Session 1 Flashcards
(25 cards)
What is Health Psychology?
Psychology is the science of how people think, feel and behave
Health psychology is the contribution (application) of the discipline of psychology to:
The promotion and maintenance of health
The prevention and treatment of illness
The identification of psychological factors influencing health and illness
AND the analysis and improvement of the healthcare system and health policy formation
Adapted from Matarazzo, 1982
What is the Biomedical Model?
- Mind and body are two separate entities and therefore require separate treatment.
- Pathogens, injury or physiological change/damage causes illness
- Individuals are not to blame for their conditions since the causes are mainly outside their control
- Illness is treated by intervention in the body – drugs, surgery etc
- The responsibility for treatment rests squarely with the medical profession
- There is little role for psychology in health and illness although recognized that illness could affect mood e.g. depression. No relationship between psychological factors and the onset of ill-health
- Approach to illness and treatment – reductionist
- Focus of treatment: eradication or containment of pathology
- Focus of health promotion: avoidance of pathogens
- Causality: linear
What is the Biopsychosocial Model?
- There can be a combination of bio (e.g. virus), psycho (e.g. stress, behaviour) and social (e.g. employment) factors at different levels
- Causality: circular
- Because health and illness is a consequence of a variety of factors including lifestyle then the individual is no longer seen as a passive victim – therefore patient is responsible for their health in that sense.
- The whole person should be treated and not just the physical changes that have taken place – holistic approach
- Responsibility for treatment is shared between the doctor and the patient
- Psychological factors are important not just as the consequence of illness; they may also have causal influence.
- Mind-body relationship: part of dynamic system; influence each other
- Focus of treatment: physical, psychological and social factors contributing to illness
- Focus of health promotion: reduction of physical, psychological and social risk factors.
Explain why the biopsychosocial model is important in modern medicine
- The more recent biopsychosocial approach has the capacity to unify disciplines in theory and practice, and encourage a holistic approach to medicine.
- The approach provides a clear framework where illness is seen to be caused by many factors at different levels rather than purely by pathogens.
- It should lead to more comprehensive research that examines the multiple levels, systems and factors involved in health.
- Moreover in clinical practice, the biopsychosocial approach should result in a more complete understanding of the many factors that can contribute to health or illness. This in turn should lead to a more holistic approach – that is, treatment of the whole person.
- The biopsychosocial approach has already resulted in a more patient-centered approach to medicine (Borrell-Carrio et al., 2004).
- It should also lead to better medical training, with the inclusion of education about psychological and social factors.
What does the holistic approach mean?
The holistic approach means we should consider biomedical factors, lifestyle behaviour, psychological factors (e.g. beliefs, emotions, symptoms) and social factors.
What is the Cognitive Model of Psychology?
- How we store memories and organize knowledge is known as the COGNITIVE MODEL of psychology
- Knowledge is stored as mental representations, organized in schemata (groups of related information)
- E.g. restaurant schema, fruit schema.
- We’ve made our assumptions based on our previous experiences, so we don’t have to think actively everytime
- The function of the cognitive model of psychology is to save ‘processing power’; environment is more predictable; allows anticipation; avoids ‘information overload’
Explain about schemata and how normal human cognitive functions lead to stereotypical thinking
- Schemata: mental framework that helps you organize and perceive new information with little processing power
- In the schema (singular), members of group share some characteristics e.g. apples all share similar, common features to allow us to recognize an apple
- But this cognitive shortcut has a risk of overlooking diversity and can lead to prejudice
What is meant by social cognition?
Compliance, conformity and group behaviour
Behavior in influenced by social and cognitive processes we may not be aware of
All human beings are susceptible so we need to know about them and be vigilant.
What are stereotypes?
- Generalisations we make about specific social groups, and members of those group. Stereotypes are social schemata (about people, roles, relationships)
- Ideas about ‘typical’ older person, gay man etc
- Prone to an emphasis on negative traits and are resistant to change – even in the face of contradictory information.
- When stereotypes are negative or inaccurate, they can lead to undesirable social behavior
- ‘Rules of thumb’ – broadly correct but can be erroneous. We can’t assume every member will conform to that stereotype.
- Generally stereotypes are funnier if we’re not part of that group
Explain about in-group and out-group attributions
- Groups are a source of self-identity and self-esteem (we assign people to categories to help understand social environment), consider social identification (‘medical student’), social comparison builds self esteem (feeling of belonging)
- People are more likely to focus on negative attributes of people from other social groups, and on positive attributes of people in their own social groups.
- Group membership is an important part of individual identity.
- Different social roles entail different rights and obligations; in medicine, social roles influence the behaviour of doctors and patients (e.g. the sick role)
People tend to conform to the expectations of the groups to which they belong
Group decision making can be impaired by the tendency toward conformity and because alternative positions are not considered.
How can stereotypes lead to prejudice and discrimination?
- Negative bias in many stereotypes can lead to prejudice
- Stereotypes (cognitive component)
Organization of semantic knowledge in schemata
Energy saving, useful ‘most of the time’
Overlooks individuality
- Prejudice (evaluative and affective component)
Attitudes
Pre-judgment often based on negative stereotypes
- Discrimination – (behavioral component – activity based on emotional response and cognitive thoughts)
- Behaving differently with people from different groups BECAUSE OF THEIR GROUP MEMBERSHIP
- If we make an assumption about someone about someone on the basis of their age, we are pre-judging them by saying they will conform to the stereotype. That is prejudice. IF we then act on the assumption, we would be discriminating.*
Unconscious impact of stereotypes: e.g. the way you talk to your patient.
Are patients’ stereotyped beliefs important?
YES! One study found that patients who expressed more negative stereotypes about physicians were less likely to seek medical care when they became ill, were less satisfied with the medical care that they did obtain and were less likely to be adherent to the treatment prescribed by their physician (Bogart et al, 2004). It may also be important for doctors to try to change their behaviour so that they do not reinforce unhelpful stereotypes.
Give an example about stereotypes leading to prejudice and discrimination
Previous research has indicated that many people with mental illnesses report ufair treatment from their own GPs – in one study, GS were significantly less happy to register a patient with schizophrenia and significantly more concerned about the risk of violence and the child’s welfare and were more likely to say that would personally contact the patient’s previous GP. Schizophrenia arouses concerns in GPS that are not simply due to the fact that patients have a mental illness. Patients with schizophrenia may have difficulty finding a GP prepared to register them and this can hamper the likelihood they will receive the integrated community-based healthy care they need. The results also suggest a need to educate GPS about the care of patients with schizophrenia.
Describe the conditions under which people are more likely to rely on stereotypes
Under time pressure
Fatigue
Suffering information overload
E.g. night shifts, multi-tasking
Give examples of ways to avoid reliance on stereotypes
Getting to know members of other social groups (of different and diverse cultures and backgrounds) helps challenge negative stereotypes – FAMILIARITY
Reflective practice can also help
What are common assumptions of the elderly?
- In general our society has a negative view of ageing which is seen as the loss of youth and a decline in physical, cognitive and social functioning
- Dementia is present in 25% of the population aged 85+ but it is a myth that all old people suffer from fundamental intellectual decline.
What is meant by crystalline intelligence and fluid intelligence?
Do they decline with age?
- Crystalline intelligence: reflects experience and long term memory (highly learnt skills and general knowledge)
- Fluid intelligence: reflects processing speed and short term memory (problem solving without prior training or exposure)
- Tests of fluid intelligence (e.g. IQ tests) suggest many older people are ‘mentally disadvantaged’ however their behaviour does not match this description. One reason for this is that crystalline intelligence may compensate for declines in fluid intelligence. In addition, IQ tests may not assess real-world skills. Age-related declines in fluid intelligence are associated with physical health and organic change in the central nervous system. Research shows that enhancing physical fitness can therefore improve cognitive function in older adults regardless of whether they have existing dementia or cognitive impairment.
What have longitudinal studies such as Shaie and Willis shown?
a Seattle study a collected cohort of young people and followed them up 35 years.
- They considered five ‘skill areas’: verbal meaning, verbal fluency, inductive reasoning, numeracy and spatial orientation.
- The study showed decline does not occur in all areas at same rate – variation.
- The most age-sensitive component of intelligence seems to be processing speed.
- If their health deteriorates, they may get a lot worse over a short period of time
- The general supposition is that it gets worse with age…but different aspects of memory function may behave differently. Long term / semantic memory is believed to generally more highly preserved as you age compared to short term memory.
- Effects of disease such as dementia, Alzheimer’s disease and MCI (Mild Cognitive Impairment – cognitive problems aren’t bad enough to be defined as dementia)
- To summarize, some aspects of intellect are very stable with age whilst some aspects of cognitive function do in general decline with age. Some individuals change very little.
What is the developmental model of personality ageing?
The developmental model of personality ageing derives from psychoanalytical theory. Freud et al had a fairly negative view of later life. The most influential ideas were those of Erikson with his ‘life-stages’ and associated conflicts
Young adult life: Intimacy vs. isolation
Mid-adult life: Generation vs. stagnation
Old age: Integrity vs. despair.
What is meant by the Trait Model of Personality?
The Trait Model of Personality: personality is described in terms of constituent traits
Cross-sectional studies suggest a differential distribution of traits at different ages
Longitudinal studies however emphasize the stability of traits within an individual over time
Discuss social adjustment and ‘successful’ ageing
- Disengagement model (Cumming & Henry 1961): Disengagement from social involvement as an adaptive mechanism – ‘apples to introverted people’
- Activity model (Havighurst 1961 and on): successful ageing requires maximal engagement in all areas of life – ‘applies to extroverted people’
- Both these are right for different groups of people
- Continuity model (Atchley 1971) – older adults will usually maintain the same activities, behaviours, personalities and relationships as they did in their earlier years of life by adapting strategies that connected to their past experiences.
What is meant by the social context of ageing - families in old age?
- Major family adjustments with aging e.g. ‘Empty nest phenomenon’ and Grandparenthood
- Changing patterns of family contact – families live further apart these days. Adult children generally are less supportive of parents due to state and social welfare schemes – but different for different cultures. Relationship is more voluntary – no longer out of necessity (parents are not so dependent on children e.g. they receive a pension now)
- The importance of friendships – social networking allows you to keep in touch with friends more easily whereas in the past, contact was really limited to close family members (generalization)
What is meant by the social context of ageing - work and retirement?
- Loss of manifest and latent rewards of paid work (work builds self-esteem, social activity with work colleagues)
- Unemployment (no control over this, inflicted upon you, normally at an age when you should be working) vs. retirement (something to look forward to, work toward, enjoyable). Retirement is much more commonplace than in the past
- A pension still means you are less financially well off than whilst you was working
- Most people do adjust successfully
What is meant by the social context of ageing - death and bereavement?
- Bereavement in old age is not different but more common place as you’re more likely to lose your friends (of a similar age) and this is the most likely age period for spouse death
- Depression tends to be associated with declines or losses in other areas including functional disability, cognitive impairment and social deprivation. Bereavement has an important impact on rates of depression. Older people are more likely than younger people to experience the death of their spouse and friends. Given that average life expectancy is longer for women, in each age band there is a greater proportion of widows than widowers. This may help to explain higher rates of depression among older women than men. Depression is common old age.
- Later life is not a period of stagnation but a time of great and often unanticipated change during which people have to adapt rapidly to enforced limitations.
