Chapter 7

Question 1

What is a physical sign? What is an example?

Answer 1

> A physical sign refers to observable evidence of a physical change in our bodies

> When Nick Cannon experienced his body swelling up, shortness of breath, and severe right-sided pain.

Question 2

What is a physical symptom? What is an example?

Answer 2

> is something that is only experienced by us and cannot be directly observed by others.

> pain is an example

Question 3

How many physical signs/symptoms do we experience in a day?

Answer 3

> at least one physical sign or symptom a day

Question 4

According to the common sense model, what occurs after we notice physical sensations (stimuli)? What is this mental process called?

Answer 4

> we form a “common-sense” or “lay” representation of these sensations in an attempt to determine the meaning of the physical sensations.

> This mental representation is some-times called a schema, belief, cognition, or perception.

Question 5

What does the mental process/representation of the common sense model influence for coping?
1. When a threat is there and
2. When there is not threat?

Answer 5

> influences how we cope with the physical sensations we experience.
threat = cope + further appraisal for the success of the coping with physical sensations which affects our representations of those sensations
not a threat = no need for coping.

Question 6

Central to the common sense model is what interaction and what does it mean?

Answer 6

> is the interaction between our perceptions of physical sensations and our emotional response to the physical sensations.

> = how we view our physical sensations influences our emotions and our emotions influence our views of the physical sensations.

Question 7

Research on the CSM has revealed that we do not develop a single schema or representation of our health/illness, but instead we do what and what does that include?

Answer 7

> we conceptualize our health/illness along multiple dimensions.

> These dimensions include forming a representation of the identity, cause, consequences, timeline, and controllability of the physical signs and symptoms

Question 8

Under the dimensions of the CSM:
1. what is identity?
2. How is it measured?

Answer 8

1. Identity refers to how we label the signs and symptoms we experience (e.g., lupus, cancer, heart disease).
2. Identity is often measured by asking individuals about their physical signs and symptoms (e.g., pain, breathlessness, fatigue).

Question 9

Under the CSM, what is the cause dimension?

Answer 9

> refers to our beliefs about what brought on the signs and symptoms; we might consider biological, emotional, environmental, or psychological causes.

Question 10

Under the CSM what is consequences dimension?

Answer 10

> the impact of the signs and symptoms on our every-day lives

Question 11

Under the CSM, what is the timeline dimension?

Answer 11

> refers to our beliefs about how long the signs and symptoms will last (e.g., acute vs chronic) and whether they will fluctuate or persist over time.

Question 12

Under the CSM, what is the controllability dimension?

Answer 12

> refers to our beliefs about whether we have control over our signs and symptoms and whether we believe treatment will be efficacious.

Question 13

Under the CSM, are the representations we make about physical signs static? If not, what makes them change?

Answer 13

> these representations of our signs and symptoms are not static but change over time, especially in response to treatment

Question 14

1. The Illness Perception Questionnaire was developed to measure what about the CSM?
2. What are the questions like?
3. Is there a revised version?

Answer 14

1. these specific illness representations
2. are asked to indicate whether they strongly disagree/disagree, neither agree nor disagree/agree/strongly agree with statements such as “My illness will last a short time”
3. Yes, (IPQ-R) it divides some dimensions i.e. control to include personal control

Question 15

What does the CSM model recognize about coping?

Answer 15

> recognizes wide variability in the types of coping strategies we use, and how we view our signs and symptoms determines how we select a coping strategy

Question 16

As many as what percentage of people seek care for minor medical symptoms that could have been managed without medical intervention?

Answer 16

> 40 percent

Question 17

Individuals with what type of beliefs are less likely to attend medical appointments regularly?

Answer 17

> Those who hold negative beliefs about their ability to control their illness and negative perceptions about its course and consequences

Question 18

Our views regarding ill-ness not only predict whether we seek medical care, but they also predict what?

Answer 18

> whether we follow medical advice that is provided

Question 19

In a meta-analysis research of the association between how we view our signs/symptoms and our coping behaviour, what was found for:
1. those who perceive themselves as having many symptoms and view their symptoms as chronic and disabling?
2. those who view their signs and symptoms as controllable

Answer 19

>

1. are more likely to cope with symptoms by using avoidance and emotional expression

2. are more likely to cope by using problem-focused coping strategies

Question 20

Our views of illness and how we cope with illness impacts our emotional and physical health- What does research suggest?

Answer 20

> suggests that certain illness representations are associated with improved emotional and physical well-being

> while other illness representations are associated with emotional distress and poorer physical health

Question 21

In terms of emotional well-being, viewing an illness causes different forms of “being”
1. When we percieve it as within our control is associated with what?
2. Perceiving one’s illness as having mul-tiple symptoms and being chronic is associated with what?

Answer 21

1. greater psych-ological well-being and social functioning;
2. associated with negative psychological well-being

Question 22

The CSM suggests that our views of an illness determine what which in turn impacts what?

Answer 22

our views of an illness determine our behaviours, which in turn impact our physical health

Question 23

McSharry, Moss-Morris, and Kendrick (2011) conducted a meta-analytic study of patients with diabetes. They found that higher and lower scores on some dimensions of the CSM allowed for higher blood sugar.
1. What high dimensions were they?
2. What low dimensions were they?
3. What did this suggest about that person’s treatment and risk?

Answer 23

1. HIGHER SCORES:
   - identity,
   - negative consequences,
   - cyclical timeline,
   - concern,
   - emotional representations
2. LOWER SCORES:
   - personal control
3. suggests that treatment was not being followed and has a greater risk of diabetic complications.

Question 24

A specific example from a study of young adults with type 1 diabetes regarding illness representations (e.g., beliefs about ability to control diabetes) predicted what?

Answer 24

> blood glucose monitoring; adherence to recommendations for insulin, food, and exercise; and emergency precautions three months late

Question 25

Illness representations are important targets of change to improve what disease management? (For what disease)

Answer 25

> diabetes management.

Question 26

Petrie, Cameron, Ellis, Buick, and Weinman (2002) found that if patients altered their illness perceptions, they experienced what type of health outcomes? What occurred in the intervention group during treatment and what at 3m/o follow-up?

Answer 26

> improved health outcomes
In the intervention group, but not the control group, patients reported fewer angina symptoms and more often reported that they were better prepared for discharge. At three-month follow-up, they returned to work at a significantly faster rate than the usual care group

Question 27

How do we develop our beliefs or views about our physical sensations? According to the CSM we do it in what way? What kind of appraisal is this called?

Answer 27

> we actively seek information to understand our physical sensations and base our mental representations on the physical sensations we are experiencing
illness appraisals

Question 28

What are 7 factors that illness appraisals are affected by?

PE, CH, SFS, C, P, M, HWPF

Answer 28

> past experiences,
cognitive heuristics
social factors,
culture
personality
mood.
how we feel physically (to an extent)

Question 29

In this study, those who were undergoing dialysis for end-stage renal disease (experiencing physical symptoms) and those who had a kidney transplant (no longer experiencing significant symptoms) differed in how they perceived illness. Describe their perceptions:

Answer 29

> stronger timeline and disruptive beliefs + lower control beliefs, compared to those who had a kidney transplant

Question 30

In this study (of those with chronic osteoarthritis), investigators examined if illness perceptions changed over a six-year period in individuals diagnosed with osteoarthritis. What happened to their beliefs about the illness once it worsened?

Answer 30

> over time, as osteoarthritis worsened, people with osteoarthritis perceived their condition as more chronic and less controllable.

Question 31

While physical sensations are important in shaping our beliefs, the CSM recognizes that appraisal of physical sensations are highly what and does not correspond with what?

Answer 31

> highly individualized and does not always correspond with physical input.

Question 32

How do past experiences affect illness appraisals specifically?

Answer 32

> The memories of illness INFLUENE how we interpret + respond to our current physical signs and symptoms.

Question 33

Diefenbach and Leventhal (1996) have suggested that, in addition to our personal history, most of us have decision rules or heuristics that influence how we appraise signs and symptom. What are the 4 rules?

Answer 33

> symmetry rule
stress-illness rule
prevalence rule
age-illness rule

Question 34

What is the symmetry rule that affects illness appraisals?

Answer 34

> refers to the fact that we tend to believe we are ill if we experience symptoms, and believe we are healthy if we do not experience symptoms.

Question 35

What is the stress-illness rule that affects illness appraisals?

Answer 35

> his holds that symptoms that develop in the context of stressful events are assumed to be part of stress rather than illness.

Question 36

What is the prevalence rule that affects illness appraisals?

Answer 36

> refers to the fact that rare conditions are perceived as threatening, whereas common conditions are perceived as less serious.

Question 37

What is the age-illness rule that affects illness appraisals?

Answer 37

> refers to our tendency to believe that mild symptoms that develop gradually are a normal part of aging.

Question 38

Are the rules suggested by Diefenbach and Leventhal helpful to our illness appraisals?

Answer 38

> In general, these rules are helpful, but they can also lead to errors.

Question 39

How do social factors affect illness appraisals?

Answer 39

> information that medical professionals communicate to us has a powerful influence on how we interpret and respond to physical signs and symptoms

> family and friends input

Question 40

Describe the results of Craig & Weiss’s classic study thatdemonstrates how others in our environment impact how we interpret our physical sensations:

Answer 40

> Exposure to the confederate displaying low pain tolerance led participants to report greater pain than when they observed confederates displaying high pain tolerance.

Question 41

Another example of how social variables influence how we respond to symptoms comes from a study conducted by Giannousi, Karademas, and Dimitraki (2016).
1. What was found about patients that had more intense psychological symptoms of cancer? (Why did they have them?)
2. What did the researchers conclude about the adjustment to cancer (what kind of process was it?)

Answer 41

1. when their views of the consequences of illness were discrepant from their partners.
2. concluded that adjustment to cancer is a dyadic process impacted not only by the sufferer but also by how others understand his or her illness

Question 42

At least three divergent approaches to how family and friends respond to patient illness have been described (Vilchinsky et al., 2011). What are they and briefly describe each:

Answer 42

1) active engagement - involves family & friends discussing illness with the patient, asking how they are feeling, and attempting to assist the patient with constructive problem-solving activities.

2) protective buffering - withholding their concerns about the patient + denying being worried about the patient’s health condition.

3) overprotection - involves family & friends underestimating the patient’s ability to cope and providing unnecessary and excessive assistance.

Question 43

Of the approaches to social response to patient illness as presented by Vilchinsky et al., which one provides the best patient support?

Answer 43

> active engagement (compared to the other approaches)
with this, patients respond to illness with less distress and greater self-efficacy.

Question 44

A study of critically ill patients who were in an in-tensive care unit for more than three days illustrates the difference between cultural responses to illness.

1. How was the perception of illness difference between African-American patients and caucasian patients?

Answer 44

> African-American patients tended to perceive illness as less enduring than Caucasians did, and reported more confidence in treatment efficacy as well in their own personal control

> They also tended to view illness as being less serious, having less emotional impact, while simultaneously perceiving illness as less coherent.

Question 45

Another example of research showing cultural differences in illness beliefs comes from a study of inpa-tients with coronary artery disease;

1. Compare the illness perceptions of south asian to caucasian.

Answer 45

> patients who identified themselves as South Asian reported having lower personal control over their illness compared to those who identified themselves as Caucasian

> They were also more likely to attribute their illness to worry and poor medical care in the past, and, compared to Caucasian patients, less likely to attribute illness to aging.

Question 46

Personality, in particular which trait, influences how we view physical symptoms?

Answer 46

> Neuroticism

Question 47

What is neuroticism?

Answer 47

> Neuroticism, also referred to as negative affectivity, is the tendency to experience negative emotions and emo-tional instability.

Question 48

Neuroticism is associated with a tendency to:
1. report what kind of symptoms or complaints?
2. influences our attention to and interpretation of what?

Answer 48

> somatic complaints
our symptoms

Question 49

For example, women who scored higher on neuroticism were more likely to view their newly diagnosed and surgically treated breast cancer as what?

Answer 49

> Not being under control.

Question 50

What three psychological disorders are associated with neuroticism? Does they affect our illness appraisals?

Answer 50

> Depression, anxiety, and stress,
also have a significant impact on how we view and respond to signs and symptoms.

Question 51

when daily mood is negative and stress is high, people tend to report what? How about positive mood?

Answer 51

> increased pain, miss work more often, and seek out health care more frequently
those who have a positive mood report lower pain and lower health-care use

Question 52

Who is widely known for providing a personal account or anecdotal evidence on how viewing comedy films assisted him in coping with pain and illness?

Answer 52

> Norma Cousins (1976)

Question 53

Experimental studies also support the relationship between mood and appraisals of health. In a classic laboratory study, it was found that inducing a positive mood as compared to a negative mood by watching pre-selected movie clips resulted in what?

Answer 53

> more favourable perceptions of health

Question 54

Health anxiety specifically refers to what?

Answer 54

> the experience of excessive anxiety about one’s present or future health and is often based on a misinterpretation of signs and symptoms

Question 55

Is health anxiety recognized as a dimensional construct?

Answer 55

> Health anxiety is recognized as a dimensional construct characterized by a lack of concern about one’s health at one end of the continuum and excessive anxiety about health on the other

Question 56

Transitory or fleeting health anxiety is a common experience in the general population - what is “fleeting health anxiety”?

Answer 56

> fleeting health anxiety is suspected to be adaptive by motivating individuals to take necessary action to prevent the development of a medical condition or deterioration of health

Question 57

When is health anxiety reported as excessive?

Answer 57

> when it is continuous
results in distress
causes extreme behaviours designed to alleviate anxiety
these behaviours actually heighten anxiety and interfere with daily functioning.

Question 58

When health anxiety is extreme, what can occur? (It becomes the attention of what?)

Answer 58

> it becomes the subject of clinical attention.

Question 59

1. In the past, extreme health anxiety was referred to as what?
2. Is this label still used?
3. What is used now?

Answer 59

1. referred to as hypochondriasis.
2. no longer used in the current edition of the DSM as it was considered unclear
3. are now diagnosed with either somatic symptom disorder or illness anxiety disorder

Question 60

A diagnosis of somatic symptom disorder is given to those with what?

Answer 60

> A diagnosis of somatic symptom disorder is given to those with one or more distressing somatic symptoms who also experience persistently high levels of anxiety about health.

Question 61

A diagnosis of illness anxiety disorder is given to those who are?

Answer 61

> are preoccupied with having or acquiring a serious illness and who have a high level of health anxiety but do not have significant somatic symptoms

Question 62

1. Can health anxiety occur for those who have a medical condition?
2. How is it different to those who do not have a medical condition?

Answer 62

1. Yes. even people diagnosed with a medical condition can become overly health anxious.
2. presents as a preoccupation with the medical condition that is substantially greater than typically experienced by other people with the same medical condition and is associated with increased distress and disability

Question 63

1. In terms of prevalence among medical patients,
   approximately what per cent have extreme health anxiety?
2. What patient group has the greatest amount of health anxiety compared to other groups?
3. What percentage of health anxiety is found in the regular population?

Answer 63

1. 20%
2. patients with neurological problems having greater health anxiety than other patient groups.
3. 7.7%

Question 64

Extreme health anxiety is associated with what two factors and includes what?

Answer 64

> considerable emotional distress and increased disability
including higher rates of unemployment

Question 65

Extreme health anxiety results in what for the health care system and as a result what occurs? What about for the individual?

Answer 65

> a substantial increase in medical care
increased use of unnecessary, invasive, dangerous, and expensive medical procedures
for the patient it is associated with lifetime history of diagnoses of anxiety and depressive disorders

Question 66

How many with elevated health anxiety never recover?

Answer 66

> 50 to 70 per cent of patients diagnosed with extreme health anxiety do not recover. I

Question 67

In a recent study, health anxiety at age 5 to 7 years was associated with what while at age 11 to 12 years and it was associated with what?

Answer 67

> 5-7 years = health anxiety symptoms
11-12 years = presence of other emotional disorders, unspecific somatic complaints, and health-care costs

Question 68

a number of predis-posing traits are suspected of increasing vulnerability to health anxiety, and these traits seem to have what? What traits have a genetic vulnerability?

Answer 68

> A genetic component

> trait is anxiety sensitivity or the tendency to be fearful of anxiety-related sensations such as increased heart rate (inherited)

> somatization or the occurrence of recurring multiple somatic complaints

> neuroticism or a tendency to experience negative affectivity and mood instability is also thought to increase vulnerability to health anxiety

Question 69

Under the cognitive behavioural model, it is suspected that health anxiety results through what type of experience?

Answer 69

> a learning experience whereby people either directly or indirectly experience a distressing event that leads them to believe that their health is in danger

> These experiences are thought to be responsible for the development of core cognitions and behaviours that consequently produce health anxiety.

Question 70

Similar to the common-sense model of illness representation, the cognitive behavioural model recognizes what? But - what does it emphasize?

Answer 70

> like the CSM model, this model recognizes that thoughts significantly impact how people feel about and respond to physical sensations

> This approach emphasizes, however, that the individual with health anxiety has developed dysfunctional thoughts based on past experience and that health anxiety arises when these dysfunctional thoughts are triggered.

Question 71

Death of an ill parent has been found to predict what in young adults?

Answer 71

> elevated health anxiety in young adults

Question 72

Are people that are health anxious able to tell the signals from their body easier/better than those who aren’t health anxious? In other words, what is not associated with health anxiety?

Answer 72

> while health anxiety is associated with biased tendency to attend to mild and benign bodily sensations, there is no evidence to suggest that people who are health anxious are actually better able to detect body signals than individuals who are not health anxious

> it does not seem that abnormalities in interoception (i.e., sensitivity to internal stimuli) account for health anxiety

Question 73

Several thoughts are believed to be central in the development of health anxiety, including what thoughts?

Answer 73

including holding beliefs that:
(1) the feared disease is serious and catastrophic;
(2) one is vulner-able to disease;
(3) one is not capable of coping with the feared illness; and
(4) inadequate medical resources are available to treat the illness.

Question 74

People with extreme health anxiety hold other general dysfunctional beliefs, such as the belief that:

Answer 74

> there must be an explanation for all aches, pains, and unusual sensations and that there is far more illness in the world than people realize

Question 75

Hedman and colleagues also observed that individuals who are health anxious tend to perceive others as what? What do those thoughts trigger behaviourally?

Answer 75

> tend to perceive others as less healthy and to rate the risk of contagion as higher

> these thoughts specifically are expected to trigger avoidance behaviours.

Question 76

What are the three forms of bias that are associated with extreme health anxiety?

Answer 76

> confirmatory bias whereby indi-viduals with health anxiety tend to focus on information that confirms their fears and ignore in-formation that disconfirms their fears

> thought–action–fusion bias = anxious people to believe that when they think a negative thought the thought will come true

> ex-consequentia reasoning= anxious individuals believe that if they feel anxious = danger is present

Question 77

he cognitive behavioural approach to health anxiety also identifies behaviour as playing a role in the _ and _ to anxiety?

Answer 77

> plays a role in development + maintenance

Question 78

When exposed to physical sensations or information about health, people who are health anxious engage in what type of behaviours?

Answer 78

> engage in safety behaviours that, although designed to reduce threat and anxiety, in the longer term have the opposite effect.

Question 79

The classic behaviour associated with extreme health anxiety is what?

R-I-S or General R-s

Answer 79

> is repeated information-seeking or reassurance-seeking from medical professionals or family and friends.

Question 80

What is body-monitoring?

Answer 80

which refers to monitor-ing one’s physical sensations and appearance, is another form of safety behaviour

Question 81

What is a general behaviour associated with extreme health anxiety?

Answer 81

> avoidance behaviours (that avoid those who enoke health anxiety

Question 82

behavioural dimensions of health anxiety (e.g., reassurance seeking) arise as a method of compensating for what?

Answer 82

> compensation for ineffective cognitive coping strategies

Question 83

he cognitive behavioural model posits that when health anxiety is triggered, the person who is anxious becomes what?

Answer 83

> vigilant and engages in these behaviours to reduce threat.

Question 84

Abramowitz and Moore had participants expose themselves to personally significant health-related stimuli and found this provoked anxiety and resulted in individuals doing what? What are these behaviours supposed to do but for individuals with this disorder what do they actually do?

Answer 84

> resulted in individuals reporting urges to perform safety behaviours.

> PROBLEM: contrary to expectations among health-anxious individuals, they increase rather than decrease anxiety

Question 85

What is the treatment of choice for health anxiety?

Answer 85

> Cognitive behavioural therapy (CBT) has emerged in the past 20 years as the treatment of choice for health anxiety.

Question 86

Most clients who receive CBT for health anxiety visit their therapist for approximately how many sessions? Is it variable among patients?

Answer 86

> approximately 12 sessions of 50 to 60 minutes

> the exact number of sessions depends on the client.

> More sessions are provided to clients who experience greater health anxiety and a greater number of health fears.

Question 87

Also notable about CBT and health anxiety is what? (What do clients have to do?)

Answer 87

> clients typically are responsible for the completion of assignments and homework between sessions.

Question 88

CBT treatment is more difficult if clients have one/some of what 7 factors?

Answer 88

1. Have had extreme health anxiety for a longer period of time.
2. Suffer from severe symptoms.
3. Have strongly held beliefs.
4. Present with a personality disorder.
5. Experience co-morbid general medical conditions.
6. Report the presence of stressful life events.
7. Appear to benefit in some way (e.g., financially) from having health anxiety.

Question 89

How does CBT begin and what is the key component of it?

Answer 89

> CBT begins by providing psycho-education to clients

> KC= for clients to understand how health anxiety develops, with specific attention to how thoughts lead to health anxiety (basically realize that the attention to bodily sensations is selective and uneccsary

Question 90

Why are people in CBT encouraged to have a diary?

Answer 90

> In the diary, they record the date, the level of health anxiety experienced, triggers for health anxiety, thoughts, behaviours, and physical symptoms they may be experiencing.

Question 91

What are the steps to CBT?

Answer 91

1) psycho-education

2) sessions turn to helping clients iden-tify the specific thoughts they are having about their health that may be triggering health anxiety

3) Exposure with response prevention

4) followed by direct exposure to a feared object, situation, or stimulus.

5) helping clients examine their safety behaviours, such as
body-checking or reassurance-seeking

Question 92

What is a challenge to psycho-education in CBT? (Clients are more focused on what which prevents them in exploring…)

Answer 92

> clients are focused on proving they have a medical condition, and therefore may not be open to exploring alternative explanations for their physical sensations.

Question 93

What is the exposure with response prevention therapeutic technique?

Answer 93

> that involves having clients first formulate a hierarchy of the stimuli and thoughts that they tend to avoid.

> Clients order the hierarchy so that they work on exposing themselves to items that are lower (i.e., less anxiety provoking) on the hierarchy first before graduating to items that are higher on the hierarchy.

Question 94

What is the wait for two weeks approach?

Answer 94

> this approach assumes that most symptoms resolve on their own in two weeks and do not require further medical attention. If the symptoms persist beyond this period, then it is reasonable to see a physician.

Question 95

During exposure exercises, clients rate their fear on what scale?

Answer 95

> the subjective units of discomfort scale (SUDS), which ranges from 0 or no fear to 100 or maximal fear.

Question 96

What are some adjunctive strategies to incorporate with CBT?

Answer 96

> stress management
focusing on improving general life satisfaction and enjoymen
mindfulness
work with the family in the course of treatment

Question 97

What is the empirical support for CBT?

Answer 97

> For instance, when randomly assigned to a CBT or a control condition, clients significantly improve in response to CBT in comparison to the control.

> also improves associated problems such as generalized anxiety, depression, social function, and use of medical services

> efficacious for treating health anxiety when delivered in a cost-efficient manner (group format)

> when CBT is presented online in weekly modules and paired with therapist support, clients improve in comparison to individuals who receive no treatment

> cognitive therapy + exposure therapy = work

Question 98

What therapies work for health anxiety?

Answer 98

> medication
behavioural stress management
CBT
Mindfulness
group psycho-education based on a problem-solving approach
short-term psychodynamic psychotherapy