Lecture 1 - Psychosocial and biomedical aspects of chronic illness and disability
(introduction)
1. What is chronic illness?
Chronic somatic diseases are noncontagious, long-term conditions that:
● Can often be controlled
● Generally cannot be cured
● Are not preventable via vaccination
● → Globally, >50% of deaths are due to chronic diseases.
2. Risk factors for Chronic Disease
Behavioral risk Biological risk Additional psychosocial risk contributors:
factors: factors:
● Age (especially elderly)
● Physical ● High blood ● Gender differences (e.g., women
inactivity pressure show unique vulnerability via
● Unhealthy ● High psychosocial & biological pathways)
diet cholesterol ● Maladaptive coping
● Tobacco use ● Overweight ● Stress-related neuroendocrine and
immune dysfunction
● Personality factors
3. Chronic illness across the lifespan: the elderly
Key statistics:
● 80–90% of adults ≥65 have ≥1 chronic condition.
● Hypertension affects 70–80% of adults ≥65.
● Coronary artery disease affects 10–20%.
● Type 2 diabetes affects 25–30%.
● Osteoarthritis affects 50%.
3. What does a health psychologist do?
Clinical role:
● Address barriers to healthy behavior (e.g., adherence)
● Help with adjustment and coping
● Treat psychosocial problems associated with chronic disease
1
,Research role:
● Identify facilitators/barriers to healthy behavior
● Study mechanisms of psychological adjustment and interventions
● Examine psychosocial factors related to chronic disease
4. Consequences of chronic illness (GENERAL)
Chronic illness may impact: Factors that influence adjustment:
● Changes in body integrity ● Personal factors
● Changes in mental and physical (gender, age, coping skills)
well-being ● Social and family support
● Changes in self-concept and loss of (emotional & practical help)
● Socioeconomic status
control
(access to resources/healthcare)
● Changes in life goals and future plans
● Cultural background
● Changes in social roles (relationships, (beliefs and values about illness)
colleagues) ● Impact on daily activities
● Potential loss of independence (work, school, recreation)
● Financial instability ● Personal goals (what the person wants
to maintain/achieve)
→ Overall: redefining yourself as a person ● Life stage (child vs adult vs older adult)
with a chronic condition
Emotional reactions:
● Grief (reaction to loss)
● Fear & anxiety (response to threat; rational and irrational aspects)
● Anger (frustration, self-blame, blaming others)
● Depression, helplessness, hopelessness, apathy
● Guilt (self-criticism or blame)
5. The Biopsychosocial Model (practical application)
● Biological factors: genetics, physiology, pathogens
● Psychological factors: behavior, cognition, stress
● Social factors: SES, culture, social support
The lecture emphasizes clinical application, not just
theory:
→ Treatment must integrate biological + psychological +
social components.
2
,A. Barriers to Integrating BPS care:
● Challenge: theory vs practice
● Physicians tend to use a biomedical model → physician = expert, patient = passive.
● Psychologists often use a psychosocial model → therapist as coach, patient active.
● This creates referral barriers and misunderstandings (e.g., patients feeling that
referral to a psychologist means “it’s all in my head”).
● Integration requires mutual understanding: “Do we speak each other’s language?”
and cross-training in both psychosocial and biomedical aspects.
6. Advanced - Psychoneuroimmunology & Brain Plasticity: Evidence for BPS Interactions
Brain changes in chronic pain can reverse after:
● Spine surgery or facet joint injections
● CBT treatment, which is shown to increase prefrontal cortex gray matter
Psychoneuroimmunology: relationship between psychological stress and immune
responses:
● Laboratory stress (Trier Social Stress Test) linked to increases in inflammatory
markers (e.g., IL-6).
● In RA/psoriasis patients, a brief stress management training (4 × 1-hour sessions
with relaxation, psychoeducation, breathing, relapse prevention) led to lower
stress-induced IL-8 and cortisol at follow-up compared to controls.
7. Irritable Bowel Syndrome (IBS)
What is IBS?
● Common, chronic GI disorder affecting the large intestine.
● Functional disorder: significant discomfort but no structural tissue damage, no
increased cancer risk.
A. Core symptoms:
● Abdominal pain (often relieved after bowel movement)
● Bloating and gas
● Changes in bowel habits:
○ IBS-D (diarrhea-dominant)
○ IBS-C (constipation-dominant)
○ IBS-M (mixed)
● Mucus in stool
● Fatigue and sleep problems
3
, B. Biological factors:
● History of gut infections (e.g., gastroenteritis)
● Abnormal gut motility (too fast → diarrhea; too slow → constipation)
● Visceral hypersensitivity (increased pain sensitivity in intestines)
C. Psychological factors:
● High stress can trigger or worsen symptoms
● Maladaptive cognitions (e.g., catastrophizing about pain, bathroom access)
● Comorbid anxiety and depression may intensify symptom perception
D. Social factors:
● Stigma → hiding symptoms → isolation → extra stress
● Low social support → fewer coping resources, more difficulty managing symptoms
● Stressful lifestyles, irregular schedules, irregular eating → worse motility &
symptoms
E. Psychological impact:
● Anxiety & depression (bi-directional relationship with symptoms)
● Social avoidance due to fear of flare-ups
● Reduced QoL (work, daily activities, relationships)
F. Medical treatment:
● Dietary changes
● Medications:
○ Antispasmodics (reduce gut muscle spasms and pain)
○ Laxatives/fiber supplements (IBS-C)
○ Antidiarrheals (IBS-D)
○ Probiotics
○ Low-dose psychotropic meds for symptom management
G. Psychological treatment:
● CBT for thoughts/behaviors related to symptoms
● Stress management (relaxation, breathing, mindfulness, meditation)
● Biofeedback to gain control over bodily responses
● Psychotherapy to address underlying psychological issues
4
(introduction)
1. What is chronic illness?
Chronic somatic diseases are noncontagious, long-term conditions that:
● Can often be controlled
● Generally cannot be cured
● Are not preventable via vaccination
● → Globally, >50% of deaths are due to chronic diseases.
2. Risk factors for Chronic Disease
Behavioral risk Biological risk Additional psychosocial risk contributors:
factors: factors:
● Age (especially elderly)
● Physical ● High blood ● Gender differences (e.g., women
inactivity pressure show unique vulnerability via
● Unhealthy ● High psychosocial & biological pathways)
diet cholesterol ● Maladaptive coping
● Tobacco use ● Overweight ● Stress-related neuroendocrine and
immune dysfunction
● Personality factors
3. Chronic illness across the lifespan: the elderly
Key statistics:
● 80–90% of adults ≥65 have ≥1 chronic condition.
● Hypertension affects 70–80% of adults ≥65.
● Coronary artery disease affects 10–20%.
● Type 2 diabetes affects 25–30%.
● Osteoarthritis affects 50%.
3. What does a health psychologist do?
Clinical role:
● Address barriers to healthy behavior (e.g., adherence)
● Help with adjustment and coping
● Treat psychosocial problems associated with chronic disease
1
,Research role:
● Identify facilitators/barriers to healthy behavior
● Study mechanisms of psychological adjustment and interventions
● Examine psychosocial factors related to chronic disease
4. Consequences of chronic illness (GENERAL)
Chronic illness may impact: Factors that influence adjustment:
● Changes in body integrity ● Personal factors
● Changes in mental and physical (gender, age, coping skills)
well-being ● Social and family support
● Changes in self-concept and loss of (emotional & practical help)
● Socioeconomic status
control
(access to resources/healthcare)
● Changes in life goals and future plans
● Cultural background
● Changes in social roles (relationships, (beliefs and values about illness)
colleagues) ● Impact on daily activities
● Potential loss of independence (work, school, recreation)
● Financial instability ● Personal goals (what the person wants
to maintain/achieve)
→ Overall: redefining yourself as a person ● Life stage (child vs adult vs older adult)
with a chronic condition
Emotional reactions:
● Grief (reaction to loss)
● Fear & anxiety (response to threat; rational and irrational aspects)
● Anger (frustration, self-blame, blaming others)
● Depression, helplessness, hopelessness, apathy
● Guilt (self-criticism or blame)
5. The Biopsychosocial Model (practical application)
● Biological factors: genetics, physiology, pathogens
● Psychological factors: behavior, cognition, stress
● Social factors: SES, culture, social support
The lecture emphasizes clinical application, not just
theory:
→ Treatment must integrate biological + psychological +
social components.
2
,A. Barriers to Integrating BPS care:
● Challenge: theory vs practice
● Physicians tend to use a biomedical model → physician = expert, patient = passive.
● Psychologists often use a psychosocial model → therapist as coach, patient active.
● This creates referral barriers and misunderstandings (e.g., patients feeling that
referral to a psychologist means “it’s all in my head”).
● Integration requires mutual understanding: “Do we speak each other’s language?”
and cross-training in both psychosocial and biomedical aspects.
6. Advanced - Psychoneuroimmunology & Brain Plasticity: Evidence for BPS Interactions
Brain changes in chronic pain can reverse after:
● Spine surgery or facet joint injections
● CBT treatment, which is shown to increase prefrontal cortex gray matter
Psychoneuroimmunology: relationship between psychological stress and immune
responses:
● Laboratory stress (Trier Social Stress Test) linked to increases in inflammatory
markers (e.g., IL-6).
● In RA/psoriasis patients, a brief stress management training (4 × 1-hour sessions
with relaxation, psychoeducation, breathing, relapse prevention) led to lower
stress-induced IL-8 and cortisol at follow-up compared to controls.
7. Irritable Bowel Syndrome (IBS)
What is IBS?
● Common, chronic GI disorder affecting the large intestine.
● Functional disorder: significant discomfort but no structural tissue damage, no
increased cancer risk.
A. Core symptoms:
● Abdominal pain (often relieved after bowel movement)
● Bloating and gas
● Changes in bowel habits:
○ IBS-D (diarrhea-dominant)
○ IBS-C (constipation-dominant)
○ IBS-M (mixed)
● Mucus in stool
● Fatigue and sleep problems
3
, B. Biological factors:
● History of gut infections (e.g., gastroenteritis)
● Abnormal gut motility (too fast → diarrhea; too slow → constipation)
● Visceral hypersensitivity (increased pain sensitivity in intestines)
C. Psychological factors:
● High stress can trigger or worsen symptoms
● Maladaptive cognitions (e.g., catastrophizing about pain, bathroom access)
● Comorbid anxiety and depression may intensify symptom perception
D. Social factors:
● Stigma → hiding symptoms → isolation → extra stress
● Low social support → fewer coping resources, more difficulty managing symptoms
● Stressful lifestyles, irregular schedules, irregular eating → worse motility &
symptoms
E. Psychological impact:
● Anxiety & depression (bi-directional relationship with symptoms)
● Social avoidance due to fear of flare-ups
● Reduced QoL (work, daily activities, relationships)
F. Medical treatment:
● Dietary changes
● Medications:
○ Antispasmodics (reduce gut muscle spasms and pain)
○ Laxatives/fiber supplements (IBS-C)
○ Antidiarrheals (IBS-D)
○ Probiotics
○ Low-dose psychotropic meds for symptom management
G. Psychological treatment:
● CBT for thoughts/behaviors related to symptoms
● Stress management (relaxation, breathing, mindfulness, meditation)
● Biofeedback to gain control over bodily responses
● Psychotherapy to address underlying psychological issues
4
