Psychology Flashcards

Question

How does the person we are imitating affect our social learning? (x4)

Answer 1

We imitate behaviours of people when the person is: (i) seen to be rewarded, (ii) high status, (iii) similar to us, and (iv) friendly.

Answer 2

A model of CLASSICAL CONDITIONING: measured salivation rates of dogs – found that dogs would produce saliva when they heard or smelt food in anticipation of feeding. However, the dogs also began to salivate when events occurred which would otherwise be unrelated to feeding. By playing sounds to the dogs prior to feeding them, Pavlov showed that they could be conditioned to unconsciously associate neutral, unrelated events with being fed.

Answer 3

Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage.

Answer 4

• POPULATION: social media campaigns, public health. • COMMUNITY: targeting ethnicities and areas more susceptible to poor health behaviours. • INDIVIDUAL: interventions made personally e.g. GP.

Answer 5

Information does have an important role and is most effective for discrete behaviours e.g. getting a child vaccinated. Messages tailored to a particular audience are more effective. But often, people need more than knowledge to change habitual lifestyle behaviours, particularly addictive behaviours e.g. studies show that education does not change smoking habits.

Answer 6

• STIMULUS CONTROL TECHNIQUES: Keep ‘danger’ foods out of the house, use small plates…. • COUNTER CONDITIONING: identify high risk situations or cues (for example, stress), and condition healthier responses e.g. find something other than eating that makes you feel better. • CONTINGENCY MANAGEMENT: for example, plan specific rewards for successful weight loss. • REINFORCEMENT: improved self-esteem, money for giving up smoking (positive reinforcement); and reduction in symptoms of breathlessness (negative reinforcement).

Answer 7

• Lack of generalization (only affects behaviour regarding the specific trait that is being rewarded). • Poor maintenance (rapid extinction of the desired behaviour once the reinforcer disappears). • Impractical and expensive.

Answer 8

When health promotion is taught with a high level of fear, the number of people that change their behaviour is LOW. When health promotion is taught with a low level of fear, the number of people that change their behaviour is HIGHER.

Answer 9

When a person is surrounded by lots of people exercising a certain health behaviour, they are more likely to copy that behaviour. For example, if a person is surrounded with lots of smokers, they are more likely to smoke.

Answer 10

The chance that a behaviour will occur is based on the expectancy (probability) that the behaviour will lead to a particular outcome (and the VALUE of that outcome to the individual) e.g. a patient who has just had a heart attack changes their diet, knowing that it’s more likely to decrease mortality (EXPECTANCY). They decided to do this because having a heart attack made them realise that living a longer life is important to them (VALUE).

Answer 11

* Behaviour change depends on a complex range of health beliefs and their interactions with an individual. * The likelihood of behaviour change is significantly influenced by PERCEIVED THREAT, which is dictated by PERCEIVED SUSCEPTIBILITY and PERCEIVED CONSCIOUSNESS (e.g. threat of coronavirus is determined by an individual’s belief that they may catch it – based on susceptibility and seriousness). * CUES TO ACTION can also influence perceived threat e.g. heart attack is a cue for many to change diet and lifestyle habits, OR family/GP tells someone to change behaviour. * The likelihood of behaviour change is also influenced by PERCEIVED BENEFIT vs COST/BARRIERS (e.g. alcohol withdrawal is seen as beneficial to health, but individual may also see it as a way of feeling comfortable in social situations). * All of these depends on BACKGROUND VARIABLES – intelligence, personality, age, sex and more.

Answer 12

Individuals’ expectations that the behaviour will lead to a particular outcome.

Answer 13

Belief that one can execute the behaviour required to produce the outcome.

Answer 14

• Mastery experience e.g. getting driving lessons before you drive by yourself. • Social learning i.e. shadowing someone first, before doing it yourself. • Verbal persuasion or encouragement. • Physiological arousal – adrenaline-rush.

Answer 15

* It is the theory that the intention to execute a health behaviour is underlaid by many factors. * (1) EXPECTANCY-VALUE – beliefs about that outcome and evaluation of the outcome, which influences the attitude towards the behaviour. * (2) SUBJECTIVE NORM – beliefs about important others’ attitudes towards the behaviour e.g. what your family and friends think about smoking. * (3) PERCERICED BEHAVIOURAL CONTROL – internal (self-efficacy) and external (perceived costs/barriers) control factors.

Answer 16

• Outlines the stages of change of behaviour. • (PRE-CONTEMPATION – does not recognise the need for change or is not actively considering change.) • CONTEMPLATION – recognises problem and is considering change. • PREPARATION – is getting ready to change. • ACTION – is initiating change. • MAINTENANCE – is adjusting to change and is practicing new skills and behaviours to sustain change. • RELAPSE – may occur and start the cycle again.

Answer 17

* COM-B outlines the causes of health behaviour. * It suggests that a health behaviour is the results of an interaction between CAPABILITY, OPPORTUNITY and MOTIVATION. Capability and opportunity influence motivation. * The model is a starting point for choosing which interventions are most effective for a patient. It forms the “hub” of a BEHAVIOUR CHANGE WHEEL around which are nine possible interventions to choose from. * Around these interventions, there are seven areas of policy that we can use as guidance to carry out those interventions.

Answer 18

* CAPABILITY: PSYCHOLOGICAL (capacity to engage in necessary thought processes i.e. is patient well-informed about behaviour) and PHYSICAL (capacity to engage in necessary physical processes e.g. adapt to diets or physical exercise; capability to walk to store and buy healthy groceries) capabilities are factors that determine whether a patient will adhere to a medication. * MOTIVATION: can be split into REFLECTIVE (patient evaluation of a medication – belief about TREATMENT, OUTCOME, SELF-EFFICACY and PERCEPTION OF ILLNESS) and AUTOMATIC motivation (emotions and impulses arising from associative learning or innate dispositions e.g. what a patient learnt about their interaction with food as children, and how this implicitly contributes to their views and behaviours in adulthood) – these all affect adherence. * OPPORTUNITY: are factors that lie outside of the individual that may prompt adherence. Opportunity can be split into PHYSICAL (physical opportunity provided by the environment e.g. costs, physical characteristics of medicine such as smell and taste) and SOCIAL (cultural environment that dictates the way we think about things e.g. stigma, supportive family and religious beliefs).

Answer 19

• Behaviour change technique: a systematic strategy used in an attempt to change a behaviour – they tend to describe something quite specific. • Interventions are broader and refers to treatment or action plans that incorporate multiple behaviour change techniques. • EXAMPLES: providing information on consequences, prompting specific goal setting, prompting barrier identification (forcing patient to identify obstacles), modelling the behaviour, planning for social support.

Answer 20

Describes 93 behaviour change techniques arranged into 16 categories. It is a resource for clinicians containing a list of possible behaviour change techniques that they can use to make up an intervention.

Answer 21

Look at photo.

Answer 22

• Cardiac rehabilitation is used in patients who have suffered from cardiovascular disease or received a cardiac intervention. DIET is a major target for behaviour change in cardiac rehabilitation to reduce risk of a second cardiovascular event – a Mediterranean diet is promoted. • The COM-B MODEL is used as the basis for deriving techniques of behaviour change: • CAPABILITY: do patients in cardiac rehab have psychological and physical capability to change their diet e.g. are they fearful to leave the house because of their cardiac event, are they aware of the best diet? • OPPORTUNITY: is there a physical opportunity to obtain Mediterranean foods e.g. are these foods too expensive? Do they have family and friends who support a change in their diet (social opportunity)? • MOTIVATION: cardiac rehab provides an opportunity to reflect on the benefit of changing diet on their future CVS risks (reflective). What is their sub-conscious view on eating Mediterranean foods (automatic)? • Next, we study possible INTERVENTION FUNCTIONS that will lead to a patient adhering to a change in their diet. In this case, EDUCATION and PERSUASION are considered the most appropriate changes in behaviour that form the intervention. • Finally, what POLICY CATEGORIES will help us execute this intervention? PUBLIC HEALTH CAMPAIGNS are ideal for education and persuasion but is expensive for the NHS. SERVICE PROVISIONS are very effective and involve group talks on Mediterranean diets and heathy eating.

Answer 23

An individual keeping record of target behaviours e.g. food intake and weight. Encourages patients to become self-aware about their behaviour!

Answer 24

BENEFIT: Studies suggest that it is the most effective method of inducing positive health behaviour changes in patients who need to change DIET and EXERCISE. DISADVANTAGE: time-consuming for the patient and is a change in behaviour that requires long-term implementation.

Answer 25

• A person-centred counselling style for addressing the common problem of ambivalence (having mixed feelings) about change. • Clinician must employ an ‘MI (motivational interviewing) spirit’: this means being non-judgemental (makes patient relaxed and less defensive, so more willing to change when you motivate them to). • Clinician must also not educate the patient or tell them what to do; instead, they should be listening out for areas in the conversation when a patient has ambivalence and recognises why they should pursue the positive behaviour. • Clinical should encourage patient to reflect on their behaviour and reinforce thoughts that identify reasons why they should pursue positive behaviour change. Doctor should ask what the patient wants and use positive reinforcement when these intentions are identified, in order to improve self-confidence that patient can pursue the positive behaviour – ENHANCE SELF-EFFICACY.

Answer 26

They are ACTION PLANS: where a clinician requests an individual to think about situations, and appropriate responses within those situations.

Answer 27

They follow an IF-THEN model e.g. IF it’s a Friday morning, THEN I will go on a run. By planning a situation in advance in which an individual will act, the intervention will become more accessible and easier for the patient to pursue. Therefore, behaviour is more likely to be enacted. FOR EXAMPLE, many patients who have a STEMI have never been on routine drugs before and are suddenly prescribed 8 different drugs. Planning cues such as, ‘each time a patient walks the dog they should take their medications’, increases the chances that the behaviour will be enacted.

Answer 28

It is a type of positive reinforcement e.g. mothers being offered cash for giving up smoking in pregnancy.

Answer 29

• ADVANTAGES: cost-effective, raises awareness (people seek incentives), brings individuals into contact with health services by allowing earlier screening and treatment of illness, and can be effective in changing health behaviours. • DISADVANTAGES: poor maintenance (rapid extinction of the desired behaviour once the reinforcer disappears), expensive and impractical, and lack of generalisation (only affects behaviour regarding the specific trait that is being rewarded).

Answer 30

e.g. Mediterranean diet and smoking cessation at the same time: targeting multiple behaviours may lead to greater OVERALL change, but reduces the change of INDIVIDUAL behaviours (sub-additivity).

Answer 31

The stimulus detection system by which our sense organs respond to and translate environmental stimuli into nerve impulses that are sent to the brain.

Answer 32

This is the next step along from sensation: It is the active process of organising the stimulus output and giving it meaning i.e. processing the sensation and figuring out what it could be.

Answer 33

Top-down and bottom-up processing. Note that perception uses BOTH processes.

Answer 34

Processing a perception in light of existing knowledge (from motives, expectations, experiences and culture) e.g. perception that there is a coffee in front of you because this is what you expect every morning, and it is familiar to your past experiences.

Answer 35

This describes the brain processing the sensory information it receives to generate a perception. Individual elements are combined to make a unified perception e.g. the smell and sight of coffee gives the perception that there is coffee in front of you.

Answer 36

• Attention. • Past experiences. • Current drive state e.g. arousal state – for example, when hungry, we are more likely to notice food-related stimuli. • Emotions e.g. anxiety increases threat perception. • Individual values and expectations. • Environment. • Cultural background. • NOTE that these are top-down processes influencing perception.

Answer 37

* The laws describe how we organise the parts of our perceptual field i.e. how we see things. * FIGURE-GROUND RELATIONS: we tend to organise parts of our visual field into foreground and background, such that the focus of our attention becomes the figure; everything else is the background. * CONTINUITY: when the eye is compelled to move through one object and continue to another object e.g. in the photo (1), even though the H and leaf are separate, our brain puts them together. * SIMILARITY: we group things together that appear similar – see photo (2). * PROXIMITY: objects that are near to each other are grouped together, even if the individual parts are different – see photo (3). * CLOSURE: things are grouped together if they seem to complete some entity – see photo (4).

Answer 38

Basic vision is spared i.e. people can see, and their primary visual cortex is mostly intact, but they can’t perceive what they see e.g. they can see a pen, but they won’t be able to identify it as a pen.

Answer 39

APPERCEPTIVE and ASSOCIATIVE.

Answer 40

A failure to integrate the perceptual elements of the stimulus. In other words, it is a failure of recognition that occurs because there is a FAILURE OF PERCEPTION.

Answer 41

PERCEPTION STILL OCCURS, but there is still a failure recognition i.e. there is a failure of retrieval of semantic (verbal) information (this means that although an individual can perceive the object in front of them, they can’t recall the name or the means to describe the object). Usually, if the object is touched, it can be recognised.

Answer 42

The process of focusing conscious awareness, providing heightened sensitivity to a limited range of experience requiring more intensive processing.

Answer 43

Focusing on a certain element of your environment AND filtering out other information.

Answer 44

FOCUSED attention where attention is directed at one thing – the ‘spotlight’; and DIVIDED attention when you pay attention to more than one thing at once.

Answer 45

• INTENSITY. • NOVELTY: is this the first time you have seen this – things that are more novel tend to receive more attention. • MOVEMENT. • CONTRAST. • REPETITION.

Answer 46

• Motives. • Interests. • Threats e.g. anxiety makes you more attentive to threats. • Mood. • Arousal e.g. are you sleepy or alert?

Answer 47

We can focus our attention on one person’s voice in spite of all other conversations. However, aspects of our brain also unconsciously focus on the environment around us e.g. when someone calls your name, it will still draw your attention.

Answer 48

• COGNITIVE STAGE: the stage in learning that requires attention. It requires explicit instruction through teaching, demonstration and self-observation. • ASSOCIATIVE STAGE: this point is reached when an effective motor programme has been developed to carry out the broad skill, but you lack the ability to perform finer subtasks with fluency. • AUTONOMOUS STAGE: the skill is largely automatic and does not require much conscious thought or attention.

Answer 49

When skills reach the AUTONOMOUS STAGE of learning, and requires little attention and conscious control, errors and medical mistakes are more common. The smaller attention on the skill means that mistakes are more likely.

Answer 50

Where normal body sensations are given excess thought, and individual develops a hypervigilance of the body (overthinking potential problems). This leads to catastrophic interpretation of the normal body sensation, leading to anxiety etc. So called ‘Medical Student Syndrome’ because it is thought that all the information medical students are bombarded with regarding what can go wrong with the body, can lead to this anxiety.

Answer 51

When students ran on a treadmill with headphones on which played the sound of their breathing, they reported greater number of bodily symptoms that students which ran on the treadmill and listened to headphones with street sounds playing.

Answer 52

Students asked to rub a piece of sandpaper. Students who were told that it was going to be a pleasant sensation reported less pain than students who were told that it was going to be painful.

Answer 53

Chronic pain is defined when it has been present for greater than three months. At this point, it is likely that the original damage/injury has been healed. Chronic pain perception involved MANY regions of the brain, and is affected by how we feel, our emotional state, attention/anxiety on the pain, mindfulness, and external factors.

Answer 54

Pain is transmitted up the spinal cord and signals are integrated at the dorsal horn before it enters the brain. In this integration, some signals are passed onto the brain and others are cancelled out. This ‘gate’ can be affected by psychological and physical factors which therefore affect perception of pain. This explains why there is pain relief by rubbing it better.

Answer 55

For people that experience pain over a long time, they can become avoidant of stimuli that promote the pain e.g. in many cases, movement can promote chronic pain. However, avoidance of pain can create a vicious cycle: This avoidance perpetuates stress, low mood and anxiety (because if you are avoiding moving around, the brain has more opportunity to focus on the pain). These feelings therefore increase the perception of pain even further.

Answer 56

The smallest unit of speech sound in a language.

Answer 57

The smallest units of meaning in a language. They typically consist of one syllable and are combined into words.

Answer 58

See photo.

Answer 59

The rules and principles which govern the way in which morphemes and words are combined to communicate meaning in a particular language.

Answer 60

There is a critical period of language acquisition, such that beyond a certain age, you struggle to pick up linguistic competence if you haven’t learnt the language. Between ages 5 to puberty, language acquisition becomes more difficult.

Answer 61

95% of right-handed people have left hemisphere dominance for language, 18.8% of left-handed people have right-hemisphere dominance for language function.

Answer 62

An inability to comprehend or formulate language (reading, speaking or writing) because of damage to areas of the brain.

Answer 63

Look at photo.

Answer 64

Also termed ‘expressive’ aphasia. There is non-fluent speech, speech repetition and poor ability to produce syntactically correct sentences. However, comprehension and ability to understand sentences is intact.

Answer 65

Also termed ‘receptive’ aphasia. Patient has problems comprehending speech (input or reception of language), and is able to speak fluently, but MEANINGLESSLY i.e. patient has fluent paraphasia, so their words are jumbled, and sentences carry no meaning. Also associated with neologisms, repetition and impairment in writing.

Answer 66

SEMANTIC – substituting words similar in meaning e.g. barn and house; PHONEMIC – substituting words similar in sound e.g. house and mouse.

Answer 67

Non-words e.g. ‘glump’.

Answer 68

1. Information about the sound is analysed in PRIMARY AUDIOTRY CORTEX and transmitted to Wernicke’ area. 2. WERNICKE’S AREA analyses the sound to determine the word that was said. 3. This information is transmitted to Broca’s area by ARCUATE FASCICULUS. 4. BROCA’S AREA forms a motor plan to repeat the work and sends the information to the motor cortex. 5. The MOTOR CORTEX implements the plan, manipulating the larynx and related structures to say the word.

Answer 69

Lesions caused by stroke, traumatic brain injuries, cerebral tumours and progressive neurodegenerative conditions.

Answer 70

The mental processes that enable us to plan, focus attention, remember instructions and juggle multiple tasks successfully.

Answer 71

Involves the disruption of executive function and is closely related to frontal lobe damage. It encompasses cognitive, emotional and behavioural symptoms.

Answer 72

Head trauma, tumours, degenerative diseases and cerebrovascular disease. Note that these are the same causes as language aphasias.

Answer 73

Involves whether human behaviour is determined by the environment (nurture – prenatal environment, parenting, stimulation and nutrition), or by genetics (nature – gender, temperament, maturational stages).

Answer 74

A person’s nature or character.

Answer 75

A bidirectional socialisation process when both the parent and child socialize each other through their interactions. For example, during the bonding process between a mother and infant, mother and child start synchronizing actions and movements when looking at each other. This leads to SCAFFOLDING behaviours, in which a parent's responses support and encourage the child's behaviour: When baby cries, the mother may pick the baby up and making soothing noises; as the baby calms, the mother will mirror this by smiling; the baby may respond again by smiling, and this can continue.

Answer 76

During a normal baby-mother interaction, the mother will react to the baby in an attempt to interact with the baby e.g. make faces to make the baby laugh or look in the direction that a baby points and go ‘wow’. However, when the mother shows a still face, the baby will do everything to try and regain the mother’s attention e.g. laughing or pointing again. These will soon turn into negative emotions as the baby starts to feel the stress of the situation.

Answer 77

Scaffolding, reciprocal socialisation, and provision of a stimulating and enriching environment (both physiologically e.g. food, and psychologically e.g. playing and smiling).

Answer 78

A theory which describes a biological instinct that seeks proximity to an attachment figure (carer) when threat is perceived, or discomfort is experienced. The 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.

Answer 79

MIND-MINDEDNESS mediates attachment: This is when parents treat their children as individuals with minds. Therefore, 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.

Answer 80

• Based on the Strange Situation Test where children are presented with an unusual environment. The experiment tests how babies respond to the temporary absence of their mothers, and how they respond when their mother returns. • SECURELY ATTACHED CHILDREN: The securely attached child explores the room freely when Mum is present. He may be distressed when his mother leaves, and he explores less when she is absent. But he is happy when she returns. • INSECURELY ATTACHED CHILDREN: there are three types.

Answer 81

• AVOIDANT-INSECURE CHILDREN: little exploration and little emotional response to mother. The avoidant-insecure child doesn’t explore much, and he doesn’t show much emotion when his mother leaves. He shows no preference for his mother over a complete stranger and, when his mother returns, he tends to avoid or ignore her. • RESISTANT-INSECURE (or ‘ambivalent’) CHILDREN: little exploration, great separation anxiety and ambivalent (mixed feelings) response to mother upon return. Like the avoidant child, the resistant-insecure child doesn’t explore much on her own. But unlike the avoidant child, the resistant child is wary of strangers and is very distressed when her mother leaves. When the mother returns, the resistant child is ambivalent. Although she wants to re-establish close proximity to her mother, she is also resentful—even angry—at her mother for leaving her in the first place. • DISORGANISED-INSECURE CHILDREN: little exploration and confused response to mother. The disorganized child may exhibit a mix of avoidant and resistant behaviours. But the main theme is one of confusion and anxiety.

Answer 82

• Promotes independence, better moods, emotional availability and better emotional coping. • Associated with fewer behavioural problems. • Associated with higher IQ and academic performance. • Associated with social competence, loyal friendships and greater leadership qualities in adolescence and adulthood.

Answer 83

• Engage and interact with the world. • Practice decision-making, planning. • Promotes language development. • Promotes creative problem solving. • Overcome fears. • Learn how to work in a group. • Extend positive emotions.

Answer 84

1. UNOCCUPIED PLAY (0-3 months): baby plays alone by moving its own limbs. Removal and reappearance from their view is fun for them. 2. SOLITARY PLAY (0-2 years): baby plays with toys by themselves. 3. ONLOOKER PLAY (2 years): observe other children playing around them but will not play with them. 4. PARALLEL PLAY (2+ years): plays alongside others but will not play together with them. 5. ASSOCIATE (3-4 years): starts to interact with others in their play and there may be fleeting cooperation. Develops friendships. 6. COOPERATIVE PLAY (4-6 years): plays together with shared aims of play with others.

Answer 85

Proposed that children’s thinking changes QUALITATIVELY with age as a result of an interaction of the brain’s biological maturation and personal experiences. This process is associated with SCHEMAS which are organised patters of thoughts and actions – development occurs as we acquire new schemas and as our existing schemas become more complex.

Answer 86

Through process of ASSIMILATION (incorporating new experience into existing schema), and ACCOMMODATION (the difference mace by the process of assimilation), leading to ADAPTATION (whereby new experiences cause existing schema to change).

Answer 87

1. SENSORIMOTOR STAGE (0-2 years): infants understand their world primarily through sensory experiences and physical (motor) interactions with objects. Concepts such as OBJECT PERMANENCE are acquired in this stage (understanding that an object continues to exist even when it cannot be seen e.g. peekaboo). Learning is based through trial and error, although errors are not assimilated! 2. PREOPERATIONAL STAGE (2-7 years): the world is represented symbolically through words and mental images, but there is no understanding of basic mental operations or rules. It is associated with ANIMISM (attributing lifelike qualities to physical objects and natural events), EGOCENTRISM (difficulty in viewing the world from someone else’s perspective), and no understanding of PRINCIPLE OF CONSERVATION (see photo). 3. CONCRETE OPERATIONAL STAGE (7-12 years): children can perform basic mental operations concerning problems that involve tangible (‘concrete’) objects and situations. They therefore have trouble with hypothetical and abstract reasoning e.g. ‘If a feather can break a glass, what happens when you hit a feather against a glass?’ 4. FORMAL OPERATIONAL STAGE (transition occurs across adolescence): where abstract though emerges. Adolescent begins to think more about moral, philosophical, ethical, social and political issues that require theoretical and abstract reasoning. This occurs because adolescence is associated with extensive brain remodelling leading to one being thrill seeking, risk taking and strongly receptive to social rewards.

Answer 88

1. Under 5s: do not understand that death is final, universal, will take euphemisms concretely, may think they have caused death. 2. 5 to 10 years: gradually develop idea of death as irreversible, all functions ended, universal/unavoidable, more empathic to another’s loss; may be preoccupied with justice. 3. 10yrs through adolescence: understand more of long-term consequences, able to think hypothetically, draw parallels, review inconsistencies.

Answer 89

Providing terminally ill people with compassionate care, addressing the medical, psychological, social and spiritual aspects of dying. It is about relieving symptoms rather than curing disease – with honest communication.

Answer 90

• Helps to reduce symptom burden. • Does not increase grief for family or caregivers after death – in fact, in some cases, it does the opposite. • It does not raise cost of care. • It aligns to the majority of patients’ personal beliefs – most prefer to die at home.

Answer 91

1. DENIAL: may lie about the situation to cushion their grief. It is often used as psychological defence. 2. ANGER: why me? Associated with feelings of isolation, betrayal and unfairness. 3. BARGAINING: the person thinks, ‘If I do this, I can make it better”. One may feel guilt and feel that it is their responsibility to fix the problems. They make an attempt to strike bargains with God, spouses e.g. “I’ll be a good person if I get another chance”. 4. DEPRESSION: the person feels depressed and overwhelmed with feelings of helplessness. It is described as anticipatory grief, as they anticipate the worsening of condition/death to come. 5. ACCEPTANCE: the person accepts their condition and loss and ways of coping going forwards.

Answer 92

• The stages model makes it seem like grief has a linear progression – gives a sense of conceptual order to a complex process and falsely provides a degree of predictability and control. • Stages are prescriptive and place patients in a passive role. • Do not account for variability in response – people deal with things differently. Distress or depression is not inevitable; for example, some benefit and grow from news of chronic illness. • Focus on emotional responses and neglects cognitions and behaviours. • Fails to consider social, environmental or cultural factors e.g. a patient in a positive and supportive environment is likely to exhibit very different stages than those who are not. • There is a tendency to pathologize people who do not pass through the stages and reach acceptance.

Answer 93

Associated with worsening mental health and is where one grieves for an extended period of time.

Answer 94

The death is sudden/unexpected, the deceased was a child, there was a high level of dependency in the relationship, or the bereaved person has a history of psychological problems or poor support.

Answer 95

• Describes how coping with bereavement is a dual process involving a combination of accepting and confronting loss. • The dual process model has two coping strategies: loss-orientated and restoration-orientated coping. • Loss-oriented focuses on coping with bereavement – recognising and accepting loss. • Restoration-oriented focuses on accepting loss and relinquishing attachments with the person who has deceased. This includes focusing on new roles in their post-loss reality and responsibilities in lives.

Answer 96

1. Distress or depression is inevitable following loss. 2. Distress is necessary, and failure to experience it is indicative of pathology. 3. It is necessary to ‘work through’ or process a loss. 4. Recovery and resolution are to be expected following loss.

Answer 97

• IMPAIRMENT refers to a problem with a structure or organ of the body. • DISABILITY is a functional limitation with regard to a particular activity. • HANDICAP refers to a disadvantage in filling a role in life relative to a peer group, as a result of impairment and disability. This strongly links with disability.

Answer 98

* Your coping process is based on COPING APPRAISAL i.e. your beliefs about illness and ability to cope. These determine your coping skills: * Associated with ADAPTIVE RESPONSES (personal growth and adjustment to illness), and MALADAPTIVE RESPONSES (psychological problems and low functioning). * Coping appraisal is affected by three main factors: ILLNESS-RELATED FACTORS, BACKGROUND and PERSONAL FACTORS, and PHYSICAL and SOCIAL ENVIRONMENT.

Answer 99

• Unexpected • Cause and prognosis • Disability • Stigma • If the disease results in any disfigurement. • Prior experience.

Answer 100

• Age of onset. • Gender – there is some evidence that women struggle to cope. • Socioeconomic status and occupation. • Pre-existing illness beliefs. • Pre-existing personality.

Answer 101

• Hospitalisation. • Accommodation and physical aids/adaptations required as a result of illness. • Societal attitudes. • Social support, and social role e.g. are you a CEO or grocer?

Answer 102

1. IDENTITY: the label of the illness and symptoms. 2. CAUSE: what may have caused the problem. 3. CONSEQUENCES: expected effects from the illness and views about the outcome. 4. TIMELINE: how long the problem will last and whether it is seen as acute or chronic. 5. CURE/CONTROL: expectations about recovery or control of the illness.

Answer 103

Tasks related to ILLNESS/TREATMENT e.g. coping with symptoms, adjusting to hospital environment; tasks related to GENERAL PSYCHOSOCIAL FUNCTIONING e.g. controlling negative feelings, maintaining a satisfactory self-image, preserving good relationships with family/friends.

Answer 104

PROBLEM-FOCUSED COPING: efforts directed at changing the environment in some way or changing one’s own actions or attitudes e.g. seeking information about an illness and changing behaviour such as diet; EMOTION-FOCUSED COPING: efforts designed to manage the stress-related emotional responses in order to maintain one’s own morale and allow one to function e.g. seeking reassurance and support, and meditation.

Answer 105

• Studies show that use of emotion-focused coping is associated with poorer adjustment and greater levels of depression. • However, circular reasoning i.e. certain people such as those who are more distressed, may need to engage in more emotion-focused coping. • Optimal coping therefore depends on the individual and situation.

Answer 106

Stress is 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. For example, with treatments and procedures, people often have a high perception of threat (Will it be painful? Will I die?), and a low perception of coping resources available (There’s nothing I can do to cope with this.).

Answer 107

• We have a moral/ethical responsibility to minimise suffering. • Distress during treatment is related to longer term psychological morbidity. • Distress during treatment is related to wide variety of treatment outcomes e.g. patients not complying.

Answer 108

Procedural information is information about the PROCEDURES to be undertaken; Sensory information is information about the SENSATIONS that may be experienced.

Answer 109

Participants given sensory information reported significantly less distress during procedures than those who received procedural information.

Answer 110

The hypothesis proposes that procedural and sensory information are both helpful because they work in different ways. Procedural information works by allowing patients to match ongoing events with their expectations in a non-emotional manner. Sensory information works by mapping a non-threatening interpretation onto these expectations.

Answer 111

* Patients undergoing dental extraction surgery were given either general or detailed information in a pre-operative preparation. An assessment of desire for information was also completed, and distress during procedure measured. * Most people desired a high level of information, and there was a normal distribution of people desiring involvement (i.e. not many people wanted 0 or 100% involvement; most people wanted a moderate amount of involvement). * The study found that for those who preferred to be given a lot of information, and were only given general information, experienced higher levels of distress. Similarly, those who preferred to be given little information, and were given a high level of information, also experienced higher levels of stress.

Answer 112

• All residents on Floor 1 were told in a meeting that they could make their own choices and had responsibility: they could rearrange furniture, could decide what to do in their free time and had choice of movies. • Residents on Floor 2 were told in a similar meeting how staff wanted them to be happy: they were told that staff will ensure rooms are pleasant, given a timetable of activities, had movie nights but no choice of film. • On behavioural measures, Floor 1 residents showed GREATER ENGAGEMENT in activities and had BETTER GENERAL WELL-BEING.

Answer 113

Older children (above 7yrs) benefit most from information presented about a week before a procedure, younger children closer to the procedure.

Answer 114

Children use the same types of coping as adults, but preference for problem-solving increases with age, whilst avoidant coping declines.

Answer 115

Distraction.

Answer 116

1. TELL: using simple language and a matter-of-fact style. Emotive and negative words avoided. 2. SHOW: procedure is demonstrated using an inanimate object. 3. DO: the procedure does not begin until child understands what is being done.

Answer 117

Pain-reducing behaviour by mother results in lower levels of pain intensity recorded by female children, compared to pain-promoting behaviour. There is no difference on pain perception when mother is pain-reducing or pain-promoting on male children, however.

Answer 118

Relatively stable cognitive, emotional and behavioural characteristics of people that help establish their individual identities and distinguish them from others.

Answer 119

Theorised that personality is derived from two dimensions of personality trait: NEUROTICISM (or stability) – the tendency to experience negative emotions, and EXTRAVERSION (the degree to which a person is outgoing and seeks stimulation.

Answer 120

• Focus on five factors of personality – ‘supertraits’ and describe the main dimensions of personality. • (1) NEUROTICISM: low scorers are calm and even tempered; high scorers are emotional, self-concious and worried. • (2) EXTRAVERSION: low scorers are loners, quiet and passive; high scorers are talkative and active. • (3) OPENNESS TO EXPERIENCE: low scorers are uncreative and convention; high scorers are imaginative, original and curious. • (4) AGREEABLENESS: low scorers are suspicious, critical and irritable; high scorers are trusting, lenient and soft-hearted. • (5) CONSCIENTIOUSNESS: low scorers are lazy and negligent; high scorers are hard-working and well-organsied.

Answer 121

EXTRAVERSION: intraverts have cortical overarousal and extraverts are underaroused; NEUROTICISM: unstable people show large and sudden shifts in limbic system arousal and stable people do not.

Answer 122

Those who are more concientous are less likely to engage in harmful behaviours and are more likely to adhere to medical treatment. Hence, they are more likely to live longer lives.

Answer 123

Increased reporting of somantic symptoms such as pain, higher rates of mental health disorders, higher mortality rates in CVD, less adherence to healthy behaviours.

Answer 124

The ability to acquire knowledge, to think and reason effectively and to deal adaptively with the environment.

Answer 125

Mental age divided by chronological age x 100. A score of 100 is considered average. Test-taker’s performance relative to average performance of other’s the same age.

Answer 126

Believed that intellectual activity involves a general factor (g) and specific factors (s).

Answer 127

• An IQ test designed to measure intelligence and cognitive ability. • It used to assess GENERAL intelligence (the g factor in Charles Spearman’s theory of intelligence). • It assesses verbal comprehension, perceptual reasoning, working memory and processing speed. • Each test is comprised of two groups of subtests: Verbal and Performance. Verbal scales measure general knowledge, language, reasoning, and memory skills. Performance measures spatial, sequencing, and problem-solving skills.

Answer 128

• Differentiates human intelligence into specific 'modalities', rather than seeing intelligence as dominated by a single general ability. • To be considered a modality, it must fulfill criteria such as having a place in evolutionary history, potential for brain isolation by brain damage, a distinct developmental progresson. • Examples of modalities include: musical, visual-spatial, verbal, logical.

Answer 129

• AVERAGING: This criticism is especially relevant for clinical applications of such tests e.g. Stroke pts where specific cognitive functions might be affected. Consider a doctor who devises a limb strength quotient or LQ by totalling the strength of all four limbs, again with a mean of 100. Now consider a tennis player who sprains his left ankle reducing his left leg score to 50, but his right leg scores 140 and his right and left arms score 160 and 130 respectively. His LQ would be 120 – well above average, so no problem, right? • CULTURAL BIAS: two individuals with the same latent abilities can perform differently in the IQ test based on their environmental influences on intelligence.

Answer 130

CRYSTALLISED INTELLIGENCE (gc): the ability to apply previously acquired knowledge to current probems. Will commonly improve with age, then stabilise; FLUID INTELLIGENCE (gf): the ability to deal with novel problem-solving situations for which personal experience does not provide a solution. Shows a steady pattern of decline ageing.

Answer 131

CRYSTALLISED includes verbal ability and numeric ability. FLUID includes inductive reasoning, spatial orientation, perceptual speed and verbal memory.

Answer 132

* Age. * Hereditary. * Physical fitness. * Sex – there is no differene in cognitive ability between the sexes, but men are more represented at the extreme ends of the IQ scale than women – see photo! * Social class. * Cognitive disease such as autism or dementia.

Answer 133

* Autism has a 4:1 male:female ratio. High functioning autism (Asperger’s syndrome) has a 9:1 male:female ratio. * Baron Cohen’s Empathizing/Systematizing Theory explains the male-female neurological differences and the reason why this high functioning autism ratio exists. * The theory explains that high functioning autism is characterised by DEFICITS in EMPATHISING (ability to infer thoughts and feelings of others) and INCREASED ABILITY to SYSTEMISE (the drive to analyse or construct any kind of system). * Baron Cohen found that men have lower levels of empathising than females, and higher levels of systemising than females. They are therefore naturally more pre-disposed to autism than females.

Answer 134

Being healthy and able is central to most people’s self-image. When someone becomes ill or obtains a life-changing injury that changes this self-image, adjustment is needed (to the symptoms and disability) which may require a considerable coping effort.

Answer 135

• They require adjustment to symptoms and the disability e.g. changing health behaviours (giving up negative health behaviours and taking up positive health behaviours). • Maintaining a reasonable emotional balance. • Preserving a satisfactory self-image and sense of competence and confidence in self. • Learning about symptoms, treatment and self-management. • Sustaining relationships with family and friends. • Preparing for an uncertain future – how long do I have to live?

Answer 136

* This model describes a self-regulatory model to illness and outlines patient beliefs and expectations about an illness or symptom. It focuses around three main responses to an illness/symptom: INTERPRETATION (a patient’s personal interpretation of their symptoms or illness), COPING (having identified the symptoms or illness, patient’s move onto a stage of coping with their presenting complain) and APPRAISAL (a self-assessment of one’s coping strategy. For example, is their paracetamol intake working?). * All of these are affected by EMOTIONAL RESPONSE TO HEALTH THREAT (e.g. fear, anxiety or depression), and REPRESENTATION OF HEALTH THREAT to a patient. Leventhal describes FIVE COMPONENTS of these illness representations: * (1) IDENTITY – the label given to the condition and the symptoms that ‘appear’ to go with it. * (2) CAUSE – perceived cause for the condition. This will be based on personal experience as well as opinions of significant others, health professionals and media. * (3) TIME-LINE – the predictive belief about how long the condition might last. * (4) CONSEQUENCES – belief about how condition will impact themselves physically and socially. * (5) CURABILITY – belief about whether the condition can be cured or kept under control and the degree to which the individual plays a part in this (affects how they cope and appraise e.g. does patient seek help from professional?).

Answer 137

• People with a chronic illness are more likely to develop depression and psychological stress than the rest of the population. • Having a mental health problem increases the risk of physical ill health e.g. co-morbid depression doubles the risk of coronary heart disease and increases mortality by 50%. This is because depression changes health behaviour, and there may also be a pathophysiological mechanism underlying this.

Answer 138

Some people may fall apart when they have a chronic health condition. Others become empowered and grow. This is associated with less distress in the short-term and better physical and mental health overall.

Answer 139

• Social support. • Personal values and life priorities – what value do they place on living life in spite of their illness? • Personal understanding of their illness – can link to feeling of control of their disease. • Patients reconstructing their history to incorporate the illness and reconstruct their identity to retain a sense of self-worth in the face of illness. • Construct meaning from the illness. • Pre-conceived ideas of illness based on representation in the media.

Answer 140

The tendency of group members to suspend critical thinking in order to reach an agreement faster.

Answer 141

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 e.g. in group, more likely to take a radical, risky treatment approach to a patient, than when the decision is made by one individual. This is because as a group, responsibility of the risks doesn’t fall to ONE individual.

Answer 142

• When a group is under high stress to reach a decision. • When a group is insulated from an outside input. • When the group has a directive leader. • When the group has high cohesiveness.

Answer 143

• Attitude – i.e. beliefs about outcome. • Attitudes of important others towards the behaviour – this is called the SUBJECTIVE NORM. • Internal control factors such as confidence that you can execute a behaviour (self-efficacy). • External control factors such as perceived barriers to executing the behaviour.

Answer 144

A positive or negative evaluative reaction towards a stimulus. Attitudes influence BEHAVIOUR more strongly when situational factors that contradict our attitudes are weak. Therefore, in order to change behaviour, we often need to target attitude.

Answer 145

Two opposing beliefs e.g. I’m a smoker, but I know smoking causes cancer.

Answer 146

• CHANGE BEHAVIOUR – in the case of smoking, this would involve quitting. But it is often DIFFICULT. • ACQUIRE NEW INFORMATION – i.e. seeking exceptions and finding excuses e.g. “My grandfather smoked all his life and lived to be 96”. • REDUCE THE IMPORTANCE OF THE COGNITIONS – reduce the importance of the opposing belief e.g. you only live once.

Answer 147

Refers to whether a message emphasises the benefits or losses of that behaviour i.e. how you present a message.

Answer 148

1. Loss-framed messages may be more effective e.g. if you do not undertake this test, you may be more likely to die from cancer. 2. Gain-framed messages may be more effective e.g. if you protect yourself from the sun, you may prolong your life.

Answer 149

• STEREOTYPE: generalisations made about a group of people, such as race or gender. • PREJUDICE: to judge, often negatively, without having relevant facts, usually about a group of individuals. • DISCRIMINATION: behaviours that follow from negative attitudes towards members of particular groups.

Answer 150

The tendency for people to expend less individual effort when working in a group than when working alone aka. Diffusion of responsibility.

Answer 151

• MORE LIKELY TO OCCUR: • When the person believes that individual performance is not being monitored. • The task has less value or meaning to the person. • When the person generally displays low motivation to strive for success. • When the person expects that other group members will display high effort. • Occurs more strongly in all-male groups. • Occurs more often in individualistic cultures. • LESS LIKELY TO OCCUR: • When individual performance is being monitored. • Members highly value their group or the task goal. • Groups are smaller. • Members are of similar competence.

Answer 152

When behaviour is dictated in accordance with a socially accepted convention.

Answer 153

ASCH MODEL, 1956: Male students participated in a ‘vision test’. Using a line judgement task, Asch put a naïve participant in a room of actors. The actors agreed in advance what their responses would be. Each person in the room had to state aloud which comparison line (A, B or C) was most like the target line. The answer was always obvious. The real participant sat at the end of the row and gave their answer last. In the end, real participants conformed with the clearly incorrect majority answers.

Answer 154

They want to fit in with the group (normative influence) and they believe the group is better informed than they are (informational influence).

Answer 155

• GROUP SIZE: conformity increases as the group size increases. There are no increases over five group members. • PRESENCE OF A DISSENTER: one person disagreeing with the others greatly reduces group conformity. • CULTURE: conformity if greater in collectivist cultures.

Answer 156

Within a group, individuals check the reactions of others in their group. If others in their group appear calm and non-concerned, they feel less inclined to help. As an individual, however, without the influence of others, we feel less pressure to help. NB: interestingly, when someone does break from the crowd and help somebody, others are also happier to break from the crowd and assist.

Answer 157

• 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. • In an adjacent room, a student was having an epileptic seizure. • 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 four people. Hardly anyone helped if group was above four. • If participant had not acted within the first three minutes, they never acted. • Those who did not help, many reported shame and guilt for not helping. Reasons given included: not wanting to expose themselves to embarrassment or to ruin the experiment which, they had been told depended on each participant remaining anonymous from the others.

Answer 158

1. Notice the event. 2. Decide if the event is really an emergency – SOCIAL COMPARISON: look to see how others are responding. 3. Assuming responsibility to intervene – DIFFUSION OF RESPONSIBILITY: believing that someone else will help. 4. Self-efficacy in dealing with the situation. 5. Decision to help based on cost-benefit analysis e.g. danger.

Answer 159

• Judging how others are responding – afraid to stand out and differ from the crowd. • Feeling of no individual responsibility to help i.e. someone else will help. • Not seeing problems as actual emergencies. • Do not feel able to deal with the situation by helping – self-efficacy. • Cost-benefit analysis e.g. danger.

Answer 160

• Reduce ambiguity and increase responsibility. • Enhance concern of self-image. • Teaching moral inclusion. • Modelling helping behaviour. • Attributing helpful behaviour to altruistic motives. • Education about barriers to helping.

Answer 161

THE MILGRAM EXPERIMENT, 1974: one ‘learner’ and one ‘teacher’ told that experiment studied the effect of punishment on learning and memory. A shock generator was used to apply punishment, and shocks grew increasingly intense with each mistake. Findings: high proportion of subjects would fully obey instructions, albeit reluctantly, to shock ‘learner’.

Answer 162

Remoteness of the victim (the less exposure to the learner e.g. behind curtains, the more likely the subject was to obey demands to shock learner), closeness and legitimacy of the authority figure, diffusion of responsibility (obedience increases when someone else administers the shocks), not personal characteristics.

Answer 163

A personal judgement of how well one can execute courses of action required to deal with prospective situations i.e. perceived competence. IN RELATION TO HEALTH BEHAVIOURS: self-efficacy can determine whether someone health behaviour will be initiated – self-efficacy determines whether someone feels like changing their behaviour is achievable.

Answer 164

• Performance accomplishments – if one has performed well at a task previously, they are more likely to feel competent to perform it again. • Vicarious experiences – through other people’s performances e.g. a person can watch another perform and compare their own competence with the other individual’s competence. • Verbal persuasion. • Physiological states – people experience sensation from their body and how they perceive this emotional arousal influences their beliefs of efficacy.

Answer 165

• AUTOCRATIC, AUTHORITARIAN: under the autocratic leadership style, all decision-making powers are centralised in the leader. They do not entertain any suggestions or initiatives from subordinates. • PARTICIPATIVE, DEMOCRATIC: this style favours decision-making by the group – leader gives instruction after consulting the group. They can win the cooperation of their group and can motivate them effectively and positively. • LAISSEZ-FAIRE STYLE: a free-rein leader does not lead but leaves the group entirely to itself. Such a leader allows maximum freedom to subordinates.

Answer 166

• AUTOCRATIC: enables quick decision making e.g. urgent environments, and there is a clear hierarchy of responsibility; can be demotivating and lead to errors. • DEMOCRATIC: can win cooperation, motivate team and can improve quality of decision making; time consuming and can lead to disagreements. • LAISSEZ-FAIRE: allows autonomous working and allows expertise to be utilised; can lead to lack of direction and there’s a lack of ultimate responsibility holder!

Answer 167

Defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim e.g. misdiagnosis, failure to employ indicated tests, error of an operation, error in dosage.

Answer 168

If an order comes from someone deemed to be higher hierarchically, then individuals feel less inclined to challenge clinical decisions if they believe they will lead to medical error.

Answer 169

Diagnostic errors account for the largest fraction of medical errors.

Answer 170

• Intuitive understanding of probabilities is combined with cognitive processes called heuristics to guide clinical judgement. • Clinicians rarely use formal computations to make patient care decisions in day-to-day practice.

Answer 171

Often referred to as rules of thumb, educated guesses, or mental shortcuts. They usually involve pattern recognition and rely on subconscious integration of patient data and prior experience.

Answer 172

• Kahneman’s two systems for decision making. • SYSTEM 1 (‘HOT’ SYSTEM): emotional, all about “go”, simple, reflexive, fast, develops fast, accentuated by stress. • SYSTEM 2 (‘COLD’ SYSTEM): cognitive, all about “know (before go)”, complex, reflective, slow, develops late, attenuated by stress.

Answer 173

In urgent situations where an individual must act. These situations are time-critical and demand action over extensive thought-processing and focus on precision and detail.

Answer 174

• Sometimes, we think we may be using System 2, but instead we are making a decision using System 1 and using System 2 to justify this initial decision (CONFIRMATORY BIAS). • In Nisbett and Wilson, four pairs of tights were presented in a row and consumers asked to pick out a pair they liked the best. In reality, all four were identical. However, consumers were significantly more likely to select the far right most pair. • Justifications for choice included sheerness and strength even though their decision was actually controlled by System 1.

Answer 175

The tendency to search for information (System 2) in a way that confirms one’s pre-existing beliefs or hypotheses (System 1), often leading to errors.

Answer 176

Describes the notion that the more we have invested in the past, the more we are prepared to invest in a problem in the future. Rationally, the only factor affecting future action should be future cost-benefit ratio, but humans do not always act rationally, and undue bearing is often given to SUNK COSTS (irretrievable costs spent on something).

Answer 177

Studies have found that medical residents’ evaluation of treatment decisions were not actually influenced by the amount of time and/or money that had already been invested in treating a patient.

Answer 178

* Describes the behaviour whereby individuals are poor at adjusting estimates when they are given a starting point (see photo) i.e. they are anchored by a starting point. * In clinical decision making, a clinician may make an initial reading in a patient as having pancreatitis. However, follow-up tests and some elements of the patient history contradict this initial reading. However, by anchoring on this initial reading of pancreatitis, it is harder for a clinician to adjust to a different reading for the patient’s health complaints. Clinicians may try to down-play these conflicting tests and findings in the history, in an attempt to validate their pancreatitis reading.

Answer 179

Subjective probability that a stimulus belongs to a particular class based on how ‘typical’ of that class it appears to be (regardless of base rate probability) i.e. the more object X is similar to class Y, the more likely we think X belongs to Y.

Answer 180

While often very useful in everyday life, it can also result in neglect of relevant BASE RATES and OTHER ERRORS e.g. 60-year-old present with SOB, sweaty and feeling sick. This does not match the typical profile of an MI, which is typically characterised by chest pain. According to representative heuristics, we would dismiss this patient for STEMI. However, it would be unwise to do this because MI is common among women of that age (base rates) and has highly variable presentations.

Answer 181

• Probabilities are estimated on the basis of how easily/vividly they can be called to mind. Individuals typically overestimate the frequency of occurrence of catastrophic events e.g. surveys show 80% believe that accidents cause more deaths than strokes. • For example, a clinician who recently missed the diagnosis of pulmonary embolism in a healthy young woman who had vague chest discomfort, but no other findings or apparent risk factors might then overestimate the risk in similar patients and become more likely to do chest CT angiography for similar patients despite the very small probability of disease.

Answer 182

• EDUCATION AND TRAINING: integrate teaching about cognitive error and diagnostic error into medical school curricula. • FEEDBACK: increase number of autopsies, conduct regular audits, follow-up patients. • ACCOUNTABILITY: establish clear accountability. • GENERATING ALTERNATIVES: establish forced consideration of alternative possibilities e.g. encourage dissenting. • CONSULTATION: seek second opinions, use algorithms, use clinical decision-making support systems.

Answer 183

Procedure which provides the most likely diagnosis for a set of symptoms – derived using the rules of probability. However, this means they exclude atypical patients.

Answer 184

Provide clinicians assistance with clinical decision-making tasks.

Answer 185

1. Registration – input from our senses into the memory system. 2. Encoding – processing and combining of received information. 3. Storage – holding of that input in the memory system. 4. Retrieval – recovering stored information from the memory system (remembering).

Answer 186

Sensory inputs go into the short-term or working memory (this lasts just a few seconds). Some enter the long-term memory.

Answer 187

Information is registered as sensory inputs. Some information is stored straight into your long-term memory e.g. traumatic events. Other inputs are transferred to the working memory store – however, this has limited capacity, and so most is lost. Information in the working memory that is rehearsed can be stored in the long-term memory. Equally, long-term memory can be retrieved, at which point, it enters the working memory.

Answer 188

• DECLARATIVE (explicit): episodic (events) or semantic (facts). • NON-DECLARATIVE (implicit): procedural (skills and habits), priming (exposure to one stimulus influences a response to a subsequent stimulus), conditioning (associative), and non-associative learning.

Answer 189

In non-associative learning the behaviour and stimulus are not paired or linked together. This form of learning is quite common in animals. Mainly there are two types of non-associative learning: habituation and sensitization. HABITUATION is when the responsiveness of an organism to a repeatedly exposed stimulus decrease. Simply, it is when a person or animal reacts less and less to something due to exposure. For example, imagine a child who is always being scolded. Although the child may first react to this, as he begins to experience it all the time, the child reacts less and less. SENSITIZATION is when the responsiveness of an organism to a repeatedly exposed stimulus increases or else the person or animal reacts even more each time it is exposed to the stimulus.

Answer 190

Involved the medial temporal lobes, including the hippocampus, entorhinal cortex and mamillary bodies. Declarative memory also involves the diencephalon.

Answer 191

Prefrontal cortex.

Answer 192

• PROCEDURAL: supplementary motor area, cerebellum, striatum and basal ganglia (putamen). • PRIMING: neocortex. • CONDITIONING: amygdala and cerebellum. • NON-ASSOCIATIVE: n/a.

Answer 193

A form of sensory perception e.g. visual and auditory modalities.

Answer 194

LEFT HEMISPHERE: mainly concerned with verbal information processing; RIGHT HEMISPHERE: mainly concerned with non-verbal information.

Answer 195

When given a list of words, you will typically remember the first words and last words and forget the ones in the middle. This is known as the primacy and regency effect respectively.

Answer 196

• Order in the list. • Personal salience of words (prominence to person). • Number of words. • Chunking or other encoding strategy i.e. a strategy to remember the words. • Delay time. • Distraction.

Answer 197

The action of obeying a wish or command.

Answer 198

Commitment to a person, cause, or belief.

Answer 199

Refers to a state of agreement between doctor and patient.

Answer 200

• COMPLIANCE refers to the extent to which patients follow doctors’ orders about medicine taking i.e. very much focuses on the doctor taking an authoritarian role. • ADHERENCE is a development of the definition of compliance. It refers to the extent to which patients follow decisions about medicine-taking that are made between doctor AND patient. • CONCORDANCE refers to the extent to which the patient is successfully supported in the decision-making partnership about medicines and in their medicines taking.

Answer 201

• Measurement of level of medicine/metabolite in the blood. • Directly observe the patient taking the medicine.

Answer 202

• Patient questionnaire. • Patient self-report. • Pill counts. • Rates of prescription refills. • Patient diaries.

Answer 203

Could ruin the doctor-patient relationship: measuring non-adherence implies that the doctor does not trust the patient.

Answer 204

In developed countries, the overall average rate of adherence to treatment in long-term conditions is approximately 50%.

Answer 205

Poorer health outcomes, AND increased healthcare costs as a result of poorer health outcomes.

Answer 206

• Early theories were based on non-adherence as a result of POOR COMMUNICATION and the impact of this on patient understanding and memory. Interventions were therefore targeted at informational provision and healthcare professional communication. • Now, we understand that it is a result of the patient – usually – as to why there is non-adherence. There are two reasons why the patient may not adhere: • UNINTENTIONAL NON-ADHERENCE: the patient’s ability (cognitive ability and memory) and resources (money) are practical barriers to adherence. • INTENTIONAL NON-ADHERENCE: the patient’s belief and motivates are perceptual barrier to adherence. • NOTE ABOUT INTENTIONAL AND UNINTENTIONAL NON-ADHERENCE: there is a lot of overlap between the two. A person’s health beliefs will influence ‘unintentional’ non-adherence e.g. a patient’s motivation to remember to take medications is going to be diminished if they don’t believe their medications to be necessary in the first place.

Answer 207

* It is a model that suggests the causes of health behaviour. * It suggests that a health behaviour is the results of an interaction between CAPABILITY, OPPORTUNITY and MOTIVATION cause the behaviour. * The model is a starting point for choosing which interventions are most effective for a patient. It forms the “hub” of a behaviour change wheel around which are nine possible interventions to choose from. * Around these interventions, there are seven areas of policy that we can use as guidance to carry out those interventions.

Answer 208

• Like the COM-B model for behaviours, the health behaviour of adherence depends on patient capability, motivation and opportunity: • CAPABILITY: PSYCHOLOGICAL (capacity to engage in necessary thought processes) and PHYSICAL (capacity to engage in necessary physical processes e.g. adapt to diets or physical exercise) capabilities are factors that determine whether a patient will adhere to a medication. • MOTIVATION: can be split into REFLECTIVE (patient evaluation of a medication – belief about TREATMENT, OUTCOME, SELF-EFFICACY and PERCEPTION OF ILLNESS) and AUTOMATIC motivation (emotions and impulses arising from associative learning or innate dispositions) – these all affect adherence. • OPPORTUNITY: are factors that lie outside of the individual that may prompt adherence. Opportunity can be split into PHYSICAL (physical opportunity provided by the environment e.g. cost of medicine, physical characteristics of medicine such as smell and taste) and SOCIAL (cultural environment that dictates the way we think about things e.g. stigma and religious beliefs).

Answer 209

• NECESSITY: beliefs about necessity of prescribed medication for maintaining health. • EFFICACY: does the patient think that the treatment will work? • CONCERNS: arising from beliefs about potential negative effects of treatment. • Remember, this affects reflective motivation to adhere.

Answer 210

• Improve understanding of illness and treatment. • Help patients to plan and organise their treatment.

Answer 211

Through consultation, (i) provide a clear rationale for the necessity of treatment, (ii) elicit and address concerns, (iii) agree a practical plan for how, where and when to take treatment, and (iv) identify any possible barriers.

Answer 212

1. Activation of the sympathetic nervous system, release of NA and adrenaline. This has results including increase in heart rate. 2. This is followed by an endocrine stage. There is activation of the hypothalamic-pituitary-adrenocortical axis, leading to production of cortisol (stress hormones). This sustains the SNS-mediated response. 3. There is an exhaustive phase: the adrenal glands lose their ability to function normally.

Answer 213

Defined as a pattern of cognitive appraisals, emotional reactions, physiological responses and behavioural tendencies that occur in response to a perceived imbalance between situational demands (PRIMARY APPRAISAL) and the resources need to cope with them (SECONDARY APPRAISAL).

Answer 214

When considering an exam, you will evaluate how hard it will be and how much it counts (primary appraisal), and how your current knowledge equips you to pass (secondary appraisal).

Answer 215

Stress can be beneficial – it leads to increased attention and interest. However, when stress is too high, it can impair performance because of strong anxiety.

Answer 216

• Stress leads to BEHAVIOURAL CHANGES, which can cause disease e.g. those who have a lack of social support increase their tobacco and alcohol usage during times of stress, which can have implications on health. • Stress also leads to PHYSIOLOGICAL CHANGES, which can lead to disease e.g. stress and anxiety leads to higher rates of heart disease than those who do not have underlying anxiety and stress; stress also has an impact on the strength of immune responses.

Answer 217

Time-urgency, free-floating hostility, hyper-aggressiveness, focus on accomplishment, competitive and goal-driven.

Answer 218

Western Collaborative Group Study followed over 3000 males for over 8 years: Type A behaviours doubled the risk of developing CHD when other cardiac risk factors were controlled for. When compared to Type B (characterised by patience, serenity and lack of time urgency), Type A behaviour alone accounted for 31% increase in risk.

Answer 219

The role of HOSTILITY in Type A behaviour is key to the increased CVD risk: hostility links to increased physiological response to stressors --\> endothelial dysfunction --\> atherosclerosis. However, mechanism is debated and not fully known.

Answer 220

• PROBLEM-FOCUSED COPING: planning, active coping and problem solving, exercising restraint etc. • EMOTION-FOCUSED COPING: positive re-interpretation, acceptance, denial, repression etc. • SEEKING SOCIAL SUPPORT.

Answer 221

Individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. Effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality such as obesity and physical inactivity.

Answer 222

The phenomenon in which a placebo – an inactive substance like sugar, distilled water or saline solution – can sometimes improve a patient’s condition because the person has the expectation that it will be helpful.

Answer 223

A negative effect that occurs after receiving treatment even when the treatment is inert. Warnings about the possible side effects of a medicine makes it much more likely that the patient will report experiencing those effects.

Answer 224

* FRAMING: giving information in a different way will influence someone’s perception of risk e.g. framing post-operative pain can influence the degree of reported pain. * SOCIAL LEARNING: observing others getting better can influence one’s own recovery. * EXPERIMENTAL LEARNING: learning through experience of positive results from one medication can influence the expectation of positive results from similar looking medications. * CLASSICAL CONDITIONING: if a stimuli e.g. seeing a syringe, leads to therapeutic effect; then an associated stimuli e.g. seeing another syringe, leads to placebo effect. See photo.

Answer 225

MIXED anxiety and depression (two separate disorders, but commonly co-occur).

Answer 226

A discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feeling of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of ‘going crazy’ or losing control are present.

Answer 227

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.

Answer 228

Characterised by a period of almost daily DEPRESSED MOOD or DIMINISHED INTEREST IN ACTIVITIES lasting at least two weeks (these are the two cardinal symptoms). Other symptoms include difficulty concentrating, feelings of worthlessness, excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, retardation and fatigue.

Answer 229

• The theory postulates that ‘phobias’ arise from classical conditioning: Before conditioning, raised heart rate would give no fear or anxiety. During conditioning, a raised heart rate (CONDITIONED STIMULUS) and a traumatic incident (UNCONDITIONED STIMULUS) leads to fear and anxiety (an unconditioned response). Next time an individual experiences a raised heart rate (conditioned stimulus), they develop a conditioned response of fear and anxiety. • TWO-FACTOR THEORY of MAINTENANCE OF CONDITIONED ASSOCIATIONS: raised heart rate leads to a conditioned response. Therefore, individual avoids raised heart rate, so the fear is reduced, and the tendency to avoid raised heart rate is reinforced.

Answer 230

Unlike in the theory that forms the basis of behavioural therapy, cognitive theory describes that a stimulus doesn’t JUST lead to a response to the stimulus; instead, there is cognition and appraisal which determines the response to a stimulus. For example, you’re walking down the High Street and someone you know does not acknowledge you. The cognitive theory describes that your emotional response to being unacknowledged (stimulus) is dependent on your appraisal. For example, if you think your friend doesn’t like you, you may respond by feeling sad or angry. However, if you think your friend just didn’t see you, you will respond by being unconcerned.

Answer 231

Individuals with panic interpret certain bodily sensations in a catastrophic fashion. Sensations, especially those involved in normal anxiety responses e.g. palpitations, are considered to be a sign of impending physical or psychological disaster e.g. palpitations --\> ‘I’m having a heart attack’. These responses set up a vicious cycle (see photo), where the misinterpretation is amplified.

Answer 232

Psychodynamic, behavioural and cognitive therapies.

Answer 233

Focuses on revealing the unconscious content of a client’s psyche in an effort to alleviate psychic tension i.e. psychodynamic therapies focus on revealing and resolving these unconscious conflicts that are driving their symptoms. Common techniques include working through painful memories.

Answer 234

• Behavioural approaches believe that maladaptive behaviours are not merely symptoms of underlying problems (as inferred in the psychodynamic theory); the behaviours ARE the problem. Problem behaviours are learned in the same ways normal behaviours are. • Behavioural therapy aims to tackle the two-factor theory of maintenance of conditioned associations. It therefore uses an EXPOSURE APPROACH. For example, in someone who is scared to drive again after an accident, you would increase exposure to the conditioned stimulus (the car) in the absence of the unconditioned stimulus (the accident). This is used to prevent the individual from an avoidant response to the car. • Exposure to the car would occur in progressive stages: begin with just sitting behind the wheel in a stationary car --\> driving down empty road --\> driving along a busy street. This approach is known as SYSTEMATIC DESENSITISATION.

Answer 235

Treatment comprises of psychoeducation, relaxation techniques, cognitive restructuring, behavioural experiments, graded exposure and relapse prevention. This therapy therefore focuses on problematic beliefs and behaviours that maintain disorders. It is goal orientated.

Answer 236

Don’t use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk-benefit ratio is poor. Consider antidepressants for people with moderate-severe depression, or subthreshold symptoms for a long time, or subthreshold depressive symptoms or mild depression that persist after other interventions.

Answer 237

Cognitive behavioural therapy.

Answer 238

People with depression who are considered to be at risk of relapse should be offered individual cognitive behavioural therapy or mindfulness-based cognitive therapy.

Answer 239

Paying attention on purpose, in the present moment and non-judgementally. It focuses on recognising thoughts as not ‘you’ and not ‘reality’.

Answer 240

Focuses on many techniques: Acceptance (being willing to experience difficult thoughts), commitment (taking action to pursue important things in your life), values (discover what is important to you), being present (focus on the here and now), defusion (observe your thoughts without being ruled by them) and self as context (see yourself as unchanged by time and experience).

Answer 241

See photo.