coping, health services, adherence (PSYC 262 Exam 2)

Question 1

Coping

Answer 1

thoughts and behaviors used to manage stress

Question 2

Name and explain the different types of social support. Be able to generate novel examples of each type.

Answer 2

• tangible or instrumental: direct assistance (give a ride, bring food)
• Informational social: give advice/ suggestions about situation (get him in touch with accessibility services, register for classes)
• emotional: express empathy/ caring/ concern (tell them it’ll be okay even though it sucks right now, visit them, call them)
• network: provides a feeling of connectedness and membership because you belong to a group with similar interests, can benefit without knowing people (sorority group, work mentality, being a bishop)
• invisible: social support without knowing who provided it to you/ anonymous, no expectation of reciprocation (go fund me accounts)

Question 3

Explain the relationship between social support and reactivity.

Answer 3

SS reduces reactivity and changing symptoms from reactivity (example: pets are proven to destress people, likely because they are not judegmental)

Question 4

Explain how reactivity is typically assessed in the laboratory.

Answer 4

When assessing stress in a lab, you hook up patients to technology to measure. Get a baseline and then give them a stressor like public speaking
High reactivity = strong change in response to stimuli
Social support can reduce reactivity

Question 5

Describe the Allen et al (2001) experiment that demonstrated pet ownership improves one measure of health. Explain the results of this study and what they mean. Explain the main methodological advantages and disadvantages of this study.

Answer 5

Allen et al (2001) experiment looked at pets and their social support effects on health.
Participants: stressed stockbrokers with high BP who lived alone and had not owned a pet in the last 5 years, and were all scheduled for a BP drug.
Randomized assignment of pets to 2 groups: no pet and pet. True Experiment.
All patients had lower BP from drug being taken
Results: Participants who got pets had a ½ BP increase when stressed compared to those without pets
Conclusion: Pets help with BP reactivity.
Criticism: A very specific group of participants and not representative of the general population.

Question 6

Buffering Hypothesis

Answer 6

SS protects a person from experiencing high, but not low, levels of stress through a reappraisal of the stressor.
Example: getting SS for an exam by studying with a study group

Question 7

Direct Hypothesis

Answer 7

the idea that SS is helpful in terms of your health no matter your level of stress. The positive effects of SS are similar under both high and low stress because SS leads to healthier behaviors and a healthier lifestyle.

Question 8

personal control

Answer 8

having the feeling/ belief that you can take action to get a desired outcome and also avoid an undesirable outcome

Question 9

Explain and be able to generate novel examples of the types of control discussed in class.

Answer 9

Behavioral control: take mental action to reduce the impact of the stress; decrease intensity or duration of stressor (study over time not at one time)
Cognitive control: reduce stress by thinking about the situation in a different way always have the ability to enhance (take hard class now)
Informational control: get information about the stressor (ask about test layout)
Decisional control: choose among alternative options (drop assignment)

Question 10

Learned helplessness

Answer 10

a person can feel like there is nothing they can do to change their situation (no control) where they develop a sense of apathy and disconnecting. Can be the result of long periods of high stress and is a characteristic of depression

Question 11

Seligman’s model

Answer 11

Learned Helplessness experiment with 3 groups of dogs (no shock, controlled shock by touching the plate, uncontrolled shock) with 2 phases.
- phase 1 (training): controlled shock and uncontrolled shock groups were at the same time and at the same intensity, but the control group has a button to turn off the shock which they learned.
- phase 2: new shuttlebox with a barrier to hop in order to turn off shock. never shocked dogs hopped the barrier quickly and so did controlled shock group. However, uncontrolled shock dogs did not hop the barrier and had learned helplessness and showed apathy.
- conclusion: people who may have learned helplessness may not try to use coping strategies because they didn’t make a difference before.

Question 12

Emotion-focused coping style

Answer 12

used when our goal is to control an emotional response towards stressor (punching the wall is a behavioral example and thinking that the fight never lasts long anyway is cognitive example) ** most helpful when there is no control

Question 13

Problem-focused coping style

Answer 13

deal with the situation by reducing the demands or to expanding resources to deal with the stressor (withdraw from the course would be a reducing example and going to tutoring would be expanding resources)

Question 14

Cognitive Behavioral therapy (CBT)

Answer 14

an approach to psychotherapy that treats dysfunctional thoughts. main idea: our thoughts influence how we feel.
when we are struggling with mood and emotions the way we perceive things is wrong and dramatic (false thoughts= dysfunctional thoughts). Modify or change dysfunctional thoughts to make them more accurate, which makes people feel better. Help people break down their primary appraisals (Lazarus model)

Question 15

Emotional Disclosure

Answer 15

Express strong emotions by talking (even if no one is listening) about it or writing about it through reflection. self-reflection about what was learned
Pennebaker had people write about events for 15-20 minutes 3-4 times a week; found people had psychological and physical benefits– better functioning immune systems

Question 16

Describe situations in which emotion versus problem focused coping is preferable/more adaptive.

Answer 16

Emotion focused coping is most helpful when there is no control
Example: Cannot control the doctor when getting tonsils out, but can control reaction to the procedure.

Question 17

Explain the differences between disease and illness.

Answer 17

Disease: process of damage to the body, both short term or long term. Ex is COVID, cancer
Illness: a personal experience of being sick AND having a diagnosis (from a professional).
**a person could have a disease but not be ill because they don’t experience the symptoms

Question 18

Illness behavior

Answer 18

things we do when we have a symptom but no formal diagnosis, to figure out if we are actually sick.
Ex) drink hot tea with honey, gargle salt water, wait and see, take a covid test, going to the doctor

Question 19

Sick role behavior

Answer 19

things we do after being diagnosed, in order to get better.
Ex) take antibiotics, sleeping, drinking a lot of water

Question 20

Discuss the relationship between personal factors, gender, age, SES, ethnicity, symptom characteristics, and treatment seeking behavior.

Answer 20

• Personal Factors: high neuroticism (response to stress with high levels of negative emotion) is correlated with seeking out healthcare; view of body= perceived likelihood of getting sick
• Gender: women are more likely to seek out healthcare than men; men are only likely to report serious symptoms
• Age:
  <5 kids have a higher number of visits because of routine checkups, vaccinations, a lot of exposure at that age, less autonomy.
  15+ both women and men, because age is a risk factor for illness which could require monitoring over time, and we could be more concerned over time
• SES: (Socio-economic status): people with higher SES report having fewer physical symptoms, but when they do occur, they are more likely to seek attention (threshold is lower when SES is higher); lower SES take longer to seek healthcare due to lack of ability to afford it. SES takes into account income and education
• Ethnicity: European Americans are most likely to seek out healthcare; minority groups are less likely to seek care due to discrimination
• Symptom Characteristics: More likely to seek healthcare when disease is visible, perceived as severe, interferes with daily life, and is frequent and persistent.

Question 21

Explain how a person’s disease conceptualization determines whether they seek out medical attention.

Answer 21

Factors that influcence perception of diseas incluse…
the identity of the disease (just a cold vs COVID)
timeline (acute [has beginning and end] vs chronic [for life] vs cyclic [reoccurring])
what we attribute the cause to (germs, lifestyle, stress, religion)
Consequence (no long-term consequence= less likely to seek care)
Controllability (viral [doc cant do much for you] or bacterial illness [like strep; will give meds])

Question 22

Explain a lay referral system and how people may use it to get medical information.

Answer 22

Lay referral network: family and friends who are not professionals that give advice by Help interpret, Recommend a remedy, or Recommend another lay referral

Question 23

Explain the sick role from the perspective of Segall’s Rights and Duties.

Answer 23

According to Segall, we have 3 rights..
- To make decisions about health issues
- To be exempt from normal duties
- To become dependent on others for help
And 3 Duties when it comes to healthcare…
- To maintain health and get well
- To perform routine health care management
- To use a range of health care resources

Question 24

Delaying medical care model has 4 stages:

Answer 24

• Appraisal delay: how serious are symptoms? (google, call parent, enlist lay referral network, monitor symptom)
• Illness delay: decide are sick, but do you get treatment? (monitor symptoms, over the counter meds)
• Behavioral Delay: time between needing treatment and seeking it out (need to go to doctor but need to go to class first or get a ride or is scared of results)
• Medical delay: time between scheduling appointment and getting care; no patient control (showing up at ER but they cant take you immediately)

Question 25

Explain why delay is concerning in the case of a heart attack, particularly.

Answer 25

MI: Myocardial Infarction: Heart Attack, is an example of a delay medical care model that would result in severe problems and is hard to notice because…
all kinds of people have heart attacks, not just white overweight men
don’t always experience pain; maybe just pressure, indigestion
often don’t realize symptoms are life-threatening and won’t seek care (call 911)
Medicine for MI is most effective in the 1st hour

Question 26

Somatic Symptom Disorder

Answer 26

symptom causes emotional distress

“psychological disorder” Somatic symptoms are physical symptoms. To be diagnosed, they need to have:
1 or more physical symptoms that they find to be VERY disruptive/ distressing; linked to neuroticism (depression, anxiety, hostility) and do not have much insight into it
Excessive thoughts/ feelings/ behaviors related to symptoms that may be exaggerated thoughts, come with persistent high anxiety, and take up a lot of time ( is the part that makes people overuse health services)

Question 27

Somatization

Answer 27

emotional stress causes symptom

super common problem where physical symptoms are the result of some emotional distress (ex: developing back pain, from chronic stress from going through grad school, that goes away after stress relieves)
the best way to help someone with this is an intervention for emotional management. argues for better integration of mental health professionals into primary care settings

Question 28

Malingering

Answer 28

someone consciously fakes having an illness usually due to secondary gain (advantage obtained from being sick); not necessarily a psychological disorder (ex: faking sickness to skip school)

Question 29

Research shows these traits in a practitioner are important to most people:

Answer 29

• communicator that matches your requirement (amount of detail)
• doctor-centered (doctor leading discussion) and people preferer patient- centered interaction (patient does most of the talking)
• limited use of medical jargon; want language that makes sense to them
• general and cultural competence (understanding medicine & is aware and incorporates knowledge about of different cultural variations between individuals)
• warmth, empathy, show concern
• open body language and dressing well (has become more complicated with the use of computers)
• can ask questions to get information and listen to responses well
• gives clear instructions about exactly what to do for aftercare: like prescription instructions and where it will be

Question 30

Adherence

Answer 30

ability AND willingness to follow recommended health practice (taking medication on time, going to the doctor regularly, etc)

*can also be called compliance but is not used much because it is implicatively negative and forceful

Question 31

Be able to discuss how common lack of adherence is and explain why adherence is so important to the management of numerous health problems.

Answer 31

Super common: 40% of patients are nonadherent to medical advice (probably undercalculated even!)
This matters because
20% of hospitalizations are due to nonadherence
The case of antibiotics: bacteria gain resistance if not taking all antibotic

HIV: attacks the immune system and has a high viral load

Viral Load: how much virus in immune system.

Question 32

Describe the strategies used to assess adherence and explain the limitations of each.

Answer 32

• Ask a healthcare professional: not great because they estimate adherence based on how well symptoms have alleviated
• Ask patient: not great because people can lie or forget
• MEMS cap (medication event monitoring system): fancy but still can open bottle and not actually take medication
• Pill count: simple, but could also not take meds.
• Biochemical tests (take blood/urine test): objective but invasive and not appropriate for every medication.

Question 33

Describe factors related to the person, regimen, and interactions between the patient and practitioner that can affect adherence.

Answer 33

Factors that make patients less adherent is a regimen that is more difficult, longer, has bad side effects, and is expensive.

Question 34

Enhance physician communication style to increase adherence by…

Answer 34

simple, concrete, instructions: take this mediation in the morning with breakfast
break down complex regimen: specifically plan out when to take medications with patient
provide written instructions: summary of what happened at the visit and aftercare
have patients repeat instructions (seems silly but very helpful): tell me how you’re going to take this medication after doc tells patient
emphasize key info: take all prescribed antibiotics even if you feel better

Question 35

How does a physician emphasize key info to improve adherence?

Answer 35

education: tell them side effects like turning urine orange
secure verbal commitment: will you take the medication as I have instructed?
social support: family member or friend can be a second set of ears and help patient make sense of information
behavioral methods to enhance motivation:
tailoring regimen to personal schedule
provide prompts: set reminders on phone or always take it with dinner
self-monitoring: check in with self and keeping track of when taking medication: medication calendar or labeled pill box
behavioral contracting: where a healthcare provider to draw up a contract where it says if you adhere to medication regimen, there will be a reward: more common with kids

Question 36

Health behavior

Answer 36

a behavior done to enhance or maintain health **even if it is not effective, it can be a health behavior if you think it is

Question 37

Healthy habits

Answer 37

extremely well established health behaviors
often automatic (routine for so long that we no longer actively think about it)
examples: drinking water, brushing teeth, staying active, eating breakfast