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Semester 3 > Healthpsych > Flashcards

Healthpsych Flashcards

1
Q

What was the problem concerning the biomedical model?

A

It did not take psychological factors into consideration.

Treatment involves physical intervention – drugs and surgery

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2
Q

Why is the biopsychosocial model preferred to the biomedical model?

A

The idea that the biological, psychological and social aspects are all linked.

Health and illness were seen through the idea of:
• Physiology, Genetics, Pathogens
• Cognition, emotion, behaviour
• Social class, employment, social support

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3
Q

Name the 3 types of learning theories

A

o Classical conditioning - association with other stimuli (behaviour becomes habit)
o Operant conditioning – behaviour reinforced by rewards and punishments
o Social learning theory – observe others’ behaviour and see what’s rewarded and punished

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4
Q

Explain classical conditioning

A

Pavlovian Conditioning – force of habit

Many physical responses can become classically conditioned
Anticipatory nausea in chemotherapy
Phobias e.g. fear of hospitals

Unconsciously paired with the environment or emotions

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5
Q

Explain operant conditioning

A

People (or animals) act on the environment; behaviour is shaped by the consequences e.g. reward or punishment
o Behaviour reinforced (increased) if it is rewarded or punishment is removed
o Behaviour decreases if it is punished or the reward is removed

Unhealthy behaviours are often immediately rewarding; driven by the short term

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6
Q

Explain social theory learning

A

People can learn vicariously i.e. observation/modelling

Behaviour is focused on desired goals/outcomes

People are motivated to perform behaviours that are valued or they believe that they can re-enact

Modelling is more effective if models are high status or “like us” (value/ability)
Family or celebrities play important part here

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7
Q

What are the two social cognition models?

A

o Health Belief model

o Theory of planned behaviour

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8
Q

What does the health belief model look at?

A

Beliefs about health threat
• Perceived susceptibility
• Perceived severity

Beliefs about health barriers
• Perceived barriers
• Perceived benefits

Cues of Action

All leading to Action

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9
Q

What are the limitations to the health belief model?

A

o Rationale and reasoning – often consequences are only thought about after the action
o Decisions – habit, conditioned behaviour, coercion
o Emotional factors – fear
o Incomplete – self-efficacy, broader social factors

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10
Q

Outline the theory of planned behaviour

A

Belief about outcomes/ evaluation → Attitude towards behaviour → Behavioural intention → behaviour

Normative beliefs motivation to comply → Subjective norm → behavioural intention → behaviour

individual control barriers and facilitators → perceived control → behavioural intention/ behaviour → behaviour

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11
Q

What are the advantages of TPB?

A

good predictor of intentions

Concrete plans of action

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12
Q

What are the disadvantages of TPB?

A

poor predictor of behaviour

Problem is translating the intentifons into a behaviour; not a certainty to happen

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13
Q

What are the Stages of Change (Transtheoretical) Model

A
  1. Pre-contemplation – “I’m a smoker and not worried about it”
  2. Contemplation – “Been coughing recently. Maybe it’s the smoking?”
  3. Preparation – “I’ll try to cut down gradually until I quit”
  4. Action – “I am smoking 1 cig per day less that the day before, until I get down to zero”
  5. Maintenance – “I’ve not smoked for 3months”
  6. Relapse – “Just having the off cigarette won’t hurt – ill cut back again (? cycle back to 3. Preparation stage)
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14
Q

How do you avoid relapse?

A
  • Identify and avoid high risk situations

* Improve coping skills, ‘road map’, written instructions

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15
Q

What are some strategies for changing health behaviour?

A
  • Information – health education, health promotion
  • Behavioural skills and resources e.g. smoking cessation programmes, exercise advice
  • Incentives to change e.g. financial incentives
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16
Q

What is motivational interviewing?

A

Client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

Aims to elicit patient’s own arguments for change

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17
Q

How do you carry out motivational interviewing?

A
  1. Express empathy
  2. Develop discrepancy
  3. Roll with resistance
  4. Support self-efficacy
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18
Q

What is the transactional model of stress?

A

It looks at both the stressors and the resources available, and appraises whether you can cope with it before leading to stress response

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19
Q

What is primary appraisal?

A

o Is this event a threat? How bad could it be?

o Benign, challenging, threatening

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20
Q

What is secondary appraisal?

A

o Do I have the resources or skills to cope?

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21
Q

What are the 3 stages to process of appraisal?

A
  • Primary Appraisal
  • Secondary Appraisal
  • Reappraisal
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22
Q

What are types of stress managements?

A
  • Cognitive strategies - e.g. cognitive restructuring, hypothesis testing
  • Behavioural strategies – skills training e.g. assertiveness, time-management
  • Emotional strategies – counselling, emotional disclosure, social support
  • Physical strategies – relaxation training, biofeedback, exercise
  • Non-cognitive strategies – drugs
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23
Q

What are the 4 ways stress can influence health?

A
  1. Physiological responses causes physical damage, especially when intense and/or prolonged
  2. Effects on the immune system can increase vulnerability to infection
  3. Coping efforts: increase in unhealthy behaviour
  4. Negative impact on mental health (e.g. anxiety, depression) affecting coping and illness behaviour
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24
Q

What is coping?

A

finding ways to manage events/experiences that are appraised as threats or demands, and which tax or exceed a person’s available resources

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25
Q

What are two types of coping strategies?

A

Emotion focused coping

Problem focused coping

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26
Q

Explain emotion focused coping

A

o Behavioural approaches; do something e.g. talking to friends, alcohol, finding a distraction
o Cognitive approaches: change how you think about the situation, e.g. denial, focus on positive aspect of problem – have to give up job you don’t like, chance to do something different

27
Q

Explain problem focused coping

A

o Reduce demands of a stressful situation e.g. find out how to cope with feelings of claustrophobia in mask for radiotherapy
o Expand resources to deal with it e.g. if mobility a problem, focus on physiotherapy exercises, buy a motorised wheelchair etc.

28
Q

What is sexual dysfunction?

A

Characterised by a disturbance in sexual desire and in the psychophysiological changes that characterise the sexual response cycle and cause marked distress and interpersonal difficulty

29
Q

How does sexual dysfunction present?

A

Sexual problems may present overtly or covertly e.g.

Never being happy with any offered method of contraception
• Reluctance to raise a sexual problem
• Increasing number of individuals seeking help

30
Q

What are points to consider with sexual dysfunction?

A
  • Empathy of reassurance
  • Embarrassment
  • Stigma
  • Privacy and confidentiality
  • Open and specific questions
  • Avoid labels and value judgements – do not make assumptions
  • Terminology
  • Religious and cultural issues
  • Interview partner
31
Q

What is a structured clinical interview?

A
  • Detailed description of the problem, its onset and progression - Include behavioural, affective and cognitive functioning
  • Relationship with partner
  • Relevant past relationships
  • Medical history and drug use
  • Mental health history
  • Family and pychosexual history – with upbringing
  • Significant life events – trauma, rape, child abuse
  • Sexuality
  • Cultural aspects
  • Coping mechanisms and support networks
32
Q

What are stereotypes?

A

o Organisation of knowledge in Schemata
o Energy saving, allows anticipation, avoid information over-flow and right ‘most of the time’
o But, overlooks the individual

33
Q

What is prejudice?

A

Pre-judgement often based on negative stereotypes

34
Q

What is discrimination?

A

Behaving differently with people from different groups because of their membership

35
Q

When are you more likely to rely on stereotypes?

A

o Under time pressure
o Fatigues
o Suffering from information overload
o Unfamiliar circumstances

36
Q

How can you avoid prejudice and discrimination?

A

o Getting to know members of other groups

o Reflective practice

37
Q

Why is mental health important to treat?

A

o Compromises quality of life
o Patients cope less well with treatment
o Association with poor HRB e.g. drinking, smoking (HRB= health related behaviour)
o Association with lower adherence to treatment
o Increased risk of morbidity and mortality

38
Q

Why might there be problems recognising psychological problems?

A

Patients may not disclose
• May wish to avoid being judged as inadequate or failing to cope
• May wish to avoid complaining/presenting additional burden
• Fear of stigma associated with mental illness
• Believe psychological problems are inevitable in their condition
• Fear of consequences e.g. more medication
• Doctor’s poor communication skills
• Lack of time in consultations

Health professionals may not ask:
• May believe psych problems are outside of their role/fear of overwhelming distress of the patients
• Reluctance to label patients as having psychological difficulties

39
Q

What is cognitive behaviour therapy?

A

Change maladaptive thoughts, beliefs and behaviour; focus on ‘there and now’
o Suitable for: depressions, anxiety, phobias, eating disorders, schizophrenia
o People need to be willing to engage actively/collaboratively and can articulate problems

40
Q

What is humanistic therapy

A

o Warmth, empathy, unconditional positive regard

o Suitable for: life events, mild depression, anxiety and stress

41
Q

What are Psychoanalytic/psychodynamic therapies?

A

Address unconscious conflicts and resolve previous painful experiences

Suitable for: interpersonal/personality problems
• People with the capacity to tolerate mental pain and interest in self-exploration

42
Q

What is compliance?

A

Extent to which the patient complies with medical advice

43
Q

What is adherence?

A

Extent to which patient behaviour coincides with medical advice

o Similar to compliance, normally used interchangeably

44
Q

What is concordance?

A

o Negotiation between the patient and doctor over treatment regimes
o Implies the patient is active and in partnership with the doctor
o Patient’s beliefs and priorities are respected and decisions are shared
o Trying to be incorporated into clinical practice more and more

45
Q

What are the two reasons for non compliance in Ley’s Model of Compliance?

A
  • Unintentional non-adherence

* Intentional non-adherence

46
Q

What are reasons for Unintentional non-adherence

A

Capacity and resource limitations e.g.
• Individual constraints – memory, understanding, dexterity
• Aspects of the environment – problems accessing prescriptions, competing demands, lack of social support

47
Q

What are reasons for intentional non-adherence

A

Beliefs, attitudes and expectations e.g.
• Beliefs about susceptibility/severity
• Costs/benefits e.g. side effects
• Other options e.g. complementary therapy
• Poor doctor-patient relationship/lack of trust
• Maintain a sense of control
• Stigma/avoid labelling as a ‘patient’

48
Q

Why may concordance lead to better adherence?

A

o Patient is involved in, and has shared ownership of, decisions about treatment
o Patients’ beliefs, expectations, lifestyle and priorities can be taken into account
o Barriers to adherence e.g. practical or informational can be addressed
o Promotes patient trust and satisfaction with care which makes adherence more likely

49
Q

What impact can there be if bad news is not delivered well?

A

o Emotional well-being of patients e.g. distress and depression
o Adjustment to and ability to cope with the illness, for patients and their relatives
o Doctor-patient relationship

50
Q

What is the strategy to deliver bad news?

A

S- Setting and listening skills

P – Patient’s Perception
o What does the patient know already? Before you tell, ask

I – Invitation from the patient to give information
o “How much information would you like me to give you about your diagnosis and treatment?”

K – Knowledge
o Give a warning shot → flagging
o Information in small chunks and avoid jargon

E - Empathy
o “How are you feeling?”
o Listen to the patient’s concerns

S – Strategy and summary
o Summarise the main discussion topics and check understanding
o Discuss the strategy and agree on the next step
o Closure

51
Q

What are the 5 Stage Grief Model

A 
Denial
Anger
Bargaining
Depression
Acceptance
52
Q

What is the importance of denial?

A
  • Can be a means of coping with overwhelming information and emotions in the early stage of getting the news
  • Check that the patient understands, and how much information they want to know
  • Respect desire ‘not to know’
  • Offer written information to patients to look at with their family
  • Check and review over time – ‘when ready’
53
Q

What is the importance of the grieving process?

A

o Need to work through grief; disbelief and shock, developing awareness, resolution
o Common elements – anger, blame, depression

54
Q

What are the risk factors for poor outcomes of the grief process?

A

o Prior bereavements, mental health
o Type of loss – young person, mature of death, caring status
o Lack of social support, stress from other crises
o Expression of grief discouraged
o Ending of grief discouraged

55
Q

What is the problem with separation during child development?

A

Separation leads to distress
o Protest, despair, detachment (in the past, this was mistaken for recovery, so restricted parental access to hospitalised child to reduce the visible distress
o But, negative psychological outcomes (less play, less sleep, depression, anxiety, aggression, detachment)

56
Q

How has practice changed now to help children in difficult situations?

A

o Parent/carer access, attachment objects (e.g. teddy), home-like environment, play, continuity in staff, trained staff (specialist paediatric nurses), reassure not punished/abandoned
o Social referencing – reassure parents

57
Q

What is the Childhood Cognitive Development?

A

o Sensori-motor → 0-2yrs
o Pre-operational → 2-7yrs
o Concrete operational → 7-12yrs
o Formal operational → 12yrs+

58
Q

What are possible difficulties regarding to children?

A

o Assess level of understanding, tailor communication
o Danger of metaphors with younger children
o Difficulty of expressing feelings
o Difficulty thinking about the future (abstract concept) even in adolescence: implications for adherence

59
Q

When is pain considered to be chronic?

A 
o	>3 months
o	No on-going tissue damage
o	Prolonged medication
o	Rest is not useful
o	Can arise from medical condition or from an unknown cause
60
Q

What factors can lead to open and closed gates for perceiving pain?

A

physiological events e.g. physical stimuli, tissue damage, nerve messages

And/or psychological factors e.g.g thoughts, beliefs, interpretations, fear, anxiety

61
Q

What are examples of open gate?

A
  • Injury
  • Over/under active
  • Sensitivity of NS
  • Stress and tension
  • Focusing on pain-expectation
  • Negative beliefs
  • Minimal involvement in life
62
Q

What are examples of closed gate?

A
  • Medication
  • Counter stimulation
  • Exercise
  • Relaxation
  • Distraction
  • Positive emotions
  • Positive beliefs – control
  • Active life
63
Q

What are the levels of alcohol drinking?

A

Abstention - non drinker

Low risk drinking – People who drink within the Department of Health’s sensible drinking guidelines and hence are at low risk of harmful effects.

Hazardous drinking - People who are drinking over the sensible drinking limits, either in terms of regular excessive consumption or less frequent sessions of heavy drinking.

Harmful drinking - Drinking at levels above those recommended for sensible drinking, typically at higher levels than most ‘hazardous drinkers’. Show evidence of alcohol related harm.

Moderate dependance - Drinkers who have a ‘degree’ of dependence but who have not reached the stage of ‘relief drinking’ which is to say drinking to avoid physical discomfort from withdrawal symptoms.

Severe dependance - serious and long standing problems and they are often seen as ‘chronic alcoholics’. Typically they have experienced significant alcohol withdrawal and may have formed the habit of drinking to stop withdrawal symptoms.

Semester 3 (5 decks)

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