Semester 2 Flashcards
Define cognition
The mental activity through which human beings acquire and process knowledge, including the functions of perception, learning, memory language acquisition, problem solving, thought and imagination
Define cognitive development
The gradual transition from an infant to adult mental capacity
Define development
The sequence and interplay of physical, psychological, cognitive and social changes that humans undergo as they grow older
What impacts human development?
Individual differences
Affected by social, emotional and environmental factors as well as development across the lifecourse
However, there are universal stages occurring among all normally developing individuals, regardless of culture and experiences
What does Piaget state about cognitive development?
Schemas are the building blocks of developmental change
What are schemas and their different classifications?
Schemas are mental structures created of organized memories, thoughts and strategies we use to interpret our world
Physical schemas are our initial, action based schemes developed via interactions with the world
Mental schemes are what develop as we begin to mentally interact with the world
What is assimilation?
Occurs when we incorporate new experiences into existing similar structures and behaviours
What is accommodation?
Our schemes change to accommodate new information learnt
What are the 4 stages of development (according to Piaget) and their age ranges?
Sensorimotor stage (Birth-2yo)
Preoperational Stage (2-7yo)
Concrete operational stage (7-11yo)
Formal operational stage (12+)
What are defining features of the sensorimotor stage?
- Substage is reflexive schemes stage (grasping, sucking, rooting, looking)
- Maturation of motor skills makes these ‘reflexes’ purposeful
- Attain object permanence
- Can imitate immediately (9mos) and remotely (18-24 mos)
What are the defining features of the preoperational stage?
- Beginning of symbolic thought shown by movement from imitation to imaginative play
- Egocentrism
- Appearance as reality
What are the defining features of the concrete operational stage?
- Thinking becomes logical, flexible and organized
- Develop conservation: knowing the physical properties of an object don’t change when nothing is added or removed
What are the defining features of the formal operational stage?
- Thinking becomes abstract
- Increased capacity for flexible/scientific thinking
- Egocentrism returns due to increased awareness of others’ perceptions
How does vygotsky believe children develop?
- They are a product of their culture
- Undergo internalisation: absorbng information from a sociocultural context
- Language important as the culture is embedded
What is Vygotsky’s theory of proximal development/scaffolding?
The zone of proximal development is the zone where children can do something with help or guidance from a peer or adult- bridges the gap between what they can and can’t do, so development should be focussed in this region
Scaffolding occurs when teacher/parent adjusts the amount/type of support to match child’s developmental level
How does experience and culture shape development?
- Difference in schooling and culture impacts concrete operational task performance
- Previous experience influences children’s understanding
- Formal operational stage not reached by many tribal societies as they’re more likely to think only about what they’ve experienced
What are the stages in health understanding and their age ranges?
Prelogical stage: 2-6yo
Concrete logical stage: 6-12yo
Formal logic stage: 12+
What are defining features of the prelogical stage?
- Phenomism: the relationship between cause and illness is ‘magical’
- Contagion: Understand need for temporal or spatial proximity to source for illness development
What are defining features of the concrete logical stage?
Contamination: Understand illnesses can have multiple symptoms and can be transmitted through physical sources
Internalization: View illness as developing by internalizing external contaminants
What are the defining features of the formal logic stage?
Physiologic: Cause is a non or malfunctioning organ or process
Psychophysiologic: acknowledge that additional contributors may be psychological
Why is it important to consider cognitive development level in health promotion?
It is important to aim ads towards those more affected by it.
Also important to get these messages across young as future illnesses may be prevented from developing.
How is cognitive development important in medical procedures?
Children with lower levels of development can misunderstand, making everything more frightening. Children's preparation depends on: - Developmental level - Type of procedure - Prior experience - Cultural/ethnic background - Family dynamic - Support systems
How can health professionals help prepare children of varying cognitive levels for treatment?
Introduce play specialists to help children understand their illnesses in a fun context Tours of major sites Videos about procedures involved Interactive books or iPads Puppet shows Medical plays with hospital equipment Books with popular figures Board games Art therapy Relaxation or coping techniques
Why have play specialist programmes been less successful than they could otherwise be?
The programmes are well evaluated by those who turn up
However, they are often poorly attended, and the same programme is offered to children 3-12. This encompasses a broad range of developmental stages, and is therefore unlikely to work for the majority
How is cognitive development crucial to chronic illness among adolescents?
Adolescents have greater concerns with chronic illness due to the:
- type and degree of impairment
- Visibility of impairment
- Uncertainty
- Irregular effects
- Treatment, and pain associated
This is due to their perception that they always have an audience
It is exacerbated by social media and online doctors
What is a chronic illness?
An illness that interferes with daily functioning for more than 3 months in a year, with hospitalization for more than 1 month a year
At diagnosis, it must be a combination of both
They are typically managed, but unable to be cured
What are the negative vs. positive reactions elicited due to chronic illness?
Negative: - Depression - Anxiety - Acting out (depends on seriousness, developmental stage and coping strategies)
Positive:
- Empowerment
- Feelings of having escaped death
- Priority change
- Improved relationships
- Lifestyle changes
What are the three different coping strategies?
Primary
Secondary
Emotional
What are primary coping strategies?
They’re problem focussed: They attempt to change their or others’ lives to fix the problem
What are secondary coping strategies?
They’re attitude focussed, and involve changing an attitude towards a problem (best if the issue is out of one’s control)
What factors affect perception of treatment and illness?
Social and emotional development
Biological Functioning
Mental Age
Family functioning/support
How does social/emotional development affect illness/treatment perception?
At concrete stages, illnesses are attributed to causes- germs, being bad etc
in formal operational stage, we become more aware of the complexity of health, as well as internal and external factors
How does biological development and mental age affect perception of treatment?
Biological development affects this especially as when we are adolescents we are much more concerned with appearances
Mental age needs to be considered, as just because someone is older doesn’t mean they understand
Why are families important when treating illness?
The children often are present for treatment with their family
Their own understanding of treatment is limited
They rely on the family to get them care
Families must manage many issues
They must also address how the issues impact the family functioning as a whole
What can cause non adherence?
Poor doctor-patient communication
Complexity of treatment
Beliefs
Type of regime
How can families be advised as to how to get their child well?
Education (good for complex and short term treatment, important when diagnosing)
Modelling (good for complex or patient-administered treatment)
Use of incentives for their children
Workshops involving support, problem solving and multi-family training
What is important regarding adherence when it comes to adolescents?
Anticipate inadequate compliance
Promote autonomy
Actively follow up regarding adherence
What is health psychology?
The application of psychological principles to health areas, involving the study of psychological processes in health, illness and healthcare
What are the aims of health psychology?
To understand, explain and predict health and coping behaviours to develop interventions and promotions, as well as understand and treat the psychological consequences of diseases
How can psychological factors affect physical health?
Impact on psychological processes: eg. patient-physician relationship affects distress and stress response, likelihood of correct diagnosis, treatment adherence and amenability.
Beliefs affect amenability to treatment
Impacts on psych wellbeing too.
What are the health behaviour models developed to explain or predict health behaviours?
- Health belief model
- Theory of reasoned action
- Theory of planned behaviour
- Transtheoretical model
- Protection motivation theory
- Health action process model
- Levelthal’s self-regulatory model
- Social cognitive theory
What does health psychology attempt to understand, predict, and develop interventions for?
Psychological influences on health Health promoting and risk behaviours Illness behaviours, symptom perception and coping Adherence Stress Emotions and health Placebo effect Pain management and relief P-P relationship Genetic testing Coping with death and dying
What is a placebo?
An inert substance that stimulates a treatment without the specific agent
What is the placebo response?
The improvement in health brought about by the nonspecific effects due to treatment context, not the active component of the treatment
What is the placebo effect?
The changes observed while taking a placebo
It’s broader than the placebo response as it involves natural recovery as well
What do placebo trials do?
- Give information about the best ways to enhance active treatments
- Test effectiveness of new drugs above placebos
What is the observed placebo effect in terms of pain medication?
Open administration, where patients see themselves receiving treatment, has a greater analgesic effect than hidden medication
How do psychological mechanisms impact the placebo response?
Involves expectations of improvement
- Influenced by suggestion, treatment appearance, previous experience, social learning and PP relationship
Flow on effects lead to activation of reward systems, reducing anxiety and the stress response
What does classical conditioning have to do with the placebo response?
- The placebos can become a conditioned stimulus after repeated pairings with active treatment
- Especially seen in endocrine and immune disorders
What enhances the placebo response?
- Open administration
- Communicating effectiveness
- Communicating price
- Communicating novelty
- Branding
- Type of treatment: Surgery> injection > capsule > pill
- More doses/frequency
- Colour
- Attention, empathy, reassurance, high prestige of doctor
- Personalization and patient involvement in treatment plan
What are the clinical implications of placebo treatment?
- Active treatments can be enhanced by using the features discovered for placebos
What are nocebo effects?
Adverse consequence of placebos that are also found in the active drugs
What causes nocebo effects?
Patient expectation of side effects from active treatment can cause more or more intense side effects
This is due to increased neural activity in pain areas
Activation of CCK in the brain, leading to hyperalgesia.
How can nocebo effects be elicited through conditioning?
Association of previously neutral stimuli with harmful stimuli
How can nocebo effects be minimized?
Framing of information in positive light
Counter-conditioning
What is treatment adherence?
The extent to which a person’s behaviour correspond with the agreed upon recommendations from a healthcare provider
Can be intentional or unintentional
What is medication adherence?
Conforming with the provider’s recommendation in terms of timing, dosage and frequency of meds, taken in the right way and for the prescribed length of time
Why is adherence important?
- Large impact on health outcomes
- Prevents additional healthcare expenditure
- Prevent antibiotic resistance
- Reduces extra appointments
- Fewer hospital admissions and mortality
What are some general factors that influence treatment adherence?
Disease type Time Age Language proficiency Treatment factors Psychosocial factors PP Relationships
How does disease type affect treatment adherence?
Those with more serious diseases are more likely to adhere, as they feel they will gain more
Eg. HIV, cancer etc.
How does time affect treatment adherence?
Levels of adherence drop over time
How does age affect treatment adherence?
Those who are younger and older tend to have poorer adherence
How does english proficiency affect treatment adherence?
If patients don’t understand, they may not be able to adhere, even if it is unintentional
How do treatment factors affect treatment adherence?
Lower adherence can be due to:
- Complexity
- Side effects
- Cost
- Duration
- Frequency
- Storage
- Lifestyle
- Lack of immediate benefit
How do psychosocial factors affect treatment adherence?
- Personal beliefs, memory, understanding, emotions, stress, support and norms affect adherence
How do personal beliefs affect treatment adherence?
A person’s beliefs about the illness (its identity, their control, its cause, timeline and consequences) impacts adherence.
Also: beliefs about medication, self efficacy, their locus of control and any perceived barriers
How does a good PP relationship influence treatment adherence?
- Revealing perceived barriers
- Suiting treatment to patient lifestyle
- Improve understanding of illness, treatment plan
- Enhance self efficacy and trust, promoting return visits
How can patients’ adherence be improved?
- Address false perceptions
- Link treatment to ilness
- Personalize the regime
- Simplify and write down the course of treatment
- Involve their spouse, or have the write a behavioural contract
- Self-monitoring
- Using pill organisers, prompts, reminders and calls
- Use interpreters if necessary
What are simple, straightforward techniques that can be used to enhance adherence?
- Use simple language, with no jargon
- Use teach-back approach
- Give concrete instructions
- Address serial position effects
- Repeat key info
- Use body language
- Written instructions
- Ask open ended questions, and paraphrase what they’ve told you
Why is it more difficult to adhere to lifestyle changes than to medication?
It takes more time and effort, and has more barriers
What are predictors of adherence to lifestyle changes?
Self-efficacy and perceived control
- Intention
- Perceptions of barriers, susceptibility, benefits and seriousness
- Cues to action
- Stage of behaviour change
- Norms and social support
- Emotions and enjoyment
How can self-efficacy be improved?
Performance experience Vicarious experience Persuasion Imaginal experience Psychological state
What are ways of increasing intention?
- Target the predictors. These include:
- Attitude towards/expectations of behaviour
- Self efficacy and perceived behavioural control
- Perceived seriousness and susceptibility
- Subjective norms
How can you reduce the gap between intention and behaviour?
- Make action plans
- Set cues to remind the patient to take action
- Self monitor the behaviour
- Set rewards
What is a stressor?
An event placing a demand on an organism for some kind of adaptive response
What is stress?
The pattern of responses an organism makes to events that disturb its equilibrium and tax or exceed their ability to cope
It is a challenge to a person’s capacity to adapt to inner and outer demands
What is primary appraisal?
Occurs when a person decides if the situation is benign, stressful or irrelevant
What is secondary appraisal?
Occurs when the person evaluates their options and decides how to respond to the situation
What are the three types of stress interpretation?
Harm or loss
Threat
Challenge
What affects your interpretation of and reaction to stress?
Resources affect whether you interpret a situation as stressful or not (physical, personal or social)
Type of stressor: can differ in intensity, duration, predictability and frequency
Culture, physiology and psychology also produce different reactions in different people
What can cause stress?
Can be a traumatic event
Can also be accumulation of hassles that build up
What are the direct effects of stress on health?
Cortisol impairs immune functions.
Can also cause heart issues and atherosclerosis
What are the indirect effects of stress on health?
Behavioural- increases smoking, substance abuse, sleep problems. This causes:
- Increased likelihood of CDs
- Slow wound healing
- CVD
- Reduced immune response
- Alters cancer and HIV progression
- Alters gene expression
What is the general stress response when a threat is perceived?
The sympathetic ANS fires, coming together with the endocrine system to produce the fight or flight response.
- The Symp. NS stimulate the adrenal medulla to secrete epi and norepi, causing increased BP, HR and sweating, as well as peripheral vasoconstriction
- HPA axis activated, and cortisol is produced from the adrenal cortex
- This releases glucose, amino acids and fatty acids, as well as suppressing immune and inflammatory responses
What are the 3 stages of the stress response?
Alarm: Initial reaction, fight or flight
Resistance: Resp and HR normal, but epi, blood glucose and cortisol still high (attempt to cope)
Exhaustion: Depletion of resources, increased vulnerability to infection and disease
What are the different classifications of stressors?
Acute time limited Brief natural Event sequences Chronic Distant
What are acute time limited stressors?
Short and easily identifiable
Causes upregulation of general immunity (macrophages) and downregulation of specific immunity (lymphocytes)
NB this is okay, as lymph function would be returned to usual by the time it is needed
Eg. electric shock
What is an example of brief natural stressors?
Exams
What is an example of event sequences?
Death of partner to cancer
What are chronic stressors?
Affects both natural and specific immunity negatively, as it is ongoing.
Increasing age and existing diseases increases vulnerability
(eg. caring for dying family member, war)
What is an example of distant stressors?
Child abuse in the past
What is problem focussed coping?
Patient attempts to change the situation
Useful when something constructive can be done
What is emotion focussed coping?
Attempt to change thoughts or emotional consequences of stressor. Useful in uncontrollable circumstances
How can reactions to stress be modified?
Preparing in advance
Seeing the event as less threatening
Establishing greater perceived control over the stressor
What is social support?
The presence of others in whom one can confide and from whom one can expect help and concern
What can social support provide?
Appraisal: gives you a different view of the situation
Tangible support (bringing food)
Information support
Emotional support
How does social support protect against stress?
- Directly: preventing you getting stressed, or giving you better health regardless of stress level
Buffering: Helping you cope with stress, by altering your appraisals (best when matched to what person wants) - Reduce depression and anxiety
- Affect health habits
- Lower likelihood of illness
- Reduced loneliness
- Reduced mortality from serious disease
How can we reduce stress?
Coping skills, assertiveness, anger management, relaxation and meditation programmes
Can also involve interventions, including listening to music and creative writing
What are some statistics about chronic disease prevalence in NZ?
- Chronic disease more likely to increase as population ages
- 5% IHD, 5% diabetic, 15% arthritic, 16% chronic pain, 16% depression, 11% asthma, 16% hypertensive
Rates 3x higher in maori, also higher in elderly
How do chronic illnesses affect quality of psychological life?
Affects patient and family quality of life
Involves emotions, vitality and social roles
What are the 3 ways in which chronic illnesses impact emotions?
Denial
Anxiety
Depression
How does chronic illness cause denial?
- People avoid the implications of the illness- severity and timescale
- Helps with initial coping, but may interfere with lifestyle, adherence and accessing medical care, potentially promoting the progression of the illness
How does chronic illness cause anxiety?
- Patients are often anxious/disoriented after diagnosis
- Can become anxious about symptoms or making symptoms worse
- Recurring anxiety about future and complications can cause depression
How does chronic illness affect depression?
Affects up to a quarter of chronic patients
Sets in once full consequences are realized
Can be long or short term
Often goes untreated due to greater focus on the illness
Less motivation to attend support groups or seek help for illness
How does chronic disease affect vitality?
Feeling tired, with insufficient energy for activities
How does chronic illness affect social role?
Impacts your ability to carry out the expectations people have from you
How does chronic illness affect physical quality of life?
Via symptoms, functioning and physical roles
How do the symptoms of chronic illness affect your physical quality of life?
Pain Sleep issues Appetite changes Nausea and bowel issues Breathlessness Ulcers Swelling
How does chronic illness impact physical functioning?
Can cause inability to play, run, lift, climb, walk, bend or even take care of yourself
How does chronic illness affect your physical role?
It limits the amount and type of work you can do
How does quality of life not related to the chronic illness fare?
It tends to be reported as good
What are the social effects of chronic illness?
Can put stress on family in terms of finances, free time and caregiving
Need to choose who to tell as some may react negatively
What are some positive outcomes of chronic illness?
Closer relationships Changed priorities Lifestyle changes Appreciation of life Empathy
What is avoidant coping?
Hiding from the issue
Linked to higher distress
What is active coping?
Linked to good adjustment, you actually try to do something to help yourself cope
What is flexible coping?
Best option: you match the strategy to the situation
What is coping with chronic illness affected by?
Patient’s beliefs about the illness’s
- Identity
- Cause
- Consequences
- Controllability
- Timeline
- Social support they ahve
What are the categories of intervention strategies to help chronically ill patients cope?
- Psycho-educational
- Community rehabilitation
- Stress management
- Medication
What are psycho-educational coping strategies?
- Change maladaptive beliefs and encourage active coping
- Change beliefs about treatment to increase adherence
- Teach use of problem vs. emotional focussed strategies
- How to access social support and cope with side effects
What are community rehabilitation programmes?
- Use of support groups and internet interventions
What is job burnout?
A feeling of emotional exhaustion, depersonalization and reduced sense of accomplishment
What is the difference between emotion and mood?
Emotions are fleeting, action oriented with facial expressions, and tied to specific stimuli
Mood is long-lasting, more cognitive without being expressed facially, and not tied to specific stimuli
What are the six basic emotions?
Sadness Fear Anger Disgust Surprise Happiness
How are emotions developed?
They are universal, inherited from genes thought to have developed due to our common experiences during evolution
Their display and rules around their display varies depending on culture
Animals also have emotions, though humans’ are more complex
What are the four theories of emotion?
Common sense theory
James-Lange theory
Cammon-Bard theory
Schachter theory
What is the common sense theory?
Stimulus –> conscious emotion –> autonomic arousal pathway
What is the james-lange theory of emotion?
Stimulus–> autonomic arousal –> conscious emotion
What is the cammon-Bard theory of emoton?
Stimulus –> subcortical brain activity –> conscious feeling and autonomic arousal
What is the schachter theory of emotion?
Stimulus –> autonomic arousal –> appraisal –> conscious feeling
What can emotions affect?
Behaviour Phsiology (via stress response) Experience Communication (signal others about situation/self) Cognition (information processing)
What are our emotional capacities in infancy?
- Crying, smiling, fear and anxiety are primarl (social smiling at 2mos)
- However, infants highly aware of others’ emotions from 4mos
- Infants use their early emotions to engage and elicit responses from caregivers, promoting attachment
What is attachment?
A strong, enduring and affectionate tie formed with primary caregiver/s
Mother-infant bond most studied
Forms within first year of life
What are the cupboard vs comfort views of attachment and whose were they?
Freud (cupboard) suggested children formed this attachment as the provision of food is necessary for survival
Harlow (comfort) proved using monkeys that comfort and love is also necessary to form an attachment
What is attachment theory (bowlby)?
Attachment style lasts from cradle to grave
Mother infant bond is evolved, and babies have inbuilt behaviours to promote it.
How can attachment style be measured?
Observing child’s reaction when:
Put in unfamiliar environment with mother
When mother leaves
When mother returns
(adulthood- looking at relationship style and support seeking)
What is secure attachment?
60% of population
Child secure, curious, happy
Mother sensitive and consistently quick to respond
Child believes needs will be met
Distressed at mother’s departure, greets at her return
Adulthood: comfortable in relationships, seek support from partner
What is avoidant attachment?
20% of population
Child not explorative and distant
Mother distant and disengaged
Child believes needs won’t be met
Focus on environment and don’t react at mother’s departure/return
Adults: great autonomy, but cut themselves off from partners
What is anxious/ambivalent attachment?
10-15%
Child anxious, insecure and angry
Mother is inconsistent- sometimes sensitive, sometimes neglectful
Child can’t rely on needs being met
Become overly distressed at mother’s departure and explore very little on her return
Adults: fear partner rejection, strongly desire closeness
How does attachment style affect health?
- via relationships- impact on chronic and mental disease
- Attachment style intensified when health threatened- secure seek help, avoidant & anxious don’t, anxious also afraid
What are the 4 factors influencing a child’s attachment style?
- Child’s temperment
- Quality of caregiving
- Family circumstances
- Culture
What is temperament?
Temperament is an early and stable disposition, inherited from parents and observable from utero to adulthood
Assessed based on reaction to stressful stimuli and self regulation
How does the child’s temperament affect attachment style?
- Associated with cognitive and social function
- Shy react to unfamiliarity with avoidance, distress. Take longer to relax, more fears and phobias
- Bold react to unfamiliarity with spontaneity, joy
Relax quickly in new situations
Fewer fears and phobias
How can quality of caregiving affect attachment style?
- Goodness of fit (match between child’s temperament and parenting style)
- Serve and return relationship- child serves up new behaviours, caregiver needs to react
How can family circumstances affect attachment style?
- Parental factors, circumstances and life transitions affect interaction
- Parental mental health, substance abuse, attachment has impacts
- Low SES, stress, violence and major life changes can lead to less attention and sensitivity, pre-empting less secure attachment
How does culture affect attachment?
Different cultural parenting norms can lead to different attachment profiles
What is emotion regulation?
The process by which individuals influence the emotions they have, when they have them and how they express them
Learnt through the developmental course
What are areas we can regulate our emotions towards a stimulus?
- Situational selection (antecedent focussed)
- Situation modification
- Situation attention
- Situation appraisal
- Situation response (response focussed)
What are the 6 categories of links between emotion and health?
- Direct links
- Links to health behaviour
- Symptoms and sensitivity
- Help seeking and screening
- Decision making
- Adherence
How does emotion directly link to health?
- Positive emotions lead to beneficial outcomes and vice versa
- Broken heart syndrome (takostubo) occurs when grief causes ventricular enlargement and heart failure
How does emotion link to health behaviours?
Negative emotions associated with damaging health behaviours and relapses
Positive emotions associated with better health behaviours, but also greater risk behaviours (invincibility)
How does emotion link to symptoms and sensitivity?
Negative emotions can prompt awareness and ability to detect symptoms, and validation can reinforce this
Positive emotions => fewer aches and pains
How does emotion link to help seeking and screening?
Negative emotions => increased help seeking => malingering and unexplained symptoms (as they want attention)
Positive emotions associated with sustained screening
How does emotion link to decision making?
- High anxiety predicts hormone treatment for cancer
- Emotion affects attention
- Optimism bias can hinder help seeking and prevent healthy behaviours
How does emotion link to adherence?
Negative outcomes linked to poor adherence due to low motivation, greater side effects/symptom noticing, and emphasized downsides
However, anxiety can fuel adherence.
What is social psychology?
The examination of human behaviour in social contexts- how thoughts, behaviours, feeling are influenced by actual, imagined or implied influences of others
How can social contexts influence individual behaviour?
Can be person to person interactions, group to person or group to group
Situational factors
Social norms
What are social roles and how are the influenced?
Defined patterns of behaviour expected of a person while functioning in a setting or group
Different roles become available in different situations
Influenced by social rules- implicit or explicit
What is role merger?
Occurs when someone identifies with a role to such an extent that they become the role, either consciously or unconsciously.
What is the hindsight effect?
People think they would have known something when you tell them first, but often don’t know it when you ask before telling them
What is social thinking?
The process by which people select, interpret and remember social information and categorize others’ behaviours
How are impressions formed?
Quickly
Based on social roles, norms and appearance
Affected by attitudes and stereotypes
What are ‘attitudes’?
Our positive or negative evaluation of people, objects, events or ideas
What is cognitive dissonance and how can it be reduced?
Occurs when one’s attitudes and behaviours are in conflict
- Can be fixed by changing your behaviour (hard)
- Justifying your behaviour by altering your attitude slightly
- Changing our attitude entirely to permit your behaviour
- This depends on the communicator of the change, whether the message targets emotion or rationality, the medium of its delivery and the target’s age and attitude strength
What is the foot in door technique?
Obtaining compliance with a small request to boost compliance with a larger request- like a slippery slope
What is social influence?
The process by which our behaviour is influenced by others and social factors
What are the three types of social influence?
Obedience
Conformity
The bystander effect
What is obedience and why does it occur?
A change in behaviour to coincide with a standard, normally set out by an authority
- Done as we want to comply with the orders of authority
- Often happens in everyday contexts- like not speeding
Why can obedience be dangerous and how is it influenced?
Can be dangerous as if people believe their orders come from a legitimate authority, they may bypass their consciousness and do terrible things
Influenced by:
Explicit demands
Modelling of behaviour by others
Proximity of the subject
Proximity of the authority
Dissent- if one person says no, more are likely to follow suit
What is the study showing obedience?
The electric shock study
Nurses giving high doses when ordered by doctors
What is conformity?
We choose to go along with the majority due to group pressure
Nobody has to ask, and it is done to fit in when we don’t know what to do otherwise
What influences conformity?
Informational influence: we like to be right, so if many have a different answer we are likely to doubt ourselves Normative influence: like to be liked Personality- low self esteem Culture Group size Dissention
What is the study showing conformity?
Stanford prison experiment- ‘guards’ lost sense of self, and became brutal and sadistic
What is the bystander effect?
Decreases in offers of assistance occurring as number of bystanders increases
Due to diffusion of responsibility as we see others as equally responsible
Eg. Kitty Genovese had 38 witnesses to her stalking-murder
What are social relations + examples?
Processes at play in our interactions with others
Includes prejudice, aggression, conflict, attraction, altruism and peacekeeping
What is prejudice and where does it come from?
Negative attitudes towards a group (discrimination is negative action) Comes from: Competition between groups (realistic conflict theory) Cultural learning and religion Personality Self esteem Emotions (scapegoat theory) Beliefs
What can prejudices do in healthcare?
Can cause differences in the quality of healthcare not due to access, and unequal or delayed treatment
What is the healthcare stereotype and what can it do for patient satisfaction?
Threat of being judged based on negative stereotypes
Patients have less satisfaction and trust, and poorer perception of health and adherence
(minorities tend to get lower quality and access)
What is aggression?
Physical or verbal behaviour intended to hurt or destroy
Emerges from the interaction of biopsychosocial factors
What is attraction?
The basis of relationships
Influenced by positive traits (attractiveness), proximity, similarity to self and reciprocal liking
(This also influences our motivation)
How does attraction affect healthcare?
Perceive higher quality of care when attracted to practice/doctor
Building a rapport helps with comfort and trust
Mirroring patients also has this effect.
What is mental health/illness?
State of emotional and social wellbeing
Illness not a single symptom: pattern of thoughts, feelings or behaviour that
- Cause distress that risk and/or get in the way of usual activities
- Happen in multiple settings
- Are ongoing
- Exist outside of positive expectations relative to culture and age
- Difficult to control
- Co-morbidity common
How are mental illnesses diagnosed?
Syndromally: diagnoses based on clusters of abnormal, dysfunctional or pathological symptoms based on experiences and observable signs
What are the issues with mental illness diagnosis?
- Diagnoses rely on interpretations, varying based on culture and time
- Behaviours that are simply uncommon, and due to physical illness or intoxication may be misinterpreted as a sign of illness
What are predisposing and perpetuating factors for mental illness?
Predisposing: elements that make individuals more susceptible to the mental disorder
Perpetuating: Elements causing the disorder to emerge
Includes personal factors, immediate and broad environmental factors
What is the difference between normal moods, depression and dysthymia?
Depression: large, profound dips below ‘average happiness’ line
Dysthymia: consistent mood below the average line, but no major dips
Normal: peaks and small lows
Which 2 symptoms must be present for depression to be diagnosed? (although only 1 is needed?
- Depressed mood most of the day nearly every day
And/Or - Loss of enjoyment (anhedonia)
