health models etc.

Biopsychosocial model/perspective

• Health, illness, and human wellbeing are the result of a dynamic interaction between biological, psychological, and social factors

• Largely a monist view

Biomedical model

• Health = absence of disease

• Focuses on physical pathology

• Doctor treats disease

• Reductionist

Broader biomedical model

• As biomedical model but includes social engagement and activity

• Being physically healthy and staying socially active are both important

Social functioning model

• Focuses on social relationships and interactions

• Includes the nature and frequency of social activities, social networks, and available social support

Psychological resources model

• Focuses on personal psychological strengths that help people age successfully

• Includes optimism, self-efficacy, sense of purpose, coping and problem-solving skills, self-confidence, and self-worth

Lay model

• Based on the above variables plus socio-economic variables of income and ‘perceived social capital’, which included access to resources and facilities, environmental quality and problems

• Strongest prediction of QoL

Hierarchy-Health Hypothesis

• Being aware of one’s lower social position and relative lack of resources can cause stress and negative emotions, even beyond the effects of absolute poverty

• Basically, the relative disadvantage, not just the amount of money a person has, can affect health

Behaviourism

• The belief that psychology is the study of observables and therefore that behaviour, not mental processes, is central

Social learning theory

• Observational learning (Bandura):

  • People learn behaviours, attitudes, and emotional reactions by observing and imitating others.

• Expectancy-value approach (Rotter):

  • Behaviour is shaped by the expectation of an outcome and the value placed on that outcome

  • Reinforcement influences future behaviour

Conditioning theory

• The theory that behaviour is directly influenced by its consequences, positive and negative

Pain Medication-Attitudes-Questionnaire

• A self-report tool designed to measure a patient's beliefs, concerns, and attitudes regarding analgesic (pain) medications

• Seven groups of concerns:

  o   Addiction

  o   Withdrawal

  o   Side effects

  o   Mistrust in doctors

  o   Perceived need for medication

  o   Scrutiny from others

  o   Worries about tolerance

Self-Determination Theory (SDT)

• Proposes that all humans have three basic psychological needs

  • When these needs are met, people experience optimal functioning and mental health

• Three needs:

  • Autonomy

  • Competence

  • Relatedness

• Intrinsic and extrinsitc motivation

3 component model of attitude(-object)

• Cognitive

o   Beliefs about the attitude-object

o   E.g. exercise is good to relieve stress/is expensive

• Emotional

o   Feelings towards the attitude-object

o   E.g. exercising is embarrassing/fun

• Behavioural (or intentional)

o   Intended action towards the attitude-object

o   E.g. I am/am not going to exercise

Health Belief Model (HBM)

• Proposes that the likelihood that a person will engage in particular health behaviours depend on demographic factors (e.g., social class, gender, age)

• and upon four beliefs that may arise following a particular internal or external cue to action:

  • Perceived severity

  • Perceived susceptibility

  • Perceived benefits

  • Perceived barriers

  • + cues to action

  • + health motivation

• Provides a solid framework for understanding one-time, analytical preventive health actions (e.g. cancer screening)

• However, it struggles to account for complex, socially driven, addictive behaviours (e.g. binge drinking)

Theory of Planned Behaviour (TPB)

• A psychological model that explains how human actions are guided by intentions

• Main components:

  • Attitude towards the behaviour (“smoking is bad for my health”)

    • Outcome expectancies (positive and negative)

    • Perceived subjective norm (“my friends and parents do not smoke and really want me to stop smoking”)

    • Motivation to comply (“I would like to please my friends and parents”)

  • Perceived behavioural control (“it is up to me and I believe I can”)

    • Intention: “I am going to stop smoking”

    • Internal and external

Trans-Theoretical Model (TTM)

• An integrative framework that describes how people modify a problem behaviour or acquire a positive one over time

• It assumes that people move through stages of change; and that the processes involved at each stage differ and are independent

  • Pre-contemplation

    • Not considering change

  • Contemplation

    • Considering change but without though about its exact nature or how it can be achieved

  • Preparation

  • Action

  • Maintenance

• Two additional stages:

  • Termination

  • Relapse

Precaution Adoption Process Model (PAPM)

• Gives greater consideration to the pre-action stages of TTM

• Theorises that those at Stage 3 (preparation) may be more open to information and persuasion than those with a definite stance (as in Stage 4 or 5; action or maintenance)

  • Those with a definite stance may benefit more from how to maintain a health behaviour

Health Action Process Approach (HAPA)

• Explains how people move from first thinking about a healthy habit to actually doing it and keeping it up over time

• Different types of self-efficacy

  • Specific self-efficacy

  • Task/pre-action self-efficacy

  • Initiative/action self-efficacy

• HAPA distinguishes between task (pre-action), maintenance/coping, and recovery self-efficacy

  • These refer to confidence in being able to start a behaviour, maintain it despite difficulties, and return to it after a setback

PRECEDE-PROCEED model

• One of the best-known frameworks for supporting the decision of which behaviours to address and how best to address them

• Psychosocial variables that could be the target of any intervention:

  • Predisposing factors

    • Knowledge, attitudes, beliefs, personal preferences, existing skills, and self-efficacy in relation to desired behaviour change

  • Enabling factors

    • Characteristics of the environment that may facilitate behavioural change and the skills or resources required to achieve change

  • Reinforcing factors

    • Factors that reward or reinforce desired behaviour change, including social support, economic rewards, and social norm

Elaboration Likelihood Model (ELM)

• Suggests that attempts to motivate people who are uninterested in a particular issue using rational arguments will not work; nor will they succeed if the arguments for change are weak

• Only those individuals with a pre-existing interest in the issue attend to such process’ messages if they are ‘motivated to receive an argument’ when:

  • It is congruent with their existing beliefs

  • It has personal relevance to them

  • They have the intellectual capacity to understand the message

• Two routes in the ELM

  • Central route

    • Technical message about health gains that can be achieved following exercise

  • Peripheral route

    • E.g. images associated with exercise that will appeal to the target audience, such as making friends while engaging in gentle exercise and wearing attractive clothes at the gym

Protection Motivation Theory (PMT)

• Suggests that individuals will respond to information in either an adaptive or maladaptive manner depending on their appraisal of both the threat and their own ability to minimise that threat (their self-efficacy judgements)

  • An individual is most likely to behave in an adaptive manner in response to a fear-arousing health message if:

    • They have evidece that engaging in certain behaviours will reduce any threat

    • They believe they are capable of engaging in them

Information-Motivation-Behaviour model

• Psychological framework to guide the development of interventions

• Identifies three primary constructs that influence behaviour change:

  • Information and knowledge about the behaviour

  • Degree of motivation to perform the behaviour

  • Having the behavioural skills necessary to perform the behaviour

COM-B model

• ‘Behaviour system’ to understand why people do or do not perform a specific behaviour, incorporating three, interactive, elements:

  • Capability (e.g., knowledge, skills, confidence)

  • Opportunity (i.e. all factors that lie outside the individual)

  • Motivation

• The model does not take into account the ‘level’ of influence within the model and does not restrict its focus on obviously intra-individual factors (specifics)

  • E.g. opportunity may be influenced by a range of factors, many of which are environmental, financial, or social

Behaviour change wheel

• To understand why people behave the way they do and how to systematically design effective behaviour change interventions

• Three movable parts:

  • Outer ring

    • Addresses a range of policy approaches to changing behaviour

  • Middle ring

    • Addresses broad strategies of change that may be used across these various policy areas (e.g. environment)

  • Inner ring

    • Addresses the elements of the COM-B system that can be influenced by each of the outer ring elements

Primary Attentional System (PAS)

• Attentional system (Brown, 2004)

• Operates below the level of consciousness and acts on stored representations such as illness schema

• When someone pays extra attention to their body, they may automatically interpret normal sensations as symptoms of an illness

• Example: A medical student learns about a disease and starts noticing similar symptoms in themselves

Secondary Attentional System (SAS)

• Involves conscious attention and control

• Attention can be influenced by deliberate thoughts and cognitive processes

• Example: Consciously focusing on something else instead of worrying about a bodily sensation

Self-identity theory

• Emphasises the importance of social identity

• Proposes that the interpretation of symptoms differs depending on a person’s current salient social identity

• Example athlete: when their athlete identity was made more important, they were more concerned about threats to their physical ability

• Overall, the identity that is most noticeable at the time can affect which parts of an illness or injury seem most threatening

The common-sense model of illness

• Explains how people notice bodily symptoms, interpret them using what they already know about illness, and decide how to respond

• Suggests that people develop mental representations (prototypes) of illnesses based on their previous experiences, observations, information from others, and social comparison

• Also explains why people can misinterpret symptoms when it does not fit someone’s prototype of an illness

• A dual-process model -> how people think, make decisions, and process information (fast and intuitive” versus “slow and deliberative”)

• A self-regulation model -> people actively regulate their behaviour in repose to their interpretation of their illness

• Feedback loop

Illness Perception Questionnaire (IPQ)

• A psychometric tool used to measure a patient’s cognitive and emotional representations (or beliefs) about an illness or health threat

• Assesses the five constructs (i.e. identity, cause, timeline, consequences, controllability/cure)

• IPQ_R (revised):

  • Control: separates how much people think they can control their illness, how treatment can help, and what outcomes they expect

  • Timeline: measures whether people see their illness as short-term, long-term, or coming and going in cycles

  • Emotions: measures emotional reactions to the illness, such as fear and anxiety

  • Illness coherence: measures how well people feel they understand their illness

Three-Talk Model

• Explains how to structure shared decision making in three stages

  • Team talk

  • Option talk

  • Decision talk

SPIKES model

• Describes six steps healthcare professionals should follow when giving bad news to a patient

• Setting up the interview; assessing the patient’s Perception; obtaining the patient’s Invitation; giving Knowledge and information; addressing the patient’s Emotions with empathetic responses; Strategy and Summary

Necessity-Concerns Framework

• Mainly addresses intentional non-adherence

  • This is because it focuses on the patient’s deliberate decision-making: they weigh how necessary they believe the medication is against their concerns about taking it

• Ilness and treatment beliefs

Social Readjustment Rating Scale (SRRS)

• Scale to measure stress by identifying and scoring major life events that require an individual to make adjustments

• Life Change Units (LCUs)

Limitations:

• Retrospective reporting

  • Individuals recall and document behaviours, symptoms, thoughts, or events after they have already occurred

  • Many studies asked people who were already ill to recall past life events

  • Relying on a patient's memory, self-report, or pre-existing medical/chart records

• Limited applicability

• Life events can interact

• Vague and ambiguous items (events can have different meanings and consequences)

• Individual differences questionable reliability

• Correlation does not prove causation

Cognitive transactional model of stress (Lazarus)

• Suggests that stress depends on how a person appraises a situation (primary) and evaluates their ability to cope with its demands (secondary)

• Two appraisal processes:

  • Primary appraisal

    • Harm/loss, threat, challenge

      • Two assessments:

        • Motivational relevance

        • Motivational congruence

  • Secondary appraisal

    • Coping:

      • Internal.external accoutability

      • Problem-focused coping potential

      • Emotion-focused coping potential

      • Future expectancy concerning situational change

• Weaknesses:

  • Circular reasoning (tautology)

  • Uncertainty about the importace of primary and secondary appraisals

  • Difficulty determining the relationship between appraisals and emotions

  • Difficulty establishing the order of events

  • Incinsistent research findings

Conversation of resources model of stress

• Proposes that people try to obtain, protest, and preserve resources they value, including:

  • Material resources

  • Social resources

  • Personal resources

  • Energy and time

• Proposes that stress occurs when:

  • A person experiences an actual loss of resources

  • Their resources are threatened with loss

  • They invest resources byt fail to gain an adequate return

• Resources loss can also create a cycle in which people with fewer resources find it increasingly difficult to recover from further losses

Yerkes-Dodson law

• Proposes that the relationship between arousal and performance follows an inverted U-shaped curve

  • Too little arousal

    • A person may lack motivation, alertness, or concentration

  • Moderate arousal

    • Performance is generally optimal

  • Too much arousal

    • Anxiety and stress interfere with attention, memory, and concentration

Karasek’s Job Demand-Control (JDC) model

• Four important job features leading to stress:

  • Demand

    • The amount and intensity of work

  • Control

    • The degree of autonomy and influence employees have over how they perform their work and make decisions

  • Predictability

    • How far employees know what to expect and can anticipate future work demands

  • Ambiguity

    • Uncertainty about job responsibilities and what is expected of an employee

• Initially, researchers thought that control acted as a buffer against job demands

  • Instead, the evidence suggested that job demands and control generally have independent direct effect on stress outcomes

Effort-Reward-Imbalance model

Proposes that stress occurs when the effort a person puts into their work is not adequately matched by the rewards they receive

Fight-or-flight model of stress

• Explains the body’s immediate physiological response to a perceived threat

• When a person perceives danger, the sympathetic nervous system activates the body and stimulates the release of adrenaline and noradrenaline

General Adaption Syndrome (Selye)

• Proposes that the body responds to prolonged stress through three stages:

  • Alarm reaction

    • Body detects stressor and activates its defence systems

    • Sympathetic nervous system -> body prepares to respond to the threat

  • Stage of resistance

    • If the stressor continues, the body attempts to adapt

    • Physiological arousal remains above normal, although it may be lower than during the alarm stage

    • The body uses resources during the alarm stage

  • Stage of exhaustion

    • If stress continues for too long, the body’s resources become depleted and its ability to resist the stressor declines

    • Vulnerability to illness increases

• Main problems:

  • It suggests that different stressors produce essentially the same bodily function

  • Individual differences not adequately accounted for

  • Stress responses are not limited to fight-or-flight behaviour

Perceived Stress Scale (PSS)

• Self-report questionnaire method of measuring stress

• Measures how frequently people perceive their lives as stressful

• Advantages

  • Relatively quick and cheap

• Disadvantages

  • Responses can be affected by mood, memory, interpretation, and social desirability

General Health Questionnaire (GHQ)

• Psychological symptoms method of measuring stress

• Assesses psychological distress and related symptoms

• Advantages

  • Measures effects such as anxiety, depression, insomnia, and distress

• Disadvantages

  • Symptoms may have other causes than stress, making it difficult to establish what caused them

Broaden-and-build-theory

• Positive emotions broaden a person’s thoughts and possible actions, and build lasting personal resources

  • Broaden

    • Positive emotions, such as joy, pride, and satisfaction, expand the range of thoughts and actions a person considers

    • Negative emotions tend to narrow attention and possible responses

  • Build

    • The broadened thinking and behaviour help people develop lasting resources over time, creating an upward spiral of positive emotions and personal growth

• Resources:

  • Intellectual → learning new information and developing problem-solving skills

  • Physical → developing strength and coordination

  • Social → strengthening existing relationships and forming new ones

  • Psychological → developing resilience, optimism, and a sense of identity

PERMA model

• Describes five elements of wellbeing

  • P – positive emotions

  • E – engagement

  • R – relationships

  • M – meaning

  • A – accomplishment

• These elements help build resilience and help people cope with stress

• Positive emotions can improve coping, positive relationships provide social support, and engagement and meaningful goals can help people manage stress

• Wellbeing may also benefit physical health through healthier behaviours and biological processes, although the evidence for some of these pathways remains limited

Direct (main) effects hypothesis

• Social support benefits health regardless of how much stress a person experiences

• Supportive relationships provide belonging, self-esteem, and positive experiences, and can encourage healthier behaviours

Buffering hypothesis

• States that resources, such as social support, community cohesion, or personal coping mechanisms, can protect or "buffer" a person from the harmful physical and mental health consequences of major stress (most visible in high-stress events)

• Social support protects (buffers) people particularly when they experience high levels of stress; it can work in two ways:

  • Changing appraisals

    • Social support makes a stressful situation seem more manageable because the person feels they have resources available

  • Improving coping

    • Social support helps the person respond more effectively to the stressor

      • E.g. through advice, practical help, or encouragement

Self-instruction training (Meichenbaum)

• Targets conscious, automatic negative thoughts (surface cognitions)

• Individuals learn to interrupt stress-provoking thoughts and replace them with positive self-talk or coping thoughts

• Two types of coping thoughts:

  • Reminders

    • Remind yourself to use stress-management techniques

  • Reassurance

    • Remind yourself that you have successfully dealt with similar situations before

• These thoughts should be practised beforehand so they can be used during stressful situations

Cognitive restructuring (Beck)

• Involves identifying and challenging the accuracy of stress-provoking thoughts

• Individuals learn to treat beliefs as hypotheses rather than facts and evaluate whether they are realistic

• Uses the Socratic method (guided discovery), in which a therapist helps the individual question their thoughts by asking:

  • What evidence supports or contradicts my assumption?

  • Are there alternative ways to interpret this situation?

  • Could I be making a mistake in my thinking?

• The goal is to replace irrational or exaggerated thoughts with more realistic interpretations

Stress-inoculation training

• A form of stress-reducing intervention in which participants are taught to control stress by rehearsing prior to going into stressful situations

• Participants are taught to relax and use calming self talk

• People are taught to control three things when facing a stressful situation:

  • Behaviour

  • Relaxation

  • Self-talk

• They also learn three steps:

  • Before the stressful event

    • Anticipate the situation and rehearse the coping strategies

  • During the event

    • Apply the planned behavioural, relaxation, and cognitive strategies

  • After the event

    • Reflecting on what happened and learn from success and failures rather than viewing them as complete triumphs or disasters

Mindfulness-Based Stress Reduction (MBSR)

• Instructions during mindfulness exercises:

  • Focus attention on the present moment and the specific target (e.g. breathing or walking)

  • Observe thoughts, emotions, and physical sensations without judging them

  • When the mind wanders, briefly acknowledge the thoughts or memories and gently return attention to the present moment

  • Do not try to suppress or change unwanted thoughts

  • Recognise that thoughts, emotions, and sensations are temporary and pass like waves in the sea

Acceptance Commitment Therapy (ACT)

• Assumes that psychological events (thoughts, emotions, and behaviours) are shaped by classical and operant conditioning

  • Rooted in radical behaviourism

• It does not see thoughts and feelings as behaviours that need to be directly changed

  • Instead, change is achieved by modifying contextual factors and directly changing behaviour

• In other words, rather than trying to control internal experiences, individuals learn to accept them and change how they respond to situations

• Goal: to increase psychological flexibility

• Five processes:

  • Acceptance

  • Cognitive diffusion

  • Contact with the present moment

  • Values

  • Committed action

Generic model of emotional coping

• Has four phases that individuals go through when being confronted with a chronic disease:

  • Uncertainty

  • Distruption

  • Striving for recovery

  • Restoration of Wellbeing

• Similar to the three stages following cancer diagnosis

  • Disbelief, denial, and shock

  • Dysphoria

  • Adaption

Coping with the crisis of illness model

Three processes:

• Cognitive appraisal

  • The individuals appraises what the illness means for their life and how it affects them

• Adaptive tasks

  • The challenges/illness-specific tasks that individuals need to manage when living with a chronic illness

• Coping skills

  • Different coping strategies to deal with these challenges:

    • Appraisal-focused coping (changing interpretation)

    • Problem-focsed coping

    • Emotion-focused coping

Self-regulation model (based on self-regulation theory)

• A psychological framework that describes how people monitor and adjust their own thoughts, emotions, and behaviours to reach personal or social goals

• According to this theory, goal disturbance influences QoL alongside how people appraise the situation, their expectations about the outcomes, available resources, and coping strategies

  • E.g. after a heart-attack, being unable to fulfil responsibilities towards others or enjoy activities can lead to anxiety, depression, and lower HRQoL

• Therefore, understanding which goals are important to someone, and how illness affects their ability to achieve them, helps explain how they evaluate their QoL

Schedule for Evaluating Individual QoL (SEIQoL)

• An individualised measure of QoL

  • Individuals identify the five most important areas of their life that currently determine their QoL

  • They rate their current level of functioning in each area

  • They assign a weighting to each area according to how important it is to them

  • They rate how satisfied they are with each area

• This produces an individual QoL assessment based on what matters most to that person

Cognitive adaptational model

• Explains how people psychologically adjust when facing major, threatening life events, such as being diagnosed with a chronic illness (e.g. cancer)

• Three tasks:

  • Searching for meaning

  • Gaining a sense of control or mastery

  • Restoring self-esteem

Congenital Universal Insensitivity to Pain (CUIP)

• A condition in which someone is born unable to experience pain, despite apparently intact pain pathways

• The danger is that pain normally acts as a warning signal; people with CUIP may:

  • Fail to notice injuries, burns, or fractures

  • Fail to recognise serious illnesses

  • Continue harmful activities without realising they are demining themselves

• Consequently people with CUIP often die at a young age

5 D’s of pain reward

• Dramatisation

  • Exaggeration of pain complaints

• Disuse

  • Inactivity and reduced physical functioning

• Drug misuse

  • Over-medication in response to pain behaviour

• Dependency

  • Reliant on others and learned helplessness

• Disability

  • Physical disability resulting from inactivity

Specificity theory

• Biological pain theory

• Different types of sensory nerves respond to different sensations

• Pain receptors transmit signals to a pain centre in the brain

• Pain is understood as a direct response to physical stimulation or damage

Patterns theory

• Pain occurs when the degree or pattern of nerve stimulation crosses a certain threshold

• Pain is determined by the intensity or pattern of stimulation rather than by a separate, specific pain receptor

Cold-pressure test

• Experimental procedure in which participants place their arm in ice-cold water, usually between 0 and 3 Celsius

• Researchers measure how long participants tolerate the painful stimulus

• It is used to investigate pain tolerance and the influence of psychological factors such as attention, mood, and perceived control

Gate control theory of pain

• Explains pain as the result of both physical and psychological processes

• The intensity of pain depends on whether the spinal pain gate is open or closed

• Physical factors and incoming pain signals:

  • A-delta fibres

    • Transmit information about sharp, brief pain quickly

  • C-polymodel fibres

    • Transmit information about dull, throbbing pain more slowly and or longer

    • Both transmit informtaion to the substantia gelatinosa in the spinal cord

    • Neurotransmiteers, including substance P, help transmit pain signals through this system

• When A-delta and C fibres activate the pain transmisstion system, they open the gate, allowing pain signals to travel toward the brain

• A-beta fibres transmit information about touch and gentle pressure

  • Rubbing an injured area activates these fibres

  • Their activity can inhitis the transmission of pain signals from A-dela and C fribres

    • This helps close the gate and reduce pain

Psychological:

• Information from the brain travels down the spinal cord and influences the gate

  • Anxiety, fear, depression, etc. can open the gate and increase pain

  • Calming thoughts, relaxation, optimism, etc. can close the gate and reduce pain

  • Emotional, cognitive, and physiological factors influence the release of endorphins which inhibit pain transmission and help close th gate

Visual analog scale (VAS)

• Measures pain intensity using a linear scale, typically ranging from 0 (no pain) to 100 (worst pain imaginable)

• Patients indicate how intense their pain is, and their score is recorded

• Advantages

  • Quick and easy to administer and score

  • Frequently used in clinical settings

• Limitations

  • Patients may find it difficult to express pain numerically

  • It only measures the sensation/intensity of pain, not its emotional, cognitive, or behavioural dimensions

McGill Pain Questionnaire (MPQ)

• Provides a multidimensional assessment of pain, measuring:

  • Type of pain

  • Emotional response

  • Intensity of pain

  • Timing of pain (e.g. continuous or intermittent)

• Is more comprehensive than simple pain scales, but it does not measure all behavioural responses of functional limitations caused by pain

Patient-controlled analgesia (PCA)

• Increasing patient’s sense of control method for treating acute pain

• Patients control the timing of analgesic medication through in intravenous system with dosage limit

Transcutaneous Electrical Feedback Nerve Stimulation (TENS)

• Uses a small electrical device connected to electrodes placed on the skin near the painful areas

• Electrical stimulation activates A-beta fibres, which compete with pain signals, and may stimulate C fibres to promote endorphin release

• Patients typically use the device for 15-20 minutes several times a day

• However, evidence for the effectiveness of TENS is generally weak and inconsistent

Cognitive-behavioural interventions (CBT)

• Also, like behavioural interventions, address the thoughts and beliefs that influence emotional and behavioural responses to pain

• Cognitions are considered central to the experience of pain and can influence how pain is perceived

• Three goals for CBT for pain:

  • Help patients change beliefs that their problems are unmanageable and become resourceful problem-solvers

  • Help patients identify the relationship between thoughts, emotions and behaviour, especially how catastrophising increases pain, distress, and psychological difficulties

  • Provide strategies to manage pain, emotional distress, and psychosocial difficulties by developing adaptive ways of thinking, feelings, and behaving

Acceptance and Commitment Therapy (ACT)

• Aims to help patients accept pain and live a meaningful life despite it, rather than trying to eliminate pain or control every unpleasant experience

• Main elements:

  • Acceptance

    • Willingly experience pain and unpleasant emotions without constantly struggling against or avoiding them

  • Cognitive diffusion

    • Learn to observe thoughts as thoughts rather than treating them as absolute truths

  • Being present

    • Focus on the present moment rather than worrying about future pain or dwelling on past experiences

  • Self-as-context

    • Recognise that the self is more than pain, thoughts, or emotions

    • Pain does not define the entire person

  • Values

    • Identify what is personally meaningful and important, such as relationships, work, or hobbies

  • Committed action

    • Continue engaging in meaningful activities despite pain, guided by personal values

• Does not primarily aim to reduce pain intensity

  • It aims to increase psychological flexibility, acceptance, and quality of life, so that pain has less control over the person’s behaviour and daily life

Cognitive-behavioural interventions (CBT)

• Psychological intervention for people with severe diseases with the purpose to reduce distress associated with having a severe condition

• Teach coping strategies such as problem-solving, cognitive restructuring, relaxation, and mindfulness

  • These help patients manage negative thoughts, emotions, and stress

Randomised controlled trial (RCT)

Randomly assigns participants to an intervention or control group

Stepped care

An evidence-based system for delivering healthcare—most commonly in mental health or chronic pain management—where the least intensive and least intrusive treatment that is likely to be effective is provided first

RAFT intervention

• Describes a group intervention addressing fatigue self-management through cognitive-behavioural approaches

• It was designed to teach patients strategies for managing rheumatoid arthritis-related fatigue

• Central to the RAFT intervention:

  • Cognitive-behavioural approach (CBT)

  • Social cognitive theory

    • People learn by observing others

• Boom-and-bust behaviour

  • Alternating between excessive activity and subsequent exhaustion/rest

    • RAFT aims to replace this pattern with better energy management

• Pacing

  • Balancing activity and rest to avoid overexertion and exhaustion

• Pragmatic trial

  • Evaluates whether an intervention works in real-world healthcare settings

Reflective-Impulsive Model (RIM)

• Explains how human social behaviour, decision-making, and social cognition are shaped by the interaction of two distinct mental systems

  • Impulsive system (IS)

  • Reflective system (RS)

• The two systems operate simultaneously and compete or cooperate to control behaviour

  • Therefore, behaviour can occur without a conscious decision (IS)

• Akrasia

  • Acting against one’s better judgement or values

  • E.g. knowing that drinking alcohol is harmful but still feeling compelled to drink

    • Knowing -> RS

    • Feeling compelled -> IS

Dual-process model

• Explains how people think, make decisions, and process information using two types of processing:

  • Fast & intuitive

  • Slow & deliberative

• The central idea is that people do not always think carefully and consciously

  • Sometimes information is processed automatically, while other times we consciously evaluate it

Dual-systems model

• Proposes that behaviour is driven by the interaction of two distinct neurobiological systems that operate differently and can independently influence behaviour

  • Impulsive system

    • Automatic and associative

    • Always active

    • Activates perceptions, feelings, and behavioural tendencies

    • Can directly produce behaviour

  • Reflective system

    • Deliberate and propositional

    • Requires cognitive capacity and attention

    • Evaluates information and makes decisions

    • Can influence behaviour through intentions

    • Operates most efficiently at intermediate levels of arousal

      • Yerkes-Dodson principle (ch11)

Cognitive Bias Modification (CBM)

• An intervention that tries to change automatic cognitive biases

  • Automatic approach tendencies toward alcohol can be trained, and this may influence drinking behaviour

• The researchers used two test:

  • Alcohol-AAT (Approach-Avoidance Task)

    • Automatic tendency to approach or avoid alcohol

  • IAT (Implicit Association Test)

    • Associations between alcohol and approach/avoidance concepts

• The alcohol-AAT was used for the CBM training

  • Measures automatic action tendencies

• The IAT was used to check whether the training effects also appeared in a different test

Incentive-motivational model of addiction

• Explains why alcohol-related cues can make people want alcohol

  • Someone repeatedly drinks alcohol in certain situations

  • They learn associations between alcohol-related cues and the rewarding effects of alcohol

  • These cues become conditioned stimuli

  • The cues become attractive and grab attention

  • They automatically activate approach tendencies

  • This increases the likelihood of seeking and consuming alcohol

Stimulus-Response Compatibility task (SRC)

• Measures how fast and accurately people react when a stimulus (like a word, colour, or picture) matches or conflicts with a physical response (like pressing a key or moving a lever)

• Participants see pictures of:

  • Alcohol-related stimuli.

  • Control stimuli, such as non-alcohol-related pictures.

• They must move a small figure called a manikin toward or away from the picture.

• The task measures automatic action tendencies through reaction times rather than asking participants directly whether they want alcohol

• Heavy drinkers were significantly faster to approach than avoid alcohol pictures

  • Did not show this difference for control pictures

• Light drinker did not show a significant difference between approaching and avoiding alcohol pictures

  • Also did not show a significant difference for control pictures