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Health Psychology > Exam 2: Part 2 > Flashcards

Exam 2: Part 2 Flashcards

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1
Q

forms of communication (3)

A

1) Person-person ⇒ direct communication
2) Print media
- Brochures
- Posters
- billboards
3) Short video (PSA ⇒ public service announcement)
- Television
- Internet

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2
Q

message framing (2)

A

gain frame: something you gain either positive or negative (usually benefit)
loss frame: something you loose either positive or negative (usually threat)

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3
Q

fear appeal

A

assumes fear will bring about behavior change
- Can be effective to motivate
- Needs to be coupled with useful information to help guide behavioral change

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4
Q

what can too much fear do?

A

it can be counterproductive and lead to defensiveness
- this is likely for people very involved in the issue

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5
Q

what framing method is better for producing change?

A

loss frame is preferred and more effective for people such as experts who understand the topic well

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6
Q

what 3 things does behavior change depend on?

A
  • Level of knowledge
  • Certainty of outcome
  • Risk taking ⇒ prevention or deal with it when it arises
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7
Q

when people have certainty vs uncertainty which framing is better?

A

when people are certain of the consequences of a behavior a gain frame works best
- If they are uncertain a loss frame works better

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8
Q

when are preventative behaviors vs detection behaviors used in framing?

A

preventive behaviors help avoid risk but detection behaviors involve risk because there is a risk of finding disease
- To push people for detection behavior the loss frame works better

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9
Q

what is risk averse vs risk tolerant?

A
  • risk averse prefers a gain frame
  • risk tolerant prefers a loss frame
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10
Q

what is message sending vs receiving

A

experts who create health messages may use frames that work for them but not well for their audience

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11
Q

health literacy

A

the degree to which individual can obtain, process, and understand the basic health information and services they need to make appropriate health decisions

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12
Q

what are skills needed in health literacy? (3)

A
  • Print literacy ⇒ read and write
  • Numeracy ⇒ understand information with numbers
  • Oral literacy ⇒ speak and understand speech
    → may help or hurt understanding of health literacy
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13
Q

what % of Americans in 2003 have limited health literacy?

A

36%
- Rates higher for elderly, minorities, people who have not completed high school, people who spoke a language other than english before starting school, people living in poverty

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14
Q

what are health literacy meta analysis study outcomes? (4)

A
  • Lower literacy associated with higher emergency room and hospital visits and lower influenza immunization
  • Lower literacy among senior was associated with higher mortality and poor overall health status
  • Lower health literacy was also associated with poorer ability to take medications appropriately or interpret labels and health messages
  • Not enough data to look at numeracy ⇒ more work is needed
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15
Q

health literacy interventions (3)

A
  • Comprehension can be improved if essential information is presented alone or first,and if reading level is lowered ⇒ videos and images also help
  • Interventions that teach self management and treatment adherence reduce emergency room and hospital visits
  • Interventions work best if they are pilot tested before implemented, emphasize skill building, and are delivered by a health professional
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16
Q

levels of prevention providing treatment (3)

A
  • primary prevention
  • secondary
  • tertiary
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17
Q

primary prevention

A

when a treatment is provided to prevent an illness from occurring
No symptoms or signs of illness are present

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18
Q

secondary prevention

A

treatments designed for use early in an illness when the illness is reversible or curable

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19
Q

tertiary prevention

A

treatments designed to contain the illness and prevent progression while minimizing symptoms
- such as cancer or diabetes

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20
Q

levels of intervention in health changes

A
  • Individual ⇒ clinical providers or health care providers
  • Proximate environment ⇒ community level
  • Distal environment ⇒ interventions at the federal or state level
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21
Q

commonalities of treatment definition

A

make it difficult for a particular treatment to be determined better than a comparison treatment

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22
Q

commonalities of treatment in therapy (3)

A
  • therapist characteristics
  • Therapeutic process: respond to success or setback, opening up about certain issues, etc.
  • Client characteristics: expectations of success or failure for themself or therapy, motivation, personality, communication skills, etc.
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23
Q

cognitive behavioral methods

A

complementary techniques that target thoughts and behaviors

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24
Q

cognitive behavioral method subsections (6)

A
  • self monitoring
  • cognitive restructuring
  • behavioral contracting
  • stimulus control
  • relaxation training
  • modeling
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25
Q

self monitoring definition

A

monitoring oneself usually through journaling by paying attention to thought, emotions, behaviors, and their environmental context

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26
Q

cognitive restructuring definition

A

use information gathered during self monitoring to challenge the person’s thoughts
- What is the evidence for a belief
- What are alternative explanations

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27
Q

behavioral contracting definition

A

creating a contract in which desirable behavior is rewarded and undesirable behavior is punished
- Operant conditioning principles
- Behaviors can be reinforced/strengthened when reworded and diminished when punished
- Rewards should be supportive of behavior to be strengthened

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28
Q

stimulus control definition

A

the environment is explored for triggers of undesirable behaviors
- built on principles of classical conditioning
- Once they are identified by self monitoring they can be modified or avoided

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29
Q

relaxation training definition

A

can help with stress that may be playing a role in triggering an undesirable behavior or anxiety

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30
Q

modeling definition

A

involves identifying people who can serve as role models for the behavior a person is trying to change
- Familiar or unfamiliar but visible in practice of their target behavior

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31
Q

relationship building objectives in the therapeutic process (and 3 components)

A

begins in the first meeting and objectives are to understand reasons and degree of motivation to achieve cooperation and negotiate a treatment agreement (action oriented)
- Understanding
- Motivation
- Negotiate a contract

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32
Q

assessment in the therapeutic process (2 components)

A

the therapist will attempt to understand the clients current health behaviors
- Personal: personality, health beliefs, knowledge, attitudes toward illness, etc.
- Contextual: family of origin, social groups, community, and cultural norms

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33
Q

reorientation in the therapeutic process

A

use of various techniques to being about changes in thoughts and behaviors ⇒ targeting the client but may also involve family members
- Social connections can help increase compliance and minimize the risk of relapse

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34
Q

3 parts of the therapeutic process

A
  • relationship building
  • assessment
  • reorientation
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35
Q

Elanor case study

A

had weight issues and met with a physician as well as a behavioral medical counselor who helped her to re-percieve her inner self and not overeat or conform to other expectations (including her husband and inlaws)
- she eventually reached her goals and her husband also began to collaborate with her and include himself in her meal plans
- also had a friend to keep her accountable

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36
Q

treatment issues (4)

A
  • health education
  • adherence
  • relapse education and prevention
  • anxiety and depression
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37
Q

health education

A

includes psychoeducation, brochures, videos, etc. to provide information and motivation for client to understand factors promoting or threatening their health
- Health literacy affects the success of education

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38
Q

psychoeducation

A

any materials or experience planned by both a provider and a client to affect behavior

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39
Q

adherence

A

sticking with the program (30-70% of clients drop out)
- Problem for everyone
- Failure to begin treatment, premature termination, minimal completion

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40
Q

relapse education and prevention

A

1) Relapse can happen any time but is most likely during maintenance
- Slips shouldnt be considered failures ⇒ rehearse relapse what happens and how to respond
2) Prevention includes self efficacy and coping and continued self monitoring
- Revising techniques learned when originally making the change and providing continuous support

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41
Q

digital methods for treatments

A

cognitive behavioral therapy is open access to many people and can reduce costs while keeping a personalized treatment plan
- Phone apps
- Internet

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42
Q

sham knee surgery results

A

veterans have pain with their knee and all decide to undergo surgery to reconstruct their knees
- 2 would be to perform a debridement
- 3 perform a lavage
- 5 would say to make some cuts in the skin and leave the knee joint alone
→ none would know the difference in what they got
- All 10 had decrease in pain and improved function

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43
Q

placebo vs nocibo in latin

A

I shall please vs I shall harm

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44
Q

placebo effect

A

beneficial health outcome resulting from a person’s anticipation that an intervention (pill, procedure, or injection) will help them

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45
Q

nocebo effect

A

detrimental health outcome resulting from a person’s anticipation that an intervention (pill, procedure, injection) will

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46
Q

what influences nocebo effect

A
  • A clinicians style in interacting with patients also may bring about a negative response that is independent of any specific treatment
  • we are often told about the possibility of negative side effects from procedures may influence a patient’s outcome
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47
Q

what influences placebo effect independent of treatment

A

A clinicians style in interacting with patients also may bring about a positive response that is independent of any specific treatment
- The placebo effect is the patient improvement due partly to the patient’s beliefs about the surgery

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48
Q

placebo-nocibo effects are due to what?

A

due to a substance
- pill, injection, acupuncture, surgery, etc.

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49
Q

placebo-nocibo response

A

includes both the placebo effect and all other influential treatment factors
- Expectations, conditioning, relationships, environment
- It is difficult to determine what else is included in the intervention
- effect is also likely due to the interactions with the doctor and the medical environment (response)

50
Q

what is different about the placebo-nocibo response

A

effects are attributed to only the patients interaction
- this is distinguished from other reactions in the environment which contribute to changes in the outcome and are important

51
Q

general placebo effect factors

A
  • invasiveness => the more invasive a procedure is, the more the placebo effect works
  • feature associations => associations with features of the intervention (such as blue pill = sleep over red pills)
  • expense => with more expensive interventions there are larger effects and brand named products have a larger effect than generic names
  • classical conditioning => prior experiences with interventions which can trigger the effect of the placebo (sometimes purposefully done before a placebo)
52
Q

factors affecting the placebo response

A
  • expectancy
  • classical conditioning
  • changes in thoughts and motions and behaviors
  • personality
  • patient provider relationship
  • clinical environment
  • social environment
53
Q

expectancy definition

A

what the patient or participant expects to happen
Influenced by what they are told by the provider or experimenter
- If they are told they will get relief, then they do (placebo)
- If they are told they will get a headache this increases the likelihood they will get one (nocibo)

54
Q

classical conditioning in placebos

A

factor in placebo and nocebo responses ⇒ we often have experiences with medical environments and these experiences can trigger +/- responses

55
Q

changes in thoughts/emotions/behaviors with placebos

A

getting treatment of any kind can change our feelings and behaviors

56
Q

personalities with placebos

A

placebo prone personalities have not been identified but people have individual differences
- Some people are more likely to respond than others
- Traits associated are optimism and self efficacy
- Traits likely interact with the particular symptom context

57
Q

patient provider relationship and placebos

A

relationship between the patient and provider can affect responses to treatment
- Warm, empathetic practitioner is associated with better placebo responses
- Cold practitioners are related with lower placebo effect and more nocibo effect

58
Q

clinical environment and placebos

A

medical setting can influence our responses through classical conditioning or cognitively by making us feel anxious/threatened or protected/cared for

59
Q

social environment and placebos

A

social environment beyond the clinic influences us so if your family and friends believe in the treatment, then we are more likely to have a placebo effect

60
Q

placebo by proxy

A

children and others are more likely to have a placebo effect when their parents or family believe it will too

61
Q

levels of placebo-nocebo responses (5)

A
  • Biology
  • Psychology
  • Social relationships
  • Clinical environment
  • Home environment
62
Q

what influences you when you take something?

A

Pill features, previous experiences, personal traits (optimism), if a friend/family gives it to you, where you take it, etc.

63
Q

double blind study design with placebos

A

placebo treatment is randomly assigned so some get the real treatment vs the fake ⇒ neither the person or the provider knows
- One of the best designs
- Easy for something like a pill but harder for surgery

64
Q

2-arm studies vs 3-arm

A

2: treatment vs placebo ⇒ used the most
3: real treatment, placebo, and no treatment studies ⇒ allows us to study the effects of the actual treatment itself when we have a group who does not get anything

65
Q

ethical concerns of 3-arm studies?

A

concern to assign people to no treatment
- some studies that aren’t interest in a treatment may use only a 2-arm design (placebo or nocibo)

66
Q

how does waitlisting affect placebo studies?

A

Using waitlisted people as part of the no treatment group is supposed to help with the ethicality
- Waitlisting people show 33% of the improvement of treatment group and 40% of the placebo group
- Suggests there is a placebo response for being on a waitlist for the treatment

67
Q

T/F 4 arm studies have been done?

A

false but could be done
- Treatment, placebo, no treatment or waitlist with clinical interactions, no treatment or waitlist without clinical interactions

68
Q

who was Henry Beacher?

A

WW2 physician influenced expectancy and soldiers responses to pain medication
- led him to study placebos experimentally
- Important to compare a treatment to a placebo ⇒ ability of a practitioner to make a patient feel better regardless of the science
- Recently it is more important to figure out how much treatment (real or placebo), compared to no treatment at all is needed to feel better

69
Q

what was assumed prior to Henry Beacher?

A

Prior to his work any change in outcome has been attributed to treatment

70
Q

bias definition

A

non random change in the outcome due to factors other than those being studied

71
Q

types of bias (4)

A
  • perceptual
  • response
  • hawthorne effect
  • publication bias
72
Q

perceptual bias definition

A

when participants perceive their symptoms more readily because they are paying more close attention to their body
- Anticipating changes or recording their feelings
- Intentional shift not a real change in health status

73
Q

response bias definition

A

patients report their symptoms differently even though they may not have changed
- may be due to social desirability

74
Q

social desirability definition

A

behavior in ways that are thought to be desired by others
- Patients are motivated to please the provider or researchers by telling them what they think they want to hear

75
Q

what types of bias can inflate treatment effect?

A

perceptual and response

76
Q

hawthorne effect

A

changes behavior because of participating in a research study
- Includes perceptual and response bias and also participants may reduce poor health decisions and increase healthy behaviors due to monitoring that can affect treatment

77
Q

publication bias

A

studies with positive results are more readily published than those with small or null effects ⇒ makes treatment effects look larger and more consistent than they actually are

78
Q

what comparisons let us look at what factors are influencing the treatment not just due to the placebo response?

A
  1. no treatment group: influenced by hawthorne, interactions with provider and researchers, research environment, etc.
  2. placebo group: influenced by all these things and features of the no treatment group plus the placebo
  3. a known treatment: all factors influencing no treatment and placebo but also factors specific to the treatment such as the drug or the procedure
79
Q

what would happen if we only compared treatment and placebo groups? (wouldn’t include a no treatment group)

A

we wouldn’t know the size of the placebo response but only that the treatment effect is bigger

80
Q

additional issues with research studies (5)

A
  • spontaneous remission
  • regression to the mean
  • concomitant treatments
  • drop out rates
  • inadequate blinding
81
Q

spontaneous remission definition

A

when patients get better but it has nothing to do with treatment

82
Q

regression to the mean definition

A

when patients who have really bad symptoms desperately want a treatment even if they may get a placebo, so they join a study ⇒ change from an extreme
- Its likely their symptoms just got better over time as they are enrolled in the study
- Patients symptoms don’t remain constant and sometimes they improve/worsen

83
Q

concomitant treatment definition

A

no treatment groups are more likely to seek out other treatment during the study
- They may be getting a treatment during the time so this affects their results in the other study they participate in where they aren’t getting a treatment

84
Q

drop out rates

A

dropout rates are higher for a no treatment group
- Maybe they are more sick or more responsive to hawthorne effect

85
Q

inadequate blinding definition

A

the participant is able to figure out if they are getting the real treatment or placebo which can alter the study’s result

86
Q

if a treatment provides more pain relief than the placebo but the placebo provides more pin relieve than no treatment what should you do?

A

use the treatment or if the treatment is associated with negative side effects then we could cut down on the dosages to help reduce this

87
Q

placebo controlled drug reduction definition

A

cutting down on a drugs dosage by using a placebo for a portion of the treatment

88
Q

if the placebo is no better than the non treatment group but the active treatment is very effective what should you do?

A

the treatment is the best course and non of it is due to placebo effect/response

89
Q

if both the treatment and placebo result in similar pain relief what should you do?

A

may be better to use the placebo alone when the treatment is associated with negative side effects

90
Q

if neither the drug or the placebo is effective with pain relief what should you do?

A

neither treatment should be used

91
Q

active placebos

A

if the placebo produces the same sensations or side effects as the active drug it will enhance the placebo even more

92
Q

characteristics of placebo-nocebo responses (9)

A
  • Subjective (self reported) and objective (measurement by researchers)
  • Dose responses ⇒ more placebo or nocibo given the greater the response
  • active placebos enhance
  • Found in healthy and ill ⇒ placebo and nocibo responses are found in both healthy and patient groups
  • Global and localized symptoms ⇒ placebo and nocibo responses are found in both
  • Open disclosure ⇒ placebo responses can still be found when participants are told they are getting a placebo (usually also told the placebo has some effectiveness for ailments)
  • Placebos are not curative ⇒ found to be effective for symptoms like pain, weakness, or depression but have never cured a disease
  • Can be short term or long term ⇒ usually studies look over hours or days but sometimes effects last longer for weeks or months (debated)
  • May be specific to outcome and intervention types ⇒ placebo effects and responses are rarer and smaller than many people believe
92
Q

what did meta analysis find with placebos?

A

only helpful for pain relief or device use

93
Q

amygdala

A

cluster of cells important for fear and anxiety feelings

94
Q

Periaqueductal gray

A

when stimulated this reduces pain

95
Q

analgesia

A

pain relief, loss of sensations

96
Q

hyperalgesia

A

pain increase

97
Q

what is the analgesic pathway in the brain

A

Placebo (positive expectations) → brain prefrontal cortex → endorphins → midbrain (PAG) and amygdala = pain relief

98
Q

what are the 2 dopamine pathways in the brain? (+/-)

A
  1. Placebo (positive expectations) → brain prefrontal cortex → dopamine → brain reward center (nucleus accumbens)
  2. Nocebo (negative expectations) → brain prefrontal cortex → decreased dopamine → no stimulation of the brain reward center (nucleus accumbens)
99
Q

what is the hyperalgesic pathway in the brain?

A

Nocebo (negative expectations) → brain prefrontal cortex → cholecystokinin (CCK) → midbrain (PAG) = pain increased

100
Q

what is an endorphin?

A

a morphine like chemical which triggers the PAG to quiet pain signals from the body and the amygdala
- Results in feelings of calm and lessening and release of pain

101
Q

what is Naloxone?

A

an endorphin blocking agent helps us observe the cessation of the placebo effect
- Confirmed the analgesic pathway

102
Q

what are the nucleus accumbent involved in?

A

the pleasure pathway for reward in the brain
- triggered by dopamine

103
Q

what does CCK do?

A

heightens the pain signals in the PAG

104
Q

what does Proglomide do?

A

is a CCK blocking agent which allowed us to observe the cessation of the nocebo effect caused by CCK
- why we know this is the hyperalgesic pathway

105
Q

what is the overview for our biological mechanisms (2)

A
  1. Biological mechanisms of placebo and nocebo can be the same (but with opposite activity)
    - One stimulates and one inhibits ⇒ dopamine reward pathway
  2. Biological mechanisms of placebo and nocebo can be different
    - Each expectation using its own pathway ⇒ endorphins and CCK
106
Q

what happened in the dental placebo study?

A

researchers told the patients they would receive morphine, saline, and something that would increase their pain
- Placebo responders were given an endorphin blocker and these patients had a reduced placebo effect from an endorphin blocker which increased pain

107
Q

what is Parkinson’s disease?

A

difficulty with movement and as the disease progresses someone may have a shaky head/limbs due to insufficient dopamine production
- due to the basal ganglia being affected
- dopamine is important for the motor network affecting the basal ganglia

108
Q

what is Parkinson’s disease treated with?

A

apomorphine which acts on dopamine receptors

109
Q

what procedure was used in the Parkinson’s disease study?

A

parkinson’s patients were given a placebo and changes in rigidity of risk and firing of neurons in basal ganglia were recorded

110
Q

what are the results of the Parkinson’s placebo study?

A

Placebo did not produce any changes alone
- If a patient was given the drug apomorphine with the placebo before the test day then there was a placebo response ⇒ stronger the more times the conditioning happened before the test day
- After 4 pairings the placebo response was as high as the drug response

111
Q

what did the Parkinson’s disease placebo study demonstrate?

A

demonstrates classical conditioning of the placebo response
- cannot replace the drug apomorphine but could work as placebo based drug reduction

112
Q

what are the factors of placebo response in clinical settings? (5)

A
  • patient provider relationship
  • expectations
  • previous experiences
  • route of administration
  • increased follow up
113
Q

patient provider relationship in clinical settings

A

warm empathetic provider is more likely to contribute to a placebo response while a cold and distant provider is less likely for the patient to be relaxed and trusting with less of a placebo response

114
Q

expectations of patients in clinical settings

A

when providers show enthusiasm this shapes their expectations toward a placebo response but if they are uncertain or emphasize side affects the patients will more likely have a nocebo response

115
Q

results of previous experiences for patients in clinic settings

A

may produce classical conditioning but if they are positive this increases the placebo response while if it is negative this leads to a nocibo response

116
Q

route of treatment administration in clinical settings

A

the more invasive the greater the response
- Ex: injection > capsule > pill (color matters due to association by culture of the person)

117
Q

increased follow up results in clinical settings

A

associated with a larger placebo response ⇒ rather than a single visit the patient will come back multiple times and receives additional support

118
Q

what are the 2 types of placebo?

A

pure placebos and impure placebos

119
Q

pure placebo vs impure placebo

A

pure is considered to have no known medical effects (like a saline injection or sugar pill) whereas an impure placebo is an active treatment for something but not the condition it is being given in

120
Q
A

Health Psychology (9 decks)

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