ____ Type of Stress ___ Physiology of Stress 1. SAM: Sympathetic-adrenomedullary Bodys thermostat: temp, thirst, hunger, emotions Event cortex hypothalamus SNS adrenal medulla catecholamines charged feeling increased BP, HR, etc. SAM Corresponds to Cannon's stress model 2. HPA: Hypothlamic-pituitary-adreocortical

Epinephrine, Norepinephrine, Dopamine Event cortex hypothalamus coritcotrophin releasing factor (CRF) pituitary adrencorticotropic hormone (ACTH) adrenal cortex corticosteriods conserves carbohydrates (carbs) reduces inflammation HPA corresponds to Selye's stress model

SAM and HPTA Stress Patterns Health Implications of Sustained Stress Catecholamine elevation, if sustained, inhibits immune system Cardiovascular effects 1. Arteriosclerosis 2. Senility: neurons in hippocampus 3. Depression 4. Fat distribution: Higher waist-to-hip ratio 5. Sudden death syndrome Hmong Nightmare

Stress, Opioids, and Illness Susceptibility Opiates are? Pain-reducing drugs, from plants. Morphine, heroin Endogenous opioids (aka endorphins): Like opiate, produced by body. Stress triggers endorphin production Stress opioid release immune suppression ? illness susceptibility Prolonged Stress Widens Window of Vulnerability

Chronic stress recovery phase cortisol phase immune suppression illness risk. Allostatic load = Effects of cumulative stress exposure Reactivity and Stress Vulnerability People vary in stress reactions NOT just a matter of being mentally tough / whimpy Physical constitutions differ Autonomic NS Neuroendocrine response response

Immune Study of children 3-5 yrs old, reactivity Measure reactivity to stressor -- a. cardio (HR, BP) b. immune Parents track stressor reactions, illness for 12 weeks Result: stress leads to illness among X High Reactive ____ Low Reactive ____ Assessing Threats: What Matters? Noise Crowding

Change of Job Relationship Breakup Family argument Upcoming Quiz (February 18) Is stress determined solely by objective qualities of the stressor? Richard Lazarus Susan Folkman Stress as Function of Person-Environment Fit Low Stress:

Resources >> Challenge Moderate Stress: Resources

Challenge High Stress: Resources < Challenge Primary Appraisal and Secondary Appraisal Primary: Determine qualities of event Positive, negative, neutral

If negative: Harm = damage done Threat = Potential harm Challenge: = Ability to manage threat Who felt more stress? __ Damage by volcano X Waiting for possible damage __ Mt. St.Helens

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