Behavioural Science

Question 1

What is the three stage theory for how people react to a diagnosis of a chronic illness?

Answer 1

-First stage is shock, feeling stunned or bewildered.
-There’s a sense of unreality, that this isn’t happening to me.
-Second stage is an encounter reaction, for example, anxiety or anger.
-This is when emotions are starting to push through the shock.
-Third step is sometimes getting a sense of retreat or denial - it is hypothesised that this it to protect us briefly from such strong emotions and to give us time to develop our coping skills.
-After these steps, reality intrudes, things have to change, the person still needs to start treatment, the person needs to see the doctor
and discuss the condition or start a new course of medication or have surgery.
-The person still needs to find a way to work through these new strong emotions, rebuild their life and find a way forward.

Question 2

What is crisis theory with regards to being diagnosed with a chronic illness?

Answer 2

-Crisis theory describes factors which influence process of adjustment and adaptation.
-The theory states that a crisis will occur when preexisting psychological equilibrium is upset by life events.
-Intervention aims at bringing about a new equilibrium.
-‘Crisis’ refers literally to a breaking or turning point.
-The crisis is characterised by instability and ambiguity with respect to one’s perceived capacity to deal with the event.
-Illness is a turning point in someone’s life and may test their capability to cope.
-The person will need to resolve this, gather resources, and use coping skills to move forward.
-That person’s social and personal resources determine how the person views the illness and how well they will reach equilibrium where they start to live their life again.
-The theory can be applied to other stress-related personal growth.
-Have background factors, which include illness related factors, patient factors and environmental and social
factors.
- Background factors feed into a person’s cognitive appraisal of the illness, including the meaning and significance of the illness.
-They will also relate to the adaptive tasks a person does, including psychosocial and
illness-related tasks.
-This is linked to a person’s general coping style - whether they tend to use emotion-focused or problem-focused strategies.
-All of these factors will lead into the outcome, meaning a person’s quality of life, how
well the person is, their symptoms, how often they have to go to the doctor and their mortality.

Question 3

What is repression of emotions?

Answer 3

Patient being unaware of emotions.

Question 4

What is suppression of emotions?

Answer 4

Patient avoiding expression of emotions.

Question 5

What is activated when we’re stressed?

Answer 5

-The sympathetic nervous system is activated.
-Have two branches to the nervous system, the sympathetic is for action and the parasympathetic is for returning to normal.
-Stress involves structures in your body that make up the
hypothalamic-Pituitary-adrenal axis, the HPA axis.
-This system is activated when you’re stressed.

Question 6

What are the structures in the HPA axis?

Answer 6

The amygdala, the hypothalamus, the pituitary gland and the hippocampus.

Question 7

What is the amygdala?

Answer 7

-An almond shaped structure in the bottom of the brain that evaluates events, deciding if they are threatening, and
processes emotions.
-Also involved in motivation, by helping us to decide whether to approach or avoid things.

Question 8

What is the hypothalamus?

Answer 8

Controls bodily functions and activates the pituitary.

Question 9

What is the pituitary gland?

Answer 9

Secretes hormones that act on other parts of the body.

Question 10

What is the hippocampus?

Answer 10

• Involved in the formation and retrieval of memories.

- Contains high levels of glucocorticoid receptors.

Question 11

What processes happen in the body in response to stress?

Answer 11

• A stimulus is the stressful event, and is detected and processed by the amygdala.
• CRF is released and this reaches the hypothalamus, which then releases more CRF, which in turn acts on the pituitary gland.
• The pituitary gland secretes ACTH, adrenocorticotropic hormone, into the bloodstream, which then travels to the adrenal glands.
• The adrenal glands release cortisol into the blood.
• Cortisol then travels to the pituitary, hypothalamus, prefrontal cortex and hippocampus.
• The cortisol is supposed to act on these structures as a feedback loop whereby once levels are detected, the stress response shuts off.
• Cortisol can be damaging though to the glucocorticoid receptors in these structures, particularly when it is in large quantities.
• This is especially the case for the hippocampus and prefrontal
  cortex.
• This then makes it harder for these structures to turn the stress response off.

Question 12

What happens in the body in acute stress?

Answer 12

-The HPA response is being triggered so that more cortisol is produced by the adrenal cortex.
-Cortisol attached to
glucocorticoid receptors in brain.
-This action tells the brain to stop making more cortisol, so cortisol stops being produced. -The stressful event has now been dealt with.

Question 13

What happens in the body in chronic stress?

Answer 13

-The HPA response is constantly triggered so there’s a constant release of cortisol.
-Blood levels get higher and there is too much for the body to break down.
-Excess cortisol damges glucocorticoid receptors.
-Damaged receptors can’t
tell the brain to stop producing cortisol, so there’s no inhibition.

Question 14

What is the transactional model of stress by Lazarus and Folkman?

Answer 14

• A situation and event occurs, and we decide if it’s a threat or not.
  -If it’s not a threat, we don’t get stressed.
  -If it is a threat, we can evaluate whether we can cope with it or not.
  -If we feel we can cope, we feel stressed, but in a positive way, e.g. excited about going on rollercoaster.
  -If we don’t feel we have
  the ability to cope with it, we might experience negative stress.

Question 15

What are the direct effects of stress on health?

Answer 15

-The excess cortisol released as part of the stress response can damage structures in the brain.
-Stress can also decrease the activity of T cells, weakening the immune system.
-This means people are more susceptible to illness, and may take longer to recover, for example from a surgery.
- An example of this is a study by Kielcot-Glaser, where
participants underwent punch biopsy procedures and the time taken to heal was measured.
-Half of the participants
were carers for a person with dementia, the other half weren’t.
-The carers took on average, an extra ten days longer
to recover.
-Stress also leads to more platelets and lipids in the blood, so the blood is thicker and stickier, so plaques
form on the artery walls.
-These things increase risk for cardiovascular incidents, like heart attacks and strokes.”

Question 16

What are the indirect effects of stress?

Answer 16

• Being stressed results in other behaviours harmful to health, e.g. smoking or drinking more alcohol, which is detrimental to health.
• Poor concentration may also expose people to danger, e.g. when crossing road.
• Stress may make people feel less motivated to do health protective activities like exercising or sleeping well.
• Stress can also put people off from seeking medical care and screening, which is possible because stress makes us procrastinate.

Question 17

What does the Diathesis stress model show?

Answer 17

-Shows how various factors can interact to create the risk of mental health problems.
-It is thought that having a
genetic predisposition and experiencing adverse situations during childhood can increase the risk and make
someone more vulnerable to mental health problems.
-If a person then experiences stressful circumstances and is
unable to cope with them, they are more likely to develop a mental health problem.

Question 18

How are attachment styles classified?

Answer 18

-Most research considers four types of attachment styles, but might see some research that splits it into just secure
and insecure attachments.
-Some research also looks at attachment on a continuum rather than a separate and
distinct category.
-The four are secure, insecure avoidant, insecure ambivalent and insecure disorganised.
-The attachment types are essentially learned behaviours and strategies that protect child and are predictive of how
children later learn to respond emotionally and engage in social behaviour and develop resilience.

Question 19

What is the importance of secure

attachments?

Answer 19

• Secure attachments are associated with better development and social outcomes as children get older and also into adulthood.
• Securely attached children have a number of characteristics that promote educational development and social skills.
• Provide a framework for children to develop other relationships and friendships.

Question 20

What are securely attached children more

likely to be?

Answer 20

Better problem solvers, more curious, have increased quality and duration of learning, have higher academic achievement, cooperative and self-regulative, less likely to develop emotional and behavioural problems, more socially empathetic and less biased in interpreting behaviour of others, and more self aware.

Question 21

How are secure attachments developed?

Answer 21

-Secure attachments more likely to occur when parents provide comfort.
-They are responding to child’s needs.
-Also when parents are reliable and consistent, so not chopping or changing whether they give attention or not.
-Parents should be attuned to the child so they occur in the right way to their needs.
-Being a role model is important, and this
is done through practicing self-care and showing positive behaviours to themselves.

Question 22

How do you identify attachment type through use of the strange situation?”

Answer 22

• This is an experimental setup to see what behaviours the child displays based on who is in the room.
• There are six steps in sequence.
• So first, parent and child enters room, usually in a laboratory so quite unfamiliar to them.
• Then a stranger comes in and sits down, so joins parent and child.
• Then stranger leaves, then parent leaves so child alone in room.
• Then stranger returns so it’s just stranger and child together.
• Finally parent returns and stranger leaves.
• Children with different attachment styles will respond in different ways to each step.

Question 23

How do securely attached children respond to the strange situation?

Answer 23

Securely attached use their mum as a secure base to go exploring, they’re upset when they’re separated but are happy to be reunited and they’re okay around stranger if mum is there.

Question 24

How do avoidant insecure attached children

respond to the strange situation?

Answer 24

-Won’t look to parent as secure base as they’ve learnt not to rely on mother and are instead quite independent.
-They are bothered if mum leaves or if stranger is there as they’re used to not receiving attention for their needs and learnt
to comfort themselves.
-Difficult as they lack experience of an adult, so may put themselves in danger and can find it quite hard to trust people.

Question 25

How do ambivalent insecure children

respond to the strange situation?

Answer 25

• Where child doesn’t bother to explore and shows intense distress when mother leaves but rejects her on her return.
• They’re uncomfortable with the stranger.
• This attachment style occurs when caregiver is inconsistent, they might comfort one time, and might neglect or reject another time.
• This means child can’t form bond as never learn what to expect and don’t tend to seek out parent when need comfort in case they’re rejected even though they really want
  them.
• These children can develop attention seeking behaviours and struggle to go and explore independently.

Question 26

How do disorganised insecure children

respond to the strange situation?

Answer 26

• Disorganised attachment style results in inconsistent responses as child doesn’t know how to respond.
• This can occur if living in a very unpredictable environment.

Question 27

What are the two theories of personality?

Answer 27

-Impulsivity is a complex construct, and the UPPS-P explores it as multidimensional, so there’s not just one
component of impulsivity, for example, it’s not just paying attention, or it’s not just being a sensation seeker - this is
the theory of impulsivity.
-The second theory is the Big 5 or five-factor model, a very popular theory of personality.

Question 28

What are the five constructs in the UPPS-P?

Answer 28

Negative urgency, lack of premeditation, lack of perseverence, sensation seeking and positive urgency.

Question 29

What did Cyder summarise in her review in 2011 about personality?

Answer 29

-Cyder in 2011 summarised in her review that negative urgency is uniquely predictive of bulimic symptoms, drinking
alcohol to cope, and craving for tobacco while sensation seeking often predicts engagement in risk taking but it is urgency traits that tend to predict problematic levels of risk engagement.
-This is an important distinction.
-Research suggests positive and negative urgency are correlated with problem drinking and pathological gambling.
-Lack of premeditation seems to be associated with anti-social personality disorder and psychopathy, this trait is characterised by lack of forethought, not thinking things through before you do them which seems to logically be linked to criminal
behaviour.
-Lack of perseverance has also been shown to be this significant predictor of inattention problems, so not
being able to focus on a task for very long.

Question 30

What is the big five/ five-factor model of personality?

Answer 30

-According to the five-factor theory of personality, five broad traits or basic dispositions affect the ways in which people respond to the world.
-These dispositions shape people’s thoughts, feelings, and actions, and how they cope with any challenges.
-There is a biological basis to the five-factor model, in that personality theorists say that our temperament/ disposition is based in biological processes.
-Theorists argue that personality should therefore be stable after the age
of 30.
-However, when we consider personality, we usually consider it as a general predisposition, because we are usually influenced by our social context or how we feel in the moment.
-Sometimes this is when people say someone has ‘acted out of character’.
-The big five has been praised for being comprehensive in covering the general broad
dispositions of people.
-The five factors are openness to experience, conscientiousness, extraversion, agreeableness and neuroticism.
-Can be remembered by
acronym ocean.

Question 31

What are the implications of personality for clinical practice?

Answer 31

-People with high extraversion and low conscientiousness on the big 5 tend to engage in more risky health behaviours.
-Messages need to be framed differently in terms of risk.
-Smokers are higher in neuroticism so they may benefit from targeted treatment to manage negative mood when they’re trying to quit or reduce smoking.
-Anxiety and depression also need to be considered in this group as there is overlap.
-There is also overlap with negative urgency, doing
something impulsive to cope with negative emotions.
-People who are higher conscientiousness are probably most likely to follow through with intentions, so people who are lower in C may need more motivation and support.
-High neuroticism should also be considered in people with chronic illnesses, as they may be more at risk for health
problems.

Question 32

How is attitude defined?

Answer 32

-First is that attitudes are learned predispositions to respond in a consistently favourable or unfavourable way towards a given object, person or event.
-This definition stresses that attitudes are learnt, for example through direct
experience, from other people, or from information.
-Also highlights that attitudes are consistent, so respond in the same way over and over.
-Another definition is that an attitude consists of an enduring evaluation – positive or
negative – of people, objects and ideas.
-This considers that attitude is a result of weighing up information about something and highlights it’s stable over time.
-Attitudes therefore thought to be cognitive processes.

Question 33

What are the three components of attitudes?

Answer 33

-Attitude has three components.
-Firstly, there’s an affective component which is how you feel about something, or the
emotions you associate with it.
-Secondly, there’s a behavioural component, and that’s your intentions to act, or your actual actions in response to something.
-Thirdly is a cognitive component, which is the knowledge you have, so your
thoughts and beliefs about something.
-The combination of your feelings, knowledge and behavioural intentions form
the attitude, and can remember by ABC.

Question 34

Why do we need attitudes?

Answer 34

-Help us to achieve our goals by motivating us to do things.
-Attitudes are hard to change and tend to last most of our
lives, so they tell us a lot about ourselves and our identity, and how we fit into different social groupings.
-This is helpful in developing shared understandings and a sense of belonging with other people.
-Can also create problems, when ideas held are maladapted, for example when people might be against vaccinations.
-Attitudes function to help us
quickly access information, make decisions quickly and identify our own tribe of people who hold similar values to us.

Question 35

What did Katz outline about the purpose of attitudes?

Answer 35

-Katz in 1960 outlined purposes of attitudes as firstly giving meaning and knowledge to the world around is.
-It enables us to predict what might happen, and how people might behave.
-For example, if know someone is a sore loser, can predict they will say their opponent has cheated.
-Attitudes will help us to communicate to each other about who we are and facets of our identity, and through that we become aware of our own beliefs and values.
-Attitudes also help us defend our sense of self, known as ego defence.
-If we hold positive attitudes towards our own sense of self, we feel good about who we are.
- If we adopt a negative attitude towards something we’re not good at, then it protects us from feeling bad about that, so for example, we might hold a negative attitude towards sport, and it makes us feel better if we’re not good at sport.
-Value-expressiveness is an adaptative property where letting people know our
attitudes integrates us in that group.
-If we hold a socially acceptable attitude, we’re then rewarded with social
acceptance.
-People tend to seek out people with similar attitudes to their own selves and this process explains how debates can become very polarised.

Question 36

What did Pratkanis and Greenwald describe in 1989 about attitudes?

Answer 36

-Pratkanis and Greenwald describe an attitude as a sociocognitive model, that enables us to access information fast.
-So an attitude has a label and rules to apply it and an evaluative summary of that object, and knowledge that
underpins that evaluation. For example, a shark can be labelled as a big fish with large teeth, our evaluation is that
it’s best avoided when swimming, and the knowledge that underpins it, is that we know that sharks will kill and eat people.
-The labelling rules help us to quickly make sense of the world around us and respond to changes in our environment.
-The evaluation is our gut feeling, which is known as the simple heuristic and it helps us make an appraisal of a situation.
-The knowledge is what is known as a schematic, and this is a way of organising our memory of events to guide us in the future if similar things happen.
-Eventually, attitudes function in an evolutionary sense, to keep us safe from different threats.

Question 37

How are attitudes formed?

Answer 37

-We form attitudes through our experiences, through things happening to us in our lives, and also through our social
roles, so we have an idea of how particular roles think and behave.
-For example, police people, farmers, medics and
hairdressers all have particular roles, and these inform everyone else of what they can expect of them.
-There are also norms in particular groups in societies, for example different, countries or religious groups or subcultures, which
all have their own norms and attitudes.
-Through learning and taking in new information, we can update the knowledge part of an attitude, although people tend to be biased to taking in information that already fits with what they already know.
-Rewarded for holding certain attitudes, and this encourages us to hold them or we might be punished for holding some, for example racism and homophobia, are punished by being shunned in our society.
-Lastly, we observe what happens to other people, and in particular our role models.

Question 38

How are attitudes and behaviour linked?

Answer 38

• Attitudes impact on how we act.
• The extent of this is dependent on the type of underlying belief we have.
• For example, socially undesirable beliefs tend to not be acted upon, and also weakly held attitudes may not translate into behaviour.
• We might jointly hold opposing ideas.
• The situation around us might prevent our behaviour.
• Behaviour can also get people to change their attitude.

Question 39

How can attitudes and behaviour be inconsistent?

Answer 39

-Attitudes are hard to measure as can’t see them, can only observe the behaviour that results from them, and often
there is inconsistency in attitudes and behaviour, especially for attitudes that aren’t socially desirable.
-A classic study in 1934, was conducted by a white American man called Richard LaPiere who was travelling with a Chinese couple.
-At this time in the USA, there was a really negative attitude towards Chinese people.
-Together they travelled to 184
different hotels and restaurants and only one of these refused them service, however when they sent a postal survey out later, they found that 92% of these same places said they’d refuse Chinese guests.
-This shows that people hold
certain attitudes but when confronted with a situation that would expose them as unacceptable, they hide them, and act in a different way.

Question 40

What is cognitive dissonance?

Answer 40

• It’s when our thoughts or beliefs don’t match our actions, so it’s a discrepancy between the cognitive or affective component of our attitude and the behavioural component.
• It can involve holding two ideas that oppose each other.
• For example, may consider self to be a healthy person who loves running, but actually probably spend more time sitting down and eating cake.

Question 41

What is stereotyping?

Answer 41

-Attitudes can lead to stereotypes.
-Stereotypes are attitudes about a group of people.
-Some can be positive, for
example that all vegetarians are kind, but they do still present a generalisation that might be unhelpful.
-Other stereotypes can be negative, and when these are repeated can lead to people thinking they are true.
-This can cause people to hold beliefs without ever having any direct experience.
-It can also impact on the group being stereotyped.
-This particular phenomenon is called stereotype threat, and here people give into the idea, and act in the way they
are perceived, for example, if you think I’m bad, then I will be bad.
- This is known as the self-fulfilling prophecy.

Question 42

How can attitudes develop into stigma?

Answer 42

-Attitudes can develop into stigma, which can often be even worse to experience than the thing or situation that led to the stigma in the first place.
-Stigma is a cluster of negative attitudes and beliefs that lead people in general to respond
with negativity or to discriminate against a group of people based on their membership of that group.
- It tends to be minority groups or groups with less power in society that experience stigma and people who hold more social power that perpetuate the stigma.

Question 43

How are some health conditions associated with stigma?

Answer 43

-Some health conditions are associated with stigma, such as mental health conditions and this might be due to there
not usually being an obvious sign that someone is ill, or sometimes that people are perceived as being at fault.
-This used to be the case for smokers who had lung cancer, for example.
- Our use of language creates stigma.
-If refer to someone as schizophrenic or a dementia patient, your language immediately puts them in a different group to you.
-This is known as othering.
-However, if you say a person with schizophrenia or a person with dementia, stay in same
group, because acknowledge with our words that we are people first.
-Tend not to other people with physical health conditions.
-Always put the person before their condition.
-A discreditable stigma is invisible or not obvious, such as mental health problems, or migraines, or even back pain, and it’s less likely to be believed, so it may be attributed to the persons own fault.
-Discrediting stigma is visible, such as being in a wheelchair, where people may discriminate
because they can see that the person is different.

Question 44

What did a systematic review of healthcare experience with people with schizophrenia
show?

Answer 44

-A systematic review of healthcare experiences of people with schizophrenia, found these people often experienced stigma.
- Firstly, patients faced stigma by not being taken seriously, and treated in a paternalistic way where they were not able to have their concerns explored, as they were instead attributed to mental health conditions.
-Secondly, patients who asked questions were often labelled as uncooperative.
-These patients experienced prejudice based on the idea they would be violent or unpredictable.
-This is often perpetuated in the news and media, where news stories on violence often highlight where mental health problems have occurred even though evidence shows that
perpetrators of violence are much more often diagnosed with any conditions, and people with mental health
conditions are much more likely to be victims than perpetrators.
-Thirdly, these patients experienced a loss of their
social contacts.
-This is where people may cut off contact with someone who has a mental health problem.
-Also, people with mental health conditions themselves, may cut their family off, as they fear not being accepted or understood, and therefore may conceal their symptoms or medication use.

Question 45

What is the impact of stigma?

Answer 45

-Stigma impacts on society and also people who are stigmatised by leading to prejudice and discrimination.
-For example, a stereotype could lead to a stigmatised view that all people with mental health problems are dangerous, leading to prejudiced views for people with mental health problems.
-This in turn leads to discrimination, and this is
seen often where people with mental health problems are denied access to healthcare and instead end up in the
criminal justice system where they don’t get the help they need.
-Stigma and discrimination only happen when there is
an imbalance of power in society, and as healthcare professionals we hold more power.

Question 46

What does memory consist of?

Answer 46

• Memory consists of different components or types, rather than being just one area.
• First type is sensory memory, and this can be further broken down into sensory specific parts.
• For example, iconic memory is for visual images and they’re stored for about half a second, and echoic memory is for sounds, which remain in place for about two seconds.
• Unattended sensory information is lost very quickly, it never really enters our consciousness.
• Some information in the sensory store does get passed on to the short-term memory but only if we’re paying attention to it.
• The short-term memory can only hold a small amount of information, and so information that isn’t rehearsed is quickly
  lost.
• Information that is rehearsed is maintained and this passes into our long-term memory.
• When we need it, it can be retrieved back into the short-term memory.
• Some information is also lost from the long-term memory over time.

Question 47

What is the sensory memory?

Answer 47

Sensory memory is about registering external stimuli and paying attention to them, or not as the case may be.

Question 48

What is short term memory?

Answer 48

• Short term memory, also called the working memory, is quite small with a limited capacity of about seven items.
• Tend to group things together in our short-term memory because they sound the same.
• So, for example, cat and hat sound similar to each other so would bunch them up together in our short-term memory.
• Short term memory operates on the recency effect, which is where the most recent things to enter that part of our memory, are the most easily recalled.

Question 49

What is long term memory?

Answer 49

• The long term or permanent memory has a huge capacity, as you remember details about your entire life in this part of your memory.
• Things here are coded in a semantic way, so items that are conceptually similar, like aunts and uncles, are bunched up together.
• Here there is a primacy effect, where the information that you received first in any situation will appear in this part of your memory.

Question 50

What is serial position effect?

Answer 50

-Primacy and recency is known as the serial position effect.
-Studies show that people tend to remember the first and
last bits of information and they forget the middle.
-This is because the first items, primacy, are moved into the
long-term memory and encoded properly.
-The last items, recency, are still in the short-term memory, but they have displaced or pushed out the middle items, so the middle items are forgotten.
-For patients this means should put most important information at start and end, so will remember.

Question 51

What are some strategies to aid patient recall?

Answer 51

Organisation, less is more, stressing importance, precise information is better than general recommendation,
involving the patient and creating a dialogue, exploiting primacy and recency effects and association with visual
imagery.

Question 52

What is reinstatement of context?

Answer 52

-In a famous study, Godden and Baddeley asked groups of divers to learn lists of words either on land or under water, and then recall them as follows.
-So, in the four conditions, divers were asked to learn on land and then recall the lists
on lands, they learned on land and then recalled under water, they learnt underwater and then recalled underwater,
and then they learnt underwater and recalled on land.
-Those learning and recalling in the same place, remembered best, as their environment helped their recall.

Question 53

What are strategies for promoting adherence?

Answer 53

-Always consider that non-compliance is a likely outcome and discuss this with patients.
-Try to create an environment
where patients feel comfortable to share their worries and concerns about adherence.
-If can identify things together
that get in the way or help adherence, can put strategies in place.
-It helps patients to know you’re thinking about this,
otherwise they might think you just don’t get what it’s like to live with a chronic condition.
-Take a consistent interest in
your patients’ everyday lives and you’ll find out how to set up a treatment plan that they can actually stick to.
-Think about communication skills and take into account patient’s health beliefs.
-Provide health education to improve understanding or signpost patients to further information if time is limited.