Notes test 1 Health Psychology (Py 426)
Notes test 1 Health Psychology (Py 426) PSY 426
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This 34 page Study Guide was uploaded by Puck Reeders on Monday February 2, 2015. The Study Guide belongs to PSY 426 at Geneeskunde Universiteit Utrecht taught by Gail Ironson PhD. M.D. in Fall2015. Since its upload, it has received 210 views. For similar materials see Health Psychology in Psychlogy at Geneeskunde Universiteit Utrecht.
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Health Psychology is the psychological well being compared to the physical wellbeing of a person Lecture Biologl Tuesday 09022014 N eurosystem of the body p 35 Sympathetic system Fight and ight Heart rate goes up Pupils dilate so more light can enter the eye and so we can see more Blood goes to the muscles Increased perspiration Increased epinephrine Adrenaline and norepinephrine Noradrenaline Decreased salivation Dry mouth Eg Getting a dry mouth before holding a public speech Heart receptors for norepinephrine causes the heart rate to go up Parasympathetic system Rest and digest Conserves and stores energy Heart rate goes down through the stimulation of the vagus nerve Pupils constrict Blood goes to digestive system Salivation goes up One way to kick in the parasympathetic nervous system is through diaphragmatic breathing Breathing using the stomach instead of the chest area This activates the vagus nerve Not in book A measure used in stress studies is the HRV Heart Rate Variability The heart rate differs when you inspire and when you eXpire When you inspire the heart rate goes up The bigger the difference between these two heart rates is the more parasympathetic output you have The more parasympathetic output you have the less stressed you are Endocrine system p 3637 Stress Hormones Sympathetic Nervous System HPAC system Sympathetic Nervous system SNS Phenylalanine precursor gt Tyrosine gt Dopa gt Dopaminegt Norepinephrine NE gt Epinephrine Epi NE originates from the Locus Coeruleus en is converted to epinephrine by the adrenal medulla All affect the mood of a person 1 The phenylalanine Tyrosine Dopa and Dopamine steps happen in the Locus Coeruleus NE amp Epi steps happen in the adrenal medulla T12 of NE is about 2 minutes Adrenal is on top of the kidneys NE stimulates the heart more Heart rate goes up then Epi does Epipen stimulates the alphareceptors on the walls of blood vessels which causes them to narrow and which stops the BP to fall It also stimulates the Betareceptors in the Heart and the lungs which relaxes the muscle and opens the airway It also stimulates the heat making it beat faster HPAC Hypothalamus CRH gtPituary ACTH gt Adrenal Cortex gt Cortisol CRH Cortico Releasing Hormone ACTH Adreno Cortico Tropic Hormone Cortisol helps swelling when you are injured Cortisol is not good chronically insomnia fat cardiovascular disease Cushing disease tumor of adrenal glands Cortisol is a steroid T12 of cortisol is about 13 minutes Not in b00k You can measure cortisol in the blood saliva and in the urine Prof likes the urine test because you can see how stressed people are during the day Cortisol is most often measured in the saliva The concentration of cortisol changes with the time of the day not by how stressed out people are If you measure the stress level using saliva you need to measure everyone at the same time Measuring cholesterol triglyceride hemoglobin AlC gt How good the glucose is controlled In an eXp they made people write about traumatic eXperiences and measured the cortisol levels before and after the assignment and measured it with a control group gt Salivary cortisol is very good to measure reactives like this But it is hard because you need to measure everyone at the same time Salivary m isnl mgde 13 Elmira 4m E l E39JI 1m Earn pm mmmgaht Extra Credit Why is cortisol highest in the morning and lowest at midnight How does lack of sleep affect the cortisol concentrations Not in b00k In studies where they measured the salivary cortisol they would at a minimum have to measure 1 right before you get out of bed and 2 12 hour later Your temperature changes 15 degrees throughout the day Evening people will be hotter at night and morning people will be hotter in the morning Blood Pressure Heart contracts Ventricles gt systolic BP is the maximum force in the arteries and when it relaxes it will fill up with blood Systolic Max BP when heart contracts Diastolic max BP when heart relaxes Normallt 12080 Prehypertension SBP 120 139 or DBP 80 90 Hypertension SBPgt 140 or DBP gt90 Hypertension causes stress on the heart because it needs to pump harder through a higher pressure in the arteries Hypertension Bad for heart Leakage of arteries Blood clot in arteriesbrainheart Blood doesn39t go to organs gt strokeinfarct Risk Factors Overweight Bad diet High cholesterol gtLDL doesn39t directly cause hypertension Females after 50 yrs Males are at greater risk on cardiovascular diseases Women have thinner vessels gt stroke Age Race blacks more hypertension Family history treatment Diet and exercise Relaxation techniques can help 510 ml Mercury but depends on person Meds beta blockersgt lt Diuretics gt Lose watervolume and decrease BP Bblockers go on the betareceptors and block the increase of the heart rate Hypertension goes down Blood 12 to 15 gallons in our body 7 of our body composition They take 1 pint of blood when you donate Components RBC carry 02 on hemoglobin and bring it to the tissues 3 month lifespan Most made principally in bone marrow White BC Leukocytes Immune response Platelets Made in bone marrow Help with clotting Plasma 55 of blood hormones enzymes waste products Lipids cholesterol and triglycerides Anything solid in your blood at room temperature is not good for you Lecture Cardiovascular system Thursday 09042014 Arteries and Veins Arteries carry blood from the heart and carry oxygenated blood to the organs that is why they look red Veins transport the blood back to the heart and veins are blue because they lack oxygen Arteries are deep and veins tend to be more superficial Pulmonary artery is the exception because it carries blood from the heart but is not oxygenated Pulmonary vein carries blood to the heart and is red Route of Blood p 45 look at drawing From the right atrium where the blood comes back fro the body and which is deficient in oxygen it goes to the right ventricle to the lunch via the pulmonary artery In the lungs the blood picks up oxygenated Blood comes back from the lungs pulmonary vein to the left atrium to the left ventricle to the rest of the body via the aorta The left ventricle has the thickest walls because it has to pump the blood to the entire body The heart and the electrical system of the heart The SA Sinoatrial node right atrium provides the impulse for the heart to beat The impulse then goes to the AV bundle and then through the Perkinje fibers LubDub is the sound of the AV valves closing preventing the back ow of the blood into the atria from the ventricles followed by the SemiLunar valves closing to prevent the back ow into the ventricles Mitrovalve prolapse I valve does not completely close because the valve is oppy look up which one is the mitro valve About 15 of women have it But its very benign Cardiovascular disorders Myocardial Infarction MI Heart attack Part of the heart muscle dies because it does not get enough oxygen Usually caused by an blockage of the one or more of the coronary arteries which supply the heart The left Anterior Descending LAD is called the widow maker Temporary blockedl heart attack Totally blockedl you die Stroke Cut off blood to the brain Caused by clot or Leakage Heart Failure Often large heart Heart cant pump very well Young peoplel because of virus Ejection Fraction Is the fraction of blood pumped out on each heartbeat from the blood tht has been pumped into the hert Normal is about 55 Having a low ejection fraction means you will not be getting enough oxygen to your tissues and may get out of breath easily A low ejection fraction may result from an M1 or heart failure EF or 30gt people have trouble walking to the bathroom stress is related to clogging of the arteriesl artherosclerosis LDL Heart attack symptoms Pressuring chest pain pain in left arm shortness of breath Women can feel pain in the jaw Cat scan to figure out if it is a leakage or clog Within 3 hours some centers can dissolve the clot Stroke symptoms you can lose functions of movement Congestive heart failure The heart does not pump adequately and becomes enlarged Often associated with atherosclerosis Atherosclerosis of the arteries The arteries become stiff and narrowed due to fatty deposits from what you eat Angina Pectoris patient feels strong paint and tightness in the bchest because of brief obstruction in an artery but little or no damage occurs Aneurysm Bulge in a weakened section of an artery If it ruptures you could die Cholesterol Guidelines Total Cholesterol TC ideal lt 200 High risk TC gt240 These guidelines change LDL low density lipproteinbad lt100 ideal Borderline highgt130 High riskgt160 HDLGood ideal gt60 Protective High risk for CVD HDL lt40 You can exercise to increase HDL Some foods have HDL some have LDL Immune system Diagram page 51 And handout Born with it no exposure necessary recognize self from nonself Innatenonspeci c immunityl page 51 Types of cells Natural killer cells Most sensitive cells to the effects of stress Fights off tumors and viruses There is a subside of people with AIDS that stayed healthy because they had more natural killer cells Connected to stress Phagocytes Macrophages and monocytes are scavengers that patrol the body engulf and ingest antigens PACman Macrophages process and present antigens secrete ILl Neutrophils When you have an infection you will have a increased amount of neutrophils Handout explanation nonself cell comes into body Macrophage presents this nonself cell and produces ILl The ILl lets the Thelper cell know to come and help Then you have cell mediated and humeral immunity Cell mediated immunity IL l signals the the thelper cell to get into gear IL2 signals to more T helper cells and to the cytotoxic Tcells to come and help Look up what the Thelper cell does and what the cytotoxic t cell does Antibody mediatedhumeral immunity Thelper cells secrete B cell factors that activate the Bcells The Bcells make more Bcells and make Plasma cells The plasma cells make antibodies Acquiredspeci c immunity Cell mediated ummunity attacks infected cells Tlumphocytes processed by the thymus T helper CD4 attacked in HIV secrete IL 2 stimulate T cells to reproduce and B cell factors so B cells develop into plasma cells T Killer kill tumor cells and viruses T Memory remember previous invaders egmumps Delayed Hypersensitivity T cells allergic Rxns Suppressor T cells CD8 slow down or stop cell mediated and antibody mediated immune reactions AnitbodyMediated humoral immunity fights bacteria fungi protozoa and viruses while they are still in bodily uids These lymphocytes are called B cells and are processed by Bursa like structures B cells give rise to plasma cells that produce antibodies Antibody types IgA Lines mucus membranes IgE in ammation IgM fight early infection IgG Later IgD Not in book Studies Looking at med students 1 month before and after exams and compared them to vacation time Found lower killer tcells right before the exam especially with people who are lonely Weaker immune function in women that are not happy in their marriage or in women that were divorced but werse upset about it or got upset about thinking about their ex Immune system is impacted in the first or two year after losing someone Protect immune system Sleep enough Good diet exercise Keep up your social support be around people that play you up Natural disasters 3 mile island People in the area where stressed Prof did a study on hurricane Andrew The area in south Kendal was devastated People were without electricity and phones for about 2 months Found that your immune system esp natural killer cells was affected It was more effected with the amount of lost ones you had during the hurricane But people who normalized their sleep got their immune system back faster Your intrusive thoughts were connected to your immune system Concl Your stress is related to the amount of lossed ones you have and you can protect your immunse system with sleep Lecture Movie Stress portrait of a Killer Robert Sapulskv Tuesday 09092014 0 Dominant baboons have lower stress levels then subordinate baboons 0 This is the same in our world 0 The lower you are in the hierarchy the higher the stress levels and the higher the risk on cardiovascular diseases 0 While the different people in the hierarchy have the same access to the same healthcare the same sort of food etc Years ago people thought that an peptic ulcer was the cause of stress 0 Later research suggests that the ulcer is bacterial so it is not the cause of stress But everyone has these bacteria in our bodies Why do only some people get peptic ulcers When people are stress the immune system go down Because of this the stomach lining wont be healed by itself and peptic ulcers arise Stress hormones trigger cardiovascular diseases The more subordinate you re the more atherosclerosis you have in the arteries When these arteries don t stretch the heart will eventually get an heart attack Chronic stress will eventually kill your brain cells 0 EXp Normal lab rats have brain cells nerve cells with many branches 0 Stressed rats have shrunken nerve cells and have a smaller hippocampus O Hippocampus plays an important role in memory and spatial memory and navigation When you have acute stress you wont remember things as well 0 Stress can make you feel miserable Stress and please Dopamine 0 Dominant monkeys have a lot of dopamine which affects their reward system 0 Subordinate monkeys have less dopamine This causes them to find things less pleasurable the sun isn t as bright Poorer less privileged neighborhoods have more stress Whitehall Study Stress I Hierarchy I Weight gain 0 Subordinate monkeys have more fat around abdomen 0 Stress alters the way you deposit fat 0 Fat brought on by stress is very bad for you Different hormones and has different effects on health LDL Multitasking causes stress Stress will damage us before we even know it 0 Dutch study the cold winter 0 pregnant women during the cold winter 0 the fetuses were connected to stress and have a higher risk of cardiovascular diseases have more cholesterolemia and react to stress differently Stressful environments affect your brain chemistry and fat deposit Telomeres the ends that protect the chromosomes shorten by age Stress hormones quicken up this process 0 The length of telomeres directly re ects on how much stress you are under and for how long 0 Telomerase Healing effect for telomeres I Group sessions example mothers with disabled children help build telomerase When baboons ate the left over meat from tourist which was infected with tuberculosis the alpha males died because they get to the food first If you were not aggressive and not socially active you would have died The result of this was that the stress levels of the group went down 0 Location effects stress levels researcher felt much calmer and happier in the savannah instead of the city he lived in 0 Condition in which people live and work is vital for their health 0 When the mount of work stress is high illness rates go up 0 When the work environment is equal less stressful and you have more control the illness rate will go down and productivity will go up 0 Create a better society that promotes human ourishing 0 Giving rather then receiving 0 Being more social and have more human interactions Professor discussion His situation was a stable environment Series of studies done on male monkeys manuck and Kaplan They studied male monkeys in stable and unstable hierarchy Stable monkeys can form their hierarchy and can stay in it Unstable Monkeys form their hierarchy and then get mixed up In stable environments dominant subjects are in favor and have less stress hormones In unstable environments dominant subjects are not in favor and have higher stress hormones Looks at graph If you give the dominant beta blockers they block the catecholamine sepinephrine and their stress levels will go down Did not have any effects in subordinates Serotonin levels drop if you are first a alpha male and then transition into a more subordinate level Zoloft Prozac I antidepressants work on serotonin Second study about female monkeys Women are protected until menopause The stability of the environment did not matter unstablestable Dominant monkeys had less stress hormones in stable and unstable situation Estrogen helped the subordinate monkeys have less stress Estrogen levels drop at menopause Maybe giving estrogen would help protecting against cardiovascular diseases I dominant I Subordinate Stable Unstable Figure 1 Male Atherosclerosis vs situation I Dominant I Subordinate Stable amp Unstable Figure 2 Female Atherosclerosis of dominant and subordinate females Lecture Stress and PTSD 10 in US Thursday 091 12014 What is stressful Page 74 I list of most stressful things not for college students Most stressful thing losing a spouse 2nd divorce Marital separation Jail term Death of close fam member Personal injury or disease Marriage Getting fired at work Marital reconciliation Retirement KNOW TOP 10 Having a child under 5 Not getting much sleep always being on guard big adjustment Defining stress What is the stressor If you have lots of stressors you have lots of stress Stress is the response of me and the stressor The response to the stressor Looking at the transactions Interactions between person and environment Stress is a circumstance where transactions lead a person to perceive a discrepancy between the physical or psychological demands of a situation and the persons resources Primary appraisal appraisal of stressor How bad is the stressor if soldier gets wounded in war he gets to get home so sees a positive A normal person would not perceive a stressor this way 2 Appraisal of stress Harmloss has the damage already occurred If you being abused who visits once i Threat is the threat done Challenge Secondary appraisal Your ability to deal with the stressor The appraisal with yourself and the resources to handle What leads to things to be stressors Self esteem Generating alternatives Belief system Married and spouse is leaving you and you don t want to get divorced if you believe you can be happy again you will be less stressed Self efficacy Believing you can do it Situational factors Dimensions of stress frequency LOOK UP WHICH OTHER 2 0 You can be stressed vicariously page 58 0 Study about a stressful videos LOOK UP 0 4 studies 0 Trauma narration had more stress then the denial track and scientific track 0 911 story 0 Mary was on the 61St oor of south tower 0 She was from FL and was send to NY for training 0 First tower was hit OOOOOOOOOOOOOOOO 0 Second tower was safe but she still left the building She was on the stairs when the second tower was hit She escaped the building without injury Walked back to the hotel and saw the towers collapse She saw people on fir falling out of buildings She felt dull for weeks and had difficulty concentrating She saw things falling Paralyzed unable to sleep Chronically depressed PTSD Summer 2003B fired from job PTSD worsened 35 years later I same feelings and nightmares and feelings of falling Nausea sweating heart palpitations Started drinking Marriage was suffering Lookup Kazi 911 and prof name for the article 2007 0 Symptoms of PTSD 0 000 O O Clusters Intrusions Flashbacks visual hallucinations Hyper Arousal Feeling irritable startle cant sleep cant concentrate Avoidance You don t want to talk about it you avoid going to NY or walking in stairwells you don t want to think about it or bring up memories New Negative symptoms You feel detached dull feeling numb inability of feeling positive emotions feeling estranged from people staying angry impaired memory blaming yourself and others for your eXperiences frequently thinking negative thoughts about self and others You felt you might be injured or your life was in danger or you actually injured 0 you need something from all four clusters 0 Treatment 0 O Normalizing symptoms Saying that its normal to have those symptoms I Give them a list of symptoms so their can share Telling them about treatment I Prolonged eXposure relive the trauma You might get worse before you get better I Access fear structure You are trying to habituate If you are anXious and you stay in the situation that makes you anXious you will habituate and anXiousness will go down 0 Hierarchy of prolonged eXposure treatment I desensitization O O ReeXperiencing the trauma In vivo hierarchy I Going to NYC I Seeing a film about 911 I Going in a busy stairwell I Walking in an empty stairwell I Hearing ambulances and fire rescue I You start with the easiest one 0 Other treatments PTSD O CPT cognitive processing therapy I You write an impact statement about the trauma 0 Why did this happened to you 0 How did this effect who you are in the world today 0 EX gay men that were abused as children I Stuck points 0 Negative things you say to yourself I Behavioral eXperiments 0 You want a healthy relationship and you are used to picking up guys Discuss other ways to meet people What are you saying to yourself that is stopping yourself doing it I EMDR eye movement desentization and reprocessing 0 Hold picture of trauma 0 LOOKUP Primary appraisal is when you look at the stressor Secondary appraisal is to look at yourself When you treat PTSD you can get secondary traumatization What do therapists do They have discussion groups to avoid getting stress Lecture Stress Tuesday 09162014 What makes life situations stressful Dimension Characteristics Life transitions Day Care Retirement Having children marriage Difficult timing Having a kid at 15 Going to school at 40 Ambuity Making decisions Surgery or not on this babe Not having clarity Low desirability Having a fire traffic ticket Low controlability Low cognitive control Biopsvchosocial aspects to stress I Study 1929 Great depressionl people lost money on stock markets 0 O O 0 Fight or ight response Symp nervous system prepares u to run or attack This could either be a negative effect or positive In the short term it is good but in the long term it is not good What can you do to get rid of the stress hormones I Exercise Allows to get rid of the stress hormones and lowers stress I Is stress specific or non specific Hans salie Everyone has the same reaction General adaptation syndrome P 60 612 0 O 0 State 1 Alarm reaction Fight or ight I SNSAdrenal glands l NE and Epi HPAC system I Cortisol controls in ammation and helps with glucose control State 2 Resistance The stressor continues even if the stressor is only in your mind vb PTSD and the horrible thoughs Chronic stressors I SNS is there I HPAC predominates I Diseases ulcers etc I Physiological arousal is higherlonger State 3 Exhaustion Prolonger physiological arousal Allostatic load accumulation of having to adapt to stressors over time and is measured by what your physiological state is Epi NE immune functions BP etc High levels relate to poor health I Autoimmune issues Cortisol pack Start you on a big dose and reduce it It works right away I In studies they see what goes into the phvsiological state General Adaptation syndrome 0 O O 0 How long the exposure was How you react to stress Rate of recovery thinking about a stressor prolongs it Recourse restoration you use recourses to deal with the stressors Ex Sleep helpt you restore your ability to combat stress If you could restore your sleep after a stressor your immune function would be healthier I Examples Brighter kids had higher cortisol I Men have more reactivity when their pompetence is challenged I Women have more reactivity when their interpersonal relationships are challenges Do all stressors produce the same reaction Mary Ann Frankenhousen study 0 O O O Depends on whether there is effort with or without distress Effort with distress increase catecholamines and cortisol Effort without distress People who like their job you get an increase in catacholamines but not cortisol Distress without effort You get an increase in cortisol Giving up feeling feeling helpless There may or may not be increases in catecholamines How can thoughts prolong stress 3 Mile island study p63 0 O O O O 0 Measure stress in Urine People who still thought about it had elevated stress hormones Stress can impact on your cognitive function When you are stressed its hard to concentrate and function Page 77 Diagram EU stress good stress There is a specific amount of stress that is optimal Emotional states can elevate your stress There are a number of things related to stress 0 O EX Section p64 65 Women report being more stressed out then men I Do they easier talk about their feelings or is their life tougher I You can look at married women with kids and married women without kids I How stressed out women are depends on how their marriage is and how much the men pitch in I Men are less stressed if they are not the only one who makes money Socioeconomic status People who have a lower income have more stress Type of stressor differs with gender differences I Men have more reactivity when their competence is challenged I Women have more reactivity when their interpersonal relationships are challenges I Men show more physiological activity when stressed and take longer to get back to their baseline I Theory Men don t talk about their stress because they get physiologically more stressed out and it takes longer to get back to normal I Hurricane study Men had more physiological stress and women had more psychologically stressed I Blacks have greater reactivity then whites Divorce is more stressful for the party that does not want the divorce Stress is nt always bad there is a level of Eu Stress Chapter 4 Social support Marriage and Health 4 p8186 0 Types of social support 0 O O O Emotional or esteem support Empathy caring concern positive regard and encouragement Tangible or instrumental Direct assistance give or lend helping with Chores Informational Giving advice or directions suggestions feedback Companionship 0 Who gets social support measurement 0 O Sociable help others Let others kow they need help pick the right provider who are able and willing to help not someone who is insensitive or too stressed out themselves Measurement Social support Questionnaire e g Who helps you feel that you truly have something positive to contribute to others List people and satisfaction with them 0 P 82 3 Gender and Socio Cultural differences in social support 0 O 0 Women receive less social support from their spouses than men do and rely heavily on women friends for social support Greenglass amp Nogudhi 1996 Blacks have smaller social networks than whites and Hispanics Blacks focus on church and family Hard for Gay blacks or women that are HIV positive Its hard to shift social networks after you are rejected by the church or your family Hispanics focus on extended families Whites have broader network of friends and coworker Men s networks larger than women s among Hispanics and blacks Women s networks are greater than men s among whites 0 Model of how SS works See diagram p85 0 Buffering Hypothesis Protective function is effective onlymainly when a stressor is encountered E g job loss have friend to led you money spouse loss have friends for emotional support Wife calls 911 with Direct effects Benefits of 33 are there regardless of amount of stress E g Lower BP in daily life and less reactivity in lab People encourage you to lead healthy lifestyle exercise drinking smoking KNOW DIAGRAM If you have low stressor intensity and low SS its going to have an impact on your health If you have a low stressor intensity and high SS it will have a low impact on your health 0 SS helps with low stressors or high stressors Social Support stress and health Potential Mechanisms O O O 0 Greater SS associated with lower HR and BP at work Karlin 1991 Hight SS greater decreases in BP at night troxel 2010 and greater decrease in cortisol at night Better SS assoc with lower E NE Cortisol and less cortisol reactivity to speech stressor SS support better immune function esp NK activity IgA ie con ict in marriage loss of spouse from previous slides less susceptibility to colds Reactivity during stressful activity BP HR and cortisol O O O O O 0 Speech stressor People are less reactive if supportive person present than alone CS Reactivity lower with a friend than a supportive stranger Reactivity lower with a pet Benefit depends on one s personality If defensive or hostile may show higher reactivity during stress with friends Increased reactivity if worried about evaluation If you are defensive or hostile its not good to have friends around Social Support amp Health Alameda County 0 O O Prospective study of 4700 people btwn 30 and 69 yrs old fu 9 yrs 4 aspects of social support measured marital status contacts with family and friends church membership group associations More social support lower likelihood of dying for both women and men SS not assoc wp illness B Imp t for IUO direction Especially important for older gt60people low contact w friends amp family approx 2X higher mortality vs high support Fig 4 2 38 v 19 SS predicted deaths from all cause CV and cancer Social Support and Health House et al 1982 O 0 2700 adults medically examined at entry initial health of those with hi SS not different from those with low social support Age at entry 52 12 yr fu People with less social support had higher mortality rates Still don t definitively know if high social support causes good health It does predict Social Support reduces both likelihood of illness and recovery 0 In initially healthy people SS associated with lower risk of developing CV disease In people who have had an MI SS predicts less risk of second MI and dying Lett 2005 Heart disease and surgery patients with high levels of social support recover more quickly p84 bottom Cutrona2004Kulik1989 Wills 2001 Social Support and health not always strong relationship 0 0 Patients who believe they can cope with emotional demands of their illness don t benefit Wilcox Kasl amp Berkman 1994 Mixed results predicting disease progression in HIV Ironson2005 Leserman 2002 Perceptions of support are better predictor of future overall health than actual received support Uchino 2009 Maybe getting wrong kind of support Social ties can sometime harm a person s health 0 O 0 Strain or con ict can increase Chances of developing serious illness DeVogli 2007 High stress and frequent social contacts more likely to develop infectious illness Hamrick Con ict in relationships evokes a strong physio response Ch3 J KG Friends may encourage unhealthful behavior smoking and drinking eating prohibited food Families may be overprotective back to work Abusive relationships put downs restriction More on gender differences 0 Women give and receive more SS than men 6 g husbands list wives as primary confidant more than wives list husbands CutronaTower 1996H Among undergraduates amount of and satisfaction with social support predicted physical symptom reports in women but not men CS Wohlgemuth 1991 Men may need SS less when they are young and healthy and before loss of spouse Or they may be less likely to report physical symptoms Men benefit more from marriage next slides and are impacted more from loss of spouse Interesting stats marriagedivorceHelgeson O O 0 Marriage rate declining 80 by age 302006 In 2006 30 were divorced v 1985 23 Why People less likely to tolerate unsatisfying relationships Greater expectations intimacy sex companionship easier to dissolve marriage society more tolerant both able to support self Factors that protect against divorce higher income education agegt25parents married religious affiliation 1St baby gt 7 mos post marriage Predicting divorce Gottman Arguing style predicts w 90 accuracy 0 4 Horseman to stay away from 39 Criticism I Defensiveness warding off attack counterattack vs interesting point I Contempt any statement you make to a partner from a superior place Rolling eyes insults name calling Also predicts illnesses over 4 yrs I Stonewalling listener withdrawal tuned out 80 are guys they were trying to calm themselves down Marriage and Health 0 Married people live longer than divorced and never married Kaplan 2004 Murphy 2004 O Widowed divorced and never married have higher heart disease Lynch 1990 Loneliness assoc w CVD Thurston 2009 0 Death rate in married v widowed show difference for men but not women CS Helsing 1981 0 Loss of Spouse increased mortality especially for men CS Matikainen 1996 17m v 7f over 5 yr fu Stroebe 1983 Greater Health Bene ts of Marriage for men Helgeson 0 Men who were married were less likely to die than men who were unmarried 9 to 15 yr fu 0 Marital status did not predict mortality among women in any of these studies 0 A recent 8 yr study Kaplan amp Kronick 2006 found never married 158 increased mortality v married differences larger for men Never married men young infectious disease accidents old CVD Distress and loneliness amp Marriage H 0 Marriage associated with less lonelinessdistress and greater perceived health across 17 countries These effects greater for men than women Western Cultures Stack 1998 0 Is it that marriage is associated with more distress for women or because being unmarried is associated with more distress for men Both May be social support and not marriage per se that is crucial factor for health protection 0 Protective role for health occurs mainly for men and women who think their marital quality is high Gallo 2003 Umberson 2006 0 Living with partner had equally lower rates of atherosclerosis as married vs higher rates for those living alone single or widowed 0 Married have lower BP than single BUT unhappily married have higher BP than single 0 Frequent contact with spouse if low in quality associated with worsening atherosclerosis O MetaAnalysis Social Support and Mortality HoltLunstad et al 2010 O Across 148 studies 308849 participants the random effects weighted average effect size was OR 150 95 CI 142 to 159 indicating a 50 increased likelihood of survival for participants with stronger social relationships I This finding remained consistent across age seX initial health status cause of death and follow up period Lecture Psychoneuroimmunology and Psychophysiologic Disorders Tuesday 09232014 From previour lecture which I missedl all slides 0 Psychoneuroimmunology and Psychophysiologic Disorders p99102 102104 0 Anatomy of an Illness 1979 Norman Cousins 40 wks on NYT best seller list 0 Had Ankylosing Spondylitis connective tissue in the spine was disintegrating a painful condition bones in spine and joints hurt Difficult to move 1 in 500 chance of full recovery He had read Walter Cannon and Hans Selye Checked into hotel room Laughter lowered Sed rate and reduced pain 0 Also did massive doses of Vtamin C 0 Studies in healthy people Stressors studied by Glaser and KiecoltGlaser 0 medical students taking exams O marital discord I From chap 2 married women with low marital satisfaction 0 Divorce I Chap 2 Divorced women who refused to accept separation or who OOOO thought excessively about it 0 caregivers of people with Alzheimer s disease vs matched controls lower immune function and more days of illness 0 Stressors that affect immune system2 0 Hurricane Andrew Ironson 0 Three Mile Island Accident Baum O Bereavement Bartrop Linn O O O I Longitudinal study of major crisis Willis p100 I Decline in NK function KG in spousal cargivers who lost spouse Animal studies inescapable shock Laudenslager Geriatric Population Rodin Unemployment Cohen 2007 which recovers after getting a new job 0 Increased risk of dying following death of spouse 0 0 Large study 15 million done in Finland Martikainen amp Valkonen 1996 5yr fu I 17 for men 16 cancer 17 circulatory I 7 for women 7 cancer 10 circulatory Meta Analysis of 15 longitudinal studies I Moon JR Kondo et al 2011 I 12 increased risk of death 22males 3f I 3X greater risk in first 6 months 41 V 14 I greater in those lt65 18 V gt65 10 0 Examples of clinically relevant studies slide 6 O The effectiveness of vaccines could be in uenced by stress medical students receiving the hepatitis B vaccine during exam periods who were more stressed and anXious or older adults who were stressed receiving the u vaccine had poorer subsequent antibody titers Stress induced reactivation of latent herpes virus I Stress can reactivate viruses that we have in our body like the kissing virus Wound healing Page 102 only in latest edition I You can use succion type cups to measure the blister I How well the blisters were healing I Blisters healed more slowly when couples reacted more hostile to each other Omega 3 fatty acids reduce in ammation Kiecolt Glaser 2012 in healthy middle aged adults in ammation is important in cancer aging cardiovascular disease alzheimer s IBSetc 0 Immune measures affected by stress slide 7 O O 0 Cellular imunity Natural Killer Cell activitygtlt I Fights of viruses and tumors I Its innate it doesn t need to recognize anything natural immunity Pro in ammatory cytokines I Biochemical messengers that signal cells to do things I IL2 secreted by helper cells IL is interliving I They are infected by stress 0 Immunoglobulins I Igg Ign O Reactivation of latent virusesgt lt O I Epstein barr virus herpes etc DNA repair I Harmed by stress 0 Mechanisms O O O O O 0 In ammation associated with atherosclerosis IBD irritable bowel disease cancer alzheimer s In ammatory cytokynes IL 1 IL 6 TNF a Telomere shortening I Stress causes shortening of the telomeres at the ends of chromosomes DNA repair I Mutations due to stress Direct connections to lymphoid organs Receptors for stress hormones on lymphocytes 0 PsychosocialEmotional States Related to Poorer Immune Function 0 O O O O O depression pessimism negative affect anxiety low social support loneliness anger childhood adversity 0 Mental Disorders and Mortality O O O O O O Gale et al 2012 gt 1 million men interviewed on conscription for military service or hospitalization 226 years follow up conscription diagnosis of mental disorders depression HR 181 Bipolar HR 555 Hospital Diagnosis Neurotic and Adjustment Disorders HR 546 Substance Use 112 Not due primarily to deaths from suicide Especially higher cardiovascular disease 0 Psychosocial Modifiers O O O OO buffer social support sleep exercise nutrition Optimism I Better immune unless persists too much less in ammation Positive Emotions I Daily logs daily logs positive events enhanced antibody content of saliva for 3 days negative depressed it for day of event Stone Social Support stronger immune amp stress resilient Spirituality ironson not in book Emotional Expression Disclosure Esterling study college students better control of EBV titers verbalgtwrittengt trivial Health Behaviors massage exercise sleep not smoking O Pennebaker Paradigm I Participants wrote about past trauma expressing their deepest thoughts and feelings surrounding it for 15 minutes I Control group wrote about neutral topics without revealing their emotions or opinions I Experimental group made fewer visits to the doctor I Although many finding it upsetting most find it valuable and meaningful 0 Optimism and physical health 0 O Meta Analysis 132 studies Rasmussen 2009 predicts better physical health ES 017 plt001 outcomes mortality CDV immune cancer physical SX Pain pregnancy birth weight Elderly Dutch age 65 85 fu 91 yrs Death rate 12 all cause 14 CV mortality Giltay 2004 Easter recovery from CABG surgery Scheier Carver 1989 CABG is when they take arteries or veins from your leg as a bypass in your heart to provide the heart with blood The more they use the worse your blockage is Slower disease progression in HIV Ironson 0 Positive Psychological WellBeing amp Mortality O O Meta analysis 35 studies in initially healthy populations 35 studies in disease pops Chida amp Steptoe 2008 Decreased mortality bigger for initially healthy populations HR82 vs diseased pops 98 Especially reduced cardiovascular mortality Included positive affectemotional well being mood joy happiness vigor energy Positive trait like dispositions life satisfaction hopefulness optimism sense of humor 0 Findng Meaning and Will to Live 0 0 Finding meaning in loss mitigated effect for men with HIV who lost a partner 3 of 16 died vd 12 of 24 I When people found meaning in their loss of partners less decline in T cells Phillip Smith People are less likely to die right before a birthday special event or holiday 0 Specific Classic PNI O O O O O Conditioning Wound Healing Catching Colds Disclosure Fighting off tumor cells O O Rheumatoid Arthritis Asthma I Conditioning 0 Wound Healing BOX p102 immune system plays a key role in healing KiecoltGlaser et al 2005 O O O Pavlov I Meat UCSDUCR salivation Immune suppression can be conditioned Drug UCS unconditioned stimulus UCR unconditioned reaction nausea immune suppression Saccharin CS controlled stimulus CR controlled reaction nausea immune suppression Rats that got the greatest amount of saccharin in the conditioning trial died A similar processing is thought to occur with chemotherapy drugs used to treat cancer Immune functioning can also be improved via conditioning Kusnecov 2001 page 102 0 Study of Catching Colds Cohen p 96 O O O O O O 394 Healthy subjects given nasal drops of 1 of 5 viruses 26 given saline Ss quaranteened 2 days before 7 days after examined daily for syntons abd of tissues Stress measure sum quartile ranks 3 to 12 major stressful life events last 12 mos I perceived stress scale I Negative affect felt last week Effect mitigated by positive emotions sleep Prevent colds wash hands 0 Cohen Cold Study Odds ratio 198 Increase in Clinical Colds by Stress Index 0 50 45 4O 35 30 25 20 15 10 5 O 3to4 middle 11 to 12 0 Disclosure studies Pennebaker Finish slide 0 College students asked to write deepest thoughts and feelings about traumatic event preferably one they had not yet disclosed 0 vs control condition daily activities what is in your closet 0 Subjects in trauma writing condition had fewer health center visits and better immune function 0 Ability to fight off tumor cells related to escapable or inescapable stressors in childhood or adulthood Seligman and Visintainer rejecting tumor L IEscalpable inescapable Mo shock Shock Shock Adult Escapable ES 30 52 Shock Experience Inesca pable 70 26 2 Shock Mo Shock 48 57 511 0 It is a good idea to let your kid overcome some challenges 0 Seligman and Visintainer Conclusions 0 1 Early helplessness training inescapable shock seemed to have little effect on adult tumor rejection only if as adult got no shock about 12 of each group receiving no adult shock developed tumors 0 2 Early eXperience matters if get shock later in life Early experience with controllable shock protects animals who get shocked later regardless of whether later adult shock is escapable or inescapable Similarly early eXperience with inescapable shock makes it more difficult to reject tumor if adult shock O 3 Effect of adult inescapable vs escapable shock is big 27 to 52 if received no shock as a child 0 Psychophysiological 0 Physical Symptoms or illnesses that result from the interplay of psychosocial and physiological processes 0 Older term is Psychosomatic which refers to symptoms or illnesses that are caused or aggravated by psychological factors mainly emotional stress 0 Ulcers 0 Tom a 9 years had an opening to ouside of his body acid production grealty increased when he was subjected to stressful situations After several weeks pronounced reddening of stomach lining O O 15 month old girl highest levels of acid when angry Stress related to are ups of IBS and IBD Ulcers Executive Monkey Study Stienti c American Brady 1958 O Monkeys given shocks every 20 seconds unless they pressed a lever Monkey with control over shocks yoked to monkey with no control Same shocks to both Monkey with control got more ulcers and died needed to be constantly vigilant But Choose the monkeys to be in the control by those that learned the fastest more emotional so perhaps not control related to ulcers but rather susceptibility to stress Mechanisms of Executive Monkey Ulcers O O O O greatest danger occurred when the sympathetic arousal STOPPED and the stomach was ooded with digestive hormones This was a parasympathetic rebound associated with the Hypothalamic pituitary adrenal axis HaiS elLe39s General Adaptation Syndrome proposes a similar effect in the Exhaustion phase parasympathetic stomach acid Digestive hormones HPAC hypothalamic pituitary adrenal axis This is the exhaustion phase Ulcers and Control Jay Weiss 0 Executive Rat Study study repeated in rats Some rats could escape the shock by turning a wheel while others were zapped regardless But design aw selection bias was corrected 0 When study repeated correctly it was the rats with NO control who developed more ulcers and symptoms of depression weight loss decreased appetite poor performance and decreased sleep 0 depression resolved after 72 hours Mechanism was NE depletion in brain stem 0 Executive study was by Brady 0 Second study that corrected Brady the ones without control got more ulcers Asthma 0 In ammation spasms and mucous obstruct bronchial tubes 0 Combination of allergies respiratory conditions arousal stress or exercise 0 Asthma patients get better when in hospital allergic to house dust 0 Researchers sprayed dust from home into hospital rooms None of children had respiratory difficulty suggesting psychosocial stress origin Not in book Sadness 0 loss of interest 0 atleast two weeks O 0 Symptoms of depression in book in chapter 3 SIG E CAPS I5 lleep clhanges increase during day or decreased sleep at night I nterest lloss of interest in activities that used to interest them lg uillt wortlhlless depressed elderly tend to devallue themsellves IE nergy laclk common presenting symptom Fatigue IQ ognitionfg oncentration reduced cognition or difficullty concentrating lg ppetite wt loss usually declinedr occasionally increased IE sycnolmotor agitation anxiety or retardations lethargic I5 uicidefdeatlh preocp 0 00000 O O 0 Lecture Cardiovascular Disease Tuesday 09232014 Type A Behavioral Pattern Lethal part Anger and Hostility need to know for exam Competitive Achievement Orientation Time Urgency AngerHostility Vigorous Vocal Style loud rapid emphatic take over and control conversation Best measured by interview because it gives people the opportunity to display competitive hostile impatient and Vigorous style Type B Behavioral Pattern Easygoing philosophical stop to smell the roses more relaxed give and take slower softer speech Type A and stress Type A s respond more quickly and strongly to stressors often interpreting them as threats Type A often choose more demanding and pressured activities Type A often evoke angry and competitive behavior from others so they have greater exposure to stressors and experience more con ict Type A s have greater reactivity to stressors especially involving competition harrassment arguments 0 Angryhostility and stress processes Exposure reactivity recovery restoration 0 0 More con ict more stress exposure Greater physiological reactivity Also they have less social support and social support doe not reduce their reactivity as much More likely to brood or ruminate about upsetting events less recovery Less restful sleep Angryhostile people also engage in more unhealthy behaviors smoking drinking obesity 0 CV System Reactivity and illness 0 O O O O 0 People that are more reacting are more likely to get CHD cardiac heart disese Hypertension Stroke Stress also related to high concentrations of activated platelets clotting factors cholesterol in ammatory substances in blood These changes promote atherosclerosis the growth of plaques within artery walls Don t forget monkey studies Manuck Kaplan 0 Type A and CHD Western Collaborative Group Study 0 O O Prospective Study of 3000 initially healthy men tested with Structured Interview 39 to 59 yr old at entry to study followup 85 years Type A individuals were twice as likely than type B to develop CHD and to have died from CHD 0 Type A deadly emotion O O Anger part Anger and hostility and the cynical hostility 255 physicians followed for 25 years from med school records found that those high on the Cook Medley Hostility scale measures anger cynicism suspiciousness etc It s safer to trust no one Some of my family have habits that bother and annoy me very much had higher rates of CHD and mortality MetaAnalysis Chida and Steptoe 2009 found anger and hostility predict CHD in initially healthy people In people with CHD AH predict poor medical outcomes additional MI s or death from CHD 0 Hypertension O O O O SBPgt140 or BDPgt90 30 of US population Risk factor for stroke CHD kidney disease 90 essentialprimary HTN cause unknown Risk factors for HTN dietsaltfatcholesterol excessive alcohol use physical inactivity family history of HTN Psychosocial factors chronic stress anger anXiety 0 Study of Air Traffic Controllers ATC page 105 of book 0 0 Compared air traffic controllers to second class airmen At each age group ATC had higher BP than second class airmen ATC with high levels of stress hi traffic density had higher BP than those with low levels of stress 0 Other factors related to High BP page 106 0 Studies show crowded aggressive conditions linked to stress and HTN humans and animals 00000 0 BP and HR reactivity greater in people from crowded neighborhoods High CV reactivity risk factor for HTN Chida 2010 Anger associated with higher nighttime BP B amp M BP higher in pessimistic people Raikkonen People who ruminate or dwell on events that provoke anger have higher BP Hogan Whit coat hypertension 0 Sociocultural Differences and HTN O O O Blacks have much higher rate of HTN than whites Highest BP readings in Detroit were blacks living in high crime crowded low income neighborhoods Blacks and Whites living in low stress area had similar BP Perceived racism may be a factor Black women who perceived racism had higher BP reactivity to stressors than those with low perceived racism BP higher in daily life among blacks who perceived racism BP higher when people adapting to a new culture gtmen gt new urban Impact decreases over time 0 Coronary Heart Disease CHD p107 0 Is CHD a disease of modern society Rate of CHD higher in industrialized countries But people live longer more obesity low physical activity and have more stress less support 0 Link between Stress and CHD has considerable support Job stress con ict in close relationships PTSD recent metaanalysis Richardson A C 2012 OR l27 for perceived stress to incident CHD 0 Also as noted Angerhostility predicts onset of CHD in initially healthy people 6 studies 20072010 Recent study of 785 Canadians Davidson 2010 suggests it is destructive anger justification that predicts CHD blaming others and ruminatingbrooding and not constructive anger eXpression ie trying to solve the problem CA is protective O Optimists are less likely to get CHD 0 How does stress impact CHD It impacts various phases of CHD and several processes 0 Initiation and progression of atherosclerosis O In the presence of advanced atherosclerosis stress contributes to ischemia MI or disturbances in heart rhythm O In people with established CHD predicts further MI s and coronary death 0 Processes l Incr in lipids and in ammatory substances incr in CV reactivity incr in stress hormones these promote atherosclerosis and HTN 2 cardiac arrythmias 3 behaviors smoking alcohol use 0 Examples of stress effects in phases of CHD 0 O Anger stiff arteries and atherosclerosis Shimbo Higher atherosclerosis in AA women who perceive high levels of discrimination stress unfair tmt vs those who do not Troxel 2003 Progression of atherosclerosis over time in daily life and jobs with hi demand low control Kamarck 2007 Karasek O In people with advanced atherosclerosis stressful events and epsiodes of anger can precipitate MI B amp Steptoe 2007 Recalling angry episode provoked lower EF in CAD pts GI O In CHD pts Anger depression and stressful neighborhoods predict recurring MI and death Chida 2009 etc 0 Denollet s Type D I 0 Add more on Depression look at your encyclopedia article and mood disorders 0 in the medically ill Denollet s Type D The placebo Effect 0 The Placebo Effect 0 Placebo Derived from Latin 1 shall please 0 Placebo Chemically inert substance or procedure that produces a real treatment e ect even though no actual medicine was given or procedure was performed Effects are real and can be lasting 0 Placebos found to work on nearly every organ system in many conditions 0 headache arthritis chest pain hypertension seasickness postoperative pain etc 0 An average of 35 of patients benefit from placebo treatment 0 Effectiveness of placebos ranges from about 15 60 depending on disease studied 0 The Placebo Effect 0 What is the missing piece 0 SUGAR PILL RELIEF FROM HEADACHE O SALINE INJECTION l PAIN FROM SHOCK 0 The Power Of Belief 0 Does the type of placebo given to a patient matter 0 Does the setting in which a placebo is given matter 0 Are all placebos equally e ective 0 Studies have found that form does matter I Capsules more effective than pills larger capsules more effective than small I Injections more effective than capsules or pills 0 Location and doctor belief I Placebos administered by a doctor in a hospital than by a family member at home I Effect stronger when practitioner indicates explicitly and strongly that they will work O Belief in Brand Names I One study found that name brand medications had a 10 greater effect than those with an unknown name Benedetti amp Amanzio 1997 Book p294 0 The Effect of Expectations 0 The attitude of the practitioner can in uence the effect of the placebo I More e ective when given by friendly enthusiastic practitioners who show interest in the patient 39 Less e ective when given by angry rushed practitioner 0 Study same anesthesiologist behaved differently toward patients ones who were treated kindly needed less pain medication and were discharged earlier Talbot 2000 0 DoubleBlind PlaceboControlled Studies 0 What are they and why do we need them 0 Key is that both experimental and control groups have equal expectations 0 What influences whether group receiving experimental drug will experience improvement 0 History of the Placebo Effect 0 In early days of medicine most remedies were ineffective and relied on placebo effect alone little known about fighting disease tonics purging bleeding etc 0 Later as more was discovered about causestreatments of disease bacteria antibiotics placebo effect became associated with snake oil remedies and superstitions of the past 0 Currently placebo effect is still controversial but is also viewed as a potential tool in understanding in uence of mind on disease and healing from illness 0 The Placebo Effect and Modern Medicine 0 In 1955 Beecher did in uential review study demonstrating improvement due to placebo in a variety of disorders chest pain headache colds 0 Since then placebo effect has been widely studied especially in chronic pain and psychiatric illnesses 0 Most variety in response to placebo seen in studies of pain response to placebo depending on study between 1 100 response rate seen in patients given placebo 0 Research on Placebos Study 1 0 Study of Surgery for Chest Pain Dimond et al 1960 O Double blind neither patients nor cardiologist knew whether real surgery had been performed 0 Patients given local anesthesia and surgeon randomly chose who would receive actual vs sham surgery I Actual Procedure vein tied off I Sham Procedure vein exposed but not tied off 0 Research on Placebos O 0000 0 Following surgery all patients felt relief needed less medication had increased exercise tolerance and sense of wellbeing Neither surgery nor sham surgery improved patients ECGs Procedure was later abandoned Author noted that chest pain was known to have an emotional component How does this relate to the placebo effect What could have led to the improvement in both groups 0 Research on Placebos Study 2 0 Study of implanting dopamine producing neurons into brain as Parkinson s treatment Freed et al 2001 Parkinson s patients randomly assigned to receive transplanted neurons or sham surgery Patients blind surgeon blind until surgery had begun Subjective ratings given by patients of their Change in functioning after surgery was no different for either group Objective tests showed greater improvement in transplant group especially for younger patients 0 Research on Placebos Study 3 O O 0 Study of knee surgery for arthritis Moseley et al 2002 Patients with arthritis of the knee were randomly assigned to 1 of 2 types of actual knee surgeries or to a sham surgery without the complete procedures Patients were blind surgeons blind until surgery had begun assessors were blind No difference in pain ratings for the 3 groups Objective assessment over 2 years showed knee function was no better in those receiving real surgeries O The dark side of placebos 0 Can the placebo effect be harmful in any way 0 Yes The Nocebo Effect 0 O O The expectation that a drug or procedure will have negative side effects itching sneezing fatigue can lead to adverse health effects Extreme example Voodoo Death resulting from belief that one is cursed stop eatingdrinking terror can i BP and lead to shock W Cannon 1942 What does the nocebo effect suggest about the in uence of the mind on the body 0 Role of Expectation and Modelling in Symptom PerceptionBox p231 O O 0 Participant and Confederate given nasal spray and told that substance had 4 symptoms it produced in some people headache nausea drowsiness itchy skin 2 observable Confederate Participant either given spray or not Conf displayed SX see if participant displayed SX too Ratings of 4 known SX greater if participant got spray SX greatest if part got spray and saw conf get spray Discrepancy between known and other SK 0 Conclusions 0 The placebo affect has been attributed to eXpectation effects conditioned responses and to the release of natural pain relieving chemicals produced by the body endorphins Currently science is still looking for the biochemical mechanisms that may underlie the placebo effect Placebos can relieve pain anXiety and suffering but have not been shown to alter disease in any way Future research will be needed to learn more about the nature of the placebo effect
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