Health Psychology 3 unipd Flashcards
Hippocrates
considered the mind and body as one unit, and thus it was thought that the level of specific bodily humours related to particular person- alities: excessive yellow bile was linked to a choleric or angry temperament; black bile was attached to sadness; excessive blood was associated with an optimistic or sanguine personality; and excessive phlegm with a calm or phlegmatic temperament.
Galen
Galen considered there to be a physical or pathological basis for all ill health (physical or mental) and believed not only that the four bodily humours underpinned the four dominant temperaments (the sanguine, the choleric, the phlegmatic and the melancholic) but also that these temperaments could contribute to the experience of spe- cific illnesses.
What happened in the eighteenth century (organic medicine)
This view (galen humors) dominated thinking for many centuries to come but lost predominance in the eighteenth century when organic medicine, and in particular cellular pathology, devel- oped and failed to support the humoral underpinnings.
However descriptions of personality types were still in use in the latter half of the twentieth century
Middle Ages
Middle Ages however (fifth–sixth century), Galen’s theories had lost dominance when health became increasingly tied to faith and spirituality. Most of the knowledge was very narrowed and concentrated in few people normally Mons And the mind shape
During Middle Ages the idea that health and disease were related to faith and spirituality
Malicious masificados- book of what is a with- now days more seen as a description of mental disorder
Obsession- resist to the devil’s possession- if not you become psychotic/ possessed.
Santa Giovanna di arco: talking with god seen as a Saint instead of a witch (in France, but wich in England)
Santa Clara- anorexic…
Treatment in Middle Ages
treatment along the lines of self-punishment, abstinence from sin, prayer or hard work
Renaissance
During the Renaissance, individ- ual thinking became increasingly dominant and the religious perspective became only one among many. The scientific revolution of the early 1600s led to huge growth in scholarly and scientific study and developments in physical medicine.
What did Rene Descartes said and the interaction between the entries is I limited or limited?
During the early seventeenth century, the French philosopher René Descartes (1596–1650), like the ancient Greeks, proposed that the mind and body were separate entities. However, Descartes also proposed that interaction between the two ‘domains’ was possible, although initially the understanding of how mind–body interactions could happen was limited
Other data from Descartes… and how he aportes to the medical understanding
pineal gland in the midbrain (see Chapter 8 ☛), but the process of this interaction was unclear. Because Descartes believed that the soul left humans at the time of death, dissection and autopsy study now became acceptable to the Church, and so the eighteenth and nineteenth centuries witnessed a huge growth in medical understanding.
What is the biomedical model
In this model, health is defined as the absence of disease, and any symptom of illness is thought to have an under- lying pathology that will hopefully, but not inevitably, be cured through medical intervention.
Some problems with the biomedical model
Problems: the medical explained symptoms (we see the effect but we can’t find the cause)we haven’t understood pathology enough? Matter of understanding where it comes from and how ti treat
Comparison between individuals
When we discuss with the physicians are symptoms, signs (objective- even though understanding is a little more complicated)
Just remove pathology through medical intervention but there is no place of subjectivity even if all the parameters are taken (reductionism)
How we can deal with unexplained symptoms?
Introduce subjectivity as a solution for the biomedical model but how?
Including your psychological symptoms
Bunt- introspection to understand subjectivity
What is what it makes an individual different from another
Individual difference is not subjectivity, our experiences, subjectivity is related but it’s not it
Consciousness… move the problem
Or this questions have to take into account for including subjectivity, where they come,
Why our subjectivity brings out medically unexplained symptoms
Maladaptive way that we perceive normal sensations.
Beyond dualism how the monastic structure can be perceive?
this monadic structure can be perceived in two different ways:
objectively and subjectively.
How does subjectivity plays a role in the illness?
subjectivity in terms of beliefs, expectations and emotions interact with bodily reactions to play an important role in the illness or stress experience (e.g. phantom limbs, placebo/nocebo response)
Sigmund fried after the biomedical model
A key role was played by Sigmund Freud in the 1920s and 1930s when he rede- fined the mind–body problem as one of ‘consciousness’ and postulated the existence of an ‘unconscious mind’ seen in a condition he named ‘conversion hysteria’. Following examination of patients with physical symp-tomatology but no identifiable cause, and by using hypnosis and free association techniques, he identified unconscious conflicts which had been repressed. These conflicts were considered to ‘cause’ the physical disturbances including paralysis and loss of sensation in patients where no underlying physical explanation catarsis
• Freud stimulated much work into unconscious conflict, personality and illness, which ultimately led to the development of the field of psychosomatic medicine.
Hysteria…. Uterus
Bio psychosocial model
model signals a broadening of a disease or biomedical model of health to one encom- passing and emphasising the interaction between body and mind, between biological processes and psychologi- cal and social influences
categories of health by Bauman 1961
a general sense of well being - feeling.
The absence of symptoms of disease- symptoms orientation.
The things that a person who is physically fit is able to do- performance.
The difference conventions of health are influenced by
State of health or illness
Age
Younger- performance centered
Middle-symptoms(matter of well being)
older people with more health problems define it more in the being of clusters
Gender
Young males measure it as performance
The perception we have of health can be different if it’s perceive from difference in this parameters.
The categories of health identified from THE HEALTH AND LIFESTYLE SURVEY findings were:
Health as not ill: i.e. no symptoms, no visits to doctor, therefore I am healthy.
● Health as reserve: i.e. come from strong family; recovered quickly from operation.
● Health as behaviour: i.e. usually applied to others rather than self; e.g. they are healthy because they look after themselves, exercise, etc.
● Health as physical fitness and vitality: used more often by younger respondents and often in reference to a male – male health concept more commonly tied to ‘feeling fit’, whereas females had a concept of ‘feeling full of energy’ and rooted health more in the social world in terms of being lively and having good relationships with others. Health as psychosocial well-being: health defined in terms of a person’s mental state; e.g. being in harmony, feeling proud, or, more specifically, enjoying others.
● Health as function: the idea of health as the ability to perform one’s duties; i.e. being able to do what you want when you want without being handicapped in any way by ill health or physical limitation (relates to the World Health Organization’s concept of handi- cap, now described as participation/participatory restriction, see ‘In the spotlight’: i.e. an inability to fulfil one’s ‘normal’ social roles).
Cross cultural perspective of health
Are diseases and health considered in the same ways in different countries and cultures?
–Pregnancy
Western Try not tell them as a patient or clients even if they need medical attention but is it the same worldwide
In some countries the matter depends on you marital status. If you are not married you are treated less humanized, as someone with a mental disorder,
Cross cultural perspective of health
Are diseases and health considered in the same ways in different countries and cultures?
Mental disorder
In some countries mental disorders do not exist for them.
Not acceptance to go to the psychiatrist
Seem as a taboo in the past
•Are the strategies to maintain health, to prevent illness and to cure it the same in different countries and cultures? How to work with health and make it better
E.g. collectivism-
vs. individualism-
What are possible examples of individualism and collectivism that have influenced health?
Evidence based methods (individualistic)vs. alternative/ritualistic/religious methods (collectivistic)
Passive smoking in a collectivist if society doesn’t harm people around me but individualists can prioritize themselves.
Pollution- the heritage of the world… think of the future generations or not
Reduction in vaccination-
•Are the strategies to maintain health, to prevent illness and to cure it the same in different countries and cultures? How to work with health and make it better
Evidence based methods vs. alternative/ritualistic/religious methods
Red towels in the windows for measles.. cultural heritage is there.
But they can have bad outcomes by taking the energy for curing ritualistic and religious issues
Childhood under 7 how they classify illness
magic explanation (if any) are typical:
- Incomprehension: child gives irrelevant answers or evades question: e.g. sun causes heart attacks.
- Phenomenonism: illness is a sign that the child has associated with the illness, but with little grasp of
cause and effect: e.g. a cold is when you sniff a lot.
-Contagion: illness is usually from a person or object that is close by, but not necessarily touching the child; or it be attributed to an activity that occurred before
asked how?
Illness: e.g: ‘You get measles from people’. If
Just by walking near them’
Child between 8-11, how they explain health
Contamination: i.e. children understand that illness can have multiple symptoms, and they recognise that germs, or even their own behaviour, can cause illness: e.g. ‘You get a cold if you get sneezed on, and it gets into your body’.
Internalisation: i.e. illness is within the body, and the process by which symptoms occur can be partially understood. The cause of a cold may come from outside germs that are inhaled or swallowed and then enter the bloodstream. Can differentiate between body organs and function and can understand specific, simple information about their illness. They can also see the role of treatment and/or personal action as returning them to health.
In this concrete operational stage, medical staff are still seen as having absolute authority, but their actions might be criticised/avoided: e.g. reluctance to give blood, accusations of hurting unnecessarily, etc. may appear as children can now begin to weigh up the pros and cons of actions.
Adults in health
Adults are less likely than adolescents to adopt new health-risk behavior and are generally more likely to engage in protective behavior: e.g. screening, exercise, etc. for health reasons
Middle age has been identified as a period of doubts and anxiety, reappraisal and change, some of it triggered by uncertainty of roles when children become adults and leave home, i.e. ‘the empty nest’ syndrome, some of it triggered by awareness of physical changes – graying hair, weight gain, stiff joints, etc. Positive health behaviour changes may follow
Symptoms
subjective perception of something that it’s not seem to be not okay. Related to diseases, symptoms can be related to disease…
Illness and disease
•Disease, then, is considered as being something of the organ, cell or tissue that suggests a physical disorder or underlying pathology, whereas illness is what the person experiences
People can feel ill without having a disease. Or the other way around! Ex: well control diabetes
Are you sick? Which is the process for define ourselves as ill…
perceiving symptoms;
interpreting symptoms as illness;
planning and taking action. (Getting the label of disease or healthy)
Ex PTSD- it was first described on the 80’s and described in the DMS….independency word of the USA, then with the two wars,
It was also seem in the golf war
It was important for the veterans of the Vietnam wars (anxiety, depression, conversion disorder) for the label for the insurance, for treatment. If there was no diagnosis the insurance didn’t pay. They had the subjective perception of being ill, so no disease? No insurance. Having definitions and how is not enough to perceive the subjectivity for the person
How does selective attention and external information influence on the somatic information contributing to our physical symptoms
There is no subjective symptoms without cognitive interpretation of it. There is no attribution of being I’ll without the cognitive evaluation of the situation, with the process of attention and the knowledge of previous deseases.
Signs can be detected and identified, for example, blood pressure, whereas symptoms have been defined as what is experienced and, as such, they are more subjective
•There are signs and symptoms that tend to be considered as pathological
Yo can explain this graph with the two examples, panic attack
The fact that you are bringing your attention to a bodily sensation to your body can create or worsen the symptoms as a reversion conditioning.
there are signs and symptoms that tend to be considered as pathological
Painful or disruptive: if a bodily sign has consequences for the person
Three types of symptoms:
• Novel: subjective estimates of prevalence significantly influence (1) the perceived severity of a symptom and (2)whether the person will seek medical attention.
Experiencing a ‘novel’ symptom (new to one- self or believed not to have been experienced by others) is likely to be considered indicative of something rare and serious, whereas experiencing a symptom thought to be common leads to assumptions of lower severity and a reduced likelihood to seek out health information or care.
Persistent: a bodily sign is more likely to be perceived as a symptom if it persists for longer than is considered usual, or if it persists in spite of self-medication.
• Pre-existing chronic disease: past or current illness experience has a strong influence upon somatisation (i.e. attention to bodily states) and increases the number of other symptoms perceived and reported
Attentional states and symptom
perception
•Individual differences exist in the amount of attention people give to their internal state and external states
•A high degree of attention increases a person’s sensitivity to new, or different, bodily signs (e.g. psychogenic illness due to well-publicised outbreaks of illnesses or the ‘medical student’s disease’)
•Previous experience with an illness can increase a person’s attentional bias toward symptoms of that illness
Social influences
on symptom perception
•People hold stereotypical notions about ‘who gets’ certain diseases and that this can inter- fere with perception and response to initial symptoms.
• Our motivation to attend to and detect signs or symptoms of illness will depend on the context at the time the symptom presents itself. As referred to above, people tend not to notice internal sensations when their environment is exciting or absorbing, but a lack of alternative distraction may increase perception of symptoms.
(influences)Symptoms interpretation in general
Once a symptom has been perceived, people do not generally consider it in isolation but relate it to other aspects of their experience and to their wider concepts of illness.
•Several influences were studied:
- Cultural influences
Child dies the degree you perceive depends on the culture and the normality of it. Other example is the deseases during the child since there can be a lot in the past and now there are more vaccinations.
- Gender
Females are more careful in monitoring and giving interpretations of symptoms and that man can be more bluster of them.
- Life stage (age):
• children have similar multidimensional illness representations to adults, including perceived illness consequences and issues of control
- Personality
• Self identity: a person’s sense of who they are at a group
.Illness experience
Illness desease prototypes
This can affect by:
HIV as an example is not as the prototype says it can be misperceived the type of persons who can acquire as just drug users and unprotected sexual Inter curse. However it can be any person who does unprotected intercourse.
Prototypes similar to heuretics!
common-sense model of illness
•In this model, illness cognitions are defined as ‘a patient’s own implicit common-sense beliefs about their illness’
• This ‘common-sense model’ states that mental representations provide a framework for understanding and coping with illness, and help a person to recognise what to look out for
S in spikes
SETTING UP the interview
•This involves mentally rehearsing the likely plan of how the interview will proceed and setting up the physical setting in an appropriate way.
–Arrange for privacy
–Involve significant others (is a patient’s choice)
–Make connection with the patient.
–Manage time constraints and interruptions.
PIK in SPIKES
Step 2: P – Assessing the patient’s PERCEPTION (What do you know about your clinical situation so far?)
•Step 3: I – Obtaining the patient’s INVITATION (understanding how much the patients want to know about his/her situation)
•Step 4: K – Giving KNOWLEDGE and information to the patient (when the bad news is given)
E in SPIKES
Step 5: E – Addressing the patient’s EMOTIONS with empathic responses
1.Observe for any emotion on the part of the patient.
2.Try to follow and identify the emotions experi- enced by the patient. If they appear sad but silent, the clinician should use open questions to find what they are thinking or feeling.
3.The reason for the emotion should be identified. It is easy to assume this is due to the bad news, but it may not be clear which issue is of concern After the patient has been given a brief period of time to express his or her feelings, the clinician should respond to their distress through empathetic feedbacks
Any further medical dialogue needs to be suspended until the patient is able to renegade it. This may take some time during which the clinician may provide more empathetic responses
last S in SPIKES
Step 6: S – STRATEGY and SUMMARY
•Having, and knowing, a clear treatment plan will reduce anxiety and uncertainty but should be discussed only after patients are ready to address these issues.
The impact and outcomes of illness : patients perspective
The process
- Uncertainty: in this period the individual tries to understand the meaning and severity of the first symptoms.
- Disruption: this occurs when it becomes evident to the individual that they have a significant illness. They experience a crisis characterised by intense stress and a high level of dependence on health professionals and other people emotionally close to them.
- Striving for recovery: this period is typified by the individual attempting to gain some form of control over their illness by means of active coping.
- Restoration of well-being: in this phase, the individual achieves a new emotional equilibrium based on an acceptance of the illness and its consequences
1.Disbelief, denial and shock
2.Dysphoria
3.Acceptance, optimism and long term copying strategies
All individuals will move through stages in the same order, it’s continuous
True or fals
Fakse
Three physical outcomes of illness
Death (not so relevant for health psychology)
• Fatigue (which is related with anxiety, depression and negative emotions)
• Immune changes
Which are the reactions to a diagnosis (which can include negative emotions)
Reactions to diagnosis (typically negative and sometimes catastrophic emotions)
• Emotional reaction to illness
- Depression and anxiety:
• Cancer
• Heart disease
• HIV and other pathologies with associated stigma (considered as a punishment)
- Loss of ‘self’
Two process not to loss yourself after a disease diagnoses:
‘hold on’ to earlier ideas of ‘self’ (identity and worth, different roles) and learning to control the illness as something separate to these
- letting go’ where patients accept that they cannot control everything and that they have boundaries.
With what is associated the positive responses to illness?
positive or optimistic outlook has been consistently associated either directly or indirectly (via effects on coping responses) with positive outcomes and reduced pain perception
Positive emotions in somatic diseases
Cardiac wellbeing in patients with CHD
- CD-4 T in HIV patients(CD4+ cell counts are usually measured when you are diagnosed with HIV (at baseline), every 3 to 6 months during first 2 years or until your CD4 count increases above 300 cells/mm3.)
- Pain reduction in patients with rheumatoid arthritis
Are Positive emotions are isomorphic to the negative ones?
No, They suggest that benefit-finding may have reflected early unrealistic hope which, when unmatched by outcomes, became a cause of distress.
Positive emotions vs negative emotions
•Positive emotions are not isomorphic to the negative ones
• Negative emotions reduce behavioral choices
• Positive emotions increase behavioral choices
•Positive emotions increase the number of behaviors
• Positive emotions may “undo” negative emotions
Meaning of post traumatic growth
In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances.[1] These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual’s way of understanding the world and their place in it.
Benefits of post traumatic growth
- enhanced personal relationships;
- greater appreciation for life;
- a sense of increased personal strength;
- greater spirituality;
- a valued change in life priorities and goals.
How to measure post traumatic growth
(a) evaluate her/his current standing on the dimension described in the item, e.g., a sense of closeness to others;
• (b) recall her/his previous standing on the same dimension;
• (c) compare the current and previous standings; (d) assess the degree of change;
• (e) determine how much of that change can be attributed to the stressful encounter
Post traumatic growth can be bias by:
Post traumatic growth
• Memory bias
• Subjective Bias (the change is attributed to the diesase)
• Magnitude of change Bias (“[e]xaggerating the difficulty of past experiences is another way people enhance [their current status] -
Schacter 2001)
Coping with illness
• According to Moos and Schaefer (1984)
illness can be described as a ‘crisis’ (crisis theory) the patient has to cope
• They identified three processes that resulted from the crisis of illness:
- 1. Cognitive appraisal: the individual appraises the implications of the illness for their lives. (Cognitive coping includes strategies such as seeking information about the illness, trying to understand its causes and consequences, and finding meaning in the experience. )
- 2. Adaptive tasks: the individual is required to perform illness-specific tasks such as dealing with symptoms, and general tasks such as preserving emotional balance, or relationships with others
- 3. Coping skills: the individual engages in coping strategies defined as either appraisal-focused (e.g. denial or minimising, positive reappraisal, mental preparation/ planning); problem-focused and emotion- focused.
