Today •  PTSD •  Being ill •  HIV/AIDS •  Cancer •  Obesity •  Gender and health •  Quality of Life •  Semester wrap-up 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 HIV / 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(unsafe sex, drug abuse) -- exposure comorbid infections (herpes, CMV) •  Beliefs impact lifestyle behaviors (much work outdated) •  Women are more susceptible to HIV and AIDS •  Discuss WHY Psychology in HIV / AIDS •  Progression of disease •  Lifestyle •  Adherence to medication (only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 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 •  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….) 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 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