Health Psych Exam #3

Why do we focus on health behaviors?

Many chronic illnesses are caused or exacerbated by behavioral factors:

• physical activity

• Diet

• smoking habits or lack thereof

• Moderate alcohol consumption

• Regular checkups/screening

Preventative health behavior

any activity undertaken by an individual who believes himself to be healthy, for the purpose of preventing or detecting illness or accident.

Primary prevention

• the prevention of illness and diseases by increasing health promoting behaviors (regular physical activity, healthy diet, good quality sleep) and decreasing health damaging behaviors (heavy substance use, low physical activity, sleep deprivation).

Health behaviors examples

flu shots, engaging in safe sex, wearing seat belts, decrease smoking, drinking, and fatty foods.

Adherence

a person’s ability and willingness to follow recommended health practices; or the extent to which a person’s behavior coincides with medical or health advice.

• asking the patient

• asking the medical professional

• asking others who are around the patient, monitoring their medication use

• medical tests

Approximately 25% of patients do not adhere to medical advice from a medical professional

• taking medication has the highest rate of adherence

• lifestyle changes like getting more exercise have the lowest.

Barries to adherence

Cost

Time

Optimistic bias (“I have been smoking since I was ___, and I haven’t had any problems yet”)

Optimistic Bias

the cognitive tendency to overestimate the likelihood of positive future events and underestimate the likelihood of negative ones.

Adherence predictions

• Gender

• Age

• Race

• Ethnicity

• Amount of medication history (adherence drops 40% when patient already has 4+ doses of medication)

• Side effects from medication may prevent someone from wanting to adhere to new medication.

• Stress and emotional problems

• environmental factors (social support, income, cultural norms).

MORE RISK FACTORS = POORER ADHERENCE*******

Continuum Theories of Health Behavior

STRENGTHS:

• Has produced substantial amounts of research to help understand theories

• Identify beliefs that should motivate anyone to change his or her behavior

• All models are better than chance at predicting behavior

WEAKNESSES:

• Some theories are better at predicting intentions than behaviors

• Rely heavily on self-report

• Leave out important factors such as self- identity and emotions

The Health Belief Model (HBM)******

Hochbaum and colleagues - remains to be widely used- theorizes that people’s beliefs about whether they are at risk for a disease or health problem, and their perceptions of the benefits of taking action to avoid it, influence their readiness to take action

Health behavior factors to consider if someone will change their behavior.

Perceived susceptibility

Perceived severity

Cues to action

Perceived benefits

Perceived barriers.

Perceived susceptibility

YOUR belief about how likely is it that you will acquire a disease or illness (individual perception of threat)

Perceived severity

YOUR perceptions about how severe the consequences would be if you did acquire the illness or disease (individuals perception of threat).

Cues to action

Are there factors in the environment that are cueing you to act (health changes i.e. chest pain, fatigue, seeing an anti-smoking ad on TV, or a sick family member, etc) (modifying factors)?

Perceived benefits

What you believe the benefits are about reducing changes of this threat or illness (likelihood of action)?

Perceived barriers

What you think might be standing in the way of health behavior change (likelihood of action).

The health behavior model - an updated version

officially incorporating self-efficacy and integrating with broader environmental and social structures thinking more about SES, gender, age, cultural and community beliefs. knowledge/education

What are the strongest components in HBM?

Perceived susceptibility

Perceived barriers

Self-efficacy theory

focuses on the idea that people can exercise limited control over their lives. An individual's belief in their ability to succeed at a specific task is a direct predictor of whether they will try, how hard they will try, and how long they will persist when facing obstacles. helps predict adherence. Although it’s not widely applied because people’s lifes are very complicated.

Theory of planned behavior (three factors that shape intention)

1st: attitude toward the behavior, whether that’s positive or negative.

2nd: the perceived control one has over their own behavior

3rd: subjective norms shaped by his or her belief that other people encourage the behavior

NOT GREAT AT PREDICTING RISKY BEHAVIOR*

Stage theories of health behavior

STREGTHS:

Recognize the benefits of tailoring interventions to a person stage of behavior change

WEAKNESSES:

more complex than continuum theories; may be unnecessarily complex

need longitudinal research to study people throughout the stages.

Transtheoretical model (stages of chance)

Suggests that people progress and regress through 5 stages:

1. Pre-contemplation (not aware of a problem)

2. Contemplation (aware of a problem, thinking and getting ready to change within the next 6 months)

3. Preparation (taking small steps and ready to change in the next 30 days)

4. Action (actively attempting to change behavior)

5. Maintenance (Obtaining and continuing on with the behavior change)

Does not predict adherence**

Precontemplation

Ignorance of the problem

don’t plan to change

underestimate benefits and overestimate costs

Contemplation

awareness of the problem

realizes costs and benefits of making change

intend to change in the next 6 months

Iffy about the change and aren’t not confident in their ability to change.

May self educate

Preparation

individuals have made a commitment to change their behavior in the next 30 days.

Small changes

Try to generate idea of how to change

Highly motivated

Action

Activley engagin in new behavior

changes has ten place for over the last 6 months

active efforts

Maintenance

Sustain the health behavior over 6 months

focus on preventing relapse

Health action process appraoch

incorporates both stage and continuum theories. This theory considers planning, though it also requires more study as it is one of the newest theories regarding Health Behavior

Intention-Behavior gap

People may have good intentions, but do not follow through. the well-documented disconnect where a person's planned goals or conscious decisions do not translate into actual actions

How to actually change a persons behavior. or at leats motivate the to change.

Unfortunately, knowledge is not enough (optimistic bias and smokers). People need to have invoked emotions, usually fear, and that is what gets people to really change. USE NEGATIVE STIMULI - anti-smoking ads.

Fear based appeals

graphic commercials/advertisements to scare people into changing their health behaviors for the better. It creates fear, but it’s important to tell people how to help themselves, focus on the short and long term consequences.

Drawbacks of fear appraisals

Much research suggests fear-based appeals are ineffective

• May increase anxiety/fear but not impact behaviors

• Increases perceptions of problems but does not translate into behavior change

Increasing Effectiveness of Fear-based Appeals****

• Moderate level of fear

• Present specific strategy to help alleviate anxiety

• Focus on short-term consequences

• Increase perceived vulnerability

Coping

constantly changing cognitive and behavioral efforts to manage [that is master, tolerate, reduce, minimize] specific external and/or internal demands [and conflicts among them] that are appraised as taxing or exceeding the resources of the person.

Lazarus and Folkman suggested

there are various external and internal resources that can help individuals cope with stress.

Self-efficacy

People’s belief in their own ability to carry out a specific behavior in order to achieve a goal

Perceived control

the belief that one can determine one’s own behavior, influence one’s environment and bring about desired outcomes

Personal resources

Perceived control/high confidence over the situation

Problem focused coping

• Doing something constructive about stressful conditions that are harming, threatening, or challenging an individual.

• a behavioral and cognitive strategy that directly addresses and attempts to change, manage, or eliminate the root cause of a stressor

Successful if the problem is solved, or the root cause is eliminated.

• health behavior changes

• studying for an exam

Emotions focused coping

• regulating (controlling/changing) emotions experienced because of a stressful event

• success means keeping emotional distress within manageable limits.

• reappraisal

• allowing yourself to feel

• normalize emotions

• practicing mindfulness and meditation

important to note that we can not always control our emotions

What type of coping is better for each situation?

All depends on the situation

Uncontrollable (death of a loved one) would be more likely to benefit from emotion based coping

Controllable (exam coming up) would likely benefit from problem based coping.

Sometimes both may be needed, but everyone/situation is different.

Ask yourself: what are you seeking to do? what is the final goal? are you eliminating or changing the problem? Are you trying to control the stressor or the emotions that arise from it?

Relaxation training

a therapeutic practice designed to lower physical, mental, and emotional tension by activating the parasympathetic nervous system

• simplest and easiest way to use all psychological interventions

• relaxation may be the key ingredient in other types of therapeutic interventions for managing stress.

• Formal training programs run for 6 to 8 weeks but can be done informally too!

CBT

a type of therapy that aims to develop beliefs, attitudes, thoughts, and skills to make positive changes in behavior (effective for stress management in people experiencing stress broadly in those with and without chronic illnesses).

Emotional disclosure

talk therapy technique in which people express their strong emotions by talking or writing about negative events that precipitated those emotions. Have shown positive effects.

Mindfulness

the practice of paying active, non-judgmental attention to the present moment, including your thoughts, feelings, bodily sensations, and surroundings. Shown great ways to calm emotions and the body down.

WHY IS MIND-BODY MEDICINE USED IN THE CONTEXT OF CHRONIC ILLNESS?

• Mind-body medicine is often used among people with chronic illnesses because these diseases are often strongly influenced by psychological and behavioral health

• It helps to regulate your physiology, which can reduce symptom burden

• Helps give patients with chronic illnesses active coping strategies to reduce their stress and manage their physical symptoms

• Medication and other ‘traditional’ interventions simply do not work for everyone

MEDITATION

a mind-body practice that trains attention and awareness to detach from ruminating thoughts and achieve mental clarity and emotional calmness. Most approaches originated in non-westernized countries as a part of religious practices. Those techniques used in westernized culture typically have no religious connections.

Mind-body medicine

refers to a variety of techniques based on the idea that the brain, mind, body, and behavior interact in complex ways.

Transcendental Meditation

Originated in the Vedic tradition in India. Focusing on and repeating a single word while sitting with eyes closed and relaxed muscles helps one’s head remain clear of distracting thoughts

Mindfulness Meditation

Rooted in ancient Buddhist practices, it has recently become a modern stress reduction practice.

mindfulness as a therapeutic tool

“Third wave” cognitive behavioral therapies

mindfulness for someone with binge ED

help regulate emotions , and help with stress reduction, anxiety and depression

Guided Imagery

While it shares some elements with mediation, people conjure up a calm, peaceful image and concentrate on that for the duration of an unpleasant experience.

Yoga

has its origins in India but is now part of mind-body practice. It includes physical postures, breathing, and meditation to help balance the body, mind, and spirit. Hatha ___ is the most common in the United States and Europe.

Qi Gong

Involves the practice or cultivation of the qi by postures and simple movements that channel vital energy and restore balance. Creates measurable changes in thermal and electrical energy, reduces BP and improves pyschological health, balance and mobility.

Tai Chi

Is one category of qi gong form, which has evolved from a martial art with a long, but disputed history. Now used to cultivate the balance between yin and yang promoting health. can help manage chronic conditions and helps train balance and fall prevention.

Biofeedback

the process of providing feedback information about the status of biological systems.

Gives info about the body and its processes and how to manipulate them using mind and behavior changes.

Attempting to control physiological responses like heart rate, and help control lower back pain and headaches by helping decrease muscle tension.

PHYSIOLOGY AND MIND-BODY MEDICINE

Neuroimaging researchers have studied what happens when a person relaxes and meditates.

• There is some proof that meditation may have the capability to delay or even reverse some of the brain changes that occur through aging.

• Additionally, stress reduction through mindfulness meditation and qi gong improves several immune system components, demonstrating routes through which meditation and qi gong might improve health.

Who uses Complementary and Alternative Medicine (CAM)?

Its been growing in popularity over the recent years.

• recent immigrants are less likely to use

• asian immigrants use CAM more than non-hispanic european Americans

• women tend to be more likely to use CAM

Motivations for seeking alternative treatment

Young ment with strong beliefs in science are less likely to use CAM

people with less faith in medicine and stronger beliefs in the roles of attitude and emotion in health are more likely to use CAM

when a type of medicine has not produce heavy favored results, someone may turn to CAM as an alternative

Its common for people to combine the two.

Effectiveness of CAMS

Alternative treatments lack sufficient evidence to prove their effectiveness. A great deal of controversy exists concerning fair evaluation of alternative medicine. Requires a double-blind study, and many alternative treatments don’t lend themselves a placebo control as easily as normal drug expirements.

Limitations of alternative therapies

Lack of information regarding effectiveness because herbs are considered food, not medicine, so the focus is on safety, not effectiveness. Additionally herbs may interfere with prescriptions and may not work for everyone

Somatosensory system

a network of sensory receptors, neurons, and brain pathways that processes conscious physical sensations from the body and external environment. CONVEYS SENSORY INFORMATION, helps the brain know that something is wrong and important.

Afferent Neurons

are one of three types that work together to relay information from the sensory organs to the brain. CARRY INFORMATION TO THE BRAIN.

Pain

the unpleasant feeling caused by illness or injury and is important for survival. Without it, we wouldn’t know when something was potentially wrong.

Primary afferents

sensory nerve fibers that carry signals from the body's outer parts—like the skin, muscles, and organs—into the central nervous system.

Spinal cord

primary conduit for all sensory information to reach the brain. Protected by the vertebrae, any damage to the spinal cord may interrupt the flow of sensory information.

• Pain

• movement

• any sensory messages

This is why paralysis and injury to the back is so detrimental.

Neurotransmitters

chemicals messengers that are synthesized and stored in neurons

What modulates pain

Endorphins, enkephalins, and dynorphins

What produces pain

Glutamate, substance P, bradykinin, and prostaglandins

Pain

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Inclusion of emotion means pain is subjective.

Acute pain

Normally brief; adaptive in that it signals the person to avoid further injury aka we learn from it.

Chronic pain

endures over months; no adaptive reason or biological benefit

Gender differences in pain

Women are more likely to report pain, but research shows men actually have greater pain sensitivity but don’t report because of stereotypes and stigma. Women are also more susceptible to chronic pain

Gate control theory of pain

suggests that pain is not the result of a linear process, rather that its perception is subject to a number of modulations that can influence the experience of pain. SPINAL CORD SERVES AS A GATE THAT OPENS AND CLOSES FOR PAIN SENSRY INPUT

Central control trigger

consists of nerve impulses that desend from the brain and influence the gating mechanism in the spinal cord.

Headache pain

Most common type of pain: migraines, tension headaches, cluster headaches.

Low back pain

Pain isn’t too serious and likely caused by injury, but can also be caused by stress and working environment. More likely to turn into chronic pain.

Rheumatoid arthritis

an autoimmune disorder characterized by swelling and inflammation of the joints as well as destruction of cartilage, bone, and tendons.

Osteoarthritis

progressive inflammation of the joints; affects mainly older adults.

Fibromyalgia

not considered an arthritic condition; it is characterized by tender points throughout the body

Cancer pain

present in 44% of patients and almost half of their pain is left untreated, try and tackle psychological treatment

Phantom Limb pain

the experience of chronic pain in a part of the body that is missing. Nervous system in not quite caught up he CNS and PNS may make maladaptive adaptations after the amputation

Pain scale

Self report by responding on a scale of 1-10 how much pain your in. Awe have to take them at their objective word, but it is really hard to determine how much pain they’re really in.

Self report

Asking people to evaluate their pain and rate how severe the pain is, ask more about the pain, is it sharp? dull? there are also some psychological tests that can help determine possible dishonesty

Behavior assessments using observation

asking the patient to do something that might cause plan and look at their face or body language that show signs of pain, useful for children and elders who may not be able to accurately report pain.

Analgesic drugs

Most common drug, they relieve pain; however, there is a high risk for addiction as many of them are opiotes.

NSAIDS

type of analgesic drug, that’s not a narcotic or addictive, and what you may find in a grocery store (advil)

safe and effective for most pain, and helpful with inflammation but not really helpful for chronic pain that doesn’t have an inflammatory component to it.

Surgery

Last resort, and aims to repair the source of pain or alter the nervous system to alleviate pain. Can result in success or complications.

Can’t not always repair the issue or help patients with pain relief.

Assumption: pain has an identifiable and modifiable cause that can be repaired (not true for chronic pain).

CBT and pain

is a type of therapy aimed at developing beliefs, attitudes, thoughts, and skills to make positive changes in behavior. One form of CBT is acceptance and commitment therapy (ACT), which encourages acceptance of pain by focusing attention on other valuable goals and activities. Mindfulness is commonly taught.

Cognitive therapy

based on the principle that people’s beliefs, personal standards, and feelings of self-efficacy strongly affect their behavior. It helps them identify irrational thoughts or “catastrophizing” and eliminate or change them.