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Summary Health Psychology Part 2: Biopsychological Interactions (POP94a)
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HEALTH PSYCHOLOGYII: BIOPSYCHOLOGICAL
INTERACTIONS
Samenvatting
2022-2023
,Inhoud
Introduction to the course ............................................................................................................................................. 9
Aims .......................................................................................................................................................................... 9
Disciplines................................................................................................................................................................. 9
Content ...................................................................................................................................................................... 9
1 Homeostatic regulation ........................................................................................................................................... 10
1.1 Intro: Homeostatic regulation ......................................................................................................................... 10
1.1.1 Feedback control ..................................................................................................................................... 10
Temperature ........................................................................................................................................................ 11
Blood pressure .................................................................................................................................................... 11
Blood pH/ PaCO2 ............................................................................................................................................... 11
1.1.2 Feedforward control ................................................................................................................................ 11
1.2 Hierarchy of homeostatic controls .................................................................................................................. 12
1.2.1 Organ level & their local reflexed ........................................................................................................... 12
1.2.2 Autonomic control mechanisms (ANS) .................................................................................................. 13
ANS vs skeletal nervous system ......................................................................................................................... 13
Sympathetic division ANS .................................................................................................................................. 14
Parasympathetic (vagal) division ANS ............................................................................................................... 15
1.2.3 Endocrine controls and messengers guided by the hypothalamus .......................................................... 18
Hypothalamus ..................................................................................................................................................... 18
PVN..................................................................................................................................................................... 18
Endocrine stress response ................................................................................................................................... 19
A. Adreno-medullary response ................................................................................................................... 19
B. Adreno-cortical response ........................................................................................................................ 19
Cortisol ............................................................................................................................................................ 20
C. Endorphin (β) .......................................................................................................................................... 20
1.2.4 No need for higher brain centers ............................................................................................................. 20
2 Central integration of stress response ..................................................................................................................... 21
2.1 Appraisal model of psychological stress ......................................................................................................... 21
2.1.1 Primary and secondary appraisal (Lazarus and Folkman’s model) ........................................................ 21
Coping responses: ............................................................................................................................................... 21
2.2 Brain structures underlying appraisals ............................................................................................................ 22
2.2.1 Brain refresher about the brain ............................................................................................................... 23
Dorsolateral prefrontal cortex DLPFC ................................................................................................................ 23
Ventromedial prefrontal cortex VMPFC: ........................................................................................................... 23
Limbic system ..................................................................................................................................................... 24
Amygdala (LS).................................................................................................................................................... 24
Hippocampus (LS) .............................................................................................................................................. 24
Anterior cingulate cortex .................................................................................................................................... 25
2.3 The 5 components ........................................................................................................................................... 25
1
, 2.3.1 Central integration of the response to psychological stress .................................................................... 25
1. Sensory intake and interpretation of the environment (association areas, prefrontal cortex, hippocampus) .. 25
2. Generation of emotions based on appraisals (prefrontal-amygdala activity) .................................................. 26
A. Pathways from HC and A to ACG ............................................................................................................ 27
B. Research with NEC task........................................................................................................................... 27
3. Initiation of behavioral, autonomic & endocrine responses ............................................................................ 28
4. Feedback to Cortex & Limbic system: Central Feedback Subsystem ............................................................ 29
A. Norepinephrine: locus coeruleus ............................................................................................................ 30
B. Serotonin: raphe nuclei ........................................................................................................................... 30
C. Dopamine ................................................................................................................................................ 30
D. Visual model of the 3 NT ......................................................................................................................... 31
5.Autonomic & Endocrine Outflow .................................................................................................................... 31
A. Startle reflex & emotions ........................................................................................................................ 31
2.4 Cortical inhibition of stress responses by reappraisal ..................................................................................... 32
2.4.1 Research .................................................................................................................................................. 33
2.4.2 Brain activity ........................................................................................................................................... 33
2.4.3 Stress (especially chronic) can change brain systems ............................................................................. 34
Functional level (neural signaling): .................................................................................................................... 34
Structural level (architecture): ............................................................................................................................ 34
Examples: ............................................................................................................................................................ 34
3 Stress and the endocrine system.............................................................................................................................. 36
3.1 Introduction ..................................................................................................................................................... 36
3.1.1 Overview of stress endocrine regulation ................................................................................................. 36
3.2 Activation of stress endocrine secretion and the central corticotrophin-releasing factor system ................... 36
3.2.1 Hypothalamic-pituitary-adrenocortical axis (HPAC) ............................................................................. 36
3.2.2 Cortisol regulation................................................................................................................................... 37
3.2.3 Stress effects and central CRF sysem ..................................................................................................... 37
3.3 Cortisol’s feedback actions in the central nervous system .............................................................................. 39
3.3.1 Cortisol receptors .................................................................................................................................... 39
3.3.2 Cortisol effects on frontal-limbic activity ............................................................................................... 39
3.4 Amygdala responses to cortisol and altered responsivity of the central nervous system ................................ 40
3.4.1 Amygdala sensitization to stress ............................................................................................................. 40
3.5 Amygdala sensitization and potential implications for health ........................................................................ 40
3.5.1 Irritable bowel syndrome ........................................................................................................................ 40
3.5.2 Posttraumatic Stress Disorder ................................................................................................................. 40
3.5.3 Cortisol and hippocampal volume .......................................................................................................... 41
3.5.4 Long-term effects of amygdala sensitization .......................................................................................... 41
3.6 The hypothalamic-sympatho-adrenomedullary axis ....................................................................................... 41
3.7 Amygdala and hippocampal responses to stress hormone feedback: modulation of emotional memory
formation and working memory ................................................................................................................................. 42
2
, 3.7.1 Emotional memories ............................................................................................................................... 42
3.7.2 Cortisol and emotional memory foundation ........................................................................................... 42
3.7.3 Cortisol, working memory and decision making .................................................................................... 42
3.8 Stress endocrine secretion and regulation of long-term stress reactivity ........................................................ 43
3.9 Hierarchy of autonomic and endocrine controls over homeostasis leading to long-term memory formation 43
4 Psychoneuroimmunology (PNI) ............................................................................................................................. 44
4.1 Overview immune system ............................................................................................................................... 44
4.1.1 Cells of the immune system .................................................................................................................... 45
4.1.2 Cytokines: communication in IS ............................................................................................................. 45
4.1.3 Non-specific innate vs specific acquired of the IS .................................................................................. 46
4.2 Psychoneuroimmunology (PNI) ..................................................................................................................... 48
4.2.1 Preconditions for PNI.............................................................................................................................. 48
Sickness Behavior ............................................................................................................................................... 49
4.2.2 IS and Depression ................................................................................................................................... 50
High levels of peripheral inflammatory markers in depression ........................................................................ 50
High levels of central inflammatory markers in depression .............................................................................. 50
IS and Depression: Neuroinflammatory Model .................................................................................................. 50
Research: Healthy volunteers.............................................................................................................................. 51
Research: Patients with depression ..................................................................................................................... 51
4.2.3 Psychoneuroimmunology (PNI) and covid-19........................................................................................ 52
4.3 Stress and the immune system ........................................................................................................................ 52
4.3.1 Social stress in mice (Resident-Intruder-Paradigm)................................................................................ 52
4.3.2 Stress in humans...................................................................................................................................... 53
4.4 Implications for health and disease ................................................................................................................. 53
4.4.1 Influenza vaccination .............................................................................................................................. 53
4.4.2 Common cold .......................................................................................................................................... 54
4.4.3 HIV/AIDS ............................................................................................................................................... 54
4.4.4 Herpesvirus infection .............................................................................................................................. 55
4.4.5 Wound healing ........................................................................................................................................ 55
Punch biopsy technique ...................................................................................................................................... 55
4.4.6 Surgery .................................................................................................................................................... 57
4.4.7 Autoimmune Disease .............................................................................................................................. 57
4.5 Conditioning of the immune system ............................................................................................................... 57
4.5.1 Conditioning of immune suppression in rats .......................................................................................... 57
4.5.2 Conditioning of immune suppression in humans .................................................................................... 58
4.5.3 Evolutionary importance ......................................................................................................................... 58
4.6 Clinical applications........................................................................................................................................ 58
4.6.1 PNI - clinical applications ....................................................................................................................... 58
4.6.2 Stress management .................................................................................................................................. 59
4.6.3 Antidepressant pharmalogy therapy ........................................................................................................ 59
3
, cancer and IFN-α treatment ................................................................................................................................ 59
Chronic hepatitis C and IFN-α treatment ............................................................................................................ 59
4.6.4 IS and depression the future? .................................................................................................................. 59
4.6.5 Exercise ................................................................................................................................................... 60
4.7 Summary ......................................................................................................................................................... 60
5 Emotional and cognitive modulation of pain perception ........................................................................................ 60
5.1 What is pain?................................................................................................................................................... 60
5.2 Physiological background ............................................................................................................................... 60
5.3 Investigating how other processes can modulate pain .................................................................................... 62
5.3.1 How can we induce pain? ....................................................................................................................... 62
5.3.2 How to measure pain (intensity/sensory) ................................................................................................ 62
5.3.3 How to measure pain? (affective dimension of pain) ............................................................................. 63
5.4 Attentional modulation of pain ....................................................................................................................... 64
5.5 Emotional modulation of pain......................................................................................................................... 65
5.5.1 Attentional and emotional modulation of pain – Summary .................................................................... 67
5.6 The face of pain............................................................................................................................................... 68
5.6.1 Summary : pain faces .............................................................................................................................. 70
5.7 Social influences ............................................................................................................................................. 70
5.7.1 Social pain = physical pain?.................................................................................................................... 71
5.8 Cognitive modulation of pain ......................................................................................................................... 73
5.8.1 Summary: cognitive regulation ............................................................................................................... 74
5.9 Summary ......................................................................................................................................................... 74
5.10 Paper: cognitive and emotional control of pai and its disruption in chronic pain ........................................... 74
5.10.1 Abstract ................................................................................................................................................... 74
5.10.2 Introduction ............................................................................................................................................. 74
5.10.3 Brain regions involved in the experience of pain .................................................................................... 75
5.10.4 Attention and emotion influences pain differently .................................................................................. 75
Different modulatory systems are involved in the attentional and emotional control of pain ............................ 76
Anticipation of pain relief activates descending pathways ................................................................................. 76
5.10.5 Effects of chronic pain on pain modulation ............................................................................................ 76
Structural changes in pain modulatory systems in chronic pain ......................................................................... 76
Neurochemical basis of cognitive and emotional modulation of pain ................................................................ 76
Evidence that disruption of endogenous pain modulatory systems alter cognitive and emotional modulation of
pain in patients with chronic pain ....................................................................................................................... 76
Can altered pain modulatory circuitry be reversed in patients with chronic pain? ............................................. 76
6 Biopsychosocial Aspects in Asthma ....................................................................................................................... 77
6.1 Introduction asthma: pathophysiology and facts............................................................................................. 77
6.1.1 Facts: ....................................................................................................................................................... 77
6.1.2 Physiology............................................................................................................................................... 78
6.2 Psychological burden in asthma ...................................................................................................................... 79
4
, 6.2.1 Asthma ↔ psychological burden ............................................................................................................ 79
6.3 Acute emotions/stress in self-reports, lab studies, field studies ..................................................................... 80
6.3.1 How do biopsychosocial aspects influence asthma? .............................................................................. 80
6.3.2 Patient Self-Report .................................................................................................................................. 80
6.3.3 Lab studies .............................................................................................................................................. 81
6.3.4 Mechanisms for acute Emotions/stress ................................................................................................... 84
6.3.5 Summary I: Acute Emotions/Stress in Self reports/Lab/Field Studies .................................................. 84
6.4 Chronic emotions/stress in human and animal studies .................................................................................. 84
6.4.1 Chronicity of stress ................................................................................................................................. 84
6.4.2 Early life stress ........................................................................................................................................ 86
6.5 Social aspects .................................................................................................................................................. 87
6.5.1 Current views .......................................................................................................................................... 88
6.6 Neural aspects ................................................................................................................................................. 89
6.6.1 Summary II: Chronic Neg. Emotions/Stress ........................................................................................... 90
6.6.2 Current views .......................................................................................................................................... 90
6.7 Paper: Evidence establishing a link between prenatal and early life stress and asthma development ............ 91
6.8 Paper: Airway responsiveness to psychological processes asthma and health ............................................... 92
7 Biopsychosocial Aspects in COPD ......................................................................................................................... 95
7.1 Introduction COPD: pathophysiology and facts ............................................................................................. 95
7.2 Psychological burden in COPD ...................................................................................................................... 97
7.3 Effects of negative emotions in COPD ........................................................................................................... 97
7.3.1 How do negative emotions impact COPD? ............................................................................................ 97
7.3.2 General vs. specific negative emotions ................................................................................................... 99
7.4 Social aspects ................................................................................................................................................ 100
7.5 Potential cause-relationships between psychosocial aspects and COPD ...................................................... 101
7.5.1 H1: High burden of disease leads to increased anxiety/depression ✓................................................... 101
7.5.2 H2: Increased anxiety/depression leads to COPD (symptoms) ✓ ........................................................ 102
7.5.3 H3: Common factor underlying/impacting both COPD and anxiety/depression .................................. 102
Neural processes: functional ............................................................................................................................. 104
Neural processes: structural .............................................................................................................................. 105
Brain structure and fear: moderated mediation analysis ................................................................................... 105
Biopsychosocial Interactions ............................................................................................................................ 106
7.6 Summary: Biopsychosocial Interactions in COPD ....................................................................................... 106
7.7 Paper: Anxiety, Depression, and Panic ......................................................................................................... 106
7.8 Paper: anxiety and depression in COPD patients .......................................................................................... 109
COPD and anxiety ............................................................................................................................................ 109
Depression and COPD ...................................................................................................................................... 110
8 Physical activity, sedentary behavior and mental health....................................................................................... 110
8.1 Definitions: physical activity vs. exercise vs. sports physical fitness ........................................................... 110
8.1.1 World Health Organization (WHO) recommendations (adults) ........................................................... 111
5
, 8.2 Mediating factors between physical activity and (mental) health ................................................................. 112
8.2.1 Biological .............................................................................................................................................. 112
Endorphins ........................................................................................................................................................ 112
Monoamines ...................................................................................................................................................... 112
Neuroplasticity .................................................................................................................................................. 113
A. Neurogenesis ........................................................................................................................................ 113
B. Brain Volume (grey matter) .................................................................................................................. 113
C. White matter......................................................................................................................................... 114
D. Cerebral Blood Flow .............................................................................................................................. 114
Inflammation ..................................................................................................................................................... 114
Neuroendocrine system ..................................................................................................................................... 115
Higher level brain function ............................................................................................................................... 115
8.2.2 Psychosocial .......................................................................................................................................... 116
Distraction ......................................................................................................................................................... 116
Self esteem ........................................................................................................................................................ 116
Social support.................................................................................................................................................... 116
Self-efficacy ...................................................................................................................................................... 116
8.2.3 Physical activity – General thoughts ..................................................................................................... 116
8.3 Sedentary behaviour...................................................................................................................................... 116
8.3.1 Mediating factors between sedentary behaviour and (mental) health ................................................... 118
Neuroplasticity .................................................................................................................................................. 118
Inflammation ..................................................................................................................................................... 118
Neuroendocrine function................................................................................................................................... 118
9 Biopsychosocial Aspects of Dyspnea ................................................................................................................... 119
9.1 Introduction: Breathlessness (Dyspnea) ........................................................................................................ 119
9.2 Psychological Burden ................................................................................................................................... 120
9.3 How do psychosocial aspects impact the perception of dyspnea? ................................................................ 121
9.3.1 Negative affect ...................................................................................................................................... 121
9.3.2 Learning ................................................................................................................................................ 123
9.3.3 Context .................................................................................................................................................. 123
9.3.4 Social aspects ........................................................................................................................................ 123
9.3.5 Attention................................................................................................................................................ 124
9.4 Do psychosocial aspects impact the neural processing of breathlessness? ................................................... 124
9.4.1 Respiratory-related evoked potential (RREP) ....................................................................................... 124
Sensory Gating (RREP) .................................................................................................................................... 125
9.4.2 MRI: functional and structural .............................................................................................................. 126
Functional MRI ................................................................................................................................................. 126
Structural MRI (VBM)...................................................................................................................................... 127
9.5 Do patients with respiratory disease show altered neural processing of perceived dyspnea?....................... 127
9.6 Summary ....................................................................................................................................................... 128
6
,10 Role of the (microbiota-)gutbrain axis in functional gastrointestinal and affective disorders .......................... 129
10.1 Introduction ................................................................................................................................................... 129
10.2 (Microbiota)-Gut-Brain Axis ........................................................................................................................ 129
10.2.1 Extrinsic innervation ............................................................................................................................. 130
10.2.2 HPA axis (efferent) ............................................................................................................................... 131
10.2.3 Vagal anti-inflammatory pathway......................................................................................................... 131
10.3 Functional gastrointestinal disorders............................................................................................................. 132
10.3.1 Definitions & epidemiology .................................................................................................................. 132
Functional dyspepsia (FD) ................................................................................................................................ 133
10.3.2 Pathophysiological mechanisms ........................................................................................................... 134
Systemic disorders of gut brain interactions ..................................................................................................... 135
A. Psychological impact on GI symptoms .................................................................................................. 136
B. The brain and how psychology mechanisms shape the perception and the symptom reporting ....... 136
10.4 Impact of the gut microbiota on psychobiological processes ....................................................................... 140
10.4.1 The microbiota-gut-brain axis ............................................................................................................... 140
10.5 Summary ....................................................................................................................................................... 146
11 Positive psychology psychobiological interactions .......................................................................................... 146
11.1 Theory and concepts ..................................................................................................................................... 146
11.1.1 Perma theory of well-being (seligman) ................................................................................................. 146
11.1.2 Flow (mihaly csikszentmihalyi) ............................................................................................................ 147
11.1.3 Positive emotions – broaden-and-build theory ..................................................................................... 147
Broaden ............................................................................................................................................................. 147
Build.................................................................................................................................................................. 147
11.2 Health ............................................................................................................................................................ 148
11.2.1 Measurement considerations: PA.......................................................................................................... 148
1. Type of positive affectivity: .......................................................................................................................... 148
2. Choice of questionnaire: ............................................................................................................................... 148
3. Choice of time frame can influence the strength of association with health outcome .................................. 148
11.2.2 Measurement considerations: physical health & item overlap.............................................................. 149
11.2.3 Evidence for PA & health ..................................................................................................................... 149
1. Mortality ....................................................................................................................................................... 149
2. Morbidity ...................................................................................................................................................... 150
3. Disease severity, progression, and survival in chronic illness ...................................................................... 150
11.2.4 How can PA improve health? ............................................................................................................... 151
Main effect model of PA ................................................................................................................................... 151
Interaction effect ............................................................................................................................................... 152
The undoing hypothesis (Fredrickson).............................................................................................................. 152
11.3 Practise .......................................................................................................................................................... 152
11.3.1 Positive psychology interventions......................................................................................................... 153
11.3.2 Positive psychology interventions: do they work? ................................................................................ 154
7
,11.4 Summary ....................................................................................................................................................... 154
8
, Introduction to the course
Aims
1. Thorough knowledge and insight into the basic processes of psychological stress. These imply:
▪ Homeostatic regulation & the autonomic nervous system
▪ Central integration of stress response
▪ Inhibition of stress responses
▪ Endocrine stress reactions
▪ Psychoneuroimmunology
▪ Genes, stress and behavior
▪ Individual differences in stress reactivity
2. Knowledge of contemporary research topics regarding health effects of stress, with a special focus on the
(presumed) explaining mechanisms.
Furthermore, students are able to relate these research topics with the basic processes of psychological stress.
Examples: psychological factors in the progression of cancer, chronic stress and the metabolic syndrome,
influence of prenatal stress from mother on child, psychoneuroimmunology and wound healing, medical
unexplained complaints, mental representation of pain, psychosocial factors in cardiovascular, gastrointestinal
and respiratory disease
3. Situating and critically evaluating research on effects of stress on health
4. Developing an attitude to consult also scientific literature outside the field of Psychology (e.g., general scientific
or medical journals) and to relate these to psychological literature and models.
5. Insight into the relevance of research findings for the setup or evaluation of clinical health psychology
interventions.
Disciplines
Content
1. Psychophysiology of stress
▪ Homeostatic regulation
▪ Central integeration of the psychologic stress response
▪ Endocrine stress responses
▪ Psychoneuroimmunology
2. Biopsychological interactions relevant to health
▪ Emotional and cognitive modulation of pain
▪ Biopsychosocial aspects of asthma
▪ Biopsychosocial aspects of COPD
▪ Psychical activity
▪ Biopsychosocial aspects of dyspnea
▪ Gastrointestinal disorders
▪ Positive psychology
9
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