BTEC Applied Psychology - Unit 3 Health Psychology

Health and Ill Health general definition

complete physical, mental and social well-being, not just the absence of disease

Health and Ill Health BIOMEDICAL definition

physical/biological factors, illness is a physical disease and health is the absence of disease

Health and Ill Health BIOPSYCHOSOCIAL definition

interaction of biological, psychological and social factors to enhance health and prevent disease

Health as a Continuum

health/ill health are two extremes with many in-between states

Stress

emotional response to situations of threat

Physical stressors

temperature, noise

Psychological stressors

life events, daily hassles

Physiological Stress Response

bodily symptoms; increased heart rate, sick, sweating

Psychological Stress Response

the emotion you feel when a stressor occurs

Perceived Ability to Cope

people react different to the same stressors due to perception of our internal and external coping resources

Addiction

complex mental health disorder, pleasurable despite harmful consequences

Physiological addiction

physical effects; withdrawal and tolerance

Griffiths 6 Components of Addiction

1. Salience (physical and psychological dependence)
2. Tolerence
3. Withdrawal
4. Relapse
5. Conflict
6. Mood alteration

HBM

explains why people engage/don't in healthy behaviour
1. perceived seriousness
2. perceived susceptibility
3. cost-benefit analysis
4. modifying factors (demographics variables, self efficacy etc)

HBM Evaluation

+ practical application, bowel/colon cancer
+ strong credibility, works irl
- not a single model
- assumes we are rational

HBM studies

Becker and Carpenter

LOC

internal: events under own control, take blame
external: outside own control, blame others

LOC evaluation

+Research, externals vulnerable to risks factors (AVTGIS)
+Practical Application, internal protects against stress (GALE)
-Limited role in health related behaviours, only current relevance
-Complex, internals can be stressed by unavoidable events (KRAUSE)

LOC 3 studies

Rotter (review into internal/external)
Abouserie (gender differences, Loc and self esteem link in students)
Krause (older adults w extreme internal/external=more stressful life events)

TPB

explain how people control voluntary behaviour
1. personal attitude (favourable/not for own behaviour)
2. subjective norms (being approved/disproved)
3. PBC (how much we believe we can control it)

TPB Evaluation

+Research, attitudes, norms and PBC influenced intentions thus alcohol consumption (HAGGER)
-Not full explanation, gambling behaviour of teens can't be explained by any (MILLER N HOWELL)
-ST vs LT, intention can't predict LT so not applicable to real life (McEACHAN)

TPB studies

Louis (TPB to explain health decision making)
Cooke (review links between TPB, intentions to consume n actual consumption of alcohol)

Self-efficacy theory

belief in own ability to succeed
1. mastery experiences (experience of successful tasks)
2. vicarious reinforcement (observe successful task)
3. social persuasion (encouragement)
4. emotional state (stress n anxiety levels)

Self-efficacy evaluation

+research, studies found its linked to several health related behaviours
+practical application, break target behaviour into achievable tasks, easiest first t
-measurement issues, unclear, confused with confidence/self esteem
- backfire effects, higher reduces next task performance

Self-efficacy studies

Bandura (snake phobia)
Marlatt

Life Events

relatively infrequent major changes

Measuring Life events

SRRS (social readjustment rating scale) 43 events with life change units, add them up over a set period
under 150 = 30% chance of stress related illness, 150-190 = 50% chance, 300+ = 80% chance (RAHE)

Life events evaluation

+research, predicted asthma within 2 years follow-up period (LIETZEN)
-theres positive and negative life events, better to look at specific events not the score

Life Events Study

Rahe
AIM - do srrs scores predict illness
METHOD - 2664 Navy personnel completed SRE (like srrs) identified all events in past 6m months, total score and reported illnesses
FINDINGS - small but significant positive correlation, sailors w most stressful life events reported most illnesses
CONCLUSION - life events are reasonable predictor of later illnesses

+large sample
-self report

Daily Hassles

minor irritations and annoyances that are part of our everyday lives

Measuring Daily Hassles

hassles scale, 117 items from 7 categories, rate their severity
uplifts scale, measure events that counteract stress (KANNER)

Daily hassles evaluation

+research, they're a better predictor of job-related illness (IVANCEVICH)
- retrospective research, have to recall hassles for may under/over estimate their effect

daily hassles and life events study

Kanner
AIM - compare daily hassles and life events as predictors of illness
METHOD - 100 participants completed hassles and uplifts scale every month for 9, and measures of life events and anxiety/depression
FINDINGS - positive correlations between no. hassles and anxiety/depression at start and end, greater than for life events
CONCLUSION - hassles more reliable as predictor of illness

-self report
-response bias

The workplace stress

inter-role= competing demands between different roles
intra-role = competition demands within the same role
temperature and noise = effect stress levels
level of control = lack of it reduces choice

the work place stress evaluation

+research, civil servants workload not a stressor but low control caused heart disease later on (BOSMA)
- cultural differences (lack fo control stressful for individualistic cultures (GYORKOS)

workplace stress study

Johansson
AIM - compare stress of 2 groups of sawmill workers
METHOD - measured illnesss, absenteeism, stress hormones, alertness and mood in high/low risk workers
FINDINGS - higher hormones, absenteeism and illness in high risk, increased during day
CONCLUSION - job demands and lack of control create stress

+practical application, giving control can reduce stress
-not causal effect, already knew jobs

Personality 2 types

HARDY: commitment, challenge, control
TYPE A: competitive, hostile, time urgent, risk of heart disease
TYPE B: laid back

Personality Evaluation

- challenge is less important studies found
+research support for type a, people who had a stroke are more likely to be type a

Physiological response to stress - GAS

alarm reaction: adrenaline and fight/flight triggered by hypothalamus
resistance:continuing stressor meaning lt responses use up bodies resources
exhaustion: resources depleted, immune system damaged

Physiological response to stress - SAM (acute stress)

fight or flight
triggers sympathetic ANS
adrenal medulla releases adrenaline
parasympathetic restores to normal

Physiological response to stress - HPA (chronic stress)

hypothalamus releases crf
pituitary glands detect it, release ACTH
stimulates adrenal cortex to release cortisol

Physiological response to stress evaluation

- gender differences, females tend/befriend
-more than 2 responses
-fight/flight is maladaptive, not useful now
-perception role, GAS based on animals, humans react different

stress and ill-health

immune system = defence against antigens
inane immunity=general, fast response, involves leucocytes and NK cells
acquired immunity=specific, lymphocytes

stress has direct effects (cortisol reduces lympho) indirect (lifestyle)

stress hormones cause atherosclerosis in blood vessels

stress and ill-health evaluation

+support for stress on immune system, women with high stress more likely to develop cervical cancer
-ST enhanced immune response, LT damaged heart

Physiological addictions

smoking, alcohol

Behavioural addictions

gambling, shopping

alcohol - cognitive

self medication model
INITIATION - early trauma experience, specific effects (alcohol=anxiety)
MAINTENANCE - stress relief, assumptions about managing the problem (low self esteem)
RELAPSE - counterproductive, increase stress, solving it causes relapse

alcohol - cognitive evaluation

+trauma and stress, strong link
+self medication and addiction, strong link
- role of specificity, many people use more than one drug
- cause and effect, mental disorders don't lead to addiction

alcohol - learning

operant conditioning
INITIATION - positive reinforcement (dopamine release, indirect from observing others) negative reinforcement (drinking to escape stress in films)
MAINTENANCE - positive reinforcement (ongoing rewards) negative reinforcement (reduces withdrawal symptoms)
RELAPSE - negative reinforcement (withdrawals strong enough for relapse)

alcohol - learning evaluation

+ research support
+ practical application, can't relieve alcohol cues by drinking
- mixed evidence for dopamine, humans drinking releases endorphins
- narrow explanation, many drink without dependance

smoking - biological

INITIATION - genetics, dopamine receptors
MAINTENANCE - dopamine, nicotine regulation
RELAPSE - withdrawals, tolerance

smoking - biological evaluation

+research for nicotine regulation, heavy smokers given cigs with less nicotine smoked more
- evidence against nicotine regulation, regular smokers smoke and don't become dependant

smoking - biological study

Vink
AIM - genetic risk factors in nicotine dependance and initiation
METHOD - smoking data from Netherlands on twin register on 5 occasions, mz and dz twins completed FTND test for nicotine dependance
FINDINGS - genes explain 44% risk initiation, 75% nicotine dependence
CONCLUSION - genes make large contribution to smoking initiation and nicotine dependence

+practical application, smoking initiation mostly environmental
-self report

smoking - learning

INITIATION - peer pressure, positive reinforcement (nicotine pleasure)
MAINTENANCE - negative reinforcement (withdrawals) classical conditioning (association with pleasure)
RELAPSE - conditioned cues, self efficacy (if believe they can quit)

smoking - learning evaluation

+ supports for conditioned cues, smokers react strongly to them
+practical application, aversion therapy, learn to associate with unpleasant stimulus
- limited explanation, many observe and don't imitate
- self efficacy role, other factors found more important from a review

gambling - cog

expectancy theory
INITIATION - cost benefit analysis
MAINTENANCE - irrational thoughts, cog biases, illusion of control
RELAPSE - recall bias, overestimation of success

gambling - cog evaluation

+ practical application, replace distortions with rational thinking to reduce gambling
- issues explaining maintenance and initiation, many people have distorted cognitions and don't gamble

gambling - cognitive study

Griffiths
AIM - compare regular and non regular gamblers thinking
METHOD - thinking aloud while playing fruit machine, content analysis placed into rational/not
FINDINGS - orgs 6x more irrational, prone to illusions of control and personification
CONCLUSION - cog factors may play major role

+ecological validity
-sampling issues, snowball sampling

gambling - learning

INITIATION - slt, cc (pleasure associated w gambling)
MAINTENANCE - positive reinforcement (buzz) negative reinforcement (temporary relief) partial reinforcement (fruit machines only pay on some bets) variable reinforcement (fruit machine pays on every 7th)
RELAPSE - cue reactivity (conditioned cues) cues are everywhere-bright lights etc

gambling - learning evaluation

+research, high freq gamblers place bets just before the race, they enjoy the delay
+role of partial reinforcement, made high freq gambler longer after rewards stopped
- individual differences, reasons for gambling
- lacks explanatory power, no single explanation

shopping - learning

INITIATION - role models, vicarious reinforcement, ads
MAINTENANCE - positive reinforcement (excited)adrenaline rush, negative reinforcement (blocks negative feelings)
RELAPSE - cues, withdrawals

shopping - learning evaluation

+role of shopping, celebs give more positive attitude
-gender differences, buy different products
- self report
- cog factors also involved, not enough explanation

shopping - cog

self-medication model
INITATION - boredom relief, relief from trauma
MAINTENANCE - reduces anxiety, boredom relief
RELAPSE - withdrawal, coping breakdown (helps & worsens)

shopping - cog evaluation

+support for early trauma, compulsive shoppers report dysfunctional families
+link to medical disorders, most have one
- non cog factors also important (inherit mental issue)
- cause and effect, shopping may cause mental disorder

Hovland-Yale persuasion theory

COMMUNICATOR (source) - personal experience, more persuasive when credible
COMMUNICATION (message) - emotional appeal
RECIPIENTS (audience) - intelligent with cog resources = less persuaded

Hovland-Yale persuasion theory evaluation

+research, most persuasive anti smoking message was high thrower and possible to quit
- role of self esteem, high are easier to persuade, opposes theory

Hovland-Yale persuasion theory study

Hovland and Weiss
AIM - does credibility affect opinion change over time
METHOD - students given high/low credibility articles on 4 topics, opinions measured before and after and 4 weeks later
FINDINGS - more opinions change with higher credibility, argument decreased overtime, low increase
CONCLUSION - credible sources more persuasive

+practical application, st campaigns need focus on credibility
-lack of generalisability, student sample

Fear arousal persuasion theory

Early theories of fear effects - Dolland and Miller argued fear creates unpleasant arousal by reducing behaviour change
Fear/behaviour relationship - Janis and Feshbach suggest its curvilinear (weak fear = no change, moderate = best, high = counterproductive)

fear arousal theory evaluation

+research, persuaded students to get vaccinated (dabs and Leventhal)
- mixed evidence, fear includes behaviour but not curvilinear link (janis n Feshbach)

fear arousal theory theorist

Janis and Feshbach
AIM - do fear arousing messages produce defensive reactions
METHOD - groups of students saw presentation on oral hygiene which was strongly/moderately/minimally fear arousing, changes in hygiene measured 1 week after
FINDINGS - 36% changed minimal, 22% moderate, 8% strong
CONCLUSION - no curvilinear support but challenges linear theory

+measured behaviour change, not just attitude/intention
-lack of replication, fear does change health related attitude, intention and behaviour

Elaboration Likelihood Model of Persuasion

process 1: central route - persuasive if relevant (high elaboration)
process 2: peripheral route - persuaded by non content factors (low elaboration)
influencing factors - celebs associates message w glamour (peripheral) or highlights content (central)
individual differences - people with high need for cognition enjoy evaluating central route arguments

Elaboration Likelihood Model of Persuasion evaluation

+practical application, ST change w celebs via 2 but combine with 1
- poor explanatory power, describes not explains, lacks psychological process

elaboration likelihood model study

Petty
AIM - does high involvement lead to central route vice versa
METHOD - students heard 1 new exam next year/10 years, 2 message from expert/no expert, 3 strong/weak arguments
FINDINGS - experts more influential when involvement low, strength more influential with high involvement
CONCLUSION - personal relevance changes attitudes

+influential study, sparked further research
-sample issues, students have greater need for condition so replication has been unsuccessful

physiological stress technique - drug therapy

benzodiazepines - anti anxiety, boost GABA calms CNS so reduces serotonin activity
beta blockers - counteracts CNS activity, reduces sympathetic arousal of f/f

physiological stress technique - drug therapy evaluation

+support for effectiveness, bz more effective than placebo
+convenient and safe
-doesnt treat underlying problem
- dependence, can't take for 4 weeks +

physio stress technique - biofeedback

tackles stress by reducing ANS activity
phase 1 - measures heart rate etc tells client
phase 2 - relaxation training, client learns to take control
phase 3 - transfer irl

physio stress technique - biofeedback evaluation

+support, doctors using it reduced stress score over 28 days
+LT benefits, given skills
- not suitable for all, commitment needed

psych stress technique - SIT

control how we think
phase 1 - identify stressor
phase 2 - learn skills
phase 3 - apply irl

psych stress technique - SIT evaluation

+evidence for effectiveness, Sheehey n Horan, used it and improved law students exam performance by 20%
+flexible, skills suitable for everyone
- demanding, needs commitment
- too complex, loads of skills not all effective

psych stress technique - social support

having support networks
instrumental - practical help
emotional
esteem support

psych stress technique - social support evaluation

+research, belief protected against common cold, hugs were 1/3 effective
+practical application, benefits depend on culture
- backfire effects, not always beneficial
-gender differences, women need more than men

physio addiction treatments - drug therapy

aversive = unpleasant consequence
antagonist = block drugs
agonists = minimise drug effect
nicotine - gum/patches, bupropion, reduces dopamine release so reduces cravings
gambling - opioid antagonists, blocks opioid system so no dopamine release

physio addiction treatments - drug therapy evaluation

+research, better lt
+further research support, low dose of opioid antagonist still reduced gambling behaviour
- individual differences, respond different
-side effects

psych addiction treatments - Cognitive Behaviour Therapy

functional analysis = identify high risk trigger situations
cognitive restructuring = challenge distorted thoughts
behaviour change = learn skills
relapse prevention = skills to avoid relapse

psych addiction treatments - Cognitive Behaviour Therapy evaluation

+research, small but significant benefit for substance addiction
- ST vs LT, no benefit after 12 months for gambling
- many flexible techniques, hard to evaluate

psych addiction treatments - skills training

assertiveness training = cope w conflict controlled
anger management = express emotions constructively
social skills training = improve communications for social situations
techniques = group discussion, role play, homework, visualising

psych addiction treatments - skills training evaluation

+research, just as good as Cognitive Behaviour Therapy to reduce gambling
+still effective after 1 year so LT
-lack of treatment adherence, demanding
- role of cog factors, only works for moderate addiction

rational non-adherence

making a logical decision to not follow medical advice
- cost benefit analysis

rational non-adherence evaluation

+supporting evidence, complex drug treatments and high costs lead to non adherence
-unjustified assumptions, health decisions aren't usually rational

Leys Cognitive Model

basics - adherence depends on understanding, memory and satisfaction
understanding - if don't then = dissatisfied
merry - can't follow advice if forget

Leys cognitive model evaluation

+practical application, use clear language, reduce anxiety, give important advice first
-correlational findings, lack of understanding and forgetting may not cause non adherence

reasons for non-adherence study

Bulpitt and Fletcher
AIM - review studies of adherence in hypertension patients
METHOD - over 40 studies analysed, compared treated and untreated patients
FINDINGS - side effects are major reason for non-adherence
CONCLUSION - didn't adhere if costs outweigh benefits

+practical application, develop drugs w less side effects
-validity issues, secondary research

physiological methods to improve adherence

biochemical tests-urine for drugs
side effects management- give other meds to reduce them
antidepressants - reduce depression to increase motivation

physiological methods to improve adherence evaluation

+research, antidepressants etc fluoxetine improve adherence
- alternatives may be better lt

psychological methods to improve adherence

- reinforcement/financial incentives
- cognitive behaviour therapy
- adherence reminders

psychological methods to improve adherence evaluation

+research, reminders increase adherence
- reminders eventually ignored by chronic patients

physiological methods to improve adherence study

Lustman
AIM - does reducing depression improve adherence
METHOD - depressed diabetic patients given fluoxetine or placebo for 8 weeks
FINDINGS - reduced depression in treatment group, better glucose control
CONCLUSION - antidepressants improve adherence to diabetes meds

+sound methodology, randomly allocated groups, placebo control, double blind
-ST vs LT, no follow up so LT unclear

psychological methods to improve adherence theorist

Volpp
AIM - would money improve lt smoking quit rates
METHOD - employees placed in financial incentive ($750) or info only groups
FINDINGS - quit after 9-12months = 14.7% money, 5% not, quit after 15-18months 9.4% money, 3.6% not
CONCLUSION - financial incentives increase quitting


+objective measures, biochemical tests not self report
-generalisability issues, not ethnic or educational representative sample