Behavioral science Yr 2

What is the biomedical model

• focuses on biological factors

• focuses on objective lab tests rather than subjective feelings or patient history

Whats the biopsychosocial model?

• a method of understanding health and illness through biological, psychological and social factors that influence a person's health outcomes.

• emphasis is placed on treating the patient as an individual

what is the adolescence BPS model

The stage between childhood and adulthood can have more biological and social changes than any other stage except infancy

what is fear avoidance behavior

a psychiatric model that describes how an individual develops chronic msk pain as a result of avoidance based on fearof certain movements or activities perceived as harmful. This behavior can perpetuate pain and disability.

give a definition and name some examples of red flags

• fever of 38 or above

• unexplained weight loss

• history of cancer

• signs of infection

• chest pain

• numbness around genitals

  = indicators suggesting a serious underlying condition

definition of a yellow flag and some examples

A psychological factor indicating potential risk for chronic pain, signaling a person's emotional state, beliefs, or behaviors that may hinder recovery.

• belief that pain is harmful

• fear avoidance behavior

• low mood & social withdrawal

• high pain intensity

when are yellow flags noted

during clinical assessment, by means of questionnaire (StarT back tool)

doctored-centered communication

• one way process

• more control over situation

• doctor asks q’s, gives advice as a result

• pantient answers, asks very few

• patient is passive with little influence on consultationa communication style where the doctor dominates the conversation, providing information and advice while the patient has minimal input. This approach often limits patient engagement and can impede shared decision-making.

Patient - centered care

• 2 way process

• doctor and patient participate

• patient encourages to express themself

• patients answers and asks q’sa collaborative approach to healthcare where the patient's preferences, needs, and values are prioritized. It involves active participation from both the doctor and patient, fostering open communication and shared decision-making.

what are the 5 basic communication tasks for the medical interview

1. initiating the session

2. gathering info

3. building the relationship

4. explanation and planning

5. closing the session

closed questions

• one way communication

• restricted range of possible answers (yes/no)

• used when info is needed immediately/emergencies

open questions

• 2-way communication

• uses how, when, where, why, who

• patient expresses freely, providing extensive detailed answers

definition of ‘paraphrasing’

refers to the restatement of the meaning of a message using other words

definition of ‘summarizing’

clarification of whats been said, clarity of understanding. Usually occurs at end of consultation

whats jargon

professional terminology used by heathcarers to demonstrate authority, impress patients or stop them from asking questions

factors affecting communication

EMOTIONAL STATE

• your emotions have impact on patient interaction and understanding.

  empathy

• - nervous/anxious

• embarrassed

• in pain

• tired or under influence of sedative drugs

  SOCIAL FACTORS

  AGE

  GENDER

  CONFIDENTIALITY

what are the levels of nonverbal communication - SOLER

1. Sitting - directly opp = patient feels threatened

2. Open posture - no crossing arms/legs

3. Lean - in slightly to show interest

4. Eye contact - maintains connection, shows attentiveness

5. Relax - calm demeanor helps patient feel comfortable

what is paralanguage

whats expressed verbally other than words such as tone, pitch, flow, clarity, and volume.

The Equality acts 9 protected characteristics are what?

1. age

2. race

3. religion

4. disability

5. sex

6. sexual orientation

7. pregnancy/maternity

8. marriage/civil partnership

9. gender reassignment

what are the 6 types of diability discrimination

1. Direct discrimination 2. Indirect discrimination 3. Failure to make reasonable adjustments 4. Harassment 5. Victimisation 6. Discrimination arising from disability

definition of dignity

the state or quality of being worthy of honor/respect.

• providing elderly people with dignified care has a positive impacts on their treatment, social outcomes, health and well being

How to develop effective communication with the elderly

1. PLAN FOR EXTRA TIME

2. GIVE YOUR UNDIVIDED ATTENTION

3. SPEAK SLOW, LOUD AND CLEAR

4. AVOID JARGON

5. USE SHORT SIMPLE WORDS/ SENTENCES

6. STICK TO 1 TOPIC AT A TIME

7. USE CHARTS/ MODELS/PICS

8. FREQUENTLY SUMMARIS THE MOST IMPORTANT POINTS

9. GIVE OPPERTUNITY TO ASK Q’S

non-verbal communication with the elderly

1. body positioning

2. touch

3. eye contact

4. head nodding

5. smiling

difference between sympathy vs empathy

Sympathy involves feeling pity or sorrow for someone else's misfortune, while empathy means understanding and sharing the feelings of another person, allowing for a deeper connection and support.

Piaget proposed 4 different stages of cognitive development, what are they?

sensorimotor - experience of world through movements/sensations

preoperational - development of language and imagination

concrete operational - understanding of concrete events and logical reasoning

formal operational - abstract reasoning and systematic planning.

what does John Bowlby’s attachment theory describe?

It describes the dynamics of long-term relationships between humans, particularly the bond between a caregiver and a child, emphasizing the importance of secure attachment for emotional and social development.

what are the 4 stages of bowlby theory

seperational anxiety - (7-12 months) child feels distress when mothers absent

preoperational stage - (2-7yrs) child has limited logic and beliefs about illness

concrete operational stage - (7-12yrs) child recognises illness has range of symptoms

formal operational stage - (12+yrs) child understands abstract concepts of health and illness.

ways to reduce pain in children

positive reinforcement

explain procedures using age appropriate props

distract their focus on something else

useful interventions during painful procedures - e.g. music, controlled breathing

what are 3 different culture categories that operate what caring for a patient

1. physician culture - medical jargo causes problems when patient is trying to understand

2. health setting culture - rules specific to the organization you're working with

3. patient cultures - patients cultural beliefs may differ to yours including beliefs about health, illness, and treatment.

personalistic systems based on 3 main causes of illness are…

1 supernatural forces, e.g. god

2 non-humans, e.g. ghosts, spirits

3 humans, witches, sorcerers

some widespread health beliefs if certain parts of Africa, india, Dominican republic etc are…

Voodoo - a belief system that includes supernatural forces influencing health and illness.

evil eye - a curse believed to cause harm or misfortune due to jealousy or envy.

naturalistic systems

Naturalistic systems are based on the belief that health is achieved through maintaining balance within the body and its environment. When this balance is disrupted, it leads to illness.

The chinese medical system

is a naturalistic system that emphasizes balance among the body's vital energies, known as qi, and the interplay of yin=cold and yang=hot to maintain health.

what is ayurvedic medicine

a naturalistic system rooted in India 3000-5000 years ago. Illness is caused by imbalance in humors (the 4 elements of fire, water, earth and wind). FOCUS IS ON RESTORING/MAINTAINING BALANCE

how can communicating across a language barrier influence how people behave

• patient may feel everyones talking about them

• excessive smiling and body language

• avoidance of people for fear of appearing stupid

• patient may pretend they understand to avoiding annoyance/forcing you to repeat

• patient may feel nervous if theyre ill and vulnerable due to the inability to communicate effectively.

recommendations for communicating across a language barrier

• speak clear but don’t raise voice

• may not use sorry, thankyou and please because its not in their culture, doesn’t mean they’re being rude

• use pictures/mimes to help get message across

• give clear instructions in logical orders

• pause between topics and check they understand

what are the problems with having family members as translators

• inaccurate translation, bias and distortion

• confidentiality/privacy are compromised which may inhibit patients from being open

• family may not disclose all info

• may answer for client can lead to misunderstandings in medical context.

definition of pain

An unpleasant sensory and emotional experience associated with actual or potential tissue damage; often described as a warning signal for the body.

definition of illness

A condition characterized by the presence of disease or health impairment, affecting physical or mental well-being.

definition of illness behavior

The way individuals respond to and cope with their illness, including their actions and attitudes towards health and healthcare.

lay referral system definition

an informal network of lay people (not medical practitioners) who provide their own info about a persons symptoms

what are the 5 components of illness representations

1. identity - name given to condition/associated symptoms

2. cause - individuals ideas about perceived cause of illness, which may not be biomedically accurate

3. timeline - the duration and expected course of the illness

4. consequences - individuals belief about consequences (how it’ll impact them physically and socially)

5. curability/controllability - beliefs about the extent to which the illness can be cured or controlled, either by oneself or through medical intervention.

what are the rights for the Sick Role

• absent from normal social responsibilities

• sick person isnt held responsible for their condition

• illness is considered beyond individuals control therefore not curable by willpower

• sick person has the right to be taken care of

duties/obligations of the sick role

sick individuals are expected to seek medical help, follow prescribed treatments, and work towards recovery, while also communicating their illness to others.

advantages of the sick role

• social support

• able to rest and be taken care of

• exempt from many daily activities

• protection from social obligations

• access to healthcare resources

disadvantages of sick role

• behaviors are scrutinized

• others may view behaviors as illegitimate in attempt to gain advantage or attention from the healthcare system; possible stigma associated with being labeled as sick.

• confusion, discomfort and anxiety from being in a role that requires constant validation of health status. Potential for dependency and loss of identity.

definition of stereotype

expectations and beliefs about a group of people that can lead to oversimplified and generalized perceptions.

definition of prejudice

a preconceived opinion or judgment about an individual or group, often without sufficient knowledge or evidence, leading to bias and discrimination.

definition of discrimination

the unjust or prejudicial treatment of different categories of people, often based on race, age, or gender, resulting in exclusion or adverse impact.

give some examples of stereotyping

ageism - old people are forgetful

sexism - women cant drive

religion - catholic families have a lot of children

profession - all bankers are greedy

media - males r always the boss

bad effects of stereaotyping

• stigma - a set of unfair beliefs that society have)

• discrimination (unfairly treating someone

• racism (violence towards people because of their race)

good effects of stereotyping

• enables us to respond rapidly to situations we’ve had similar experience in

• were given a general idea of how a specific person may think and act

• more aware of what someone finds offensive

whats the difference between prejudice and discrimination

prejudice includes 3 components of attitude (affective, behavioral and cognitive), WHEREAS discrimination only involves behavior

The nature of self includes

persona = “the mask” - the face we put on in society to appear to be in control, intelligent, witty etc

ego - the centre of the CONSCIOUS mind - it protects us in the norms of society. Responsible for dealing with reality.

shadow - the UNCONSCIOUS - that part that wants to do the things the ego tells us we cant do

the essential self - incorporates BOTH CONSCIOUS & UNCONSCIOUS - its our uniqueness. its the goals we want to achieve. MOST IMPORTANT TOOL IN PATIENT CARE

what is self efficacy

a belief in one's ability to succeed in specific situations or accomplish tasks, influencing motivation and behavior.

people with strong efficacy…

view challenging problems as tasks to be managed

develop inner interests in the activities they participate in

have stronger sense of committment to activities

recover quickly from setbacks

people with a weak sense of self efficacy…

avoid challenging tasks

believe difficult tasks are beyond their capability

focus on negative outcomes

loose confidence in personal activities and may give up easily when faced with obstacles.

personality types

Extravert - outgoing, talkative, energetic

introvert - quiet, reserved, less social interaction

Type A - intense hard driving personality (stress junkies)

Type B - relaxed, less competitive

Type D - linked with early death

what are the big 5 personality traits (OCEAN)

• Openness - ideas, values, fantasy

• Conscientiousness - order, self-discipline

• Extraversion - warmth, assertiveness, positive emotions

• Agreeableness - trust, modesty

• Neuroticism - anxiety, depression, self-consciousness

what are the 2 types of motivation

primary motives = the satisfaction on basic biological needs for survival e.g. food, oxygen, water

secondary motives = based on learnt needs, drives and goals

what strategies can you use for changing risk behavior

Motivational Interviewing (MI) = a technique based on CBT which aims to enhance an individuals motivation to change health behavior

what is one of the foundations for MI

TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE

what are the 8 components for motivation strategies

1. giving advice

2. removing barriers

3. providing choice

4. decreasing desirability

5. practicing empathy

6. providing feedback

7. clarify goals

8. active helping

what are the 5 basic principles for creating condition change in MI

1. expressing empathy

2. avoiding argument

3. supporting self efficacy

4. rolling with resistance

5. developing discrepency

miller and \\\\rollnick (2002) suggest there are 8 steps of MI that allow therapeutic process to work, what are they?

1. establishing rapport

2. setting the agenda

3. assessing readiness to change

4. sharpening the focus

5. identifying ambivalence

6. eliciting self monitoring statements

7. handling resistance

8. shifting the focus

An ethical decicion is made using ethical rules:

• veracity

• confidentiality

• fidelity

ethical rulesare taken from ethical principles, like

autonomy

beneficence

non-maleficence

justice

the teleogical ethical theory - consequentialism

= the right thing to do is that which brings about a good result

health professionals should seek to achieve the best possible outcome

what is hedonistic consequentialism

requires that a good outcome is ‘as much happiness produced as possible’

• focused on maximizing pleasure and minimizing pain.

what is interest/preference consequentialism

is a type of consequentialism that focuses on maximizing the satisfaction of individual preferences or interests, rather than just overall happiness.

deontological ethical theories

‘duty orientated’

duty based ethics teaches that some acts are right or wrong because of the sorts of things they are, and people have a duty to act accordingly, regardless of the good or bad consequences that come along.

what are Bauchamp & Childress’ 4 principles framework

1. principle of autonomy - recognizes the right of individuals to make informed decisions about their own lives. This principle emphasizes respect for personal choice and self-determination.

2. principle of non maleficence - holds that individuals should not cause harm to others, ensuring safety and well-being.

3. principle of beneficence - do what is best for patient

4. principle of justice - everyone should be treated equally, distributing benefits, risks and costs fairly

what is informed consent

is the process by which a patient voluntarily confirms their willingness to undergo a particular medical intervention, based on a clear understanding of the risks, benefits, and alternatives involved.

what is consent

is the agreement or permission given by a patient for a medical procedure or treatment after being informed about its potential risks and benefits.

definition of anger

Anger is an emotional response characterized by feelings of frustration, hostility, or irritation, often triggered by perceived threats, challenges, or injustices.

what is aggression

any behavior that is intended to inflict harm on another person or object

2 types of aggression

hostile aggression = aggression aimed at causing pain or injury

instrumental aggression = aggression intended to achieve a goal or gain something, rather than to cause harm. E.g. killing someone to steal money from them

what is the etheology theory

= the study of animals in their natural environment and how animal behaviors increase their chances of survival and reproduction.

how to deal with aggressive patients

1. stay calm and adopt an assertive approach while maintaining a safe distance and using clear communication to de-escalate the situation.

2. acknowledge the aggressor and allow them to ‘let off steam’. USE OPEN QUESTIONS

3. active listening - maintain eye contact, use open gestures

4. Do not reward rudeness or abuse -

5. do not bluff -

6. focus on story not the aggression

What is CBT

cognitive behavioral therapy is a talking therapy that can help patients manage their problems by changing the way they think and what they do

when is CBT used

CBT is used to treat various mental health conditions, including anxiety disorders, depression, and PTSD, phobias, anger, psychosis, low self-esteem, OCD. CBT is also sometimes used to treat people with long term health conditions like IBS, Chronic fatigue syndrome

what happens during a CBT session

• 30-60 min session once a week or once every 2 weeks.

• usually lasts between 5 and 20 sessions

• Pt and therapist work together to break down thoughts, physical feelings and actions to identify patterns and develop coping strategies.

• after working out what Pt can change, Pt will be asked to practice these changes in their daily life and discuss how successful this was

• THE EVENTUAL AIM IS TO TEACH THE PT TO APPLY THE SKILLS LEARNT DURING TREATMENT TO THEIR DAILY LIFE

CBT can help make sense of overwhelming problems by breaking them down into smaller parts. What are these smaller parts?

1. a situation

2. thoughts

3. emotions

4. physical feelings

5. actions/behaviors

what are cognitive distortions and what are the 11 types

cognitive distortions are ways that our mind convinces us of something that isnt really true.

1. arbitrary inference = jumping to conclusions not supported by evidence

2. selective abstraction = blowing it out of proportion and focusing on negative details while ignoring positives.

3. personalisation = taking responsibility for events outside one's control, often leading to guilt or blame.

4. dichotomous thinking = black&white all or nothing thinking

5. overgeneralisation = a single incident serves as a basis for judging all instances the same

6. magnification/minimisation = exaggerating the importance of events or downplaying achievements or positives.

7. catastrophizing = expecting the worst possible scenario, creating anxiety about potential outcomes.

8. disqualification = predicting the future negatively without considering other possibilities or outcomes.

9. mind reading = assuming you know what others are thinking without evidence.

10. labelling = assigning negative labels to oneself or others based on perceived flaws or mistakes.

11. emotional reasoning = believing that feelings reflect reality, leading to distorted judgments.

name some advantages of CBT

• helpful where medication hasnt helped

• can be completed in relatively short period of time

• can be used in different formats, e.g. groups, books etc

• teaches useful and practical strategies that can be used in everyday life

name some disadvantages of CBT

• patient must committ to get the most from it

• attending regular sessions and carrying out any extra work can take up alot of time

• it involves confronting emotions and anxieties

• can be challenging for those with certain cognitive limitations or complex mental health issues

• relies on patient engagement and willingness to change.

what is depression

an illness characterised by persistent sadness and loss of interest in activities that were normally enjoyed, accompanied by inability to carry out daily activities for atleast 2 weeks

what 5 symptoms of depression must be present for most days

• changes in thinking - negative thoughts (death, suicide)

• changes in feelings - persistent sadness, worthlessness

• changes in behaviour - frequent crying, loss of interest in enjoyable activities

• changes in physical well being - fatigue, sleeping less/more, change in appetite

what is dysthymia

= a less sever with fewer symptoms thatn major depression, but lasts longer, often for years. It can often lead to major depression (double dpression)

same symptoms as depression

What is bipolar depression

a mental health condition characterized by alternating periods of high energy or manic episodes and episodes of depression.

name some risk factors for depression

• excessive alcohol

• postpartum

• genetic

• following life threatening surgery

• poor nourishment

• chemical imbalances

psychological factors - rejection in childhood, setting very high standard for self or others, suffering chronic anxiety

social factors - unemployment, recent setbacks, having several young children at home, unable to confide in partner, economically poor background

factors for depression in the elderly

risk factors may include:

• health problems

• loneliness/isolation

• reduced sense of purposeness (retirement)

• recent bereavements

• chronic pain

• moving to carehome

symptoms of depression in the elderly

• fatigue

• weight loss

• losing interest in activities

• social withdrawal/isolation

• sleep disturbances

• loss of self worth

• increased use of alcohol of alcohol or other drugs

why is depression in the elderly overlooked

• they may assume depression just comes with aging

• they may be isoltaed - which can lead to depression - with few around to notice their distress

• they may not realise their physcial complaints are signs of depression

• may be reluctant to talk about their feelings

  alzheimers and depression share many symptoms, so it can be difficult to tell the 2 apart

depression in children and adolescents

health care professionals try avoid labelling a young person with a mental disorder. Some symptoms can be typical of the teenage development stage

risk factors of depression in children include…

• failing exams

• social rejection

• history of physical or sexual abuse

• poor communication with parents

• family turmoil

• getting in trouble at school or with police

• fighting/breaking up with boyfriend/girlfriend

what is seasonal affective disorder (SAD)

only occurs during winter months and is due to lack of sunlight

Lack of sunlight may stop the hypothalamus to work properly, which may affect:

• production of melatonin

• production of serotonin

• circadian rhythm

symptoms of SAD include

• persistent low mood

• loss of pleasure in previously enjoyed activities

• feelings of guilt and worthlessness

• feeling lethargic

• sleeping more and finding it hard to get up

• craving carbs and gaining weight

What is a genogram

A genogram is a visual representation of a family tree that uses special symbols to describe relationships, major events and dynamics of a family over multiple generations

what are the stress definitions

stress as a response = being over tired, lacking energy, having sleeping problems or feelings of depressed

stress as a stimulus = work overload, failing an exam, moving house