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broad definition of health
- a complete state of physical, mental, and social well-being and not merely the
- absence of disease or infirmity
- assumes that disease is an affliction of the body. Disease has no connection with the
- psychological and social processes concerned with the mind. This model led to a
- massive reduction in mortality due to infectious disease (e.g. whooping cough,
- measles, polio), and to the control of bacterial infection through antibiotics.
- Treating, not preventing
limitations of biomedical model
cannot account for our health status alone (e.g. Freud - conversion hysteria)
- early 1900s
- patterns of personality that linked with specific illnesses
limitations of psychosomatic medicine
- lack of methodological rigour
- too focused on role of personality type
- now known that it is the interaction of many factors that contribute to an individual's state of health
- restricted range of medical problems to which psychological and social factors were deemed to influence
encompasses medical and psychosocial aspects of health. Fundamental assumption is that health and illness are consequences of the interaction between biological, psychological and social factors. Microlevel processes are nested within the macrolevel processes, changes in each affects the other.
establish possible associations between variables that can be later assessed in a controlled randomised design
limitation of correlational research
cannot determine causal direction
advantages of correlational research
- do not require any variables to be manipulated or changed
- minimal invasiveness
- frequently entails filling out a questionnaire
- issues of patient burden
examine particular variables over time to track whether or not a relationship exists between them. Multiple assessment points so you can infer more about the likely direction of causality.
no prior assessments available, assess retrospectively the general health status and lifestyle of an individual prior to the event
limitation of retrospective research
limited by participants ability to recall certain events and behaviours
qualitative health psychology research
involves collecting data that consist of scripts from interviews with study participants.
advantages of QHPS
- in-depth understanding of a certain condition or disease,
- used to generate hypotheses,
- suitable for research in sensitive areas where there are concept that may be extremely difficult to quantify
- causes 50% of deaths
- related to certain behaviours we do or do not enact
- reducing activities harmful to health
- taking up new preventative behaviours
- increasing frequency of good behaviours
- carried out with little forethought or awareness
- initial direct reinforcement
- over time, environmental cues prompt action
- highly resistant to change
- need for appropriate health-related behaviours early on in life
7 features of disease-free lifestyle
- 1. not smoking
- 2. Moderate alcohol intake
- 3. Sleeping 7-8 hours per night
- 4. Exercising regularly
- 5. Maintaining desirable body weight
- 6. Avoiding snacks and
- 7. eating breakfast regularly
- major focus of Health Psychology theory; enduring characteristics of the individual that influence behaviour and are acquired through socialisation processes;
- amenable to change
social cognition models
how individuals make sense of social situations; how individual cognitions intervene, or mediate, between environmental stimuli and responses or behaviours.
Health Belief Model
- a value-expectancy theory
- describes the valuation of the desire to avoid illness and the types of expectations about health that are essential in influencing preventative behaviour
- 1. perceived threat
- 2. susceptibility
- 3. perceived severity
- 4. cues to action
- 5. self-efficacy
limitations of the HBM
- vague descriptions of how constructs should be measured.
- imprecise description of relationships between variables.
behavioural intention equation
B~I = w1Ab + w2SN
- w1 and w2 are weights indicating the relative importance of attitudes and subjective norms as determinants of intention
- I is intention to perform a behaviour (B)
- Ab is attitude towards performing behaviour
- SN is subjective norm concerning performance of the behaviour
Theory of Reasoned Action
- behaviour can be predicted by asking questions on one's intention to perform/not perform a behaviour
TPB - behavioural beliefs
favourable/unfavourable attitude towards behaviour
TPB - normative beliefs
perceived social pressure to perform/not perform the behaviour
TPB - control beliefs
sense of self-efficacy or perceived behavioural control.
Limitations of TPB
- · Assumes intentions are stable
- · Narrow theoretical approach
- · Attitudes alone may directly influence behaviour
- · Over time, intentions driving behaviour becomes redundant since external cues take over rather than conscious intention.
Transtheoretical/States of Change Model
- 1980, Prochaska & DiClemente
- each stage requires different strategies or processes of change to best help the individual to attain better health
immediate variables that can influence the process of change
- decisional balance
cognitive social health information processing (C-ship) model
- 1996, Suzanne Miller
- individuals have unique cognitive and emotional responses to health-threats. These responses determine health behaviours.
C-ship cognitive and emotional processes
- 1. encodings (e.g. perceptions of risk)
- 2. expectancies and beliefs (e.g. benefits and drawbacks)
- 3. values and goals
- 4. disease-related effect
- 5. self-regulatory strategies
C-ship attentional style
- a characteristic way of responding to a health-related threat.
- high monitors and low monitors
C-ship attentional style: high monitors
- focus on disease-related cues
- want large amounts of info
C-ship attentional style: low monitors
- ignore and minimise health risk-related cues
- do not attend to info
the cause of a disease
idea that mind and body are separate entities
mechanistic medical model (an underlying impairment causes some symptom that requires treatment/cure in order to enable a return to ‘normal’ health)
interdisciplinary field drawing on a range of behavioural sciences in relation to medical conditions. Examines the development and integration of behavioural and biomedical knowledge and techniques of relevance to health and illness. Applied to prevention and rehabilitation, and not solely on treatment.
started being heavily influenced by psychoanalytics. Today, most concerned with mixed psychological, social and biological/physiological explanations of illness, and illnesses addressed are often referred to as ‘psychosociological’, with acceptance that psychological factors can affect any physical condition.
health and illness considered in terms of social factors that may influence individuals (individuals being considered in the wider context of family, kinship, culture etc.).
concerned with mental health and the diagnosis and treatment of mental health problems, typically working within the healthcare setting, delivering assessments, diagnoses and psychological interventions that are derived from behavioural and cognitive principles.
takes a biopsychosocial approach to health and illness, as well as focusing on the promotion and maintenance of health.
- 1. clinical
- 2. public
- 3. community
- 4. critical
clinical health psychology
merges clinical psych’s focus on assessment and treatment with a broader biopsychological approach to illness and healthcare issues.
public health psychology
emphasis on public health issues, e.g. immunisation programs, epidemics, health education and promotion.
community health psychology
employs methods of actin research and aims to produce healthy groups and healthy communities.
critical health psychology
has been criticised for being too individualistic in focus. Critical health psychologists argue that the biopsychosocial model needs clearer distinction from the biomedical model, particularly in relation to the development of the ‘social’ component.
locus of control
a personality trait thought to distinguish between those who attribute responsibility for events to themselves or external factors
health locus of control
the perception that one’s health is under personal control, controlled by powerful others such as health professionals, or under the control of external factors such as fate and luck
perceived behavioural control
one’s belief in personal control over a certain specific action or behaviour.
the belief that one can perform particular behaviour in a given set of circumstances.
having a generally negative outlook on life and a tendency to anticipate negative outcomes (as opposed to dispositional optimism)
aka optimistic bias, whereby a person considers themselves as being less likely than comparable others to develop an illness or experience a negative event.
where the costs of behaviour are weighed up against the benefits of that behaviour.
precaution adoption process model
- 1. Unaware of issue
- 2. Unengaged
- 3. Considering whether to act
- 4. Deciding not to act (exiting the model)
- 5. Deciding to act
- 6. Action
- 7. Maintenance
protection motivation theory
[intrinsic+extrinsic rewards]-[severity+vulnerability] = threat appraisal
[response efficacy + self efficacy]-[response costs] = coping appraisal
Coping appraisal + threat appraisal = protection motivation.
limitations of Protection Motivation Theory
does not account for habitual behaviours, does not consider social norms or the environment.
Temporal self-regulation theory
mechanisms of media influence
characteristics of persuasive media messages
- engaging style and ideas
- personally relevant
- · Motivate behaviour change by threatening the audience with harmful outcomes from initiating or continuing an unhealthy practice
- · May be de-motivating
- · Physical outcomes
- · Social consequences
- · Physiological consequences
- the way in which the producers represent a particular story
- incomplete coverage or avoidance of certain topics
over or underreporting
evaluation of health behaviour change interventions
- 1. The way in which an intervention is to be judged successful should be considered throughout.
- 2. Interventions should be evaluated against relevant outcome measures.
- 3. The evaluation should consider whether the intervention has resulted in long-term behaviour change.
- 4. Sufficient funds should be allocated for evaluation.
maximising the effectiveness of campaigns
- · Refining communication to maximise its influence on attitudes
- · The use of fear messages
- · Information framing
- · Specific targeting of interventions
the elaboration likelihood model of persuasive communication
individuals are more likely to centrally process messages if they are motivated to receive an argument when
- it is congruent with their pre-existing beliefs
- it has personal relevance to them
- recipients have the intellectual capacity to understand the message
individuals threatened by a message will take one of two courses of action, according to PMT:
- danger control (reducing the threat)
- fear control (reduce the perception of the risk)
fear advertising should be structured thus
- · Arouse some degree of fear
- · Increase the sense of severity if no change is made
- · Emphasise the ability of the individual to prevent the feared outcome.
health promotion levels of responsibility
- - Individual level: personal responsibility
- - Level of the general practitioner/medical physician: increase awareness
- - Psychologists: have a role in designing and implementing interventions to change health behaviours
- - Community and governmental level
levels of prevention: primary
Keep the healthy, healthy. No obvious signs of disease – prevent disease occurring (e.g. sunscreen, raise awareness of smoking and drug risks)
levels of prevention: secondary
target individuals who have early stages of disease or emerging signs of disease. Utilisation of techniques for detecting early stages of disease. Screening, infectious disease, chronic disease. Provide prompt treatment to either arrest the development of any further disease or reverse the process.
levels of prevention: tertiary
individuals who have already been diagnosed with disease or have injury. Emphasis is on treating the existing disease/injury to minimise symptoms and/or cure the individual. Prevent recurrence of disease/injury.
levels of risk: normal
- Healthy people who are showing no symptoms of disease
- No known past history of the disease
- No particular known risk factors
levels of risk: increased
- Healthy people showing no symptoms of disease
- Family history of the disease
- Existence of other risk factors (eg exposure to toxic substances)
- The individual may have already had personal occurrence of the disease in the past.
Milne, Orbell and Sheeran (2002) - intervention to promote exercise in young adults
- Exposure to fear-related messages about the consequences of not exercising led to increases in perceived threat and an increase in intentions to exercise
- Only when this fear-laden message was incorporated with information about implementing an exercise program that exercise behaviours increased.
Kirsch and Pullen (2003) - school based education program to promote bicycle safety
- program was related to retention of knowledge and enactment of safety messages after a 1 and 2 year period
- motivators and barriers for helmet use were also identified
advantages of focusing on at-risk populations
- Prevention of elimination of poor health habits that contribute to vulnerability for disease
- Minimising risk of disease in at-risk populations is cost-effective
- Better able to identify factors that are associated with the onset of disease
limitations of focusing preventative efforts on at-risk populations
- People habitually incorrectly perceive their level of risk. Overly optimistic about their vulnerability to disease
- Being labelled as at-risk may cause some people to by hypervigilant and restrictive in their behaviour
Calnan (1984) applied the health belief model to look at factors associated with attendance at breast screening. predictive factors included:
- intention to attend, use of medical services predicted screening clinic attendance
- personal health behaviour, perceived vulnerability to breast cancer predicted instructional class attendance
- social support and self-efficacy predicted both
- Focus on prevention of relapse
- The individual frequently adopts recommended changes to behaviour that can minimize their risk
- Avoiding high risk activities that may lead to injury
- Changing diet and exercise habits
- Adhering to recommended treatment regimens
- Maintaining adherence to recommendations
- Facilitate coping processes
2 purposes of health screening
- 1. detection of early asymptomatic sighs of disease in order to treat
- 2. identification of risk factors for illness to enable behaviour change
the probability that a test is correctly positive or correctly negative
the likelihood that a test will produce a few false positive results and a few false negatives; that is, it does not produce a positive result for a negative case, and vice versa
type of screening: genetic risk
- example: BRCA1, BRCA2 mutations for breast and ovarian cancer.
- possible outcomes of screening: Routine subsequent screening for early detection of disease; Preventative surgical procedures
type of screening: early detection of disease or its precursors
- example: Cervical screening, mammography, hypertension
- possible outcomes of screening: medical or surgical treatment of any abnormalities found
type of screening: behavioural risk for disease
- example: smoking, sedentary lifestyle, poor diet
- possible outcomes of screening: behavioural change
fine needle aspiration
entails placing a very thin needle into a mass within the breast and extracting cells for microscopic evaluation. It takes seconds, and the discomfort is comparable with that of a blood test
the removal of a small piece of tissue for microscopic examination and/or culture, usually to help make a diagnosis
Holmes and Rahe Social Readjustment Rating Scale
The number of life change units that apply to events in the past year are added total gives an estimate of likely effect of stress on their health. 150 is slight risk, 150-299 is at moderate risk, >300 is very at risk
Daily Hassles (Folkman, Lazarus and DeLongis)
refers to everyday events that people experience as harmful, threatening, or annoying.
perceived stress scale
- A measure of the degree to which situations in one’s life are appraised as stressful. 10-item questionnaire designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives & direct queries about current levels of experienced stress.
- Asks about feelings and thoughts in last month.
General Adaptation Syndrome - Walter Cannon (1932)
stressor -> alarm reaction -> stage of resistance -> stage of exhaustion
- arousal diminishes from alarm stage. individual is highly vulnerable to any additional sources of stress. highly likely to develop illness
- by exhaustion, immune system is weakened and energy reserves are depleated
limitations of GAS
- neglects the influence of psychological factors as determinants of our responses to threatening and stressful events.
- Assumes that our physiological responses to all stressors are the same.
process of managing demands that are appraised as taxing or exceeding the resources of the person
- processing info about the potential stressor and gauging the level of impact that this is likely to have on the individual.
- potential stressor can be irrelevant, good, or stressful.
- if stressful, can be harm/loss, a threat, or a challenge
- ongoing assessment of resources that an individual has available for coping. resources can include
- - health and energy
- - positive beliefs
- - problem-solving and social skills
- - material resources
- - social support
regulating the emotional response to the problem
managing or altering the problem in the environment causing stress
degree to which people believe they can bring about desired outcomes in their environment and avoid undesirable ones (Skinner, 1996)
the generalised expectation that a person will obtain good outcomes in life (Carver and Scheier, 2001)
werner (1995) - three contexts for protective factors
- (1) personal attributes, including outgoing, bright, and positive self-concepts;
- (2) the family, such as having close bonds with at least one family member or an emotionally stable parent; and
- (3) the community, like receiving support or counsel from peers.
a return to earlier and less effective ways of coping with increased age. (Gutmann, 1970; Pfeiffer, 1977)
developmental explanations for age differences in stress and coping processes
- regression hypothesis
- growth hypothesis
- older people cope the same as younger people in most respects (McCrae, 1982)
- with age, people may learn to eliminate coping responses that they find ineffective
the defences used by older people become increasingly more effective and less distorting of reality. (Vaillant, 1977)
Cohort interpretation of age differences in stress and coping processes
1989 study found older adults rely less on hostile strategies. Found no support for age diffs being maturational, as findings were not consistent between cross-sectional, longitudinal & cross-sequential analyses. Instead they were better interpreted as cohort effects.
gender differences in coping
- men use more problem-focused coping and substance abuse
- women use more emotion-focused coping and seek social support
impacts of stress on health
- reduce immune system function
- affects cortisol, neurotransmitters and blood pressure
- less likely to eat/sleep/exercise well
diathesis stress paradigm
- proposes that individuals have varying degrees of vulnerability to various illnesses, but only expressed due to stress.
10 ways to build resilience
- 1. maintaining good relationships
- 2. avoid seeing crises or stressful events as unbearable problems
- 3. accept circumstances that cannot be changed
- 4. develop realistic goals and move towards them
- 5. take decisive actions in adverse situations
- 6. look for opportunities of self-discovery after a struggle with loss
- 7. developing self-confidence
- 8. keep a long-term perspective and consider the stressful event in a broader context
- 9. maintain a hopeful outlook, expecting good things and visualising what is whished
- 10. take care of one's mind and body
Schontz (1975) sequence of reactions following diagnosis of serious illness
- shock (stunned, behaving automatically, detached)
- encounter (disorganised thinking, feeling of loss, overwhelmed)
- retreat (avoidance, denial, reality slowly intruding)
Moos and Schaefer (1982) crisis theory
- illness related factors - level of threat, aspects of treatment
- background and personal factors - hardy people cope better, life stage important (young ppl appearance, older ppl raising children/have career)
- physical and social environmental - hospitals restrictive, dull, too noisy, frightening.
Moos and Schaefer - 3 parts of coping
- cognitive appraisal
- adaptive tasks
- use of coping skills
(Lazarus) Challenge appraisals: challenges with chronic disease include
- • practical problems of obtaining treatment &
- managing to maintain long term treatment;
- • dealing with associated anxiety or depression;
- • managing the impact that the disease has on social life;
- • coping with limitations on work-related or leisure related aspects of your life;
- • dealing with the subsequent loss of self-esteem which frequently results from chronic disease (possibly due to fatigue, disability, disfigurement, stigma);
(Lazarus) threat appraisals:
- threats to life and physical well-being;
- threats to body integrity and comfort (result of disease, treatment, or procedures),
- threats to independence, privacy, autonomy, and control,
- threats to self-concept and fulfillment of customary roles,
- threats to life goals and future plans,
- threats to relationships with family, friends, colleagues;
- threats to ability to remain in familiar
- surroundings; and
- threats to economic well-being.
adjustment to newly acquired spinal cord injury (kennedy, evans & sandhu)
- current cognitions (primary appraisals in particular) were important to adjustment process
- coping strategies were less important than appraisals given in predicting depression
longitudinal study - 1, 6 and 12 months after severe accidental injuries
- 1/3 had PTSD
- appraisal of controllability and predictability more important in acute phase
- active coping less useful in acute stage
- ability to cope/perceived severity predicted time off work
coping with newly diagnosed cancer (drageset et al 2010)
- women prefer to manage situation in their own way
- aware of death but hopeful
- pity and compassion increase fear
HIV/AIDS coping (parkenham & rinaldis, 2001)
- stage of illness and no. of symptoms predicted all adjustment outcomes
- problem-focused coping predicted lower depression, emotion focused higher
- higher appraisals of threat predicted poorer adjustment
juvenile arthritis (Garnefski et al 2009)
- CERQ - crossectional questionnaire
- rumination and catastrophising were the most important predictors of psych maladjustment
- challenging these maladaptive strategies
people who have chronic illness long-term and adapt well
adapt their appraisals and coping strategies over time to adjust to the changing demands of their illness
illness-related anxiety is associated with
- poor functioning following radiotherapy
- poor glucose control and increased symptom reporting in diabetics
- lower rates of heart attack patients returning to work
depression and chronic illness
- 1/3 of inpatients report moderate depression symptoms
- up to 1/4 suffer severe depression
- stroke: associated with longer stays in hospital, more discharges to nursing homes
- slows down recovery - less motivated
influence of coping on survival and recurrence of cancer Petticrew, Bell and Hunter 2002
inconsistent evidence for association between fighting coping style (rather than helplessness) and survival/recurrence in cancer patients
long-term testicular cancer survivors, Rutskij 2010. compared to approach coping, avoidance coping patients:
- less relationships
- less paid work
- had more physical and mental morbidity
- more fatigue
- poorer quality of life and self-esteem
Wang et al. 2013: positive consequences of traumatic accidental injuries - post-traumatic growth (PTG) predicted by
- avoidance of PTSD symptoms
- openess to experience
- positive coping strategies
Wang et al. 2013: positive consequences of traumatic accidental injuries. PTG can include:
- elevated appreciation of life
- improved personal relationships
- greater sense of personal strength
coping and medical adherence: Christensen et al 1995 found that
- planfull problem solving coping associated with adherence (for controllable stressors)
- emotional self-control (emotion-focused coping) was associated with adherence for less controllable stressors
coping and medical adherence: Yeh, Huang, & chou 2008.
- higher stress scores in those with comorbidities and haemodialysis than those with no comorbidities
- comorbidity has moderating effect on coping-stress relationship
- comorbidity reduces use of passive coping strategies in favour of active coping
- patients with more experience with disease learn to cope with stress better
blood pressure and coping styles
men use more maladaptive strategies in response to stress (i.e. drinking) which in turn affect blood pressure.
coping and recovering from surgery. cohen and lazarus, 1973
- dispositional coping measures: vigilant, middle and avoidant.
- avoidant and middle groups had faster recoveries
coping and recovering from surgery. Cohen, Fouladi and Katz 2005
- (pre-op) self distraction coping +ivley predicted post-op pain levels
- emotional and religious-based coping +ively associated with morphine consumption
- pre-op distress and passive coping forms may predispose patients to be more attentive to pain state
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