Psychology Flashcards
What are the steps involved in the learning theory?
Antecedents
Behaviour
Consequences
What are the basic learning processes?
- Classical conditioning Learning what events signal - Operant conditioning Learning one thing leads to another - Observational learning Learning from others
What is an unconditioned stimulus?
I stimulus that elicits a reflexive or innate response (UCR) without prior learning
What is an unconditioned response?
A reflexive or innate response that is elicited by a stimulus (UCS) without prior learning
What is an conditioned stimulus?
A stimulus that, through association with a UCS, comes to elicit a conditioned response similar to the original UCR
What is an conditioned response?
A response elicited by a conditioned stimulus
When is classical conditioning strongest?
When:
- There are repeated CS-UCS pairings
- The UCS is more intense
- The sequence involves forward pairing (i.e. CS→UCS)
- The time interval between the CS and UCS is short
What is stimulus generalisation?
A tendency to respond to stimuli that are similar, but not identical, to a conditioned stimulus. e.g. responding to a buzzer or a hammer banging, when the conditioned stimulus was a bell
What is stimulus discrimination?
The ability to respond differently to various stimuli
- e.g. a child will respond differently to various bells (alarms, school, timer)
- A fear of dogs might only include certain breeds
Give an example of fear learning.
Traumatic injection → Pain/fear
Trauma (UCS and needle (CS)→ Fear response
Clinical setting (CS) → Fear response (CR)
What are the two factors that contribute to to fear learning?
1) Fear response
2) Reduced fear from avoiding the stimulus
What is Thorndike’s Law of Effect?
A response followed by a satisfying consequence will be more likely to occur
A response followed by an aversive consequence will become less likely to occur
What is operant conditioning?
Behaviour is learned and maintained by it’s consequences
What are primary and secondary reinforcers?
Primary Reinforcers- Those needed for survival e.g. food, water, sleep, sex
Secondary Reinforcers- Stimuli that acquire reinforcing properties through their association with primary reinforcers e.g. money, praise
What is negative reinforcement?
Occurs when a response is strengthened by the removal (or avoidance) of an aversive stimulus
What are “positive” and “negative” reinforcement?
Refers to the presentation or removal of a stimuli
What is positive punishment?
Occurs when a response is weakened by the presentation of a stimulus (e.g. squirting a cat with water when it jumps on dining table)
What is negative punishment?
Occurs when a response is weakened by the removal of a stimulus (e.g. phone confiscated)
What is more effective, reinforcement or punishment?
Reinforcement
What is operant extinction?
The weakening and eventual disappearance of a response because it is no longer reinforced
What is resistance to extinction (in relation to operant conditioning)?
The degree to which non-reinforced responses persist
What are the different types of reinforced schedules? Describe each one
1) Fixed interval schedule: reinforcement occurs after fixed time interval
2) Variable interval schedule: the time interval varies at random around an average
3) Fixed ratio schedule: reinforcement is given after a fixed number of responses
4) Variable ratio schedule: reinforcement is given after a variable number of responses, all centred around an average
What is the difference between continuous and partial reinforcement?
Continuous reinforcement produces more rapid learning as the association between a behaviour and it’s consequences is easier to understand
However continuously reinforced responses extinguish more rapidly as the shift to no reinforcement is sudden and easier to understand
What is Albert Bandura’s Social Learning Theory?
1) Observational (vicarious) learning- We observe the behaviour of others and the consequences of those behaviours
2) Vicarious reinforcement- If their behaviours are reinforced we tend to imitate the behaviours
What is modeling?
Observational Learning
Occurs by watching and imitating actions of another person, or by noting consequences of a person’s actions
- Occurs before direct practice is allowed
When are we more likely to model other individuals behaviour? (social learning)
- Seen to be rewarded
- High status (e.g. medical consultant)
- Similar to us (e.g. colleagues)
- Friendly (e.g. peers)
What is a health behaviour?
Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage
What did the Alameda Study show?
Residents of Alameda county completes a list of 7 health behaviours practiced regularly: - Not smoking - Eating breakfast - Not snacking - Regular exercise - 7-8 hours of sleep - Moderate alcohol - Moderate weight At 10 year follow up the mortality rate in individuals who practiced all seven behaviours was less than ¼ of that in individuals who practiced three or less
What is the role of education in changing behaviours?
Information does have an important role and is most effective for discrete behaviours (e.g. getting a child vaccinated) but often people need more than knowledge to change habitual lifestyle behaviours, particularly addictive behaviours
What did the Kegels et al study on positive reinforcement intervention show? Describe the study.
Children were given a talk on dental hygiene and then received one of the following types of follow up:
1) No further input
2) Discussion session
3) Reward for compliance with mouthwash
Greatest success with reward group, least success with the discussion group
What did Marteau’s study show?
Analysed evidence for using incentives to change health behaviour (five year review)
Incentives used in smoking cessation schemes were most effective; those aimed at weight loss were least effective
What are the limitations of reinforcement programmes?
1) Lack of generalisation (only affects behaviour regarding the specific trait that is being rewarded
2) Poor maintenance (rapid extinction of the desired behaviour once the reinforcer disappears
3) Impractical and expensive
Describe Janis & Fesbach’s study on fear arousal. What did they find?
High school students were given one of three different lectures on dental health designed to induce low, moderate or high fear. Effects on subsequent dental hygiene behaviour was measured with self-reported questionnaires one week later.
Biggest percentage change in behaviour seen in low fear group; lowest change seen in high fear group
What did Kobus study in 2003? What were the results of the study?
Peer influences on adolescent smoking (analysing social influences)
Substantial peer group homogeneity with respect to adolescent smoking
Best friends have the greatest influence on adolescent smoking, followed by peer group
What was the Waterloo Smoking Prevention Project?
High school students were allocated to a smoking prevention or control condition
6 sessions including rehearsal skills to build confidence in ability to resist peer pressure to smoke
Significant effect in reducing number of children starting smoking, especially among those with family members who smoked
What is the Expectancy-value principle?
The potential for a behaviour to occur in any specific situation is a function of the expectancy that the behaviour will lead to a particular outcome and the value of that outcome
e.g. young woman expects if she starts to jog she will lose weight which is desirable to enhance appearance
What are Bandura’s Efficacy beliefs?
1) Outcome efficacy
Individual’s expectation that the behaviour will lead to a particular outcome
2) Self efficacy
Belief that one can execute the behaviour required to produce the outcome
What are the factors influencing self efficacy?
1) Mastery experience
2) Social learning
3) Verbal persuasion or encouragement
4) Physiological arousal
What is the Transtheoretical Model?
Contempation Preparation Action Maintenance Relapse Contemplation...
What is sensation?
The stimulus detection system by which our sense organs respond to and translate environmental stimuli into nerve impulses that are sent to the brain
What is perception?
The active process of organising the stimulus output and giving it meaning
What is the process of perception?
Combination of top-down and bottom-up
Top-down: Processing in light of existing knowledge
- motives, expectations, experiences, culture
Bottom-up: Individual elements are combined to make a unified perception
What factors affect perception?
- Attention
- Past experiences
- Current drive state (e.g. arousal state)
- Emotions
(Anxiety increases threat perception) - Individual values
- Environment
- Cultural background
What are Gestalt Laws?
1) Figure-ground relations: tendency to organise stimuli into central/foreground and a background
2) Continuity: When the eye is compelled to move through one object and continue to another
3) Similarity: Similar things are perceived as being grouped together
4) Proximity: Objects near each other are grouped together
5) Closure: Things are grouped together if they seem to complete some entity
What is Visual Agnosia?
A condition where a person can see, but cannot recognise or interpret visual information
- Basic vision is spared
- Primary visual cortex can be mostly intact
- Knowledge about information from other senses
- Associated with bilateral lesions to the occipital, occipitotemporal or occipitoparietal lobes
What are the different types of Visual Agnosia?
Apperceptive agnosia
- A failure to integrate the perceptual elements of the stimulus
- Individual elements perceived normally
- May be able to indicate discrete awareness of parts of a printed word, but cannot organise into a whole
- Damage to lower level occipital regions
Associative agnosia
- A failure of retrieval of semantic information
- Shape, colour, texture can all be perceived normally
- Typically sensory specific
- Damage to higher order occipital regions
What is the process of object recognition?
Visual perceptual analysis ↓ Viewer centred repreentation ↓ Visual object recognition system ↓ Semantic system ↓ Name retrieval
What is attention? What are the processes involved?
The process of focusing conscious awareness, providing heightened sensitivity to a limited range of experiences requiring more intensive processing
2 Processes:
- Focus on a certain aspect
- Filter out other information
External stimuli → Sensory buffers → Limited capacity short-term memory → Long-term memory → Responses
What are the components of attention?
1) Focused attention
2) Divided attention
What stimulus factors affect attention?
- Intensity
- Novelty
- Movement
- Contrast
- Repetition
What personal factors affect attention?
- Motives
- Interests
- Threats
- Mood
- Arousal
What is the Cocktail Party Effect?
Attention can be focused on one person’s voice in spite of all the other conversations in a room
BUT we have an ability to hear someone say our name in another conversation relatively nearby
What causes someone to produce incorrect actions?
- Multitasking leads to competing processes and influences how each task is carried out
- Correct response is not most habitual or strongest
- Full attention not given to task
- High levels of stress of anxiety present
- The more automatic a task, the less conscious control available
What is Medical Student Syndrome?
A psychological condition amongst medical trainees that experience symptoms of the disease or diseases that they are studying
Exposure to medical knowledge affects symptom perception via expectations and beliefs that arise from it
This leads to selective attention to physical symptoms and misinterpretation leading to preoccupation
What is thought to cause chronic pain?
If the pain is there for 3 months or longer, it is possible that the original damage has healed but the pain pathways become oversensitized/dysregulated
Research- 3 months of stimulation to pain pathway causes molecular changes to RNA in neurons of the spinal cord as a result of maladaptive coping strategies
What effect does expectation have on acute pain?
Stimulus: vibrating piece of sandpaper Told it would be: - Painful - Pleasant - Nothing Conclusion: Expectation changes the response to the same stimulus
What is the multidimensional model of pain?
Tissue damage Pain sensation Thoughts Emotions Suffering Pain behaviour
What are the processes involved in acute pain?
1) INFLAMMATION- Damaged cells release sensitising chemicals
TRANSDUCTION- Noxious stimuli translated into electrical activity at sensory nerve ending
2) CONDUCTION- Passage of action potentials along neurons
3) TRANSMISSION- Synaptic transfer and modulation of input from one neuron to the next using chemical messengers
4) MODULATION- Anti-nociception neurons originating in brain stem descend to spinal cord and release chemical messengers that inhibit transmission of painful stimuli
5) PERCEPTION- Recognition and reaction in the brain: complex interactions involve thalamus (master switchboard), the sensory cortex, limbic system and reticular activating system
What is the process of chronic pain?
NEUROGENIC INFLAMMATION- Increased prostanoid production at site of pain produces allodynia and hyperalgesia and generates spontaneous pain
DAMAGED NERVE- Damaged sensory nerves may send constant pain signals like an alarm bell that won’t shut off
SENSITIZATION- Repeated pain signals produce changes in the nervous system. Pain becomes more painful
LOSS OF CONTROL- Normally innocuous stimuli become painful. Once activated, even small movements/deformity of tissues becomes painful
MENTAL OVERLOAD- Possible neurochemical link between pain and memory. High incidence of depression, anxiety. Suffering increases perceived pain
What is the Fear-Avoidance Model of chronic pain?
PAIN ⟷ Mood / Thoughts / Stress
↳ Day-to-day functioning ↵
(behaviour)
Pain breeds avoidance which perpetuates stress, low mood, anxiety etc.
What is a phoneme?
The smallest unit of speech sound in a language that can signal a difference in meaning
- Humans can produce just over 100 phonemes
- English language consists of 44 phonemes
- 112 in !Xóõ
What is a morpheme?
The smallest units of meaning in a language
- Typically consist of one syllable
- Morphemes are combined into words
What is the structure of language?
Discourse ↑ Sentence ↑ Phrases ↑ Words ↑ Morphemes ↑ Phonemes
What is syntax?
Rules are phrases which govern the way in which morphemes and words are combined to communicate meaning in a particular way
- An innate property of the brain results in this:
Children of speakers of pidgin laguages which lack basic grammatical structures develop languages which are fully grammatical
What are the speech characteristics of a 1-3 month old child?
Infant can distinguish speech from non-speech sounds and prefers speech sounds (phonemes). Undifferentiated crying gives way to cooing when happy
What are the speech characteristics of a 4-6 month old child?
Babbling sounds begin to occur. These contain sounds from virtually every language. Child vocalises in response to verbilizations of others
What are the speech characteristics of a 7-11 month old child?
Babbling sounds narrow to include only the phenomes heard in the language spoken by others in the environment. Child moves tongue with vocalizations. Child discriminates some words without understanding their meaning and begins to imitate word sounds heard from others
What are the speech characteristics of a 12 month old child?
First recognisable words typically spoken as one-word utterances to name familiar people or objects (e.g. da-da)
What are the speech characteristics of a 12-18 month old child?
Child increases knowledge of word meanings and begins to use single words to express whole phrases or requests (e.g. “out” to express desire to get out of the cot; primarily uses nouns)
What are the speech characteristics of a 18-24 month old child?
Vocabulary expands to between 50-100 words. First rudimentary sentences appear, usually consisting of two words (e.g. “more milk!”) with little or no use of articles (the, a), conjunctions (and) or auxilliary verbs (can, will). This condensed or telegraphic speech is characteristic of first sentences through-out the world
What are the speech characteristics of a 2-4 year old child?
Vocabulary expands rapidly at the rate of several hundred words every 6 months. Two-word sentences give way to longer sentences that, though often grammatically incorrect, exhibit basic language syntax. Child begins to express concepts with words and to use language to describe imaginary objects and ideas. Sentences become more correct syntactically
What are the speech characteristics of a 4-5 year old child?
Child has learned the basic grammatical rules for combining nouns, adjectives, articles, conjunctions and verbs into meaningful sentences
What is the ‘critical period’ in language acquisition? What does this mean?
As a person ages it becomes more difficult to learn a language. Easiest the younger you are, up to the age of 4. After this time it quickly becomes more difficult
When is it easiest to acquire a second language?
Before the age is 7; it then becomes increasingly difficult
A mutation in what gene is thought to be responsible for severe language problems?
FOXP2 gene
What is the involvement of brain structure underlying language?
Hemispheric specialisation for language:
- 95% of right-handed people have left-hemisphere dominance for language
- 18.8% of left handed people have right-hemisphere dominance for language function
- 19.8% of the left-handed have bilateral language function
What affect does Broca’s area have on speech?
A patient with a lesions on Broca’s area could only produce a single repetitive syllable ‘tan’ when trying to utter a phrase or respond to a single question
What are the characteristics of Broca’s aphasia?
- Non0fluent speech
- Impaired repitition
- Poor ability to produce syntactically correct sentences
- Intact comprehension
What is Wernicke’s aphasia?
Problems in comprehending speech (input or reception of language)
- Fluent meaningless speech
- Paraphasias: errors in producin specific words
- Semantic paraphasias: substituting words similar in meaning (“barn”→”house”)
- Phonemic paraphasias: substituting words similar in sound (“house”→”mouse”)
- Neologisms: non words (“galump”)
- Poor repetition
- Impairment in writing
What is the process of repeating a heard work?
1) Information about the sound is analysed by primary auditory cortex and transmitted to Wernicke’s area
2) Wernicke’s area analyses the sound information to determine the word that was said
3) This information from Wernicke’s area is transmitted through the arcuate fasciculus to Broca’s area
4) Broca’s area forms a motor plan to repeat the word and sends that information to the motor cortex
5) Motor cortex implements the plan, manipulating the larynx and related structures to say the word
A lesion where in the brain would still allow the patient to retain comprehension of spoken language, and speak spontaneously, but not repeat spoken words?
A lesion of the arcuate fasciculus
It would disrupt the transfer of information from Wernicke’s area to Broca’s area
A patient has intact comprehension, but non fluent expression. What is the diagnosis?
Broca’s Aphasia
A patient has fluent expression but impaired comprehension. What is the diagnosis?
Wernicke’s aphasia
A patient has impaired comprehension and non fluent expression. What is the diagnosis?
Global Aphasia
What can cause lesions to the dominant hemisphere?
- Stroke
- Traumatic brain injury
- Progressive neurodegenerative conditions (e.g. Alzheimer’s, fronto-temporal dementias, Parkinson’s)
What can cause transient aphasia?
- Transient Ischaemia Attack (TIA)
- Migraine
What is Dysexecutive Syndrome?
The disruption of executive function and is closely related to frontal lobe damage
- Executive functioning skills are the mental processes that enable us to plan, focus attention, remember instructions and juggle multiple tasks successfully
- Encompasses cognitive, emotional and behavioural symptoms
- Can result from: head trauma, tumours, degenerative diseases and cerebrovascular disease as well as several psychiatric conditions
What are the behavioural and emotional characteristics of dysexecutive syndrome?
- Hypo/hyperactivity
- Lack of drive
- Apathetic
- Poor initiation of tasks
- Emotional bluntness
- Theory of mind difficulties
- Reduced empathy
- Impulsive
- Disinhibited
- Perseverative
- Emotional dysregulation
- Socially inappropriate
- Rude, crass, prone to swearing
What are the cognitive aspects of dysexecutive syndrome?
- Attentional and working memory difficulties
- Poor planning and organisation
- Difficulty coping with novel situations and unstructured tasks
- Difficulty switching from task to task
- Difficulty keeping track of multiple tasks
- Difficulty with complex/abstract thinking
What is predetermined in child development by nature?
- Gender
- Genetics
- Temperament
- Maturational stages
What influences shape a baby from their pre-determined course?
- Environment
- Parenting
- Stimulation
- Nutrition
When babies are delivered can they recognise her? Explain.
Yes A memory of her has been built up in utero via: - hearing - smell - taste
What hearing do babies have in the womb When does it develop?
Receptive hearing (16/40) Functional hearing (24/40)
What did DeCasper and Fifer discover in 1980 with regard to child development?
Babies prefer their mothers’ voices to the voices of other women when recorded voices were played back
What did Mehler et al discover about babies development in 1987?
Babies who overhear a particular language in the womb will prefer that language over another
What evidence is there to support the fact that babies learn very quickly about smell?
- Newborns can recognise the smell of their own amniotic fluid
(Varendi et al 1996) - Newborns recognise the smell of maternal breast odours
(Varendi and Porter 2002) - Newborns preferred the smell of their mother’s expressed breast milk compared to others’ EBM
(Mizuno et al 2004)
What is a newborn babies taste ability and preference?
- A newborn senses all tastes (sweet, bitter, sour and umami), except one: salt; they cannot taste this until about 4 months old (Beauchamp et al 1986)
- Newborns love sugar solutions- the sweeter, the better
- Newborns also seem to like the taste of glutamate, which is found in breast milk (Beauchamp and Pearson 1991)
What preference do new born babies have for faces?
- Babies 12-36 hours old shown video playbacks of women’s faces. Preference for watching their mother’s faces (rather than a strangers). (Bushnell et al 1989)
- Newborn infants have shown a preference for looking at faces and face-like stimuli. (Batki et al 2000; Turati et al 2002)
- Show a preference for faces with open eyes and look longer at happy face stimuli
What is reciprocal socialisation?
Baby: cries, moves, grimaces, smiles, calms, looks
↓ ↑
Parent: mirrors, repeats, interprets, responds
What did Tronick study in 1975 with regard to child development?
Experiment which shows how a 1-year old child will react to a suddenly unresponsive parent.
Newborns are more likely to change their behaviour, look away and show signs of distress (Nagy 2008)
Why is environment important for child development?
Scaffolding, reciprocal socialisation, provision of a stimulating and enriching environment (physiologically and psychologically) give babies the resources to thrive and develop
- An “internal working model” is established through this social process; the baby doesn’t do this on his own but coordinates his systems with those of the people around him
What is the theory of attachment? How does it affect psychological development?
- Theory of attachment was defined by Bowlby as a biological instinct that seeks proximity to an attachment figure (carer) when threat is perceived or discomfort is experienced
- This sense of safety the child experiences provides a secure base from which they can explore their environment thus promoting development through learning whilst being protected in the environment
What is “mind-mindedness”?
Parents with mind-mindedness treat their children as individuals with minds; they respond as if their children’s acts are meaningful - motivated by feelings, thoughts or intentions (an attempt to communicate); this ultimately helps the child to understand others’ emotions and actions
What is the development of attachment of a childs 1st year?
Birth-3 months: prefers people to inanimate objects, indiscriminate proximity seeking (e.g. clinging)
3-8 months: smiles discriminately to main caregivers
8-12 months: selectively approaches main caregivers, uses social referencing / familiar adults as “secure base” to explore new situations; shows fear of strangers and separation anxiety
From 12 months (corrected age); the attachment behaviour can be measured reliably
What is The Strange Situation Test (Ainsworth et al 1978)?
Designed to present children with an unusual, but not overwhelmingly frightening experience.
It tests how babies or young children respond to the temporary absence of their mothers. Researchers are interested in two things:
1. How much the child explores the room on his own, and
2. How the child responds to the return of his mother
What is the difference between secure vs insecure attachment style?
Securely-attached children:
- free exploration and happiness upon mother’s return
Insecurely attached children:
- little exploration and little emotional response to mother
Resistant-insecure children:
- little exploration, great separation anxiety and ambivalent response to mother upon return
Disorganised-insecure children:
- little exploration and confused response to mother
What are the benefits of secure attachment in children?
Promotes: - Independence - Emotional availability - Better moods - Better emotional coping Associated with - Fewer behavioural problems - Higher IQ and academic performance Contributes to a child's moral development Reduces child distress
What are the benefits of secure attachment in adolescence and adulthood?
Associated with:
- Social competence
- Loyal friendships
- More secure parenting of offspring
- Greater leadership qualities
- Greater resistance to stress
- Less mental health problems such as anxiety and depression
- Less psychopathology e.g. schizophrenia
What is the effect of play on child development?
Has important positive effects on the brain and on child’s ability to learn
- Rats had bigger and smarter brains in an enriched environment, plus more BDNF essential for growth and maintenance of brain cells (Greenough and Black 1992; Huber et al 2007)
What are the benefits of play?
- Engage and interact with world
- Create and explore own world
- Experience mastery and control
- Practice decision-making, planning
- Practice adult roles
- Promotes language development
- Promotes creative problem solving
- Overcome fears
- Develop new competencies
- Learn how to work in groups
- Develop own interests
- Extend positive emotions
- Maintain healthy activity levels
What types of play do children engage in at different ages?
0-2 years
Solitary: Plays alone. There is limited interaction with other children
2-2½ years
Spectator: Observe other children playing around them but will not play with them
2½-3 years
Parallel Play: alongside others but will not play together with them
3-4 years
Associate: Starts to interact with others in their play and there may be fleeting co-operation between play. Develops friendships and the preferences for playing with some but not all other children. Play is normally in mixed sex groups
4-6 years
Co-operative: Plays together with shared aims of play with others. Play may be quite difficult and they are supportive of other children in their play. As they reach primary school age, play is normally in single sex groups
6+ years
Competitive: Play often involves rules and has a clear “winner”
What is Piaget’s Stage Model?
Proposed that children’s thinking changes qualitatively with age
- The result of an interaction of the brain’s biological maturation and personal experiences
- Process of assimilation and accommodation which leads to adaptation
What is Piaget’s sensorimotor stage?
Birth - age 2
Infants understand their world primarily through sensory experiences and physical (motor) interactions with objects
- Object Permanence: the understanding that an object continues to exist even when it cannot be seen
- Gradually increasing use of words to represent objects, needs and actions
- Learning is based on trial and error (although errors do not become assimilated)
What is Piaget’s Preoperational Stage?
Age 2-7
The world is represented symbolically through words and mental images; no inderstanding of basic mental operations or rules
- Rapid language development
- Understanding of the past and future
- No understanding of Principle of Conversation: basic properties of objects stay the same even though their outward appearance may change
- Irreversibility: cannot mentally reverse actions
- Animism: attributing lifelike qualities to physical objects and natural events
- Egocentrism: difficulty in viewing the world from someone else’s perspective
What is Piaget’s Operational Stage?
Age 7-12
Children can perform basic mental operations concerning problems that involve tangible (“concrete”) objects and situations
- Understand the concept of reversibility
- Display less egocentrism
- Easily solve conversation problems
- Trouble with hypothetical and abstract reasoning
What are the criticisms of Piaget’s Stage Model?
- Outcomes have been replicated in populations around the world
- Some researchers query whether children respond as they do to please the adult asking the question
- SOme argue the (repeated) question is odd as the answer is obvious. The child thinks the adult wants or expects you to change the original answer - when more naturalistic ways of asking the questions were developed children performed much better (Goswami and Pauen 2005)
What is the development of children’s concept of death?
Under 5s: Do not understand that death is final, universal, will take euphasmisms concretely, may think they have caused death
5-10 years: Gradually develop the idea of death as irreversible, all functions ended, universal/unavoidable, more empathic to another’s loss; may be preoccupied with justice
10-adolescence: Understand more of long-term consequences, able to think hypothetically, draw parallels, review inconsistencies
Dependent on cognitive development and experience (pets, extended family members)
What development occurs in adolescence?
The transitional stage of physical and psychological human development that generally occurs from puberty to legal adulthood
- Involves cognitive development and physical growth, as distinct from puberty, which can extend into the early twenties
- Chronological age only provides a rough marker of adolescence
- Transition to Formal Operational Stage; where abstract thought emerges. Begin to think more about moral, philosophical, ethical, social and political issues that require theoretical and abstract reasoning
- Begin to use deductive logic, or reasoning from a general principle to specific information
What are the characteristics of the Adaptive Adolescent Brain?
12-25 years extensive brain remodelling (myelinisation, synaptic pruning- reason for so much sleeping)
- Cognitive changes may help journey from the secure world parents provide to fitting into world created by peers
- Thrill seeking
- Openness to new experiences
- Risk taking
- Social rewards are very strong
- Prefer own age company
- Emotionally becomes less positive through early adolescence (but levels off and becomes more stable by late adolescence)
- Storms and stress more likely during adolescence than the rest of the lifespan but not characteristic of all adolescents
What are the psychological impacts of long-term conditions?
One LTC: 2-3 times more likely to develop depression than the rest of the population
3+ LTC: 7 times more likely to have depression
Having a mental health problem increases the risk of physical ill health. Co-morbid depression doubles the risk of CHD in adults and increases the risk of mortality by 50%
Adults with both physical and mental health problems are much less likely to be in employment
People with mental health problems (e.g schizophrenia or bipolar disorder) die 16-25 years younger than the general population
What is the Self Regulatory Model?
Stage 1: Interpretation
Stage 2: Coping
Stage 3: Appraisal
What is the Kübler-Ross Stage Theory of death and dying?
Five reactions of the person facing death:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What are the weaknesses of Stage Theories?
- Stages are prescriptive and place patients in a passive role
- Do not account for variability in responses
- Focus on emotional responses and neglect cognitions and behaviour
- Fail to consider social, environmental or cultural factors
- Pathologise people who do not pass through stages
What are the problems associated with pathologising people in stage theories?
- Distress or depression is not inevitable
(Weinman et al, 1999) - “Acceptance” might not be achieved
(Parkes and Weiss 1983; Shadish et al 1981) - “Good” patients vs “Bad” patients
(Taylor, 2006)
What are the different responses to bereavement?
Bonanno & Kaltman, 2001)
Loss ↓ First year of bereavment 15-50%: Minimal grief 50-85%: Common grief - Cognitive disorganisation - Dysphoria - Health deficits - Disrupted social and occupational functioning - Positive experiences ↓ Second year of bereavment 85%: Minimal grief 15%: Chronic grief: - Major depression - Generalised anxiety - PTSD symptoms
What does the severity of a person’s grief may depend on?
- How attached they were to the deceased person
- The circumstances of death and the situation of loss
- How much time they had to work through anticipatory mourning
When is chronic grief less common?
If:
- the death was sudden or unexpected
- the deceased was a child
- there was a high level of dependency in the relationship
- the bereaved person has a history of psychological problems, poor support and additional stress
What is personality?
The distinctive and relatively enduring ways of thinking, feeling and acting that categorise a person’s responses to life situations
What is a personality trait?
Relatively stable cognitive, emotional and behavioural characteristics of people that help establish their individual identities and distinguish them from others
A trait is a continuum along which individuals vary, like nervousness or speed of reaction
What is Eysenck’s Two Factor personality model?
Has two factors:
- Neuroticism or stability- the tendency to experience negative emotions
- Extraversion- the degree to which a person is outgoing and seeks stimulation
Proposed a biological, genetic basis for personality traits:
- Differences in customary levels of cortical arousal (introverts are overaroused, extroverts are underaroused)
- Suddenness of shifts in arousal (unstable, neurotic people show large and sudden shifts in limbic system arousal; stable people do not)
What is the Five-Factor Model of Personality?
OCEAN
- Openness to experience
(Imaginative, creative, original and curious)
- Conscientiousness
(Hard-working, well-organised, punctual)
- Extraversion
(Joiner, talkative, active, affectionate)
- Agreeableness
(Trusting, lenient, soft-hearted, good-natured)
- Neuroticism (emotional instability)
(Worried, temperamental, self-conscious, emotional)
What are the genetic influences on personality?
Research suggests that personality differences in the population are approximately 50% genetically determined
What factors interact to produce personality?
- Cognitions
- Behaviours
- Environment
What is the locus of control?
An expectancy concerning the degree of personal control we have in our lives
- Internal: life outcomes are under personal control
- External: outcomes have less to do with one’s own efforts than with the influence of external factors
e. g. Health may be attributed to three sources: internal factors (such as a healthy lifestyle), powerful others (such as one’s doctor) and luck (lifestyle advice will be ignored)
What effect does optimism have on life?
Optimists live longer
What is intelligence?f
The ability to acquire knowledge, to think and reason effectively, and to deal adaptively with the environment
What did Alfred Binet and Théodore Simon develop?
The first intelligence test to identify French children that might have difficulty in school
Binet-Simon scale measures mental age
How do you calculate IQ?
IQ= (mental age / chronological age) x 100
What is the average IQ score?
100
What is Charles Spearman’s theory of intelligence?
Believed intellectual activity involves a general factor and specific factor Specific abilities include: - Mechanical - Spatial - Verbal - Numerical
What is included in Gardner’s Multiple Intelligences?
- Linguistic intelligence
- Logical-mathematic intelligence
- Spatial intelligence
- Musical intelligence
- Bodily-Kinaesthetic intelligence
- Intrapersonal intelligence
- Intrapersonal functioning
Also recently added:
- Naturalistic intelligence
- Existential intelligence
How did Cattell and Horn break down Spearman’s general intelligences into two subtypes?
- Crystallized intelligence: the ability to apply previously acquired knowledge to current problems. Will commonly improve with age then stabilise
- Fluid intelligence: the ability to deal with novel problem-solving situations for which personal experience does not provide a solution. Shows steady pattern of declining in aging
What is the effect of heredity and environment on intelligence?
Genetic factors can influence the effects produced by the environment
- Accounts for ½ to ⅔ of the variation in IQ
- No single “intelligence gene”
Environment can influence how genes express themselves
- Accounts for ⅓ to ½ of the variation in IQ
- Both shared and unshared environmental factors are involved
- Educational experiences are very important
What are the gender differences in intelligence?
- Gender differences in performance on certain types of intellectual tasks, not general intelligence
- Men generally outperform women on spatial tasks, tests of target-directed skills and mathematical reasoning
- Women generally outperform men on tests of perceptual speed, verbal fluency, mathematical calculation and precise manual tasks
What are the social and emotional difficulties associated with autism?
- Friendships
- Managing unstructured parts of the day
- Working co-operatively
What are the language and communications difficulties associated with autism?
Difficulty processing and retaining verbal information and understanding:
- Jokes and sarcasm
- Social use of language
- Literal interpretation
- Body language, facial expression and gesture
What are the flexibility of thought difficulties associated with autism?
Difficulty with:
- Coping with changes in routine
- Empathy
- Generalisation
What is the difference between occurrence of autism between different genders?
- Autism has a 4:1 male:female ratio
- ‘Asperger’s syndrome’ (High Functioning autism) has a 9:1 male:female ratio
What is the difference between impairment, disability and handicap?
Impairment: A problem with a structure or organ of the body (e.g. ejection fraction)
Disability: A functional limitation with regard to a particular activity (e.g. mobility, ADLs)
Handicap: A disadvantage in filling a role in life relative to a peer group (e.g. access to sports centre, prejudice of employers
Strong correlation between disability and handicapVery low correlation between impairment and disability
What is the crisis theory of coping with serious illness?
Illness-related factors + Background and personal factors + Physical and social environmental factors
↓
Coping appraisal
↓
Adaptive tasks
↓
Coping skills
↓
Outcome of crisisWhat factors affect adjustment to illness?
Illness-related factors - Unexpected - Cause and outcome/prognosis - Disability - Prior experience - Stigma - Disfigurement Background/Personal factors - Pre-existing personality - Age of onset - Gender - SES and occupation - Pre-existing illness beliefs Physical and Social Environment - Hospitalisation - Accommodation and physical aids/adaptations - Social support and social role - Societal attitudes
What are the illness representations?
- Identity
The label of the illness and symptoms - Cause
What may have caused the problems, such as genetics, circumstances, trauma etc - Consequences
Expected effects from the illness and views about the outcome - Time-line
How long the problem will last and whether it is seen as acute, chronic or episodic - Cure/control
Expectations about recovery or control of the illness
What are the different adaptive tasks associated with coping with an illness?
Tasks related to illness or treatment:
- Coping with symptoms or disability
- Adjusting to hospital environment and medical procedures
- Developing and maintaining good relationships with healthcare professionals
Tasks related to general psychosocial functioning
- Controlling negative feelings and retaining a positive outlook for the future
- Maintaining a satisfactory self image and sense of competence
- Preserving good relationships with family and friends
- Preparing for an uncertain future
What are the different types of coping?
Problem-Focused coping:
- Seeking relevant information about an illness
- Learning specific illness related procedures e.g. pacing activities
- Changing behaviour e.g. diet
Emotion-Focused
- Seeking reassurance and emotional support
- Learning relaxation strategies
- Meditation
What is stress in terms of medical treatments?
A condition that results when the person/environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available
Why is patient distress a bad thing?
- Moral/ethical responsibility to minimise suffering if possible
- If treatment is distressing there is a greater chance of patients avoiding or not complying
- Distress during treatment related to longer term psychological morbidity
- Distress during treatment related to wide variety of treatment outcomes
What is the different types of information patients can be given prior to treatment?
Procedural information: Information about the procedures to be undertaken
Sensory information: Information about the sensations that may be experienced
Participants given sensory information reported significantly less distress during the procedure
What is the most effective coping strategy for younger children?
Distraction
Benefit from information close to the procedure
What is the most effective coping strategy for older children (>9)?
Matching the coping strategy to the child’s preferred coping strategy
They benefit most from information presented 5-7 days before a procedure
What is the combined approach for helping a child to cope with a procedure?
- Tell:
Using simple language and a matter-of-fact style, the child is told what is going to happen before each procedure (comparisons the child understands are used and negative, emotive words are avoided) - Show:
The procedure is demonstrated using an inanimate object (e.g. a doll), a member of staff or the clinician - Do:
The procedure does not begin until the child understands what will be done
What did Frank et al 1995 discover about children’s distress during procedures?
Children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety
What is the effect of maternal behaviour on pain?
In girls: Pain promoting (reassurance and empathy) increased pain intensity Pain reducing (distraction and humour) reduced pain
No effect on boys
What is social psychology?
The study of:
- Social thinking: how we think about our social world
- Social influence: how other people influence our behaviour
- Social relations: how we relate toward other people
What is attitude?
A positive of negative evaluative reaction toward a stimulus, such as a person, action, object or concept
Attitudes influence behaviour more strongly when situational actors that contradict our attitudes are weak
What is cognitive dissonance?
When an individual has two conflicting beliefs
e.g. “I am a smoker” and “Smoking causes cancer”
How is dissonance resolved?
- Change behaviour:
In the case of smoking, this would involve quitting, which might be difficult and thus avoided - Acquire new information:
Such as seeking exceptions e.g. “My grandfather smoked all his life and lived to be 96” - Reduce the importance of the cognitions (i.e. beliefs, attitudes):
A person could convince themself that it is better to “live for the moment”
In terms of changing an individual’s attitude, what makes a message more effective?
If it:
- Reaches recipient
- Is attention-grabbing
- Easily understood
- Relevant and important
- Easily remembered
In terms of changing an individual’s attitude, what makes a message more persuasive?
They are:
- Credible (e.g. doctors)
- Trustworthy (e.g. objective)
- Attractive (e.g. well presented)
What is framing?
Whether a message emphasises the benefits or losses of that behaviour
Research shows that:
- When we want people to take up behaviours aimed at detecting health problems or illness (e.g. HIV testing) loss-framed messages may be more effective
- When we want people to take up behaviours aimed at promoting prevention behaviours (e.g. condom use) gain-framed messages may be more effective
Which of the two statements will be most effective for encouraging breast self-examination?
- If you do not undertake breast self-examination you may be more likely to die from cancer
- If you do undertake breast self-examination you may decrease the risk of dying from cancer
- If you do not undertake breast self-examination you may be more likely to die from cancer
Which of the two statements will be most effective for promoting sunscreen use?
- If you do not use SPF15 sunscreen, your skin will be damaged and you may die younger
- If you do use SPF15 sunscreen, your skin will stay healthier and you may prolong your life
- If you do use SPF15 sunscreen, your skin will stay healthier and you may prolong your life
What is a stereotype?
Generalisations made about a group of people or members of that group, such as race, ethnicity or gender. Or more specific such as different medical specialisation (e.g. surgeons)
What is prejudice?
To judge, often negatively, without having relevant facts, usually about a group or its individual members
What is discrimination?
Behaviours that follow from negative evaluations or attitudes towards members of particular groups
What are schemas?
- Schemas are mental or cognitive structures that contain general expectations and knowledge of the world
- Schemas help us process information quickly and economically and facilitate memory recall
- This means we are more likely to remember details that are consistent with our schema than those that are inconsistent
What is Social Loafing?
The tendency for people to expend less individual effort when working in a group than when working alone
When is social loafing more likely to occur?
When:
- The person believes that individual performance is not being monitored
- The task (goal) or the group has less value or meaning to the person
- The person generally displays low motivation to strive for success
- The person expects that other group members will display high effort
- Occurs more strongly in all-male groups
- Occurs more often in individualistic cultures
What can social loafing disappear?
When:
- Individual performance is monitored
- Members highly value their group or the task goal
What did Asch study in 1956?
Conformity
What factors affect conformity?
- Group size
- Conformity increases as group size increases
- Increased over five group members - Presence of a dissenter
- One person disagreeing with the others greatly reduces group conformity - Culture
- Greater in collectivistic cultures
What was the Milgram experiment (1974)?
One “learner”, one “teacher” - told that the experiment studied the effect of punishment on learning and memory
- Shock generator used to apply punishment
- Shocks grew increasingly intense with each mistake
What factors effect obedience?
- Remoteness of the victim
- Closeness and legitimacy of the authority figure
- Diffusion of responsibility: obedience increases when someone else does the dirty work
- Not personal characteristics
What is group polarization?
The tendency of people to make decisions that are more extreme when they are in a group as opposed to a decision made alone or independently
What is groupthink?
The tendency of group members to suspend critical thinking because they are striving to seek agreement
When is groupthink most likely to occur?
When a group:
- Is under high stress to reach a decision
- Is insulated from outside input
- Has a directive leader
- Has high cohesiveness
What is bystander apathy?
The tendency of bystanders to avoid helping an individual due to shared group responsibility
What is the Darley and Latane experiment?
- Participants were invited into the lab under the pretext they were taking part in a discussion about ‘personal problems’
- Participants were all in separate rooms in the lab and communicated via an intercom system
- One student (actor) has a seizure and asks for help over the intercom
- 87% helped if they believed it was just them and the other student
- But only 31% helped when they believed they were in a group of 4 people, hardly anyone helped if the group was above 4
- If participant had not acted within the first 3 minutes they never acted
What is the Bystander Effect?
Presence of multiple bystanders inhibits each person’s tendency to help
- Due to social comparison or diffusion of responsibility
What is the 5-step Bystander Decision Process?
Latané and Darley 1970
- Notice the event
- Decide if the event is really an emergency
Social comparison: look to see how others are responding - Assuming responsibility to intervene
Diffusion of responsibility: believing that someone else will help) - Self-efficacy in dealing with the situation
- Decision to help (based on cost-benefit analysis e.g. danger)
What increases helping behaviour?
Reducing restraints on helping - Reduce ambiguity and increase responsibility - Enhance concern for self image Socialise altruism - Teaching moral inclusion - Modelling helping behaviour - Attributing helpful behaviour to altruistic motives - Education about barriers to helping
What are the different leadership styles?
- Autocratic or authoritarian style
- Participative or democratic style
- Laissez-faire or “free rein” style
What is autocratic leadership? What are the advantages and disadvantages of this?
- All decision-making powers are centralised in the leader, as with dictator leaders
- They do not entertain any suggestions or initiatives from subordinates
Advantages - Enables quick decision making - Clear hierarchy of responsibility Disadvantages - Can be demotivating - Can lead to errors
What is democratic leadership? What are the advantages and disadvantages of this?
- Favours decision-making by the group. Leader gives instruction after consulting the group. They can win the co-operation of their group and can motivate them effectively and positively
Advantages - Can win cooperation and motivate team - Can improve quality of decision making Disadvantages - Time consuming - Can lead to disagreements
What is Laissez-faire leadership? What are the advantages and disadvantages of this?
- Does not lead, but leaves the group entirely to itself; such a leader allows maximum freedom to subordinates, i.e. they are given a free hand in deciding their own policies and methods
Advantages - Allows autonomous working - Allows expertise to be utilised Disadvantages - Can lead to lack of direction - Lack of ultimate responsibility holder
What is a medical error?
An error is defined as the failure of a planned action to be completed as intended (i.e. error of execution) or the use of a wrong plan to achieve an aim (i.e. error of planning)
What happened to Wayne Jowett?
In 2001 he was mistakenly given Vincristine intrathecally. He became slowly paralysed and a moth later his parents turn off his life support machine
What are the causes of medical errors?
Both system-related and cognitive factors (46%)
Cognitive error only (28%)
System-related error only (19%)
No-fault factors only (7%)
What is the significance of diagnostic errors?
They account for:
- The largest fraction of claims
- The most severe patient harm (more often result in death)
- The highest total of penalty payouts
What is heuristics?
- Often referred to as rules of thumb, educated guesses or mental shortcuts
- Usually involve pattern recognition and rely on a subconscious integration of patient data with prior experience
What are the systems for decision making?
System 1
- “Hot” system
System 2
- “Cold” system
What is system 1 of decision making?
- Emotional
- “Go”
- Simple
- Reflexive
- Fast
- Develops early
- Accentuated by stress
- Stimulus control
What is system 2 of decision making?
- Cognitive
- “Know”
- Complex
- Reflective
- Slow
- Develops late
- Attenuated by stress
- Self control
What did Nisbett and Wilson study in 1977?
“Consumer study” in a shopping mall asking consumers to pick a pair of (identical) tights they liked the best.
- Consumers were significantly more likely to select the far right most pair, even though they were switched around
- System 1 controls actions automatically but believe system 2 is in control
What is confirmatory bias?
The tendency to search for or interpret information in a way that confirms one’s preconceptions, often leading to errors
What did Podbregar study with regard to overconfidence in medicine?
- Studied 126 petients who died in the ICU and underwent autopsy
- Physicians were asked to provide the clinical diagnosis and also their level of uncertainty
- Clinicians who were “completely certain” of the diagnosis ante-mortem were wrong 40% of the time
How did Arkes and Blumer (1985) investigate sunk cost fallacy?
- Arranges to have season tickets sold to visitors to the ticket booth randomly at full price ($15) or at a discount ($13 or $8)
- Then observed frequency or attendance at plays over the season
- Rationally, the price paid for ticket should not influence how often it is used
- However, they found that the people who paid a higher price used the ticket more than those who paid the discounted price
What is the Sunk Cost Fallacy?
The more we have invested in the past, the more we are prepared to invest in a problem in the future
What is anchoring?
Individuals are poor at adjusting estimates from a given starting point (probability and values)
- Adjustments are crude and imprecise
- Anchored by starting point
What is the gambler’s fallacy?
A logical fallacy involving the mistaken belief that past events will affect future events when dealing with independent events.
- In clinical situations it could encompass a belief that is one patient in a clinic presents with a rare condition it would be impossible for the next patient to present with the very same condition
What is the difference between loss or gain framing?
“Out of 100 patients taking this drug 70% get better”
OR
“Out of 100 patients taking this drug 30% don’t get better
What effect does age have on framing?
When presented with treatment descriptions described in positive, negative or neutral terms, older adults are significantly more likely to agree to a treatment when it is positively described than they are to agree to the same treatment when it is described neutrally or negatively
What is the availability heuristic?
Probabilities are estimates on the basis of how easily/vividly they can be called to mind
- Individuals typically overestimate the frequency of occurrence of catastrophic, dramatic events (e.g. 80% believe accidents cause more deaths than strokes)
- People tend to heavily weigh their judgements toward more recent information
How can decision making be improved?
- Education and training
- Integrate teaching about cognitive error and diagnostic error into medical school curricula
- Recognise that heuristics and biases may be affecting our judgement even though we may not be conscious of them - Feedback
- Increase number of autopsies
- Conduct regular and systematic audits
- Follow-up patients - Accountability
- Establish clear accountability and follow-up for decisions made - Generating alternatives
- Establish forced consideration of alternative possibilities (e.g. the generation and working through of a differential diagnosis)
- Encourage routinely asking the question: “What else might this be?” - Consultation
- Use of algorithms
- Seek second opinions
- Use of clinical decision making support systems
What is the significance of algorithms in healthcare?
An algorithm is a procedure which, if followed exactly, will provide the most likely answer based on the evidence
- Algorithms are most useful in situations where the problem is well defined - which excludes many everyday decisions
What is anterograde amnesia?
A loss of the ability to create new memories after the event which caused the amnesia
What is memory?
The processes that are used to acquire, store, retain and later retrieve information. Three main processes: - Encoding - Storage - Retrieval
What are the stages of memory?
Registration
- Input from the senses into the memory system
- Not everything that a person registers is stored
Encoding
- Processing and combining of received information
- More effective encoding into long-term memory increases the likelihood of retrieval
Storage
- Holding of that input in the memory system
- The fact that information is stored does not guarentee that is will be retrieved on a particular occasion
Retrieval
- Recovering stored information from the memory system (remembering)
What are the different types of encoding?
- Effortful processing
- initiated intentionally
- required conscious attention - Automatic processing
- occurs without intention
- requires minimal attention
How does depth of processing of information relate to memory?
Words are encoded better when there is more meaning. The more understanding (and depth of processing) the better the memory
What are the different types of retrieval?
- Conscious (effortful)
- Unconscious (automatic)
What is the multicomponent model of working memory?
Central executive prefrontal cortex Information then sent for processing: - Visuospatial Sketchpad (Occipital lobe) - Episodic buffer - Phonological Loop (Left Parietal) All feed in to long term memory - Visual semantics - Episodic LTM - Language
What is the role of the central executive?
- Manipulation of information and direction of attention-driving
- Suppression of irrelevant information and undesired actions
- Supervision of information integration
- Coordination of multiple tasks to be executed in parallel
- Coordination of the sub-systems of WM (working memory)
What forms of processing transfer memory from the central executive to the long term memory?
Visuospatial Sketchpad
- storage of visual and spatial information
- e.g. for constructing and manipulating visual images, for the representation of mental maps
Phonological loop
- storage of auditory/verbal information
- preventing decay by silently articulating contents, refreshing the information in a rehearsal loop
- e.g. phone number/reading
Episodic buffer
- Temporarily integrates phonological, visual and spatial information in a unitary, episodic representation
- Provides interface with episodic long-term memory
What is the model of memory?
Information in ↓ Sensory Registers ↓ Attention Working memory ⤸Rehearsal Retrieval ↑↓ Storage Long Term Memory
Some sensory registers will go straight into long term storage
What is long-term memory?
- Store of all things in memory that are not currently being used but are available for use in the future
- Allows the use of past information to deal with present and the future
- Can hold unlimited amount of information
What are the different types of retrieval from long term memory?
Explicit/declarative (conscious) - Episodic (biographical events) - Semantic (words, ideas, concepts) Implicit/non-declarative (unconscious) - Procedural (skills) - Emotional conditioning - Priming effect - Conditioned reflex
What is non-declaritve memory?
- Familiar with something, know how to interact with object or in situation but don’t have to think about it
- For actions or behaviours is called procedural memory
- Can carry out complex activities without having to think about them e.g. walking, eating)
What is declarative memory? What are the different types?
- Store of our knowledge
Two separate types
1. Episodic- Memory related to personal experience
- What we generally think of as ‘memories’
- Knowing what you did last night or where you went on holiday
2. Semantic - Memory for facts
- What we think of as general knowledge
- Knowing the capital of France or the colour of a bus
How does the autobiographical memory develop?
- We learn simple associations before we are born
- Not until ages 2-3 years does the autobiographical memory develop- we need language to help remember
- Typically ages 6 is when we remember autobiographical events
- ‘Reminiscent bump’ we remember the most during later adolescence
What are the theories of why we remember the most during the reminiscent bump?
- Frontal lobe development
- Emotionally driven learning
- Important, driving events: love, driving, graduation
What are the different types of memory and the information they store?
Episodic memory → Personal memories/events
Semantic memory → Facts
Implicit memory → Skills and procedures
Prospective memory → Remembering to do things in the future
What is the associative network?
Stored ideas are connected by links of meaning, strengthened through rehearsal and elaboration
Multiple links to a given concept in memory make it easier to retrieve because of many alternative routes to locate it
- Each concept represented by a node
- Activation of one network leads to spreading activation of related concepts
- Activation of node results in increased ease of activating related (neighbouring) node
- Works to a lesser extent for indirectly related nodes
What is a schema? What is their purpose?
- A mental structure that represents some aspect of the world
- Used to organise current knowledge and provide a frameowrk for future understanding
- Automatic not effortful thought e.g. sterotypes
- Acquired through experience
e. g. How to behave at a wedding
What are the different alterations made to situations to store them to human memory?
Rationalisations:
- People tend to add material to justify parts of the story
Omissions:
- Parts of the story, particularly those difficult to understand, were left out
Changes of order:
- The storyline was rearranged in an attempt to make sense of it
Distortions of emotion:
- People added their own feelings and attitudes to the story
How do schemas affect our memory? (Cohen 1993)
- Selection: information that does not fit current schemas is ignored
- Abstraction: we are inclined to recall the overall gist and forget the detail
- Interpretation: schemas provide existing knowledge to help us understand novel situations
- Normalisation: memories are distorted to fit with our existing expectations
- Retrieval: schemas help us fill gaps in our memory by making a best guess
What is the misinformation effect?
Distortion of a memory by misleading post-event information (role of schema)
How did Loftus and Palmer study the misinformation effect? (1974)
Got subjects to watch a video of a car crash
Asked what speed they were going when they smashed/collided/bumped/hit/contacted each other?
Speed 10mph higher with “smashed” than with “contacted”
“Smashed” 3 times more likely than “contacted” to recall (falsely) broken glass
What effects the probability of recalling a words from a list?
- Order in the list (serial position effect)
- Personal salience of words
- Delay time
- Distraction
What is the serial position effect?
Probability higher when early on a list “Primary effect”
Probability highest when later in a list “Recency effect”
Probability lower in the middle
What are the different methods for committing information to memory? What is most effective?
- Rote
- Frequent repitition (verbal)
- Forms a separate schema, not closely linked to existing knowledge
- Least efficient
- Less deep processing - Assimilation
- Fitting new information into existing schema(s)
- Learning by comprehension
- Can only be used where there is link between old and new knowledge
- Deep processing
- Wholly declarative - Mnemonic device
- Artificial structure for reorganising or encoding information to make it easier to remember
- Useful when info doesn’t fit into existing schemas
- e.g. hierarchies, chunking, visual imagery, acronyms
- Need to recall artificial structure to access information - Move your body
- People remembered more words on a learning test when they moved eyes L-R: right-handed people (Parker & Dagnall)
- Other experiments found acting out idea with relevant hand gestures improved recall
- Links learning abstract concepts to simple physical movement
- Short intense bursts of exercise helps learning
What is the PQRST method for committing information to memory?
P = Preview
- the information to learn
Q = Question
- write down the questions that you want to be able to answer once finished
R = Read
- through information that best relates to questions you want to answer
S = Summary
- summarise the information by writing, diagrams, mnemonics, voice recording
T = Test
- try to answer the questions
Why do we forget?
- Ineffective encoding: information not encoded in the first place
- Decay theory: forgetting occurs because memory fades with time if not used
- Interference theory: forgetting occurs due to competition “for space” from other material either from previously learned or new information
- Encoding Specificity Principle: retrieval will occur depending on how well the retrieval cue corresponds to the memory code
What are the neural correlates of memory?
- In Alzheimer’s disease the hippocampus is one of the first regions of the brain to suffer damage; memory problems and disorientation appear among the first symptoms
- Damage to the hippocampus can also result from anoxia, encephalitis or medial temporal lobe epilepsy
- Significant anterograde amnesia for autobiographical information following bilateral Medial Temporal Lobe ablation
- The hippocampus has an important role in the formation of new episodic or autobiographical memories
What is the role of the hippocampus in memory?
Older memories remain stable- this sparing of older memories leads to the idea that consolidation over time involves the transfer of memories out of the hippocampus to other parts of the brain
This is difficult to test. In some cases of retrograde amnesia, the sparing appears to affect memories formed decades before the damage to the hippocampus occurred, so it’s role in maintaining these older memories remains uncertain
What parts of the brain are involved in the different memory systems?
Episodic memory: - Medial temporal lobes including the hippocampus and parahippocampal cortex Semantic: - Inferolateral temporal lobe Procedural: - Supplementary motor area - Basal ganglia (putamen) - Cerebellum Working: - Prefrontal cortex
What causes memory difficulties?
- Loss of consciousness resulting from head injury disrupts memory processing (post traumatic amnesia) patient unable to make new memories / disorientated
- Significant head injury typically see a period of retrograde amnesia and depending on the site of injury anterograde amnesia
- Korsakoff’s syndrome: reduction in thiamine (vit B1) which helps brain cells to produce energy from sugar- inability to learn new information from recent events but also long-term memory gaps. Common to see confabulation
- Semantic dementia: progressive loss of semantic memory - loss of word meaning and presents as a progressive aphasia
What is compliance?
Acting according to request or command
What is adherence?
“To stick fast to”
The extent to which a person’s behaviour- taking medication, following a diet, and/or executing lifestyle changes corresponds with agreed recommendations from a health care provider
What is the best way to detect non-adherence?
Ask the patient
Nurses and doctors are less effective at detecting
What are the methods of measuring adherence?
Direct methods
- Directly observed therapy
- Measurement of the level of medicine or metabolite in the blood
- Measurement of the biologic marker in the blood
Indirect methods
- Patient questionnaires, patient self-reports
- Pill counts
- Rates of prescription refills
- Electronic medication monitors
- Measurement of psychologic markers
- Patient diaries
What is the average rate of adherence to treatment in long term conditions?
50%
What are the consequences of non-adherence?
- Increased hospital admissions (20% of all hospital admissions probably due to non-adherence
- Rejection of transplants
- Occurrence of complications
- Development of drug resistance
- Increased mortality
What are the different types of non-adherence?
Unintentional non-adherence
- Patient ability and resources
- Practical patient barriers to adherence
Intentional non-adherence
- Patient beliefs and motivations
- Patient perceptual barriers to adherence
What could cause intentional non-adherence?
- Treatment does not make sense (e.g. exercise for back pain)
- Worries/concerns about the treatment (e.g. worried about side effects)
- Beliefs about the disease (e.g. not having MMR poor knowledge of measles)
What are the potential causes for unintentional non-adherence?
- Poor HCP-Patient communication
- Low patient satisfaction and/or recall
- Cognitive difficulties - problems in planning/executive functioning or prospective memory
- Financial or other barriers
- However - health beliefs still influence unintentional non-adherence e.g. will impact on the patient’s motivation to overcome practical barriers
What is the COM-B model?
Capability→Motivation←Opportunity
⤡ ↕︎ ⤢
Behaviour
Capability: e.g. memory, dexterity, swallowing
Motivation: beliefs about illness, treatment, emotions, habits
Opportunity: e.g. access, HCP communication, social support
What percentage of non-compliance is intentional? Why is it thought to occur?
70% of non-compliance is intentional
Strong evidence to suggest it is due to concerns about treatment (fear of side effects) beliefs about illness (cause, timeline), cost of therapy, necessity (perceived need) for treatment, perceived drug efficacy
What key beliefs influence adherence to treatment?
- Patient’s perceptions of the illness
- Patient’s perceptions of treatment
What factors make up the core beliefs about illness?
Identity- abstract label (e.g. hypertension, asthma, arthritis). Concrete symptoms that a person associates with the condition
Causal beliefs- stress, environment, genetics, own behaviour, ageing
Timeline- perceived duration and profile (e.g. chronic, acute, cyclical)
Consequences- personal, economic, social
Cure/control- beliefs about the amenability to control or cure
What effect does illness perception have on treatment adherence?
Some illness perceptions are associated with treatment adherence in some conditions:
- Causal beliefs predict adherence behaviour in post MI
- Timeline beliefs predict preventer medication adherence in asthma
- Causal, timeline and control beliefs predict adherence to CBT in psychosis
BUT illness beliefs are not strongest predictors of treatment adherence. Need to look at other factors such as patient’s beliefs about treatment
What factors effect patient’s beliefs about treatment?
NECESSITY: beliefs about necessity of prescribed medication for maintaining health
Doubts about necessity
CONCERNS: arising from beliefs about potential negative effects
Concerns about potential adverse effects
What ways can increase patient adherence to treatment?
- Use the consultation to anticipate and plan
- Interventions to:
a) improve understanding of illness and treatment
b) help patients plan and organise taking of their treatment - Check patient’s understanding of treatment and, if necessary:
- Provide clear rationale for necessity of treatment
- Elicit and address concerns
- Agree practical plan for how, where and when to take treatment
- Identify any possible barriers
What are the consequences and reasons for non-adherence to asthma preventer medication?
Consequences: - Increase in symptoms - Increase in healthcare utilisation - Reduction in quality of life Reasons: - Belief about illness - Beliefs about medication
What effect does shared decision making have on adherence to medication?
Shared decision making is associated with better adherence to medication and clinical outcomes when compared to normal care
What factors affect recall?
Individual factors
- Anxiety
- Medical knowledge
- Memory impairment
What is the percentage recall of the following information?
- Diagnostic statements
- Information regarding illness
- Instructions
- Diagnostic statements - 87%
- Information regarding illness - 56%
- Instructions - 44%
How useful is written information for patients?
- Most patients would like to receive written information (97%)
- The majority of patients report that they do read written information when it is given to them (88%)
- Written information leads to increased knowledge and adherence
What cognitive techniques can be used to improve adherence?
- Cognitive restructuring
- Imagery/role play
- Goal setting/problem solving
- Stepped behaviour change
- Rewards
- Relapse prevention
- Stress management
- Desensitisation to stressful stimuli (e.g. needle phobia)
- Assertiveness training/increase self-efficacy
What forms of social support increase adherence?
- Support groups
- Buddy systems
- Social media/web forums
- Making changes with other family members
- Support from HP
What is stress?
- Stress can be a stimulus
- Events that place strong demands on us are known as stressors
- Physiological response to stress (e.g. Fight-Flight response)
- Also, the presence of negative emotions including feeling tense, difficult concentrating and losing your temper easily
- Combination of stimulus and response as a person-situation interaction
- A pattern of cognitive appraisals, emotional reactions, physiologicla responses and behavioural tedencies that occur in response to a perceived imbalance between situational demands (primary appraisal) and the resources needed to cope with them (secondary appraisal)
What is the General Adaptation Syndrome? (Selye, 1956)
Stage 1: Alarm reaction
- The shift to sympathetic dominance causes increased arousal
Stage 2: Resistance
- The endocrine system releases stress hormones to maintain increased arousal
Stage 3: Exhaustion
- The adrenal glands lose their ability to function normally
What is the Yerkes-Dodson Law?
As arousal increases as does performance, to mid arousal, but as anxiety continues to increase the performance will become more and more impaired
What is the pathways from stress to disease?
Events
↓
Stress
↙︎ ↘︎
Behavioural Physiological
Changes Changes
↘︎ ↙︎
DiseaseWhat is the link between anxiety and heart disease?
Recent meta-analysis found anxiety was associated with 52% increased risk of developing CVD independent of traditional risk factors (eg. smoking, obesity, high BP) and depression
What effect does stress have on coronary heart disease?
When measuring cortisol in response to mental stressors and comparing the degree of coronary artery calcification (CAC)
Heightened cortisol reactivity is associated with a great extent of CAC
What are the effects of stress?
- Slows wound healing (decreased IL-1 production)
- More likely to acquire an infection
What is type A behaviour? What effect does this personality type have on CHD?
- Time urgency
- Free-floating hostility
- Hyper-aggressiveness
- Focus on accomplishment
- Competitive and goal-driven
When compared to type B, type A individuals had a 31% increase in risk of CHD
What is the effect of depression on onset of CHD?
- Relative risk of depression leading to onset of CHD is 1.64 to 1.9 times higher
- CHD patients with depression have a 2-2.5 times higher risk of mortality in the first two years
What are the different strategies for coping with stress?
Problem-focussed coping - planning - active coping and problem solving - suppressing competing activities - exercising restraint - assertive confrontation Emotion-focussed coping - positive reinterpretation - acceptance - denial - repression - escape avoidance - wishful thinking - controlling feelings Seeking social support - help and guidance - emotional support - affirmation of worth - tangible aid (e.g. money)
What is the effect of social support on breast cancer survival?
Social support group was found to increase survival compared to normal medical care
What are the factors contributing to stress burnout?
Emotional and physical exhaustion
- Can lead to an inability to engage fully with many aspects of the job but, particularly, with those aspects involving interaction
Depersonalisation
- Patients are seen less as individuals and situations become simply part of a routine
Reduced personal accomplishment
- Little sense of achievement in relation to the job, even if the reality is very different
What factors can help to manage stress?
- Organisation
- Time management
- Recognising stress
- Appraisal review e.g. role of perfectionism of self-criticism
- Relaxation techniques
- Social support
- Formal support
What is the nocebo effect?
- A negative effect that occurs after receiving treatment (therapy, medication), even when the treatment is inert/sham
- Warnings about the possible side effects of a medicine makes it much more likely that the patient will report experiencing those effects
- One out of 20 placebo treated patients discontinued treatment due to side effects
What effect does a placebo have when the patients know they are taking a placebo?
Placebo still improved the condition (IBS) even though the patients knew it was a placebo
What psychological processes contribute to the placebo effect
- Expectancy
- Classical conditioning
- Anxiety/Attention
- Release of endogenous opiates
What is the most common mental disorder in Britain?
Anxiety and depression (~9% of people)
Between 8-12% of the population experience depression in any year
What are the symptoms of a panic attack (DSM)?
Four of more of the following symtpoms:
- palpitation, pounding heart, or accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- chest pain or discomfort
- feeling dizzy, unsteady, lightheaded, or faint
- feelings of unreality (derealization) or being detached from oneself (depersonalization)
- fear of losing control or going crazy
- fear of dying
- paresthesias (numbness or tingling sensations)
- chills or hot flushes
What is Panic Disorder?
- Recurrent unexpected panic attacks
- At least one of the attacks has been followed by at least one month of one or more of the following:
- persistent concern about having additional attacks
- worry about the implications of the attack, having a heart attack, “going crazy”
- significant change in behaviour related to the attacks
What is Agoraphobia?
- Develops as a complication of panic attacks
- Agoraphobia may arise by the fear of having a panic attack in a setting from which escape is difficult (or embarrassing)
- As a result, sufferers of agoraphobia avoid public and/or unfamiliar places, especially large, open spaces where there are few ‘places to hide’ or prevent easy escape
What is the main goal of psychological therapy?
Goal of all psychotherapy is to help people change maladaptive thoughts, feelings and behaviour patterns Major schools: - Psychodynamic - Behaviour - Cognitive
What is the rational for behaviour therapies?
Behavioural approaches believe that:
- Maladaptive behaviours are not merely symptoms of underlying problems
- The behaviours are the problem
- Problem behaviours are learned in the same ways normal behaviours are
What is the two factor theory for maintenance of classically conditioned associations (e.g. fear)?
Factor 1
Car (CS) + Traumatic car accident (UCS) → Conditioned fear response to cars (CR)
Factor 2: Operant conditioning of avoidance
(Avoidance of cars is negatively reinforced)
Avoid cars → Fear is reduced → Tendency to avoid cars is strengthened
How are behaviour therapies executed?
Exposure approach is influenced by both classical and operant conditioning approaches:
- Treat phobias through exposure to the feared CS in the absence of the UCS
- Response prevention is used to keep the operant avoidant response from occurring
- Highly effective for reducing anxiety
- Controversial because intense temporary anxiety is created by treatment
What is Clark’s (1986) cognitive theory of panic?
- Individuals with panic interpret certain bodily sensations in a catastrophic fashion
- Sensations (esp. those involved in normal anxiety responses e.g. palpitations, breathlessness, dizziness) are considered to be a sign of impending physical or psychological disaster
- e.g. palpitations → “I’m having a heart attack”
What is cognitive restructuring?
- Identify the nature of thought: they don’t have to be true to affect emotions
- Learn about common biases in thought
- Treat thoughts as “guesses” or “hypotheses” about the world
What would CBT for cardiac anxiety be comprised of?
- Psychoeducation
- Relaxation techniques
- Cognitive restructuring
- Behavioural experiments
- Graded exposure
- Relapse prevention
What are the core features of CBT?
- Fuceses on problematic beliefs and behaviours that maintain disorders (“here and now” rather than original causes)
- Goal oriented i.e. specific and measurable
- Collaberative relationship between therapist and patient
- Brief (8-16 sessions)
- ‘Scientific’ approach e.g. Collecting data, testing hypotheses
According to NICE guidlelines what is CBT recommended as first line treatment for?
- Depression
- Social anxiety
- PTSD
- Generalised anxiety disorder
- OCD
- Bulimia
- Panic disorder and specific phobia
- Schizophrenia
What is more effective, CBT or anti-depressants?
CBT has been shown to have significantly lower relapse rates then anti-depressant medication in:
- Panic disorder
- Social phobia
- OCD
- Depression
What is depression?
A) Five (or more) of the following symptoms, present during the same 2 week period and represent a chnage from previous functioning;
1. Depressed mood*
2. Loss of interest or pleasure*
3. Loss of appetite
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate
9. Recurrent thought of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
*at least one of the symptoms is
B) The symptoms do not meet the criteria for a Mixed Episode
C) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
D) The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. hypothyroidism
E) The symptoms are not better accounted for by Bereavement
What is the difference between the effect of antidepressants and placebos, used to treat depression?
There is not a clinically significant difference between the two
What is the use of Motivational Interviewing? What is it used for?
Helps the patient identify the thoughts and feelings that cause them to continue "unhealthy" behaviours and help them to develop new thought patterns to aid in behaviour change. Use Elicit-Provide-Elicit Used for: - Smoking - Alcohol use - Drug addiction - Weight loss - Medication adherence
What psychological intervention can be used for pain management? What is it used for?
Involves teaching relaxation techniques, changing old beliefs about pain, building new coping skills and addressing any anxiety or depression related to pain. Often uses CBT techniques
Used for any kind of chronic pain, including back pain, arthritis, pelvic pain etc
