HEALTH PSYCHOLOGY Flashcards
Health Psychology involves the study of:
- factors that influence wellbeing and illness
- measured ti promote health and prevent illness
What is physical pain?
- unpleasant sensory and emotional experience caused by disease or injury
- pain can range from mild to severe
- can be acute or chronic
- pain has both physical and emotional components
The experience and management of pain:
- most people find it very unpleasant and are motivated to avoid
- mediated by specific fibres that carry pain impulses to the brain where conscious appreciation may be modified by many factors
- chronic pain can severe consequences for a person’s wellbeing
Why study pain in psychology?
- features of many illnesses and may be a major stressor
- complex perceptual phenomenon involving numerous psychological processes
Fordyce, 1988; Melzack, 1998: people can expeircen debilitating pain and have no injury or have a severe injury with no pain.
Where are pain receptors NOT found?
- brain
- hair
- bones
- teeth
- nails
Biological mechanisms
Pain receptors are stimulated ->
nerve impulses sent along spinal cord to the brain ->
relay sensory info about pain intensity and location to somatosensory regions of the cerebral cortex
OR direct nerve impulses to the limbic system (motivation and emotion centre)
Theory
• Pain results from the opening and closing of gating
mechanisms in the nervous system.
- When spinal cord ‘gates’ are open, nerve impulses can travel to the brain.
- Sensory inputs (e.g. touch) can close the ‘gates’ and stop the experience of pain.
- Nerve impulse fibres from the brain can also open and close the ‘spinal gates’, increasing or decreasing pain stimulation from the brain.
• This central control mechanisms allows thoughts, emotions and beliefs to influence pain.
What opens the gate?
Physical Factors:
• Bodily injury
Emotional Factors:
• Anxiety
• Depression
Behavioural Factors:
• Attending to the injury and concentrating on the pain
What closes the gate?
Physical Pain:
• Analgesic remedies
Emotional Pain:
• Being in a good mood
Behavioural Factors:
• Concentrating on things other than the injury
Endorphins
Endorphins = hormones secreted within the brain and nervous system = the body’s natural painkillers.
- Endorphins created in the Pituitary glands inhibit release of neurotransmitters involved in transmitting pain impulses from the spinal cord to the brain (Fields, 2005).
- Some endorphins are incredibly potent – one more than 200x more powerful than morphine (Franklin, 1987).
- Endorphins may explain how psychological factors can influence pain.
Zubieta et al. (2001)- Endorphins
- P’s were injected with radioactive form of an endorphin and then received painful injections of salt water into their jaw.
- Brain scans revealed a surge of endorphin activity within the thalamus (sensory switchboard), the amygdala (emotion centre) and a sensory region of the cortex.
- As the endorphin surge continued over 20mins of pain stimulation, p’s reported decreased sensory and emotional pain ratings.
- P’s differed in their experience of pain due to: • Number of opioid receptors.
- Ability to release endorphins.
Acupuncture:
How could it relate to Gate Control Theory?
How could it relate to Endorphins?
Gate Control – stimulation of sensory fibres that shut sensory gates in the pain system.
Endorphins – acupuncture stimulates the release of pain reducing endorphins.
Stress-Induced Analgesia
What is it? Study? Adaptive? Endorphins? Chronic?
• Reduced or absent pain in stressful situations.
• 65% of soldiers wounded during combat reported feeling
no pain at the time of injury (Warga, 1987).
• Highly adaptive – fight or flight given immediate priority over normal pain responses
• Endorphin rush which supresses pain related behaviours so the individual can perform the action needed for immediate survival.
• Painkilling effects of endorphins may come at a price! Chronically high levels of endorphins reduce the activity of the immune system.
Cultural influences on Pain: Entertainment
In the Dugum Dani of Highland, New Guinea a highly regarded form of entertainment is spear fights within the tribe.
The men play ‘war games’ and position themselves side by side in two parallel lines, facing each other with a distance of 30 yards between the lines.
Each man holds a long spear and upon signal throws it at the man across from him.
Cultural influences on Pain: Childbirth (Kroeber, 1948)
In Papua New Guinea and Bolivia, the woman’s husband would get into the bed an groan as if he was in pain, while the woman calmly gave birth.
In more extreme cases, the husband then stayed in bed with the baby to recover from the terrible ordeal and the mother returned to work in the fields almost immediately.
The effect of culture on pain sensitivity
(Al-Harthy et al. 2016)
Participants
Pain measurement (mechanical and electrical)
Results
Participants: Saudi Arabian (n = 39), Italian (n = 42) and Swedish (n = 41) females participants.
Pain measurement: Most pressure to the palm p’s could stand and intensity of current needed for the subject to perceive pulses in the thumb and index finger.
Results:
• Italian females reported the highest sensitivity to mechanical and electrical stimulation, while Swedes reported the lowest sensitivity.
• Mechanical pain thresholds differed more across cultures than electrical thresholds.
• Cultural factors may influence response to pain.
Cultural Influences -meanings and beliefs - Melzack and Well (1991)
Pain sensation is similar across cultures but pain tolerance differs across cultures.
Interpretation of pain impulses sent to the brain is partly influenced by an individual’s experiences and beliefs – both factors which are influenced by culture.
Cultural Influences -meanings and beliefs - Rollman (1998)
Childbirth
Different cultural groups do not differ in their ability to discriminate among pain stimuli, but may differ in their interpretation of pain.
• Mothers in cultures where childbirth is not feared do not attach such strong negative feelings to childbirth and as a result experience less pain.
Cultural Influences -meanings and beliefs - Beecher (1959)
Soldiers and civilians
25% of 2nd World War soldiers required pain medication, compared to 80% of civilians who received similar wounds during medical operations
• Soldiers perceived their wounds positively – evacuation from war
zone and ticket home.
• Civilians perceived their wounds negatively – major life disruption.
• Different meanings result in different levels of suffering and different needs for pain relief.
Placebos-what are they?
- Physiologically inert substances that have no medical value but are thought to by patients.
- Placebos produce a reduction in pain.
Placebos- (Beecher, 1959)
Post-op and morphine
67% of patients suffering post-operative pain who received morphine reported pain relief, but 42% of those who received a placebo reported equal relief
Placebos- (Petrovic et al., 2010)
Positive belief
Positive belief in placebo’s effectiveness resulted in a release of endorphins to reduce pain
Personality
Interpretation of pain?
Neuroticism?
Optimism?
- Certain personality traits influences how an individual interprets and responds to pain.
- High neuroticism (tendency to experience negative emotions) linked to higher levels of pain (Asghari & Nicholas, 2006).
- Individuals high in optimism and who have a high sense of personal control over their life experience less pain and suffering (Pellino & Ward, 1998).
Social Support
Networks
Arthritis
Menstrual pain and depression and anxiety
- An individual is not in a social vacuum – social support networks can influences responses to pain.
- Social support enabled patients with rheumatoid arthritis experiencing daily pain to more effectively use coping strategies to manage their pain (Holtzman et al., 2004).
- Women with self-reported depression and anxiety experienced greater menstrual pain, especially if they recently lost a significant source of social support (Alonso & Coe, 2001).
Global prevalence of chronic pain
20% (Boris-Karpel, 2010)
Cognitive strategies- Dissociation
What is it and what does it involve?
Effective?
Research into burn wound cleaning and VR?
- Distracting oneself from pain.
- Direct your attention to some other feature of the external situation.
- Imagining a pleasurable experience.
- Repeating a word/thought to yourself - mantra.
- Most effective if requires a great deal of concentration or mental effort.
- Children and adults with 60% burns reported lower pain ratings when having their wounds cleaned when wearing virtual reality googles that took patients into a world of shapes and colours (Hoffman et al., 2001).
Cognitive strategies- Association
What is it?
Effective?
When to use?
Research into using dissociate and associative strategies?
• Focus your attention on the physical sensations and study them in a
detached and unemotional fashion.
- Associative strategies are more effective than dissociative strategies for intense pain.
- Use dissociative strategies for as along as possible and then switch to associative strategies.
- P’s who used a combination of dissociative and associative strategies were able to tolerate the pain of submerging their hand in ice cold water for longer than a placebo and control group (Bandura et al., 1987).
Forys and Dahlquist (2007)
Participants
Pain measure
Cognitive strategy
Participants: 95 undergraduate students with no chronic pain. P’s were low, high, or mixed monitors of pain.
Pain measure: Cold pressor.
Cognitive strategy:
• During distraction, participants were asked to count aloud, beginning at 1,000 and subtracting by 7s.
• Participants in the sensation monitoring condition were asked to focus on and describe the sensations that they were feeling in their immersed hand.
• The participants in the control group were not given task- related instructions.
Forys and Dahlquist (2007)
Results
• Low monitors’ pain threshold was significantly higher
during distraction AND sensation monitoring than baseline.
• Mixed monitors’ pain threshold was significantly higher during distraction AND sensation monitoring than baseline.
• High monitors’ pain threshold was significantly higher in the sensation monitoring than baseline.
• Controls’ pain threshold did not differ, regardless of coping style.
Fox et al. (2016)
monitors/ blunting
Participants
Cognitive Strategy
Lemons…
Participants: Chronic pain suffers classified as Monitors (n = 16) or Blunters (n = 19).
• Monitoring (attending to)
• Blunting (avoiding)
Cognitive Strategy:
• P’s were provided with an audiotaped intervention in which they were instructed to focus on pain sensations or to engage in a distraction task.
- Sensation-focused = focus on pain sensations, but label them in an objective, non-threatening way.
- Distraction = visualise an interactive scene and focus on the different sights, sounds, and smells unrelated to pain
- ‘Imagine a pure white plate with a lemon on it, resting on a table. See the glossy yellow of the lemon’s skin against the whiteness of the china plate …’
• P’s had to rate pain intensity and their anxiety during and after the sensation-focused and distraction conditions.
Fox et al. (2016)
Blunters report the lowest pain when distracted.
There was no significant difference in reported pain between blunters and monitors across the sensation-focused and distraction conditions.
Hospital interventions
Taylor, 2011
Information about a challenging environment is a kind of cognitive control as it tells us what to expect.
Sensory information
info on the symptoms after the operations
Procedural information
what is going to be done and why
Coping guidance
how to manage the pain or other complications
Informal interventions
- have been found to be effective in many medical settings.
* Patients show a better course of recovery and require less pain medication (Faust, 1991).
what is emotion?
Physiological
Cognitive
Behavioural
An individual state that occurs in response to an external or internal event.
Physiological - changes in bodily arousal
Cognitive - subjective interpretation
Behavioural- verbal/non-verbal
All 3 components necessary for emotion.
Emotions are distinct from moods
Emotions
- usually have clear cause
- can be fitted into distinct category
- are typically brief
Moods
- may only involve subjective experience
- usually based on just pleasantness and arousal
Behavioural displays
- fighting or fleeing
- facial expressions
Psycho-physiological reactions
- facial EMG
- GSR
- H-R
- Startle response
Self report
- retrospective or realtime
e. g. PANAS questionnaire
6 basic human emotions recognisable across gender, age
& culture
(Ekman, 2003)
& statements about emotions
Anger Fear Disgust Surprise Happy Sadness
- Ability to recognise & experience emotion is genetically programmed (Izard, 2009)
- Evolutionary theories of emotions – they have evolved because they serve a useful function
Research from the Institute of Neuroscience and Psychology - University of Glasgow (2014)
There are only four emotions?
- wide-open eyes that come with fear/surprise are a response to “fast-approaching” danger, and that we widen our eyes to get more visual information
- wrinkled nose that comes with anger/disgust, they say, is a response to “stationary danger,” such as pathogens — by wrinkling your nose, you may be less likely to breathe in something harmful.
Functions of emotions - Cognitive - Emotions help us to:
- organise our memories
- prioritise our concerns, needs or goals
- form judgements and make decisions
Functions of emotions - Cognitive - Evidence for adaptive function:
- memories accosted with emotional content are easier to recall (Abercrombie et al, 2008)
- Stranger danger: children rely on their own emotional states when making decisions about people, esp. stranger
Functions of emotions - Behavioural - Emotions help us to:
Respond to events
Functions of emotions - Cognitive - Action tendencies associated with different emotions
Happiness Embarrassment Anger Anxiety Sadness
Happiness
– indicates goal attainment, encourages behaviour to continue
Embarrassment
– evokes forgiveness from others
– motivates reconciliation & adherence to social norms
Anger
– signals injustice, prompts aggression & self-protection
Anxiety
– attention to threat, motivates action (avoid/cope)
Sadness
– may signal loss of important positive relationship
– seek support & assistance from others
Functions of emotions - Behavioural - Emotions help us to:
Facilitate and maintain relationships
Functions of emotions - Behavioural - Evidence
- Viewers assigned more positive ratings of friendliness & competence to those who showed a sincere smile in their yearbook photo
- Taking about emotions (positive or negative) predicts marital satisfaction
Cannon-Bard Theory of emotion
CNS arousal does not cause the emotion, rather arousal and emption are simultaneous
Stimulus-> thalamus relays information -> physiological arousal/ emotion e.g.Fear
Schacter & Singer’s 2 Factor Theory
- emotion is a function of arousal and cognition
- cognitive appraisal of the situation provides a label
Stimulis-> physiological arousal->label “I’m sacred”->emotion:fear
Misattribution of arousal - Dutton and Aron (1980) - Attractive experimenter
- Men had to walk across long and windy bridge
- Then meet an attractive female experimenter with survey
- After completion given name and phone number of E
- Those who had no time to rest (increased arousal) more likely to phone experimenter
- Due to misattribution of arousal to attractiveness of E?
Misattribution of arousal - Zillman and Bryant (1974) - Exercise and Aggression
- Strenuous exercise (to create physiological arousal) - Experimenter provoked participant
- Pp more likely to respond aggressively if aroused
Facial Feedback Theory
Muscular activity effects the experience of emotion.
Strack, Martin & Stepper, 1988
Participants held pens in their mouths (teeth or lips) whilst rating the funniness of cartoons
Duchenne Smiles
- Smiles reflecting genuine emotion involve the activity of certain muscles near the mouth & eyes.
- ‘Social’ smiles only involve muscles near the mouth
- Supports facial feedback theory
Characteristic of Stress
- major changes in life (e.g., getting married, changing job)
- may be positive or negative event
- everyday hassles (being stuck in traffic, preparing lectures) - some are acute; some are chronic (e.g., unhappy marriage)
4 main categories of stress
- traumatic event (outside usual range of experience) PTSD
- uncontrollable /unpredictable events
- internal conflicts
- major life changes
Psychological reactions to stress: Anxiety
PTSD
- caused by psychological trauma
- a severe set of anxiety-related symptoms
- detachment
- repeated reliving of the experience (flashback)
- sleep disturbances, over-altertness, concentration probs - survivor guilt
- may develop immediately after trauma
…or years later (in reaction to a stressor) - may last years
- human caused traumas may be more likely to cause PTSD
Physiological Reactions to Stress
- Initial sympathetic nervous system response to threat (Flight or flight)
- Blood pressure & heart rate increase
- Respiration becomes more rapid
- Pupils dilate
- Perspiration increases & saliva / mucus decreases
- Blood sugar levels increase
- Blood clots more quickly
- Blood diverted from stomach/intestines to brain/muscles
- Hairs on skin become erect (goose pimples)
How does Stress affect Health ?
- Coronary Heart Disease
- Immune system
- Health related behaviours
- Increase in colds with increase in stress levels
Type A checklist examples
- thinking of doing two things at once
- failing to notice or be interested in the environment or things of Beaty
- hurrying the speech of others
- believing if you want something done well, you ave to do it yourself
- frequent knee jiggling
- having difficulty doing nothing
- measuring your own and others’ success in terms of numbers
- becoming impatient while watching others do things you think you can do better or faster
3 distinct aims of psychology before WW2
- curing mental illness
- making all lives more productive and fulfilling
- identifying and nurturing social talents
The rise of clinical psychology
– 1946 Veterans Administration
– 1947 National Institute of Mental (Health)
- Rise of behaviourism
-Psychology = science of healing: great progress made
Focus on
– Pathology & disease – Repairing damage
Neglect
– Human qualities & fulfilment
– Building strengths
Problem focused
behavioural or cognitive
means of dealing with the problem
Usually deals with potential controllable problems such as work-related problems and family-related problems.
Emotion-focused
behavioural or cognitive aimed at alleviating the negative emotion
Stressors perceived as less controllable, such as certain kinds of physical health problems, prompt more emotion-focused coping.
Active
aimed at confronting the problem
either behavioral or psychological responses designed to change the nature of the stressor itself or how one thinks about it
Usually active coping strategies, behavioral or emotional better in dealing with stressful events.
Avoidant
aimed at avoiding the problem
lead people into activities (such as alcohol use) or mental states (such as withdrawal) that keep them from directly addressing stressful events
Avoidant coping strategies appear to be a psychological risk factor or marker for adverse responses to stressful life events (Holahan & Moos, 1987).
Lazarus’ Transactional Model of Stress
Lazarus & Cohen 1977
Stress emerges from transition between a person’s personality, thoughts and environmental situations.
Stressors are demands made by the internal or external environment that upset abalone, thus affecting physical and psychologic well being and requiring action to restore balance.
Lazarus’ Transactional Model of Stress and COPING
- evaluation the process of coping with stressful events
- stressful experiences are constructed as a person-environment transaction
- these depend on the impact of the external stressor
- mediated by appraisal and social and cultural resources at disposal
Primary appraisal
evaluation of the significant of a stressor or threatening event
Secondary appraisal
evaluation of the controllability of the stressor and a person’s coping resources
coping efforts
actual strategies used to mediate primary and secondary appraisals
dispositional coping styles
generalised was of behaving that can affect a person’s emotional or functional reactions to a stressor ; relatively stable across time and situations
Coping strategies: what are they and what are used?
What are they determined by?
Specific efforts (behavioural and psychological) that people employ to master, tolerate, reduce or minimise stressful events.
Research indicates that people use both types of strategies to combat most stressful events (Folkman & Lazarus, 1980).
Predominantly determined by -personal style
-type of stressful event
Currently the revival of positive psychology: redressing the balance
- positive experiments
- positive personal traits/ human strengths
- behaviour towards others/groups
Positive experiences
– Well-being & satisfaction
– Flow, joy, sensual pleasures, happiness
– Optimism, hope, faith
Positive personal traits / human strengths
– Love, courage, creativity, forgiveness, talent, etc.
Behaviour towards others / groups
– Responsibility, altruism, tolerance, work ethic etc.
