COGNITIVE FOUNDATIONS OF BHD Flashcards
(263 cards)
1
Q
Classical conditioning
A
occurs unconsciously through associations between stimuli within our environment.
2
Q
Operant conditioning
A
learning controlled by the
consequences of our behaviour.
3
Q
Unconditioned Stimulus
A
Naturally elicits a reflexive response.
Example: Food.
4
Q
Unconditioned Response
A
Reflexive response to the US.
Example: Salivation.
5
Q
Neutral Stimulus
A
Initially does not elicit the response.
Example: Bell.
6
Q
Process of Operant conditioning
A
Pairing: Repeatedly pairing the NS with the US.
Conditioned Response (CR): After repeated pairings, the NS becomes a Conditioned Stimulus (CS) and elicits the response on its own.
Example: The bell (CS) causes salivation (CR) after being associated with food.
7
Q
Conditioned Stimulus
A
A previously neutral stimulus that is able to elicit a particular response after being paired with the unconditioned stimulus.
8
Q
Conditioned Response
A
The response elicited by the conditioned stimulus.
9
Q
Acquisition
A
learning phase during which a conditioned response is established.
* Impacted by frequency and timing of stimuli.
10
Q
Extinction
A
gradual reduction and elimination of the CR after the CS is presented repeatedly without the UCS.
11
Q
Spontaneous recovery
A
a seemingly extinct CR reappears if the CS is presented again.
12
Q
Stimulus generalisation
A
individual responds to stimuli that are similar to the CS.
13
Q
Stimulus discrimination
A
individual can discriminate between stimuli that are similar to the CS less pronounced CR, or NO RESPONSE
14
Q
Chemotherapy
A
Nausea is a common side effect of chemotherapy.
* Conditioned taste aversions
* Neutral stimuli CS when
paired with the UCS
15
Q
OPERANT CONDITIONING
A
Learning controlled by the consequences of our
behaviour probability that a behaviour will occur is
influenced by the previous consequences of that behaviour.
16
Q
Thorndike’s Law of Effect
A
Behaviours which lead to a “satisfying state of affairs”
are more likely to be repeated in the future.
17
Q
Skinner Box (Operant Conditioning Chamber)
A
Invented by: B.F. Skinner to study operant conditioning.
Key Features: Lever/button for animal to press, delivers rewards (food/water) or punishments (mild shock).
Purpose: Animal learns to perform actions (e.g., pressing lever) for rewards or to avoid punishment.
Significance: Demonstrates how reinforcement and punishment shape behavior in controlled experiments.
18
Q
Reinforcement
A
stimulus which occurs after the behaviour and increases the likelihood that the behaviour will occur again
19
Q
Punishment
A
stimulus which occurs after the behaviour and decreases the likelihood that the behaviour will occur again
20
Q
Positive reinforcement
A
The presentation of a pleasant stimulus after a behaviour
21
Q
Positive punishment
A
The presentation of an unpleasant stimulus after a behaviour
22
Q
Negative reinforcement
A
The removal of an unpleasant stimulus after a behaviour
23
Q
Negative punishment
A
The removal of a pleasant stimulus after a behaviour
24
Q
Extinction (operant)
A
the fading out of a behaviour when reinforcement of the behaviour stops
25
Extinction burst
initial increase in behaviour following withdrawal of reinforcement
26
Stimulus generalisation
eliciting a response to stimuli which are similar, but not identical, to the original stimulus
27
Stimulus discrimination
displaying a less pronounced
response (or no response) to
stimuli that differ from the
original stimulus.
28
Continuous reinforcement schedules
Reinforcement occurs after every response (after each time the behaviour is performed)
29
Intermittent/partial reinforcement schedules
Reinforcement occurs intermittently rather than
after every response
* Fixed or variable
* Ratio schedules or interval schedules
30
Fixed Ratio
Reinforcement occurs after a fixed number of behavioural responses
31
Variable Ratio
Reinforcement occurs after variable number of behavioural responses, the average of which is predetermined.
* VR schedules usually yield the highest rates of responding, and are most resistant to extinction
32
Fixed Interval
reinforcement occurs for the first behavioural response performed following a specified time interval.
33
Variable Interval
reinforcement occurs for the first behavioural response performed after a variable time interval, the average of which is predetermined.
34
Key factors of observational learning
Motivation
Attention
Retention
Reproduction
35
Vicarious Conditioning
Definition: Learning through observation of others being rewarded or punished for their behavior.
Impact: Behavior is more likely to be imitated if the model is observed being rewarded, and less likely if punished.
36
Imitation Factors:
Model's Characteristics:
Prestige: Higher status increases likelihood of imitation.
Likeability and Attractiveness: More likely to imitate someone who is likable and attractive
37
Cognition
the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
38
SOCIAL-COGNITIVE LEARNING is influenced by
* Interpersonal differences in perception
* Subjective interpretation of our environment and
personal relationships.
39
Learned helplessness
the tendency to feel helpless in the face of events that we cannot control.
40
The path to learned helplessness
Uncontrollable Adverse Events: Trigger feelings of helplessness.
Perceived Lack of Control: Leads to the belief that one cannot escape aversive events.
Feelings of Helplessness: Result in helpless behavior.
Explanatory Style: Expectation that one cannot escape aversive events.
41
Three Types of Deficits
Motivational: Slow to initiate known actions.
Emotional: Appear rigid, lethargic, frightened, or distressed.
Cognitive: Demonstrate poor learning in new situations.
42
LOCUS OF CONTROL
* We form expectations about the consequences of our behaviours
* We might believe that reinforcements and/or
punishments lie inside or outside of our
control
43
Internal locus of control
Belief that our own actions
determine our fate
44
External locus of control
Belief that our lives are
governed by forces outside
of our control, or by
people more powerful
than ourselves
45
Locus of Control in Healthcare
Impact on Health:
Internal Locus of Control: Individuals who believe they control their own health are more likely to engage in healthy behaviors and practice good healthcare habits.
External Locus of Control: Those who believe their health is controlled by external factors may take fewer actions to improve their health, potentially leading to poorer health outcomes.
46
Self efficacy key factors
Mastery
Experience
Vicarious
Experience
Persuasion
Emotional
Arousal
47
High self-efficacy in health context
people feel in control of their own health, and the effects of their health condition become less of a stressor.
48
Low self-efficacy in health context
negative impact on their health outcomes.
* Complex / strict diet
* Self-injecting insulin
49
Dispositional attributions
behaviour is caused by an internal or personal factor
50
Situational attributions
behaviour is caused by an external, or environmental factor
51
Optimistic style
credits success to internal factors, failures to external-> confidently work for
success
52
Pessimistic style
Credits success to luck and failure to lack of ability-> low expectation of success
53
Fundamental Attribution Error
Definition: The tendency to attribute another person’s behavior to their personality (disposition) while ignoring situational causes.
Key Points:
Underestimation of Situational Factors: Even when strong situational cues are present, we often downplay their influence.
Reasons for Making the Error:
Lack of Information: We often don't have enough information about the situational factors affecting the other person.
Self-Reflection: We may not reflect on how we would behave in the same situation.
Cultural Influences: Cultural norms and values can shape our tendency to make dispositional attributions.
54
FUNDAMENTAL ATTRIBUTION ERROR
HEALTH CONTEXT
*Can influence communication in a health care team and hinder collaboration
* Can influence how interpret a patient’s adherence to a medication/treatment/
lifestyle change
* Can exacerbate health inequity, e.g. judgment about missed appointments
55
Self-Serving Bias
Definition: The tendency to attribute personal successes to internal factors (e.g., talent, effort) and personal failures to external factors (e.g., luck, circumstances).
Short-Term Effect: Can be protective, boosting self-esteem.
Long-Term Impact: May prevent learning from mistakes and hinder personal growth.
56
WHAT IS PAIN?
“An unpleasant sensory and emotional experience
associated with actual or potential tissue damage.”
57
Sensation
activation of sense organ → neural impulses transmitted to the brain
58
Perception
the brain’s organisation + interpretation of sensory input
59
What is the starting point of the pain pathway?
The site of injury, where nociceptors detect harmful stimuli.
60
What type of fibers transmit sharp, acute pain signals?
A-fibers (fast, myelinated fibers).
61
What type of fibers transmit slow, dull, aching pain signals?
C-fibers (slow, unmyelinated fibers).
62
Where do pain signals first synapse in the spinal cord?
In the dorsal horn of the spinal cord.
63
What is the role of the somatosensory cortex in the pain pathway?
It interprets the physical sensation of pain.
64
How does the limbic system contribute to the pain response?
The limbic system processes the emotional and cognitive response to pain.
65
What is the role of the thalamus in the pain pathway?
The thalamus acts as a relay station for pain signals to various parts of the brain.
66
What is the name of the pathway that transmits pain signals to the brain?
The spinothalamic tract.
67
What part of the brain is responsible for processing both the sensation and emotional response to pain?
The cerebrum, involving the somatosensory cortex, limbic system, and thalamus.
68
WHY DO WE EXPERIENCE PAIN?
Pain is an evolved defence mechanism which informs
the individual of injury or dangerous stimuli → critical
for our survival...
* Prevents tissue damage and/or protects from
further damage
* Promotes immobilisation for healing
69
Traditional biomedical perspective assumes
Symptoms are the result of tissue damage
* Pain severity is proportional to the amount of tissue damage
* There is an organic explanation for all pain symptoms. Therefore... everyone with the same injury should experience the same amount of pain!
70
PAIN BEHAVIOURS
Responses can include:
* Outward expressions of the pain
* Attempts to reduce the pain (i.e. medication, withdrawing
from activities)
* Attempts to cope with or ignore the pain (i.e. distraction). Pain behaviours can impact the way we perceive and experience pain
71
CHRONIC PRIMARY PAIN
Pain in one or more body systems that:
(a) persists or recurs for longer than 3 months,
(b) is associated with significant emotional distress and/or
significant functional disability, and
(c) includes symptoms that are not better accounted for by another diagnosis.
72
GATE CONTROL THEORY
A “gate” exists at the spinal cord that can block some
pain signals while allowing others through to the brain
The “gate” receives two-way input:
* Ascending messages are biological in nature (activation of pain receptors); can be modulated by non-painful stimuli → i.e. touch/pressure
* Descending messages are psychological in nature →
i.e. attention, emotional state (stress, anxiety)
73
What does Gate Control theory explain?
explains how psychological
states can influence pain
perception...
* Negative emotional states
(stress, anxiety) + focused
attention = GATE OPEN
* Positive emotional states
(acceptance, calm) +
distraction = GATE CLOSED
74
PAIN MANAGEMENT (Gate)
Focuses on techniques to ‘close’ the gate
- Rubbing the site of injury
- Distraction techniques
- Relaxation exercises
- ‘Non-traditional’ therapies, i.e. acupuncture or massage therapy
75
OPERANT THEORY
Operant model offers a behavioural approach to pain, particularly the development and maintenance of
chronic pain + associated behaviours.
76
Pain Management (Operant)
Pain behaviours → create a cycle of chronic pain,
where the patient receives positive consequences for
being in pain (i.e. rest, attention from others)
Focuses on changing behaviours (behaviour modification)
Uses principles of learning through conditioning to:
* Decrease unhelpful behaviours, i.e. avoidance
* Increase helpful behaviours, i.e. exercises, relaxation
Interventions seek to:
* Identify/modify antecedents of experiences/behaviours
* Identify controlling consequences of behaviours
* Reinforce helpful behaviours
* ‘Punish’ unhelpful behaviours
77
COGNITIVE BEHAVIOURAL THEORY
* Initially developed as a treatment framework for
mental health problems → since been applied to
management of chronic pain.
* Role of patient’s appraisals (experience, perception)
and coping strategies (behavioural responses) is key.
78
Active coping
Focus on trying to control pain or function despite it
* Regular exercise
* Maintaining ADLs
* Distracting yourself from
pain sensation
* Relaxation exercises
79
Passive coping
Focus on avoiding the pain
* Using medications, and
increasing clinician visits
* Avoidance of activity +
socially withdrawn
* Increased reaction to
painful stimuli
80
COGNITIVE BEHAVIOURAL THEORY - Pain management
Helps individuals develop skills to change negative
thoughts and behaviors.
* Improves coping strategies: passive → active coping.
* Explores patient’s expectations + understanding of
pain → reframing beliefs regarding chronic pain
* Promotes relaxation + distraction skills
Multidisciplinary approach, i.e. medications, physical
therapy, lifestyle changes
81
What does EEG measure?
EEG measures the electrical activity of the brain in the form of nerve impulses.
82
What are the four basic brain waves?
The four basic brain waves are Alpha, Beta, Delta, and Theta.
83
How are brain waves measured?
Brain waves are measured by their frequency (Hz) and amplitude (microvolts).
84
Which brain wave is associated with relaxation?
Alpha waves
85
Which brain wave is linked to active thinking?
Beta waves
86
Which brain wave is dominant during deep sleep?
Delta waves
87
Which brain wave is associated with light sleep and drowsiness?
Theta waves
88
How long does NREM Stage 1 last?
NREM Stage 1 lasts 5-10 minutes.
89
What happens during NREM Stage 1?
It is the transition from drowsiness into sleep, where eye movements slow, blood pressure drops, muscles relax, and the body enters a calm state.
90
Which brain waves start to appear in NREM Stage 1?
Slower Theta waves start to appear in NREM Stage 1.
91
NREM: Sleep Stage 2
* Sleep deepens
* Main body of light sleep
* Memory consolidation + synaptic pruning
* Alpha waves disappear
* EEG shows slightly larger Theta waves along with bursts of:
* Sleep spindles (fast, low amplitude)
* K complexes (slow, high amplitude)
92
NREM: SLEEP STAGE 3 & 4
* Also known as Delta sleep or deep sleep
* Characterised by relaxed muscles, lowering of body
temperature; muscles rest and rejuvenate
* Stage 3 characterised by large, slow Delta waves
* When delta waves make up 50% of recorded brain activity
you have entered Stage 4 sleep
* Stage 4 – Delta waves >50% of brain activity
93
REM SLEEP (STAGE 5)
Rapid Eye Movement (REM) Sleep:
* Named for the darting eye movements in this stage
* Stage in which most dreams occur
* EEG shows an active pattern resembling awake state
(Beta waves) but body movement is inhibited
* HR and BP increase
* Respiration becomes fast and irregular
94
What are the three main factors affecting sleep?
Biological, Psychological, and Social/Environmental factors.
95
Biological Factors
Age
Genetics
Hormonal changes (e.g., during puberty, menopause)
Circadian rhythm
Physical health conditions (e.g., sleep apnea, chronic pain)
Neurotransmitter levels
Medications and substances (e.g., caffeine, alcohol, drugs)
96
Psychological Factors
Stress and anxiety
Depression and other mental health disorders
Emotional trauma
Cognitive patterns (e.g., racing thoughts, worry)
Mental health conditions (e.g., bipolar disorder, schizophrenia)
97
Social/Environmental Factors
Sleep environment (e.g., noise, light, temperature)
Work schedule (e.g., shift work, long hours)
Lifestyle habits (e.g., diet, exercise, screen time)
Social interactions and relationships
Cultural norms and expectations
Life events (e.g., moving, job changes, personal loss)
98
LACK OF SLEEP & HEALTH
Insufficient / poor sleep can lead to a range of health problems:
* Obesity
* Cardiovascular health
* Diabetes
* Impaired self regulation
* Mood
* Memory problems
99
What is encoding in the memory process?
Encoding is converting information into a form usable in memory.
100
What is storage in the memory process?
Storage is the process of retaining information in memory.
101
What is retrieval in the memory process?
Retrieval is bringing to mind information stored in memory.
102
Encoding initial stimuli & short term memories
The set of processes involved in transforming
external events & internal thoughts into both temporary & long lasting memories
103
Encoding long-term memories
* Anatomical change via neurotransmitter release
* Engram created: physical memory trace in brain
* Long Term Potential: gradual strengthening of the connections among
neurons from repetitive stimulation
104
What does good memory depend on?
Good memory depends on the depth and elaboration of the initial encoding.
105
What is Semantic encoding?
Semantic encoding involves processing information based on its meaning, which leads to deeper memory.
106
What is Phonemic encoding?
Phonemic encoding involves processing information based on how it sounds, which is a more shallow level of encoding compared to semantic.
107
What is Structural encoding
Structural encoding involves processing information based on its physical or visual features (e.g., letters or appearance), which is the shallowest level of encoding.
108
What is the relationship between depth of processing and memory?
Deeper levels of processing, such as semantic encoding, lead to better memory retention compared to shallow levels like structural encoding.
109
What is the capacity and duration of sensory memory?
Sensory memory has a large capacity but a short duration.
110
How long does Iconic memory last?
Iconic memory lasts about 1 second.
111
How long does Echoic memory last?
Echoic memory lasts 5-10 seconds.
112
How long does Haptic memory last?
Haptic memory lasts about c1 second.
113
What is the capacity of working memory?
Working memory typically has a capacity of about 7 ± 2 chunks of information.
114
What is the duration of information in working memory?
The duration of information in working memory is about 15-30 seconds without rehearsal.
115
What is a chunk in working memory?
A chunk is a meaningful unit of information that can be a single item or a group of items grouped together based on their significance.
116
What is the duration potential of Long-Term Memory (LTM)?
Long-Term Memory (LTM) has a potentially long duration, lasting a lifetime.
117
What is the capacity of Long-Term Memory (LTM)?
Long-Term Memory (LTM) has a huge capacity.
118
What does Long-Term Memory (LTM) include?
Long-Term Memory (LTM) includes past experiences and events, thoughts and feelings, skills and abilities, and identity and sense of self.
119
Semantic memory example
Our knowledge of
facts about the world
120
Episodic memory
Recollection of events and
experiences in our lives
121
Explicit memory
Knowing “what”
* Memory for facts, events & beliefs about the
world that we are consciously aware of
* We recall intentionally (split into semantic and episodic)
122
What does the multi-store system of Long-Term Memory (LTM) include?
The multi-store system of Long-Term Memory (LTM) includes knowing "how" and experiential or functional forms of memory.
123
How is information in the multi-store system of LTM typically remembered?
Information in the multi-store system of LTM is not deliberately remembered and cannot be consciously recalled or reflected on.
124
What types of skills are part of the multi-store system of LTM?
The multi-store system of LTM includes motor skills, habits, and "how to do things."
125
What is a characteristic of memory retained in H.M. related to the multi-store system of LTM?
Memory retained in H.M. included the ability to identify stimuli more easily after prior exposure
126
What forms of learning are associated with the multi-store system of LTM?
Forms of unconscious learning, such as procedural memory and motor skills, are associated with the multi-store system of LTM.
127
Anatomical change of LTM
* memory trace may reflect alterations in neurotransmitter release at specific
sites
* Engram – physical memory trace of info in brain
* Patients with brain injury/surgery tell us about link between brain
structure and function
* E.g. famous surgery patient, H.M. (no new LTM capacity but working
memory & procedural memory mostly intact)
128
What part of the brain is associated with sensory memories?
The thalamus
129
Which brain structure is important for habit formation?
The striatum
130
Which part of the brain is linked to memories about emotions?
The amygdala
131
What role does the cerebellum play in memory?
It is associated with procedural memory, involving motor skills and tasks.
132
Which brain structure is involved in the consolidation of memories and semantic memory?
The hippocampus.
133
Three ways to access memories:
. Recall: Generate a mental
representation of
information/stimuli now absent
2. Recognition: Notice that
info/stimuli is like the one
experienced before
* Recognition than recall
3. Reconstruction: Piece together memory based on info/stimuli that can be recalled
134
Factors affecting LTM performance
1. Stress/arousal
2. Serial position of information
3. The context
4. Failure to encode
135
Stress, arousal & memory
* Level of attention or arousal related to memory performance
* Relationship between stress and memory is not linear
* Affects ability to encode (if fail to encode, memory not there to retrieve)
* Directly relevant to information
giving in stressful clinical context
136
Emotional arousal
* Flashbulb memories - Strong, vivid (usually visual) and detailed
memories of dramatic events
* Because vivid, belief that resistant to decay – BUT evidence
questions this
* Emotional arousal triggers adrenalin release > enhanced memory
137
Serial Position
* Relates to position of information when given lots of info at once
* Primacy effect – first items recalled better (long term memory)
* Recency effect – last items recalled better (working memory)
* Clinical context – important info first, repeat last
138
Context
External & internal context state can affect retrieval
* Environment
* State
* Encoding specificity – context embedded with info
* The more overlap between conditions at encoding & retrieval, the better the retrieval
* Use environmental cues to aid episodic memory retrieval
139
Failure to encode
* Failing to effectively put material into LTM
* Too much stress
* Not enough attention
* Lack of rehearsal
* No elaboration of information
* Serial position
140
Decay theory
* Memory traces fades over time
* Points to impermanence of memory storage
* Relates to how frequently recalled/rehearsed
141
Interference
* Confusion or entanglement
of similar memories
* Greatest when competing
info most similar
142
Motivated forgetting
* Motivated forgetting:
* Forgot what don’t want to think about repression
* Usually due to trauma
143
Memory, development and clinical context
* Age – development in childhood, decline in later life
* Mental health, stress, sleep
* Hormones: menopause, thyroid
* Medications and substance use
* Diet/fluid intake
144
Infantile amnesia
The lack of explicit memory for events before age of 3
years
* Adults’ earliest autobiographical memory averages back to 3 – 3 ½ years
145
Infancy (0-1 years)
* Implicit memory
predominates
* Recognition not recall
* Object permanence
* Implicit memory
* Semantic & episodic memory
forming
* Able to recall names, objects &
places
* Development of language
* Recognition better than recall
146
Toddler (2-3 years) memory
* Implicit memory
* Semantic & episodic memory forming
* Able to recall names, objects & places
* Development of language
* Recognition better than recall
147
Memory in early childhood (3-6yrs)
* Significant improvement due to advances in:
* Attention
* Speed & efficiency of information processing
* Language development
* Influences on children’s episodic memory:
* Remember things they did better than things they saw
* Drawing helps children’s memory
* How parents talk during shared experience
148
Implicit memory in early childhood
Implicit memory develops first
* Can produce behavioural change without
conscious awareness
* E.g. how to catch a ball
149
Explicit memory in early childhood
Explicit memory continues to improve
* Memories people know they have
* Facts, names and events
150
Memory in middle childhood (6-10 years)
* Gradual increase in own understanding of memory
* Become aware that we forget things
* Can learn and use mnemonics
* Learn to use external aids
* E.g. shoes ready for school
* Rehearsal
* Basic repetition then associations
* Organisation
* Elaboration
151
Causes of memory problems in childhood
* ADHD / executive functioning
differences / learning disabilities
* Cerebrovascular events
* Epilepsy
* Trauma or stress
* Fetal alcohol syndrome
152
Accuracy of Memory
* Misinformation Effect
* Misleading information is incorporated into one's memory after an
event
* Suggestive memory techniques
* False memory
* Recollections that feel real but are not
153
Implications for interviewing
* Suggestive interviewing can lead to construction of false memory
* Stories/reports told in response to free-recall prompts are more accurate
than stories told in response to a series of closed questions. E.g.:
* Tell me more about that?
* What happened next?
* Avoid praise for revelations
* Make it ok to not know answer
154
Changes in memory & information
processing across adulthood
* Crystallised intelligence
* Skills that depend on accumulated knowledge, experience,
* Judgment & social skills
* Semantic & procedural memories
* Fluid intelligence
* Depends on information processing skills
* Speed of analysing information
* working memory capacity
155
Memory in adulthood (20s – 60s)
* Brain volume peaks in 20s and gradually declines
* Information in working memory diminishes
* Use of memory strategies declines
* More difficulty retrieving info from LTM
* Sustaining two complex tasks becomes harder
* Focusing on relevant info becomes more difficult
* Ability to combine pieces of visual info into a pattern declines with age
* Compensation – allow more time for processing
* Memory skills used daily decline less
* General, procedural & occupational
knowledge unchanged or increase
* Great increase in cognitive competence
in midlife – apply vast knowledge and life
experience to problem solving
156
Fluid intelligence
Decreases over time
* Working memory (e.g., planning,
organising, flexible thinking)
* Episodic (“did I take my medication?”)
* Source (“which doctor told me about my treatment?”)
157
Crystalised intelligence
Stability over time
* Semantic (words, facts & concepts)
* Procedural learning without conscious effort (I can ride a bike)
158
Why does memory decline in late adulthood? - Biological hypothesis
* Decline in neuron density of frontal cortex & hippocampus
* Vulnerable to injury as blood pressure rises
* Extensive loss of nerve cells in hippocampus early sign of Alzheimer’s disease
159
Dementia
* On the rise, though not an inevitable part of ageing
* A set of progressive disorders marked by global disturbance of higher
cognitive function
* A syndrome and umbrella term that other illnesses fall under
* E.g., Alzheimer’s Disease & cerebrovascular dementia
* Half of dementia cases are related to Alzheimer’s disease (AD)
* AD associated with brain damage and loss of neurons critical for memory
160
Cerebrovascular dementia
* Strokes leave dead brain cells & can lead to dementia
* Risk of stroke increased via:
– Indirect genetic factors: Blood pressure, CVD, diabetes
– Indirect behavioral/psychological factors: E.g., substance use, stress, obesity, smoking, heavy alcohol use
* Men at higher risk
161
Signs of stroke
* Weakness, numbness in arm, leg or face
* Sudden vision loss or double vision
* Speech difficulty & severe dizziness, imbalance
* Important to pick up signs early and treat swiftly
162
Sporadic AD
*No obvious family history
*Later onset (over 65)
*But heredity may play role through somatic mutation (e.g., abnormal gene on chromosome 19)
163
Familial AD
Early onset
More rapid progress
*linked to genes on chromosomes 1, 14 and 21
164
Symptoms of alzheimer's
Memory Problems:
Recent memory problems first
Severe memory problems
Communication Issues:
Problems with speaking, reading, and understanding
Judgment:
Poor judgment
Disorientation:
Disorientation to time and place
Personality Changes:
Changes in personality
Sleep Disturbances:
Sleep disturbances
Mood:
Depression
Motor Skills:
Deterioration of skilled and purposeful movements
165
Mild cognitive impairment
* Transitional state between cognitive
changes of normal ageing & dementia
* Some memory loss
* Still maintain daily functioning
* Mild cog impairment = higher risk of dementia
* Differentiate via Mini-mental state exam (MSE)
166
Alzheimer’s: Brain deterioration
* Neuron death
* Inside neurons
* Neurofibrillary tangles
* Outside neurons
* Plaques
* Chemical changes
* E.g., Serotonin (50-75%) drop may contribute to sleep
disturbances and depression
167
Alzheimer’s: Risk & protective factors
Risk factors
* High blood pressure
* Obesity & diabetes
* Smoking
* Depression & chronic stress
* Head trauma
Protective factors
* High education (more synaptic connections cognitive reserve
* Physical activity & active lifestyle
* Some evidence about diet (e.g. Fish oils, coffee)
* HRT & Anti-inflammatory drugs (aspirin)
168
*Memory & Music project
* Reductions in depression & anxiety
* Increased activity
* ‘Bus stop’ programme
* Addresses wandering
* Virtual Reality for dementia care
* Nursing homes that resemble familiar environments
* ’Reminiscence therapy’
Supporting patients with dementia
169
Preventing memory loss
* Healthy lifestyle
* Exercise & good diet
* Limit alcohol
* Stress management
* Improve self–efficacy/address stereotypes
* Social engagement
* Stay mentally active
* Years of education
* Learn a new language
* Learn a new instrument
* Short mental workouts
170
Perception
The process of sensing and interpreting the world around us through our senses.
171
Learning
Acquiring new information or skills through experiences, observations, and interactions.
172
Memory
The mental process of storing, retaining, and recalling information from past experiences.
173
Language Acquisition
The process of learning to understand and use language for communication.
174
Problem-Solving
Figuring out solutions to challenges by identifying the problem, analyzing options, and making decisions.
175
Thinking and Imagining
The mental processes involved in processing ideas, forming thoughts, and creating mental images.
176
Cognitive-Developmental Stage Theory: Before Piaget
It was assumed that children were simply less competent thinkers than adults, with no distinct developmental stages.
177
Cognitive-Developmental Stage Theory: After Piaget
Piaget demonstrated that children think differently from adults, showing unique cognitive processes that evolve through distinct developmental stages.
178
Mental Structure: Scheme
A mental framework consisting of organized memories, thoughts, and strategies.
179
Scheme as an Internal Map
Functions like a mental map we use to interpret and navigate the world around us.
180
Schemes as Units of Knowledge
Schemes represent 'units' of knowledge linked to specific content or experiences.
181
Adapting Schemes
Schemes evolve as we encounter new experiences, leading to modifications, additions, or changes.
182
Piaget's View: Infancy
We begin with physical schemes, such as actions like sucking and grasping.
183
Piaget's View: Over Time
Physical schemes develop into complex mental/internal schemes, aiding deeper understanding of the world.
184
Piaget: Assimilation
Involves 'filling existing containers'—incorporating new information into existing schemes. Example: Seeing a cow and calling it "Doggie" because it fits the existing scheme of a 4-legged animal.
185
Piaget: Accommodation
Involves 'reshaping existing containers'—changing schemes to fit new information. Example: Differentiating between a "Doggie" (small 4-legged animal in the house) and a "Cow" (large 4-legged animal on a farm).
186
Assimilation in Action
Encountering a new idea and fitting it into an existing scheme. Example: Seeing a horse and initially calling it "Cow."
187
Accommodation in Action
Adjusting schemes to incorporate new distinctions. Example: Learning that a cow goes "moo" and a horse goes "neigh."
188
Equilibration
The process of balancing assimilation and accommodation to create stable understanding.
189
Piaget: Sensorimotor Stage (Birth - 2 Years)
The stage where infants learn through sensory experiences and motor activities.
190
Newborn Reflexes and Early Learning
Reflexes like sucking and grasping are hard-wired and serve as the foundation for learning.
191
Reflexive Actions (0-1 Month)
Infants initially respond to stimuli with reflexes, regardless of the situation.
192
Learning Through Repetition
Babies learn by repeating actions, which helps them understand cause and effect.
193
Development of Motor Skills
Movements evolve from reflexive actions to more purposeful, voluntary, and coordinated actions as infants grow.
194
Sensorimotor Stage: Object Permanence
Emerges around 8-12 months, fully developed by 24 months. It’s the understanding that objects continue to exist even when they are out of sight, marking the beginning of symbolic thought.
195
Sensorimotor Stage: Imitation Skills
Imitation begins around 9 months, with deferred imitation appearing between 18-24 months. Infants start copying actions and can later imitate behaviors after a delay.
196
Piaget: Preoperational Stage (2-7 Years)
Characterized by the development of symbolic thought and the ability to mentally represent objects and events.
197
Key Achievement: Symbolic Thought
The ability to create clear mental representations of objects and events that are not physically present.
198
Transition from Sensorimotor Intelligence
Marks the shift from thinking based on physical actions to internalized mental actions, with rapid language development.
199
Symbolic or Make-Believe Play
Children can now engage in pretend play and use objects for purposes other than their intended use.
200
Egocentrism in the Preoperational Stage
Thought is marked by difficulty in taking another person’s perspective, as children interpret the world from their own point of view.
201
Piaget: Concrete Operational Stage (7-11 Years)
The third stage, characterized by more logical, flexible, and organized thinking, but still tied to concrete experiences.
202
Key Turning Point in children thinking ability
Children begin to work out problems internally rather than needing to physically manipulate objects.
203
Inductive Logic
Children start using inductive reasoning, moving from specific examples to general principles.
204
Reduced Egocentrism
Thinking becomes less self-centered, with an increased ability to understand others' perspectives.
205
Core Attainment: Conservation
Understanding that an object's physical properties remain the same even when its appearance changes, as long as nothing is added or taken away.
206
Piaget: Formal Operational Stage (12 Years and Onward)
The stage where thinking becomes increasingly abstract, flexible, and systematic.
207
Abstract Thinking
Shifts from "what is" to "what could be if" thinking, allowing for hypothetical reasoning.
208
Higher-Order Reasoning
Ability to combine and classify different arguments and perspectives, leading to scientific thinking.
209
Creative and Hypothetical Thinking
Increased capacity for creative thought and considering abstract, hypothetical situations—key indicators of formal operational thought.
210
Example of formal operation
Pendulum task and third eye problem
211
New Research on Concrete Operational Thought
Skills do not emerge spontaneously; influenced by factors such as schooling, practice, context, and culture.
212
Impact of Teaching Methods
Children taught to divide toys/treats among peers may learn the concept of conservation more quickly due to relevant experience.
213
Role of Previous Experience
A child’s prior experiences significantly influence their understanding of concrete operational tasks.
214
Importance of Context
Context is crucial for understanding; tapping into a child's experiences helps assess their comprehension (e.g., differences between a child with many hospital admissions and a new patient).
215
Do All Individuals Reach the Formal Operational Stage?
Not all individuals attain this stage; it may be absent in societies where symbolic skills aren't emphasized. People are more likely to think abstractly in familiar contexts. Studies show that 40% to 60% of university students struggle with formal operational problems, highlighting variability in attainment.
216
Understanding Illness: Bibace & Walsh (1980) - Prelogical Stages (Ages 2-6 Years) - Phenomenism
Children explain illness in magical terms, showing little grasp of cause and effect. Example: "People get colds from the sun."
217
Understanding Illness: Bibace & Walsh (1980) - Contagion
Contagion: Children believe illness originates from nearby people or objects, or activities preceding the illness. Example: "People get colds from the outside when someone gets near them."
218
Understanding Illness: Bibace & Walsh (1980) - Prelogical Stage (Ages 2-6 Years) - Internalization
Children recognize that illness originates within the body, differentiating between body organs and understanding that various treatments/actions can improve health. Example: "Cold comes from germs that I inhaled/swallowed."
219
Understanding Illness: Bibace & Walsh (1980) - Prelogical Stage (Ages 2-6 Years) - Contamination
Children learn that illness can have multiple symptoms and recognize that germs and their own behavior can cause illness. Example: "You get a cold if you take your jacket off outside, and it gets into your body."
220
Understanding Illness: Bibace & Walsh (1980) - Formal-Logical Explanations (Ages 12+) - Physiologic Explanations
Illness is defined in terms of bodily malfunction. Example: "Colds come from viruses, I guess. Other people have the virus, and it gets into your bloodstream, and it causes a cold."
221
Understanding Illness: Bibace & Walsh (1980) - Formal-Logical Explanations (Ages 12+) - Psychophysiologic Explanations
The most mature understanding of illness, recognizing that the mind and body interact and accepting the role of stress and worry. Example: "A heart attack can come from being all nerve wracked. You worry too much. The tension can affect your heart."
222
Implications for Health Professionals - Reassuring Children
Health professionals can reassure children by providing explanations that align with the child's understanding of illness, helping to ease their concerns and promote better cooperation
223
Adult Development of Perspectives on Health
Adults develop new perspectives based on experiences and interactions with their environment, impacting their health behaviors.
224
Young Adulthood Health Behaviors
In young adulthood, individuals tend to engage in less risky behaviors and are more likely to adopt protective behaviors, such as regular screening and exercise.
225
Middle Age Health Seeking Behaviors
Middle age is a period of change, anxiety, and uncertainty, often leading to an increase in health-seeking behaviors as individuals become more proactive about their health.
226
Vygotsky (1896-1934) and his sociocultural
theory
Children are influenced by social interactions with adults, which impacts their thinking and learning. Internalization occurs as children absorb knowledge from their culture.
227
Cultural Influence on Cognitive Development
Different cultures prioritize various types of knowledge and schooling practices, causing cognitive development to vary and adapt to cultural contexts. Vygotsky believed children are products of their culture.
228
Key Concept: Social Constructivism
Learning is an active creation of knowledge through social interaction and language use, making it a shared experience rather than an individual one.
229
Key Concept: Continuous Development
Vygotsky believed development is continuous rather than occurring in distinct stages.
230
Key Concept: Language and Thought
Language plays a central role in cognitive development; culture is embedded in language, which shapes thought. Children develop ‘private speech’ as they learn language.
231
Key Concept: Zone of Proximal Development
The zone of proximal development is the difference between a child’s independent performance and their performance with assistance or guidance.
232
Key Concept: Scaffolding
Scaffolding involves adjusting the amount and type of support provided by teachers or parents based on the child's developmental level.
233
Zone of Proximal Development - Example
1. A child is reading a book aloud with you.
2. They encounter a word they don’t know.
3. The child asks you to tell them what the word is.
4. Instead of providing the answer, you ask them to look at the pictures and discuss the story.
5. With your guidance, the child is likely to deduce the meaning of the word on their own.
6. The child will later attempt to figure out similar words independently without asking for help.
234
Emotional Toll on Families - Hospitalization
Hospitalization is a stressful and anxiety-provoking time for both the child and their family/whānau as a whole.
235
Emotional Impact on Children
Children experience stress and anxiety due to separation from family, friends, and support networks during hospitalization.
236
Procedures and Tests
Invasive tests can contribute to physical discomfort for the child, adding to their emotional stress.
237
Pain and Discomfort
Medical interventions can directly affect the child's comfort and well-being, leading to fear and anxiety about procedures.
238
Life Disruptions
A serious illness diagnosis creates uncertainty about future health and treatments, especially with long-term conditions, affecting the entire family.
239
Educational Disruptions
Hospital stays can disrupt the child's education, and the family may face financial and employment impacts due to the child's health needs.
240
Preparing children
and adolescents –
role of the family
* Family dynamics and
support:
* Assess if family
members are at ease or
anxious
* Recognise that family
composition and
dynamics can vary
* Evaluate whether the
family has robust
support systems
241
Preparing children for surgery
* Familiarisation with the hospital environment:
tours of theatre and related areas - familiarising children with
the surgical environment to reduce fear and anxiety.
* Educational resources: videos, slides, and movies about
surgical procedures
* Using visual aids to explain what will happen during surgery.
* Interactive materials
* Colouring books, puppet shows, and tablets/iPads to engage
children in a friendly manner
* Use characters like "Dora the Explorer" to make the material
relatable and less intimidating.
* Practical engagement: play with actual hospital
equipment
* Allowing children to handle real medical equipment to
desensitise and normalise the surgical environment.
* Sensitive topics: considerations for personal
embarrassment
* Addressing potential discomfort about sensitive topics like
'private parts' delicately.
* Anxiety management: relaxation techniques and
coping strategies
* Consulting with liaison psychiatry or other professionals to
teach effective anxiety management techniques to children.
242
Definition of chronic illness
1. Interferes with daily functioning for >3
months/year
2. Hospitalisation lasting >1 month/year
* At diagnosis likely to include either one or both
3. Typically, affects child for life – cure is rare,
243
Impact of chronic illness isn’t
uniform and typically depends on:
Variations in impact can be based on:
1.type of diagnosis & degree of physical impairment
e.g., asthma diagnoses may affect a young athlete differently than others,
considering the severity of the illness (severe vs mild)
2.visibility of illness
e.g., chemo and hair loss or steroid treatment and weight gain contrast with
conditions like chronic fatigue, which might be perceived sceptically by peers
3.uncertainty about prognosis
how it affects life presently and in the future; discussions about long-term
effects can be challenging for children who may find it difficult to imagine their
future.
4. Irregular and unpredictable effects of illness
* example: Conditions like multiple sclerosis can have unpredictable flare-ups,
causing uncertainty about when symptoms will occur, which can significantly
impact planning and quality of life
5. Treatment & pain associated with disease & treatment
* example: Treatments for diseases like juvenile arthritis may involve painful
joint injections and regular hospital visits, contrasting with conditions
managed by daily oral medications at home, which are less disruptive to daily
life.
244
Emotional Responses to Illness - Negative
Children may experience:
Low self-esteem, poor social skills, and social isolation
Depression and low mood
Anxiety or severe stress
Acting out, substance use, and risky behaviors
Responses often depend on the seriousness of the illness, stage of development, and coping strategies used
245
Emotional Responses to Illness - Positive
Children may also experience:
A sense of empowerment
Re-examination of priorities after escaping death
Improved family and peer relationships
Healthy lifestyle changes
246
Psychological problems
may appear for children at
At diagnosis
* Scary/anxious time
* Dealing with uncertainty & mortality
* During the onset of adolescence
* Seeking independence , rebellion against rules,
* Puberty and physical/emotional changes that accompany
it
* Typical risky behaviours emerge, peer pressure
* During transition to adulthood
* Adult health services, are much more individually
focused and a young person may not be ready/able to
face their illness without family suppor
247
Living with Chronic Illness
Long-term medical treatment plans often include medication, behavior changes, and medical procedures.
248
Importance of Adherence
Good adherence improves health outcomes; health practitioners should work with children and families to encourage and support adherence.
249
Forms of non-adherence
1) discontinuation of treatment
* Example: A teenager might stop taking their asthma medication
because they feel it's not needed anymore or due to side effects
2) modifying dosage without medical consultation
* Example: A child might take less pain medication than
prescribed due to fear of side effects or because they
mistakenly feel it’s sufficient.
250
Age and developmental status influence adherence
* Younger children are typically under the control of their family who
manage their treatment schedules
* Adolescents often seek autonomy and may resist treatments that
they feel impact their independence or social life
251
Non-adherence: adolescent-
specific causes
* Identity - ”who am I?” – challenging to incorporate chronic illness/diagnosis
into own sense of self
* Denial of illness (feeling invincible, want to look tough, comparing yourself to
others etc).
* Shift towards more independence from parents - expected to take increasing
responsibility for their health
* Illness can make them feel powerless – trying to get control
* Overprotective parenting can delay teen’s taking responsibility
* Confronting parental/doctor’s authority/testing limits
* Peer pressure – conforming to social pressure
* Stigma around illness
* Lack of understanding – difficulty in ‘future thinking’/long-term consequence
of non-adherence
252
Supporting adherence – take a developmental perspective
* For younger children: Ensure parents are fully
educated about the importance of the treatment
regimen and the risks of non-adherence
* For adolescents: Involve them in decision-making
processes, discussing the benefits and
consequences openly to encourage responsibility
and compliance.
Don’t be hard on teens – most adults struggle with
adherence. Especially when it comes to behaviour
change/lifestyle
253
Family's Role in Young People's Health Treatment
Young people often rely on family for support during treatment and at home. Dependency shifts from full reliance in young children to greater independence in adolescence. The role of family changes, and health practitioners must recognize this. Families face multiple stressors beyond one ill child, leading to a cumulative impact on family functioning, including medical, psychological, financial, and relationship challenges
254
Family's Role in Young People's Health Treatment
Young people rely on family for support during treatment and at home.
Dependency shifts from full reliance in young children to greater independence in adolescence.
The role of family changes; health practitioners must recognize this.
Families face multiple stressors beyond one ill child, including significant challenges.
Cumulative impact on family functioning includes medical, psychological, financial, and relationship issues.
255
Educational Approaches for Families in Health Care
Family Education:
Provide knowledge to the whole family, including children and adolescents.
Offer specific information about the disease, treatment, and the rationale behind treatment.
Use verbal explanations supported by written materials and extra resources (online videos, age-appropriate).
Emphasize repetition for understanding; check comprehension regularly.
Information for Children:
Use concrete and simple language; young children may struggle with treatment concepts.
Incorporate visual aids (pictures, diagrams) to explain treatment regimens.
Information for Adolescents:
Assess their knowledge about the disease and adjust information to their cognitive level.
Consider their previous experiences with medications/treatments and online research.
Diagnosis Support:
Provide clear information at the time of diagnosis (prognosis, treatment details).
Repeat information to aid processing; check understanding during follow-ups and gradually add more information.
256
Modeling
The process of demonstrating specific behaviors or skills for patients, particularly children, to observe and imitate in order to facilitate learning and understanding of treatment regimens or health-related actions.
257
Supporting Families in Healthcare
Importance of Family Involvement:
Parents manage logistics: medication, appointments, and treatment schedules.
Dependency shifts from young children to more independence in adolescents.
Ways to Support Families:
Psychological Support:
Foster family closeness and cohesiveness.
Enhance problem-solving strategies for both illness and family dynamics.
Peer Support Groups:
Offer shared experiences and coping strategies through camps or online networks.
Peer Educators:
Older teens serve as role models for younger teens with similar experiences.
258
Primacy and Recency Effect
Primacy Effect: Tell patients the most important information first (36% increase in recall).
Recency Effect: Repeat key information at the end.
259
Stress Importance
Key Strategy: Stress the importance of key parts of information (15% increase).
Example: “It’s very important that you remember what I’m going to say next.”
260
Simplification
Simplify Language: Use shorter words and sentences, matching your patient’s health literacy level (13% increase).
261
Explicit Categorisation
Strategy: Categorise material before presenting it (9–18% increase).
Technique: List category names to the patient and repeat the name before each category of information is presented.
262
Repetition
Repetition Increases Recall: Use repetition to improve memory retention (14–19% increase).
263
Specific vs. General Statements
Specific Statements: Use specific instructions to boost recall (35% increase).
Example: “Go for an hour’s walk three times a week” instead of “Make sure you take regular exercise.”
