Health Psych Exam 2

What aspects of stress are impacted by culture?

• Stress exposure (Ex. poverty/discrimination)

• Reactivity to stressors (what bothers you)

• Access to health care

• Risk and Symptom profiles

General Idea: There are going to be specific stressors that affect you depending on how you identify

Micro Aggressions

• ____________ mediate the link between racial microaggressions and poor mental health 

• People who engage in a ___________ tend to engage in more rumination

Micro Aggressions

• Ruminations mediate the link between racial microaggressions and poor mental health 

• People who engage in a hierarchy (wanting to be the best of the best) tend to engage in more rumination

Working mothers have higher levels of ________, ________, and ________ as compared to mothers who don’t have to deal with both children & work 

Cortisol, cardiovascular reactivity, and home strain

Working Mothers

• Negative effects of multiple roles:

• Positive effects of multiple roles:

• Protective factors against stress:

Working Mothers

• Negative outcomes: higher cortisol, higher cardiovascular reactivity, more home strain

• Positive outcomes: self-efficacy, life satisfaction, resistance to colds

• Protective factors: control/flexibility at work, good income, supportive/helpful partner

________ teens spend 2x as much time providing family assistance

Latino teens spend 2x as much time providing family assistance

Fulgini et al. 2009 Study

• Generally, greater family assistance → higher levels of ______(neg. effect)______

• However, ________(pos. effect)__________ moderates the relationship

Fulgini et al. 2009 Study

• Generally, greater family assistance → higher levels of inflammation (sIL-6r, C-reactive protein)

• However, role fulfillment (whether you like being in the assistance role) moderates the relationship

Which of these affect the relationship between greater family assistance and higher levels of inflammation?

Which of these do not affect the relationship between greater family assistance and higher levels of inflammation?

• Ethnicity

• Parental education

• BMI

• Role fulfillment

• Substance use

• Daily distress

AFFECTS: Role fulfillment

DOESN’T AFFECT: Ethnicity, Parental education, BMI, Substance use, & Daily distress

Which study is associated with Social Stress Theory?

Meyer et al. 2008:

Stress Findings for Meyer et al. 2008:

• Woman: ___________________

• LGB status: ___________________

• Racial/ethnic minority + LGB: ___________________

Stress Findings for Meyer et al. 2008:

• Woman: greater expected stigma

• LGB status: more general and prejudice-related stressors

• Racial/ethnic minority + LGB: more general and prejudice-related stressors, greater chronic strain (Ex. Unemployment, housing issues)

Coping Findings for Meyer et al. 2008:

• Racial/ethnic minority + LGB: ____________________________

• Non-minority women and non-minority LGB: ______________________

Coping Findings for Meyer et al. 2008:

• Racial/ethnic minority + LGB: smaller social network, lower sense of mastery

• Non-minority women and non-minority LGB: No coping deficits

What is the intersectional approach when considering risk?

Understanding and addressing how sexism, racism, ageism, etc. connect and overlap, rather than trying to handle one as a standalone problem

• In Meyer et al. 2008 intersection of identities predicted increased risk for stress 

Implications of Meyer et al. 2008:

• Interpersonal versus non-interpersonal stress: Majority of our stress comes from ______________

• Acute versus chronic stress: There will always be ________________, but the problem comes from __________________

• Prejudice versus non-prejudice related

Implications of Meyer et al. 2008:

• Interpersonal versus non-interpersonal stress: Majority of our stress comes from other people 

• Acute versus chronic stress: There will always be one-off stress experiences that everyone can have, but the problem comes from certain cultural groups being exposed to chronic stress 

• Prejudice versus non-prejudice related

In terms of psychological adjustment, what are the key elements that lead to coping success/adaptation to chronic disease? (5 things)

• Successful performance of adaptive tasks

• Absence of psychological disorders

• Presence of low negative affect and high positive affect

• Adequate functional work status

• Satisfaction and well-being in various life domains 

What are the three models concerning psychological adjustment to chronic disease

• Model of Cognitive Adaptation

• Stress & Coping Model

• Personality Model

Model of Cognitive Adaptation

• Emphasizes illness acceptance and perceptions of control over illness

• If you’re not in denial, and feel that you can manage your illness, you’re more likely to adjust better and follow your treatment plan 

Stress & Coping Model

• Emphasizes strategies used by patients to deal with adaptive tasks imposed by disease

• Good vs bad coping strategies 

Personality Model

• Emphasizes the role of personality factors in adjustment

  • Ex. Higher neuroticism = more risk. Higher optimism = less risk.

Components of Adjustment to Chronic Disease

• Physiological: ___________________

• Behavioral: ___________________

• Emotional: ___________________

• Cognitive aspects: ___________________

• Physiological: Role of cytokines

• Behavioral: Self-management/treatment adherence

• Emotional: Coping & emotion regulation

• Cognitive aspects: Benefit finding & optimism

Physiological Process

1. Disease can induce constellation of non-specific symptoms that may or may not be directly caused by disease symptoms (sickness behaviors) such as: ____________________________________

2. The psychological effects of these pathophysiological processes are mediated by ____________

1. Weakness, Malaise (discomfort), Inability to concentrate, Depressed mood, Lethargy, Anhedonia (inability to feel pleasure), Anorexia

2. Psychological effects of these pathophysiological processes are mediated by cytokines

Physiological Process

What role do pro-inflammatory cytokines play in

1. heart attacks

2. diabetes

3. cancer

1. In heart attacks, these cytokines can contribute to vital exhaustion (loss of energy, increased irritability, and feelings of demoralization)

2. In diabetes, these cytokines can contribute to depression and so-called sickness behaviors

3. In cancer, these cytokines contribute to fatigue, memory and concentration problems, depression, and anxiety

__________ activation is key in psycho-education. When instructing patients, pace out goals. Assign daily activities that are ______________ at the beginning.

Behavioral activation is key in psycho-education. When instructing patients, pace out goals. Assign daily activities that are easy and manageable at the beginning.

Behavioral Process

1. What is the relationship between wellbeing and adherence to self-management?

2. What are the psychological risk factors for nonadherence to medication or lifestyle changes?

1. Bidirectional association between wellbeing and adherence to self-management (good moods → better adherence → improved wellbeing → good moods)

2. Depression, fear of other negative effects of the disease, guilt or anxiety when problems in self-management occur

Behavioral Process: What does self-management of disease encompass?

• Characterized by many responsibilities regarding medication use, lifestyle changes, and behavior to prevent long-term complications

• Others can help, but part of it relies on your agency 

Behavioral Process

• Low adherence (lifestyle changes or taking medication) is a major problem in the US

  • Common reasons behind not taking meds:

Costs, uncomfortable side effects, forgetting, misunderstanding instructions, denial, distrust in the medicine, physical issues (ex. Arthritis making it hard to open bottles) 

Behavioral Process: Important considerations when creating self-management plans for patients

• Important to make sure patients see value in the adherence

• It’s the simplest regime possible and fits into their lifestyle

• Patient can see proof of function (ex. at home blood pressure monitors)

• Trust between patient & doctor 

Emotional Process

• Emotional avoidance → __________________

• Emotional expression → __________________

Emotion Regulation

• Emotional avoidance → maladaptive outcomes

• Emotional expression → better adjustment

Findings on emotional regulation are culturally specific

• In Western Society: Avoidant styles → ________ outcomes

• In Eastern Society: Avoidant styles → ________ outcomes

  • ______________________________________

Findings on emotional regulation are culturally specific

• In Western Society: Avoidant styles → Bad outcomes

• In Eastern Society: Avoidant styles → Good outcomes

  • Due to social norms (showing weakness leads to lack of support)

Benefits of Emotional Expression

• Focuses attention on threats, elicits _______

• Provides feedback on progress toward _______

  • Ex. Body language letting us know how a conversation is going 

• Habituation to difficult situations

• Insight into modulating _______

• Enhances _______ with others

• Allows benefit finding

Benefits of Emotional Expression

• Focuses attention on threats, elicits action

• Provides feedback on progress toward goals

  • Ex. Body language letting us know how a conversation is going 

• Habituation to difficult situations

• Insight into modulating emotions

• Enhances closeness with others

• Allows benefit finding

Emotional Process

1. Processing and expression vs rumination: ________________________

2. Ways to regulate emotion are often _________ to our initial emotional urge. When you’re sad your brain’s instinct is to self isolate, but instead to modulate your emotions you should: ______________

1. Processing and expression are active engagement with an issue, rumination is passive

2. Ways to regulate emotion are often opposite to our initial emotional urge. When you’re sad your brain’s instinct is to self isolate, but instead to modulate your emotions you should: Be around others/get active

Emotional Process: Active coping

• Problem-focused coping (when controllable)

  • Ex. good for dieting, studying harder, etc.

• Emotion focused

  • Helpful when things aren’t controllable 

• Positive re-framing

• Acceptance (when uncontrollable)

Emotional Process: Avoidant coping

• Denial

• Disengagement

  • Distancing/isolating yourself

• Substance use

Emotional Process

1. Situations for problem-focused vs emotion-focused coping:

2. What type of coper adjusts especially well?

1. Both can be effective in different situations

   • Problem focused is the best if the situation is actually solvable 

   • Chronic health problems typically require more emotion-focused coping

2. Flexible copers appear to adjust especially well

   • Do you have one coping strategy for everything (even if it’s a good strategy) or a toolbox? 

Personality Process

• Benefit Finding

• Across illnesses, small to moderate degree of perceived positive change

  • Appreciation of life

  • Sense of purpose

  • Changes in life priorities

  • Closer relationships

Personality Process

Someone who’s optimistic views bad events as:

1. ___________________

2. ___________________

3. ___________________

1. Time limited (vs. permanent)

2. Narrow in their effects (vs. pervasive)

   • “This effects my whole life” vs “I can't go to the store today”

3. External to the self (vs. personal)

   • “This is my fault” vs “I’m having a flare up” 

Personality Process

Optimism predicts less distress and better quality of life in response to many health stressors, for example:

• Unsuccessful in vitro fertilization

• Pregnancy and childbirth

• Coronary artery bypass surgery

• Cancer diagnosis

• Taking care of someone with a difficult illness

Personality Process

Does optimism or pessimism lead to:

1. Problem-focused coping (when controllable)

2. Denial/Disengagement

3. Substance use

4. Positive re-framing

5. Acceptance (when uncontrollable)

6. Avoidant coping

7. Active coping

1. Optimism: Problem-focused coping (when controllable)

2. Pessimism: Denial/Disengagement

3. Pessimism: Substance use

4. Optimism: Positive re-framing

5. Optimism: Acceptance (when uncontrollable)

6. Pessimism: Avoidant coping

7. Optimism: Active coping

What did Ali et al. 2018 measure?

• Network Diversity

  • Range of social ties with whom participants had contact across the four different types of role relationships

  • (children, other relatives, friends, and neighbors)

• Found: Social network diversity associated with reduced decline in cognitive and physical functioning and reduced risk for mortality

What did Ali et al. 2018 find in terms of Social Network Size & Social Network Diversity?

Social Network Size

• Associated with lower mortality risk

• Associated with higher cognitive & physical functioning at baseline but not change over time

Social Network Diversity

• Associated with lower mortality risk (16% lower for a one unit increase in network diversity)

  • One unit = one of the four groups 

• Associated with reduced decline over time in cognitive and physical function

  • Independent of network size

Receiving Social Support reduces which physiological responses?

• Reduced cardiovascular risk and neuroendocrine response

• Reduced distress-related neural activity

• Reduced pain-related neural activity

Culture and Social Support

• Compared to European Americans, Asian American individuals are:

  • Less willing to seek (explicit/implicit) social support

  • Less benefitted by (explicit/implicit) social support

  • (Explicit/Implicit) support is adaptive (less impact on their social standing)

• Compared to European Americans, Asian American individuals are:

  • Less willing to seek explicit social support

  • Less benefitted by explicit social support

  • Implicit support is adaptive (less impact on their social standing)

Culture and Social Support

• Implicit Support:

• Explicit Support:

• If you’re looking for implicit support and get explicit you may feel ___________, while seeking explicit and receiving implicit may not be _____________.

• Implicit: Perceived support

  • Emotional comfort one can draw from reminding oneself of close others, being in the company of close others

• Explicit: Reaching out and getting direct help from others 

• If you’re looking for implicit support and get explicit you may feel shame, while seeking explicit and receiving implicit may not be enough support.

Culture and Social Support

Giving Support

• Examples: ___________________________

• You can either provide instrumental or emotional support

  • Instrumental: _________________

  • Emotional: _________________

• Giving support leads to greater __________ and decreased rates of ________________________________

Giving Support

• Examples: Altruism, volunteering

• You can either provide instrumental or emotional support

  • Instrumental: Advice/helping fix things

  • Emotional: Can’t fix things but can be a shoulder 

• Giving support leads to greater positive affect and decreased rates of mortality, distress, and pain related neural activity

Culture and Social Support

Why does giving support benefit us?

• Distraction (not worrying about our own problems) 

• Puts things into perspective 

• Increased sense of meaning, purpose, and connection with others 

• Increased self-efficacy (if I can help others then I can help myself)

Social Support Interventions

Individual Therapy vs Group Therapy

Individual Therapy

• Space for processing emotions

• Treatment of relationship difficulties

• Social isolation, Grief, Conflict, Role changes

Group Treatment Approach

• Emotional expression about health problems

• Interaction with other patients within and outside of group

• Validation, Advice, Instrumental support (Practical advice), Emotional support 

Social Support Interventions

Strengths Spotting Exercise

• This strengths spotting group activity aims to help participants identify and recognize psychological or character strengths in both themselves and others

•  One powerful benefit of conducting this typically individual exercise in a group context is that it enables each participant to get feedback on their own strengths from those around them

Social Support Interventions

Positive Effects of Peer Support Interventions

Improved knowledge, empowerment, meaning finding, changed knowledge/behavior

Social Support Interventions

Alcoholics Anonymous (aka __________)

• “The only requirement for membership is _____________________.”

• Principles: _________________________

• What makes AA so accessible: ________________________________

• Unique Feature of Social Support Interventions: __________

Alcoholics Anonymous (aka 12 step)

• “The only requirement for membership is an honest desire to stop drinking.”

• Principles: Addiction as a disease (an “allergy”), abstinence, acceptance, powerlessness/loss of control, higher power

• What makes AA so accessible: Global presence, only need three people, no medical training needed, meetings every day of the week, free & open

• Unique Feature of Social Support Interventions: Peer support

Social Support Interventions

What are the three categories of AA steps?

• “Surrender” Steps (1-3): Accepting reality and letting go of control by admitting willpower isn't enough and accepting external help/a higher power

• “Action” Steps (4-9): Self-examination, confession, and making direct amends to address relationships

• “Maintenance” Steps (10-12): Continual self-awareness, spiritual practice, and helping others

Social Support Interventions

What effects of going through 12 step does research explain?

What effects of going through 12 step does research NOT explain?

Explainable: Social support, self-efficacy

Not Explainable: Lower anger, depressive symptoms, selfishness, & narcissism

• No proof AA decreases these things, but their decrease does lead to less drinking

Social Support Interventions

Potential theories for why AA increases abstinence

(What are the two things that could fill in the blank?)

1. Social support

2. Self-Efficacy

(PDA = Abstinence)

Cognitive Behavioral Interventions

• Cognitive Behavioral Therapy Principles:

• Thoughts cause emotions and behavior

• Benefit of remaining neutral when faced with difficult situations

• Challenging negative patterns of thought about the self and the world (most emotional and behavioral reactions are learned)

Cognitive Behavioral Interventions

• Goals of CBI:

• Modify attitudes (Cognitive re-structuring)

• Enhance coping skills

• Improve self-efficacy

• Improve social support

Cognitive Behavioral Interventions

• Self Monitoring:

Note the situation, your automatic thoughts, and the emotions that stemmed from them.

Cognitive Behavioral Interventions

• Questions involved in cognitive restructuring

THe FAD

• If the thought were true, what would it mean? What’s the worst that could happen?

• How helpful is this thought to me?

• What facts do I have? Do they support or contradict this thought?

• Are there alternative explanations for the event, or alternative ways of viewing the event?

• Does this thought contain any common cognitive distortions?

Cognitive Behavioral Interventions

• Four facets of enhancing coping skills:

RICE

1. Relaxation skills

   • Deep breathing, Progressive muscle relaxation, Mindfulness

2. Interpersonal skills

   • Assertiveness training, Building social networks, Conflict resolution

3. Chronic illness skills 

   • Medication adherence, Healthy behaviors, Barriers to effective communication with doctors, Consultation with healthcare providers

4. Emotion regulation skills 

   • Exposure, decreasing avoidance, Behavioral activation, Self soothe, and distraction

Cognitive Behavioral Interventions

How does behavioral activation in CBI impact depression?

Stops the loop between negative behaviors (sleeping late, not calling friends, not exercising, etc.) and worsening outcomes (worse health, less social interaction, etc) 

Cognitive Behavioral Interventions

• What are the roles of the client and therapist?

• Client role: define goals, express concerns, note barriers, and learn & implement new ways of thinking/new skills 

• Therapist role: help client define goals, listen, teach, encourage

Cognitive Behavioral Interventions

• Unique components:

Collaborative empiricism, goal focused, structured, practice exercises, homework

Cognitive Behavioral Interventions

• CBT Model of Substance Use and Addictive Behaviors:

1. Triggers elicit negative response

2. You believe that substance use will alleviate it

3. Experience urges/cravings

4. You have an opportunity to abstain

5. But give yourself permission to engage

6. Lapse/relapse 

Cognitive Behavioral Interventions

• Abstinence Violation Effect:

• Cognitive distortion: All-or-nothing/black-&-white thinking

  • “If I relapse once I’m a failure”

  • “I’m not strong enough to do this” 

• Characterized by:

  • Personal attribution, guilt

  • Loss of sense of control & accomplishment

Mindfulness Interventions

• Mindfulness was popularized in the East by ______________________

  • Mindfulness (Sati) is considered to be the first step towards ________

• In the West its popularity can be traced to ________________________

• Mindfulness was popularized in the East by religious and spiritual institutions (Hinduism and Buddhism)

  • Mindfulness (Sati) is considered to be the first step towards enlightenment

• In the West its popularity can be traced to particular people and secular institutions

  • John Kabat-Zinn (creator of Mindfulness Based Stress Reduction)

  • Mind and Life Institute

Mindfulness Interventions

• Mindfulness Definition:

• Trait or State Theories:

• Definition: Mindfulness is an umbrella term used to characterize a large number of practices, processes, and characteristics, largely defined in relation to the capacities of attention, awareness, memory/retention, and acceptance/discernment

• Trait/Disposition: Mindfulness is an inherent capacity present at varying levels regardless of one’s meditation experience

• State of Being: Mindfulness is developed only through intensive meditation practice

Mindfulness Interventions

• Trait Mindfulness Definition:

• Five Facet Mindfulness:

• Trait Mindfulness Definition: Awareness that comes from paying attention to present moment experience in a purposeful and non-judgmental manner (Bishop et al., 2004; Kabat-Zinn, 1994)

• Five Facet Mindfulness: DO JAR

  • Describing: Refers to labeling internal experiences with words

  • Observing: Noticing or attending to internal and external experiences, such as sensations, cognitions, emotions, etc.

  • Non-judging of inner experience: Non-evaluative stance toward thoughts/feelings

  • Acting with Awareness: Living in the moment instead of autopilot

  • Non-reactivity of inner experiences: Allowing thoughts and feelings to come and go, without getting caught up in them

Mindfulness Interventions

Monitor and Acceptance Theory:

• Monitoring: Paying close attention to the present moment improves cognitive functioning outcomes, but only noticing your feelings can increase reactivity

  • Affective reactivity: “I notice that I'm sad…now I'm sad.” 

• Acceptance: You can’t only be aware of your feelings, you also have to view them non-judgmentally (acceptance) and do something to manage them if you want mindfulness to improve your health 

Mindfulness Interventions

True or false: We can engage in mindful practices, but all of us are mindful at different levels inherently 

True

Mindfulness Interventions

• Variable vs Person Centered Approaches

• Variable Centered Approaches

  • Goal is to identify significant predictors of outcomes and describe how dependent and independent variables are related

• Person Centered Approaches

  • Goal is to identify/classify individuals into distinct classes/profiles based on individual response patterns

Mindfulness Interventions

• 4 Profiles of Mindfulness (person-centered)

•  High mindfulness group (most adaptive profile)

•  Low mindfulness group (maladaptive profile)

  • Largest subgroup, suggesting the promise of mindfulness based interventions

•  Judgmentally observing (most maladaptive profile)

•  Non-judgmentally aware (adaptive profile)

Mindfulness Interventions

• Mindfulness Based Relapse Prevention is designed to target 3 specific processes:

• Awareness of the present moment

• Ability to tolerate aversive experiences

• Kindness and compassion towards oneself

Mindfulness Interventions

• Role of the therapist in MBRP:

• Modeling aspects of mindfulness to participants

  • Awareness of the moment

  • Ability to tolerate aversive experiences

• Kindness and compassion

  • Particularly showing kindness and compassion to oneself

• Elicit and reinforce noticing present moment experiences non-judgmentally

  • Curiosity & non-judgment

Mindfulness Interventions

• Urge Surfing:

Mindfulness Interventions

• S.O.B.E.R Breathing Space:

• Stop: When you are in a stressful or risky situation, or even just random times throughout the day, remember to stop and do this exercise

  • This is the first step in stepping out of automatic pilot

• Observe: Observe the sensations that are happening in your body. Also observe any emotions, moods or thoughts you are having

  • Notice your experience. Why am I feeling this way? 

• Breathe: Allow your attention to settle on your breath

• Expand: Expand your awareness to include the rest of your body, to your experience, and to the situation, seeing if you can gently hold it all in awareness

• Respond: Respond (versus react) mindfully, with awareness of what is truly needed in the situation and how you can best take care of yourself