Ch. 1: What is Health Psychology?

What was the mind-body relationship during the beginning or the Renaissance, continuing into present day?

Strides to understand technical basis of medicine Invention of microscope; Autopsy to see origin of disease Humoral theory put to rest Medical practice drew on lab findings & looked to bodily factors rather than mind as bases for health & illness Break superstitions of past= Resisted acknowledging any role of mind in disease process Focused primarily on organic & cellular pathology as basis for diagnosis & treatment recs

What is epidemiology?

Study of frequency, distribution, & causes of infectious & noninfectious disease in popn -Study not only who has what kind of cancer but also why some cancers are more prevalent in particular geographic areas or among particular group of ppl

What was the mind-body relationship during the Middle Ages?

Supernatural explanations for illness Disease = God's punishment for evildoing Goal= driving out evil forces by torturing body "Therapy"= penances & good works Church- guardian of medical knowledge Medical practice assumed religious overtones Functions of physicians absorbed by priests Healing & practice of religion became virtually indistinguishable

What is psychosomatic medicine?

Profiles of disorders believed to be psychosomatic in origin- caused by emotional conflicts Ulcers, hypothyroidism, rheumatoid arthritis, essential hypertension, neurodermatitis (skin disorder), colitis, & bronchial asthma

What are the clinical implications of the biopsychosocial model?

Process of diagnosis can benefit from understanding interacting role of bio, psych, & social factors in assessing health/illness Recs for treatment focus on all three Makes explicit sig of relationship b/w patient & practitioner Effective relationship can improve use of services, efficacy of treatment, & rapidity that illness resolved

What are the advantages of theory for guiding research?

Provide guidelines for how to do research & interventions -General principles of CBT can tell one what components should go into intervention w/ breast cancer ppl, same principles can help diff. develop weight loss intervention Generate specific predictions Can be tested & modified as evidence comes in -ppl need to believe they can actually change behavior- imp. of self-efficacy incorporated into theories of health behavior Help tie together loose ends -Smokes relapse, go off diets, alcoholics have trouble remaining abstinent- Theory of relapse helps unite scattered observations into general principles of relapse prevention that can be incorporated into diverse interventions

Why are experiments and randomized clinical trials the gold standard for health psychology research?

Provide more definitive answers to problems than other research methods When we manipulate variable & see effects, can est. cause-effect relationship definitively

What were some problems with the biomedical model? Why is it ill-suited to understanding illness?

Reduces illnesses to low-lvl processes - disordered cells & chemical imbalances Fails to recognize social & psych processes as powerful influences over bodily estates Assumes mind-body dualism Emphasizes illness over health rather than focusing on behaviors that promote health Model can't address many puzzles practitioners face: Flu virus doesn't affect everyone, just some

What is an experiment?

Researcher creates two or more conditions that differ from ea. other in exact & predetermined way Ppl randomly assigned to diff. conditions Reactions measured

What are factors that have fueled the growing field of health psychology?

Changing patterns of illness Advances in tech & research Expanded health care services Increased medical acceptance

Why are morbidity and mortality statistics essential to health psychologists?

Charting major causes of disease can lead to steps to reduce occurrence Mortality: car accidents major cause of death- led to various safety measures (set belt laws, raising drinking age) Morbidity: Why is use of affecting cause of death if ppl remain ill but simply don't die? Quality of life & symptom reduction imp. Work to improve quality of life so that ppl w/ chronic disorders can live lives free of pain, disability, & lifestyle compromise as possible

What is meta-analysis? Why is it useful?

Combines results from diff. studies to ID how strong evidence is for particular research findings Powerful methodological tool- uses broad array of diverse evidence to reach conclusions -on 100 studies of dietary interventions to ID which characteristics lead to more successful dietary change interventions that enhance self-efficacy (belief that one will be able to modify died) are successful

What is health?

Complete state of physical, mental, & social well-being Not merely the absence of disease or infirmity

Why do health psych represent an imp. perspective on the issues of health care services?

Containing health care costs important Health psych main emphasis is on prevention - modifying risky behavior before they become ill Can reduce dollars devoted to management of illness Know what makes ppl happy/sad w/ health care Help design user-friendly health care system Health care industry employs mills of ppl Nearly every person in country has direct contact w/ health care system as recipient of services = impact is enormous

What is a theory?

Set of analytic statements that explain set of phenomena (why ppl practice poor health behaviors) Best are simple & useful will see references to many theories- theory of planned behavior that predicts & explains when ppl change their health behaviors

What are randomized clinical trials?

Experiments conducted by health care practitioners to evaluate treatments/interventions & their effectiveness over time Target treatment compared against existing standard of care or placebo control (organically inert treatment)

What factors led to the development of health psychology? What was the response?

Factors: Developed models... How & why some ppl get ill & others don't How ppl adjust to health conditions What factors lead to ppl practicing health behaviors Response: APA- task force to focus on psych's potential role in health research 1978: Division of Health Psych formed 2001: APA added "promoting health" to mission statement

What are the focus and goals of a health psychologist?

Focus on health promotion & maintenance -how to get ppl to develop good health habits; promote reg. exercise; media campaign to improve diet Study psychological aspects of prevention & treatment of illness -stress management skills; maintenance of treatment regimen Etiology & correlates of health, illness, & dysfunction -behavioral & social factors that contribute to health, illness, & dysfunction Analyze & improve health care system & formulation of health policy -study impact of health institutions & health prof on ppl's behavior to develop rec for improving health care

What was the case in which the biopsychosocial model unraveled the nightmare death puzzle?

Showed completeness of how mind & body were intertwined All clues suggest Pressures of adjusting to life in US played role in deaths Overwhelmed by cultural differences, language barriers, & difficulties finding good jobs Combination of chronic strain, genetic susceptibility, & immediate trigger provided by family argument, violent tv, or frightening dream = nightmare death

What is conversion hysteria? What did it give rise to?

Freud Rise of modern psychology changing biomedical viewpoint Specific unconscious conflicts can produce physical disturbances that symbolize repressed psych conflicts Gave rise to field of psychosomatic medicine

What is the biopsychosocial model?

Fundamental assumption that health & illness are consequences of interplay of biological, psych, & social factors Idea that mind & body together det. health & illness Onset of disease usually due to several factors working together Biological pathogen (viral, bacterial infection) coupled w/ social & psych factors - high stress, low social support, & low SE status

What is the biomedical model?

Governed thinking of most health practitioners for past 300 years All illness can be explained on basis of aberrant somatic bodily processes- biochemical imbalance or neurophysiological abnormalities Assumes that psychological & social processes are largely irrelevant to disease process

Why has there been an increasing acceptance of health psychologists w/in the medical community?

Have developed variety of short-term behavioral interventions that address health-related problems -Managing pain, modifying bad health habits (smoking), managing side effects of treatments Techniques take few hours to teach, can produce years of benefit Have contributed to actual decline in incidence of some disease (coronary heart disease) ex: Informing patients fully abt procedures & sensations involved in unpleasant medical procedures improves their adjustment to it Now routinely prepare patients for it

How has the expansion of health care services affected health psychology?

Health care delivery has substantial social & psych impact on ppl, impact addressed by health psych Health care is largest service industry in US- rapidly Come under increasing scrutiny = substantial increases in health care costs haven't brought improvement in basic indicators of health Huge disparities exist in US Basic preventative care & treatment for common illnesses out of financial reach = Fueled recent efforts to reform health care system to provide all w/ basic health care package

What is the difference between acute disorders and chronic illnesses? Why was there a shift?

Acute disorders: Short-term illnesses Often result of viral/bacterial invader Usually amenable to cure Until 20th cent., was major cause of illness/death Tuberculosis, pneumonia, & other infectious disease Chronic illnesses: Slowly developing diseases ppl live w/ for many years Can't be cured, but managed by patient & provider Main contributors to death/disability in industrialized countries Heart disease, cancer, respiratory diseases Prevalence of acute infectious disorders (TB, influenza, measles, & polio) declined b/c of treatment innovations & changes in public health standards Improvements in waste control & sewage

What was the mind-body relationship during the ancient Greeks time?

ID role of bodily factors in health/illness Humoral theory of illness 4 humors- circulating fluids of body were out of balance -Blood, black bile, yellow bile, phlegm Goal= restore balance Mind was imp. Personality types associated w/ ea. of 4 humors Blood- passionate temperament Black bile- sadness Yellow bile- angry disposition Phlegm- laid-back approach to life

What did Dunbar & Alexander do? What did they help shape?

Idea that specific illnesses produced by ppl's internal conflicts Linked patterns of personality, rather than specific conflict, to specific illnesses Emphasis on physiological mechanisms Conflicts produce anxiety - becomes unconscious - takes physical toll on body via autonomic nervous system - eventually produce actual organic disturbances ulcer Helped shape emerging field of psychosomatic medicine

Why have chronic illnesses helped spawn the field of health psychology?

These are disease that psych & social factors are implicated as causes -Personal health habits (diet, smoking) contribute to development of heart disease & cancer; sex activity to AIDS Ppl may live w/ chronic diseases for many years = psych issues arise in management Help chronically ill ppl adjust psychologically & socially to changing health state & treatment regiments (self-care) Illness affect family functioning, relationships - help ease problems Develop interventions to help ppl learn regimens & promote adherence to them May require med use & self-monitoring of symptoms; Changes in behavior- altering diet, exercise

What kind of experiments do health psychologists undertake?

To det. if social support groups improve adjustment to cancer Cancer patients randomly assigned to participate in support group or comparison condition (educational intervention) Evaluated at subsequent time to pinpoint how two groups differed in adjustment

Why did health psychology develop?

To ppl, health = staying well or getting over illness quickly Don't think of psych & social contributions Cold virus- some get sick, some don't Married men live longer Life expectancy increase, but dramatic social upheaval causes it to plummet Women live longer then men, but denied access to health care; more disabled & need more services Infectious disease used to be major cause of illness, not chronic diseases (heart disease, cancer, & diabetes) main cause of disability & death Tending to spiritual needs is good for health

How have mobile and wireless technologies related to health psychology?

Intervene & assess health env't Ecological momentary interventions (EMI)- use phones, tablets, etc. to deliver interventions & assess health-related events in natural env't -smoking cessation, weight less, diabetes management Participate through phone- provide on the spot administration of treatment or intervention or collection of data -pre timed alert to request answers abt current experience for info abt daily stress; before mails to remind ppl of intentions for diet Activity & sensors- accurately measure exercise/activity Medication reminders Measuring biological indicators of health Blood pressure-hypertension; diabetes results mixed, needs more research

What are retrospective designs?

Look backward in time to reconstruct conditions that led to current situation -Critical in IDing risk factors that led to development of AIDS researchers saw abrupt increase in rare cancer, observed that men who dev. this cancer often died of general failure of immune system by taking extensive of men who dev. disease, able to det. that practice of anal-receptive sex w/o condom related to dev. of disorder B/c of retro studies, know some of risk factors for AIDS even before ID the retrovirus

What is prospective research? What are the two types?

Looks forward in time to see how group of ppl change How relationship b/w two variables changes over time -Hostility develops relatively early in life, but heart disease develops later -Would be more confident that hostility is risk factor for heart disease & recognize that reverse direction of causality (heart disease causes hostility) less likely Used to understand risk factors that related to health conditions Experimental prospective study: Intervene in diet of one community & not in another; Over time, look at difference in rates of heart disease Correlational prospective study: Measure diets that ppl create for themselves & look at changes in rates of heart disease, as det. by how good/poor diet is

How does the biopsychosocial model of health & illness overcome the disadvantages of the biomedical model?

Maintains that bio, psych, & social factors are all imp. det. of health & illness B/ macrolvl (social support, depression) & microlvl (cellular disorder, chemical imbalances) continually interact to influence health/illness & their course Emphasizes b/ health & illness Health becomes something achieved through attention to bio, psych, & social needs, rather than something taken for granted

What is correlational research? What are the advantages & disadvantages?

Measure whether change in one variable corresponds w/ changes in another variable -Might reveal that ppl who are more hostile have higher risk for cardiovascular disease Dis: Difficult to det. direction of causality unambiguously -cardiovascular risk factors lead ppl to become more hostile, maybe? Adv: More adaptable, enabling us to study issues when variables can't be manipulated experimentally

What is evidence-based medicine?

Medical interventions go through rigorous testing & evaluation of their benefits before they become standard of care, usually through randomized clinical trials Criteria for effectiveness also frequently applied to psychological interventions

What is longitudinal research?

Type of prospective study Same ppl observed multiple points in time -To understand factors associated w/ early breast cancer in women at risk, follow group of young whose mothers dev. breast cancer, ID who dev. breast cancer, & see if there are any factors reliably associated w/ dev.

What is morbidity and mortality? What is incidence and prevalence?

Morbidity: Number of cases of disease that exist at some given point in time Tells us how many ppl have what kinds of disorders at any given point in time can be expressed as... Incidence: Number of new cases Prevalence: Total number of existing cases Mortality: Numbers of deaths due to particular causes

What was the mind-body relationship during the prehistoric times?

Must cultures regarded mind & body as intertwined Disease = evil spirits entering body Treatment = exorcise spirits Some skulls have small holes to allow spirits to leave body

How have advances in technology & research affected health psychology?

New medical technologies & scientific advances create issues that need help Certain treatments that prolong life may severely compromise quality of life Patients asked abt preferences in life-sustaining measures May require therapy ex: genes uncovered that contributes to breast cancer = early detection of disease If tested positive, how will this change her life?

What is wellness?

Optimum state of health Achievement involving balance among physical, mental, & social well-being not just absence of illness

What is etiology?

Origins or causes of illness

Where does training in health psychology lead to?

Undergraduate lvl: Medicine - physician or nurses; maybe conduct research Allied health prof fields: Social work- assessing where patients go after discharge, decisions that are informed by knowledge of psychosocial needs of patients Dietetics- dietary management of chronic illnesses Physical therapy- help regain use of limbs & functions compromised by illness & treatments Public health Ph.D/Psy.D Academic research Private practice- individual & group counseling Hospitals & other health care settings Management of health care: business & gov't positions Medical schools, hospitals & other treatment settings I/O health settings- promote healthy behavior, prevent accidents, help control health care costs

What is Health Psychology?

Understanding psychological influences on how ppl stay healthy, why the become ill, & how they respond when they do get ill Study issues & develop interventions to help ppl stay well or recover from illness

How have the tools of neuroscience related to health psychology?

fMRI- permit glimpses into brain Produces knowledge of autonomic, neuroendocrine, & immune systems Make breakthrough studies possible -Can now connect psychosocial conditions (social support & positive beliefs) to underlying biology How placebos work, why functional disorders seem to have no underlying biological causes, why chronic pain intractable to treatment Applications of neuroscience help to address clinical puzzles that have mystified ppl before