Psychobiological Processes in Health and Illness

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Kate Hamilton-West

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    Dedication

    To Tim, Honor and Phoebe

    Preface

    Conceptualisations of health, illness and disease have changed considerably over the past few decades. These changing conceptualisations have influenced (and been influenced by) the development of new fields of study, many of which span traditional disciplinary boundaries.

    Perhaps the most important boundary to be bridged in health research is that between the study of the mind (psychology) and the study of the body (biology). The emergence of disciplines such as health psychology, behavioural medicine and psychoneuroimmunology reflects a growing recognition that while particular psychological and biological processes can be isolated for research purposes, this isolation can distort the processes we aim to understand. To understand the nature of biological processes and their implications for health, we must also consider the influence of psychological processes; to understand the nature of psychological processes and their implications for health, we must also consider the influence of biological processes.

    This integration between psychological and biological approaches is essential if we are to tackle the health challenges facing us today. Take, for example, the rise in chronic illness associated with behaviours such as drinking, smoking and overeating. How do we get to the root cause of this problem?

    Explaining the causes of human behaviour has traditionally been the domain of psychologists, and there are numerous theories within this field to explain why individuals may engage in behaviours that are apparently self-defeating. These theories, however, tend to explain health-related behaviour in terms of consciously accessible beliefs, attitudes and expectations. It is becoming increasingly evident that explanations at this level cannot fully account for behaviour. People who want to follow a healthy diet, quit smoking or cut down on alcohol frequently fail, despite their best intentions, and recent research suggests that biological processes may be to blame. ‘Will power’ apparently relies on limited resources, and the energy required to constantly resist temptation may simply ‘run out’. Such resources may be even more limited during stressful periods or periods of illness as the organism must redirect resources towards dealing with more immediate threats. Research also suggests that behaviours such as drinking, smoking and overeating may function in a similar manner to the body's own homeostatic mechanisms, allowing the individual to maintain normal functioning during challenging periods.

    So, while psychologists still play a key role in explaining health-related behaviours, there is now increasing recognition that theories must be expanded to incorporate a role for psychobiological processes and that these processes may not necessarily be accessible to conscious awareness or self-report.

    Other bodies of research are also important to this endeavour. Genetic research, for example, has important implications when considering to what extent health (and health-related behaviour) is ‘written in the genes’. Perhaps the risk of disease is genetically predetermined. If so, does behaviour really matter? Perhaps some people are predestined to become obese or addicted to alcohol or cigarettes. If so, can we really do anything to change these outcomes?

    Alternatively, perhaps it is the environment that is truly to blame. For example, epidemiological research highlights marked social gradients in health, both between and within countries. How do we account for these gradients? Why should life expectancy and the risk of disease depend on the country we live in or our occupation?

    If we really want to tackle global health issues, should we be trying to change people's attitudes, genes or environments? It is clear that no one discipline can provide a complete answer to the health challenges that face us today. Scientists across a number of health-relevant disciplines will need to work together more closely, and we will need to train more scientists to work at the interface of psychology, biology and medicine.

    The Aims of This Book

    While integration of the disciplines is important if we are to further understand, prevent and treat disease, it is not necessarily easy to achieve.

    Differences in terminology exist between relevant disciplines and these render much research inaccessible to readers from other disciplinary backgrounds. Differences in research methods also present barriers to integration. For example, the process of defining and measuring psychological constructs may appear mysterious to researchers who are more accustomed to studying biological processes. This means that, outside the discipline of psychology, psychological constructs can appear ‘woolly’ or difficult to apply. Researchers with a pure psychology background may find immune or endocrine processes just as mysterious. While the discoveries arising from the Human Genome Project undoubtedly have important implications for all disciplines concerned with understanding the causes of disease and illness, scientists outside the genetic field may not be aware of the methods used to differentiate environmental and genetic contributions to disease or identify disease genes.

    The purpose of this book, then, is to begin to break down some of these barriers and provide an accessible introduction to psychobiological processes relevant to health and illness, summarising key findings across a number of disciplines. Research methods within these disciplines are also discussed and key terms are defined as we proceed (these are also listed in the Glossary at the back of this book). Since the literature summarised in the following chapters is both vast and diverse, we have not attempted to cover it all, but instead provide a useful entrée. The structure of the book is described in greater detail below.

    The Structure of This Book

    The first chapter invites you to take a step back and consider what we mean by commonly used terms such as ‘health’, ‘illness’ and ‘disease’, as well as what it means to be ‘normal’ (or ‘abnormal’). In this chapter we also explain what we mean by ‘psychobiological processes’; we consider disciplines concerned with these processes and discuss the methods used to define and measure theoretical constructs.

    In this chapter we summarise research focusing on stress - a concept that has been defined and measured in a number of ways and is therefore often viewed as particularly ‘woolly’. Despite problems of definition, the stress concept is critical to an understanding of how changes in the external environment may influence processes within the body. Research focusing on psychobiological responses to stress also requires us to consider how the health effects of toxic environments should be measured - how do we quantify changes across multiple physiological systems, for example?

    Here we turn our attention to positive processes in health and illness. If negative emotions can damage our health, do positive emotions have the power to cure? Why is it that some people appear relatively resilient to life's challenges? How do patients find positive meaning in their experiences of illness? Are happier people healthier (or vice versa)? This chapter also aims to highlight trends in the psychological research literature - particularly the growing body of research focusing on promotion of positive psychological outcomes (as opposed to amelioration of psychopathology).

    In this chapter we consider the role that our genes play in determining personality, behaviour, health and well-being and how the Human Genome Project has contributed (and continues to contribute) to our understanding of the determinants of health and illness. You are invited to consider the opportunities and challenges presented by predictive genetic testing - is it useful, desirable or even ethical to predict an individual's risk of disease months or even years before symptoms appear? Would you want to know your risk? What are the implications of predictive genetic testing for the prevention and treatment of illness?

    Here we discuss an aspect of human experience in which psychological and biological processes are particularly closely interrelated - the experience of pain. Like stress, pain has proved difficult to define and measure, and a number of theories have been presented over the years to account for our experience of it. Nonetheless, pain is a very real and a very common problem. We consider how pain may influence and be influenced by psychological and biological processes and how understanding of psychobiological interactions may help to develop more effective treatments.

    While the research reviewed in Chapters 1 to 5 highlights implications of psychobiological processes for health and illness at an individual level, it is also important to consider to what extent these processes may account for variations in the risk of disease at the group level. For example, do we see higher rates of infectious illness or heart disease in groups exposed to chronic stress over a number of years (the stress associated with long-term caregiving or economic hardship, for example)? If not, we need to question whether associations between psychological and biological processes observed in the laboratory have any relevance in the real world. In this chapter, then, we take a look at a number of ‘at risk’ populations and consider the extent to which real-world evidence supports the findings of laboratory research.

    Next, we shift our attention from theory to intervention. In this chapter we consider to what extent psychobiological research has resulted in changes in the way we treat or prevent illness and disease. We discuss a wide range of approaches, including both coping-based interventions for patients with chronic illness and cognitive behavioural therapies for patients with chronic illness or pain. You are asked to consider the relative strengths and limitations of alternative approaches and the extent to which intervention effects may be explained by the theories and processes described in previous chapters.

    We focus here on methodological issues. We consider what kind of evidence is needed to demonstrate that psychological processes actually produce alterations in physical functioning, or that psychobiological processes actually produce changes in health outcomes. We describe the principles of experimental design and discuss alternative research designs, considering the relative advantages and disadvantages of each. The methods available for evaluating the effects of intervention are also discussed and we consider the complexities involved in developing and applying theory-based interventions.

    The final chapter presents a summary of the research discussed in previous chapters, highlighting themes that cut across disciplines and present opportunities for interdisciplinary collaboration. We draw some tentative conclusions regarding the nature of ‘toxic’ and ‘optimal’ conditions in relation to social, psychological and biological functioning and take a look into the future in order to consider how psychobiological research could benefit from recent technological advances. These include advances in information and communication technologies, brain imaging technologies and virtual reality applications. In this chapter we also consider how psychobiological research could be expanded to include a role for macro-level influences, those related to religion, culture and community.

    Notes on Features of This Book
    Key Terms and the Glossary

    Key terms are highlighted in bold the first time they appear and are listed at the end of each chapter. They are also listed in the Glossary at the end of this book, together with a brief definition or explanation - for a more detailed explanation please refer to the chapter.

    Boxes

    Some points require a more detailed explanation than is practicable within the main body of the text. These are therefore explained in greater detail in boxes. Some boxes summarise controversies in the research literature - for example, ‘Can stress shrink your brain?’, ‘Does coping influence cancer survival?’

    While research findings are summarised throughout this book, it is also important to take a detailed look at individual studies - what methods did the researchers use, what did they find and what conclusions did they draw? The ‘Research in focus’ boxes provide detailed descriptions of key studies in relation to the topics discussed in each chapter.

    Discussion Questions and Further Reading

    Each chapter ends with a list of discussion questions and further reading. These are to encourage you to delve further into the literature and relate the research discussed in each chapter to your own experience - clinical, research-based or real life.

    About the Author

    I completed a PhD in health psychology in 2003 and have since qualified as a chartered psychologist and practising health psychologist. I have a very long-held interest in health and have previously worked in medical education and training, in health and social care research and in health psychology education and training. I am now a lecturer in health psychology at the University of Kent. My research focuses on relationships between emotions and health and the psychological implications of living with chronic illness. Much of my current research is multidisciplinary and I enjoy collaborating with colleagues (both academics and clinicians) across a range of health-related disciplines.

    Acknowledgements

    I would like to thank a number of people who have contributed to the process of writing this book: Chris Bridle, Christina Chryssanthopoulou, Aileen McGettrick, Katja Rudell and Derek Rutter for reading and commenting on early drafts, and Sarah Hotham for her work on the References section.

    Publisher's Acknowledgements

    The author and publisher wish to thank the following for permission to use copyright material:

    We thank the American Psychiatric Association for permission to use Figure 1.1 Hierarchy of Natural Systems. From Engel, G. L. (1980). The Clinical Application of the Biopsychosocial Model. American Journal of Psychiatry, 137, 535–544. Reprinted with permission from the American Journal of Psychiatry, (Copyright 1980). American Psychiatric Association.

    We thank the American Psychological Association for permission to use Table 3.1 Components of subjective well-being. From Diener, E., Suh, E., Lucas, R. & Smith, H. (1999). Subjective well-being: Three decades of progress. Psychological bulletin, 2, 276–302.

    We thank BioMed Central for permission to use Figure 4.2 Diagram Showing Inheritance in Hybrid Pea Plants. From Porteous, J.W. (2004). We still fail to account for Mendel's observations. Theoretical Biology and Medical Modelling, 1, 1–4.

    We thank BMJ Publishing Group for permission to use:

    Figure 5.1. From Holdcroft, A. & Power, I. (2003) ‘Recent Developments: Management of Pain’. British Medical Journal, 326, 635–9.

    Figure 8.2 Sequential Phases of Developing Randomised Controlled Trials of Complex Interventions. Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A.L., Sandercock, P., Spielgelhalter, D., & Tyrer, P. (2000) ‘Framework for Design and Evaluation of Complex Interventions to Improve Health’. British Medical Journal, 321, 694–696.

    We thank Elsevier for permission to use:

    An excerpt from Slagboom, P.E. & Meulenbelt, I. (2002) ‘Organisation of the Human Genome and our Tools for Identifying Disease Genes’. Biological Psychology, 61, 11–31.

    Figure 1.2 An Integrative Model of Psychoneuroimmunology and Health Psychology. From Lutgendorf and Costanzo (2003) ‘Psychoneuroimmunology and Health Psychology: An Integrative Model’. Brain and Behavior and Immunity, 17, 225–315.

    Figure 1.4 Social Readjustment Rating Scale. From: Holmes, T. H. & Rahe, R H. (1967) ‘The Social Readjustment Rating Scale’. Journal of Psychosomatic Research, 11, 213–18.

    Figure 2.5 Theoretical Model of the Coping Process. From Folkman, S. (1997) ‘Positive Psychological States and Coping with Severe Stress’. Social Science and Medicine, 45, p1207–1221.

    Figure 2.6 The Cognitive Activation Theory of Stress. From Ursin, H., & Eriksen, H. R. (2004) ‘The Cognitive Activation Theory of Stress’. Psychoneuroendocrinology, 29, 567–592.

    Table 2.1 From Homeostasis to Pathology. From LeMoal, M.L. (2007) ‘Historical Approach and Evolution of the Stress Concept: A Personal Account’. Psychoneuroendocrinology, 32. S3–S9.

    Figure 3.1 Theoretical Model of the Coping Process and Figure 3.2. Revised theoretical Model of the Coping Process. From Folkman, S. (1997) ‘Positive Psychological States and Coping with Severe Stress. Social Science Medicine, 45, 1207–1221.

    Figure 4.5 Causal Model of Emotional Dysregulation as a Candidate Endophenotype of Alcohol Dependence. From Lesch, K. P. (2005) ‘Alcohol Dependence and Gene X Environment Interaction in Emotion Regulation: Is Serotonin the Link? European Journal of Pharmacology, 526, 113–124.

    Table 5.1 Definitions of Pain. From Summers, S. (2000) ‘Evidence-based Practice Part 1: Pain Definitions, Pathophysiologic Mechanisms, and Theories’. Journal of PeriAnaesthesia Nursing, 15, 357–365.

    Figure 5.3 The Gate Control Theory of Pain and Figure 5.4 The body-self Neuromatrix. From Melzack, R. (1999) ‘From the Gate to the Neuromatrix’. Pain, 82, S121–S126.

    Figure 5.5. Site of Endogenous Opioid Receptors. From Pleuvry, B. J. (2005). Opioid Mechanisms and Opioid Drugs. Anaesthesia and Intensive Care Medicine, 6, 30–34.

    Figure 6.1 Life expectancy plotted against GDP per head. From Marmot, M. (2006) ‘Health in an Unequal World’. Lancet, 368, 2081–2094.

    Figure 6.4 from Spolentini, I., Gianni, W., Repetto, L., Bria, P., Caltagirone, C., Bossu, P., & Spalletta, G. (2008) ‘Depression and Cancer: An unexplored and unresolved Emergent Issue in Elderly Patients. Critical Reviews in Oncology/Hematology, 65, 143–155.

    Figure 6.5 from Gilley, D., Herbert, B-S., Huda, N., Tanaka, H., & Reed, T. (2008) ‘Factors Impacting Hman Tlomere Hmeostasis and Age-related Disease’. Mechanisms of Aging and Development, 129, 27–34.

    Figure 7.1 Diagram Showing Relationships between Placebo Treatment, Internal Regulatory Processes, and Outcomes. Wager, T. D. & Nitschke, J. B. (2005) ‘Placebo Effects in the Brain: Linking Mental and Physiological Processes. Brain, Behavior, and Immunity, 19, 281–282.

    Table 8.1 Hierarchy of Scientific Evidence for Inferring Causality. From Ketterer, M. W., Mahr, G., & Goldberg, A. D. (2000) ‘Psychological Factors Affecting a Medical Condition: Ischemic Coronary Heart Disease’. Journal of Psychosomatic Research, 48, 357–367.

    Table 8.2 from Glasgow, R. E., McKay, H. G., Piette, J. D., & Reynolds, K. D. (2001) ‘The RE-AIM Framework for Evaluating Interventions: What can it tell us about Approaches to Chronic Illness Management?’ Patient Education and Counselling, 44, 119–127.

    We thank Merck & Co. for permission to use Figure 5.2 Referred Pain. From The Merck Manual of Medical Information - Home Edition, edited by Robert S. Porter. Copyright 2007 by Merck & Co., Inc., Whitehouse Station, NJ. Available at: http://www.merck.com/mmhe. Accessed on 2/5/2008.

    We thank the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health and the U.S. Department of Health and Human Services for permission to use Figure 6.2 Coronary Atherosclerosis.

    We thank Nature Publishing Group for permission to use Figure 4.4 from Boomsma, D., Busjahn, A., & Peltonen, L. (2002) ‘Classical Twin Studies and Beyond’. Nature, 3, 872–882.

    We thank Oxford University Press for permission to use:

    Figure 2.1 The Autonomic Nervous System. From “Dictionary of Psychology” by Coleman Andrew (2006). By permission of Oxford University Press.

    Fig 2.2 The Endocrine System. From ‘The Oxford Companion to the Body’ by Colin Blakemore and Sheila Jennett. By permission of Oxford University Press.

    We thank Taylor and Francis for permission to use Figure 3.3. Schematic representation of Leventhal et al.'s (1980) Common Sense Model of Illness Representations. From Hagger, M.S. & Orbell, S. (2003) ‘A Meta-analytic Review of the Common-sense Model of Illness Representations. Psychology and Health, 18, p141–184.

    We thank the Public Library of Science (PLoS) for permission to use Figure 4.6 Waddington's epigenetic landscape. From Mitchell, K.J. (2007) ‘The Genetics of Brain Wiring: From Molecule to Mind. PLoS Biology, 5, e113–115

    We thank Wiley-Blackwell for permission to use Figure 2.7 Four Types of Allostatic Load. From McEwen, B.S. (1998) ‘Stress, Adaptation, and Disease: Allostasis and Allostatic Load’ Annals of the New York Academy of Sciences, 840, 33–44.

  • Glossary

    A-beta fibres Rapidly conducting non-nociceptive fibres. See gate control theory.

    Acceptance and commitment therapy (ACT) A mindfulness-based therapy that encourages patients to disentangle from troubling thoughts or sensations, develop deepened conscious contact with the present moment and construct patterns of action linked to chosen values.

    Acupressure Stimulation of acupuncture points without piercing the skin, applying pressure instead. Used to relieve pain.

    Acupuncture Involves insertion of solid needles at acupuncture points. Used to relieve pain.

    Acute pain Pain elicited by substantial injury to body tissue and activation of nociceptive transducers.

    Adaptive immunity (also called acquired or specific immunity) Highly targeted immune response to overcome specific foreign invaders.

    A-delta fibres Fast, myelinated fibres carrying information about intense, sharp pain. See gate control theory.

    Alleles Alternative forms of a gene at a specific chromosomal location.

    Allocation bias Deviation from random assignment in which group allocation is related to (known or unknown) risk factors or confounding variables.

    AllodyniaSee stimulus-evoked pain.

    Allostasis The process of maintaining stability through change.

    Allostatic load The biological ‘cost’ associated with allostatic systems.

    Altered homeostatic theory Suggests that age-associated diseases result from a shift from parasympathetic to sympathetic regulation and loss of maintenance and repair functions.

    Appraisal Cognitive evaluation of a situation or stimulus.

    Autonomic nervous system (ANS) The division of the peripheral nervous system responsible for controlling the functioning of a number of organs and glands.

    Autosomal dominant inheritance A mutant gene from one parent is sufficient to cause the disease, even if a normal copy is inherited from the other parent.

    Autosomal recessive inheritance Each individual must inherit two copies of the mutant gene (one from each parent) to develop the disease.

    Autosome Any chromosome other than a sex chromosome.

    Behaviour therapy A therapeutic approach involving the use of a range of techniques aimed at eliminating problem behaviours by manipulating response contingencies.

    Behavioural genetics The genetic study of behaviour.

    Behavioural medicine An interdisciplinary field concerned with the integration and application of behavioural, environmental and biomedical knowledge relevant to health and disease.

    Benefit-finding Finding positive meaning (benefit) in stressful experiences.

    Biochemical theory of pain Describes biochemical mechanisms implicated in pain.

    Biofeedback A technique used to produce learned control of a wide range of physiological responses, including systolic and diastolic blood pressure, peripheral vascular responses and various brain rhythms.

    Biomedical model Considers disease to be fully explained by deviations from the norm of biological variables.

    Biopsychosocial model Considers health to result from complex interactions between biological, social and psychological factors. Blinding Withholding information from the participant about the assigned intervention (drug v. placebo, for example). Information may also be withheld from the person delivering the intervention (‘double blind trial’) and from the person responsible for analysing the data (‘triple blind trial’).

    Broaden and build theory Suggests that positive emotions perform an important adaptive function by broadening the thought–action repertoire and building resources.

    Catastrophising A coping strategy aimed at increasing attention or empathy from others.

    Cellular immunity, cell-mediated immunity, Th1 response Involves the use of killer T cells and NK cells to destroy infected cells.

    Central nervous system (CNS) The brain and spinal cord.

    Central sensitisation Increased excitability of neurons in the central nervous system.

    C fibres Slow, unmyelinated fibres carrying information about dull, throbbing pain. See gate control theory.

    Chromosomal disorders Result from an abnormal chromosome number or structural rearrangement of chromosomes.

    Chromosome Large stretches of DNA.

    Chronic pain Pain that persists beyond the normal time of healing.

    Circadian pattern A rhythmic, 24-hour cycle in relation to sleep.

    Classical conditioning An associative learning process resulting in a conditioned response to a previously neutral stimulus, such as dogs salivating in response to a bell.

    Cognitive activation theory (CAT) Conceptualises stress and coping in terms of expectancy.

    Cognitive behavioural therapy (CBT) A therapeutic approach involving the use of behaviour therapy and cognitive therapy techniques. See behaviour therapy and cognitive therapy.

    Cognitive therapy A therapeutic approach involving the use of a range of techniques developed to challenge problem thinking.

    Commonsense model of illness representations Proposes that individuals hold cognitive and emotional representations of illness, and these guide their attempts to cope.

    Complex interventions Interventions involving several components that may be difficult to describe and standardise, such as in pain clinics and stroke units.

    Complex or multifactorial disorders Result from complex interactions between genes and the environment.

    Conditioned immunomodulation Alteration of immune function via classical conditioning.

    Confounding variables Variables that could influence the relationship between an independent (manipulated or measured) variable and a dependent (outcome) variable.

    Consolidated Standards of Reporting Trials (CONSORT) Statement A set of evidence-based guidelines for reporting randomised controlled trials.

    Coping skills training A psychological intervention based on coping theory.

    CopingEither efforts to alter a stressful situation, and/or minimise resulting distress (see transactional model of coping) or positive outcome expectancy (see cognitive activation theory).

    Coronary atherosclerosis A progressive disease involving a gradual thickening of the walls of the coronary arteries.

    Corticosteroids Steroid hormones produced by the adrenal glands (cortisol in humans, corticosterone in rats and mice).

    Cytokines Chemical messengers released by cells of the immune system.

    Deep brain or motor cortex stimulation Electrical stimulation of the brain. Used to treat refractory neuropathic pain states.

    Deoxyribonucleic acid (DNA) The primary material (in most organisms) containing the information for all hereditary traits of the organism.

    Disease An organising construct for explaining and responding to constellations of symptoms. Dizygotic (DZ) twins Derive from two distinct fertilised eggs and, therefore, have the same genetic relationship as non-twin siblings.

    Double blind trialsSee blinding.

    Ecological momentary assessments Involve the use of methods by which a participant in research can report on his or her emotions, cognitions or behaviours as they are experienced.

    Electroacupuncture Weak, pulsed electric current passed through acupuncture needles. Used to relieve pain.

    Electrodermal response (EDR) A technique used to monitor sweat gland activity.

    Electroencephalography (EEG) A technique used to monitor brainwave activity.

    Electromyography (EMG) A technique used to monitor muscle tension.

    Emotional disclosure A psychological intervention that involves expressing negative thoughts and feelings. Typically, it involves writing in a diary for three to four days.

    Endocrine system A system of glands that produce and secrete hormones.

    Endocrinosenescence Age-related changes in endocrine function.

    Endophenotype Higher-order variables explaining individual variability in self-reported and observed behaviour.

    Endorphins Endogenous, morphine-like substances that attach to pain receptors to modulate or decrease pain.

    Enteric nervous system Division of the autonomic nervous system responsible for controlling intestinal functions.

    Environmental epigenomics A new field of study that aims to determine which human genes are likely to be involved in susceptibility to disease when epigenetically deregulated.

    Epidural block Injection of anaesthetic into the epidural space near the spinal cord to relieve pain.

    Epigenetic landscape A theoretical model that explains phenotypic variance in terms of environmental forces acting on an organism, represented by a ball rolling over a landscape.

    Epigenetics Localised changes in gene expression that take place without a change in the DNA sequence.

    Epigenomics Changes in gene expression across many genes in a cell or organism.

    Evidence-based medicine (EBM) The process of systematically reviewing, appraising and using research evidence to guide the delivery of clinical care.

    Experimental design Involves manipulating one or more independent variable(s) in order to observe changes in the outcome (dependent) variable, while controlling for potential confounding variables.

    External or ecological validity The extent to which the results of a study may be generalised beyond the study sample or experimental setting.

    Extinction Lack of reinforcement for a previously reinforced (conditioned) response, resulting in cessation of the conditioned response.

    Fight or flight response Bodily changes associated with fear and rage, as described by Walter Cannon (1871–1945). See relaxation response.

    Flow A state of optimal psychological functioning in which challenges are matched to the individual's level of skill.

    Functional magnetic resonance imaging (fMRI) A non-invasive brain imaging technique used to map brain activity, evidenced by changes in blood flow.

    Gamma-aminobutyric acid (GABA) The primary inhibitory neurotransmitter of the nervous system.

    Gate control theory (GCT) A theory of pain that incorporates both physiological and psychological dimensions.

    Gene Unit of genetic material made up of deoxyribonucleic acid (DNA).

    Gene expression How and when genes are ‘switched on’.

    Gene therapy An experimental technique that uses genes to prevent or treat disease.

    General adaptation syndrome (GAS) A three-stage response to prolonged stress, as described by Hans Selye (1907–1982).

    Genome The entire complement of genetic material of a cell. Genotype The individual's unique set of genes.

    Graded exposure therapy Involves repeatedly presenting a feared stimulus under conditions in which the stimulus will not result in unfavourable consequences.

    Habituation The process by which an animal (or person) learns to ignore a stimulus that does not predict anything of value.

    Hardiness A personality construct characterised by commitment, control and challenge.

    Health An evaluative notion based on adherence to physical, social and mental ‘normality’.

    Health psychology An applied branch of psychology concerned with understanding and improving health and the healthcare system.

    Health psychology interventions Psychological (cognitive, emotional, behavioural) interventions designed to improve health or target processes contributing to illness and disease.

    Homeostasis The process of maintaining physiological equilibrium.

    Humoral immunity, antibody-mediated immunity, Th2 response Involves the use of molecules that bind with an antigen in order to clear it from the body.

    HyperalgesiaSee stimulus-evoked pain.

    Hypothalamic-pituitary-adrenal (HPA) axis Refers to interactions between the hypothalamus, pituitary gland and adrenal gland.

    Illness A deviation from physical, social or mental ‘normality’ that is perceived by the patient as distressing and a title to special treatment.

    Immune surveillance hypothesis Suggests that tumours develop when the normal surveillance function of the immune system is suppressed.

    Immune system A network of cells, tissues and organs responsible for defending the organism against attack by ‘foreign’ invaders, such as bacteria, fungi, parasites, viruses.

    Inflamma-ageing An increased inflammatory immune response with advancing age.

    Innate immunity (also called natural immunity) Non-specific immune response that acts near entry points into the body.

    INUS Stands for causes that are Insufficient but Necessary components of Unnecessary but Sufficient causes.

    Leukocytes White blood cells of the immune system.

    Local anaesthetic A drug that causes reversible local anaesthesia.

    Lymphocytes Cells of the immune system responsible for identifying and eliminating foreign invaders.

    Lymphoid organs Organs of the immune system.

    Magnetoencephalography (MEG) A non-invasive brain imaging technique used to map brain activity, evidenced by changes in magnetic fields.

    Mediator A variable that explains how or why the relationship between two other variables exists.

    Mere measurement effect or question–behaviour effect The phenomenon in which behaviour is altered simply by asking the participant to answer a question.

    Meta-analysis The use of statistical methods to summarise the results of a number of relevant studies and examine the consistency of evidence across studies.

    Mindfulness-based cognitive therapy (MBCT) An adaptation of mindfulness-based stress reduction (MBSR), used for treating chronic depression.

    Mindfulness-based stress reduction (MBSR) A group intervention that involves training in mindfulness meditation and its applications in daily living and coping with stress, pain and illness.

    Moderator A variable that explains under which conditions a relationship between two other variables exists.

    Monozygotic (MZ) twins Derive from a single egg and, therefore, inherit identical genetic material.

    Multifactorial causality Outcomes that are produced by multiple causal inferences for which several different causal pathways may lead to the same outcome.

    Mutations Changes in DNA sequence with an effect on gene function.

    Natural experiment A study design that involves examination of naturally occurring risk and protective factors using design elements that allow an approximation to experimental conditions.

    Naturalistic studies Studies that involve recording risk and protective factors under natural (rather than experimental) conditions.

    Negative automatic thoughts (NATs) Dysfunctional thoughts that arise automatically, without deliberation or reasoning, and have the capacity to produce dysfunctional behaviours.

    Neurofeedback Self-regulation of functional brain networks using functional magnetic resonance imaging (fMRI) feedback. See fMRI.

    Neuromatrix theory of pain A theory of pain that incorporates genetic, cognitive neurohormonal and neural mechanisms.

    Neuropathic pain Pain that is not thought to indicate tissue damage, but results from changes to the nervous system.

    NeuropeptidesSee neurotransmitters.

    Neurosignature The characteristic pattern of nerve impulses produced by the pattern of synaptic connections in the neuromatrix.

    Neurotransmitters Chemical messengers released by neurons. Includes small molecule neurotransmitters (such as ACTH, GABA) and neuropeptide neurotransmitters (such as CRH, ACTH).

    Nociception The physiological response to tissue injury.

    Nociceptive transducers Peripheral terminals of nociceptors.

    Nociceptors Nerves that transmit pain signals to the brain.

    Non-steroidal anti-inflammatory drugs (NSAIDS) Non-steroid drugs used to treat inflammation.

    Normal distribution A bell-shaped distribution of measurements or scores, with the highest frequency around the average value for the group.

    Obesity epidemic A term used to refer to the rapid rise in obesity levels recorded by the World Health Organisation in the late twentieth and early twenty-first century.

    Operant conditioning Involves pairing an unconditioned response (such as spontaneously pressing a lever) with an unconditioned stimulus (such as food) in order to produce a conditioned response (pressing the lever to obtain food).

    Opiate drugs Drugs that bind to opioid receptors, used in the treatment of pain.

    Opioid receptors Receptors that bind opiates or opioid substances.

    Parasympathetic nervous system (PNS) Division of the autonomic nervous system responsible for rest and storing energy.

    Patient preference trials Involve randomising participants without strong preferences, and allowing those with a strong preference to receive their preferred treatment.

    Patient-centred care Emphasises the role of the patient in their own care.

    Pattern theory One of the main theories of pain until the 1960s. Suggested that the intensity of the stimulus and central summation are the main determinants of pain.

    Perceived control The individual's belief that he or she is able to alter the outcome of a situation.

    Peripheral nerve stimulation Non-noxious stimulation of peripheral nerves, used to relieve pain.

    Peripheral nervous system Nerves that carry information to and from the central nervous system.

    Pharmacogenetics or pharmacogenomics The targeting of pharmaceuticals based on an individual's genetic characteristics.

    Phenotype The individual's set of observable characteristics or traits.

    Placebo therapies Therapies that involve the administration of dummy pills or sham treatments in place of active therapies.

    Polymorphisms Changes in DNA sequence that have no effect on the functioning of the gene.

    Population ageing The process by which older individuals become a proportionally larger share of the population.

    Positional cloning The process of localising and identifying a disease gene. Predictive genetic testing The use of a genetic test to predict risk of a disease in the future.

    Progressive relaxation A technique used to produce relaxation by first tensing and then releasing muscles.

    Prospective longitudinal design A study design that involves the measurement of independent (predictor) variables at time 1 and outcome variables at time 2.

    Proteins Large molecules made of one or more chains of amino acids.

    Psychological resilience The ability to ‘bounce back’ from negative emotional experiences and adapt to the changing demands of stressful experiences.

    Psychological well-being (PWB) Conceptualisation of well-being in relation to meaning or self-realisation and the degree to which a person is functioning fully.

    Psychoneuroendocrinology (PNE) The study of interactions between the brain and endocrine system and resulting implications for health.

    Psychoneuroimmunology (PNI) The study of interactions between the brain and immune system and resulting implications for health.

    Psychophysiology (PP) The study of relations between psychological manipulations and physiological responses.

    Psychosocial threat Sense of threat resulting from the interpretation of changes in the environment.

    Psychosomatic medicine The study of relations between the mind, body and health.

    Quantitative genetic strategies Methods used to determine if, and to what extent, a disease may be heritable.

    Random assignment A process of assigning participants to groups, ensuring that the probability of being assigned to either the experimental or control group is the same for each participant.

    Randomisation check A statistical comparison of experimental and control group data performed to test for group equivalence at baseline.

    Randomised controlled trial (RCT) or randomly assigned controlled clinical trial (RACC) Involves randomly assigning participants to receive either an active intervention or an inactive control (such as a dummy pill) using an experimental design.

    Randomised waiting list study A study design that involves randomly allocating participants to intervention or waiting list conditions (participants in the waiting list condition receive the intervention at a later point in time).

    RE-AIM framework A framework used to evaluate the long-term effectiveness of interventions when delivered in real-world settings, considering both individual-level factors (such as cost, transport, inconvenience to patients) and organisation-level factors (such as level of resources, expertise required, fit with current practice).

    Referred pain Pain felt at a site remote from the site of origin or stimulation.

    Relationship-centred care Emphasises the role of both patients and clinicians (and relationships between patients and clinicians) in the care process.

    Relaxation response (RR) The physiological counterpart of the fight or flight response. See fight or flight response.

    Replicative senescence The characteristic of all normal somatic cells to undergo a limited number of cell divisions (the Hayflick limit).

    Self-determination theory (SDT) Suggests that fulfilment of basic psychological needs is essential for well-being.

    Self-management interventions Interventions that aim to increase patients’ interest and involvement in their own care and empower them to manage their condition.

    Self-regulation The process by means of which individuals maintain control over thoughts, feelings and actions.

    Serotonin (also called 5-hydroxytryptamine, 5-HT) A neurotransmitter that plays an important role in the regulation of mood and is used in the treatment of depression.

    Sex chromosomes Either of a pair of chromosomes that combine to determine the sex of an organism.

    Single-gene disorders Caused by a mutation in a single gene. Somatic marking The process by which threats to homeostasis activate feeling states and initiate attempts at self-regulation.

    Specificity theory One of the main theories of pain until the 1960s. Suggested that pain signals are carried to the brain by specific types of fibres in the spinal nerves.

    Spinal cord stimulation (SCS) Non-noxious stimulation of the spinal cord, used to relieve pain.

    Spontaneous pain Pain arising owing to spontaneous activity in the primary sensory neurons.

    Statistical normality A statistically defined concept of ‘normality’ based on the distribution of scores for a particular group or population. See normal distribution.

    Steroids Anti-inflammatory substances that occur naturally in the body (such as cortisol) or are produced synthetically in order to treat inflammation.

    Stimulation-produced analgesia (SPA) Pain relief via nerve stimulation.

    Stimulus-evoked pain Heightened reaction to a painful stimulus evoked by brushing or pressure (hyperalgesia) or tactile pain to an innocuous stimulus (allodynia).

    Stressful life events Events that normally demand readjustment of the average person's routine.

    Subjective well-being (SWB) Conceptualisation of well-being as a subjective construct, dependent on the individual's personal evaluation of their own life circumstances.

    Sympathetic nervous system Division of the autonomic nervous system responsible for arousal and energy release.

    Sympathetic-adrenal-medullary axis (SAM) Links between the sympathetic nervous system and adrenal medulla.

    Systematic review A methodically rigorous review of relevant literature using explicit scientific methods to synthesise findings of individual studies in an unbiased manner.

    Telehealth The use of advanced telecommunications to provide access to healthcare, such as assessment, diagnosis and intervention, to underserved or isolated populations.

    Teletherapy (also called e-therapy, telepsychotherapy or telepsychology) The use of computer-mediated communication to deliver psychotherapy.

    Telomere hypothesis Suggests that the counting mechanism for replicative senescence is provided by progressive shortening of telomeres.

    Telomeres Specialised DNA or protein structures at the ends of chromosomes that act to protect chromosome caps.

    Thymic involution Age-related degeneration of the thymus.

    Transactional model (TM) of coping Conceptualises stress and coping in relation to dynamic interactions between the individual and environment.

    Transcutaneous electrical nerve stimulation (TENS) A non-invasive method of applying electrical stimulation to the skin for pain control.

    Tricyclic antidepressants Antidepressant drugs that prevent the reabsorption of noradrenalin and serotonin. Also used as frontline therapies for neuropathic pain states.

    Triple blind trialsSee blinding.

    Type A personality A personality construct characterised by impatience, competitiveness and hostility.

    Undoing effect A reduction in physiological arousal to negative emotion resulting from exposure to positive emotion stimuli. See broaden and build theory.

    Viral challenge studies Involve exposing participants to a virus under experimental conditions and then measuring the relationship between risk factors (assessed prior to exposure) and the subsequent development of symptoms.

    Virtual reality (VR) The use of technologies that involve immersion of the user in a virtual environment.

    X-linked dominant inheritance Diseases linked to the X chromosome. Individuals need inherit only one copy of the mutant gene to inherit the disease.

    X-linked recessive inheritance Disease linked to the X chromosome. Females must inherit two copies of the mutant gene to inherit the disease, but males will inherit the disease if only one mutant gene is inherited.

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