PSYCHOLOGY Flashcards
What is the bio-psychological approach to the psychology of aging?
Suggests ageing brain is principle determinant of psychological changes associated with age
What did David Wechsler find out about IQ scores throughout life?
Scores on IQ tests were highest in early twenties and declined constantly afterwards
When is intellectual decline considered abnormal?
Statistically intellectual decline is more abnormal when it occurs earlier in old age and affects life
In old age, it is more common to lose what type of intelligence?
Loss of wit (fluid intelligence) is more common than loss of wisdom (crystallised intelligence)
What is one way to measure wisdom?
Giving someone an impossible scenario and asking them to provide solutions
What is the critical age period in humans where there is maximal brain plasticity
0-12 years
When is a life event less likely to demand individual adjustment? Give example
When it is more predictable e.g. widowhood in an older person
What is a positive illusion?
Unrealistically favorable attitudes that people have towards themselves or to people close to them
What are the 3 kinds of positive illusion?
Inflated assessment of own abilities
Unrealistic optimism about future
Illusion of control
People consistently _______ the likelihood of anything bad happening to them
Underestimate
What experience in early adult life helped older people cope with reduced income better than those not so affected?
Depression
People who had been exposed to traumas in childhood and adolescence were more likely to suffer from what in later life?
Anxiety disorders
Some research suggests that those who express a sense of personal responsibility for what has happened are more or less likely to adjust to trauma?
More likely to adjust to such trauma than those who see such events as their bad luck
Study found that looking after a pot plant in a nursing home showed what in mortality?
Increased life span by about 7 months even if their mortality risk was lower before
Perception of time remaining in life prompts shifts in motivation away from gaining knowledge towards what?
Emotional satisfaction
Describe Erikson’s model
He argued that at each stage of life we face a particular type of psychosocial crisis, whose resolution helps establish an emergent trait or ‘virtue’ that then serves us well in addressing challenges later in life
Psycho-social crisis according to Eriksons’s model: age 18 months
Trust vs mistrust
Psycho-social crisis according to Eriksons’s model: age 3-5 yrs
Initiative vs guilt
Psycho-social crisis according to Eriksons’s model: age 5-13 yrs
Industruy vs inferiority
Psycho-social crisis according to Eriksons’s model: age 13-21 yrs
Identify vs role confusion
Psycho-social crisis according to Eriksons’s model: age 21-39 yrs
Intimacy vs isolation
Psycho-social crisis according to Eriksons’s model: age 40-65 yrs
Generativity vs stagnation
Psycho-social crisis according to Eriksons’s model: >65 yrs
Ego integrity vs despair
50% of suicide victims >60 had seen GP in month of death with 26% in the week of death yet more than half only reported what?
Physical complaints
Define loss
Being separated from or deprived of someone or something we are emotionally attached to
List some things a person could experience loss of
Person Relationship Health Hope or dream Role or job or function Change in body image Stage in life - children moving house, leaving home, old age
Define bereavement
Describes having lost someone significant through death
Define grief
Normal, natural emotional reaction to loss. Incorporates psychological (cognitive, social, behavioural) and physical (physiological, somatic) responses
Describe mourning
Process of adaptation to loss, with particular reference to cultural and social rituals and expectations. Includes public display of grief and social expression
Acute grief responses - 7 listed
Disbelief/ shock/ numbness/yearning
Agitation/anger/hostility/irritability
Crying, tearful, sadness
Disrupted sleep and eating patterns
Aimless activity / inactivity
Illusions or hallucinations and worry that the think they are going mad
Preoccupation with images of the lost person
Duration of acue grief response
Difficult to estimate duration: may last around 6 wks or so – individuals differ, very vague guideline
When does the duration of acute grief response become concerning?
Should start worrying if these signs are there many months after bereavement
Longer term grief responses - 7 listed
Social withdrawal Sleep disturbance Restlessness or anxiety Decreased concentration Decreased or increased food intake Reduced libido Depression
Duration of longer grief response
May last 3 -12 months plus: individuals vary
Is a minimal/absent grief response normal?
Yes
What is one of the biggest impediments to children’s healing after death?
Actions of adults
Children who suffer bereavement are vulnerable to a range of negative factors - give 5 examples
Low self esteem Mental health problems Anxiety and depression Substance abuse Increased risk of suicide (2 to 3x)
What are some things that can mediate the negative impacts of bereavement on children? List 5
- Parental warmth and positive family relationships, particularly with surviving parent
- Child feels safe and secure within supportive family
- Personal attributes e.g. sport, hobby
- Having ongoing relationship with person who died through visual or auditory cues
- Being helped to understand loss, express, accept grief, share with others who have had similar experiences
Children from disadvantaged backgrounds are particularly vulnerable following bereavement - describe why
Greater risk of experiencing other stressful events such as physical or mental illness of surviving parent, financial problems, relationship breakdown. 6x more likely than peers to be looked after by local authorities at some point
Five stages of loss: Elisabeth Kübler-Ross is a theory of loss or grief - describe
Framework originally developed for patients with terminal illness facing death:
- Denial, numbness, isolation
- Anger
- Bargaining - doesn’t work in bereavement, applies more to those facing death themselves
- Depression, despair
- Acceptance
Pros of the 5 stages of loss theory
Well known theory, easy to understand and quantify
Cons of the 5 stages of loss theory
- Based on interviews with people who were facing death, not those facing bereavement
- Grief is not linear as theory suggests. Stages may/will repeat
- Model has been applied to other situations (e.g. loss as a result of bereavement, divorce). Little evidence to support the efficacy
Describe a problem with the bargaining stage of the grief theory
Traditionally this stage for people facing death can involve attempting to bargain with God. People facing less serious trauma can bargain or seek to negotiate compromise e.g. “can we still be friends?” Rarely provides sustainable solution
Dual Process Model of Grief (Maggie Stroebe & Henk Schut, 1999) - describe
Emphasises grieving as a dynamic process involving oscillation between Loss Oriented and Restoration Oriented coping
According to Stroebe and Schut, what is “healthy grieving”?
Engaging in a dynamic process of oscillating between loss-oriented and restoration-oriented coping. Griever will oscillate between confronting and avoiding loss
In the Dual Process Model of Grief the authors suggest that there are two types of stressor that are associated with grieving: describe what they are and how they are overcome
Loss-oriented stressors and restoration-oriented stressors. Both types require coping, but Stroebe and Schut are quick to point out that we also must take important breaks from said coping
Define loss-oriented stressors
Stressors that come from focusing and processing loss and relationship with that person. Includes everything from looking at photos, yearning, remembering, imaging loved one would say about something, reminiscing
Define restoration-oriented stressors
Secondary sources of stress and coping. Instead of just thinking about grief, this considers stress of isolation, having to fulfill tasks that late person used to do (cooking, cleaning, managing finances)
Traditional grief theories vs newer theories
Traditonal have focused on ‘letting go’. Newer recognize the frequently adaptive role of maintaining a continuing bond with deceased and move away from idea that all bereaved persons respond in similar way
Four points on the health of bereaved people
More likely to:
- Suffer mental illness
- Suffer physical illness
- Die
- Have higher rates of medication use, disability, hospitalisation
Death of a spouse increases risk of mortality by what percent?
10 to 40%
Greatest risk of death after bereavement is when? It goes down after this time but how long does it remain raised for?
First 6 months
Remains raised for at 10 to 18 years after bereavement
__% increased mortality risk for mothers following death of a child
31%
What are the possible causes for increased mortality after bereavement? 7 listed
- Change in usual health practices
- Neglect early signs disease onset
- Unstable management chronic diseases e.g. diabetes
- Alcohol / drug abuse
- Loss of care provided by deceased
- Stress, impact on immunity
- Suicide
Percentage of bereaved people who will ‘recover’ from their loss within a ‘reasonable’ time period
90-95%
Help may be needed if grieving is one of what 2 things?
→ Abnormally severe after first few months
→ Abnormally prolonged - no diminution in depressive symptoms after 6 months; persistent disabling grief after a year
Describe the types of symptoms that may be seen in someone with abnormally severe (complicated) grief
- Preoccupation with longing and yearning for deseased which does not lessen with time
- Persistent intrusive images, ideas, recurrent dreams/ nightmares
- Active avoidance of thoughts, communication or action associated with loss
- Interference with daily functioning
What percentage of people experience abnormally severe (complicated) grief?
10%
5 broad risk factors for complicated grief with examples
- Circumstances surrounding loss e.g. unexpected
- Individual circumstances e.g. mental health
- Social support unavailable
- Quality of lost relationship
- Disenfranchised grief e.g. loss cannot be openly acknowledged
Describe some circumstances surrounding loss that can lead to complicated grief - 5 listed
→ Sudden, unexpected bereavement – accident, suicide, trauma, natural disaster
→ Violent cause of death – assault, homicide, domestic violence, terrorist attack
→ Multiple bereavements
→ Not told – delay in finding out
→ Excluded
Describe some individual circumstances surrounding the loss that can lead to complicated grief - 6 listed
→ Previous problems coping → PMH mental health problems → Separation anxiety → Unable to understand or explain loss → Dependent children → Intellectual disability
Describe siutatons in which social support unavailability will increase risk of complicated grief
→ Pre-existing isolation
→ Loss disrupts other routines and relationships
→ Others make choices and decisions
Describe how the quality of the lost relationship can increase risk of complicated grief. 2 listed
→ Very close, dependent relationship
→ Difficult, ambivalent, abusive or violent relationships
Describe disenfranchised grief
→ A loss that cannot be openly acknowledged, publicly mourned or socially supported. Causes:
Relationship is not recognised
Loss is not recognised
Mourner is not recognised
Describe prolonged mourning - 5 points
Unresolved mourning
Initially seems ‘normal’
Continues with disabling severity beyond ‘normal’ duration
Not showing diminution in experience of grief 12 months after loss
Loss still central in life 6-9 months on
Describe delayed or absent grief
Individuals may not express/experience grief symptoms at the time of bereavement. May result severe anniversary reactions/later anxiety/difficult family relationships. No evidence it leads to adverse outcome
Painful feelings in grief vs depression
In grief it often come in waves, often intermixed with positive memories of person who died. In depression, mood and ideation are almost constantly negative
Self esteem in grief vs depression
In grief, self esteem is preserved whilst in depression feelings of worthlessness, hopelessness and self loathing are common
Suicidal ideation in grief vs depression
Presence of suicidal ideas as distinct from wanting to join deceased loved one and impairment of overall function suggest presence of depression in addition to the normal response to a significant loss
An episode of depression occurs in context of bereavement, it presents at least one of the following features suggestive of major depression rather than normal grief - 7 listed
Duration >2 months
Suicidal ideation
Morbid preoccupation with worthlessness
Marked psychomotor retardation
Prolonged and marked global functional impairment
Psychotic symptoms
History of major depressive disorder in circumstances other than bereavement
List some support services available to bereaved people
Usual social networks – family, friends, colleagues
Faith based networks
Doctors/ GP - who can listen, and also refer e.g. Wandsworth Bereavement Service, in-hospital services, counselling services
Self help groups (e.g. Compassionate Friends, National Association of Widows)
Cruse Bereavement Care (supports adults, adolescents and children)
‘Facing the Future’ and SOBS (Survivors of Bereavement by Suicide)
‘Hope Again’ and ‘Child Bereavement UK’ support children
The Miscarriage Association
Child death helpline
Define sensation
Process of detecting presence of stimuli by sensory organs
Define perception
Recognition, integration, interpretation of raw sensory information/stimuli. Brain can alter perception of sensation
What is the Bottom up school of thought? Is it correct?
‘It is the physical characteristics of stimuli that result in a particular perception’. Suggests a realist view on the world and the brain doesn’t add anything. This is wrong
Top Down vs. Bottom Up
→ Bottom up processing suggests information is drawn directly from sensorial data
→ Top down processing involves combination of sensorial data with other psychological constructs such as expectancies, previous experiences, or other sensorial information to provide context
Describe perceptual grouping
Wertheimer (1923) demonstrated that we tend to perceive objects as “going together”
→ Perhaps because this makes world simpler e.g. remembering a phone number in chunks, rather than a-digit-at-a-time
The important lesson to be learned from the study of perception
Perceptual experience in response to stimulus event is a response of whole person. In addition to info provided when your sensory receptors are stimulated, your final perception depends on who you are, whom you are with, and what you expect, want, and value
What are 2 ways to measure perception?
- Qualitative measurements → “Say what you see or feel”
- Quantitative measurements → Absolute thresholds: minimum intensity required for senses to perceive stimulation e.g. Hearing: a watch ticking from about 20 feet away in a quiet room
How does patient’s attention affect clinical practice?
In absence of attention it is likely that patients will not perceive given info accurately. Pain is perceived as higher when less distracted
How does patient emotion/psychopathology affect clincial practice?
Depressed patients can perceive info as more negative or can dismiss positive outcomes as being unlikely
How do patient expectations affect clinical practice?
Expectations about symptoms can lead to patients ignoring potentially serious illness (e.g. angina or diabetic symptoms are seen as familiar and so not serious)
How does patient motivation affect clinical practice?
As patients often have very particular needs (especially when related to worries/fears) they may be prone to interpreting info as relating to their needs e.g. search for wonder drugs
Why does focusing attention on one thing reduce ability to focus on another?
Focusing attention on one stimulus reduces capacity to focus on others. Attention, therefore, is often distributed towards ‘concern-related’ cues. Can be problamatic in addiction recovery
Define pain
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Describe pain in a psychological point of view
Final experience of pain is a psychological construct arising from physiological processes occurring in the brain (usually but not always in response to nociceptive activity)
Nociception vs neuropathic pain
Nociception: “pain” receptor response to temperature, pressure/stretch or chemical stimuli
Neuropathic: structural damage and nerve cell dysfunction
Affect of persistent pain on grey matter
Ages brain, reducing grey matter twice as fast
Who is at higher risk of persistent pain? 6 listed
Severe and long-lasting nociception
Depression/anxiety
Lower socioeconomic status + low job satisfaction
Certain vocations (e.g. truck driving)
Trauma survivors
Genetically sensitive to noxious stimulation
Persistent pain often produces changes in brain activity that contribute to what phenomenon?
Central sensitization
Brain imaging studies indicate that which psychological factors lead to greater experience of pain (through altered cortical activation)?
Anxiety, depression, catastrophising, anger
What is the biopsychosocial model of pain?
In order to understand a person’s perception of pain and associated disability, psychological and sociocultural context all need to be considered. Model allows for a dynamic view of pain with experience unique to each person. Emphasises distinction between contributors and causes of pain syndromes
Psychological interventions for pain managment
CBT, counselling, ACT, mindfulness
Somatic interventions for pain managment
TENS, injection therapy, acupuncture, manipulation, massage
Define exercise
Activity requiring physical effort, carried out to sustain or improve health and fitness
1 in 5 men in England and 1 in 4 women in England are classified as ‘inactive’ - define
Having less than 30 minutes moderate exercise a week
Mental health benefits of exercise
Improves mood
Lifts self-esteem
Reduces stress
Lowers risk of depression + anxiety
Determinants of physcial activity - 8 listed
Higher socio-economic status - safer environment
Being male - stronger sports culture
More social support
Fewer barriers - ‘as lack of time’, ‘don’t enjoy exercise’
Active childhood
Being younger
Lower BMI – psychological and physical barriers of high BMI
Non-smokers –smokers: non-PA culture, CV fitness hampered
4 psychological determinants of physical activity
Social support
Self efficacy
Beliefs
Motivations
Describe self efficacy as a determinant of physical activity
Confidence a person has in their ability to perform a behaviour and overcome barriers. One of the strongest predictors of physical activity. E.g. How confident are you that you will still go for a run when it’s raining?
Describe the components of the health belief model
Am I susceptible to disease?
Are the consequences of disease severe?
Will I benefit from health behaviour change?
Can I overcome the barriers preventing health behaviour change?
Considers perceived benefits vs perceived barriers
Top reasons for engaging in physcial activity (motivations)
Health Appearance Enjoyment Social interaction Stress relief Challenging Skill development/improve performance Personal Satisfaction
Barriers to physical activity
Time Cost Gender Caring for others Cultural expectations Lack of motivation Low self-efficacy Health issues Social isolation – lack of support Lack of knowledge about PA benefits Fear of injuries/fall Weather
Describe theory of planned behaviour
Behaviour is affected by intention which is affected by the following 3 factors:
- Attitude
- Subjective norm
- Perceived behavioural control
How long does it take to form a habit?
66 days
Range 18-254 days
Describe the COM-B model
Behaviour is influenced by:
Capability
Opportunity
Motivation
Different levels of physical activtiy intervention - 4 levels
- Individual: Allows tailoring, flexible scheduling, labour intensive
- Group: Added group dynamics, ‘buddying’, less tailoring, less labour intensive
- Organisational/community: e.g. schools, corporate fitness, primary care): wide impact, existing infrastructures, lack of facilities and trained staff, favours those who need it least
- Societal: e.g. mass media campaigns, transport policy, environment, PE curriculum, insurance incentives): widest impact
NHS recommendations for physical activity
5-18 yrs: 60 mins/day
19-64 yrs: 150 mins moderate aerobic/wk
65+: As above plus strength exercises 2 days/wk
Define physical activity
Any bodily movement produced by skeletal muscles that results in energy expenditure
Define self efficacy
Individual’s belief in their innate ability to achieve goals
