helath psych final

Biomedical model vs. Biopsychosocial model

Biomedical: all illness can be explained by abnormal somatic processes. Mechanistic: focus on specific parts. Dualistic: views psychological health as separate from physical health.
Biopsychosocial: health is influecned by biological, psychological, and social factors.

Proportion of deaths attributable to health behaviors

between 40% and 50%

Correlational design

A research design that measures the association between two variables. Correlation ranges from -1.00 to +1.00. A positive correlation means variables change in the same direction; a negative correlation means they change in opposite directions. Correlation does NOT indicate causation — alternative explanations include reverse causation (B causes A) or a third variable (C) causing both A and B.

Experimental design (randomized controlled trial)

The researcher manipulates an independent variable (IV), randomly assigns participants to conditions (equal chance of being in any condition), and uses experimental control to ensure only the IV differs between groups. The only design that allows causal conclusions. Often includes a placebo control group. Has higher internal validity but concern about external validity.

Interpreting correlation coefficients

Correlation ranges from -1.00 to +1.00. Values closer to ±1.00 indicate a stronger relationship; values closer to 0 indicate a weaker relationship. A positive value (e.g., r = +0.4) means both variables increase together. A negative value (e.g., r = -0.4) means one variable increases as the other decreases. Correlation does NOT indicate causation.

Quasi-experimental design

Comparison of groups WITHOUT random assignment. Causality can be tentatively assumed only if: (1) preexisting groups differ on the variable of interest, (2) temporal priority is established, (3) a dose-to-response relationship exists, (4) the intervention has a demonstrable effect, and (5) animal analogs support the finding.

Moderator

A variable that changes the magnitude and/or direction of the relation between the IV and DV. Applies in both experimental and correlational designs. (IV → DV, moderated by a third variable)

Mediator

A variable THROUGH WHICH the IV is related to the DV. The causal chain is: IV → Mediator → DV. Applies in both experimental and correlational designs.

Confound (confounding variable)

A variable that is potentially responsible for the change in the DV but is NOT the IV. Represents an alternative explanation for the results and is a threat to internal validity.

Retrospective vs. prospective design

Retrospective: predictor variables are measured AFTER the outcome has already occurred (problem: outcome already known, may bias recall). Prospective: predictor variables are assessed IN ADVANCE of the outcome (stronger design for establishing causality).

Cross-sectional vs. longitudinal design

Cross-sectional: data collected from a sample at ONE point in time (problem: cannot establish temporal precedence). Longitudinal: data collected from the same sample at MORE THAN ONE point in time (problem: time-consuming).

Internal validity vs. external validity

Internal validity: the likelihood that changes in the DV were caused by the IV (threats include confounds). External validity: the likelihood that results would generalize to other people and situations. Laboratory research has higher internal validity; field/naturalistic research has higher external validity.

Meta-analysis

A statistical combination of results from multiple studies. Calculates the average effect size across all studies. Can include moderator analyses to explain variability in results across studies.

Allostatic load

The cumulative physiological cost associated with repeated allostasis (McEwen and Stellar, 1993). Results from: chronic stressors, inability to adjust to continuous or recurrent stressors, or inability to end the stress response. Can lead to outcomes such as decreased immunity.

Autonomic nervous system (ANS)

Manages internal organs without conscious control. Has two parts: the sympathetic nervous system (mobilizes the body to react to a stressor — arousing) and the parasympathetic nervous system (restores body to normal state after arousal — restoring).

Sympathetic nervous system effects

Increases heart rate, inhibits digestion, opens lungs, dilates pupils, inhibits salivation, increases blood glucose, and stimulates the adrenal gland to release catecholamines (epinephrine and norepinephrine).

Parasympathetic nervous system effects

Slows heart rate, stimulates digestion, constricts lung passages, constricts pupils, promotes salivation, and lowers blood glucose.

Endocrine system

A regulatory system that secretes hormones. Key structures: Hypothalamus (controls the pituitary gland); Pituitary gland (the "master gland" — secretes hormones that directly influence other endocrine glands); Adrenal glands (located above the kidneys, consist of the adrenal medulla and adrenal cortex). Stress activates: CNS → hypothalamus → SAM and HPA systems.

SAM vs. HPA hormones

SAM system (Sympathetic-Adrenal-Medullary): activates the adrenal medulla → releases catecholamines: epinephrine (adrenaline) and norepinephrine. HPA system (Hypothalamic-Pituitary-Adrenal): activates the adrenal cortex → secretes cortisol.

Social Readjustment Rating Scale (SRRS)

Holmes and Rahe (1967). Measures stress in terms of LIFE CHANGE — events (positive OR negative) that bring changes to how one lives and require considerable adaptation. The key assumption is that life change itself predicts illness, regardless of whether the event is positive or negative.

Daily hassles

Minor annoying events that require some degree of adjustment (DeLongis, Folkman, and Lazarus, 1988). Have negative cumulative effects on health. DeLongis et al. (1982) found negative correlations between daily hassles and health outcomes.

Perceived stress

Appraisals of life situations as unpredictable and overwhelming (Cohen et al., 1983; Perceived Stress Scale). Young et al. (2004) found negative correlations between perceived stress and health outcomes.

Models of stress and illness: Indirect effect model

Stress leads to UNHEALTHY BEHAVIORS as a way of coping, which then cause physiological changes and disease. Pathway: Stress → unhealthy behavior → physiological changes → disease. Example: Stress → cortisol → increased appetite for sweet and fatty foods → abdominal fat accumulation → greater disease risk (cortisol affects abdominal fat cells more than gluteal fat cells).

Models of stress and illness: Direct effect model

There is a DIRECT link between stress and physiological changes that lead to disease. Pathway: Stress → physiological reactions → disease. Evidence: stress predicts vulnerability to colds (Cohen et al., 1993) and impairs wound healing (Marucha et al., 1998); stress causes cardiovascular activation.

Models of stress and illness: Diathesis-stress model

A predisposition (diathesis) to disease combined with environmental stress produces illness. The condition does NOT develop without BOTH the diathesis AND the stress.

Cannon's fight-or-flight response

The physiological stress response: preparation for mobilization in response to a perceived threat. Involves sympathetic nervous system activation to prepare the body to either fight or flee. Part of the direct effect model.

Selye's General Adaptation Syndrome (GAS)

The body's generalized attempt to defend itself against stressors. Three stages: (1) Alarm: immediate impact — body mobilizes to respond to stress (high physiological arousal); (2) Resistance: body continues responding to stressor — still high arousal but lower than alarm stage; (3) Exhaustion: physical resources, including stress hormones, are depleted. Note: Selye was not entirely correct — the response is not fully general and nonspecific.

Cardiovascular reactivity

An individual-difference variable reflecting variation in cardiovascular response to stress. Participants doing serial subtractions under stress showed faster heart rates and higher blood pressure (Uchino et al., 1995). Participants giving speeches showed individual variation in cardiovascular response (Sgoutas-Emch et al., 1995).

Social support and health: Holt-Lunstad and Smith (2012)

Meta-analytic results show that social support, social integration, and providing support are all strong predictors of decreased mortality risk — comparable in size to other well-known predictors of health. Social isolation and loneliness both increase mortality risk.

Direct effects hypothesis vs. buffering hypothesis

Direct effects hypothesis: social ties provide protection during BOTH stressful AND non-stressful times. Buffering hypothesis (Cohen and Wills, 1988): social ties provide protection specifically AGAINST the effects of stress — social support moderates (buffers) the impact of stressors on health.

Mechanisms linking social support and health

(1) Cognitive appraisal: social support may change how stressors are interpreted; (2) Health behaviors: social support influences exercise, diet, substance use, and adherence; (3) Psychoneuroimmunological pathways: social relations moderate physiological responses to stress (e.g., social network diversity predicts cold resistance — Cohen et al., 1997; supportive presence lowers BP during speech — Lepore et al., 1993; holding a spouse's hand reduces brain activation in stress-processing areas — Coan et al., 2006).

Tend-and-befriend hypothesis

Taylor et al. (2000): females' responses to stress may differ from males'. Successful stress responses should involve protection of offspring through "tending" (nurturing) and "befriending" (forming social alliances). Oxytocin is released in response to stress, promotes affiliative behavior (Carter et al., 1995), and is associated with reduced SNS and HPA stress responses.

Langer and Rodin's control and health studies

Giving greater choices to nursing-home residents (Langer and Rodin, 1976) led to improvement in health 3 weeks later. Perceived control — beliefs about one's ability to affect outcomes — is associated with better health (Infurna and Gerstorf, 2014), partially mediated by physical activity. In animal models, rats with escapable shock showed better tumor rejection than those with inescapable shock (Visintainer et al., 1982).

Hardiness

Kobasa, Maddi, and Kahn (1982). A personality characteristic that can affect cognitive appraisal of events. Three components: (1) Commitment: sense of purpose and involvement; (2) Control: belief in one's ability to influence events; (3) Challenge: viewing change as a growth opportunity. Kobasa et al. (1982) measured hardiness and stress at T1 and found that harder individuals had fewer illness symptoms at T2 even with similar stress levels.

Explanatory style and its 3 dimensions

Peterson and Seligman (1984). A cognitive personality variable about how people explain negative events. Three dimensions: (1) Internality vs. Externality; (2) Stability vs. Instability; (3) Globality vs. Specificity. Optimistic style: external, unstable, specific attributions for negative events. Pessimistic style: internal, stable, global attributions — associated with higher risk of death (Peterson et al., 1998).

Health behaviors model of personality and health

Personality influences health-related behaviors, which in turn influence health. Example: childhood conscientiousness predicts the lowest rates of smoking and alcohol use in adulthood (Friedman et al., 1995; Hampson et al., 2006).

Stress moderation model of personality and health

Personality moderates the effect of stress on health.

Big Five personality traits and health

Costa and McCrae (1985). The five traits are: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. Conscientiousness is most consistently related to positive health behaviors and longevity (lower mortality risk — Friedman et al., 1993; Turiano et al., 2013), mediated by health behaviors. Neuroticism shows mixed findings (associated with both increased and decreased mortality risk in different studies).

Type A behavior pattern and its unhealthy component

Type A (Friedman and Rosenman — cardiologists): competitive, hurried, hostile, tense; linked to heart disease. Type B: relaxed, less competitive. Landmark studies: Western Collaborative Group Study (Rosenman et al., 1976) — Type A → 2x risk of CHD 8.5 years later; Framingham Heart Study (Haynes et al., 1980) — Type A → 2x risk of CHD 8 years later. The UNHEALTHY component is HOSTILITY: hostility predicts CHD and mortality 25 years later (Barefoot et al., 1983) and increased all-cause mortality (Barefoot et al., 1995). Interventions reducing Type A behavior reduced MI recurrence (M. Friedman et al., 1984) and hospitalization days and costs (Davidson et al., 2007).

Problem-focused vs. emotion-focused coping

Problem-focused coping: actions taken to CHANGE a stressful situation or reduce its effects. Emotion-focused coping: attempts to REDUCE distress emotions (includes both approach and avoidance strategies).

Approach coping vs. avoidance coping

Both are types of emotion-focused coping. Approach coping: changing cognitions or expressing emotions (examples: expressive writing, positive reappraisal). Avoidance coping: ignoring or denying the problem (example: abusing alcohol).

Religiosity and health

Religiosity (religious attendance; finding strength and comfort from religious beliefs) is associated with better health and lower mortality risk (McCullough et al., 2000, meta-analysis; Li et al., 2016). Partial mediators include: social ties, health behaviors, depressive symptoms, smoking, and optimism. Public religious involvement shows stronger effects than private. Lifespan trajectories of religiosity: high, low, and parabolic (McCullough et al., 2009).

Expressive writing and health

Traumatic experiences kept secret show a stronger link to health problems (Pennebaker and Susman, 1988). Pennebaker and Beall (1986): writing about trauma (vs. a superficial topic) produced: reduced doctor visits, enhanced immune functioning, lower BP and heart rate, and better self-rated health. Meta-analytic effect sizes: d = .47 (Smyth, 1998) and d = .15 (Frattaroli, 2006). Moderators: physical health problems, history of trauma, disclosing at home, previously undisclosed events.

Gratitude and health

Emmons and McCullough (2003): Three conditions (gratitude, hassles, neutral events). The gratitude condition showed improved psychological and physical well-being.

Mindfulness and health

Focus on and awareness of current thoughts; accepting and acknowledging the present. Associated with: stronger immune functioning, lower blood pressure, and less pain.

Spending time in nature and health

Associated with: lower levels of depression and blood pressure; lower stress (Roe et al., 2013); better immune functioning (Li et al., 2010); lower rates of chronic illness (Beyer et al., 2018).

Humor and health

Potential mechanisms by which humor may improve health: physiological changes in the systems of the body, inducing positive emotional states, moderating the adverse effects of stress on health, and increasing social support.

Self-affirmation and stress

Positive affirmation of one's personal values lowers the physiological response to stress. Sherman et al. (2009): participants who wrote about important personal values before an exam showed a lower physiological response to stress compared to controls.

Temptation bundling

Pairing immediately satisfying activities with behaviors that require more effort but provide long-term health benefits (Milkman et al., 2014 — operant conditioning). Example: audiobooks only allowed while at the gym. Three conditions: full treatment (audiobooks only at gym), intermediate treatment (encouraged to only listen at gym), and control. Gym attendance was highest in the full treatment condition.

Friction

External barriers (e.g., effort) that make performing a behavior more difficult (Wood, 2019). To DECREASE an unwanted behavior: add friction. To INCREASE a desired behavior: remove friction.

Health Belief Model (HBM)

Rosenstock (1960). Four factors that influence participation in preventive health behaviors: (1) Perceived susceptibility: beliefs about the degree of health threat; (2) Perceived severity: beliefs about the consequences of the illness; (3) Perceived benefits of behavior change: belief that engaging in the behavior will reduce the health threat; (4) Perceived barriers to behavior change: beliefs about obstacles to engaging in the behavior. Additional concepts: cues to action (any reminder about a health problem or behavior) and self-efficacy (belief in one's ability to execute a behavior).

Theory of Planned Behavior (TPB)

Fishbein and Ajzen (1975). Behaviors are determined by behavioral INTENTIONS. Intentions are determined by: (1) Attitudes: feelings about engaging in the behavior; (2) Subjective norms: beliefs about whether important others would support the behavior and what other people are doing; (3) Perceived behavioral control: the extent to which a person believes they can engage in the behavior. Limitation: the intention-behavior gap — intentions do not always predict behavior.

Implementation intentions

Specific plans for WHEN, WHERE, and HOW one will engage in a behavior. Addresses the intention-behavior gap in the Theory of Planned Behavior.

Transtheoretical Model (TTM)

Prochaska and DiClemente (1983). Behavior change is a complex, non-linear process (spiral change that includes relapse). Six stages: (1) Precontemplation: no intention to change; (2) Contemplation: beginning to consider change; (3) Preparation: commitment to change; (4) Action: starting to engage in new behavior; (5) Maintenance: change is sustained over time; (6) Termination: no longer much risk of relapse.

Most important component of health behavior models

Self-efficacy (the belief that one can actually execute a behavior) appears across all major health behavior models (HBM, TPB as "perceived behavioral control," and social cognitive theory) and is consistently a strong predictor of behavior change.

Primary, secondary, and tertiary prevention

Primary: taking measures to PREVENT illness from occurring. Secondary: detecting or treating illness at an EARLY STAGE to reduce its potential effects. Tertiary: actions taken to MINIMIZE OR SLOW THE DAMAGE caused by an illness that has already developed past an early stage.

Prospect theory: loss-framed vs. gain-framed messages

Tversky and Kahneman (1981). Decisions are affected by how messages are presented and the type of behavior targeted. For SCREENING/DETECTION behaviors (risky): loss-framed messages (emphasizing costs of not acting) are most effective. For PREVENTION behaviors (not risky): gain-framed messages (emphasizing benefits of acting) are most effective. Examples: Meyerowitz and Chaiken (1987) — BSE pamphlets; Detweiller et al. (1999) — sun-protective behaviors at the beach.

Fear appeals: when do they work?

Fear-based messages are most effective when they: (1) induce a MODERATE level of fear, (2) provide a SPECIFIC strategy for change, (3) focus on short-term consequences, and (4) include an image of having the particular condition. Example: Leventhal (1965) — tetanus shots study: fear + specific strategy > fear alone. Problem: high anxiety leads to impaired cognitive processing.

Behavioral nudges

Interventions that aim to promote positive behaviors WITHOUT limiting choice (Thaler and Sunstein, 2009). Example: Dai et al. (2021) COVID vaccine intervention — sent text message reminders with scheduling links, messages creating psychological ownership ("the vaccine has just been made available for you"; "claim your dose"), and/or videos challenging misperceptions about the vaccine.

Nicotine regulation model

Leventhal and Cleary (1980) — an extension of the fixed-effect model. Nicotine level must be ABOVE the body's "set-point" for nicotine to provide pleasurable effects. If nicotine drops below the set-point, withdrawal occurs. Smokers compensate: when given lower-nicotine cigarettes, they take more and bigger puffs to maintain nicotine levels (Strasser et al., 2007). The fixed-effect model (also Leventhal and Cleary, 1980) states that nicotine increases action of neurotransmitters that enhance pleasure, physical relaxation, and mental alertness.

Affect-regulation model of smoking

People smoke to INCREASE positive affect OR DECREASE negative affect. Positive affect: smoke to enhance pleasure. Negative affect: smoke to cope with anxiety, stress, and tension. Evidence: Schachter et al. (1977) — smokers under high stress (strong shock) took more puffs than those under low stress (mild shock). McEwen et al. (2008) — smokers at a cessation clinic rated stress relief and negative-affect reduction as primary reasons for smoking.

Social influence programs to prevent smoking

Targeted at high-risk groups (adolescents). Components: (1) provide education about SHORT-TERM negative effects of smoking; (2) highlight peer attitudes AGAINST smoking; (3) use role models.

Stimulus control (smoking cessation)

A self-management technique: identifying and modifying environmental cues (stimuli) that trigger the urge to smoke to break the conditioned association.

Response substitution (smoking cessation)

A self-management technique: replacing the smoking behavior with a healthier alternative behavior when the urge to smoke arises.

Contingency-contracting (smoking cessation/behavior change)

A self-management technique: establishing a formal agreement (contract) that provides rewards for meeting behavioral goals and/or consequences for not meeting them.

Alcohol myopia

Alcohol causes behavior to be influenced by the most SALIENT cues rather than the most important or relevant ones (behavioral disinhibition — reduced association between attitudes and behavior). MacDonald et al. (1995): intoxicated participants had HIGHER intentions to drink and drive when asked a contingent question ("If I only had a short distance to drive…") than a non-contingent question ("I would drive while intoxicated"), because the short distance became the most salient cue.

Tension-reduction theory (alcohol)

People drink to COPE WITH NEGATIVE EMOTIONS (reduce tension). Hull and Young (1983): High self-conscious individuals drank significantly more wine after receiving negative feedback than positive feedback. Self-consciousness moderated the effect of negative feedback on wine consumption. Limitations: mixed support, only explains some drinking, focuses on negative emotions and ignores positive emotions.

Pluralistic ignorance (Prentice and Miller, 1993)

Pluralistic ignorance: the assumption that one's own attitudes and beliefs differ from those of others, despite engaging in the same behaviors. Prentice and Miller (1993): students believed there was too much alcohol use on campus BUT believed other students approved of the amount — so individuals privately disagreed with drinking norms while publicly conforming to them.

Alcohol intervention program components

(a) Providing information about the consequences of alcohol use; (b) Skills training — providing strategies for decreasing alcohol use (e.g., how to drink in moderation); (c) Challenging expectations about alcohol (e.g., using real or placebo alcohol to disprove myths); (d) Social influence — challenging perceptions about others' alcohol use (e.g., providing accurate information about actual peer use). Public policy approaches: drinking age laws, limits on when and where alcohol can be purchased.

Antabuse

A classical conditioning (aversion therapy) treatment for alcohol use disorder. When a person taking Antabuse consumes alcohol, it produces a severe, unpleasant physiological reaction, creating a conditioned aversion to alcohol. Also used: Emetine.

BMI problems (Tomiyama et al., 2016)

BMI (weight in kg divided by height in meters squared) is problematic because: a substantial percentage of people classified as overweight or obese are metabolically HEALTHY, and a substantial percentage of normal-weight people are metabolically UNHEALTHY (Tomiyama et al., 2016). A more accurate measure is percentage of body fat.

Fat distribution and health (apples vs. pears)

Distribution of fat matters more than total fat. Waist-to-hip ratio is the key measure. Abdominal (central) fat — "apple" body shape — is associated with greater disease risk than gluteal (peripheral) fat — "pear" body shape. Cortisol affects abdominal fat cells more than gluteal fat cells, explaining the stress-obesity-disease link.

Set-point theory

The body seeks to maintain a certain weight. If caloric intake decreases, metabolism SLOWS. If caloric intake increases, metabolism INCREASES. Genetic factors may influence metabolism — Levine et al. (1999): "normal-weight" participants consumed 1000 extra calories per day for 9 weeks and showed a large range in weight gain, suggesting metabolic differences.

Internal-external hypothesis

Individuals (especially those prone to overeating) use EXTERNAL cues (e.g., food taste, smell, variety) rather than INTERNAL cues (hunger and satiety) to determine when to eat.

Mood regulation theory (stress/comfort eating)

Food is used to MANAGE MOODS (stress, anxiety, depression). Rutters et al. (2009): all participants were full, stress was induced, and snacks were offered — stress led to higher food consumption, demonstrating eating in the absence of hunger.

Restraint theory

People restrict the amount and type of food they eat in an attempt to lose weight, but this can backfire. Herman and Mack (1975): after consuming milkshakes (a "diet violation"), dieters ate MORE ice cream than non-dieters (disinhibition effect). Tomiyama et al. (2009): restrained eaters who consumed a milkshake on day 7 showed disinhibition (ate more) rather than compensation. Tomiyama et al. (2010): restricting food intake increased cortisol; monitoring food intake increased subjective stress.

Why diets often fail

(1) One-third to two-thirds of dieters regain more weight than they lost (Mann et al., 2007); (2) Weight cycling is unhealthy; (3) Dieting increases stress — food restriction increases cortisol and monitoring increases subjective stress (Tomiyama et al., 2010); (4) Set-point mechanisms: metabolism slows with reduced intake; (5) Disinhibition: diet violations can trigger overeating.

Ways of non-adhering to medical recommendations

Failure to keep scheduled appointments; failure to take full dose; taking other medications not prescribed; failure to take medication at correct intervals; taking expired medications; creative/intelligent/rational nonadherence (intentionally modifying the regimen).

Average rate of nonadherence

25

Causes of nonadherence

Cost; Patient factors (forgetting, failure to understand, not believing in treatment efficacy, anxiety, depression, low self-efficacy, environmental factors, social support, culture); Treatment factors (long-term treatment, complex treatment, interference with activities, aversive side effects, low perceived benefit or efficacy); Physician-patient communication (lack of clarity in instructions — e.g., "Take 1 tablet in the morning and 1 at bedtime" is better understood than "take 1 tablet twice daily" — Wolf et al., 2016).

How to increase adherence

Physician communication training → better patient adherence (Haskard Zolnierek and DiMatteo, 2009, meta-analysis); physician training → better adherence; clear written materials and tape recordings of visits; reminders; simplifying regimens; physician nonverbal behavior — forearm touch by physician → more pills taken and higher perceived competence and concern (Guéguen et al., 2010); increasing positive affect in hypertension patients → higher adherence (Ogedegbe et al., 2012).

Importance of patient history in diagnosis

Sir William Osler: "Listen to your patient, he is telling you the diagnosis." According to the slides, 56

Frequency of physician interruptions

Beckman and Frankel (1984) studied the opening segments of medical visits. Updated research (Singh Ospina et al., 2018) found the average time to first physician interruption is 11 SECONDS.

Patient understanding of medical terms

Very poor. Samora et al. (1961): a list of common medical terms was shown to patients — none were correctly identified by every patient, and no patient was able to accurately identify every term. Engel et al. (2009): 78% of people discharged from the ER did not understand their discharge instructions. Physicians use "medspeak" (medical jargon) to allow efficient communication, show competence, and create distance from the patient.

Talbot (2000): warm/empathic vs. cold/aloof anesthesiologist

Study of "bedside manner" — a physician's ability to instill trust and respond to patients' emotional needs. An anesthesiologist visited patients before surgery in either a warm/empathic or cold/aloof manner. DVs measured: pain medication use and time to discharge. The warm/empathic anesthesiologist produced better patient outcomes (lower pain medication use and shorter time to discharge).

Haskard et al. (2008): communication training for physicians

Communication training and coaching for physicians. DVs: patient satisfaction and information giving. Improved physician communication → improved patient satisfaction and information giving. (See also: Haskard Zolnierek and DiMatteo, 2009 meta-analysis — physician communication and physician training both predict better patient adherence.)

Pain as a subjective experience

Pain is considered subjective because: (1) it is NOT necessarily directly associated with tissue damage — two people with identical injuries can experience very different pain levels; (2) it is influenced by psychological, social, and cognitive factors; and (3) it is beneficial to health and survival (signals damage).

Acute vs. chronic pain

Acute pain: intense but TIME-LIMITED. Chronic pain: lasts LONGER THAN 3 MONTHS — can be intermittent or constant, and mild or severe.

Pain threshold vs. pain tolerance

Pain threshold: the point at which a person FIRST PERCEIVES a stimulus as painful. Pain tolerance: the point at which a person is NOT WILLING to accept stimulation of a higher magnitude. Variations in reactions to pain across individuals are related to TOLERANCE rather than threshold (e.g., Beecher's soldiers vs. civilians).

Gate control theory (Melzack and Wall, 1982)

A theory of how psychological factors can influence pain perception. Pain messages traveling to the brain are modulated by a neural "gating" mechanism that determines how much information is transmitted from the spinal cord to the brain. The gate can be OPENED OR CLOSED by the brain (e.g., through distraction) or by competing sensations. Counterirritation is a competing sensation that closes the gate. Some signals are blocked before reaching the brain.

Counterirritation

A competing sensation that can block or reduce pain by closing the neural gate (per gate control theory). Example: rubbing a painful area creates a competing sensation that reduces perceived pain.

Yoshino et al. (2010): emotion and pain

An fMRI study. Pain was induced via electrical shocks; mood was induced via pictures of faces. DVs: subjective pain rating and activity in brain regions associated with pain. Emotional state influenced both subjective pain experience and neural activity in pain-processing brain regions (negative mood increases perceived pain and pain-related brain activation).

Beecher's observations of soldiers vs. civilians

Variations in reactions to pain are related to TOLERANCE rather than threshold. Dr. Henry Beecher observed that soldiers with serious injuries often requested LESS pain medication than civilians with similar injuries, because the injury had DIFFERENT MEANING — for soldiers, the wound represented escape from the battlefield (positive meaning), whereas for civilians, injury is purely negative. Context and meaning shape pain tolerance.

Why patients take less than effective pain medication doses

Physicians' reluctance: pain management is not addressed extensively in medical training; fear of patient addiction. Patients' reluctance: belief they should bear the pain; concern about side effects; cost; fear of addiction.

Relaxation, distraction, and meditation for pain

These are cognitive methods for pain management. Imagery, relaxation, distraction, and meditation can all reduce pain experience. They work by "closing the gate" in gate control theory terms — distraction and cognitive engagement compete with pain signals and reduce the amount of pain information transmitted to the brain.

Cherkin et al. (2016): mindfulness and pain

Patients with lower back pain were randomly assigned to one of 3 conditions: Mindfulness-Based Stress Reduction (MBSR), Cognitive-Behavioral Therapy (CBT), or usual care. DVs: functional limitation and pain intensity. Both MBSR and CBT were more effective than usual care at reducing functional limitation and pain intensity.

Jackson et al. (2005): thoughts about pain and pain tolerance

Participants randomly assigned to receive threatening information about pain, reassuring information about pain, or a control condition; then completed a cold pressor task (DV = pain tolerance). Threatening information about pain DECREASED pain tolerance; reassuring information INCREASED pain tolerance — demonstrating that cognitions and thoughts directly affect pain experience.

Master et al. (2009): pain and social support

Participants rated pain during 7 conditions: held a partner's hand, a stranger's hand, or an object; looked at a picture of a partner, a stranger, or an object; or a control condition. DV: pain rating. Holding a ROMANTIC PARTNER'S hand reduced pain ratings most effectively, followed by seeing a picture of the partner — demonstrating that social support (even symbolic) reduces pain.

Bandura et al. (1987): cognitive control training and pain tolerance

Using the cold pressor test, participants were randomly assigned to: cognitive control training, placebo-pill, or control. The COGNITIVE CONTROL condition showed the highest pain tolerance. The identified mechanism was ENDORPHIN RELEASE — cognitive coping triggers endorphin release, which increases pain tolerance.

Bandura et al. (1987): testing the endorphin mechanism

To test whether endorphins are the mechanism: participants in the cognitive control condition received either naloxone (an endorphin ANTAGONIST that blocks endorphins) or saline (placebo injection). Cognitive control participants who received SALINE had MUCH HIGHER pain tolerance than those who received NALOXONE — confirming that the benefit of cognitive coping is mediated by endorphin release.