Health Psychology part 2 Flashcards
What are stress moderators?
Modify how stress is experienced and the effects it has
Which appraisal does stress moderators affect?
Both primary and secondary appraisals are affected
What is coping?
Stress moderator; the thoughts and behaviors used to manage the internal and external demands of situations that are appraised as stressful - think of challenge vs threat model
What are 2 key aspects of coping?
set of responses between the person and the environment that occurs over time
involves both positive and negative responses
What are the factors that determines one’s coping ability?
Negative and Positive Affect, Psychosocial resources and Psychological resilience
What is Negative Affect (NA)/neuroticism?
Pervasive experience of anger/hostility (Type A), anxiety, depression (Type D)
What is Chronic Negative Affect (NA)/neuroticism linked to?
elevated levels of stress indicators, e.g. cortisol
Poor health habits
Poorer response to treatments
illusions of poor health - think that they are sicker than they are
What is Positive Affect (PA)?
Positive emotions
What does the presence of Positive Affect (PA) is linked to?
lower levels of stress; better immune function and health
investing more time and effort to deal with stressors and obstacles
A host of traits and psychological resources that improve coping
Those who have neuroticism/Negative Affect have…
Higher baseline of stress - need more coping
What is emotional stability?
Not mere absence of NA or presence of PA - we experience both its more important to consider when we do experience NA and how fast do we recover
Name the 4 types of psychological resources
Optimism, Psychological control, self-esteem, conscientiousness
What is optimism?
Promotes active and persistent coping efforts
What is psychological control?
Believing that one can influence and change one’s behavior environment
- Primary (perceived) control: self-efficacy
- secondary control: collective efficacy, through working with family, friends, clinicians, therapists
What is self-esteem linked to in terms of stress response?
Linked to more effective coping, but typically under low or moderate stress compared to high stress
What is conscientiousness?
Highly disciplined, with clear goal and plan
What is conscientiousness linked to in terms of stress response?
Longevity, healthier behaviors and habits, higher adherence to treatment
What is psychological resilience?
“broader package’ of psychological resources: that modifies the experience of stress and helps one bounce back from bad experience and adapt flexibly to changing demands of stressful situations
What are some traits and characteristics linked to greater resilience?
Psychological resources, sense of purpose, meaning, and coherence about one’s life, having strong religious beliefs, Grit
What is a coping style?
Inclination toward dealing with stressful events in a particular way
What is the Approach coping style?
gathering information and/or directly taking action to confront stressors
What is Avoidant coping style?
Escaping from or minimizing efforts at confronting stressors
What is the difference between approach and avoidant coping style?
Approach coping is more adaptive than avoidant coping - although it incurs short-term anxiety, but overall long-term benefits
Avoidant coping helps relieve short-term anxiety, but may not promote long-term adaptive responses to stressors
What is problem-focusing coping?
Attempts to do something constructive to address the stressors
What is emotion-focused coping?
Efforts to regulate emotions experienced due to stressors
- involves working through the emotions experienced in relation to a stressors
In what situations are problem-focused and emotion-focused coping are effective?
Depends on type of problem
If something constructive can be realistically done -> problem-focused coping
Chronic physical condition e.g. terminal illness or environmental conditions e.g. poverty -> emotion-focused coping
What is proactive coping?
Anticipating potential stressors and acting in advance to prevent or reduce their impact
What does proactive coping depends on?
Ability to anticipate stressors, being equipped with the coping skills, ability to self-regulate and exercise self-efficacy
- cultivated with repeated experiences of coping over time
What are the 4 types of coping interventions?
Expressive writing, Self-affirmation, Relaxation Training, Mindfulness Mediation/Mindfulness-Based Stress Reduction (MBSR)
What is expressive writing?
Disclosing emotions from stress or trauma can be good for health
What are possible reasons on why expressive writing helps with stress?
Allows disinhibtion, clarification of emotions and affirming important personal values
Allows rationalizing and switching focus from negative to positive aspects of the situations
Meaning-making process through organizing thoughts
What is the limitation of expressive writing?
Less helpful when one is still meaning-seraching or meaning-making is difficult
What is self affirmation?
Form of writing intervention that involves writing about a personal value and how it is important (positive affirmation) before undergoing a stressful task
What does self affirmation do to us?
reduces physiological stress reactivity and feeling of distress in response to an upcoming or post stressors
- lower BP and HR levels among students prior to taking an exam when they affirmed their self
Why does self affirmation helps?
Remind people of their wide-ranging resources and abilities
Self-expansion; broadening their own perspective of who they are
Form of proactive coping
What is relaxation training?
Deep breathing, progressive muscle relaxation, transcendental mediation, guided imagery, yoga, listening to joyful music
How does relaxation training help us in reducing stress?
To reduce arousal - the physiological experience of stress
Reliably reduces HR, BP, muscle tension, inflammatory response, feeling of anxiety and psychological tension
What is mindfulness mediation or MBSR?
Mindfulness mediation involves striving for a state of mind marked by heightened awareness of the present, focusing on the moment, and accepting and acknowledging it without becoming distracted or distressed by stress
- draws on Buddhist meditative traditions and principles
-billion dollar industry
What are the claims of mindfulness based programs?
reductions in medical and psychological symptoms - anxiety, panics + psychological hardiness and greater sense of coherence
What are the issues of mindfulness?
Inconsistence definitions of mindfulness, novice, experts
Methodology: very small NS, non standardized lengths (5mins -3 month), RCTs that lack active control
Failure to disclose COIs
failure to monitor/report adverse events; mindfulness meditations is contraindicated for some disorders, bipolar, schizophrenia, ptsd
Too much mindfulness can backfire
-People who suffer from internalizing disorders - this level of non-judgement and acceptance may not for people suffering from externalizing disorders marked by higher levels of impulsivity
What is a more balanced perspective on mindfulness
Most mindfulness studies only care to demonstrate whether it works rather than why -> what are the active ingredients for mindfulness to be successful? -> knowing active ingredients help us which parts of mindfulness to promote and which parts to be more cautious about
Note: the lack of understanding of what the ‘active ingredients’ are in psychological interventions is a huge issue that is not unique to mindfulness interventions -> tldr mindfulness is not for everything, nor everyone nor the only thing
What is social support?
the information from others that one is loved and cared for, esteemed and valued, and part of a network of communication and mutual obligations - parents, spouse, partner, relatives, social and community circles
What are the 4 forms of social support?
tangible assistance, informational support, emotional support, ‘invisible’ support
What is tangible assistance?
providing material help e.g. money, cooking
What is informational support?
sharing information or experiences from someone who has gone through the same problems
What is emotional support?
providing care and concern for a friend/family member facing a stressors; assuring them that support is available
What is “invisible support”?
People can feel bad about receiving too much help, cases social support to backfire -> providing invisible support such that recipient is unaware of receiving help can help reduce feelings of guilt and burden
How does social support influence physiological response?
Common Cold Project: found that larger social network = less likely to be sick
People who did TSST with presence of friends showed lower stress reactivity compared doing it alone
Married women showed lower neural activity in response to stress when receiving shock when they hold hand of husband than stranger
- increase marriage quality + even looking at picture of loved one
What two hypothesis shows that social support is a stress moderator?
Direct effect hypothesis - social support is beneficial anytime - in both stressful and non stressful times - supported as assessed as size of social network
stress buffering hypothesis - beneficial only under stressful times, but no enhancing effects when there is no stress - supported when assessed as no of people who would be available to provide help when needed
What is the influence of social support and health (direct and stress buffering)?
Direct effect: high SS consistently lower health symptoms than low SS (graph is parallel)
Stress buffering effect: high SS showed lower stress than low SS (graph diverge from starting pt)
What are some threats to social support?
People who express too much distress to others -> drive pple away and undermine SS
too much or overly intrusive support may make things worse
People whom you assume to be sources of SS may not provide the right support
Can bad relationships (SS) affect your health?
Chronic negative and competitive social interactions with people you share a r/s with can lead to chronic inflammation that affect your health
Chiang et al. (2002): an 8 day diary study that looked at experience of college students: breif descriptions of positive, negative and/or compeitive social interaction -> did TSST in lab and measured inflammation levels
Results on inflammation levels:
+ve < -ve
+ve < competitive
Competitive interactions: leisure < academic or work
Can pet ownership affect your health?
Pet is source of SS and enjoy of cardiovascular benefits from having them
Pet-owners and non-pet owners performed a mental arithmetic task and the CPT alone or in the presence of their pets, partners or friends
results: pet owners who performed in front of partners, pets, friend had significantly smaller increase in HR and BP + recovered to baseline quicker than non pet owners - pet = spouse = friend
What happens if you lack social support (loneliness)?
Loneliness and social isolation are powerful predictors of health and longevity, esp among elderly - predicts depression, suicide, poorer health as friends and family provide info/encourage seniors to go health screening
Is loneliness the same a social isolation/living alone?
loneliness is a perception - you can live with family members but still feel psychologically alone
Why focus on chronic health disorders?
1 in every 2 Sgs die from cardiovascular diseases or cancer
1 in every 3 Sgs, die either of cardiovascular diseases or Type 2 diabetes
What is Coronary Health Disease (CHD)/ Ischaemic heart disease
cluster of illness caused by atherosclerosis - the narrowing of the coronary arteries due to plaque buildup on the arterial walls
What is the consequences of Coronary Heart Disease?
Obstruction of oxygen and nourishment to the heart
- temporary O2 shortage: angina pectotis, or pain in chest or arm
- prolonged or severe O2 shortage: Myocardial infarction, or heart attack
How to predict coronary heart disease?
Metabolic syndrome - needs 3 or more of the following results in the diagnosis:
central adiposity, high BP(hypertension), difficulty metabolizing blood sugar (risk for diabetes), low levels of HDL*good cholesterol, high level of triglycerides, a type of fat
What are the risk enhancers for coronary heart diseases (CHD)?
Hypertension, Acute and chronic stress reactivity, Personality, Depression
What is hypertension: CHD risk enhancer?
aka High BP: supply of blood through the vessels is too much - high CO and High TPR - when this happens frequently, it is called hypertension
How is hypertension diagnosed?
Using BP reading measured by sphygmomanometer (BP cuff) - measure systolic (top reading): ideal =120 and below, mild =140-159, moderate - 160-179, severe = abv 180
*Diastolic not used
Strong genetic links + poor lifestyle
- If one parent has high BP, offspring has 45% chance of developing it
- If both parents has high BP, probability increase to 95%
Note: not fatalistic, but if you do take care of your health, you will reduce the chance
What is acute and chronic stress reactivity: CHD risk enhancers
Stress reactivity*
Acute stress reactivity: negative emotions (*anger and hostility), sudden bursts of activity
Chronic stress reactivity: low ses, urban and industrialized societies, workplace stress (high demand + low control), job insecurity
What is personality: CHD risk enhancers?
“Type A” personality: pervasive experience of anger and hostility
- Cynical hostility: frequent anger, antagonism, suspicion, distrust, resentment
How does personality enhance risk for CHD?
Hostile people tend to show exaggerated cardiovascular reactivity, longer stress episodes and slower recovery to both acute and chronic stressors
- engage in health-compromising behaviours (e.g., smoking, greater alcohol consumption)
- have less social support due to having more interpersonal conflict
How does Depression enhance risk for CHD?
Depression increases the other risk factors of CHD (e.g., metabolic syndrome, health-compromising behaviours)
Depression is also linked to increased inflammation, which elevates C-reactive protein (CRP) levels that can rupture arterial plaques, causing a blood clot.
How can coronary heart disease be managed?
Initial treatment
- Coronary balloon angioplasty
- Coronary artery bypass graft
Medication: Beta-(adrenergic) blockers, statins
Cardiac rehabilitation: To regain normal or optimal level of physical and psychosocial functioning
- Physical: dietary and exercise programs
- Psychosocial: Stress management, increase social support
Prevent delay in treatment-seeking
- Patients and family members to learn to recognize symptoms
Is sugar linked to Coronary Heart Disease?
YES - we be lied to for 50 years - sugar company paid the Harvard scientists a shit to of money to exclude sugar - only later in 2016 when a group of scientist when to look at the old study found that sugar is linked to hypertension and cardiovascular disease
How does type 2 diabetes come about?
Imbalance between insulin production and responsiveness resulting in insulin resistance
What is insulin resistance?
Insulin is a hormone that bring broken down carbs/sugar into our cells for immediate energy, and excess into fat cells for storage and instructs your fat cells to release sugar for energy or not
Insulin naturaly released when body detects rise in glucose in blood to perform 1. and 2. -> when you overeat and don’t exercise -> body produce more insulin to transport excess carbs and sugars to fat cells -> When carbs and sugars in the blood are persistently in excess, your pancreas constantly works harder to produce more insulin to transport them away -> the pancreas becomes overworked and eventually unable to produce sufficient insulin to keep up, resulting in insulin resistance
Excess sugar remain in your blood - detected as high blood sugar
- chronic high blood sugar is sign of insulin resistance and diabetes
What other health risk or complications can diabetes cause?
Heart diseases and stroke, blindness, damage to blood vessels, kidney failure and diabetic nephropathy: >60% have mild to severe nerve damage - lead to amputation
What is cancer?
dysfunction in one’s DNA, which “provide instructions” for cell growth and cell reproduction -> The malfunctioning DNA causes excessive, rapid growth of cancerous cells that only take up resources and provide no benefit to the body.
Who gets cancer?
Complex interaction between genes and lifestyle
- exposure to infectious agents (HPV) or carcinogens (1st/2nd hand smoke)
Diet: chronically malnourished or excessive consumption of far, certain additives and alcohol
How does psychological factors affect the course of cancer?
Depression can exaverbate the impact of other risk factors
Avodiance coping predicts more rapid progression of cancer
Underlying mechanism:
- Unabated stress and negativity activate the SAM and HPA, affecting immune function and allowing cancer cells to flourish
- Natural killer cells in the immune system, which are supposed to destroy tumor cells, do not function as expected.
How can cancer be managed?
CBT for stress management
Family therapy: increase SS, particularly in early course of disease - develop strong partnership r/s, impact on children
Community support (informational coping): Sharing and learning about emotional concerns and various coping strategies, allowing one to find the most suitable coping method
Is quality of life important for chronic health disorders?
High QOL can reduce the rate of illness progression and symptoms experienced.
In the past - focus on biological consequences - increase length of survival
Recently, more focus on psycho social consequences (QOL)
- Pinpoint the likely problems to emerge in course of the disease.
- Compare and assess the impact of treatments on QOL.
- Inform care & interventions that maximize long-term health with the highest QOL possible.
How can emotional response hinder chronic health disease management?
Denial: avoid implications of the disorder
Anxiety: awaiting diagnose, invasive medical procedure, side effects of treatments, mistaken to underlie the disease
Depression: exacerbates the course of disease esp for CHD, increase the use of health services for treatment
How does chronic health diseases threaten oneself?
The physical self - body image and perceived health (self-rated health predicts mortality strongly .7 > objective indicators) , the achieving self - threats to self concept & self-esteem, the social self - social support, the private self- unfulfilled dreams and goals
What are the other impacts of chronic disorders?
Loss of income - Cut back on work/c/n work
Discrimination - hard to find job
-ve responses from family and friends as they hold -ve stereotypes e.g. aids, cancer
Strain r/s with family and caregiver ->need for constant care + stresses of chronic disorders
What are some positive impacts of chronic disorders?
empathy, appreciative of health and life, reorder priorities, going thru challenges can increase closeness
How does coping affect with chronic disorders management?
Avoidant coping: greatest psychological distress and predicts worse responses to health disorders
Active coping: predicts good adjustments and increase self control
Acute beliefs abt disorders tend to have adherence problems
self blame: motivate patients to assume responsibility but also lead to guilt -> depression
What kind of professionals help those with chronic health disorders?
Physical therapists, Dieticians, Occupational therapist, social workers
What is social class (SES)?
Objective Social Class: Income, Education, Occupation
Subject Social Class: own judgement of where you stand along the social ladder in society - independent of obj ses
What is the health gradient?
phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged
What is the white hall studies?
whitehall is where london civil service worked
Aspect: tight categorization of rank with London service sector - extremely hierarchical
Aspect: all service workers have same access to health benefits regardless of rank
YET, there was a strong association between employment rank and mortality rates
Whitehall studies: Perceived control at work explained a significant portion (more than half) of the health gradient among civil servants
What is the overall psychological process that affects health?
SES determines our environment and psychological response -> influences exposures to virus & injury, health-relevant behaviors and biological responses -> health and illness
How does SES influence the environment that people live in?
Physical: higher levels of toxins, pollution (air, noise), poor infrastructure, jobs more dangerous, poor access to health care facilities and healthy foods
Social: crime, violence, less social support
How does SES influence one’s psychological response in terms of health?
Affect: awareness about -ve stereotypes abt low SES + daily distress can evolve into depression
cognition: low sense of personal control/low perceived control
Cognition affects affect -> low optimism leads to hopelessness, hostility and anger -> greater risk of CHD + slower recovery form major surgeries
How does psychological responses affect biological response in terms of health?
Allostatic load -> AL score: Sum of indicators in the highest risk quartile (top 25%).
Indicators: BP, waist-to-hip ratio, cholesterol, blood glucose, cortisol, etc.
Higher AL score, higher disease risk and earlier mortality.
Karlamangla et al. (2002): Elderly adults without clinical conditions
- higher AL scores at baseline among those lower in SES
- higher AL scores predicted poorer physical (esp. cardiac) health, cognitive function and mortality up to 7 years later
Objective and subjective SES are…
related but distinct + predict health outcomes significantly and independently
Subjective SES appears to…
predicts health indicators a lot better than others - Cardiac index, body fat distribution, cortisol response, awakening cortisol
What are psychosocial buffers?
factors that protect low SES individuals from stressors that lead to poor health e.g. social support, psychological beliefs: sense of control, optimism, non-existentialist (genetic) beliefs and resilience strategies: shift and persist
Having high sense of control and non-genetic beliefs and correlation to stress is
psychological buffers - that greatly reduce stress -> graphs diverge
What is the “Shift and persist” resilence strategy?
A strategy for dealing with adversity and is protective against stressors, particularity for low SES children and youth
- aids in their psychological response
Shift: accept & reappraise
Persist: Meaning & optimism
How to/What is important for the “shift and persist models” to work?
Stable and positive role models : esp those who went thru life adversities
socialization of behaviors
- learn emotional regulation behaviors and appropriate responses (shift)
- focus on future orientation (persist)
- successful role models serve as inspiration (shift and persist)
Positive attachment figures
- Act as social support (persist)
- Increase optimism (shift and persist)
Why “shift”?
shifting involves 1. accepting stressors, followed by 2. re-appraising the stressors to adjust oneself to external environment
- re appraisal: re-evaluating a stressful situation to reduce its emotional impact
- stressors of lower emotional impact become more manageable
children who are able to re-appraise stressors tend to have less behavioural problems and higher emotional well-being
Why “persist”?
persisting involves enduring adversity through 1. finding meaning in life, and 2. maintaining optimism about the future
- meaning increases sense of coherence in the world, and helps to reconcile stressful encounters with one’s belief about the world and self
What are some direct evidence for the shift and persist mdoel?
High shift and persist leads to extreme low increase in inflammation and fall in obesity as compared to those having low shift and persist
Why is shift-and-persist helpful for low SES indivduals
Primary vs. Secondary control
Primary: Changing the environment to fit the self.
Secondary: Changing the self the fit the environment.
Due to lack of resources, low SES individuals can afford secondary (change the self) rather than primary (change the environment) control.
Shifting facilitates secondary control.
Persisting helps to sustain secondary control
How has health care services evolved over time?
In the past, physician’s authority accepted without question
Now -> “patient consumerism” - give patients with choices -> patients do better when engaged + increase self-efficacy
What is the patient’s perspective in the patient-provider setting?
Need to present and convey symptoms in 12-15 mins, feeling sick and discomfort, feel low status
What is the provider’s perspective in the patient-provider setting?
need to extract key information relevant to diagnosis under tight schedule, patients may not present relevant or most important symptoms for diagnosis , feel High status
What does the provider’s communication look like?
Inattentiveness, Stereotypes, Depersonalisation for concentration and emotional protection, Use of jargon to hide uncertainty abt diagnosis and prevent question from patients, Baby talk
What does patient’s communication look like?
Poor health literacy esp amg less educated and elderly, language barrier, anxious/neurotic leads to exaggeration of symptoms, patient expectation about what should be treated
What is the challenges to assessing & understanding patient-provider communication?
When patient don’t follow up, unclear if its good or bad -> lack of feedback esp positive feedback, knowing what went right is as impt as what went wrong
What are the consequences of poor patient-provider communication?
Dissatisfaction with service -> increase stress and reduce willingness to use medical services in future
increases non-adherence/non-compliant to treatment recommendation -> affect process and likelihood of recovery
What is the placebo effect?
produces an effect—psychological or physiological—in the patient, due to its therapeutic intent and not its specific chemical or physiological properties
How does placebos work?
Placebo -> beliefs and expectations that can lead to improvement or dampening of -ve affect and stress physiology (often psychologically mediated effect that can also trigger real changes in physiology)
What is the nocebo effect?
when information about the potential adverse effects of a procedure, rather than the procedure itself, produces the adverse effects
Nocebo effects are similar to placebo effects as…
effects can be psychologically (-ve expectations and beliefs) and physiologically mediated (increased negative affect and activate stress systems)
In what ways can patient-provider communication can enhance placebo effects?
- Creating symbolic value
- when patient-provider communication is clear, patients understand what is wrong and perceives that the provider is doing smth abt it -> understanding and perception is soothing; reduces -ve affect and stress - Increases treatment adherence
- when patient-provider communication is +ve, increases treatment adherence, enabling placebo effects to occur
How did they test the effects of provider characteristics on placebo/nocebo responses?
- Histamine skin-prick -> 2. Gave cream with 3. information c1: Placebo - reduce reaction or c2: nocebo - increase reaction -> info told be physician what was High or Low warm + High or Low competence (factorial design)
Can provider characteristics affect placebo/nocebo responses?
Nocebo effects (negative expectations) occurred, regardless of physician characteristics.
Some placebo effects (positive expectations) occurred as long as the physician was high in competence or warmth.
Placebo effects were the strongest when the physician was high in both warmth and competence.
How can providers help improve treatment success?
- Enhancing provider communication - simple behaviors (greeting by names), increase warmth thru non verbal contact, regular training and encourage patients to ask qns (Warm and friendly physicians were less likely to be claimed against for malpractice )
- Probing barriers to adherence - provide clear info about treatment, breakdown complex treatment into sub-goals, address practical barriers to adherence (costs), engage technology for reminders
What is burnout among healthcare professionals?
occupational risk for those in human services sector
Cycle: Emotional exhaustion -> low sense of efficacy -> cynicism
What cost does burnout have?
Institutional: absenteesim, high turnover, suicide
Personal: lack of sleep, insomnia, health compromising behaviors, psychosomatic disorders, irritability
What are some causes of burnout among health care professionals?
Hectic and fast pace in hospitals, Expectation of consistent empathy
Giving too much than “receiving” (from patients & family), Low control, autonomy, (positive) feedback, perception of success, Being very empathic by nature
What happens when there is a lack of support for physicians providers?
- Engage in defensive medicine: deviation from sound medical practice due to fear of medial malpractice
- avoid high risk surgeries
- avoid patients with complex medical problems
- eliminate or avoid procedures prone to complications - Burnt out
- esp surgeons - highly complex and high stakes
- fear of litigation
- higher empathy = higher likelihood of burnout
How can we better support physicians providers?
Health services for medical doctors: training, reducing burnout, allow them do job without fear
Health services for institutions: ensuring sufficient & sustainable healthcare resources, reducing healthcare worker burnout, improving operations, fair pay vs taxes
