HEALTH PSYCHOLOGY Flashcards
Health Psychology involves the study of:
- factors that influence wellbeing and illness
- measured ti promote health and prevent illness
What is physical pain?
- unpleasant sensory and emotional experience caused by disease or injury
- pain can range from mild to severe
- can be acute or chronic
- pain has both physical and emotional components
The experience and management of pain:
- most people find it very unpleasant and are motivated to avoid
- mediated by specific fibres that carry pain impulses to the brain where conscious appreciation may be modified by many factors
- chronic pain can severe consequences for a person’s wellbeing
Why study pain in psychology?
- features of many illnesses and may be a major stressor
- complex perceptual phenomenon involving numerous psychological processes
Fordyce, 1988; Melzack, 1998: people can expeircen debilitating pain and have no injury or have a severe injury with no pain.
Where are pain receptors NOT found?
- brain
- hair
- bones
- teeth
- nails
Biological mechanisms
Pain receptors are stimulated ->
nerve impulses sent along spinal cord to the brain ->
relay sensory info about pain intensity and location to somatosensory regions of the cerebral cortex
OR direct nerve impulses to the limbic system (motivation and emotion centre)
Theory
• Pain results from the opening and closing of gating
mechanisms in the nervous system.
- When spinal cord ‘gates’ are open, nerve impulses can travel to the brain.
- Sensory inputs (e.g. touch) can close the ‘gates’ and stop the experience of pain.
- Nerve impulse fibres from the brain can also open and close the ‘spinal gates’, increasing or decreasing pain stimulation from the brain.
• This central control mechanisms allows thoughts, emotions and beliefs to influence pain.
What opens the gate?
Physical Factors:
• Bodily injury
Emotional Factors:
• Anxiety
• Depression
Behavioural Factors:
• Attending to the injury and concentrating on the pain
What closes the gate?
Physical Pain:
• Analgesic remedies
Emotional Pain:
• Being in a good mood
Behavioural Factors:
• Concentrating on things other than the injury
Endorphins
Endorphins = hormones secreted within the brain and nervous system = the body’s natural painkillers.
- Endorphins created in the Pituitary glands inhibit release of neurotransmitters involved in transmitting pain impulses from the spinal cord to the brain (Fields, 2005).
- Some endorphins are incredibly potent – one more than 200x more powerful than morphine (Franklin, 1987).
- Endorphins may explain how psychological factors can influence pain.
Zubieta et al. (2001)- Endorphins
- P’s were injected with radioactive form of an endorphin and then received painful injections of salt water into their jaw.
- Brain scans revealed a surge of endorphin activity within the thalamus (sensory switchboard), the amygdala (emotion centre) and a sensory region of the cortex.
- As the endorphin surge continued over 20mins of pain stimulation, p’s reported decreased sensory and emotional pain ratings.
- P’s differed in their experience of pain due to: • Number of opioid receptors.
- Ability to release endorphins.
Acupuncture:
How could it relate to Gate Control Theory?
How could it relate to Endorphins?
Gate Control – stimulation of sensory fibres that shut sensory gates in the pain system.
Endorphins – acupuncture stimulates the release of pain reducing endorphins.
Stress-Induced Analgesia
What is it? Study? Adaptive? Endorphins? Chronic?
• Reduced or absent pain in stressful situations.
• 65% of soldiers wounded during combat reported feeling
no pain at the time of injury (Warga, 1987).
• Highly adaptive – fight or flight given immediate priority over normal pain responses
• Endorphin rush which supresses pain related behaviours so the individual can perform the action needed for immediate survival.
• Painkilling effects of endorphins may come at a price! Chronically high levels of endorphins reduce the activity of the immune system.
Cultural influences on Pain: Entertainment
In the Dugum Dani of Highland, New Guinea a highly regarded form of entertainment is spear fights within the tribe.
The men play ‘war games’ and position themselves side by side in two parallel lines, facing each other with a distance of 30 yards between the lines.
Each man holds a long spear and upon signal throws it at the man across from him.
Cultural influences on Pain: Childbirth (Kroeber, 1948)
In Papua New Guinea and Bolivia, the woman’s husband would get into the bed an groan as if he was in pain, while the woman calmly gave birth.
In more extreme cases, the husband then stayed in bed with the baby to recover from the terrible ordeal and the mother returned to work in the fields almost immediately.
The effect of culture on pain sensitivity
(Al-Harthy et al. 2016)
Participants
Pain measurement (mechanical and electrical)
Results
Participants: Saudi Arabian (n = 39), Italian (n = 42) and Swedish (n = 41) females participants.
Pain measurement: Most pressure to the palm p’s could stand and intensity of current needed for the subject to perceive pulses in the thumb and index finger.
Results:
• Italian females reported the highest sensitivity to mechanical and electrical stimulation, while Swedes reported the lowest sensitivity.
• Mechanical pain thresholds differed more across cultures than electrical thresholds.
• Cultural factors may influence response to pain.
Cultural Influences -meanings and beliefs - Melzack and Well (1991)
Pain sensation is similar across cultures but pain tolerance differs across cultures.
Interpretation of pain impulses sent to the brain is partly influenced by an individual’s experiences and beliefs – both factors which are influenced by culture.
Cultural Influences -meanings and beliefs - Rollman (1998)
Childbirth
Different cultural groups do not differ in their ability to discriminate among pain stimuli, but may differ in their interpretation of pain.
• Mothers in cultures where childbirth is not feared do not attach such strong negative feelings to childbirth and as a result experience less pain.
Cultural Influences -meanings and beliefs - Beecher (1959)
Soldiers and civilians
25% of 2nd World War soldiers required pain medication, compared to 80% of civilians who received similar wounds during medical operations
• Soldiers perceived their wounds positively – evacuation from war
zone and ticket home.
• Civilians perceived their wounds negatively – major life disruption.
• Different meanings result in different levels of suffering and different needs for pain relief.
Placebos-what are they?
- Physiologically inert substances that have no medical value but are thought to by patients.
- Placebos produce a reduction in pain.
Placebos- (Beecher, 1959)
Post-op and morphine
67% of patients suffering post-operative pain who received morphine reported pain relief, but 42% of those who received a placebo reported equal relief
Placebos- (Petrovic et al., 2010)
Positive belief
Positive belief in placebo’s effectiveness resulted in a release of endorphins to reduce pain
Personality
Interpretation of pain?
Neuroticism?
Optimism?
- Certain personality traits influences how an individual interprets and responds to pain.
- High neuroticism (tendency to experience negative emotions) linked to higher levels of pain (Asghari & Nicholas, 2006).
- Individuals high in optimism and who have a high sense of personal control over their life experience less pain and suffering (Pellino & Ward, 1998).
Social Support
Networks
Arthritis
Menstrual pain and depression and anxiety
- An individual is not in a social vacuum – social support networks can influences responses to pain.
- Social support enabled patients with rheumatoid arthritis experiencing daily pain to more effectively use coping strategies to manage their pain (Holtzman et al., 2004).
- Women with self-reported depression and anxiety experienced greater menstrual pain, especially if they recently lost a significant source of social support (Alonso & Coe, 2001).
Global prevalence of chronic pain
20% (Boris-Karpel, 2010)
Cognitive strategies- Dissociation
What is it and what does it involve?
Effective?
Research into burn wound cleaning and VR?
- Distracting oneself from pain.
- Direct your attention to some other feature of the external situation.
- Imagining a pleasurable experience.
- Repeating a word/thought to yourself - mantra.
- Most effective if requires a great deal of concentration or mental effort.
- Children and adults with 60% burns reported lower pain ratings when having their wounds cleaned when wearing virtual reality googles that took patients into a world of shapes and colours (Hoffman et al., 2001).
Cognitive strategies- Association
What is it?
Effective?
When to use?
Research into using dissociate and associative strategies?
• Focus your attention on the physical sensations and study them in a
detached and unemotional fashion.
- Associative strategies are more effective than dissociative strategies for intense pain.
- Use dissociative strategies for as along as possible and then switch to associative strategies.
- P’s who used a combination of dissociative and associative strategies were able to tolerate the pain of submerging their hand in ice cold water for longer than a placebo and control group (Bandura et al., 1987).
Forys and Dahlquist (2007)
Participants
Pain measure
Cognitive strategy
Participants: 95 undergraduate students with no chronic pain. P’s were low, high, or mixed monitors of pain.
Pain measure: Cold pressor.
Cognitive strategy:
• During distraction, participants were asked to count aloud, beginning at 1,000 and subtracting by 7s.
• Participants in the sensation monitoring condition were asked to focus on and describe the sensations that they were feeling in their immersed hand.
• The participants in the control group were not given task- related instructions.
Forys and Dahlquist (2007)
Results
• Low monitors’ pain threshold was significantly higher
during distraction AND sensation monitoring than baseline.
• Mixed monitors’ pain threshold was significantly higher during distraction AND sensation monitoring than baseline.
• High monitors’ pain threshold was significantly higher in the sensation monitoring than baseline.
• Controls’ pain threshold did not differ, regardless of coping style.
Fox et al. (2016)
monitors/ blunting
Participants
Cognitive Strategy
Lemons…
Participants: Chronic pain suffers classified as Monitors (n = 16) or Blunters (n = 19).
• Monitoring (attending to)
• Blunting (avoiding)
Cognitive Strategy:
• P’s were provided with an audiotaped intervention in which they were instructed to focus on pain sensations or to engage in a distraction task.
- Sensation-focused = focus on pain sensations, but label them in an objective, non-threatening way.
- Distraction = visualise an interactive scene and focus on the different sights, sounds, and smells unrelated to pain
- ‘Imagine a pure white plate with a lemon on it, resting on a table. See the glossy yellow of the lemon’s skin against the whiteness of the china plate …’
• P’s had to rate pain intensity and their anxiety during and after the sensation-focused and distraction conditions.
