Health Psychology 2301 Flashcards
World Health Organization definition of Health
state of complete physical, mental and social well‐being
Note: not just the absence of illness
Infectious Disease
bacteria or viuses in the body
Early Culture (3)
- Magic/Supernatural: linked to bad “spiritual health”
- undo spell
- magical sucking
- scare demon out (trephination- bore hole skull)
- ceremony coax skull back
- Greece: visit temples to be cured
- Hippocrates: Humoral Theory (excess of either blood, black or yellow bile or phlegm led to disease) plus imbalance was due to “personality”
Galen / Plato
Galen:
- illness can be localized / different diseases have different effects
Plato:
- Mind has no relationship to health, separate entities
Middle Ages and the influence of Church (4)
- Illness was God’s punishment for evildoing
- Only God can cure you / priest as physician
- NO autopsies as the body was considered as sacred
- pilgrammages to cure illnesses (stops on way to house sick were “hospices” thus “hospital” origin
*
Renaissance - Da Vinci (2) and Descartes
- more human centered than God centered
- autopsies now ALLOWED
- Da Vinci’s anatomical drawings
- Cauterization - amputate to save lives
Descartes:
- body as machine (pain pathway)
- mind and body communicate through pineal gland
- soul leaves at death
Biomedical Model (2)
All diseases or physical disorders are caused by disturbances in physiological processes
- psych. and social processes- independent of diseases
- New definition of health: “Freedom from disease, pain or defect” so…if not sick, must be in good health
Illness today versus past
Early centuries:
- illness due to disease
- “person” not a part of it
Today:
- chronic disease and injury (living longer, more exposure to stress / chemicals)
- can vary with each person
- people are more aware of the signs and symptoms
- able to find health care and better diagnostics
Definition Risk Factor
Characteristics or conditions associated with the development of a disease or injury
Breslow’s Correlational Study
7 apsects of lifestyle:
- Health got better as lifestyle improved (as # of HB increased)
- Age not a determinent
Conclusion: behaviour matters
Health Care Models (5)
- Psychosomatic medicine
- Behavioural Medicine
- Health Psychology: behaviour, perception, lifestyle, cognition
- Biopsychosocial
- Biomedical
Psychosomatic Medicine (3)
- symptoms or illnesses caused / aggravated by psychological factors
-
Freud: psychoanalyatic theory: some symptoms are converted from repressed emotional conflict)
- patient converts the conflict into symptom
- anxiety decreases as no long repressed
-
Canon:
- stomach affected by emotional state
- stress affects autonomic nervous system
- Fight or Flight response (devp)
- Today: moe than just conflict/stress/type to cause illness - variety factors
Classical / Operant Conditioning
- Classical: (Pavlov) 2 stimuli repeatedly paired, response elicited by 2nd stimulus (potent) eventually elicited by 1st (neutral)
-
Operant: behaiour changes due to consequences
- reinforcement: strengthens behaviour
- punishment: suppresses behaviour
Biopsychosocial Perspective
- Biological factors: genetics / strucutre & function body
- Psych. factors: cognition, emotion, motivation
- Social factors; social world, community, mass media
All above are interrelated - holistic perspective, human body is dynamic entity with components that are interrelated and we interrelate with society, family, community
Health Psychology (4)
- promote and maintain health
- prevent and treat illness
- identify causes and correlates of health, illness and related dysfunction
- analyze and improve health care systems and improve policy
6 terms used by Epidemiology
- Mortality - death (generally large scale)
- Morbidity - illness, injury or disability
- Prevalence - # cases of disease or ppl at risk
- Incidence - # NEW cases reported in spec. period
- Epidemic - incidence has rapidly increased
- Pandemic - epidemic that has increased to international or worldwide proportions
Sociocultural Perspectives (2)
Sociocultural differences:
- ethnic or income variations that impact on health
- health belief and behaviour: e.g. yin/yang (imbalance leads to bad health), inuit and view of cancer (sickness which cannot be fixed)
Non-experimental research
- Quasi-experimental: good when can’t randomly assign groups or manipulate independent variables
- Correlational: relationship between variables
- Experimental: controlled study in which researchers manipulate an independent variable to study its effect on a dependent variable
- usually experimental, control and placebo groups
Correlational Study (4)
- non-experimental investigation of the degree and direction of statstical association between two variables.
- can help predict risk factors for health problems
Cause and Effect Conclusion
Need:
- levels of independent and dependent variables corresponded together
- cause precedes the effect
- all other plausible causes have been ruled out
Retrospective / Prospective
-
Retrospective: look back at the history of subjects to find commonalities that may suggest why they developed (or not) a disease
- caveat: relying on ppl’s memories
- Prospective: look forward to see if differences in a variable at one point in time are related to a difference in the variable at a later date
Developmental Approach
- Cross section: diff people of diff ages observed at same time
- Longitudinal: repeated observation of SAME person or ppl over long period of time
- Cohort effect: influence of having been born and raised at different times
- Single subject approach: case study (best for unusual medical or psych problem)
Genetics research
e.g. twin and adoption studies
- heredity affects physiological functions (eg BP)
- genetic disorders can produce high levels of cholesterol in blood - at risk CHD
- heredity impacts early/ later it’s lifestyle
- environmental factors stronger than heredity re cancer
- molecular genetics - identify genes that affect addictive behaviour, high cholest. etc.
Exampes genetic abnormalites
-
Sickle-cell anemia:
- mostly ppl African and Caribbean
- cells that are low oxygen clump together, can’t fit thru capilleries
- vital organs don’t get enough oxygen
- tissue damage, organ failure
-
Phenylketonuria (PKU)
- more for white ppl
- baby’s body fails to produce enzyme needed to metabolize Phenylalanine
- toxic acid builds up, causes brain damage
Stress - definition
transactions that lead a person to perceive a discrepancy between the physical and psychological demands of a situation and the resources of his biological, psychological or social system
(demand, resource or discrepancy can be real OR simply believed to exist)
Environmental Stressor
any environmental demand that creates a state of tension or threat (stress) and requires change or adaptation (adjustment).
Conflict
approach/approach - simultaneous attraction to two appealing possibilities, neither of which has any negative qualities.
avoidance/avoidance - facing a choice between two undesirable possibilities, neither of which has any positive qualities.
approach/avoidance - being simultaneously attracted to and repelled by the same goal
Chronic vs Acute Stress
Acute: short lived (e.g. writing an exam)
Chronic: ongoing conflict, illness
e.g. work - stressful job (no control or decision-making, heavy workload)
where you live: low SES and health can have a direct relationship (safety concerns, poor housing or hygiene, stress between neighbors)
Nervous System - definition
- Controls the way we initiate behavioiur and respond to events
- Stores information, allows us to think, reason and create
Myelin Sheath
- increases speed of nerve impulses
- prevents interference from adjacent nerve impulses
- degenerates and nerves can become severed
- developes top to bottom
- poor nutrition can retard myelin growth
Forebrain (5)
(anything covered if wearing a helmet)
Cerebrum (sensory / motor)
Limbic System (emotion)
Thalamus - relay sensory & motor info to cortex
Hypothalamus - adjustments (homeostasis - will see what’s off and send hormone or NT to fix it)
Cerebellum - balance, coordination
Diencephalon
Thalamus and Hypothalamus
- Thalamus: chief relay station for directing sensory messages to cortex and commands to skeletal muscles from motor cortex
-
Hypothalamus: emotion / motivation
- eating, drinking, sexual activity
- maintain homeostasis in body
- feedback system: receptor (sensory nerve cell that monitors changes in condition)/control centre/effector
- directs either NT or Hormone release or both
Effectors
impulses carried to glands, muscles and organs and target cells to adjust to controlled condition
NT communicate needed adjustment
Hormones in blood act on target cells
Positive feedback can ONLY be stopped from outside
(i.e. give birth)
Cerebellum
Back brain, below cerebrum
cerebrum initiates action, cerebellum coordinates it
Brain Stem
- Midbrain - below Thalamus, gets info and relays to Thalamus
- Reticular Activating System - attention, arousal, sleep
- Pons - facial expression, chewing
- Medulla - vital signs
Spinal cord carries messages (efferent, afferent)
Spinal Cord
Neurons to and from the brain
efferent / afferent
Peripheral Nervous System
Somatic / Autonomic
- Somatic - skin, skeletal
- Autonomic - organs
- Sympathetic - Fight or Flight
- Parasympathetic - Rest and Digest
Sympathetic NS
- anything perceived as possble threat & hypothalamus will trigger release epinephrine and norepin (Walter Canon)
- also platelets aggregate and adhere to inhibit loss of blood (clotting) in case we get cut
- decrease of blood flow from skin
- increase blood sugar or energy
Parasympathetic
- Antagonistically to the sympathetic
- (restores body to normal)
- slows breathing, decrease HR, lower BP
Endocrine System
(part of the Flight or Fight)
- Hormone system / Glands
- Uses blood stream to transmit hormones
- hypothalamus helps out here too
- slower than the symp.NS response, catches up
- Cortisol (stress hormone)
- Glucocorticoids to keep blood sugar up
- Mineral corticoids to mobilize the immune response
- Endocrine and N.S. connected by link from hypoth.(NT) to pituitary (hormone) then can stimulate other glands (more chemicals)
- Long term: can supress and begin to fail
How does Hypothalamus work
Activates BOTH NS and Endocrine systems
NS - send nerve impulse to the Adrenal Medulla to release epinephrine and norepinephrine (NT’s) - SAM axis (Sympath. to Adrenal Medulla)
Endocrine: signals the Pituitary which then signals the Adrenal Cortex to release cortisols - HPA axis
Hypothalamus to Pituitary to Adrenal Cortex
Primary Appraisal (3)
3 possibilites
- Good (benign, positive) - can increase well-being
- Irrelevant - no implication for well-being
- Stressful - potentially harmful
If Stressful go on to 3 more (secondary) appraisals:
Secondary Appraisal
Assesses the resources available to cope (transactional) - change as you move through it
Coping: cognitive, emotional and behavioral efforts to manage the stress / event
a) Harm / loss - damage already occured
b) Threat - expectation of future harm
c) Challenge - opportunity to grow, master or profit
Cope: no stress OR Coping not good = stress
Selye’s General Adaptation Syndrome (GAS)
(for prolonged stress)
- SAM: alarm stage (says: MOBILIZE)
- epinephrine and norepinephrine
- HPA trigger for cortisol
- Resistance - HPA predominates (body will then replenish hormones adrenals release)
- Exhaustion - severe, long term or repeated stress
- disease, damage organs, death
- Criticisms: some stressors elicit stronger emotional response than others; cognitive appraisal plays role; we mediate stress response using our brains and find ways to cope (mice can’t)
Allostatic Load
Allostatic load is “the wear and tear on the body” that accumulates as an individual is exposed to repeated or chronic stress.
- Frequency of exposure
- Duration exposed for
- Magnitude of the stress
- Magnitude of the reactivity - response to stressor
- Rate of recovery - ruminating will delay recovery; sleep will help
Habituation?
Physiological Habituation:
- magnitude of stress response decreased with repeated exposure to the stimulus
Cognition as a source of stress
- can be stressed even without exposure to stressor (imagine what could go wrong)
- anticipation can be as stressful as the event
- planning, inventing and reason - lead to stress
- worry / rumination - stressor
- negative impact on decision making (cuz stressed)
How do we appraise events as stressful? (3)
- Personal Factors:
-
self esteem / self efficacy
- whether webelieve we have resources
- see as threat? challenge?
-
motivation
- if an important goal is threatened (need A+)
-
Irrational Belief?
- can be an irrational belief that increases stress (I must be perfect)
Measuring Stress
-
Physiological Arousal:
- BP, respiration, HR, persperation
- biochem analysis (blood, urine, saliva)
- quantifiable, objective
- neg: expensive and measurement stressful
-
Life Events (rate how you adjust)
- can be ambiguous depending on question
- e.g. change in $ situation (more $? less $?)
- Daily Hassles - minor annoyances - if cumulative or continual can lead to poor health (depends on your appraisal) + might put X over edge or cope with unhealthy behaviors (poor diet, no gym, etc.)
Stress as Positive
- Need some stress to function at an optimal level of arousal (energized, some adrenalin), focused
- also builds resilience and coping skills
Social Support
- Social Support
-
Emotional
- empathy, understanding, caring, ecouragem.
- feel validated, valued
-
Tangible / Instrumental
- money, stuff, help,
-
Informational
- information, insight, advice (doc, nurse)
- Perceived Social Support - know you have a social network you can rely on whether you use it or not
Phobia / Anxiety
- Phobia: intense and irrational fear directly associated with specific events and situations
- Anxiety: uneasiness or apprehension of impending doom (uncertain/unspecified threat)
- If severe depression/sadness lasts MORE than 2 weeks: Disorder
Gender and Stress
- Women: more reactivity when freindship or love challenged; more “tend and befriend”
- Men: more reactivity if comptence challenged; more fight or flight
Family and Stress
- Can be source of tension and conflict
- addition to family
- divorce
- family illness/disability/death
- child with chronic illness
- sick parent
Jobs and Stress (7)
- demands of the task (workload)
- responsible for peoples’ lives (medical personnel)
- environment - noise, temperature,lighting
- perceived insufficient control: can’t make decisions
- poor interpersonal relationships
- perceived inadequte recognition or advancement
- job loss or insecurity
Can all spill over into family (stress spillover) and if effects another person (stress crossover)
Environmental Stress (7)
- constant threat of violence or harm
- hazardous chemical seepage into water supply
- natural disasters
- wealth vs poverty in neighborhood (low SES has reduced life expectancy and higher risk disease)
- stressful social relationships - less supportive
- Rural areas - more stress if no accessible health services
- low SES can be discriminated against - more stress
Social Adjustment Rating Scale
- How well we adjust per life event
- Look at past 24 months and sum up for total score
- used to relate stress to illness (but not strong as stress not always reason ppl get sick)
- items can be very vague/ambiguous
- no distinction between desireable and undesireable events
- measures only acute and not chronic stress
- depends on accurate recall
Who does not get social support?
- some people don’t get the kind support they need
- trouble getting the support or asking for it
- can be a difficult person to support
- might worry you are a burden on others
- provider might be tapped out (can’t provide support)
So: if have big social circle with intimate connections it’s better and more likely to get support
Sociocultural Differences re support
Socio: native born Canadians more support than immigrents (smaller network, less family here, might use them less); smaller communities have better support (know everyone)
Technology and Social Support
Positives:
- can get it quicker (texting)
- can get informational support online
- having “close others” to text daily may reduce impact of stress
Negatives:
- can waver according to social media (“likes”)
- if “too available” can be distracting
- can become dependent - don’t do things on own
- found correlational but not causal link that allostatic load decreases
Acute Stressful Situation Study
Acute stressful situation study:
- measured the SAM and HPA responses to stress
- lower response when supportive companion present
- can keep HR, BP and stress-related hormones low
- (dogs therapy dogs great)
Longitudinal Study re SS and increased health
4700 person study of social support; 9 year follow-up, all ages
found: lower mortality rate, lower cancer incidences, and heart disease (measured SS before then health outcome later)
found: low SS and death link; risk factor was on par with smoking and sedentary lifestyle
Loneliness: public health issue (screen ppl for social connectedness?)
Buffering Hypothesis
Social support affects health: protects person against the negative affects of stress
Why?
- may be less likely to appraise event as stressor
- may modify after initial appraisal (secondary appraisal)
Direct Effect Hypothesis
Social support benefits health and well being regardless of the amount of stress people experience
i.e.: belongingness / self esteem are good all the time
NOT all SS beneficial to health (7)
- wrong kind of support - get adivce, need validation
- insufficient
- might not want help
- personal cost - feel guilty that needed $ or physical help and could not handle it
- impact self-esteem - makes us feel stupid, can be controlling or overly directive
- “dense” - family in your business, want privacy
- overprotective - too much, create helplessness
Personal Control / Self -efficacy
can make decisions and take effective action to produce desirable outcomes and avoid undesirable ones
(experiment in seniors homes re plants and furniture of level of independent choice and caring for things)
- High PC - happier, more alert, more active
- prolonged stress can lead to learned helplessness when have Los PC
Self Efficacy
can succeed at an activity if we want to
- decide activiy based on
- outcome expectancy - behaviour properly carried out would lead to favorable outcome
- self-efficacy expectancy - can perform behaviour properly
- Ppl with strong self-efficacy may have less stress (physiological, mental) as know can meet demands
- make judgement based on prior successes and failures
Learned Helplessness (3)
- more likely to say that can’t fix it
- think thing will be forever like that
- will affect whole life, not just part
Type A Personality and Stress (5)
Type A
- Competitive / Achievement oriented
- even when no competition
- Time urgency - never enough time/ “running” all day
- Impatient - anthing that gets in way is problematic
- Vigorous vocal style - rapid, emphatic, gestures, dominant
- Anger / Hostility - quick to anger, more likely to perceive situations as threatening
- Measured in interview setting (manipulated)
Cardiovascular System Reactivity and Illness
- physiological changes in heart, blood vessels, blood
- vascular changes, platelets, cholestorol, high inflammatory substances - artherosclerosis
- link to CHD, hypertension and stroke
- different than exercise when heart is asking to receive more oxygen
- increase in HR and BP are excessive - well beyond what need (goes to F or Fl levels)
Endocrine overactivity
- wear and tear
- if always releasing glucose into bloodstream to give body eneregy for F or Fl can develop diabetes
- impair immune system (always in resistence state)
- cortisol study: amt. of cortisol in urine predicted risk of dying of CHD or stroke or heart attack
Adrenal Glands
- Top Kidneys
-
release hormones in response to emergency/stress
- epin. and norepin. (adrenalin)
- cortisol - reduce swelling
- works with Sympath. N.S. to speed up HR, respiration and liver’s sugar output
Immune reactivity and illness
- release of epinephrine, norepinephrine during arousal and looking for pathogens to destroy
- emotions (pessimism, depression, stress impair immune)
- brief stressor: activate immune system
- chronic stress: suppresses immune system and inflammation - body less sensitive to anti-inflammatory effects of cortisol
- Study: a) how well antibodies replenish themselves b) how well T cells working to kill antigens c) how well respond to flu vaccine
Antigen
substance that triggers an immune response
(bacteria, virus)
Lymphatic organs
Develop and deploy lymphocytes (white blood cell soldiers of defense)
White Blood Cells
Lymphocytes and Phagocytes
Phagocyte will respond to ANY antigen
Lymphocytes attack SPECIFIC antigens
Autoimmune Diseases
Immune response directed at body part it should protect
Rheumatoid arthritis, MS, Lupus
Common Cold Study
- reported social ties, SS system
- Those with larger social groups were less likely to develop a severe cold
- immune system less likely to be suppressed
Emotional Disclosure Study
- 2 groups to write about traumatic or trivial even
- Trauma group - more upset right away but 6 months later had fewer visits to clinics for health issues
- So: more we express better for immune system
Kelly McGonagal Video on Stress
Changing your mind about stress can change your body’s reaction to the stressor
- one group told to view their stress response to stressor as helpful for challenge - those who did were les stressed and anxious; blood vessels did not constrict
- What you think about stress matters
- need to get “better” at stress
Coping
The process by which people try to manage the perceived discrepancy between the demands and resources they appraise in a stressful situation
- in response to the secondary appraisal
- We cope to: manage how we think, calm our emotional reaction or do things to change the stressor itself
- not a personality trait as not stable over time
Emotional focused coping (4)
- Emotional focused coping - not much we can do about it so we manage our emotions about it
- distract ourselves
- get our SS to manage it
- change way we think about it - redefine
- deny / avoid
- can interfere with getting medical treatment
- low SES use this more
Relationship or Dyadic coping: bolster each other’s emotional needs
Emotional Focus Coping continued
- Engage positive emotions: not all stressors are bad, infuse good into situation (AIDS caretaker case)
- Find benefit or meaning - e.g. everything happens for reason, tested by God, etc., positive significance
- Accommodate to it - carry on, take personal control
- Engage in an emotional approach - actively process it and express it (Breast cancer case - those who vocalized 3 mos after procedure had better perception of health; those who overprocessed or ruminated had more distress)
Problem Focused Coping
Reduce the demands of the stuation or expand resources
- not available to everyone (need time, sometimes $, good health, education, etc.)
- if low SES or disadvanted might not apply
- simultaneous stressors lead to fewer resources (tapped out)
How to know you are coping successfully?
- Psychological distress decreases (depression, anxiety)
- Physiological arousal decreased (sleeping good, breathing relaxed, lower BP)
- Return to pre-stress activities - getting on with it
- Stress reaction is gone or less
Possible explanation for Exercise and Coping
- can be a placebo effect - think you are less stressed
- people with less stress more likely to exercise
- exercise causes people to feel less stress (there is evidence!
showed reduced BP and HR for those who exercised
People who exercise still have stress but it impacts them less
Stress Management Program
program of behavioural and cognitive techniques that is designed to reduce psychological and physical reactions to stress
- Pharmacological - benzodiazepines (xanax, valium)
- Relaxation - progressive relaxation
- Mindfulness
- Meditation
- Massage
- Hypnosis
Mindfulness
- Attention: more present, less going on to be stressed about, not worrying about past regrets or future worries - in the present
- Awareness: experience events from a place of curiosity, openness, and acceptance regardless of desireability
Reduces BP, enhances immune system
Self Compassion
- release of oxytocin
- say kind things to ourselves
- have to learn to be good to yourself
Biofeedback
- electromechanical device monitors physiological prcesses (HR, muscle tension)
- info feeds back to participant
- person can learn to control the processes
Thinking errors and cognitive reframing
- Event is a stimulus - leads to negative thought
- Catastrophize or cognitively distort the event
- need to reframe the even as neutral or positive
CBT can help to think of things in a more helpful way to experience less stress
cognitive - change thoughts / feelings
behavior - help ppl interact in world in better way through operant and classical conditioning
Exposure Therapy
- good for reducing fear / anxiety
- calm resonse to replace fear response
- use graded sequence to fear stimulus
- use some real life stimulus and some imagined (work up to the real things)
Cook Medley Hostility Scale
measures negative traits
Angry, hostile ppl experience more conflictwith others at home and work, likely have less SS and:
- don’t respond to SS with reduced physiological reactivity
- sleep more likely to suffer during stress
- often related to obesity and drinking and smoking
- social dominance as risk factor
3 Types Health Behaviour
Well Behaviour
Symptom-based Behaviour
Sick-role Behaviour
Well Behaviour
- activity or behaviour undertaken to maintain or improve current health and avoid illness
- nutrition, exercise, brush and floss, seatbelt
- Don’t often do them when you are well because you don’t have a “threat” to motivate you
Symptom-based Behaviour
- do this to find out the problem and find a remedy
- find way to reduce or eliminate symptoms
- seek help or advice
- complain
- may not do it if you are either not concerned (think it will pass) or scared of what you might find out OR have no money for care
Sick-role Behaviour
- treat or adjust to a health problem after deciding that you are ill
- Learned behaviour: how you display the behaviour will depend on what you observed when you were young (i.e. if babied by parents) vs (suck it up)
- can use it to get out of obligations and life tasks
- example: going to doctor
- getting prescription and filling it
- differernt cultures respond differently
Belloc and Breslow Longitudinal Study
- more HB practised the fewer the illnesses and disabilities
- 9-12 years later, regardless of age, #HB directly related to mortality
- Health Behaviours especially important for men
Health Behaviours NOT strongly linked
- people fluctuate wrt behaviours
- if engage in one HB not necessarily engaging in all HB and each person is different
Why
- reasons we do them are different for each type of HB
- Reasons change over time (teen vs adult)
- Changes can reflect learning about harms
Primary Prevention Strategy
- used to avoid illness or injury
- getting kids immunized
- eating well, exercising, not smoking
- yearly physical
- docs giving health promotion material
- many illnesses are preventable (cancer, CHD, accidents - can do things to prevent these
- CHD: High BP or cholest, diabetes, obesity, alcohol abuse, inactivity, smoking, stress
Secondary Prevention Strategy
-
actions taken to identify and treat an illness or injury with the aim of stopping or reversing the problem
- symptom-based behav of complaining
- get prescription and take meds
Tertiary Prevention
-
Can’t reverse or stop illness so try and cope with it or slow the progression
- arthritis: manage symptoms to reduce amount of disability
- Lease cost effective of the 3 approaches
- $$ for meds, treatments
Problem in Promoting Wellness
Factor Within Person (4)
-
People who think they are healthy will not have the incentive to change behaviours
- may have to change longstanding behaviours and even possibly addictions
- need cognitive resources to know what to do or will create obstacles
- need self-efficacy or motivation will be impaired “I can do it”
- being sick can affect mood and energy level and can slide back (stress, low energy, work)
- some people will try to set limits (middle ground) but some go with what feels good at time
Interpersonal reasons/problem wellness promotion
- can be affected by partner’s habits (if you are trying to eat well and they eat poorly)
- in family, one person’s unhelathy behaviour in house can affect others - might not have control over food cooked, or others don’t care about your goal
- workplace: someone brings in donuts every day
- Community: may not be enough money to fund promotional programs (e.g. to fund a smoking cessation program)
Learning For HB
Learning
- reinforcement -likely to repeat
- extinction-without reinf. response weakens
- punishment
- modelling - see behaviour (ie parents made salad every night, exercised)
Anything you give after the behaviour (reinforcement) will increase the likelihood they will do it again (even if take reward away)
Unrealistic Optimism
- do mind tricks to justify a behaviour
- unrealistic about the risk of developing illnesses
- (less optimistic if alreay sick)
- Note: if unrealistically optimistic less likely to take preventative action
Health Belief Model (2)
(hint: good to decrease risk AIDS and for dental care)
Likelihood that a person will take preventive action depends directly on the ourcome of two assessments:
- Perceived threat: a) perceived seriousness of the problem - more severe, will engage in HB b) perceived susceptibility (more susceptible, more likely to engage - mad cow example) c) cues to action - things around will help (sign: free flu shot)
-
Pros and Cons
- benefits - reduced risk of being healthier - time off to go to doc, office far, etc.
- barriers - cost in taking action
Example of Health Belief Model - KNOW THIS
Perceived Susceptibility: Youth believe can get STIs or HIV or create a pregnancy.
Perceived Severity:Youth believe consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.
Cues to Action:Youth receive reminder cues for action in the form of incentives (reminder messages (such as messages in the school newsletter).
Perceived Benefits:Youth believe recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.
Perceived Barriers:Youth identify their personal barriers to using condoms (limit the feeling, too embarrassed to talk to partner about it) and explore ways to eliminate or reduce barriers (i.e., practice condom communication skills to decrease their embarrassment level).
Planned Behaviour Model
Need behavioural intention (i.e. to be able to predict whether person actually intends to engage in behaviour
- Attitude re action: if they see the action (ie quitting smoking) as negative or positive (if positive, so of value, more likely to have intention
- Social Norm: if social group agrees with behaviour and supports it more likely to have intention
- Know what to do / have a plan / capable of it (high self-efficacy)
Good predictive Model
Stages of Change Model
- good for addicion counselling
- move people along based on how ready they are to engage in the health behaviour
- 5 stages of readiness
- approach depends on the stage they are at
5 Stages / Stages of Change Model
- pre-contemplation: not usually there of your own accord (mandated or family intervention)
- Contemplation: starting to think about it so best to focus on benefits re treatment
- Preparation: will do it (ready), plan to do the change soon, might have (eg) quit smoking by half but not for good yet
- Action (change made) - usually over 6 month span
- Maintenance - work to maintain the specific behavioural change
Less Rational Processes
Not true that people will always weigh pros and cons and look at things rationally:
- e.g.: use biased cognitive processes to justify making decisions / mind trickery
- sexual intimcy no condom: think if someone is good looking they are less likely to have an STI
- Grandma lived till 90’s and smoked so no need quit
- Vaccines can lead to Autism - don’t vaccinate kids
Providing Information
- WHO: enabling people or supporting then to increase their control over improving their health
- theory: if give general public info they will do the behaviours (not necess. the case)
- NOT great at making people change unless massive blitz/constant exposure (smoking/seatbelt)
- colorful better / vivid / trustworthy communicator
- short / clear / direct - too much small print bad
- fear messaging: yes, but if too scared will distance themselves
- a) emphasize consequences of not engaging in HB b) personal testimonials c) provide specific instructions d) bolster confidene “You can do it!”
Motivational Interviewing
- Great when used with Stages of Change model because at each stage have to motivate person to get them to next stage of readiness
- helps people resove ambivelence
- Decisional Balance: help people understand their level of risk and associated consequences (perceived susceptibility)
- walk them through barriers to identify them and brainstorm them to overcome them plus can then help them plan - esp. addictions
Behavioural re specific behav. / BEFORE
-
triggers: manage antecedents (former experiences that trigger us) - what comes BEFORE behaviour
- self-observation- how feel afternoon re energy
- monitoring - what happen right before you eat donut? (bad sleep so tired, no gym, bad mood)
- Stimulus control: get better sleep, go to gym, etc.
- linked pairs: cig/coffee, mood/carb loading
- remove the stimulus for while or replace it
- will get clues as to what you need to change (triggers)
Broad Spectrum CBT
- Combine different techniques to be able to tailor the treatmeny to the person’s spcific problem
Relapse Prevention (3)
- biggest problem in health habit modification
- biopsychosocial factors:
- bio: family history, genetic vulnerability/withdrawl symptoms from addiction
- psych: negative emotion - common re relapse
- social: conflict - common re relapse
Relapse Violation Effect
- override something that is naturally happening in the body e.g. body hungry but deny it food
- do not listen when body hungry, try to cognitively control when to eat, structured, rules
- lots of work, vigilence
- if bad mood or fight or alcohol (reduces vigilence) and lapse? may engage in extreme behaviour (binge eat)
- okay now to talk about relapse in counselling - help ppl identify high risk situations re relapse and plan how to avoid them (can mentally rehearse situations, responses for difficult encounters)
Support Systems
- Family: can help ppl restructure positive health change, help with reward, etc.)
- Worksite: can offer programs that are convenient, cheap, have incentives, can remove junk food bldg., promote self management
- Community: campaigns re risks and services, limited funding but cost-effective (Naloxone Kits)
- Social Engineering: law comes down and decides for us, (e.g. with legislation) - more impact and success (seatbelts, texting &driving, weed / driving ?)
Learned Helplessness/Attribution
- Internal - external - is it within my control or not
- Stable/Unstable - long-lasting (stable) or temporary (unstable) - Unstable or chronic, more likely to feel helpless
- Global - specific - wide ranging or narrow effects; if helpless more likely global judgement (I’m no good at anything) vs I’m no good at “this”
