Health psychology: Biopsychological interactions
relevant to health
Table of contents
How do biopsychosocial aspects have impact on asthma? ........................................................................................................ 5
Stress .......................................................................................................................................................................................... 7
Early life stress .......................................................................................................................................................................... 11
Faces of pain ............................................................................................................................................................................. 22
Social pain = physical pain? ...................................................................................................................................................... 26
Hypothesis 3: Common factor underlying both COPD and anxiety/depression ...................................................................... 37
Happiness research (Lyubomirsky) ........................................................................................................................................... 43
Evidence for PA & health .......................................................................................................................................................... 44
Brain-gut axis ............................................................................................................................................................................ 54
FGID .......................................................................................................................................................................................... 59
Brain mechanisms underlying the processing & modulation of visceral sensory signals ......................................................... 67
Current pitfalls & future perspectives ...................................................................................................................................... 79
5. Biopsychosocial Aspects in Asthma
Introduction asthma: pathophysiology and facts
Definition: “Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation.
It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that
vary over time and in intensity, together with variable expiratory airflow limitation.”
Wheeze is the sound that the lungs make caused by mucus
A lot of patients have difficulty exhaling
Facts:
Asthma is a common and potentially serious chronic disease that can be controlled
Symptoms are associated with variable expiratory airflow, i.e. difficulty breathing air out of the lungs due to
o Bronchoconstriction (airway narrowing)
o Airway wall thickening
o Increased mucus
Symptoms and airflow limitation vary over time and in intensity. These variations are often triggered by factors
such as exercise, allergen or irritant exposure, change in weather or viral respiratory infections.
Symptoms and airflow limitation may resolve spontaneously or in response to medication and may sometimes be
absent for weeks or months at a time. On the other hand, patients can experience episodic flare-ups
(exacerbations) of asthma that may be life-threatening and carry a significant burden to patients and the
community.
Asthma is usually associated with airway hyperresponsiveness to direct or indirect stimuli, and with chronic airway
inflammation. These features usually persist, even when symptoms are absent or lung function is normal, but may
Asthma phenotypes (react differently to different types of medication)
Allergic asthma (often in childhood/family history of allergy, good ICS response)
Non-Allergic asthma (in adults, less ICS responses)
Late-onset asthma (often women/usually non-allergic, less ICS responses
Asthma with fixed airflow limitation (in long-lasting asthma, airway wall changes)
Asthma with obesity (obese patients with asthma, prominent symptoms but less eosinophilic inflammation)
Also common:
o Exercise-induced asthma
o Occupational asthma and work-aggravated asthma
Asthma treatment
Inhaled controller medications: inhaled corticosteroids (ICS). They are used to reduce the inflammation within the
airways
Inhaled reliever medications: short (SABA) or long (LABA)-acting beta2-agonists. They should do more over the day
(12h)
Patient education/Rehabilitation
Asthma burden
Worldwide: 300 millions of affected patients
Worldwide: prevalence range across whole population(s): 1-18%
Germany (children: 9-14%, adults: 4-5%)
Belgium (children 12-13 years: 4.2%)
In children: most common chronic disease
In adults: one of the most common chronic diseases
Worldwide: 346.000 deaths/year due to asthma
High direct (treatments) and indirect (productivity loss) costs
Germany (costs per case/year)
o Moderate asthma: EUR 2200 –2270
o Severe asthma: EUR 7900 –9300
Difficult to obtain exact/comparable numbers!
Physiology
↑ Parasympathetic activity: bronchoconstriction = tubes become smaller (main controller of airway muscle tone
and mucus secretion)
↑ Sympathetic activity: bronchodilation
Afferent vagus notices when there's something going on
When an antigen enters the airways, this attracts a whole bunch of cells (dendritic cells, T-cells which communicate
via interleukins)
Acute response: muscles contract or edema (swelling)
Late response: inflammatory injury hyperresponsiveness of the airways, often caused by recruitment of IS cells in
the bone narrow
Psychological burden in asthma
Routine primary care electronic medical records for 1 424 378 adults (=/> 18yrs) in Scotland
Psychological comorbidities are prevalent in asthma
Psychological stress also prevalent in caregivers of children with asthma vs. healthy children (meta-analysis: anxiety: d =
0.50; depression: d = 0.44)
Caregiver psychological stress worsens child’s asthma!
Depression/anxiety are often not diagnosed in asthma (< 44 %)
Depression/anxiety are often not treated in asthma (< 21 %) Psychological burden and course of disease
Asthma increases risk of developing psychological burden
Psychological burden increases risk of developing asthma
How do biopsychosocial aspects have impact on asthma?
Early views
Sigmund Freud (19th century)
o Asthma is a psychosomatic disease
o (e.g., cry for mother)
Franz Alexander (1950, 1977)
o Some affects are powerful in eliciting asthma symptoms (e.g., anger, depression, separation anxiety,
jealousy, and sexual arousal)
MacKenzie (1886)
o Women (allergic to roses) develops asthma attack after watching paper rose
Early views often hypothetically and/or only individual cases
Early studies often not (well enough) experimentally controlled More current views are based on more sophisticated techniques and include various methodological approaches:
Patient reports
Laboratory studies
Field studies
... and try to examine the underlying mechanisms.
Document Outline
5. Biopsychosocial Aspects in Asthma
Introduction asthma: pathophysiology and facts
Psychological burden in asthma
How do biopsychosocial aspects have impact on asthma?
Acute emotions/stress in self-reports, lab studies, field studies
Emotions
Stress
Chronic emotions/stress in human and animal studies
Early life stress
Social aspects
Neural aspects
Summary
6. Emotional and cognitive modulation of pain perception
What is pain?
Attentional modulation of pain
Emotional modulation of pain
General effects of emotions
Fear and anxiety
Faces of pain
Social influences
Social pain = physical pain?
Cognitive modulation of pain
Summary
7. Biopsychosocial Aspects in COPD
Introduction COPD: pathophysiology and facts
Psychological burden
Effect of negative emotions
Social aspects
Potential cause-relationships between psychosocial aspects and COPD
Hypothesis 1: High burden of disease leads to increased anxiety/depression
Hypothesis 2: Increased anxiety/depression leads to COPD (symptoms)
Hypothesis 3: Common factor underlying both COPD and anxiety/depression
8. Positive psychology
Theory
Positive psychology (Seligman)
Perma theory of well-being
Positive emotions – evolutionary perspective (Fredrickson)
Happiness research (Lyubomirsky)
Positive affectivity (PA) and health
Measurements considerations: PA
Measurement considerations: physical health
Measurement considerations: item overlap
Evidence for PA & health
Mortality
Morbidity
Disease severity, progression, and survival in chronic illness
How can PA improve health?
Practice: positive interventions
9. Gastrointestinal disorders
Introduction: Anatomy & physiology of the “gut-brain axis”
The GI tract
Intrinsic innervation
Extrinsic innervation
Brain-gut axis
HPA-axis
Vagal anti-inflammatory pathway
GI hormones
Functional Gastrointestinal Disorders
Definitions & epidemiology
(Unexplained) gastrointestinal symptoms
‘Stress-related’ gastrointestinal symptoms
“Functional gastrointestinal disorders”
Irritable bowel syndrome (IBS)
Functional dyspepsia (FD)
FGID
Pathophysiological mechanisms
Efferent pathway
How does the ANS influence lower GI functioning?
Gastric accommodation
Barrier function of efferent pathway
Afferent mechanisms
Gastrointestinal sensitivity testing
Emotional modulation of visceral pain
Learned fear of innocuous GI sensations in health
Fear conditioning of visceral sensory stimuli effect on perception
Brain mechanisms underlying the processing & modulation of visceral sensory signals
Impact of gut-brain signals on psychological & brain function
Food and emotion
Exteroception
Interoception
Microbiota-Gut-Brain Axis
How to test anxious behavior in mice?
How to measure emotional responses in humans?
Current pitfalls & future perspectives
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