health psychology 2

what is Rogers protection motivation theory (PMT)?

social cognition model

extended HBM by including fear

• severity

• susceptibility

• fear

• self-efficacy

• response efficacy

what are fear appeals?

threatening health messages that aim to elicit emotional response

what are the two components of fear appeals?

fear arousal

• there is a threat

• you are at risk

• threat is serious

safety conditions

• recommended actions

• action is effective and easy

what was found in the brown & smith: people responses to distressing anti-smoking messages study?

daily smokers assigned to one of two conditions, high/low distress

• perceived risk, time spent reading messages

  • with low distress worked better (risk, time, and evaluation)

what do fear appeals pose a threat to? (2)

• threat to freedom

• threat to self as component

how do fear appeals work?

stress severity → defensive responses

• denial of risk

• biased processing of information

• avoidance

useless at best? harmful at worst?

what happened in the Malouff et al: australian smokers study?

assigned two conditions: written warnings & written/graphic warnings

• graphics worked better in both conditions

  • more noticed

  • rated as more effective

  • elicit more negative feelings about smoking

does the amount of fear matter?

yes

what makes a threat?

perceived severity

perceived vulnerability

what determines someone’s coping?

perceived response efficacy

perceived self-efficacy

what does the addition of threat and coping lead to?

intentions → behavior

True or false: fear appeals are one of the most popular methods for behavior change?

true, but are argued to be among the least effective

why doe we continue to use fear appeals given the mixed support?

• intuitive appeal

• lack awareness of research and theory

• what are the alternatives?

True or false: there is often a gap between theory and practice.

true

theories describe factors that predict behaviors of behavior change, but do not give direction on how to change constructs

what are the four steps of developing interventions?

1. identify target behavior

2. what are the most salient beliefs

3. predictors of target behavior

4. develop intervention

What does step 1 of intervention developing consist of?

• target behavior should be as specific as possible (action, time/context)

• who are you targeting? LIMIT vagueness of behavior

  • the harder it is to measure success of intervention

  • harder it is to identify key beliefs about behavior

what does step 2 of intervention developing consist of?

defining salient beliefs: beliefs about target behavior in target population

• qualitative research/open-ended questions (benefits, consequences, barriers)

population matters

what does step 3 of intervention developing consist of?

drawing on modal beliefs, what theoretical constructs predict behavior

• cost as perceived barrier = - outcome?

• longevity as health benefit = + outcome?

do all modal beliefs predict behavior? are all theoretical constructs needed?

what does step 4 of intervention developing consist of?

target the beliefs in steps 2 and 3

decide how to target beliefs and methods (leaflets, videos, lectures, discussion, etc.)

theories describe what beliefs to change but not how

what were the takeaways of the Montanaro & Bryan: student condom use study?

• interventions do not always follow the four steps to development

• not all TPB components necessary for changing preparation behaviors

• dropping components does not allow us to test theories, but could lead to more efficient interventions

• more than one study needed

based on bandura’s theory, self-efficacy can be increased by what 3 factors?

• mastery experience

  • during session/after session/multiple graded

  • past experience

• vicarious experience

  • live or virtual

  • coping or mastery models

• verbal persuasion

what are some takeaways from approaches to changing self-efficacy theory?

• theory provides a useful tool for developing interventions

• lots of potential ways to apply theories

  • research needed to test whether theory-driven techniques work

• intervention work can inform theory

what is motivational interviewing?

intervention developed for those who are unmotivated to change

• SOC (stages of change): pre-contemplation → contemplation

directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence

what does motivational interviewing look like in the interviewer?

• non-confrontational

• non-judgemental

• empathetic

• request permission to discuss, open-ended questions, reflective listening (NOT advice), offer support

what does motivational interviewing look like in the client?

• responsible for decision making

• explores barriers and benefits

• expresses thoughts and behaviors

• generates arguments for change instead of being convinced

how does motivational interviewing work?

self-efficacy (HBM)

autonomous motivation (SDT)

what are ecological momentary interventions (EMIs)?

intervening on behavior as it occurs “in the moment”, by utilizing mobile technologies

• delivery of interventions in real time in the “real world”

• can take many forms: supplements vs. stand alone

what are the strengths and drawbacks of EMIs?

strengths:

• potential promise to bridge gap in MIs

• EMIs are a delivery approach, (think format), content matters

drawbacks:

• more ‘up-front’ costs than more traditional methods

• time for setup of system, patient use of devices

• ethical considerations: patient confidentiality, equity in health interventions

• not yet widely accepted, or adopted in clinical settings

what are some future directions EMIs can go?

• developing a taxonomy of behavior change approaches

• sustained behavior change

• multiple behavior change

what is stress?

response to a stressor in external environment

• involves biochemical, physiological, cognitive, and behavioral changes

• chronic or acute

what events are more likely to be perceived as stressful?

• uncontrollable

• ambiguous

• overload

what is the transactional model of stress?

stress is not an automatic response to a stressor (events aren’t inherently stressful)

stress is a consequence of how we interact with the world

• we don’t passively respond to stressors, we make appraisals

what is the steps in which amount of stress is determined in transactional model of stress?

stressor → primary appraisal: assessment of external event → secondary appraisal: assessment of self → amount of stress

what are the factors that make a primary appraisal?

do i have a stake?

• irrelevant

• benign and positive

• harmful (damage done)

• threat

• challenge

what are the factors that make a secondary appraisal?

can i cope?

do i have resources to cope?

what is the physiological response to stress?

sympathetic activation (SAM):

• epinephrine and norepinephrine

• “cranked up feeling”

blood pressure → too much increase = heart disease

immune functioning

hypothalamic-pituitary-adrenocortical (HPA) activation: cortisol

• not detected by indiv

• slower onset

does stress lead to illness?

yes, physiological changes can occur:

• heart rate, blood pressure, increase fatty deposits, immune function

why else might stress lead to poorer health?

• health protective behaviors

• health impairing behaviors

• illness behaviors

• sick role behaviors

• psychosocial resources

what were the results of the Keller et al., stress impact study?

the amount of stress a participant had did not predict death NOR did their believing stress = poorer health predict death.

but reporting a lot of stress AND perceiving that stress affects health, increased the risk of death by 43%

• effect of amount of stress on death depended on appraisal.

What were the results of the Jamieson et al., study on teaching people to rethink physiological responses to stress?

3 conditions → did trier social stress task → outcomes: cardiac output

higher cardiac output suggests less stress, more bias to threat (more stress) = higher scores, interpretations of bodily signals impacted how the body and mind responds to acute stress

what is coping?

regulation of external stressor and internal emotions

• constantly changing cognitive and behavioral efforts used to manage demands of situation appraised as stressful

what are the goals of coping?

• reducing/eliminating stressful conditions

• adjust or tolerate the event

• maintain positive self image

• maintain emotional equilibrium

• continue satisfying relationships

• physiological recovery

what are the two approaches to coping described by Folkman & Lazarus?

• problem-focused coping: active efforts to modify stressors, plan, address, and deal with it

• emotion-focused coping: regulate emotions by minimizing, denying, seeking emotional support, wishful thinking, and distracting

is PFC of EFC better at dealing with coping?

PFC: adjustment

EFC: maladaptive

most coping strategies aren’t all pos or neg

what is the goodness of fit hypothesis for coping strategies?

PFC is more helpful in more controllable situations

EFC is more helpful in less controllable situations

in the college EFC or PFC 15min writing task, what were the results?

EFC worked better for people with low emotional clarity

PFC worked better for people with high emotional clarity

positive coping strategy outcomes have been related to what things?

• creation of narrative around stressful event

• finding meaning in stressor

• expression and labeling of emotions

• affirmation of important self domains

as opposed to changing appraisals to cope, what is an alternative strategy?

reducing arousal - i.e., mindfulness meditation

how is mindfulness different from regular relaxing techniques? how does this technique help efficacy?

no intentional focus on relaxing during practice

helps in:

• psychological disorders

• physical health

• across populations (clinical/non-clinical)

what was found in the Creswell et al., study of mindfulness changing responses to trier social stress task?

mindfulness training didn’t help people who were naturally mindful, it stressed them out more

mindfulness training helped people who were not naturally mindful (low dispositional mindfulness)

those who were naturally more mindful PERCEIVED less stress

what cannot be configured through bodily data for symptom perception?

• symptoms can be generated in the absence of bodily data

• bodily data does not always lead to symptoms

what other sources do symptom perception depend on? (3)

1. mood: stress and anxiety

2. cognitions: focus or distractions

3. social context: other people

what are the correlations between symptoms and mood?

stress can lead to greater subjective experiences

seen with heartburn/reflex patients & trier social stress task study

what are the correlations between symptoms and cognition?

focused attention: more intense & noxious symptoms

• i.e., early labor/pain → women who go to the hospital earlier experience more pain than women who distract themselves in other tasks

what is the correlation between symptoms and social contexts?

other people influence our experience of symptoms

• i.e., contagious itching

cross-cultural differences in symptoms (i.e., USA v. Canada: americans said they had more vision problems than canadian counterpart though both had same levels of severity)

what value of medical students incorrectly report having symptoms of illness?

~2/3 medical students will do this

what is an illness cognition?

patient’s own common sense belief about their illness

what is the commonsense model of illness? what is its 5 core dimensions (illness cognitions)?

a framework for understanding and coping with illness

1. perceived cause

2. time line

3. consequences

4. cure/control

5. identity

what are some critiques of the commonsense model of illness?

• 5 dimensions aren’t enough, necessary to add:

  • cyclical timeline perceptions (acute or chronic)

  • illness coherence (understanding of what’s happening)

  • emotional representation

do how doctors communicate influence illness cognitions?

yes, doctors often use euphemisms instead of medical terms to ease patients

becoming ill involves what two things?

symptoms perception (bodily data, mood, cognition, social context)

forming illness cognitions (commonsense model)

• social messages (i.e., doctors)

what is the self-regulatory model of illness behavior?

incorporating illness cognitions into broader model of illness, based on general problem solving

interpretation (symptom perception/social messages) → illness cognitions (w/ emotions) → coping → appraisal of coping

how are illness cognitions related to treatment seeking?

symptoms → illness cognitions → coping

how do people decide to seek medical care?

symptoms are necessary but not sufficient, helping seeking is associated with people perceiving health as:

• increased identity

• increase consequences if not sought

in the Cameron et al., study about comparing people’s illness burdens/demographics, what factor was most associated with help seeking?

consequence was the highest

what is delay behavior?

time from symptoms recognition to treatment

• sometimes appropriate

• sometimes critical

what stages can delay behaviors occur at?

• symptom perception → appraisal delay

• illness cognitions → illness delay

• behavioral delay

• medical delay

what is a sick role? what are the cost and benefits of seeing a doctor to them?

expectations of a person who is regarded as ill

• seeking help

• exemption from social duties

• social stigma and discrimination

what factors contribute to delay?

• being female

• symptoms

how do you reduce delay?

• acute myocardial infarction

• therapies soon after symptom onset = - morbidity & mortality

for the REACT trials, was MI delay interventions effective?

no, EMS use increased but no difference in delay patterns or fatality rates

what are some recommendations of more beneficial MI interventions?

• knowing symptoms and consequences of inaction is not enough

• people may need to know how to make decisions

• need to address emotional responses (denial and coping) & social factors

• mass media may not be an effective vehicle for change

  • more individualized programs may be needed