PPS Psychological Perspectives Flashcards
Define psychology
Formal study of the mind and behaviour
Conclusions are based on systematic observation and experiment
What is health psychology?
Relatively new field /concerned with all
aspects of health and illness across the lifespan / devoted to understanding the psychological influences on health and illness and people’s behaviours in response to illness.
Matarazzo’s definition of health psychology
“Health psychology is the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of aetiologic and diagnostic correlates of health, illness and related dysfunction and the analysis and improvement of the health care system and health policy formation.”
Why do we need health psychology?
Mind-body relationship (psychological and social factors are also influential factors in health and illness )
Goals of health psychology
- To promote and maintain health (e.g., stop smoking, buckle
belts) - To prevent and treat illness (e.g. reduce High Blood pressure).
- To focus on cause and detection of illness: influence of personality, cognitive processes
- To improve the health care system/health policy.
Historical and cultural origins
Psychoanalytic contributions by Sigmund (barf) Freud
Sigmund Freud (1856-1939) and his work on conversion hysteria:
- Specific unconscious conflicts can produce particular physical disturbances that symbolize repressed psychological conflicts - Pt converts conflict into a symptom via voluntary nervous system, thus becoming free of the anxiety that would be produced by the conflict
When and how did health psychology begin?
Formally began in the 1970s
- Health Psychology division in the American Psychological Association (APA) was developed in 1979
- British Psychological Society (BPS) set up a section in 1986, which was formerly recognized in 1997
- “Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” WHO 1946.
The holistic nature of health was thus emphasized.
Changing patterns of illness
1900’s and before - infectious diseases or war were the main cause of death
(acute conditions such as TB and pneumonia)
Today : contagious diseases and infections contribute minimally to illness and death in the Western World -> most deaths are caused by heart disease, cancer and strokes, diseases which studies suggest are a by-product of
lifestyle
WHO (2004) - 65% of the world’s population live in countries where
overweight and obesity kills more people than underweight
Half of all deaths that occurred in the United States in 2000 can be attributed to a limited number of largely
preventable behaviours and exposures (Mokdad et al., 2000). This is where Health Psychologists are particularly
effective.
Illnesses related to Psychological/Behavioural factors
Heart disease and stroke Cancer HIV/AIDS COPD Type II diabetes Poor birth outcomes Chronic pain conditions Infectious illnesses
Biomedical vs Biopsychosocial model of health
BIOMEDICAL MODEL
Focuses only on the biological and medical aspects that constitute health
Therefore only focusing on presence/absence of clinical illness and disease to define “healthiness”
A narrow and focused model of health
BIOPSYCHOSOCIAL MODEL
Focuses of the biological, psychological and socio-cultural aspects that constitutes health and wellbeing
- Biological aspects – e.g. -Presence/absence of clinical illness
- Psychological aspects – e.g. mental state and feelings
- Socio-cultural aspects – e.g. financial aspects, occupations
A more holistic approach to health
other main areas of psychology relevant to medicine?
Paradoxical effects
Erskine, Georgiou and Kvavilashvili 2010
Trying not to think about smoking versus thinking about smoking for a one week period (2 groups plus control to provide baseline)
Following week suppression group smoking was elevated compared to expression group- paradoxical effect as you would think group trying not to think about smoking would smoke less.
Research methods in psychology
Randomized controlled trials = compare effect of a treatment intervention vs a control intervention (stress management training on pain reduction)
Laboratory experiments= interventions in a controlled setting
Quasi-experiments= when we don’t have a control condition or when sample is not random
Cross-sectional surveys= when you question certain groups of individuals about psychological factors (ie, is greater physical activity participation associated with improved mental health among adolescents)
Longitudinal surveys= questioning a group across time
Field experiments= experiments conducted in participants usual environment (ie, questioning pregnant women in their homes and asking them to keep diaries while attempting smoking cessation )
What do health psychologists do?
Help measure/assess for mental and behavioural problems
Conduct clinical interviews
Administer surveys and personality tests.
Design interventions to help:
With stress management,
Educate about disease and illness,
Ways to cope with disease,
Perform more health behaviours such as physical activity.
Health psychology research examines
The causes and development of illness,
Methods to help individuals develop healthy lifestyles to promote good health and prevent illness,
The treatment people get for their medical problems,
The effectiveness with which people cope with and reduce stress and pain,
Biopsychosocial connections with immune functioning
Factors in the recovery, rehabilitation, and psychosocial adjustment of patients with serious health problems.
Health psychologists carry out research in areas such as:
HIV,
Cancer
Compliance with medical regimens,
Health promotion,
The effect of psychological, social, and cultural factors on numerous diseases (diabetes, chronic pain, sleep disorders, cancer, hypertension and coronary artery disease)
Theories of obesity
Genetics
E.g. parental obesity, or slower metabolic rates
Economic
E.g. Higher energy, fatty foods cheaper
Behavioural
E.g. Eating more than needed/used
Psychosocial
BMI raised depression eating -> cyclical event
Obesity interventions
Psychological interventions:
- Weightwatchers
- Food diary
- Cognitive Behavioural Therapies
Exercise
Changing work patterns
Changing modes of transport
Two types of data collection for psychological studies of health behaviour
QUANTITATIVE
Objective data – usually from larger cohorts
Examples: Surveys, Likert scales
Pros: Quicker to do, easy to compare data, cheaper
Cons: Not in-depth, possibly affected by bias
QUALITATIVE
Subjective data – usually from smaller cohorts
Examples: Interviews, Narratives analysis
Pros: In-depth, generates lots of information about behaviour/governance
Cons: Hard to standardise/compare data, time consuming, hard to find participants
Models of health behaviour list
There are 4 main models
- Health Belief Model
- Planned Behaviour Theory
- Transtheoretical Model
- COM-B model
5th theory/model = Cognitive Dissonance
HEALTH BELIEF MODEL ANSWER LAYOUT
definition, pro, pro, con, con, example
Expectancy-threat based model – weighing bad outcome of behaviour vs ability to act against it *
Perceived threat + Susceptibilities + Barrier/Benefit Vs Self-Efficacy -> Behaviour change
Pros:
Lets you compare influences of behaviour changes *
Highlights importance of “barriers” influencing behaviour changes*
Cons:
Ignores emotions/social norm/motivations for bad behaviours *
Doesn’t “predict” behaviour change *
People like to underestimate risk
Elements of the model aren’t tested as to their relationship to one another
Example: “Cake is bad for me, I’m fat and at risk of T2DM, family have it, cake is cheap and tasty, can I quit?
PLANNED BEHAVIOUR THEORY ANSWER LAYOUT
Expectancy based model – intentions + self control affect behaviour changes*
Intentions comprise of: Attitude + Subjective Norms + Perceived control
Pros:
Model is somewhat predictive of behaviour change (28%)*
Factors in social norms affecting thought process*
Perceived control is most important
Cons:
What happened to the other 72% predictive value?
Past-behaviour is not factored in – most indicative predictor*
Doesn’t factor environmental or socioeconomic factors*
Example: “I like cake – My PBL group eats cake – I could stop eating it – but cake is addictive…”
TRANSTHEORETICAL MODEL ANSWER LAYOUT
Stage-based model: Suggests 5 stages leading to intentional behaviour change*
Assumes a drawn out cyclic process where they undergo decision making processes (6mo)
Pre-contemplation -> contemplation -> Prep -> Action -> Maintain (Relapse)*
Pros:
Intuitive model*
Can predict some behaviour change*
Identifies broad processes leading to change
Cons:
Ignores spontaneous change*
Stages don’t always go in same order*
No assessment of readiness to change
Example: “I like cake -> Cake can kill me I’m hiding cake paraphernalia -> I eat less cake -> Feeling healthy now”
COM-B MODEL ANSWER LAYOUT
Change-assessing model:
Capability +Opportunity + Motivation = Behaviour change*
A change in 1≤ of the 3 factors can lead to behaviour changes
Pros:
Model can help design behaviour interventions*
Can identify components needed to be changed to hit behaviour targets*
Cons:
Doesn’t explain statistical behaviour variance*
Biased assumption that people are “rational” beings*
Example: “I like cake and buy it daily, and I want to quit, and the bakery is shut. Therefore I don’t need cake”
COGNITIVE DISSONANCE ANSWER LAYOUT
Not a model
Cognitions are thoughts/beliefs
Cognitions can be:
Consonant* - Thoughts that agree
Dissonant*** - Thoughts that disagree – induces negative thoughts
- Resolved by changing belief, blocking a belief, or adding a new belief
Irrelevant* - Thoughts that do not relate to each other
Health Model Table Summary
other main areas of psychology relevant to medicine?
Psychoanalytic contributions by Sigmund (barf) Freud
Sigmund Freud (1856-1939) and his work on conversion hysteria:
- Specific unconscious conflicts can produce particular physical disturbances that symbolize repressed psychological conflicts - Pt converts conflict into a symptom via voluntary nervous system, thus becoming free of the anxiety that would be produced by the conflict
Psychoanalytic contributions by Sigmund (barf) Freud
Sigmund Freud (1856-1939) and his work on conversion hysteria:
- Specific unconscious conflicts can produce particular physical disturbances that symbolize repressed psychological conflicts - Pt converts conflict into a symptom via voluntary nervous system, thus becoming free of the anxiety that would be produced by the conflict
