Health Psychology Midterm
What are some methods for assessing patient adherence?
(1) ask the practitioner, (2) ask the patient, (3)ask other people, (4) monitor medication usage, - CRAP Machine (5) examine biochemical evidence, (6) use a combination of these procedures.
Validity
-Accuracy -The extent to which a measuring instrument measures what it is designed to be measured -Face validity: looks like it is measuring what is supposed to measure -Construct validity: matches up with other measures of the same construct -Does your operationalization really represent your conceptualizations? -is about how well a test measures the concept it was designed to evaluate. It's crucial to establish the overall validity of a method. -Psychologists determine the validity of a measuring instrument by comparing scores from that instrument with some independent or outside criterion—that is, a standard that exists independently of the instrument being validated.
What is the self-efficacy approach to improving adherence to medical advice?
-Albert Bandura proposed a theory that assumes that humans have some capacity to exercise limited control over their lives. -Emphasizes the interaction of behavior, environment, and personal factors, especially cognition or thinking; referred to this interactive triadic model as reciprocal determinism -An important component of the personal factors is self efficacy -Self efficacy is a persons belief that they have the ability to perform specific behaviors that will lead to a desired outcome -Self-efficacy theory, people's beliefs concerning their ability to initiate difficult behaviors (such as quitting smoking) predict their likelihood of accomplishing those behaviors. People who think they can do something will try and persist at it; people who do not believe they can do something will not try or will give up quickly. -Also important in self-efficacy theory are outcome expectations, which are people's beliefs that those behaviors will produce valuable outcomes, such as lower risk for heart problems. -The combination of self-efficacy and outcome expectations plays an important role in predicting behavior. -To successfully adhere to a health behavior, people must believe that the behavior will bring about a valuable outcome and that they have the ability to successfully carry out the behavior.
What are protective factors?
-Any characteristics that occur with greater frequency and people who do not get a disease than it does in people free of the disease -Examples for heart disease: exercise, low-fat diet, positive emotions
What is the main reason why placebos work?
-Expectancy is a huge part of why it works. People act in ways that they think they should.
What is the difference between experimental and correlational studies?
-Experimental studies determine causality while correlational designs assess the strength of the relationship between two variables. -could not answer questions of causality directly. -Correlation does not equal causation
What is the difference between how male and female physicians work with patients?
-Female practitioners show more friendly behaviors -Listen better and longer -Ask more questions -All related to better adherence
What is illness?
-Illness refers to the experience of being sick and having a diagnosis of sickness.
What are two ways stress is measured? Discuss their advantages and disadvantages.
-Physiological measures- measured through blood pressure, heart rate, galvanic skin response, respiration rate Advantage: reliable and direct Disadvantage: process may produce stress itself; expensive -Self-report measures Life event scale- checklist of life events such as marriage, death, traffic violations. every day hassle scale- measures daily hassles (experiences of every day living that may be threatening to a persons well-being) example traffic, concerns of weight, household chores Advantages: skills can predict occurrence of stress related symptoms such as good predictive validity Disadvantages: people may overreport some events and under report other events
What are the main factors that predict adherence or compliance to medical and health advice?
-Social support -Some like to use the terms cooperation or collaboration to describe the ideal relationship between health care professionals and patients
Double-blind study
-The arrangement in which neither participants nor experimenters know about treatment conditions is called a double-blind design. -Double-blind designs are not easy to perform with these treatments
How can we create immunity to a virus?
-Vaccinations: a weakened form of virus or bacterium is introduced into the body, stimulating production of antibodies. -These antibodies then confer immunity for an extended period. -Smallpox eradicated through vaccine. -Especially useful for viruses, but must be specific to virus
What is adherence?
-We define adherence as a person's ability and willingness to follow recommended health practices -The extent to which a person's behavior (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice
What is the purpose of inflammation in the immune system response?
-Works to restore tissues that have been damaged by invaders. -Blood vessels in area of injury dilate causing redness and warmth. -Damaged cells release enzymes that help destroy invaders. -Granulocyte and macrophage migrate to site of injury to help destroy invaders -Finally, tissue repair begins
What are the three leading causes of death in the U.S. currently and in the past?
Pneumonia, tuberculosis, diarrhea
Primary appraisal:
a person determines whether events are a relevant, benign-positive (good), or stressful. l. Irrelevant events are those that have no implications for a person's well-being, such as a snowstorm in another state. Benign-positive events are those that are appraised as having good implications. A stressful event means that the event is appraised as being harmful, threatening, or challenging. Lazarus (1993) defined harm as damage that has already been done, such as an illness or injury; threat as the anticipation of harm; and challenge as a person's confidence in overcoming difficult demands.
How can self-efficacy be acquired, enhanced, or decreased?
-(1) performance, or enacting a behavior such as successfully resisting cigarette cravings; -(2) vicarious experience, or seeing another person with similar skills perform a behavior; -(3) verbal persuasion, or listening to the encouraging words of a trusted person; -(4) physiological arousal states, such as feelings of anxiety or stress, which ordinarily decrease self-efficacy
Why is studying adherence important?
-125,000 people may die in the US because they fail to adhere to medical advice -Understand why people fail to follow medical advice -To understand what can be done to make it more likely that people will follow medical advice
What is health psychology? (UNFINISHED)
-A field of psychology that contributes to both behavioral medicine and behavioral health -The scientific study of behaviors that relate to health enhancement, disease prevention, and rehabilitation
How is stress related to HIV?
-People under substantial stress—such as caregivers—show weakened antibody production following flu vaccination compared with people under less life stress. -This relationship between stress and weakened response to vaccination suggests it is as apparent among younger adults as it is among older adults. they concluded that stress affects both the progression of HIV infection and the infected person's immune response to antiviral drug treatment.
What is the difference between stress as a stimulus and stress as a response?
-Sometimes used to describe something that happens to us -a stimulus -When some people talk about stress, they are referring to an environmental stimulus, as in "I have a high-stress job. -It is sometimes used to describe a response to what happens to us - a response -Others consider stress a physical response, as in "My heart races when I feel a lot of stress." -either our physical response or our psychological response
What is the tend-or-befriend response and how is it different from the fight-or-flight response?
-Taylor and her colleagues propose that women's behavioral responses to stress are better characterized as "tend and befriend" than "fight or flight." -That is, women tend to respond to stressful situations with nurturing responses and by seeking and giving social support, rather than by either fighting or fleeing. -Indeed, one of the largest gender differences in coping with stress relates to social support seeking: -Women seek out the company and comfort of others when stressed more than men and also provide better support when stressed than men
What is the relationship between adherence and the number of times a day a person has to take medication?
-The greater the number of doses or variety of medications people must take, the greater the likelihood that they will not take pills as prescribed this may be due to people having difficulty fitting medications into daily routines. -Type 2 diabetes, patients who were prescribed the most complex regimen—in terms of both the need to split pills as well as the number of doses per day—showed the lowest rates of adherence
What function does the immune system serve?
-Tissues, organs, and processes that protect the body from invasion -Locates foreign micro organisms, mutant cells, or damaged cells and activates processes to eliminate them -Generally to protect against injury; specifically to protect against foreign substances the body encounters When something foreign enters our body we have either a general or specific immune response
What is prevalence?
-refers to the proportion of the population that has a particular disease or condition at a specific time
How effective are the different methods for assessing patient adherence?
-used a variety of methods to assess adherence, including interviewing patients, counting pills, electronic monitoring, and measuring biochemical evidence, as well as a combination of all these methods. -The results indicate good agreement among pill counts, electronic monitoring, and measuring biochemical evidence -poor agreement between these objective measures and patients' or clinicians' reports.
Cross-sectional
-Compares two or more separate groups at only one time -which make them incapable of revealing information about changes in individuals over a period of time
Example of a Ex Post Facto?
-For example, researchers might study the link between meat consumption (subject variable) and cancer risk (dependent variable) by recruiting participants from two community groups: one group being a vegetarian/vegan cooking club and the other being the local chapter of Steak Lovers Anonymous. -There is no random assignment in this ex post facto design, but the two groups would certainly differ in red meat consumption.
What is incidence?
-Incidence measures the frequency of new cases during a specified period, usually 1 year. The number of new cases of a disease during a particular time
What is Medicare?
-Medicare pays hospital expenses for most Americans over the age of 65, and thus few people in this age group are without hospitalization insurance. -Medicare also offers medical insurance that those who participate may purchase for a monthly fee, but many expenses are not covered, such as routine dental care.
What is an autoimmune disease and what are some examples of autoimmune diseases?
-Occurs when the immune system attacks the body; not well understood -In autoimmune diseases, the immune system loses the ability to distinguish the body from an invader, and it mounts the same vicious attack against itself that it would against an intruder. -Examples would be lupus, rheumatoid arthritis, multiple sclerosis, allergies
What determines how people respond to symptoms?
-Personal factors -Gender differences -Age -Socioeconomic status, culture, ethnicity -Symptom characteristics -Conceptualization of symptoms
How is stress related to how likely people are to report physical symptoms?
-Personal factors include people's way of viewing their own body, their level of stress, and their personality traits. -Those with higher levels of stress are more likely to seek treatment -Those with prolonged stress are more likely to seek help for ambiguous symptoms -Women under stress judged less likely to have disease than men under high stress
What are some reasons why there may be differences between ethnicities in health?
-That is, poverty and low educational level both relate to health problems and lower life expectancy. -Thus, some of the ethnic differences in health are due to socioeconomic differences. -Even with the expansion of prenatal care by Medicaid, poor mothers, especially teen mothers, are more likely to deliver low-birth-weight babies, who are more likely than normal-birth-weight infants to die. -African Americans are 3 more times to die in infancy as Europeans -Access to medical insurance and care
Single-blind study
-participants do not know if they are receiving the active or inactive treatment, but the providers are not blind to treatment conditions. -the control for expectancy is not as complete as in double-blind designs, but creating equal expectancies for participants is usually the more important control feature.
What are the main types of coping and how are they different?
-problem focused coping-it involves changing the source of stress. For example, if you don't do well on a test, then making a study schedule and following it would be an example of problem focused coping -Emotion focused coping- it involves changing your emotional response to the stressor. For example, if you don't do well on a test, rather than studying more you eat chocolate or drink beer while you think about how you did on the test
Example of low prevalence and high incidence:
Colds- Low percentage of the population now but more new cases every year
Is self-efficacy global or specific to the situation?
Self-efficacy is a situation-specific rather than a global concept; that is, it refers to people's confidence that they can perform necessary behaviors to produce desired outcomes in a particular situation, such as fighting off a temptation to smoke
What is allostatic load and why is it important?
-Allostatic load occurs when many changes are required by the presence of chronic stressors. -Allostatic load represents the "wear and tear" that the body experiences as a result of prolonged activation of physiological stress responses. -Allostatic load may be the source of a number of health problems, including weak or dysregulated cortisol production in response to stress, high blood pressure, insulin resistance, fat deposits, and even decline in cognitive abilities over time -Thus, the allostatic load can become overloaded, resulting in damage and disease. -The physiological cost of chronic exposure to the stress response cumulative strain on multiple organs and tissues -The adaptation in the face of stressful situation is called alostasis or maintaining stability through change, which is an essential component of maintaining homeostasis -Hormonal mediators for stress response is cortisol and adrenaline -The hormones short term can be essential for adaptation maintenance of homeostasis and survival allostasis -Over long periods of time when called upon frequently they can exact the allostatic load that can accelerate disease processes
What is the sham knee surgery study and what did it find?
-Arthroscopic surgery -Half got anesthesia and knee surgery and the other half got anesthesia and sham knee surgery -The participants didn't know which condition they were in for years -that arthroscopic knee surgery provided no real benefits beyond a placebo effect. Those who received the sham surgery reported the same level of knee pain and functioning as those who received the real surgical treatment. -Moseley's results suggested that it was patients' beliefs about the surgery, rather than the surgery itself, that provided the benefits.
Do people generally prefer male or female doctors and why?
-Behaviors that differentiate practitioners whom patients rate as providing excellent treatment include being confident, thorough, personable, humane, forthright, respectful, and empathetic. -Female physicians are more likely to show these behaviors than male physicians. -people are more likely to follow the advice of doctors they see as warm, caring, friendly, and interested in the welfare of patients -female physicians: Were more patient centered Spent 10% more time with patients Employed more partnership behaviors Were more emotionally focused Were more likely to discuss medical psychosocial concerns
Who was John Snow and how did he help reduce the rates of cholera?
-Cholera epidemic in London 1848. Cholera is A severe form of diarrhea that can result in death -was that it was spread through foul air from sewers, swamps, etc. lots of miners were dying -Two water companies were supplying water to South London. -Cholera was five times higher in homes receiving water from one of the companies -Jon Snow removed the handle of the Broad street pump nearest to most fatal cases. The pump was the source of the disease and the removal of the handle led to the ending of the epidemic -Ultimate source of outbreak was a dirty diaper that contaminated the water supplies -This demonstration reinforced the goals of sanitation movement, which developed sewage drainage systems and water purification systems in cities and towns in the following decades
Reliability
-Consistency -The reliability of a measuring tool is the extent to which that tool measures in a consistent fashion -Reliability often measured with correlation coefficient or percent agreement -Test-retest reliability- In health reliability is most frequently determined by comparing scores on two or more administrations of the same instrument -High-reliability coefficient such as 0.80 to 0.90 indicate that participants have obtained nearly the same scores on to administration of a test -Interrater reliability-By comparing readings obtained from two or more judges observing the same phenomenon -Percentages can express the degree of agreement between the independent ratings of observers. If the agreement between two or more raters is high (such as 85% to 95%), then the instrument should elicit nearly the same ratings from two or more interviewers
What are the "stress hormones"?
-Cortisol: can be used as index of stress and assesses in saliva and urine -Norepinephrine: both a hormone and neurotransmitter and produces in many places in the body -Epinephrine (adrenaline): produced and the adrenal medulla and used as a index of stress and can be measured in urine
What are the effects of discrimination on health?
-Discrimination is a source of stress that may increase the risk for cardiovascular disease -Discrimination is associated with both increased physiological stress responses, as well as maladaptive health behaviors that people use to cope with discrimination -May increase blood pressure and cardiovascular reactivity -May lead to worse health behaviors such as poor eating, less exercise, more smoking and drug use
What is disease?
-Disease refers to the process of physical damage within the body, which can exist even in the absence of a label or diagnosis -People can have a disease and not be ill. For example, people with undiagnosed hypertension, HIV infection, or cancer all have a disease, but they may appear quite healthy and be completely unaware of their disease.
What is a secondary immune response?
-During initial exposure to an invader, some of the sensitized T-cells and B-cells replicate and, rather than go into action, are held in reserve. -These memory lymphocytes form the basis for a rapid immune response on second exposure to the same invader. -Memory lymphocytes can persist for years but will not be activated unless the antigen invader reappears. If it does, then the memory lymphocytes initiate the same sort of direct and indirect attacks that occurred at the first exposure, but much more rapidly. -This specifically tailored rapid response to foreign microorganisms that occurs with repeated exposure is what most people consider immunity.
What is epidemiology?
-Epidemiology is a branch of medicine that investigates factors that contribute to health or disease in a particular population -With the increase in chronic diseases during the 20th century, epidemiologists make fundamental contributions to health by identifying the risk factors for diseases. -Evolved into a scientific discipline during the 19th century and played an important role in the fight against infectious diseases -Research in epidemiology uses two broad methods: (1) observational studies and (2) randomized, controlled trials.
What are some main ethnic differences in health and life expectancy?
-European America would rank higher in life expectancy than African America—47th African America place 113th in the world -European Americans have a longer life expectancy than African Americans, but neither should expect to live as long as people in Japan, Canada, Iceland, Australia, the United Kingdom, Italy, France, Hong Kong, Israel, and many other countries. -24th among industrial nations -50th among all nations
Experimental study
-Experiments may be single or double blind -When you manipulate X it is referred to as an independent variable -Y is referred to as a dependent variable and it is the one being measured -Determine causality -Psychologists want information on the ability of one variable to cause or directly influence another. Such information requires a well-designed experiment. -consists of administering a treatment, whereas the control condition consists of withholding that treatment and perhaps presenting some sort of placebo. If the experimental group later shows a different score on the dependent variable than the control group, the independent variable has a cause-and-effect relationship with the dependent variable. -In addition, good experimental design requires that experimenters assign participants to the experimental or control group randomly to ensure that the groups are equivalent at the beginning of the study.
Longitudinal
-Follow the same participants over an extended time -Thus, longitudinal studies are costlier than cross-sectional studies and they frequently require a large team of researchers -Many other longitudinal studies confirmed this lack of relationship. Thus, the results of these longitudinal studies—which provide stronger evidence than the earlier correlational studies
Example for the diathesis stress model
-For example, a study of symptom stress and depression revealed that surgical patients with low coping competence were vulnerable to developing depression in the months following their surgery, whereas patients with better coping skills were less vulnerable to depression. -Abuse or maltreatment during childhood may create another source of vulnerability to physical and psychological disorders. As adults, these individuals show increased vulnerability to schizophrenia, anxiety and depression, posttraumatic stress disorder, and infectious disease. A person's social environment may also create a diathesis; stressful life events can increase suicide risk among adults, but especially for those who also report high levels of loneliness. Therefore, personal and psychosocial factors have the power to create vulnerabilities to disorders.
What is illness behavior?
-Illness behavior consists of the activities undertaken by people who experience symptoms but who have not yet received a diagnosis. -That is, illness behavior occurs before diagnosis. -People engage in illness behaviors to determine their state of health and to discover suitable remedies. -EX: Armstrong was engaging in illness behavior when he sought the opinion of his friend and when he finally made an appointment with a physician. -People routinely experience symptoms that may signal disease, such as chest pain, soreness, or headaches. -Symptoms are a critical element in seeking medical care
What is a placebo?
-Inactive substance or condition that has the appearance of active treatment and that may cause participants to improve or change due to the belief in the placebo's ability to make a difference. -Anywhere from 7% to 43% of pain patients improve with placebos -Argue that the placebo effect is responsible for much of the effectiveness of antidepressant drugs -Placebos can lead to noticeable improvements in health outcomes, especially in the context of pain and nausea -The more a placebo resembles an effective treatment, the stronger the placebo effect. -Placebo effects are a tribute to the ability of humans to heal themselves, and practitioners can enlist this ability to help patients become healthier -is not merely improvement but includes any change resulting from an inert treatment
What is sick role behavior?
-Is the term applied to the behavior of people after a diagnosis, whether from a health care provider or through self-diagnosis. -Armstrong exhibited sick role behavior when he underwent surgery and chemotherapy, kept medical appointments, took a break from cycling, and recovered from his treatments. -A diagnosis, then, is the event that separates illness behavior from sick role behavior.
How frequent is nonadherence?
-Kumar's experience as a medical student suggested that nonadherence among his patients was common. -More recent reviews confirm the problem of nonadherence, estimating nonadherence to medication regimens at nearly 25% -Nevertheless, failure to adhere to medical advice is a widespread problem -25% over the last 50 years -adherence was lower for medication taken for a chronic condition over a long period; adherence was around 50% for either prevention or cure. -Lower if you had to make your own appointment 50%
What is Medicaid?
-Medicaid provides health care based on low income and physical problems, such as disability or pregnancy. -These restrictions make many poor people ineligible; only about half of people living in poverty receive coverage through Medicaid.
What shows higher adherence rates: medication treatment or exercise, diet, and other health-related behaviors?
-Medication treatments showed higher adherence rates than exercise, diet, or other health-related behaviors -with one prominent review stating that finding "effective ways to help people follow medical treatments could have far larger effects on health than any treatment itself -Adherence rates were higher when treatment was meant to cure rather than to prevent a disease. -Found higher rates for patients' keeping appointments when patients initiated the appointments (75%)
What is relaxation training and what is it effective in treating?
-Modern uses of relaxation training that developed progressive muscle relaxation during the 1930s -While we're cleaning in a comfortable chair, often with eyes closed and with no distracting lights or sounds, patients first breathe deeply and exhale slowly. After this, the series of deep muscle relaxation exercises begins. -Is an effective treatment program for stress related disorders such as depression anxiety, hypertension, and insomnia. -Also helps reduce hormonal stress responses following breast cancer surgery and promotes faster healing following gallbladder surgery
What is Ex Post Facto?
-One of several types of quasi-experimental studies -ex post facto designs do not involve the manipulation of independent variables. -Instead, researchers choose a variable of interest and select participants who already differ on this variable, called a subject variable (or participant variable). -Both experiments and ex post facto studies involve the measurement of dependent variables. -The comparison group in an ex post facto design is not an equivalent control group, because the participants were assigned to groups on the basis of their food preferences rather than by random assignment. findings about differences in risk between the two groups can yield useful information, making this type of study a choice for many investigations, particularly when random assignment is difficult or impossible.
What are the differences between people of high and low socioeconomic status in symptoms and health care seeking?
-People at higher socioeconomic levels are less likely to have symptoms because less stress and more prevention -They seek out healthcare more because knowledge of the implications of symptoms is similar in all groups, but access to care various with socio-economic status poor people are over-represented among the hospitalized, an indication that they are much more likely than middleand upper-income people to become seriously ill -People in lower socioeconomic groups tend to wait longer before seeking health care, thus making treatment more difficult and hospitalization more likely. -The poor have less access to medical care, have to travel longer to reach health care facilities that will offer them treatment, and must wait longer once they arrive at those facilities. -Thus, poor people utilize medical care less than wealthier people; when poor people do utilize medical care, their illnesses are typically more severe.
How are pain and stress related to adherence to medical advice?
-People who experience stress and emotional problems also have difficulties with adherence. -Stressful life events often interfere with efforts to be physically active -The risk of nonadherence is three times greater in depressed patients than in those who are not depressed. -More recent studies show that depression relates to lower adherence among people managing chronic illnesses -The pain associated with the condition is related to adherence
How do patients achieve a strong response with the placebo?
-Placebo responses also relate to other characteristics of the practitioner, such as his or her reputation, attention, interest, concern, and the confidence he or she projects that a treatment will be effective
What is a nocebo?
-Placebos can also produce adverse effects -these negative effects appear as side effects, which show the same symptoms as other drug side effects, such as headaches, nausea and other digestive problems, dry mouth, and sleep disturbances. -When participants are led to believe that a treatment might worsen symptoms, the nocebo effect can be as strong as the placebo effect
What is the difference between extrinsic and intrinsic rewards?
-Rewards for adherence can be extrinsic (money and compliments) -Intrinsic (feeling healthier); the ShapeUp online program included numerous rewards, including the opportunity for praise or encouragement from team members, or the possibility of beating another team in a competition.
What has Janice Kiecolt-Glaser's research shown about stress and the immune system?
-Showed that medical students had more symptoms of infectious disease before and after exams -They drew blood and found the evidence that the immune system functioning was suppressed -More recent studies show anxious students show lower immune functioning, demonstrating that the effect of immune function was specific to situation and psychological state -Exam stress is typically a short-term stress, but chronic stress has even more severe effects on immune competence. -Students under exam stress show a decline in a specific immune function related to wound healing; the same students took 40% longer to heal during exams than they did during vacation
What is the diathesis-stress model?
-Some individuals are vulnerable to stress related diseases because either genetic weakness or bio chemical imbalance inherently predisposes them to those diseases. These diseases may not occur without environmental stress, -the diathesis-stress model holds that some people are predisposed to react maladaptively to environmental stressors. -This predisposition (diathesis) is usually thought to be inherited through biochemical or organ system weakness, but some theorists also consider learned patterns of thought and behavior as components of vulnerability. -What varies over time is the presence of environmental stressors, which may account for the waxing and waning of illnesses. -diathesis-stress model assumes that two factors are necessary to produce disease. First, the person must have a relatively permanent predisposition to the disease, and second, that person must experience some sort of stress. -For people with a strong predisposition to a disease, even a mild environmental stressor may be sufficient to produce an illness episode.
What is the behavioral approach to improving adherence to medical advice?
-The behavioral approach has been applied to increase adherence by the use of cues, rewards, and contracts to reinforce adherent behavior. -When people begin to engage in a health behavior, behavioral principles may strengthen or extinguish those behaviors. -operant conditioning proposed by B. F. Skinner (1953). -The key to operant conditioning is the immediate reinforcement of any response that moves the person toward following medical recommendations. -With positive reinforcement, a positively valued stimulus is added to the situation, thus increasing the probability that the behavior will recur. An example of positive reinforcement of adherent behavior would be a monetary payment contingent on a patient's keeping a doctor's appointment. -With negative reinforcement, behavior is strengthened by the removal of an unpleasant or negatively valued stimulus. An example of negative reinforcement would be taking medication to stop your spouse from nagging you about taking your medication. -Punishment also changes behavior by decreasing the chances that a behavior will be repeated, but psychologists seldom use it to modify nonadherent behaviors. -The effects of positive and negative reinforcers are quite predictable: They both strengthen behavior -The behavioral model also predicts that adherence will be difficult because learned behaviors form patterns or habits that often resist change. -People need help in establishing such changes, and advocates of the behavioral model also use cues (written reminders), rewards, and contingency contracts to reinforce adherent behaviors.
What is the difference between longitudinal and cross-sectional studies?
-The difference between the two is cross-sectional is faster and cheaper but longitudinal allows researchers to identify trends and determine the direction of relationships -cross sectional is incapable of revealing information about changes in individuals over a period of time
What does the General Adaptation Syndrome fail to consider?
-The major criticism of Selye's view is that it ignores the situational and psychological factors that contribute to stress. -These factors include the emotional component and a person's interpretation of stressful events, which makes Selye's view of stress incomplete in the view of most psychologists.
What is the endocrine system and how does it send messages to the body?
-The neuroendocrine system consists of those endocrine glands that are controlled by and interact with the nervous system. -Glands of the endocrine and neuroendocrine systems secrete chemicals known as hormones, which move into the bloodstream to be carried to different parts of the body.
What is the Hispanic paradox?
-The research finds that Hispanics in the US tend to paradoxically have substantially better health than the average population in spite of what their aggregate Socioeconomic indicators would predict
What did Sheldon Cohen's research show about the relationship between stress and colds?
-The results indicated that the higher the person's stress, the more likely it was that the person would become ill. -also used the same inoculation procedure to see what types of stressors increase susceptibility to a cold virus. -They found that duration of a stressful life event was more important than severity. -Acute severe stress of less than 1 month did not lead to the development of colds, but severe chronic stress (more than 1 month) led to a substantial increase in colds. -people who are sociable and agreeable develop fewer colds than others after exposure to a cold virus -People in the upper 25% of perceived stress were about twice as likely as those in the lowest 25% to get a cold, which suggests that stress may be a significant predictor of developing infectious disease.
What are the main factors that predict adherence? (Come back pls)
-The severity of the disease; People adhere more when they perceive a disease as severe -Treatment characteristics, including side effects and complexity of the treatment; -Personal characteristics, such as age, gender, and personality; -People adhere less to treatments that are complex and produce unpleasant side effects. -Complex relationship exists between age and adherence, with younger and older adults adhering less than middle-aged adults -Stress and depression predict poorer adherence; conscientiousness predicts better adherence. -Environmental factors such as social support, income, and cultural norms; -People with lower income generally show poorer adherence -People adhere better when they have strong social support -People adhere more to modern medicine when their cultural beliefs support a reliance and trust in modern medicine.
How are the sympathetic and parasympathetic nervous systems related to the stress response?
-The sympathetic division of the ANS mobilizes the body's resources in emergency, stressful, and emotional situations. -The reactions include an increase in the rate and strength of heart contractions, increase in rate of breathing, constriction of blood vessels in the skin, a decrease of gastrointestinal activity, stimulation of the sweat glands, and dilation of the pupils in the eyes. -The parasympathetic division of the ANS, on the other hand, promotes relaxation, digestion, and normal growth functions. -The parasympathetic nervous system is active under normal, nonstressful conditions. The parasympathetic and sympathetic nervous systems serve the same target organs, but they tend to function reciprocally, with the activation of one increasing as the other decreases. -For example, the activation of the sympathetic division reduces the secretion of saliva, producing the sensation of a dry mouth. The activation of the parasympathetic division promotes secretion of saliva.
How good are the Theory of Planned Behavior and the Theory of Reasoned Action at predicting who will adhere to an exercise program?
-The theory of planned behavior is better at predicting intentions rather than behavior -A recent meta-analysis of over 200 studies found that the theory of planned behavior was most successful at predicting physical activity and dietary behaviors -For the most part, physical activity and diet represent ongoing, planned, individual choices that the theory of planned behavior was designed to predict.
How do people without health insurance usually seek health care?
-These people are less likely to have a regular physician, more likely to have a chronic health problem, and less likely to seek medical care because of the cost -People who do not have health insurance may receive care from convenient care clinics or hospital emergency rooms, even for chronic conditions. -Convenient care clinics offer basic health care, primarily by physicians' assistants and nurse practitioners. -Seeking care through the emergency room may result in people receiving care only after their condition meets the definition of an emergency. Thus, these patients are sicker than they might have been if they had easier access to care. -seeking care from emergency rooms is more expensive and overburdens these facilities, decreasing their ability to provide care to those with acute conditions.
What are the differences between men and women in seeking health care?
-Women are more likely to seek treatment when they have physical symptoms -Women also report more non-threatening symptoms -Women under stress are judged less likely to have disease than men under high stress -This may be particularly true for male physicians who are less likely than female physicians to recommend cardiac testing for women who complain of chest pain. -This tendency to discount symptoms may be a very important factor in the treatment of women who experience symptoms and for the health care providers who hear their reports. -Women tend to report more body symptoms and distress than men -When asked about their symptoms, men tend to report only life-threatening situations, such as heart disease -The female gender role may make it easier for women to seek many sorts of assistance -whereas the male gender role teaches men to act strong and to deny pain and discomfort (as Armstrong did). -Indeed, men are more likely than women to delay seeking health care for symptoms that might indicate cancer
How are effects of marriage on health different for men and women?
-Women often encounter stress because of the increased burden of doing the work associated with their multiple roles as employee, wife, and mother, but overall, these multiple roles offer health benefits. -Partner and family support affects both men and women, but its absence more strongly affects women's health. -Women with children and no partner are especially burdened and, therefore, stressed. -Thus, filling multiple obligations is not necessarily stressful for women, but low control and poor support for multiple roles can produce stress for both men and women. -Despite the possibilities for conflict and stress, families are a major source of social support, a resource that is important for coping with stress. -Men get more benefits than women -Men have more health problems when losing their spouse than women -Men may also rely on spouses more for emotional support
Meta-analysis
-allows researchers to evaluate many research studies on the same topic, even if the research methods differed. -The results from a meta-analysis include a measure of the overall size of the effect of the variable under study. -The ability to offer an estimate of the size of an effect is an advantage. -If an effect is statistically significant but small, then people should not be encouraged to change their behavior on the basis of such findings; doing so would provide too few benefits. -On the other hand, if an effect is large, then working toward change would be beneficial, even if it is difficult
Correlational study
-are useful when experimental designs are not possible or ethical -Designed to assess the strength of the relationship between two variables -identify possible factors that predict or are related to a health condition -a type of descriptive research design -measures each of these variables in a group of participants and then calculates the correlation coefficient between these measures. -The calculation yields a number that varies between −1.00 and +1.00. -Positive correlations occur when the two variables increase or decrease together. -Negative correlations occur when one of the variables increases as the other decreases, as is the case with the relationship between smoking and longevity. -Correlations that are closer to 1.00 (either positive or negative) indicate stronger relationships -Small correlations—those less than 0.10—can be statistically significant if they are based on a very large number of observations, as in a study with many participants. -correlational study suggested a link between diet and cancer risk, but could not answer questions of causality directly. Correlation does not equal causation
What is the biomedical model?
-defines health as the absence of disease -spurred the development of drugs and medical technology-oriented toward removing the pathogens and curing diseases. The focus is on disease, which is traceable to a specific agent. -Removing the pathogen restores health. -is compatible with infectious diseases that were the leading causes of death 100 years ago -allowed medicine to conquer or control many of the diseases that once ravaged humanity -model became inadequate for the chronic diseases
What is psychoneuroimmunology?
-focuses on the interactions among behavior, the nervous system, the endocrine system, and the immune system. -Research in psychoneuroimmunology aims to develop an understanding of the role of behavior in changes in the immune system and the development of disease. -To reach this goal, researchers must establish a connection between psychological factors and changes in immune function and also demonstrate a relationship between this impaired immune function and changes in health status. -Ideally, research should include all three components—psychological factors such as stress, immune system malfunction, and development of disease—to establish the connection between stress and disease -Not all people with impaired immune systems become ill -The best approach in PNI comes from longitudinal studies that follow people for a period of time after they (1) experience stress that (2) prompts a decline in immunocompetence and then (3) assess changes in their health status. -Few studies included all three components, and most such studies are restricted to nonhuman animals -Most studies look at the first two -Most studies measure the immune system's function by testing blood samples rather than by testing immune function in people's bodies -Some research concentrates on the relationship between altered immune system function and the development of disease or spread of cancer -show a clear relationship between stress and decreased immune function, especially for chronic sources of stress. -Short term stress may produce changes that are adaptive, such as mobilizing hormone production, but chronic stress exerts effects on many types of immune system response that weaken immune system effectiveness. -Students under exam stress show a decline in a specific immune function related to wound healing; the same students took 40% longer to heal during exams than they did during vacation
What is motivational interviewing and how is it can it be applied to adherence?
-is a therapeutic approach that originated within substance abuse treatment but has been applied to many other health-related behaviors, including medication adherence, physical activity, diet, and diabetes management -attempts to change a client's motivation and prepares the client to enact changes in behavior. -The procedure includes an interview in which the practitioner attempts to show empathy with the client's situation; discusses and clarifies the client's goals and contrasts them with the client's current, unacceptable behavior; and helps the client formulate ways to change behavior. -Reviews indicate that the technique is effective, particularly for motivating people to stop smoking
What is cognitive-behavioral therapy and what is it effective for?
-is a type of therapy that aims to develop beliefs, attitudes, thoughts, and skills to make positive changes in behavior. -It assumes that thoughts and feelings are the basis of behavior, so CBT begins with changing attitudes CBT focuses on modifying environmental contingencies and building skills to change observable behavior -Based on the assumption that a change in the interpretation of an event can change peoples emotional and physiological reaction to that event -Because pain and stress or at least partially due to psychological factors, CBT attempts to get patients to think differently about their stress or pain experiences and increase their confidence they can cope with them -It is effective in helping people manage a wide variety of problems that involve stress or pain including: rheumatoid arthritis, irritable bowel, cancer, heart disease, AIDS, diabetes, low back pain, and headache
What does Lazarus think is the most important part of stress?
-proposed by Richard Lazarus, which focuses on stress as a product of both the person and the environment. -the interpretation of stressful events is more important than the events themselves. -Neither the environmental event nor the person's response defines stress; rather, the individual's perception of the psychological situation is the critical factor. -For example, a job promotion may represent an opportunity and challenge for one person but a significant source of stress for another person. -Tending a soccer goal in the midst of a World Cup match might be a challenge for Solo, but a panic-inducing event for almost anyone else -His transactional view emphasizes psychological factors including perception or appraisal, vulnerability, and coping.
What is the biopsychosocial model?
-the approach to health that includes biological, psychological, social influences, and even spiritual aspects of a person's health -it incorporates not only biological conditions but also psychological and social factors -it views health as a positive condition. -Can also account for some surprising findings about who gets sick and who stays healthy
What body systems are active in the fight-or-flight response?
-the sympathetic nervous system -The sympathetic division of the ANS mobilizes the body's resources in emergency, stressful, and emotional situations. -The reactions include an increase in the rate and strength of heart contractions, increase in rate of breathing, constriction of blood vessels in the skin, a decrease of gastrointestinal activity, stimulation of the sweat glands, and dilation of the pupils in the eyes.
What is emotional disclosure and what is it effective for?
-therapeutic technique whereby people express their strong emotions by talking or writing about a stressful or Trumatic event that caused the emotion -People are usually told to write three or four times a week for 15 or 20 minutes about their deepest thoughts and feelings about the event -A control group is usually told to write about trivial things such as the layout of a University campus -Students writing about anxiety and entering college had fewer health problems -Keeping a journal of stressful events reduced physical symptoms and improved functioning in rheumatoid arthritis and cancer patients -Email writing about traumatic events showed benefits -The strongest effects have been in: reducing feelings of emotional distress, anxiety, depression. -Reducing physical symptoms, improving immune function, reducing blood pressure, reducing healthcare visits -Also found that by writing about something positive during A stressful event such as having cancer can help them benefit as much without the emotional distress
What are the stages of the General Adaptation Syndrome? How can this help explain how stress relates to illness?
-to the body's generalized attempt to defend itself against a stressor. -The first stage is the alarm reaction-defenses against a stressor are mobilized through activation of the sympathetic nervous system. -the second phase of the GAS is the resistance stage- the organism adapts to the stressor and the person gives the outward appearance of normality, but physiologically the body's internal functioning is not normal. Continuing stress will cause continued neurological and hormonal changes. -the final stage of the GAS is the exhaustion stage-At the end, the organism's ability to resist is depleted, and a breakdown results. This stage is characterized by activation of the parasympathetic division of the ANS. -Under normal circumstances, parasympathetic activation keeps the body functioning in a balanced state. -In the exhaustion stage, however, the parasympathetic system functions abnormally, causing a person to become exhausted. Selye believed that exhaustion frequently results in depression and sometimes even death. -Selye believed that these demands take a toll, setting the stage for what he described as diseases of adaptation—diseases related to continued, persistent stress -Among the diseases Selye considered to be the result of prolonged resistance to stress are peptic ulcers and ulcerative colitis, hypertension and cardiovascular disease, hyperthyroidism, and bronchial asthma. In addition, Selye hypothesized that resistance to stress would cause changes in the immune system, making infection more likely.
What are risk factors?
A risk factor is any characteristic or condition that occurs with greater frequency in people with a disease than in people free from that disease. That is, epidemiologists study those demographic and behavioral factors that relate to heart disease, cancer, and other chronic diseases. For example, epidemiology studies were the first to detect a relationship between smoking and heart disease. (obesity and heart disease) (poverty and poor health) The presence of a risk factor does not mean you will defintely develop the disease. Correlation is not Causation.
What are three sources of stress?
Cataclysmic events- includes intentional terrorist attacks or unintentional natural disasters they are unique and powerful events. These events can cause people to experience depression and post traumatic stress disorder Changes in a person's life history- divorce or break up Hassles from everyday life- arguing with partner, traffic, balancing work/family, discrimination, noise, pollution, etc.
What does "suppression" of the immune system mean?
Describes a loss of immune function
What are the three leading causes of death in the U.S. in the past?
Heart disease, cancer, and chronic lower respiratory disease/Stroke
Example of high prevalence and low incidence
High blood pressure (hypertension)- High percentage of the population now, but not as many new cases every year
What are the stages of the transtheoretical model? (CAMPPS)
Precontemplation- no recognition of need for or interest in change Contemplation- thinking about changing Preparation- People have made a commitment to change and are preparing themselves to begin the change process. Action- People actively begin to modify their behaviors and their surroundings. Maintenance- ongoing practice of new, healthier behavior. People have changes and are trying to consolidate their changes and deal with lapses.
What is the Theory of Planned Behavior? How does this differ from the Theory of Reasoned Action?
Theory of Reasoned Action -The most immediate determinant of behavior is the intention to perform a behavior -Behavioral intention is determined by: Attitude towards a behavior- positive or negative -Subjective norms- The value that significant others place on the behavior Theory of Planned Behavior -assumes that people act in ways that help them achieve important goals. -assumes that people are generally reasonable and make systematic use of information when deciding how to behave; they think about the outcome of their actions before making a decision to engage in a particular behavior. -They can also choose not to act, if they believe that an action would move them away from their goal. -One strength of the theory of planned behavior is that it identifies beliefs that shape behavior. -most successful at predicting physical activity and dietary behaviors -less successful at predicting risk-taking behaviors such as speeding, smoking, and alcohol and drug use, as well as screening, safe sex, and abstinence behaviors. -For the most part, physical activity and diet represent ongoing, planned, individual choices that the theory of planned behavior was designed to predict. -intentions and perceived behavioral control were less likely to predict risk-taking and sexual behaviors because these behaviors are likely to be reactions to specific situations rather than planned choices. -The theory of planned behavior adds your perception of how much control you have over your own behavior Differences and similarities: -Both theories have some value and predicting who will adhere to an exercise program and two will not, but these theories are only modestly successful -The theory of planned behavior is better at predicting intentions rather than behavior
Secondary appraisal
a person determines whether they can successfully apply coping strategies to alleviate stress. After their initial appraisal of an event, people form an impression of their ability to control or cope with harm, threat, or challenge, an impression. Naturally, having a number of options available that you feel you can use to reduce harm or threat will make the event less stressful.
Reappraisal:
a person who incorporates any new information. l. Appraisals change constantly as new information becomes available. Reappraisal does not always result in more stress; sometimes it decreases stress. For example, a person could reappraise the stress of a breakup with a boyfriend or girlfriend as an opportunity to spend time with other friends, which could make the experience less stressful.
What did Ader and Cohen demonstrate about the immune system?
s-howed how the nervous system, the immune system, and behavior could interact—a discovery that essentially created the field of PNI -conditioned stimulus was a saccharin and water solution that rats drank, and the unconditioned stimulus was the administration of a drug that suppresses the immune system. -Using classical conditioning, he taught a rat to associate sweet tasting water with a chemical that suppressed the immune system -They drink the solution and then we're injected with the immune suppressing drug -Immune system was suppressed with just water after removing injection -Ader and Cohen found that some of the animals they had force-fed with the saccharin later died. -The magnitude of the avoidance response and the mortality rate of the rats was directly related to the volume of solution consumed. What could be going on? " -A hypothesis that seemed reasonable to me was that, in addition to conditioning the avoidance response, we were conditioning the immunosuppressive effects (of cyclophosphamide)", Ader said in a 2010 interview. -In other words, the taste of saccharin alone was enough to stimulate neural signals that suppressed the rats' immune systems, just as if they had been overdosed with the immunosuppressant. -Ader and Cohen went on to confirm this hypothesis in a controlled experiment, showing that the behavioural conditioning process could suppress immune responses as measured by antibody concentrations—thereby revealing connections between the brain and the immune system.
