Health Psychology Flashcards
What are the two main branches of theories used to explain health related behaviour?
Learning theories - Learning through association
Social Cognition models
What are the 3 main learning theories used to explain health related behaviour?
Classical conditioning. i.e. pavlov’s dogs
Operant conditioning - reward and punishment i.e. skinner’s rats
Social learning theory - learning through watching other people i.e. bandura’s bobo doll
How can learning theories be used to change health related behaviour?
Classical coniditioning - Make new associations between old behaviour and negative effect e.g. disulfiram
Operant conditioning - reward abstinence from negative behaviour
Social learning - use role models exhibiting positive behaviour
What’s a disadvantage of using learning theories to explain health related behaviour?
Only really focus on unconscious behaviours and don’t take thoughts and feelings into account
What are the two social cognition models used to explain health related behaviour?
Health belief model - mostly used around health screenings etc. Takes into account impact of beliefs about health threat and the new health related behaviour, upon the likelihood of taking action
Theory of planned behaviour - Assumes that strongest prediction of behaviour is behavioural intention
How can social cognition models be used to help change health related behaviours?
Health belief model - educate and focus on dangers to health. Help people overcome perceived barriers
Theory of planned behaviour - Make plans to bridge gap between intention and behaviour
What is the stages of change model?
Best way of explaining health related behaviour. Includes different stages of change (pre contemplation, contemplation, preparation, action, relapse and maintenance.
Emphasises that change isn’t linear process which helps if/when patients do relapse - isn’t a failure
What are the two models used for physiological response to stress?
Fight or flight response
General adaptation syndrome model
What changes are seen in the fight or flight response?
Increased secretion of adrenaline
Increased blood pressure, heart and respiratory rate
Activation of HPA axis - cortisol secretion
Increased availability of oxygen and other fuels
Upregulation of immune response which is suppressed in long term stress
What in involved in the general adaptation syndrome?
uses 3 phases and states that long term stress is physiologically damaging
Initial phase of fight or flight
Adaptation phase
Exhaustion phase
What is the stressful life events scale?
Measure of how stressful many different life events are. Used to help explain that both major life events and smaller, daily hassles can impact on stress. Major life events often cause more daily hassles
What is the transactional model of stress?
Model that describes stress as a subjective process.
Demands/stressors and resources available to a person, affect how a person appraises a situation as stressful or not. If resources aren’t sufficient to cope then there is a stress response
What kind of resources are appraised in the transactional model of stress?
personality
social support
coping skills
How are stressful events appraised in the transactional model of stress?
Primary appraisal involves assessing how threatening a stressor is
Secondary apparaisal then asses the resources available
What are some symptoms of stress?
Dizziness, chest pains, breathlessness, GI problems
Anger, irritability, anxiety
Changes in eating and sleeping patterns
How can stress impact on behaviour?
The physiological response can cause physical damage, especially to CVS
Can suppress immune system so increase risk of infections
Maladaptive coping mechanisms can lead to development of unhealthy behaviours
Increase risk of anxiety and depression, leading to negative thinking habits.
Can be signs of learned helplessness so person’s less likely to engage in positive health behaviours and less likely to seek support
What does the attachment theory of child development describe?
Is a biologicall driven process, evolved to keep child close to caregiver for protection.
States that strong attachments are made to very few people early one. Crucial period in first year but strong attachments can still be made in first 4 years. Separation is especially traumatic in first 4 years.
What is the pattern exhibited on separation of child from primary caregiver?
Initial protest. Child may cling to substitute caregiver
Despair. Cries less. Signs of helplessness and withdrawal
Detachment. When carer returns child can appear apathetic
What are the negative effects of prolonged separation of child from primary caregiver?
Less play
Worse sleep
Increased chance of depression/ anxiety
All of these can negatively impact on health
How can knowledge of attachment theory of child development be put to use, clinically?
Allow parental access, home comforts, continuity of staff and attachment objects.
This decreases stress so can help aid recovery of children in long hospital stays
What are the different stages seen in Piaget’s theory of child cognitive development?
Sensori motor 0-2 years - develop body schemata and sense of object permanence
Pre-operational 2-7 years - Learn to use language and symbolic thought. Have ego-centrism and no concept of conservation. Can’t handle complex classification. Don’t know what is and isn’t reversible
Concrete operational 7-12 years - Think logically. difficulty with abstract thought
Formal operational 12+
What is a disadvantage of theory of child cognitive development?
Too focussed on child’s limitations so can limit child’s learning.
What is meant by zone of proximal development?
Gap between what a child can achieve and understand on their own and what they might need help with. Should provide scaffold to bridge this gap.
What is the model of compliance?
Model that identifies key reasons why a patient might not be compliant.
Understanding and memory of treatment instructions can impact on patient satisfaction. Satisfaction, understanding and memory can then all individually impact of compliance.
How can compliance be improved?
By improving communication, information given and the satisfaction of the patient
What is a disadvantage of the model of compliance?
Can be over simplistic as compliance is actually affected by many more factors e.g., nature of treatment, illness itself, patient’s beliefs and social context
What is unintentional non-adherence?
Non-adherence due to capacity and resource limitations, such as lack of understanding or physical limitations
What is the definition of chronic pain?
Pain lasting for longer than 3 months, with no ongoing tissue damage and not eased by medication
What is the gate control theory of pain?
States that pain is a complex process due to complex pathways between the damage and the brain.
Works on the basis that pain messages pass through 2 ‘gates’ or neural relays in the spine and whether these gates are open or closed, impacts on the perception of pain.
So, pain can be amplified or interrupted, depending on factors that open or close these gates.
Factors can be psychological eg anxiety or physical such as medication or physical stimulation
What barriers are there to the recognition of mental health problems?
Lack of symptom disclosure due to fear of judgement or not wanting to complain or fear of stigma or consequences of disclosure
Poor communication so bad patient - doctor relationship.
Doctors may be reluctant to ask about mental health symptoms as they feel it’s not in their remit, lack of time or don’t want patient to feel distressed
What is the aim of CBT?
To help people with cycles of maladaptive thoughts
What techniques are used in CBT?
Mixture of cognitive, so challenging thoughts and belief processes
and Behavioural eg role play and gradual exposure to the feared situation
What are the 5 stages of grief?
Deinal Anger Bargaining Depression Acceptance
What is the SPIKES model for breaking bad news?
Setting - eg privacy, patient at eye level
Patient’s perceptions - so ask what they already know
Invitation from patients to explain everything. Might not want full details
Knowledge and delivery - give a warning shot and give information in small chunks, regularly asking for understanding
Empathy and emotional support
Strategy and summary
What’s the difference between compliance and adherence?
Compliance is authoritarian and is the extent to which the patient acts according to medical advice
Adherence is the extent to which patient behavious coincides with medical advice and is more patient centered
What factors can impact on adherence?
Patient factors such as understanding, such as understanding and beliefs
Illness factors such as symptoms and severity
Medication factors such as preparation, administration, consequence and immediate character
Psychosocial factors such as psychological health, social support and social context
Healthcare factors, such as setting, prescribers, perceived manner, positive behaviours, communication and perceived competence
What illness related factors may patients have to cope with?
Diagnosis Treatment Physical impact Hospitalisation Adjustment Socioeconomic impact
What non-illness factors may patients have to cope with?
Family issues eg bereavement, relationships
Personal problems
Workplace issues
Financial problems
What are the two main coping styles?
Can be emotion focussed to change associated emotion by doing something and changing behaviour, or changing how you think about the problem
May also be problem focussed by either reducing the demands of the situation or expanding the resources available to deal with it
How can medical professionals help with a patient’s coping style?
Increase or mobilise social support
Teach stress management techniques
Increase level of personal control
Prepare patients for stressful events
What can be the benefits of improving coping style?
Improves ability to tolerate and adjust to negative events
Maintains positive self image
Reduces threat
Enhances prospect of recovery
Maintains emotional equilibrium
Enables continuance of satisfying relationships
What can be two problematic responses to chronic illness?
Depression
Anxiety
What unhelpful thinking patterns can arise in sustained anxiety?
Increased recall of threatening memories
Increased vigilance for threats
Interpretation of ambiguous information as threatening
How can psychological distress indirectly affect health?
Associated with worsening of risk factors and health related behaviours
Compromised quality of life
Impact on coping
Poorer self management
What are some problems with recognising psychological problems in patients?
Symptoms may be attributed to illness or treatment
Patient may want to avoid feeling like a burden
Patient may be worried about stigma
Doctor may not want to label the patient
Doctor may feel it’s outside of their role if not a psychiatrist
Why is it important to recognise psychological problems in patients?
Link between mental and physical health
Need to offer help for symptoms
How can psychological problems be managed?
Support in coping
Medication
Counseling and psychological therapies
Recognition, assessment and management
Antidepressants
Low intensity psychological interventions eg for generalised anxiety disorder
High intensity interventions if more severe/persistent
What are some common healing factors of psychotherapeutic approaches?
Emotionally charged, confiding relationship with a helpful person
Healing setting
Rationale explaining symptoms and suggesting a way forward
Ritual requiring active participation from patient and therapist
Combats patients sense of alienation
Inspires patient’s expectation of help
Provides new and different learning experiences
Arouses emotions
Enhances sense of mastery and self-efficacy
Provides opportunities for practices
What are the three different types of psychological therapy?
Type A - Psychological treatment such as reflection as an integral part of mental health care, such as in a GP consultation
Type B - Eclectic mix of psychotherapy and counselling that borrows from various different approaches
Type C - Formal psychotherapies
How effective is CBT in psychosis?
CBT distracts from symptoms and alters abnormal beliefs and perceptions so can be useful in reducing preoccupation with delusions and intensity of beliefs. However, it’s not as useful for dealing with negative symptoms, such as withdrawal
Who is CBT suitable for?
Patients who are keen to be active participants
Patients who can engage collaboratively
Those who can accept a holistic model emphasising thoughts and feelings
Those who can articulate problems and are actively seeking help
What are some limitations of CBT?
Evidence of efficacy is often from homogeneous populations with few comorbidities
Carried out by expert practitioners so not feasible in routine practice
Restricted benefits when problems are complex and diffuse
What is the purpose of analytic therapy?
To allow unconscious conflicts to be re-enacted and interpreted withing the patient-therapist relationship
How does focal therapy work?
Involves ID conflicts that arise in early life to be reenacted and resolved, with the patient-therapist relationship being the main vehicle for change
When is psycholanalytic therapy used?
For people with interpersonal difficulties and personality problems
For people with a capacity to tolerate mental pain
For people with an interest in self-exploration
What are some disadvantages of psychoanalytic therapy?
May be too painful and relationship may be too intense
Less focused than CBT
Quite subjective
Relies on constructs that are difficult to measure
What is systemic therapy?
Any therapy involving more than one person, most commonly family therapy with the child being the symptom bearer of a familial problem
What is involved in humanistic/client centered therapy?
General counselling skills such as warmth, empathy and unconditional positive regard
What is involved in a negative cognitive triad?
Negative view of self
Negative view of outside world
Negative view of the future
In terms of sexuality, what’s the difference between identity and behaviour?
Identity refers to what a person thinks about themselves and how they feel, whereas behaviour refers to what people actually do.
What can be done by healthcare professionals to improve the LGBT healthcare experience?
Don’t pathologise or moralise
Validate and affirm a patient’s identity, rather than just being neutral
Trans people are protected by law from exposure of their identity
Don’t ‘out’ them without their consent
Distinguish between a patient’s problems and their identity
Respect patient’s lifestyle and identity and don’t show inappropriate interest
Be knowledgable
What’s the difference between a person’s gender identity and a person’s gender role?
A person’s gender identity is someone’s internal perception and experience of their gender, whereas their gender role is how the person lives within society and interacts with others
What is meant by ‘transgender’?
Umbrella term for those whose gender identity and/or gender expression differs from their birth sex
What is the difference between transsexual, transvestite and gender queer?
Transsexual is someone that wants to transition and fulfil their life as a member of the opposite sex.
Transvestite is someone that doesn’t want to change anatomically
Gender queer is someone with know strict gender identity.
How can discrimination impact on health?
Increased stress levels long terms negatively impacts health
Low self esteem means less likely to carry out good self care
Isolation means less likely to access healthcare and may be poorer living conditions
Being within a subculture means higher levels of drugs, alcohol and smoking
Distrust of authorities means may not access healthcare
Discriminatory healthcare system can affect access
What is meant by heterosexism?
Assumption that heterosexuality in the only normal and valid form of sexuality. Assumes that everyone is straight and acts accordingly
What is a stereotype?
A limiting generalisation about a group of people
What is meant by healthy life expectancy?
How long a person can expect to live in good health
What are some physical symptoms of bereavement?
Palpitations Fatigue Digestive symptoms Shortness of breath Reduced immune functions
What are some behavioural symptoms of bereavement?
Irritability
Insomnia
Crying
Social withdrawal
What are some emotional symptoms of bereavement?
Depression Anxiety Anger Loneliness Guilt
What are some cognitive symptoms of bereavement?
Lack of concentration Hallucinations Memory loss Preoccupation Hopelessness Disturbance of identity
What are some risk factors for chronic grief?
Prior bereavement Poor mental health Type of loss Stress from other crises Lack of social support
When may complications arise in the grief process?
If expression of grief is discouraged
If ending of grief is discouraged
What is sexual dysfunction?
Disturbance in sexual desire and in the psychophysiological changes that characterise the sexual response cycle. Cause marked distress and interpersonal difficulty
What are some important aspects to be covered in a history discussing sexual problems?
Detailed description of the problem Behavioural, cognitive and affective functioning Relevant past relationships Relationship with partner Past medical history and drug use Mental health history Family and psychosexual history Significant life events Sexuality Cultural aspects Coping mechanisms and support networks
What can medical professionals consider to improve histories covering sexual problems?
Express empathy and reassurance Don't show embarrassment Stigma Cultural and religious issues Privacy and confidentiality Use open and specific questions Avoid labels, judgements and assumptions Avoid terminology Interview partner if possible
What is involved in psychosexual therapy?
Educative counselling
Modification of attitudes and beliefs
Facilitation of communication and assertiveness
Specific directions for sexual behaviour
What are some physical treatments available for male sexual dysfunction?
Oral therapy of viagra, testosterone or SSRIs
Local therapy of EMLA cream. As well as SSRIs, used to reduce sensation to help with premature ejaculation
Self injection therapy to stimulate erection
Mechanical therapy, eg pumps to increase blood flow or rings to maintain erection
What are some physical treatments available for female sexual dysfunction?
Testosterone
Lubricants
Oestrogens
Clitoral therapy device or zestra gel stimulate blood flow to clitoris to increase arousal
Why is it important that patients are always told about bad news?
To promote trust Reduces uncertainty Allows adjustment Prevents unrealistic expectations Promotes open communication
In terms of breaking bad news, what does the amount of information given to the patient depend on?
Patient’s needs, wishes and priorities.
Patient’s level of knowledge and understanding
Nature of condition
Complexity of treatment
Nature and risks associated with treatment
Why is it important to consider diversity within healthcare?
Increasing diversity of populations
Impacts on legislative frameworks
Impact on differential outcomes
May be disparities in care accessed or beyond the point of access
Increasing evidence that taking a patient centered approach improves outcomes
What problems can arise in relation to diversity in healthcare?
Lack of knowledge can lead to inability to recognise differences
Self protection and denial leading to an attitude that differences aren’t significant
Fear of the unknown can be intimidating and may not fit into person’s world view
Feeling of pressure from time constraints can mean doctor is unable to look into patient’s needs in sufficient depth
What problems can lack of appreciation and knowledge of diversity cause?
Affects patient-provider relationship if understanding of expectations is missed
Miscommunication
Non-compliance
Misunderstanding of patient’s perspective
Rejection of healthcare provider
Conflict/isolation within staff groups
How can culture affect how/when people present?
Perception of mental health problems
Methods of dealing with certain symptoms and behaviours
Views of services and if they accept these services
Acceptance of treatment and management strategies
Visibility and accessibility and experience of services
How can culture cause problems for young people?
Pressures to conform to religion or other practice
Pressure to conform to expected gender roles
Pressure to conform to social norms
Pressure to conform to familial expectations
Sexual orientation
Forced marriages
Difficulty in reconciling culture in private and public domains
What are some signs of insecure attachements?
Avoidant - Little response to caregiver leaving or returning
Ambivalent - Clingy/distress on leaving and difficult to comfort on return
Disorganised - Difficulty coping on return. May indicate maltreatment
What factors can predict a secure child-carer attachment?
Carer sensitive to child's signals Rapid, appropriate, consistent responses Interactive synchrony with carer Carer has high self esteem Carer accepts their role
What are some behavioural signs exhibited if a child’s primary care giver role isn’t filled?
Separation anxiety Increased aggression Bed wetting Detachment Clinging behaviour
What are some physical signs exhibited if a child’s primary care giver role isn’t filled?
Depression Slower movement Less play Less sleep and less REM sleep Reduced heart rate Reduced body temperature
Why is distress on separation most overt in children aged 6 months - 3 years?
Can’t ‘see’ carer in their mind
Limited language so difficult to grasp concept of time and return
Lack ability to understand abstract concepts
May view separation as punishment
What are some implications for separation problems in children in healthcare?
May impede adherence
Stress has adverse health effects
Worsened experience of pain due to high anxiety levels
What are some criticisms of attachment theory?
Too simplistic
Overly focused on mums with role of Dad being marginalised
Multiple attachment figures may be formed
Quality of substitute care is not considered
How does cognitive development of children affect their treatment?
Practitioners shouldn’t assume an average ability. Individual level of understanding should be assessed as well as zone of proximal development and tailer communication accordingly.
Young children may assume others know how they feel as they lack theory of mind
Difficult for children to articulate feelings, especially if language is still developing
Can’t always think in abstract or metaphors so communication should be kept abstract
Children can have difficulty comprehending the future which has implications for consent and adherence
