Notes Flashcards
What does it mean to be healthy?
“a complete state of physical, mental and social wellbeing… not merely the absence of disease or infirmity” (World Health Orginisation, 1946, p. xi)
What are some critiques of the World Health Orginisation (1946, p. xi) definition of health
- May be too broad
- Not just presence or absence of symptoms, but how the individual interprets/exeriences them
- No mention of socio-economic health and cultural influences
What is Wellbeing?
The overall state of being comfortable, healthy, and happy, both physically and psychologically (Wilroth, 2023)
What are the 6 dimensions of wellbeing
- Physical
- Mental/Emotional
- Social
- Environmental
- Occupational
- Spiritual
Which out of the 6 dimensions is this:
state of ones body - encompassing aspects e.g nutrition, exercise, sleep and overall health
Physical
Which, out of the 6, dimension is this:
state of ones mind- involving emotional regulation, resilience and psychological health
Mental/Emotional
Which, out of the 6, dimension is this:
quality of relationships and social connections
Social
Which, out of the 6, dimension is this:
state of the external surroundings, including impact of the environment on health and overall satisfaction
Environmental
Which, out of the 6, dimension is this:
satisfaction and fulfilment derived from work
Occupational
Which, out of the 6, dimension is this:
sense of purpose, meaning and connection to something greater than oneself
Spiritual
Subjective vs Objective Wellbeing
Subjective:
individuals personal assessment of their life and overall wellbeing
Objective:
measurable indicators such as physical health, income, and social relationships that contribute to overall wellbeing
Early concepts of illness (History):
(3000 BC)
What was the treatment of abnormal behaviour attributed to supernatural explanations (such as possession)
Trephining- allowed evil spirits to escape the head
Early concepts of illness (History):
What did Hippocrates (460-377 BC) establish?
Note: he was a Greek physician of the classical period
Humoral theory:
the body contained four different fluids i.e humours that can being a state of balance (good health) or imbalance (illness)
Mind concerned with thoughts, perceptions, and feelings - little to no relationship to the body and its state of health
Early concepts of illness (History):
- What are the four humours?
- Who came up with the theory of them?
- Yellow bile (fire), hot/dry
- Blood (air), hot/wet
- Phlegm (water), wet/cold
- Black bile (earth), dry/cold
- Hippocrates (460-377 BC)
Early concepts of illness (History):
What did the Greek physician Galen (129-216 AD) establish?
During the roman empire, aware of disease localisation
Early concepts of illness (History):
What period of time did science, maths and medicine flourish?
Islamic Golden Age (750-1300)
Early concepts of illness (History):
What period in history did progression in understanding health seem to be going backwards?
Hint: Back to supernatural explanations for widespread disease
Middle Ages (concept of illness): 5th-14th Century
Early concepts of illness (History):
What theories were maintained during the Middle ages (5th-14th century)?
Maintained humoural theory but upheld causes of disease (including God punishing people for their behaviour)
Early concepts of illness (History):
What period of time was credited for producing new ideas and significant change?
Renaissance (17th-19th Century)
Early concepts of illness (History):
Renaissance concept of illness used a term “Bedlam” meaning crazy- what did this term refer to?
Individuals that acted ‘abnormally’, also the name of the first asylum used to contain people that fit that description
Early concepts of illness (History):
What period of time is credited to have rapid acceleration in medial and scientific knowledge?
19th-19th century, enlightenment and scientific revolution
Early concepts of illness (History):
What did the enlightenment and scientific revolution (17th-19th century) find?
Found surges in
- intellectual reason
- individualism
- challenged supernatural and religious understandings/structures
Early concepts of illness (History):
What is Wilhelm Wundt (1832-1920) credited for?
The birth of psychology - campaigned to make psychology an individual form of health.
Which model was found after the long-standing mind/body belief split?
Biomedical model
Biomedical model
- Traditional view of western medicine
- Health = absence of disease
- Disease in conceptualised as a biological
process (absence of psychological and
social influences)
- Disease in conceptualised as a biological
Psychosomatic Medicine
- Psychoanalytic school of thought that looks at researching psychosomatic medicine (early 1900s)
What model is this: theory is that patterns of personality are linked to specific illness
Psychosomatic Medicine
Which model brought about the formation of the DSM-1 (1952)?
a) Biomedical model
b) psychosomatic medicine
c) Humanitarian reform
d) Information age
c - humaintarian reform (1950s-1970s)
Which model introduced the biopsychosocial model?
Humanitarian reform (1950s-1970s)
Key points on the Humanitarian Reform (1950s-1970s)
- introduced the biopsychosocial model
- formation of the DSM-1 (1952)
- Reformation for deinstitutionalisation from asylums (focus on community health care)
What model saw a surge of new technologies that shaped the modern world
Information Age (1970s-now)
Which model refined holistic psychopharmacology options- creating more subjective and individualistic treatment for patients?
a) Biomedical model
b) Psychosomatic medicine
c) Humanitarian reform
d) Information age
Information age (1970s-now)
What is EBP?
Evidence-based practice
Evidence is used to determine or demonstrate an assertion of truth
EBP integrates SCP, What does that stand for?
S: scientific evidence
C: clinical experience
P: patient values
What is the purpose of EBP?
- improve quality, effectiveness and appropriateness of clinical practice
- reduce variation in practice patterns, gaps between knowledge and application to care
- substantiate the care provided to clients
- shared decision making w/. client
- framework for quality care
Why is research important for EBP?
- The goal of the research process is to provide reasonable answers to interesting questions (i.e., evidence!)
- EBP relies on critical thinking skills and includes:
- evaluating research findings (i.e., evidence)
- awareness of bias
- ethical practice
- clinical reasoning and logic
What is EMINENCE-based practice?
Health-related fields seem to rely on experience → however, theres no evidence to support this
What is a link between eminence-based practice and pseudoscience
Modern comeback from 1800s:
- Physiognomy: attempt to read personality from facial features
- Phrenology: personality traits are represented by different parts
What are some of the contemporary issues with media, marketing and self-help?
Social media: destigmatise BUT still lots of misinformation
“Self-help”: industry influenced by media and marketing - encourages using resources that provide personal monetary gain for the seller - utilises the word “may” to not hold accountability (dodgy stuff fr)
Influences to biases and thoughts can cause individuals to form personal beliefs and belief systems
The statement refers to Individual psychology and cognitive biases… How is this a threat to critical thinking?
- Confirmation bias
- ‘My side’ bias
- Attentional bias
Anchoring/insufficient adjustment bias - influence of anecdotes over statistics
OVERALL: access to simplified, condensed, consumable info doesn’t give the same help as clinical practice (duh)
What is confirmation bias?
search for evidence that confirms beliefs and discount other evidence that may discredit it
What is ‘My side’ bias
evaluate situations from a personal perspective
What is attentional bias?
drawn to our emotional responses, neglecting objective data
What is anchoring / insufficient adjustment bias
Overly influenced by one past reference of information
“Practice” part of EBP, What are the AAAA?
1 . Accountability
2 . Advocacy
3 . Alturism
4. Autonomy
Which AAAA (Practice part of EBP) is this:
Practitioners need a high degree of legal accountability
accountability (duh its legit in the definition)
Which AAAA (Practice part of EBP) is this:
using good evidence to support their client
advocacy
Which AAAA (Practice part of EBP) is this:
always seek to do the best for your clients by using evidence that improves outcomes
Alturism
Which AAAA (Practice part of EBP) is this:
independent professional judgement to support your clients
autonomy
What are the 6 steps of the hierarchy of evidence?
Research:
1. Intervention: does the treatment work?
2. Diagnosis
3. Prognosis: what is the outcome of a condition?
4. Aetiology: cause of the condition?
5. Epidemiology: what is the trend of risk?
6. Experiences
Qualitative research
provides findings in words → used for questions about experiences : anti-positivist (not everything can be measured in number)
Quantitative research
provides findings in numbers → needed for studies about interventions, diagnose tests etc: positivist (things can be numeric)
Selecting a qualitative method: Understanding human experience
(note: further info in notes + diagram)
Phenomenological methods
(What is the human experience of…)
Selecting a qualitative method: Uncovering social processes
(note: further info in notes + diagram)
Grounded theory
(what is the theoretical explanation for people’s reaction to…)
Selecting a qualitative method: Learning cultural patterns
(note: further info in notes + diagram)
Ethnographic method
(How does this cultural group express their pattern of…)
Selecting a qualitative method: Capturing unique stories
(note: further info in notes + diagram)
Case study method
(What are the details and complexities of the story of…)
Observational research (non experimental) is an example of a quantitative research… What are some related study methods?
Prospective studies and Retrospective studies
Prospective studies
(observational research)
begin with participants that don’t have a condition → longitudinal study to see if it develops
Retrospective studies
(observational research)
begin with participants who have the condition and look back to see if you can identify why these participants have the condition
Aetiological claims: if we cannot use experimental methods, there are six criteria that need to be met…
example: How do we know that chronic pain causes depression?
- A “dose-response relationship” exists between chronic pain and depression
- Chronic pain precedes the onset of depression
- A cause-and-effect relationship between chronic pain and depression is physiologically plausible
- Relevant research data consistently reveal a relationship w/ depression and chronic pain
- Strength of that correlation is relatively high
- Studies revealing correlation are well designed
What is the “Hierarchy of evidence”?
a framework for ranking evidence that evaluates health research - indicating which studies should be given most weight in an evaluation
What is the order (top to bottom) of the “Hierarchy of evidence” ?
(note: elaboration and diagram in notes)
- Systematic reviews
- Randomised controlled trials
- Cohort studies
- Case-control studies
- Case series, case reports
- Editorials , expert opinion
“Hierarchy of evidence”: Systematic Review (SR)
What rank is it (out of 6)?
What is it?
Rank: 1
Comprehensive and transparent literature review that uses explicit and systematic methods to
- identify
- select
- critically appraise
- synthesise
all available evidence
“Hierarchy of evidence”: Randomised Control Trial (RCT)
What rank is it (out of 6)?
What is it?
Rank: 2
rigorous design of health research… determine whether a cause-effect relation exists between the treatment and outcome
- participants randomised to receive on of the treatment arms
- randomisation balances risk factors
Describe the process of a randomised control trial (RCT)
(note: elaboration and diagram in notes- more useful)
Population recruitment
↓
Becomes sample
assessed for eligibility - if not they’re excluded
↓
Eligible sample = baseline assessment + random allocation
↓.
Grouped into…
Control: start/end of treatment assessment
OR
treatment
“Hierarchy of evidence”: Non-randomised Control Trial (hint, apart of RCT)
What rank is it (out of 6)?
What is it?
Rank: 2
compare control and treatment group outcomes
- Study lacks the random allocation of participants to either control or treatment group
“Hierarchy of evidence”: Cohort studies
What rank is it (out of 6)?
What is it?
Rank: 3
Longitudinal study of a group (often share a common trait/experience). Followed to study and track outcomes of a intervention/exposure
- good for cause-and-effect relationships
“Hierarchy of evidence”: Case-control studies
What rank is it (out of 6)?
What is it?
Rank: 4
compare a group with a certain disease or outcome (cases) with another group who do not have the outcome or disease (control)
“Hierarchy of evidence”: Case series
What rank is it (out of 6)?
What is it?
Rank: 5
(Aka time series or before and after study
for more rare conditions where only a few people are affected. Researcher measures participants at the start and end of the intervention (no control treatment allocated)
“Hierarchy of evidence”: Case study/report
What rank is it (out of 6)?
What is it?
Rank: 5
(n=1 study), qualitative or quantitative evaluation of one case (often measured before and after an intervention)
“Hierarchy of evidence”: Expert opinion
What rank is it (out of 6)?
What is it?
Rank: 6
Low-level evidence since there is capacity for bias (but still has value)
Meta-analysis (MA)
objective statistical method used to combine and analyse the results of ,multiple independent studies on a specific topic
Benefits of a Meta-analysis (MA)
- more precise estimate of effect size
- increases the generalisability of the results of individual studies
- identify patterns
- establish consistency
- determine overall measure of a treatment’s effect
Limitations of a Meta-analysis (MA)
- dependence on study quality
- trust in accuracy of raw data
- complexity surrounding its methodology and interpretation
*different to systematic review as this contacts the researchers and asks for their raw data so you can run the research yourself - more subjective
Interval validity vs external validity
Internal = truth in the study
External = truth in real life
*Note: generalisation can lead from internal to external
Threats to internal validity: (hint… theres 8)
- Placebo effect (focus for today tho)
- Hwthorne effect
- Natural recovery or maturation
- Bias from assessor
- Recall bias
- Process of treatment
- Performance bias
- Rosenthal effect
Placebo effect
Improvement due only to experiencing an intervention or event, whether real or not
- a ritual of intervention
- estimated to be around 30% improvement
Placebo impact people psychologically and physically by altering neurotransmitters, hormones, and endorphins
Key term: Interviewing
Gathering data, Providing information, suggesting workable solutions to resolve concern
Key term: Coaching
Parterining with others in a thought-provoking and creative process to inspire the maximisation of personal and professional potential
Key term: Counselling
Intensive, personal → listening and developing strategies for change and growth
Define a ‘Therapeutic alliance’
Use of effective skills to seek and assist others
- review their problems and their options/choices to deal with these problems
Key term: Psychotherapy
Deep-seated individual issues, require more time for resolution
What are dual purposes of a therapeutic alliance
- provide opportunities to develop coping skills (internalised empowerment)
- increase of self-understanding and self-control
- decreased emotional distress
- progress toward self-identified goals
attending: S.O.L.E.R
S: Sit Squarely
O: adopt an Open Posture
L: Lean forward
E: maintain Eye contact
R: be Relaxed and natural
attending: S.U.R.E.T.Y
S: Sit at an angle
U: Uncross legs and arms
R: Relax
E: maintain Eye contact
T: Touch
Y: use Your intuition
The Skilled Helper Model stages
Egan (1990s) - Model to help and focus on a problem
Stage 1: Current scenario (Exploration stage)
Stage 2: Preferred scenario (Challenges stage)
Stage 3: Getting there (Planning stage)
- sub-stage: reality testing and options
Stage 4: Committing to action (Action stage)
What are the two forms of reflection
- reflection-IN-action
- quick thinking while you’re engaged in an activity - reflection-ON-action
- when you consider the activity afterward