Behavioural Science Flashcards
what does the Scientist Practitioner Model
- Don’t make assumptions.
- Use systematic methods to test out different theories and methods of intervention.
- Learn from the outcomes of your investigations.
- Report investigations in detail so others could repeat the exact same procedure.
- Many professions work with a scientist practitioner model. It is highly relevant to behavioural science because human behaviours and interactions can be very subtle and seem ‘obvious’.
what does the medical model of care outline
The dominant philosophy of thinking about health and illness which dominates much medical care offered in Western cultures today
- Diagnosis and Treatment
- Focus is objective disease
- Signs and symptoms expected to resolve with treatment.
- Continuing symptoms related to unresolved pathology.
why was the Biopsychosocial Model developed
• Developed out of a recognition that some people with physical illness recover much better than others and that this seems to be influenced by a wide range of factors. Now widely used. Particularly useful for considering why people do or do not engage in protective behaviours such as regular attendance or tooth brushing.
what are the social, biological and physiological factors that link to the biopsychosocial model
social- family, culture, habits, beliefs
biological- infection, structural change, nociception, nutrition, medications
psychological- thoughts, behaviors, emotions, attitudes, beliefs, concerns, expectations
Examples of Social Factors- biopsychosocial model
- Interactions between the patient and the dental team.
- Attitudes of family, friends and society.
- Access to transport, mobility, finance.
- Work and family commitments.
Examples of Psychological Factors- biopsychosocial model
- Thoughts (Beliefs, attitudes, memories of past experiences)
- Feelings
- Behaviours
what are some Behavioural Science contribution: examples in the dental practice
- Differences in communication style predicted patient complaints.
- Dental anxiety was reduced in patients who were able to communicate their anxiety to their dentist and who’se dentists demonstrated that they took it seriously.
- Reassurance was unhelpful for young children who had fluoride varnish applied but praise, information and giving a compliment were helpful.
- Brief intervention based on psychological theory improved toothbrushing, bleeding and plaque scores.
Reassurance and Distress Behavior in Preschool Children Undergoing Dental Preventive Care Procedures in a Community Setting: a Multilevel Observational Study
- Extended Duty Dental Nurses applying fluoride varnish in nursery settings to children aged 2-5.
- Children provided with reassurance were less likely to accept application of fluoride varnish.
- Interactions recorded and analysed through video coding.
- Increased anxiety-related behaviour following reassurance, especially early in the consultation.
- Praise, instruction, information-giving and paying a compliment were more often followed by co-operation.
- Led researchers to consider whether nurses were responding to their own anxiety rather than the children’s when they provided reassurance.
what is the implication of fearful patients in the dental practice
- Fearful people are more likely to have poor oral health and reduced oral quality of life (Milgram 2019).
- Fearful people are more likely to ‘no show’ or cancel appointments at short notice (Milgram 2019).
- Fearful people are more likely to need to be treated with sedation which is expensive, potentially risky for some patients and does not resolve the fear meaning that the problem remains unchanged the next time treatment is required.
- Fear may increase the incidence of behaviour problems such as uncooperativeness and aggression in clinic.
what is the Self-efficacy theory
- Self efficacy is a key factor in whether people will engage in a behaviour.
- Definition: a person’s confidence in their ability to perform a behaviour.
- Sources: practising the behaviour, observing someone else do it, verbal persuasion, how people physically feel after the behaviour.
what is the Implementation Intention Theory
- The likelihood of a person performing a behaviour is increased by making an explicit action plan about where and when the behaviour will be performed.
- Action plans function as cues that remind a person to perform the behaviour.
what is the Standardised Intervention and is it better than usual hygeine advice
- Give information about EXACTLY what to do, for how long, how it should feel.
- Demonstrate on a model of a mouth.
- Ask patient to clean teeth with electric toothbrush. Correct if necessary. Praise.
- Give electric toothbrush. Ask when is the best time to use it.
- The intervention group improved significantly more than the control group on self-efficacy, planning and self-reported toothbrushing technique.
- Bleeding at gumline and plaque score was also improved in the intervention group relative to the controls. This was only statistically significant in one of two studies reported.
How Stress can impact on individual performance
- Take more time off
- Arrive at work late
- Be twitchy and nervous
- Mood swings
- Withdrawn
- Loss of motivation, commitment, confidence
- Heightened sensitivity, tearfulness, aggressiveness
How Stress can impact on team performance
- Arguments
- Higher staff turnover
- More sickness absence
- Decreased performance
- More complaints and grievances
what is burnout
• Emotional and physical exhaustion resulting from a combination of exposure to environmental and internal stressors and inadequate coping and adaptive skills. In addition to signs of exhaustion, the person with burnout exhibits an increasingly negative attitude toward his or her job, low self-esteem, and personal devaluation.
in a medical setting what has burn out been linked to
- Not fully discussing treatment outcomes (Prins et. al. 2009).
- Not answering a patient’s questions (Shanafeltetal 2010).
- Less favourable ratings by patients (Leiter et. al. 1998).
what are Factors affecting wellbeing in dentists
- High levels of work-related stress.
- Active coping required.
- Stigma (can we counteract it?)
- Peer networks.
what are ways of Managing Stress is a professional responsibility
•Standards for the Dental Team Standard 9.2
- You must protect patients and colleagues from risks posed by your health, conduct or performance
- 9.2.1 If you know, or suspect, that patients may be at risk because of your health, behaviour or professional performance, you must consult a suitably qualified colleague immediately and follow advice on how to put the interests of patients first.
- 9.2.2 You must not rely on your own assessment of the risk you pose to patients. You should seek occupational health advice or other appropriate advice as soon as possible.
the pressures of 4 challenges combined contributes to burnout are …
- Emotional (dealing with anxious patients).
- Cognitive (complex treatment decisions).
- Physical (maintaining difficult postures).
- Quantitative (short time allocated for patients).
how can social factors of the biopsychosocial model such as:
psychological issues seen by colleagues as weak, stigmatised. culture does not support self care. lack of string role models
be resolved
supportive and open work/study culture. psychological issues seen as normal , people openly talk about difficulties they have experienced and look out for each-other
how can biological factors of the biopsychosocial model such as:
lowered immunity, disrtupted sleep, fatigue, cravings, lower concetrations, ache and pain, ibs
be resolved
sleep, nutrition, exercise, healthy lifestyle, medication
how can psychological factors of the biopsychosocial model such as:
thoughts- im weak
feelings- anxious, depressed
behaviors- avoidance, withdrawn, keep quiet, poor attendance, poor time keeping
be resolved
thoughts- do i need support, who should i speak to, what might help me?
feelings- anxious, depressed, afraid, - feelings are more contained and less overwhelming
beaviours- may vary between a range of stratergies e.g. seek support, adopt heathy behaviours, express feelings, follow advice you would give to a friend
what is fear
refers to here and now • An emotion • Associated with a sense of danger • Strong urge to escape or fight • Usually accompanied by a physical response that would support ‘fight or flight’
what is anxiety
refers to the future.
• An emotion
• Associated with an anticipation of danger – not about something happening right now, much more long lived compared to fear
• Strong urge to avoid (instead of escaping or fighting)
• Physical response might be less intense and longer-lasting.
what is pain
- ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ more to pain that actual damage
- Pain is known to cause emotional distress and to be increased by distress.
what are Behavioural Science Theories relevant to Fear, Anxiety and Pain.
- Behavioural learning theory
- Cognitive factors
- Social / Environmental factors
what is • Classical conditioning
two things that always occur together will become linked.
bad experience at the dentist, may have the same process where fear is caused by classical conditions.
what is an Unconditioned stimulus and response
a stimulus exerts a particular response before any conditioning takes place (eg a sudden noise may trigger fear).
what is a Neutral stimulus:
something which at first has no impact on the response (eg the rat that Little Albert used to play with). The neutral stimulus can be conditioned
what is a Conditioned stimulus and response
a previously neutral stimulus is ‘paired’ with an unconditioned stimulus. The conditioned stimulus will then come to evoke the same response as the unconditioned stimulus through the process of association. This response is known as the conditioned response.
what is • Generalization
when the conditioned response can also be triggered by other stimuli that are similar to the conditioned stimulus. – e.g. if the dogs salivated to the sound of a buzzer
what are Implications of classical conditioning
- Patients may react with fear to features of the dental environment such as the smell of the surgery, sight of staff in uniform or sound of the drill.
- Elements of dental care may resemble past experiences of patients who have experienced trauma or abuse.
how can implications of classical conditioning be reduced
pay careful attention to the environment and interpersonal factors to reduce the similarity (and association) with any previous bad experience.
how are Behaviours and Emotions are often linked
Approach behaviour and confidence
Avoidance behaviour and fear
Aggressive behaviour and anger
what is Operant conditioning
behaviour is shaped by what happens immediately following the behaviour.
Positive re-inforcement
a behaviour is followed by a rewarding outcome.
Negative re-inforcement
- a behaviour is followed by the cessation of an unwanted experience.
- Something unpleasant is taken away, behaviour isn’t rewarded its reinforced
- E.g. patient getting out of chair and not wanted treatment
Punishment
- a behaviour is followed by an unwanted experience.
Extinction
- a behaviour is followed by no rewarding outcome (and eventually stops).
- E.g. ignore the behaviour we don’t want to see as long as its not dangerous, but we smile at the behaviour we want to see.
what is the Cognitive Model (Impact of thinking)
- Feeling anxious makes it more likely that we will have anxious thoughts.
- We may assume that these thoughts are realistic and true.
- Anxious thoughts are characterised by ‘thinking the worst’.
- Often they will not be true.
- It can be important to recognise that they are not facts, and that they are related to the way that we feel.
- Anxious thoughts can increase our anxious feelings.
- In general you assume your thoughts are true, however they’re often not true and related to our feelings
