Psyc101
Psyc101 includes Health, Social and Abnormal Psychology
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- Fishbein and Ajzen (1977)
- proposed the Theory of Reasoned Action.
- Cox and Mackay's model of stress
- 3 features: 1) Feedback from physiological and psychological mechanisms activated by stress can influence the levels of stress. The psychological mechanisms activated by stress can be differentiated into behavioural and cognitive components. The latter may be conscious ‑ coping, or unconscious - defence mechanisms. 2) Stressors are defined in perceptual rather than objective terms. Thus, there is the important aspect of individual appraisal of the demands (and personal resources). 3) Stress is seen to be a consequence of the mismatch between demands and resources.
- Health psychology's sources of knowledge
- Clinical interview and questionnaires
- Depression after myocardial infarction
- Strongly linked to re-infarction rates... more so than hypertension or cholesterol (M-HART study, Frasure-Smith)
- Brown (1999)
- Study which looked at hospital admissions for a heart attack (MI) following the Lomo Prieta earthquake in San Francisco in 1989 (at 5pm) and that in Northridge in Los Angeles County, 1994 (at 4.30am). In the former, little evidence of increased admissions in the former but 110% increase in the latter. It is suggested that the difference was accounted for by the time of day.
- Exhaustion
- Bodily resources are depleted, may lead to illness
- Theory of planned behaviour
- adds notion of behavioural control to the theory of reasoned action
- Fontana et al (1986)
- examined adherence to exercise in cardiac patients using a range of dispositional variables, differing behaviours (specifically Type A and leisure activities) and their social interaction with others. They differentiated the adherence during the programme (12 wks.) from its continuation (over 1 year). They found a negative relationship between both adherence and the agreement to participate in the programme and the perceived vulnerability to further illness. However, other psychological variables such as self‑motivation and perception of benefits did not predict adherence. There was also no relationship between adherence and resulting aerobic gains. Indeed, variables that did predict adherence were either physical factors (such as transport), as opposed to psychological barriers, and social variables (such as liking of staff).
- Resistance stage
- Body continues to fight the threat/stressor
- Morbidity rate
- incidence/prevalence of an illness
- Learned helplessness
- term described by Seligman, In the face of an uncontrollable aversive event what is learned is that behaviour has no consequences
- Wolfe (1964)
- conducted studies of parents of children with terminal illness and women with breast cancer. Found not all of these demonstrated predicted elevations of stress hormones although there was a correlation between levels of distress and hormone levels. Emphasised the concept of defence mechanisms, especially denial and intellectualisation.
- Adrenal glands consist of these two parts
- The inner medulla and the outer cortex.
- The General Adaptation Syndrome
- or GAS, proposed by Selye, consists of three phases.
- Karasek et al (1980s)
- Examined the relationship between workers and their work environment. At the core it has documented that high psychological perceived workload and low decision latitude (e.g. low control) led to job strain and ill-health including coronary episodes.
- Monitoring vs Blunting
- former assess the situation in order to understand what is happening, latter ignores/distracts themselves from the stressor
- Hardiness (Kobasa)
- has three elements: Control, Commitment, Challenge.
- Distress
- caused by 'bad' stressors, e.g. work, death of a family member etc
- Health
- State of complete physical, mental and social well-being..... and not merely the absence of disease or infirmity (World Health Organisation)
- Incidence
- the number of new cases of an illness over a specified time period
- Work
- One of the most quoted causes of stress by CHD patients.
- Implicit theory of rational action
- when people know of the risks of inactivity and/or the benefits of exercise they will follow through with the appropriate behaviour
- Biomedical model
- Symptoms of illness have an underlying biological cause
- COPE inventory (Carver et al. 1990)
- comprises fifteen sub-scales of coping with stress: Active planning, planning, seeking instrumental support, seeking emotional social support, suppression of competing activities, religion, positive interpretation and growth, restraint coping, acceptance, focus on venting emotions, denial, mental disengagement, behavioural disengagement, alcohol/drug abuse, humour.
- Weiss (1972)
- Used rats. Critical components: a) additional non‑shocked control b) found more ulceration in yoked controls c) added two kinds of signal to 'tell the animal' it was performing the correct response at the correct time. d) demonstrated a refinement of the notion of control e) raised the potential stress reducing effect of predictable events. d) showed importance of constitutional differences between animals. The animals that provided more 'coping attempts' showed more ulceration. e) reinforced the importance of random assignment of subjects in yoked design f) added adrenal hormone levels as dependent measure
- Falls in the elderly
- Leading cause of accidental death, 200,000 Hip fractures per year in the USA, 84% of these in 65+ years, Cost is $2 billion per annum
- Biopsychosocial model
- Includes biological, psychological and social perspectives of health and illness
- Alarm stage
- Initial mobilisation of the body to fend off the threat/stressor
- Response mode
- Stress is what happens within the individual rather than 'to' the individual. The demand is referred to as the stressor
- Market research approach
- what do people want?If they are considering exercise, what dimensions of change would be important for the individual?
- McCready and Long (1985)
- confirmed negative effects of attitude to exercise on adherence to a programme. They found no relationship between adherence and inner locus of control. Other variables such as age, employment status, enrolling with or without a friend (aspect of social support), family support, previous experience of individual exercise behaviour, were all unrelated to adherence.
- Psychophysiological conditions
- New name for 'psychosomatic' conditions.
- Osteoporosis
- Disease of bone that leads to an increased risk of fracture. Bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Annual cost of hip fractures in the UK is 500 million. 60,000 hip fractures PA. Estimate of lifetime risk of fractures in a 50year old postmenopausal women: Hip fracture:16%; Vertebral fracture:32%. Risk reduction from oestrogen treatment is 50-70%. Duration of treatment required is approx. 5 years
- Alameda County study
- Sleeping 7 - 8 hours each night, not smoking, eating breakfast each day, no more than 1 or 2 drinks each day, regular exercise, not eating between meals, no more than 10% overweight are all health promotive behaviours.
- Rockeach (1973)
- described relative values. mphasises perception ‑ the subjective nature of the process ‑ and the fact that it is a goal directed action. The choice is rational. It is decision making about relative costs of behavioural choice ‑ a balance sheet
- Eustress
- caused by 'good' stressors, e,g, winning, getting a promotion, marriage etc.
- 'toughening up'
- occurs when a high number of unpredictable shocks are given, there are less effects, as opposed to learned helplessness.
- Prostate Cancer
- Rate in men over 70 years is high. Treatment within and across countries varies markedly with relatively little difference in outcome Biological approach emphasises pathology. Treatment - removal by surgery or irradiation Alternative emphasising quality of life is 'watchful waiting'. Side effects of treatment are impotence and incontinence. Metastases rate is low (5%) with median development rate of 14 years.
- Two physical models of stress
- SAM (Sympathetic Adrenal Medullary) system and HPAC (Hypothalamic-Pituitary Adrenocortical) system
- Mortality rate
- number of deaths per year due to illness
- QALY (Quality Adjusted Life Year)
- A measure of disease burden, including both the quality and the quantity of life lived. It is used as a means of assessing the value for money of a medical intervention. Requires utility independent, risk neutral, and constant proportional tradeoff behaviour. It is based on the number of years of life that would be added by the intervention. Each year in perfect health is assigned the value of 1.0 down to a value of 0.0 for death.
- Type A personality
- Person displays: Sustained aggressiveness, is ambitious, has chronic sense of time urgency, is behaviourally alert, and competitive
- Endler (1991)
- elaborates three dimensions of coping with stress: Emotion Focused coping, Task oriented coping , Avoidance
- Triandis model (1977)
- incorporates intention as a separate variable and construes behaviour to be determined by: (i) intention (ii) the habit for the behaviour (iii) the facilitating of harmful conditions. BEHAVIOUR = (INTENTION X FACILITATING CONDITIONS) + (HABIT X FACILITATING CONDITIONS) or B = (I x F) + (H x F). Intention has four components: cognitive, affective, social and personal. The affective variable represents the felt well‑being or pleasure derived from the activity. The final two variables represent the perception of the normative and role beliefs the individual has concerning the appropriateness of the behaviour for the individuals reference group and for himself/herself. This model additionally places emphasis on the individual's belief that it is their own responsibility to exercise (PNB). INTENTION = (COGNITIVE) + (AFFECTIVE) + (SOCIAL) + (PERSONAL NORMATIVE BELIEF) or I = (C) + (A) + (S) + (PNB)
- Stimulus model
- Refers to situational stress, Doesn't take individual differences into account.
- SAM system consists of
- Activation of the sympathetic nervous system, which leads to the adrenal medulla to secrete adrenaline and noradrenaline. Increases in cardiovascular activity, respiration, perspiration, metabolism occur.
- Oldridge
- did a review and found only 30% of volunteers to exercise programmes were still active after a mean period of 3.5 years and 35% after only 2 years.
- Brady (1958)
- conducted the Executive Monkey Ulcer Study - Critical components: a) use of yoked control b) non‑signalled Sidman avoidance schedule c) more ulcers in executive animal than yoked control
- Myocardial Infarction
- Heart attack
- Some personality features which affect coping with stress:
- Self-esteem, internal locus of control, strength of coping strategies, hardiness.
- Dishman (1988)
- found attitudes to exercise and beliefs of the value of exercise at entry were not predictive of adherence. In one study, it was found that overweight and the degree of self‑motivation did provide a high prediction as to levels of adherence.
- Type B personality
- Person is: calm, relaxed, easy-going.
- two components of self-efficacy
- 1) outcome expectancy - belief that behaviour will provide outcomes 2) efficacy expectation - that one can execute required behaviour for reinforcement outcomes.
- Western Collaborative Group Study
- Prospective study over 8.5 years, examined 3,154 males, 257 developed CHD, 67% had Type A profile.
- Hypertension
- High blood pressure
- Scale used to measure of FOF (fear of falling)
- FES (falls efficiency scale). FOF occurs in 50& of elderly (eve those who have never fallen). FOF reduces activity, leading to muscle weakness and lower bone density -leading to a downward spiral.
- Roth and Cohen (1986)
- suggested different conceptual types based upon whether coping strategies are: Behavioral vs. Cognitive; Emotion focused vs. Task focused; Approach vs. avoidance.
- Bourne (1971)
- looked at troops in Vietnam. Three groups: helicopter ambulancemen, enlisted men, Officers. The latter two groups formed a platoon cut off in enemy territory. All men clearly in dangerous positions however stress hormone levels were higher only in the Officers. Argued that this was because of the stress related to their need to make decisions. There was also evidence for defence mechanisms and of protective effects of religious conviction in enlisted men.
- The HPAC system.
- the adrenal cortex secretes two groups of hormones: glucocorticoids and mineralocorticoids. Focus here on former (such as cortisol, hydrocortisone, 17-OHCS) which are anti‑inflammatory and regulate the release and metabolism of glucose from glycogen, and fat stores with the mobilisation of fatty acids. They also change the receptivity of smooth muscles in arteries to catecholamines and may compromise the immune systems of the body. Glucocorticoids (or glucocoids) are released under the influence of adrenocorticotrphic hormone (ACTH) from the anterior pituitary. The relationship is one of negative feedback control. ACTH is itself activated by corticotrophin releasing factor (CRF) from the hypothalamus.
- Criticisms of the Alameda County study
- Didn't test health before the study, the measures are culturally and temporally relative.
- Behavioural medicine's sources of knowledge
- Direct observational methods and physiological recordings
- CHD
- Coronary Heart Disease
- The transtheoretical model of stages of change (Prochaska & DiClemente, 1984)
- consists of five stages: 1)Precontemplation 2) Contemplation 3)Preparation 4)Action 5)Maintenance.Stages 1-3 concern the readiness to adopt a particular health promotive behaviour, while stages 4-5 relates more directly to the issue of adherence.
- Some coping strategies include:
- Environmental planning, relabbelling, and self-talk
- Prevalence
- the total number of cases in a population
- Miller and Mangan (1983)
- compared surgical patients under two conditions: a high level of pre-surgical information or a low level of information. Ss whose 'treatment' condition was consistent with their preferred coping strategy or style had less distress than those for whom there was a discrepancy between the two.
- Three phases of exercise adherence
- 1) initiation of the exercise 2) Adherence to the formal exercise program, and the drop-out issue 3) continuation of exercise after completion of a supervised programme.
- Health psychology
- The aggregate of the specific educational, scientific and professional contribution of the promotion and maintenance of health, the prevention and treatment of illness and the identification of aetiological and diagnostic correlates of health, illness and related dysfunction...
- Lazarus described stress as
- ..a failure to cope
- Percentage of people who die from heart problems
- 25%
- an informal model of cognitive stages for health promotion states:
- people: 1) accept there is a contribution from the 'risk' 2) Accept this risk does apply to the individual 3) accept a particular action may combat the risk 4) accept that this action would reduce the risk for 'self' 5) contract to initiate appropriate action 6) have a belief at the outset that they will maintain the behaviour.
- Purpose of behavioural medicine
- To design and evaluate treatment and rehabilitation programmes
- The Theory of Reasoned Action states:
- The behavioural intention is determine by: (i) attitude toward the behaviour and (ii) the perception of whether it is thought that significant others think the behaviour should, or should not, be performed. Or B I = AT + SN
- Repression vs Sensitisation
- former avoids stressor, whilst latter ruminates over stimulus or situation
- The health belief model (Becker, 1974) states:
- adherence depends on 1)perception of severity, 2) perception of vulnerability, 3) perceived effectiveness of action.
- Purpose of health psychology
- To predict and/or explain individual or group states of illness or health habits, to sharpen diagnostic methods and to design interventions.
- INTERHEART (Yusif) study
- A case-control Study, 11,119 Cases, 13,648 Controls in 52 Countries. Stress found to be significantly higher in coronary patients.
- Behavioural medicine
- The interdisciplinary field concerned with the development and integration of behavioural and biomedical science knowledge techniques relevant to health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation...
- RDA of calcium
- 800-1000mg per day
- Miller's three types of avoidance
- Distraction; Defence systems; Reinterpretation