PSYC 314

Placebo Effects Can Go Both Ways

-Stronger when providers: Exude warmth, confidence, empathy -Radiate competence -Provide reassurance -Take time with patients -Even effective drugs lose effectiveness when providers express doubts in them

Alcohol in University-The Sam Spady Story

-Student in the last year of her program died as a result of excessive drinking -everyone was drinking and failed to recognize that she was over-doing it -at least one friend should have accurate judgement

What is Health Psychology?

-Subfield within Psychology -Devoted to an understanding of psychological influences on :How people stay healthy ,Why people become ill, How people behave when they become ill

Smoking Interventions: Maintenance and Relapse Prevention

-Many people relapse on the road to quitting -A single lapse reduces perceptions of self-efficacy -When self- efficacy wanes, vulnerability to relapse is high

Cognitive Reappriasal (person-environment transaction)

-continuous reappraisal on the basis of new information -similar to the initial process -may lead to more or less stress perceived

Video clip for sickness treatment in children

-coping mechanisms: Child has stuffed animal, soothing tone of voice, both parents present, doctor guides the child through the procedure

CHAPTER 15: future outlook of health psychology

-current controversies that need to be addressed include: the impact of environmental factors on people's health and psychological status, patients quality of life, ethical decisions in medical care (relating to technological advance, euthenasia)

CHAPTER 9: how widespread is noncompliance?

the average rate of non-adherence to medical advice is about 40% (range= 20 to 80%), 2 of every 5 patients fail to adhere to their regimens

Textbook Chapter 3: all-encompassing definition of stress

the condition that results when person-environment transaction lead to a perceived discrepancy between the demands of a situation and the resources of the person's biological, psychological, and social systems

Textbook Chapter 4: Psychoneuroimmunology

the feild focuses on the relationships between psychosocial processes and the activities of the nervous, endocrine, and immune systems

Textbook Chapter 7: cue exposure

used to decrease the impact of substance-related cues in maintaining smoking, drinking, and drug use -develop through classical conditioning -therapists exposure their patients regularly to cues associated with drinking, like holding a beer can but telling them they cant drink it -cognitive behavioral methods are the most successful psychosocial approaches for reducing smoking, alcohol and drug use

CHAPTER 11: acute pain

usually lasts less than three months (chronic 3+)

canadian community health service- most reported activity for older adults with or without chronic disease?

walking was the most reported activity for older adults with or without chronic disease -walking: recreational (for pleasure) or ulitiarian (e.g. commuting, walking while doing tasks)

CHAPTER 11: somatic symptom disorder

when people experience long term pain as a part of excessive concerns for physical symptoms or health. usually the persons symptoms are medically unexplained

CHAPTER 11: Three common types of chronic pain- chronic-intractable benign pain

discomfort present all the time, varying levels of intensity due to underlying chronic condition

Physical activity guidelines

-150 min/ week of moderate to vigorous physical activity, 10 minute bouts, strength training 2x/week, sit less

The Theory of Planned Behavior Chart

-Attitude toward behavior & subjective norm & perceived behavioral control--> behavioral intention--> behavior

Are there any positive experiences in caregiving?

-Purpose in life -Expression of values -Appreciation of life and its frailty.

CHAPTER 9: why do women report pain at lower pain thresholds?

-hormones -sex role differences

CHAPTER 9: Placebo effect and color of pill

-red, green, yellow, orange associated with stimulant effect -blue and green associated with sedative effect

Textbook Chapter 7: binge drinking

5+ drinks on a single occasion at least once in a 30 day period

Response Definition of Stress: Adaptive short-term response to stress

-Stressor removed -Back to homeostasis--> ACUTE -but stress in modern world is not always acute, may be chronic and continuous

Behavioral Delay:

The time between deciding to seek treatment and actually doing so

The Seven Up Project- Sue

-Sue was married at 24, 2 children -35 y.o. divorced -This shows that you must take background into effect (Through the longitudinal method)--> doesn't work with cross-sectional

Tend and Befriend Hypothesis- Response to stress

-Taylor and colleagues (2000) -Women respond to stress with social and nurturing behavior -Fight or flight response may be down-regulated in females to keep self and offspring safe

Nonverbal cues

-Used ubiquitously -Disclose emotions, motivation, cognitive dispositions (e.g., attention, intention, interest -Enhances social effectiveness -Highly visible -Faces are very plastic; remarkable array -Provide syntax for speech

Insite Presentation

-Vancouver downtown east side = biggest open air drug site in the world -geography in downtown east side: buildings with many single rooms create high density of injection, sharing needles, also ton of alleyways for private injection out of police view, might use puddle water instead of clean water for drug mixing -HIV rates peaked in 1996--> most explosive epidemic outside of Sub-Saharan Africa, also an overdose epidemic at this time -1994 supervised injection sites were proposed -but instead policing stayed dominant -on a global level there is an enforcement based approach to drug problems (including the UN) -conventional approach: focuses on individual behavior and choice -risk environment approach: focuses on external factors like social (peer networks, cultural norms, stigma), physical environment (injecting settings, housing environments), economic (neighborhood level deprivation, poverty), structural (policies and laws, criminalization, availability of sterile syringes) -local drug uses started to lobby city hall in the downtown east side, the four pillar approach was proposed--> pledged to open insite--> people bring own drugs, 12 booths for injecting, obtain sterile supplies, nurses respond accordingly in event of overdose, people spend ~ 20 minutes -the objectives of insite: reduce public disorder, reduce transmission of diseases, increase contact with health services, reduce risks associated with overdose--> this was allowed due to scientific evaluation -mixed method data evaluation of insite: described site, evaluate any positive effects, evaluate negative impacts -results: MANY fewer public injections, helped to improve public disorder, less discarded litter on the ground e.g. syringes (Controlled for weather, police officers on the street), people who injected at insite 70% less likely to share needles, 30% increase in detoxification service use, increased rates of addiction treatment initiation -most important paper on insite: obtained location of overdose death using 6 digit postal code, using mapping program to map all those deaths, area of interest: all blocks within 500 meters of the safe injection site, quasi control blocks >500m from insite, overdose deaths declined by 35% in the area of interest, reduction in HIV related medical costs, no difference in drug related crime, no change in initiation of drug use -The science around Insite became very politicized: RCMP said that the positive views of insite came from the opinioned authors, drug free American foundation created their own pseudo-science journal critiquing insite --> they fiercely oppose the concept of harm reduction -Then the researchers worked with the RCMP to organize a press conference (which they backed out of) the researchers released all of the statements that were initially planned -Bill C-65 was released saying that for SIF to be implemented neighbourhood and police officials have to agree with it -heroin prescription can be vastly helpful for people living with addiction, courts decided to rule in favor of health professionals -health behaviors and drug-related harms are shaped by an array of social, structural, and environmental factors -drug enforcement remains the dominant response to illicit drugs -establishing alternatives required culture change promoted by a range of actors within and outside of the bureaucracy -supervised injection sites are evidence-based facilities that challenge dominant negative attitudes of harm reduction -conservatives were so against this bc they saw it as the first step in legalization of hard drugs

How to support adoption and maintenance of behavioral change?

"an observable, replicable, and irreducible component of an intervention designed to alter or redirect causal processes that regulate behaviour [...] an ' active ingredient'."

Guest Lecture by Asche: Physical Activity

"any bodily movement produced by skeletal muscles that result in energy expenditure" 1.Leisure-time (exercise, sports) 2.Occupation 3.Transportation 4.Activities of Daily Living--> basic (e.g. personal hygiene) and instrumental (e.g. housework)

Cost of feeding Northern first nations for family of four

$2000

Healthcare spending 2015

$219 billion -1.6% growth -average of $6,105 per person -10.9% of GDP

The Third and the Forth Age

'Old age' is not a uniform experience; it extends over multiple decades -The good news: the third age/the young old (60-85)--> -people are relatively fit -Increased life expectancy -Substantial latent potential and reserve capacities -Enjoy relatively good physical and mental health -High levels of well-being -Effective strategies to master challenges -Not-so-good news: the forth age/the oldest old (85 and above) -Sizable losses in cognitive potential (high risk of dementia) -Increased chronic disease burden -Sizable prevalence of dementia and frailty

Textbook Chapter 4: learned helplessness and three dimensions

-internal/ external -stable/ unstable -global/ specific -people who believe bad events result from internal, stable, global factors have a pessimistic explanatory style

The Theory of Planned Behavior

- Attitudes: What will happen if I change my behavior? -Subjective Norms: Am I motivated to comply? -Perceived Behavioral Control: Do I have the ability to control my behavior? -Intention: Do I intend to change my behavior?

Age-adjusted prevlance of obesity and diagnosed diabetes among US adult

-major increase in obesity and diabetes across US states, correlation between obesity and diabetes, South eats more poorly than the north

Textbook Chapter 7: factors involved in becoming a regular smoker

- at least one smoking parent -percieved parents as unconcerned/supportive -siblings or friends who smoke -rebellious, thrill-seekrs, low school motivation -receptive to tobacco advertisements -peer pressure to smoke -held positive attitudes toward smoking -didnt believe smoking would harm their health -believed they could quit smoking if they wanted to

The Last Lecture by Randy Pausch

- diagnosed with pancreatic cancer - talk is about "life and how to live", fulfilling childhood dreams - if you don't achieve your dreams, you get the experience of trying

Age-Related Changes in Health

- objective illness and objective functional health declines, interestingly, subjective health compared to others increases (they see the silver lining and think that they are lucky to have made it to such old age)

Caregiving and Dementia

-"Sandwich family generation" -why is it stressful?: role reversal (daughter has to make medical decisions for her own father), conflicts--> what is most urgent tasks? helping the children or your father, daughter given up her dreams and goals to care for her dad -positives? Important opportunity to show theirs kids what really matters, opportunity to spend time together through shared intimacy -high SES, enough space in the house for everyone, education where they can have flexible hours/ work spaces, professional caregivers coming in

Disadvantages of Cross-Sectional Self-Reports

-->Retrospective Response Biases eg: -Mood Dependent Memory -Memory distortions -Salience of an event -Recency -Systematic over-or underreporting -->Low internal validity e.g: -Cannot determine causal or time-ordered effects -->Third variable problem e.g: -Are there other important factors causing the relationship between thecentral variables of interest?

Patient Factors and retention of their diagnosis

-1/3 of patients cannot repeat their diagnosis within minutes of discussing it -Anxiety impairs retention of information

Chapter 8 textbook: how many canadians are overweight/ obese?

-1/4 obese, when combined with overweight the prevalence is 50%, weight typically drops off after the age of 65

Standard Psychosocial Stress Test (TSST) - Response to stress

-10 minute stress test with two components: -wanting to be hired by cold-faced panel through a pitch for new job -Mental arithmetic- counting backwards from 2000 in intervals of 13 BOTH cause significant stress

Death Across the Life Span

-100 years ago people died from acute illnesses -Average life expectancy in Canada: 80 years -By 18 years of age, most of us have known someone who has died -Average Canadian: Knows cause of death years in advance (there is an opportunity to think about what is best for you, however there is also the problem of how to make the situation comfortable and supportive)

Proportion of Canadians with one or more chronic health conditions by age group in Canada,

-12-29: majority have none, 20% have one -30-54: majority have none, 20% have one, 10% have two -55-64: equal split between none and one disease (25% and 25%), 20% have two, 10% 3, 10% 4+ 65-79: practically equal split between none, one, two, three, four + -80+: similar to last age group but fewer with none, more with 4+ -chronic disease more prevalent in low SES groups (likely due to stress), women have more chronic disease even though they live longer

Textbook Chapter 4: health and personal control in old age homes

-2 floor study: -one one floor residents given oportunities to have respsonsibilites (ex select small plants to care for and encouraged to make decisions about participating in activities and rearranging furniture) -residents on other floor had little personal control -those who were given personal control--> happier more active and alert, also had half mortality than the other floor

Canada's population is aging

-2 million people today providing informal care to a loved one -now instead of a pyramid we have a bean or tree shaped population distribution -the baby boomers are aging and as they get older they will be in need of support--> this need will be covered by healthcare -younger people may have to care for more than one person in the future -there is a rapid inc. in individuals who are able to live beyond 65 -the amount of the population which is 65+ is catching up to the individuals below 14

Intentions, Planning, and Exercise Study

-484 Persons with CVD (had a heart attack) -3 assessments (during rehabilitation, at 2 months, at 4 months) -tried to get people to be more active -Behavioral intentions -Action planning -Coping planning -Physical exercise

Textbook Chapter 7: smoking differences in canada

-50% of on-reserve first nations and 58% of inuit people smoke, compared with about 20% of the general population -general population Canadian teens have lowest smoking rates, not true of natives who usually start around 14 -smoking declines with increasing SES

Fleig et al: older adults in west end and walkability

-65.1 min of physical activity a day -examine whether the link between the perceived environment and behavior is mediated by psychosocial variables -effects of street connectivity and diversity of land use on physical activity were mediated by behavioral control --> Mediation analysis revealed that perceived street connectivity and diversity of land use were negatively related to sedentary behavior, but only indirectly through behavioral control. -that is: perceptions are positively linked to older adults ability to go out in walkable neighbourhood -Results highlighted that the perceived built environment is important for physical activity and sedentary behavior, largely because these environmental perceptions are positively linked to older adults' confidence in walking.

Eating Disorders: Statistics Canada

-70% of women and 35% of men are dieting •Women between the ages of 15 and 25: 1-2% have anorexia nervosa, 3-5% have bulimia nervosa •Eating disorders have the highest mortality rate of all mental illnesses, with 10% to 20% dying from complications

Alcohol in Canada and injury/ hospital visits

-8% of all hospitalizations are directly attributable to alcohol -10% of days spent in hospital are directly attributable to alcohol abuse -Number of Canadians who got injured in alcohol-related vehicle accidents in the year 2011: 841 -BC has higher alcohol consumption than the average in Canada (known from self-reports measures) -research from Uvic based alcohol consumption on liquor sales and determined drinking in BC is even higher than expected from self reports (Uvic study: 8.56 litres of pure alcohol per year, stats canada's self reports: 8.10 litres of pure alcohol per year) Canadian average ~ 8

Alcohol in Canada

-9.2% of Canadians report serious problems with drinking. Among those: -5.1% alcohol affects physical health -4.7% alcohol affects financial position -43.9% report problems with other people's drinking -23.8% disturbed by loud parties -20.9% being insulted or humiliated -15.6% having serious arguments

Development of Health behaviors: Health Habits

-A health-related behavior that is firmly established -Often automatic -Occurs outside awareness -Often develop in childhood -Typically stabilize around age 11 or 12 -Resistant to change

Planning as a Key Variable in Health Behaviors

-A mental simulation commits the individual to perform a behavior once the critical situation is encountered -Action plans: plans regarding the initiation of behavior (when-where-how structure) -Coping plans: plans regarding the maintenance of behavior in the face of barriers

Placebo

-A placebo is "any medical procedure that produces an effect in a patient because of its therapeutic intent and not is specific nature, whether chemical or physical" -Placebo (in Latin) means, "I will please" -Any procedure, from drugs to surgery to psychotherapy, can have a placebo effect -generally based on a patients beliefs--> anterior cingulate cortex, thalamus, and frontal regions involved in experience of pain and placebo effect (patients are not making it up, we see actual changes in the brain in regards to pain)

The Achieving Self

-Achievement is important to self esteem and self concept -Does the chronic illness threaten these?

Treatment Adherence: The Simplest Form (Antibiotics)

-Acute condition -Sample case: Antibiotics (used for bacteria, not viral infection) -Young adult studies: Sub-optimum antibiotic concentrations--> antibiotic resistant organisms: 11% did not finish (4% to 22 % depending on the age group)

Future outlook: Compression of morbidity

-Adding years to life --> adding life to years -Win-win -Individual: Optimizing quality of life -Society: Managing health care expenditures -Health care system: Focus on prevention -health care costs high in the 5 years preceding death, goal is not to add years to the morbid state, but rather to reduce morbidity or keep it constant before individual dies

Research Methods in Health Psychology

-Adequate research method depends on phenomenon of interest -Research Methods in Health Psychology: -Retrospective self-reports -Longitudinal studies -Time-sampling research -Different research methods complement each other

Window of Vulnerability: Adolescents and health behaviors

-Adolescents may ignore early training -Adolescents are particularly vulnerable -Poor diet -Cigarette Smoking -Alcohol and drug use -Risky sexual behaviors -Low physical activity

Perceived Stress & Colds (Cohen et al., 1991): Statistical Controls : integration of stimulus, response, & transactional

-Age, sex, education, allergic status, weight, the season, the number of subjects housed together, infectious status of subjects sharing the same housing, virus-specific antibody status at base line -Smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, total immunoglobulin levels -Personality variables: self-esteem, personal control, and introversion-extraversion

POST MIDTERM 2 Who Uses Health Services?

-Age: Young and old (treatment for chronic disease) -Gender: Pregnancy / childbirth--> form a relationship with their doctor -Socio-economic factors: Who can take time off from work?

Evidence for the direct effects hypothesis of social support:

-Alameida County Study -Several other longitudinal studies (other studies have found that too many ties for women can backfire, but in general large network to draw on is a good thing)

Eating Disorders: Bulimia

-An eating syndrome characterized by alternating cycles of binge eating and purging through such techniques as : -Vomiting -Laxative abuse -Extreme dieting -Drug or alcohol abuse >Binge eating: Usually the person is alone and feels out of control >Bulimics: ypically normal or overweight

Eating Disorders: Anorexia Nervosa

-An obsessive disorder amounting to self-starvation -Dieting and exercising till body weight is grossly below optimum -First treatment step: bring weight up to safe level by monitoring caloric intake

Emotional Responses to Chronic Illness: Anxiety

-Anxiety is common after diagnosis: -It increases when people: Have to wait a lot, or when people Anticipate substantial changes

Effects of Oxytocin on Stress Reactivity MEN- Response to stress

-Asked men to come in to the lab with their best friends or did not N=37 healthy men Comparison of four groups: -Alone prior to TSST: with/without Oxytocin (saline spray) -Social support prior to TSST: with/without Oxytocin (saline spray)

The Mind-Body Relationship: Middle Ages

-At this time, animal dissection was forbidden (due to the catholic church who believed humans and animals had spirits) -Disease was regarded as a punishment from God -Good health was regarded as reward for religiousity -Cure for disease: Torture evil out, later: Do penance (repenting for having done wrong) -Healing was viewed as within the realm of the priest -Holistic view: disease was punishment from god

Child Poverty in BC

-BC Child rate of poverty is higher than national average -about 21% of children in BC grow up in poverty--> rural and single parent households most at risk

Childhood Poverty in Canada

-BC has Worst rate of child poverty in the country, 8th year in a row we have come in last -1/5 children in BC lives below poverty line -this is felt multiply for immigrant families (over 40% in poverty) -population SES quin tiles demonstrate that people of lower SES die younger (up to 5 year difference in men between lowest and highest income group) -there are also major differences in infant mortality rates among first nation vs non-first nation Canadians

Socioeconomic Position and Stress: Whitehall II- Stimulus definition of stress

-Based on first 3 measurement waves (~ 5 years; complete data on 72 % of the sample) -Job control: self-rating and manager rating of skill discretion and decision authority -New heart diseases (angina pectoris, long-lasting severe pain across chest; physician-diagnosed ischemia) -Men and women with low job control had 1.5-1.8 higher risks of developing new heart disease than men and women with high job control

Intentions, Planning, and Exercise Results

-Behavioral intentions goals, action planning and coping planning were associated with physical exercise at baseline -Coping planning became a more important predictor of exercise over the long term in the study

Health-Compromising Behaviors and Culture

-Behaviors are tied to the peer culture -Image of these behaviors as "cool" -Behaviors, though dangerous, are pleasurable -Behaviors develop gradually rather than being acquired "all at once" -during adolescence, people have a drive to make themselves distinct from their family and create an identity

The Physical Self

-Body Image -Perception and evaluation of one's physical functioning and appearance -Body image can be restored, but it takes time

Obesity

-Body Mass Index (BMI) of 30 or higher -Body Mass Index is a measure of an adult's weight in relation to height: -Weight (kilograms) / Height (meters) 2

Response Definition of Stress: Hans Selye (1956)

-Born in Vienna in 1907 -used rats as model- when he stressed his rats by putting them into glass tube, he observed chronic stressor after systematically places them in the tube over and over again -systematic changes observable at the organ level -General Adaptation Syndrome -Orchestrated set of bodily defences against noxious stimuli -Different stages of stress

CHAPTER 9: Medicare

-Canada's publicly funded healthcare insurance program, includes: primary care physicians and hospitals (but each province pays its citizens medical costs and determines what will be covered) e.g. fertility treatment in Quebec = covered -Canada is the only country where universal health care system does not cover prescription drugs-- 60% of prescription drugs paid for privately (by individual or employer health plan)

Infancy and death

-Canadian infant mortality rate: 5.8 deaths per 1,000 births -Countries with low infant mortality: Have national medical programs, Provide free or low-cost maternal care -SIDS: Sudden Infant Death Syndrome (baby stops breathing, encouraged the "back to sleep program" -Disparities in access to healthcare exist *- SIDS is still a significant factor - happens more often in households where there is smoking (still unsure about whether its from the smoke or other factors) - we have a relatively low infant mortality rate because of our medical health care system however it does vary across regions

Caregiving

-Caregiving role typically falls on women (wife in 70s, daughter in mid-life)--> problems? The wife might have health conditions of her own as she ages, the daughter may be in a "sandwich" condition where she has her own full-time work, own family, and responsibility to ailing parent -Caregivers are at risk for declining mental and physical health

Teachable Moment: teaching health practices

-Certain times are better than others for teaching particular health practices -Examples: Putting on your own and child's seat belt before driving -Emphasizing correct brushing at first dental visit -Proper diet for a coronary heart patient following surgery -Stopping smoking during pregnancy

Time-Sampling Tools: Paper

-Cheap -Easy to implement -Familiar to participants BUT.... -Low compliance (e.g. dont know at which time they filled out the survey) -Back-filling -Time intensive

Children's Understanding of Death, 5-9

-Children aged 5 to 9 -Develop concepts of the finality of death -May personify death as a shadowy figure (symbolic perceptions) -By age 9 or 10, death is seen as universal and inevitable, they understand dead person will not come back

Chronic Illness: Positive Changes

-Chronically ill people and their family may reorder their priorities -Find meaning in smaller activities of life -Changes in future time perspective affect social relationships

Cross Behavior Cognitions and Healthy Lifestyles

-Co-regulation of health behaviors -Does one serve as a gateway to the other? -Cross-sectional online study with N = 767 participants -Health action process approach variables PLUS transfer cognitions and compensatory health beliefs -'If I am physically active on a regular basis... it also becomes easier for me to eat healthier' -'If I stick to a balanced diet on a regular basis ... I can afford to exercise less'

Lazarus' Transactional Model of Stress: Primary and Secondary appraisal

-Cognitive Appraisal -Primary Appraisal: -Am I in trouble? -What is at stake in this situation? (neutral/positive/negative?) and (harm or loss/ challenge/ threat) -Secondary Appraisal: -Concerned with a person's evaluation of his/her ability to cope with the situation -What can I do about it? -Do I have resources for coping?

Chronic stress and long term outcomes

-Cognitive decline -Physical health problems -Mental health problems -Mortality

Dyadic coping in the context of prostate cancer RESULTS

-Collaborative problem solving helps the patient, but the couples who collaborate a lot have more permeable emotional boundaries (spouse picks up the negative affect) -On days where things are not going well, the network is affected as well (have to think about supporting significant others)

The Seven Up Project-Niall

-Coming out of England, British Film maker wanted to describe life trajectories of kids from differing backgrounds (wealthy vs poor, rural vs urabn) -first interviewed at age 7 and tracked them down every seven years following the initial interview. Now in 40s. -Started with 20 kids -grew up in suburb, wanted to be in politics -Aberdeen uni, dropped out after 1st time -working on building site -homeless by 28 in Scotland -42 liberal democrat in London

Socioeconomic Position and Stress Video Clip 2- Stimulus definition of stress

-Conditions in which people work are vital for their health -control is related to where you are in occupational hierarchy -when you have more control, fair treatment, illness goes down and vice versa -give ppl more involvement, give them more praise/reward for their work--> better outcomes -having a boss who appreciates you and allows you to contribute is very important -other examples of things being done: sports and recreational-- employee being admitted to hockey coach

What Is Quality of Life? Contemporary view

-Contemporary view -Physical, Psychological, Vocational, and Social functioning -addresses additional disease or treatment related outcomes

The General Adaptation Syndrome: Exhaustion- Response to stress

-Continued exposure to stressor drains the body -The capacity to resist illness is depleted -Morbidity -Mortality (when taken to the extreme)

Current Definitions of Coping

-Coping is the process of managing demands (external or internal) that are appraised as taxing or exceeding the resources of the person (Lazarus et al.). -Coping consists of efforts, both action-oriented, and intrapsychic, to manage (i.e., master, tolerate, reduce, minimize) environmental and internal demands and conflicts among them (Lazarus & Launier)

Longitudinal method disadvantages

-Costly -Time consuming -May need large number of people to get enough cases with outcome of interest -Reflect what people where interested in when they were launched (network size and health) -Many long-term longitudinal studies were not started with the intention of following people over decades -Limited in terms of the measures that were included in baseline battery -Sample selectivity and attrition (drop outs) -Third variable problem remains -Cohort effects (product of your environment and the time period in which you grew up in) -Practice effects

Common Methods in Health Psychology

-Cross-sectional retrospective self-reports (present everywhere e.g. teaching evaluations) -Longitudinal studies -Time-sampling research

Biopsychosocial Factors in Development and Maintenance of Health Compromising Behaviors: sociocultural factors (social relationships)

-Culture and Ethnic Background -->Norms and religious beliefs (higher in religiosity=less prevalence of drinking) -Family History -->Dysfunctional family settings (higher in vulnerable populations, e.g. marginalized, low SES, poor backgrounds (coping strategy) -Peer Influences -->Social pressure (largely prevalent in high schools)

Childhood and death

-Death between ages 1 to 15 years -#1 cause of death is accidents -#2 cause of death is cancer -Mortality for most causes of death in infants and children have declined

Emotional Responses to Chronic Illness: Denial

-Defense mechanism -Denial is a common early reaction to the diagnosis of a chronic illness -Immediately after the diagnosis, denial can serve a protective function -During treatment and rehabilitation, denial may have adverse effects

Treatment Delay

-Delay: The time between recognition of a symptom and obtaining treatment -An individual is aware of the need to seek treatment but puts off doing so -Example: Lance Armstrong -Recognition: I should get this checked? -Decision: I am too busy -involves appraisal delay, illness delay, behavior delay, and medical delay

The Mind-Body Relationship Today

-Despite criticisms of early views -> they did lay groundwork for current holistic view -Physical health is interwoven with psychological and social environment -The mind and the body cannot be separated in matters of health and illness

Stigma and Chronic Pain

-Devaluing and discrediting reactions of others (friends, family, employers, health care professionals, etc.), Allege pain is exaggerated, imagined, Patients perceive hostility and feel blamed and abruptly dismissed -Observers react with uncertainty when pain not medically understood, General population, medical and nursing students, physicians, physiotherapists, etc., attribute reduced pain, Less inclined to help, feel less sympathy, dislike patients, suspect deception

Spousal Interrelations in Well-Being and Health: Social contextual approaches to well-being and health

-Development occurs in a social life context -Marriage as a special social unit (this unit is the most studied, often struggle over the same kinds of issues) -Empirical evidence for spousal interrelations in key domains of functioning

Social Support: Effects of well-being on health

-Direct Effects Hypothesis: Social support is generally beneficial during non-stressful times as well as during highly stressful times -Buffering Hypothesis: The health benefits and mental health benefits of social support are chiefly evident during periods of high stress, When there is little stress, social support may have few health benefits

Future Directions of epigenetics: Questions to be answered

-Do epigenetics help us understand how stress gets under the skin? Evidence regarding regulation of glucocorticoid receptors in individuals with childhood abuse -How does nurture affect resiliency? Maternal licking and grooming reduces stress reactivity in rats --> oxytocin is mediating factor -How are health behaviors associated with later outcomes?

Sudden Death Benefits

-Does not have to cope with: Pain, Physical and mental deterioration -Financial resources are not severely taxed

3) Etiology (cause) and correlates of health, illness and dysfunction

-Does social isolation increase the risk of disease? -Does stress alter susceptibility to disease? example: several famous studies showing that social relationships affect susceptibility to the common cold and long term health outcomes--> it is important for people to be socially interactive

Placebo as Healer: Social Norms

-Drug taking is a normative behavior -People believe drugs work -People have experience in taking drugs

The Mind-Body Relationship: Renaissance

-Dualistic concept of mind and body -Breaking away from superstitions of past centuries -Theologians, priests, philosophers deal with the mind -Physicians heal the body -Aspects of the body were viewed as having potential for disease

Targeting At-Risk People for health behaviors

-Early identification may benefit prognosis -Knowledge helps monitoring -prevention is better than treatment -must tailor interventions to the specific person -Problem: People don't always perceive risk correctly, Most people are unrealistically optimistic, people may get stressed as a result of tailoring disease prevention to a person, stigma accompanies certain types of diseases e.g. people don't want to identify as having AIDS

Types of social support

-Emotional support -Informational support -Ta n g i b l e a s s i s t a n c e -can come from the same people but often come from different people

Intentions, Planning, and Health Behaviors Empirical Evidence

-Empirical evidence for benefits of pre-and post- intentional processes across a number of health promoting behaviors

Intentions and Planning Across Health Behaviors- longitudinal studies

-Empirical evidence for role of intentions and planning for: -Physical activity -Dietary behavior -Seat belt use -Dental flossing -Breast self examination -All based on separate long -term longitudinal studies with (N>1000 participants)

Health risks associated with smoking video clip

-England banned smoking in all enclosed places, including workplace -1/2 of all regular smokers will die from their habit -lightweight paper, cellulose acetate, many different chemicals including nicotine (addictive ingredient) -smokers more susceptible to colds, weakened heart & poor circulation, damages esophagus, leading to heartburn and ulcers, inc risk of cancer, gum disease, tooth decay, prematurely ages skin, inc prevalence of ceriasis, discoloration of fingers -passive smoke greatly impacts others

Determinants of Regular Exercise

-Exercise schedules are usually erratic -Lack of time and stress undermine good intentions -About 50% of people who begin with an exercise program are still doing it after 6 months -Individual Characteristics: Gender (women do less), weight, social support, self-efficacy -Characteristics of the Setting -Convenient and accessible settings predict adherence (e.g. walkable neighbourhoods)

Expressive Writing and Readjustment Study results

-Expressive writing versus no intervention: In expressive writing condition--> Reduced distress, less anger, fewer physical complaints, Reduced PTSD symptoms, less reintegration difficulty, more social support -Expressive writing versus factual writing: Reduced distress, less anger, fewer physical complaints

Time-Sampling Research

-Focus on daily life processes, get people's opinion on certain things several times a day -High ecological validity -Reduces retrospective response biases -Can be combined with biomarkers -Assessment via daily diaries, phone calls, computer- based assessments, sms -Can be combined with biomarkers, e.g. cortisol in saliva or behavioral measures, e.g. accelerometers -Not limited to individuals-also couples, families -Example: Positive couple interactions buffer work stress in couples

The biomedical model

-Focus on illness -Dominant model for the past 300 years -All illness can be explained by biological malfunction e.g. you have a virus that is causing a fever. The fever is treated, case closed. -Psychological/social processes seen as Independent of disease in the biomedical model -ALTHOUGH complex diseases require that other factors like the psychosocial be taken into account

Young Adulthood and death

-For those aged 15 to 24, death is due to -#1 accidents -#2 suicide -#3 cancer -Death of a young adult is considered: Waste of life, Robbed of a chance to develop and mature

Effects of Lactation on Stress Reactivity- Response to stress

-Free speech OR -Mental arithmetic N=43 healthy breastfeeding women -Comparison of two groups: Hold baby prior to TSST OR Breastfeed baby prior to TSST -looking for affect on HPA response and the amount of cortisol released

Generative Goals

-Generativity: Guiding the next generation, Taking responsibility for well-being of others, Passing on knowledge -want kids and young adults to focus on academic accomplishments to embark on professional career but we need to move beyond one's own trajectory (older people can guide the next generation)

CHAPTER 11: overt bahvioral and covert coping

-overt behavioral: getting rest, using relaxation, taking medication -covert: hoping or praying the pain will get better, diverting ones attention

Caveats and critical issues related to social support and stress

-Having at least one strong intimate relationship is an important predictor of good health (Coyne & DeLongis) -The "dark side of close relationships": "Negative Support" predicts outcomes far better than "positive support." ̈-Karen Rook

Chronic stress and health

-Health outcomes depend on type and duration of stress -Dementia caregiving: -Long duration (3-15 years) -High demands (physically and emotionally) -Little control

Future Directions: Promoting Resilience and Growth

-Health psychologists are increasingly looking at positive experiences that keep people from developing chronic disorders

Increasing Acceptance of Health Psychologists

-Health psychologists, in the past saw "problem patients" that could not be treated by the medical model (no solution to their condition) -Psychologists administered/ interpreted psychological tests to see if there was an underlying condition -Growing recognition--> Psychological/social factors are ALWAYS important -The role of the health psychologist in changing health habits and in contributing to treatment is increasingly acknowledged

Scientific Definition of Health Psychology (including 4 areas of focus in health psychology)

-Health psychology is the aggregate of the specific educational, scientific, and professional contributions of psychology to : Health promotion and maintenance -Illness prevention and treatment -Identification of etiologic and diagnostic correlates of health, illness, and dysfunction -Improvement of health care systems and health care policy

Time sampling tools: Plastic

-High compliance -Better data management -Time intensive BUT... -Resource intensive -May not work with all populations

Time sampling tools: Phone

-High compliance -Familiar -Builds rapport BUT... -Time intensive -Resource intensive -Intrusive

Perceived Spousal support study: RESULTS

-Higher perceived support is associated with overall lower mean levels of negative affect, but not positive affect (support doesn't necessarily lead to more positive affect) -Higher perceived support is associated with increased negative affect co-variation (neg affect in both partners), lower perceived support is less associated with negative affect co-variation -Higher perceived spousal support is associated with more pronounced co-variation in negative affect -Lower perceived spousal support is associated with less pronounced co-variation in negative affect

The Mind-Body Relationship: Ancient Greeks

-Holistic view Hippocrates (ca. 460 -ca. 377 B.C.) proposed the humoral theory which was later expanded by Galen (A.D. 129 -ca. 199) -Hippocrates believed that whatever happens to the body has ramifications on the spirit

Psychological Factors in Terminal Illness: Medical Staff

-Hospital staff are significant to the patient -Patients can be candid with medical staff -Symbolic immortality: The sense that one is leaving a lasting impact on the world, Need to find meaning in life while making a loving separation -Care for dying patients in the home: Choice of care for many terminally ill patients, Often hard for family members

1) Health promotion and maintenance

-How can we encourage children to develop healthy eating habits? -How can we promote physical activity? example: Piano staircase in transit, when people step on the stairs they make a piano noise and now everyone was taking the stairs

Coping with Stress: Role of Appraisals

-Impact of stress depends on how the person appraises it -Primary appraisal: How significant is this event? Positive, negative, neutral -Secondary appraisal: Do I have the resources to cope with it? This is a dynamic process--> may have an initial reaction that is continually adjusted

Uncontrollable situations: Psychological distress

-In uncontrollable situations, secondary coping (emotion focused coping) is better for reducing procedural distress and behavior problems than problem focused coping (primary coping). This is important for situations in which you cannot change the outcome--> can be problematic to use problem-focused coping in sitautions you cant change

Physical activity: benefits

-Increases in cardiovascular fitness and endurance -Improvement of psychological well-being -Cognitive functioning--> reduce cognitive decline -Decreases in risk of chronic disease e.g. diabetes, cardiovascular disease, cancer -Increases in longevity -Yet, the majority of Canadian adults don't meet physical activity guidelines--> major problems are sedentary life styles and lack of exercise (these two can be separated)

Selective Optimization with Compensation (SOC) - strategies for implementing goals

-Individuals are active agents who shape developmental outcomes •Selection: Focus on most important goals •Optimization: Acquisition/refinement of means to achieve goals •Compensation: Substitution of means (recruiting additional means when other means are no longer available e.g. asking for help) e.g. Arthur Rebinstein pianist played into 70s and 80s despite his skills not being as great as in his 30s and 40s, now that hes 80 he limits the pieces he performs (selection), practice the same pieces over and over again (optimization), slows down his key strokes bc fingers can't move as fast (compensation)

Infant Mortality Rates, 2000

-Infant mortality in rural and urban first nations groups is quite high compared to rural and urban non-first nations groups--> ~14 per 1000 babies in rural and ~12 babies urban first nations -less drastic stats for neonatal and post neonatal mortality but still greater prevalence in aboriginal communities *the infrastructure that is unavailable to first nations leads to high mortality rates

Social Support: Definition & where can it come from?

-Information from others -That one is loved and cared for -Esteemed and valued -Part of a network of communication e.g. family, friend group, church -And of mutual obligation e.g. kids take care of their aging parents -Social support can come from: -Spouses or lovers -Friends and family -Social and community contacts -And pets!

Canada and paediatric pain

-we publish 4% of scientific papers annually, but Canada publishes 15.5% of papers on paediatric pain annually

Findings from the Experience Corps Program

-Intergenerational volunteer-based tutoring program to support reading in elementary school aged children who are struggling -inner-city schools with disadvantaged backgrounds --> recruited relatively educated adults from the same neighbourhood -Win-win -Fostering literacy skills in disadvantaged children (adults 50+ volunteer to help children learn to read) 3 or 4 afternoons a week -Promoting health, cognitive skills, and social engagement in older adult volunteers -this is acting upon a generative theme (leaving a legacy) -ongoing program, promoting the health of the volunteers even more than fitness programs because they have a commitment to the child they're working with and will leave the house no matter what

Advantages of biopsychosocial model

-Interplay between micro-and macro-level processes -Multiple factors influence health and illness -Mind and body form part of the same system -Emphasis on both health and illness

Challenges with pain perception

-Intrapersonal focus neglects the interpersonal -An incomplete definition of pain biases action -Assessment suffers from preoccupation with self-report of pain intensity -Absence of objective measures contributes to errors and biases in pain assessment -Chronic pain stereotyping and discrimination is a widespread public health problem

Define cognitive appraisal (person-environment transaction)

-It is the individual's perception of the psychological situation that defines stress -Stress is a function of both: the person (e.g., neuroticism, vulnerability, ability to cope) & the stressor (e.g., controllability, intensity)

Evidence for the stress buffering hypothesis

-Jim House, Work Stress and Social Support, 1984 -Interviewed 2000 men from a range of occupations : factory workers to physicians -for various measures of work stress: Overload, Responsibility -Variety of outcomes: Anxiety, Depression, Heart disease, All cause morbidity -having someone who provides adequate support alleviates the negative health outcomes from stressful job

Factors Affecting Symptom Recognition Video

-Lance Armstrong: he mad many symptoms--> blurry vision, headaches (attributed to getting old), coughing up blood (attributed to allergies), pain in testicles --> "mentality of a young person" and he did not recognize his testicular cancer

Lay Definitions of Coping

-Lay definition often implies that the situation was handled well, For example, to say someone "coped" often means that a stressful situation was handled well -This definition confounds the behavior with the outcome

Changing Health Habits: Theory of Planned Behavior

-Linking attitudes and intentions directly to behavior --> need to set goals -Behavioral intentions depend on: Attitude toward the specific action, Subjective norms regarding the action, Perceived behavioral control

Types of social support: invisible support chart

-Looked at couples where one of them was studying for the bar exam: looked at daily lives of couples leading up to bar exam for a month. He monitored support from the partner and the perceived support by the receiver and related this to depression. Core finding: Partner did something for student but student did not notice= least depressive symptoms (they have been supported w/o noticing and do feel guilty about having to pay them back). When the student perceived they received support from partner but actually didn't= most depressive symptoms bc you feel in dept even though they did not get any supportive benefit from partner.

Low Spouse support and Patient coping

-Low spouse support may lead to poor patient coping -Spouse Criticism associated with: -Patient maladaptive coping strategies -Patient poorer psychological adjustment

Older Adults: Health Behaviors and Age-Related Declines in Functioning:

-Maintaining a healthy, balanced diet -Developing an exercise regimen -Taking steps to reduce accidents

The Private Self

-Major threats to self, because illnesses create loss of independence -Adjustment to chronic illness involves exploring alternative routes to fulfillment

Health-Compromising Behaviors

-Many of these behaviors share a window of vulnerability in adolescence -Drinking to excess -Smoking -Illicit drug use -Unsafe sex -Risk-taking behaviors

Smoking Interventions: Media campaigns

-Media campaigns have helped instill antismoking attitudes among the general public -Even adolescents view smoking as addictive -Changes in social norms (from largely positive to strongly negative) have motivated many people to quit -BUT attitude-change campaigns by themselves don't help smokers quit (help people make the decision to NOT START, but not influential enough to get people to QUIT)

Placebo as Healer: Situational Determinants

-Medical formality strengthens the placebo effect -Shape, size, color, taste, price, and quantity

OCED estimates of obesity in adults and projections for the future

-Mexico, Us, England, Australia have worse prognosis, spain italy, fance, switzerland, korea have better prognosis than canada

Socioeconomic Status and Stress- Stimulus definition of stress

-Michael Marmot, University College London -Whitehall Studies-->-interested in association of SES and health outcomes -Whitehall I--> link between status (SES) in heirarchy and mortality (did not include women in this study) -Whitehall II-->Prospective longitudinal study of 10,308 female and male British Civil Servants (73 % of all London-based civil servants). Tried to unpack first experiment by understanding the mechanisms by which SES impacts mortality rates. -here we can establish time-ordered relationships b/c it is longitudinal (e.g. how careers and baseline health influence later health) -Nine waves of data since 1985

The main focus of health psychology

-Mind and body are inextricably linked -Biopsychosocial model: Biological, psychological, and social factors interact to produce health or disease (circle diagram with sociological, biological and psychological overlapping to form "health"

Chronic Stress and Glucose Regulation: Chart

-Neighborhood characteristic modifies the effect of care giving on glucose metabolism -worse neighborhood: higher glucose levels than better neighborhoods

Characteristics of Exercise Interventions

-Strategies: -Cognitive-behavioral strategies promote uptake and adherence -Individualized Exercise Programs: -Understanding motivation and attitudes aids in development of a program of activities that are liked and are convenient

Chudyk et al: older adults low income in Metro Vancouver and walkability

-Neighborhood destinations may encourage mobility, as older adults typically leave their homes to travel to specific destinations. cross sectional- older adults receiving rental subsidy in Metro Vancouver -examine associations btwn environment and trips/day -participants: 3 trips/day, 6 different destinations per week -destinations: grocery stores, malls, restaurants -Our findings provide preliminary evidence regarding destinations that may be most relevant to older adults. They also suggest that the prevalence of these neighborhood destinations may encourage walking

Winters et al: older adults walking in West End, walkability and their walking habits

-Neighbourhood environments support or hinder mobility especially as health declines and physical vulnerability increases with age -cross sectional study of older adults living in Vancouver West end -destinations visited: grocery stores, malls/marketplaces, restaurants, others homes -participants: 4.6 one way trips/ day -7910.1 steps/ day 39.2 minutes/day -travel mode: 62.8% walk, 3.2% bike and 22.4% car -this is a lot of walking for their age group -Older adults living in highly walkable neighbourhoods were very mobile and frequently used active transportation -he high rates of active travel and physical activity in a walkable neighbourhood suggest that when provided compelling destinations, community dwelling older adults walk more and may achieve health benefits through daily travel.

Placebo as a Methodological Tool

-No drug can be marketed until it is evaluated against a placebo -Double-blind experiment: ½ the patients receive the experimental drug, ½ the patients receive a placebo -Neither the researcher nor the patient knows whether the patient received the drug or the placebo

Adherence and public health agency of Canada, what conditions have the highest and lowest adherence?

-Non-Adherence ranges from 15% to 93%, average of about 50% -Adherence highest : HIV, Arthritis, Cancer, Gastro-Intestinal diseases (e.g., inflammatory bowel disease) -Non-adherence highest: pulmonary diseases (e.g., Chronic Obstructive Pulmonary Disease), diabetes, sleep disorders

Factors Impacting Treatment Adherence

-Pain (Cardinal symptom that motivates people to seek treatment in the first place, creates urgency) -Perceived seriousness -Visibility of symptoms -Complexity of treatment (length & dose) -Age -Mental health -Creative Non-adherence: Involves modifying a prescribed treatment regimen--> Patient beliefs and private theories e.g. only taking one of two pills for high BP and using herbs and other natural substances for treatment

Attitudes Toward Symptoms

-Patients focus on : Pain -Providers are concerned with: Underlying illness -Embarrassment may lead patients to give faulty cues about health history and practices

Role of Behavioral Factors on Health promotion

-Patterns of disease in North America have changed from acute infectious disorders to "preventable" disorders -Half of all deaths are caused by preventable behaviors -Obesity and lack of exercise is about to overtake tobacco as the most preventable cause of death--> may lead to decrease in life span (rather than ongoing increase we have recently experienced)

Goals and Wellbeing

-People are active agents that navigate through life by setting and pursuing goals -Goals: Cognitive representations of the self in the future -Guide behavior over time -Individual reference standard -Linked to stress and wellbeing -resources to accomplish goals change over lifespan, content of goals differ across different lives of individuals -as long as people work towards something that helps them grow this translates into high well-being

Perceived Spousal Support and Emotional Transmission

-Perceived spousal support can make partners more attuned to each other's emotions •more permeable boundaries especially facilitate negative affect -Well-established benefits of spousal support might be undercut •increased vulnerability to transmission of distressing emotional states

Support for Theory of Planned Behavior Across a Broad Spectrum of Health Behaviors

-Physical activity -Fruit and vegetable consumption -Flossing -Breast self-examination -Seat-belt use -HAVING A GOAL AND NOT HAVING A GOAL MAKES A DIFFERENCE

Smoking: Who is best able to induce people to stop smoking?

-Physician recommendations--> Especially effective for pregnant smokers -Patients with symptoms of coronary heart disease more likely to stop -Hospitalized patients -this is a unique opportunity to help people commit to a healthier lifestyle involving behavior changes

Links between chronic stress and health

-Physiological changes in response to stress -Do not serve original purpose: short term mobilization of resources to fight or flee -E.g. dysregulated cortisol patterns may lead to health problems

Future Directions: Broaden and Build Theory

-Positive emotions widen people's outlook on life: Broaden attention and thinking, Broaden repertoire of desired actions, Increase openness to new experiences -Positive emotions build resources: Increase optimism, Ego-resilience, Mental health -Waitlist control study on loving-kindness meditation: N=202 middle aged adults, 9 weeks of daily life assessments; six meditation sessions, More daily positive emotions (joy, gratitude, contentment), More positive relations and social support, more purpose in life, fewer depressive symptoms, fewer health symptoms after 9 weeks

Future Directions: Positive Psychology

-Positive psych is based on research and brain scans: seeks to study what is above average to find out what is working. Need to study the healthy, not only the unhealthy. -21:1 negative to positive ratio in study of psych -we have to learn from positive outliers e.g. resiliency, happiness, humor, life span--> take these ideas and move the average up Talk by Seigleman -The pleasant life: Positive emotion--> as many of the pleasures you can have & Learning the skills that amplify them. Drawbacks: the aptitude to experience pleasant life is 50% heritable, pos emotion habituates, its not malleable. -The Good Life (engagement): work, love, leisure --> people experience "flow" where you can't feel anything, you have intense concentration and time stops -The Meaningful Life

Transactional Definition of Stress

-Stress is neither a stimulus nor a response -Stress is a transactional process that includes both the environmental stimulus and the response of the organism

Interpretation of Symptoms

-Prior Experience: Interpreting a symptom is heavily influenced by prior experiences -Expectations: Ignore symptoms that aren't expected, Amplify symptoms that are expected -Seriousness of symptoms: More likely to seek treatment if it causes pain -Lay referral network: an informal network of family and friends who offer an interpretation of symptoms -Internet: difficult to tell the quality of medical advice, can lead to messiness when you contact a doctor

Criticism of Stimulus Definition of Stress

-Problem with normative ratings (same event can have different meanings) -No change can be stressful -Other important stressor ignored (chronic stress, daily hassles) -Limited role given to psychological factors-->Appraisal is important -For whom and under what condition do stressful events lead to illness? -Large individual variation in the effects of events e.g., Control, neuroticism as third variables causing both stress and illness

Patient-Provider Communication: Baby-talk

-Providers may underestimate what a patient is able to understand -Baby talk can forestall questions -What patients can understand lies between technical jargon and baby talk

The mind-body relationship today

-Psychology and medicine initially embraced the dualism of mind and body -Psychological variables contribute to physical health -New understanding of the link between psychology and medicine and of mind-body holism

Advantages of Cross-Sectional Self-Reports

-Quick, Simple, Easy, and Cheap -Can be administered in group sessions, via mail, over the internet -Can be used to collect data from large samples (e.g. Statistics Canada)

Dyadic Associations in Wellbeing: Seattle Longitudinal Study RESULTS

-Real Couples Differ from Unrelated Pairs -positive relationship btwn partner 1 and 2 in real couples -when spouses report changes in well-being over time, there is a change in the same direction for their significant other/ partner --> systematic co-variations in well-being -this same effect was not found in unrelated pairs

The Social Self

-Rebuilding social self -Interactions with family/ friends -Fears about withdrawal of support are common worries of the chronically ill -Individuals with chronic disease often elicit ambivalence from acquaintances (they may feel insecure, dont know the appropriate way to react, so they distance themselves so that they dont have to think about the possibility that they themselves could get a chronic disease).

Coping with Stress: Emotion focused

-Regulating emotions that are experienced because of the stressful event -Some situations simply cannot be changed Examples: -Denial (It didn't happen.) -Avoidance (avoiding thinking about the problem) -Emotional support seeking (e.g. calling a friend for help when you got a poor diagnosis from the doctor) -Positive reappraisal (focus on the bright side.) -This strategy is often used in situations that you cannot change

Alcoholism and Problem Drinking: Relapse Prevention

-Relapse rates--> 50% or more relapse within first 3 months -Helpful for problem drinkers to know: Relapse is normal, Relapse doesn't mean total failure, should have coping plans in place -Important relapse prevention skills: Learning "drink-refusal skills," Learning nonalcoholic beverage substitutions

Some Sources of Error in Judgment in Decoding Pain Expression

-Relationship factors-->Kin, friendship, profession, Socioeconomic status, Similarity/affinity: age, gender, ethnicity/race, Liking -Cognitive/Affective Dispositions Catastrophizing, hypervigilance, fear, Depersonalizing/dehumanizing expressions, Suspicion of deception -Setting (priming) factors Institution (Longterm Care; WCB; courts; hospital) Comorbidity; lesions; psychological dysfunction

Spousal Interrelations in Well-Being and Health: midlife and old age

-Relative stability in well-being across adulthood (even when things go less smoothly) -Individual differences in well-being as related to social relationships -Spousal interrelations in long-term physical and mental health (spouses often go up and down together in their quality of life)

Chronic Stress and Glucose Regulation

-Repeated increases in blood sugar -Consequences: Development of insulin resistance,Type 2 diabetes

Tend and Befriend Hypothesis role of oxytocin- Response to stress

-Role of the neuropeptide oxytocin -Animals and humans with high oxytocin levels show behaviors that are: Calmer and more relaxed, More social and maternal -Under stress, females are more likely to turn to others than are males -Most of the research on this focuses on prairie voles (they are unique bc they form monogamous pair bonds- not true for other voles) -when is oxytocin released? childbirth, breastfeeding

Case study: Bill, Ethel, and John

-Rural B.C. -research trying to get older adults in BC to be more active -Bill was a previous farmer and now he has a small greenhouse of plants to tend to -Ethel: she has lost the vision in her right eye, tries to keeo busy at home with chores, she does line dancing -John: entertains at seniors homes, trying to be more active with his grandchildren to reduce his weight

Expressive Writing and Readjustment Study

-Sample: 1292 US Afghanistan and Iraq war veterans with reintegration difficulties (not adjusting well to life back in the US) -Randomized controlled trial (could be in one of three conditions): Expressive writing- online where they logged in 4 times and identified an event and recounted their feelings, OR Factual writing- online where they logged in 4 times and wrote about 4 different topics that were factual and content specific, OR No writing -Outcomes (at 3 and 6 months) they looked at: Physical complaints, Anger, Distress, Social support, Life satisfaction

Transactional Definition of Stress: Richard S. Lazarus

-Stress occurs when the environment taxes or exceeds the resources of an individual

Perceived Stress & Colds (Cohen et al., 1991): integration of stimulus, response, & transactional

-Sample: 394 healthy volunteers + 26 controls -Methods: Perceived Stress Scale + life events + negative affect -made sure people were healthy at start -Nasal drops: respiratory virus vs. saline -Quarantined for 10 days (from 2 days prior to 7 days after)

Chronic Disease Challenges:

-Self-Concept -Self-Esteem

Health Action Process Approach Chart

-Self-efficacy, outcome expectancy, risk perception all impact intentions--> action planning and coping planning--> ACTION (initiative, maintenance, and recovery)

Biopsychosocial Factors in Development and Maintenance of Health Compromising Behaviors: psychological factors (personality)

-Sensation-Seeking-->Excessive need for stimulation (high sense of curiosity) -Impulsivity -->Inability to effectively control or restrain behavior -Negative Affect--> Anxiety & depression -Poor Coping -->Deficits in cognitive and behavioral skills

Smoking: Why Do People Smoke?

-Smoking begins early (adolescence) -Significant proportion of teens smoke regularly -Initial experimentation -Try out cigarettes -Experience peer pressure to smoke -Develop attitudes about smokers -Peer influence: 70% of all cigarettes smoked by teens are smoked in the presence of a peer -Adolescents are more likely to start smoking if: Their parents smoke, They are lower-class, They feel social pressure to smoke, There has been a major family stressor -To adolescents, the image of a smoker= Rebellious, Tough, Mature -Smoking cigarettes may help convey the image that an insecure teen longs to display -Smoking is clearly an addiction -It is harder to stop than other health compromising behaviors -Nicotine may be a way of regulating performance and affect -Smoking is paired with rewarding experiences- when someone is tired they get a boost, people are willing to trade short term desirable outcomes for neg health in the future

Smoking: Synergistic Effects

-Smoking enhances the impact of other risk factors in compromising health -Nicotine stimulates release of free fatty acids -Nicotine increases reactivity to stress -Smokers engage in less physical activity

Losses in the Fourth Age: Social context

-Social Context: the majority of the oldest old ... -is female -is widowed and live alone -was hospitalized in the last years of life

Alameida County study

-Social Ties and and 9 year Mortality in Alameda County, CA -men: When you count their social ties, men with the most social connections were healthier and men with LEAST connections had HIGHEST incidence of death -women show the same pattern

Socioeconomic status and control- stimulus definition of stress

-Socioeconomic status and control as key determinants of health -Important: Individual differences in sense of control at the same hierarchy level

Future Time Perspective and Motivational Shifts

-Socioemotional Selectivity Theory -Shifting future time horizons: -Changes in goals for social interactions -Greater value on emotional meaning -Preference for familiar social partners -Appreciation of fragility and value of human life

Criticism of transactional model of stress

-Some noxious events have been found to have an effect above and beyond that accounted for by cognitive appraisals of stress -Bigger problem: -Blaming the victim-->e.g. someone was in a car crash and broken a few bones people might prescriptively say "just think a little more positively." Not all problems can be solved by secondary appraisals alone. -Focus on subjective experience -Value of evaluating stress "objectively" so that we know it is the stressful event and not aspects of the person causing the stress-illness correlation

Spousal Interrelations in Well-Being and Health: Mechanisms contributing to spousal interrelations in well-being and health

-Spouses derive emotional meaning from their relationship (they care about each other, empathic) -Collaborative problem-solving and dyadic coping (action-oriented approach, trying to help troubleshoot what is going on- develop an action plan) -Long history of joint experiences including shared stressors

Social Support and Stress Test

-Standard Psychosocial stress test: Free speech or mental arithmetic -the lead up to this test is crucial: researchers observed a person alone (prepared for stress test alone for 10 minutes) or dyads (prepared for stress test w/ opposite sex stranger for 10 minutes), (lastly, social support by partner to help them prepare for stress test for 10 minutes) -N= 66 partnered young adults N no social support = 23 N social support by stranger= 22 N social support by partner= 21 -Results: AUC= area under curve-->total cortisol released -Men were more stressed in general than women -with no support: men were highly stressed, most cortisol released (most stressed in this condition), women less stressed than men, not alot of cortisol release -stranger: Men showed less stress and less cortisol release, women show stress level roughly equivalent to preparing alone-->not alot of cortisol release -Partner: The men were LEAST stressed in this condition, least cortisol, women MOST stressed in this condition--> female recipient did not benefit very much from partner support -both men and women report that their partner supported them in 10 min before test--> But women typically are better supporters than men and this was shown in the study

Patient-Provider Communication: Stereotypes

-Stereotype of doctors: white men -people find it easiest to connect to someone who is similar to them -this impacts: -Gender (women) -Ethnicity (non-white) -Low SES -Elderly (understanding what it is like to have 4 chronic diseases) -Acute versus chronic (some may be better at treating acute vs chronic)

the facial expression of pain:

-Stereotyped pattern different from aversive emotional displays (fear, anger, disgust, etc.), i.e., sensitive and specific -Stable over life span -Invariably used in social interaction--> a preferred source of information, accounts for substantial variance in judgements, relative to other sources

Disadvantages of Time-Sampling Research

-Still have third variable problem (unmeasured variable that is impacting the study's finding) -Labor intensive -Lots of information on few people

Pain assessment:

-The International Association for the Study of Pain: incomplete, sporadic, or nonstandard pain assessment -U.S. Institute of Medicine (2011): Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research-->the lack of specific scientific assessment tools and biomarkers is prohibitive to determining which treatment will work best for individual patients1.

The General Adaptation Syndrome: Resistance- Response to stress

-The body enters this stage if the stress is prolonged -Body continuously draws on biological resources at an above normal rate -Sets the stage for diseases of adaptation

The Rise of the Biopsychosocial Model

-The discovery of micro-organisms and the resultant development of antibiotic medications led to a decrease in causes of death due to infectious agents. -The most prevalent causes of death are no longer infectious or acute conditions (e.g., respiratory diseases, or tuberculosis or gastroenteritis.) -There is now a higher prevalence of chronic disease, which means rising healthcare costs, developing relationships between doctor and patient, complex conditions and different treatment options

Patient-Provider Communication

-The medical office is an unlikely setting for effective communication -The person who is ill-- >may not be thinking clearly -The provider-->might be well-intentioned but might have to take a step back and put some distance between them -the healthcare system--> doctors are paid for 7 minutes per patient

Stages of Change Model Explained

-The model identifies a number of stages which a person can go through during the process of behavior change -It provides a framework for a wide range of potential interventions by health promoters

Implications of the Biopsychosocial Model

-The process of diagnosis must consider the interaction of (1) biological, (2) psychological, and (3) social factors -Recommendations for treatment must also consider these three factors -The relationship between the patient and the health care practitioner is important for the delivery of care

Longitudinal Methods

-The same individuals are followed over time -Examine naturally existing phenomena as they occur -Allow investigation of antecedents and consequences of certain events -Help to study time-ordered relationships -Example I: The Seven Up Project -Example II: The Alameida County Study

Coping-General Tendencies/Dispositions: Brief COPE (Carver)

-There are lots of ways to try to deal with stress. This questionnaire asks you to indicate what you generally do and feel, when you experience stressful events. -People can choose between: Active coping, positive reinterpretation, mental disengagement, which are worded in different ways in the questions e.g. I take the problem step by step, i try to see the positive aspects, i go to the movies to stop thinking about it.

Future Directions: Focus on Individuals at Risk Clip

-There are systematic differences in health in segments of the population despite having a public health care system -poverty is something that can't be ignored- it is linked with health outcomes, people who are considered poor are often full-time employees but still have to make decisions such as food or shelter

social determinants of pain:

-Thesis: Social contexts of people's lives, past and present, are powerful determinants of pain -The Evidence: Causally related to exposure to pain, what people think, feel and sense during pain, how they behave and communicate distress and how others decode and react to them -Thus, pain presence, perception, expression , maintenance, exacerbation and respite all caused by social factors

engel et al: older adults low income in Metro Vancouver and walkability

-This study examined the association between the built environment and social cohesion in low-income older adults -street connectivity and social cohesion were significantly associated with general quality of life. No variable were significantly correlated to health related quality of life

Percentage of Canadians reporting that they consumed fruit and veggies at least 5 times a day

-This trend is around 50% of Canadian women with females being consistently higher than males (30%) in their consumption of health foods -the trend is remaining stagnant from 2001 to 2014

Social Ties and and 9 year Mortality in the Alameda County Study

-Three different age groups 30-49 yo, 50-59, 60-69 -linked people in someone's network to the percentage of people that had died from all causes -individuals with the most social ties, had the lowest risk of death (they survived at later age categories) -fewest social ties were more likely to have passed away

Goals of this unit on Research methods:

-To understand research methods in health psychology. -To be able to critically evaluate research in health psychology

Coping with Traumatic Events: Emotional Expression and Pennebaker's writing assignment

-Traumatic past experiences require emotion focused coping (it happened in the past, nothing you can do now to change it). Example for emotion focused coping: Dr. Pennebaker's basic writing assignment--> over course of 4 days take 20 min in a quiet place and write down your stream of thoughts connected to emotional upheaval that has been bothering you. People dealing with severe depression will likely be unaffected by this but "normally" functioning people with distress may benefit--> leads to better grades, better sleep, went to doctor less, improved mental health, inc. well-being. Why do these changes occur? Translation of emotional experiences changes the way its organized in the brain (tied to other events in their lives)

Reactions to Young Adult Death

-Typical reactions to young adult death: Shock and outrage, An acute sense of injustice -Young adults may be parents of young children: Cheated of chance of watching children grow, Concerned about how children will fare without them

Psychosomatic medicine and ulcers- is there a biological cause?

-Ulcers eat away at your stomach lining -Australian researchers discovered bacteria that cause ulcers-> pill was created to treat bacteria -it was also discovered that 2/3 of the population has this bacteria for ulcers but they dont necessarily get an ulcer.. when stressed the immune system shuts down and the stomach ulcers develop as a result of bacteria action.

Risk Factors for Pain Under-estimation

-Uncertainty -Absence of medical diagnosis (pathophysiology) -Distant relationship to the patient -Likeability of the patient -Strong evidence of psychosocial causes/exacerbation -Patient social and language skills

The Dangers of Antibiotic Resistance Clip

-WHO warns that resistance to antibiotics has reached alarming levels, there are 7 superbugs that are resistant to antibiotics e.g. stronger strains of e.coli and STI gonorrhea. We need to be more cautious about prescribing but also patients MUST finish their antibiotics if they're given them.

2) Prevention and treatment of illness

-What can be done to prevent and treat common diseases such as cardiovascular disease, cancer, diabetes? -What are effective ways to cope with chronic disease and influence illness trajectories? example: Doctor Steven Knope says that if we remove obesity, sedentary lifestyles, tobacco and alcohol addiction then we will remove 40% of all cancers. Then healthcare money can be better spent on other unavoidable diseases--> prevention is key.

4) Improving the health care system and formulating health policy

-What impact do health institutions have on people's behavior? -How can we improve the communication between patients and providers? Example: Atlanta man caught a rare form of Tuberculosis and there were no adequate/ conventional medications to perscribe him. There was a doctor conference to discuss treatment options and the patient understood that things were not looking good for him... so he did not show up to his next meeting. He flew to Athens for his wedding, spent his honeymoon in Rome, then went to Prague, flew to Montreal and drove across the boarder to NYC where he was eventually apprehended and prisoned. At the time, the TB was dormant but he had the potential to infect many people along his journey.

Choosing a Research Method

-When a researcher is ready to formulate a study, he or she chooses from several different methods. -The best method depends on the research question and hypothesis.

Symptom Recognition

-When and how does a person decide they are sick? -When are symptoms dismissed as inconsequential? -When does a person decide that they are in need of treatment from a professional?

Textbook Chapter 6: leading cause of death in childhood and adolescence in Canada

-accidental injury

How does stress get under the skin? Levels of resiliency

-acute stress situation: spike in cortisol, return to baseline afterwards--> recovery -if there is continuous stress: there is a moderate then severe loss of resilience--> don't return totally to baseline bc stressor is more chronic

CHAPTER 9: how does adherence fluctuate?

-adherence for acute illness= 67%, adherence for chronic illness= 50-55% -adherence higher in the days before doctor visit and after -adherence to lifestyle changes is quite variable and generally low

Goal adjustment with aging

-adult's flexible adjustment of goals (realistic goals that match their resources) linked with well-being -e.g. farmer has worked his entire life but it is time to retire--> retire the farm to his kids and tend to vegetable garden behind his house (goal is still there)--> further aging then tending to house plants

CHAPTER 10: research conclusions on helping children adjust to hospital setting

-age: children younger than 7 seem to profit from information presented shortly before the medical procedure, older children are more likely to benefit from info presented days before -experience: for children who have had prior experiences with medical procedures, information is more likely to make younger children more anxious than older children -coping: children who tend to use avoidance strategies to cope with stressful events probably derive less benefit from info about medical procedures than those who use attention strategies

why pain? interpersonal functions

-alarm signals, warn of danger -instigate empathy and care--> counterproductive with competitors or enemies -social regulation: signify competence capabilities; social hierarchies-->capacity to contribute to well being of the group

Textbook Chapter 6: health behaviors research findings (3)

-although people's health habits are fairly stable, they often change over time -particular health behaviors are not strongly tied to eachother e.g. cant link using seat belts and exercising -health behaviors do not seem to be governed in each person by a single set of attitudes or response tendencies WHY? -various factors may differentially affect different behaviors -people change as a result of experience -people's life circumstances change

Compression of Morbidity

-an effort to not just extend life and add years but to push back the onset of chronic disease and condense it so that you can spend more years in good health

Chapter 8 textbook: treatment plans for anorexics and bulemics

-anorexia treatment typically involves a family centered approach and the dynamics of meal time -psychotherapy is more effective for bulimia --> self-monitoring, reinforcement, cognitive resturcturing

Textbook Chapter 6: sick-role behavior

-any activity people undertake to treat or adjust a health problem after deciding that they are ill and what the illness is. Sick people take on a role making them exempt from their usual possibilities

CHAPTER 9: medical student's disease

-as medical students learn about the symptoms of diseases more than 2/3rds believe they have contracted one of these diseases at some point in their life

Developmental Themes

-before Erikson, developmental psychologists looked at development before the 20's, no research after this point •Goals reflect changing themes of life •Psychosocial stage theory •Early adulthood: Intimacy vs. isolation •Middle adulthood: Generativity vs. stagnation •Later adulthood: Integrity vs. despair (people who master this struggle are called wise) •Empirical Evidence •Ryffet al., 1994 •McAdams et al., 1998

CHAPTER 10: how to help patients gain control

-behavioral control (being able to reduce discomfort and promote recovery) -cognitive control (focus on benefits of medical procedure) -informational control (gaining knowledge about the events/ sensations to expect) *informational & behavioral control proved to be very important in patients who were undergoing cardio bypass surgery

5 leading causes of death by age group in Canada: 1-24 years

-biggest cause of the five: accidents then suicide, cancer, homocide, congenital malformations

5 leading causes of death by age group in Canada: 25-44 years

-biggest cause of the five: accidents, then cancer, suicide, heart disease, homicide

5 leading causes of death by age group in Canada: 45 to 64 years

-biggest cause of the five: cancer, heart disease, accidents, suicide, liver disease

5 leading causes of death by age group in Canada: 65+

-biggest cause of the five: cancer, heart disease, stroke, chronic lower respiratory disease, AZ

The Seven Up Project -Nick

-boarding school, reading physics, would like to do research -nuclear fusion research in US -at 35 Associate prof -42 full professor -by 49 abandoned his research

The neonatal facial coding

-brow lower, eye squeeze, squint, blink, flare nostril, nose wrinkler, nasolabial furrow, cheek raiser, open lips, upper lip raiser, lip corner puller, horizontal/vertical mouth stretch

CHAPTER 11: physiology of pain

-chemical activity at site of pain: seratonin, histamine, bradykinin that promote immune system activity, cause inflammation, activate nerve fibers in damaged regions signalling injury--> nociceptors--> spinal chord--> brain -A delta fibers associated with sharp pain (have myelin) -C delta fibers associated with dull/ aching pain, no myelin

Chapter 8 textbook: what is the main culprit in atherosclerosis?

-cholesterol! Contributes to the deposit of fatty plaques in the blood vessels -this is also associated with having plaques: low density lipoprotein -the risk for LDL depends on: age (45 y for men 55 y for women), cigarette smoking, high blood pressure, low "good cholesterol" , family history of cardiovascular diesase -lowering LDL along with dietary and drug treatment will reduce risk of heart attack and reverse atherosclerosis -strangely, lowering people's cholesterol has been associated with death from accidents, suicide, and violence

Textbook Chapter 7: the role of nicotine

-cigarette smoke is high in carbon monoxide, gas that's readily absorbed by the blood streamand affects physiological functioning -nicotine is the addictive chemical in cigarette smoke and produces rapid and powerful physiological effects--> body arousal, inc alertness, BP HR

Cross Behavior Cognitions and Healthy Lifestyles Chart

-compensatory beliefs are detrimental to strong intentions--> Ie: Belief that I'm having a salad so I dont need to exercise -it is also shown that some people see healthy eating as a gateway to physical exercise -person-dependent

Poor Communication video clip

-confronted patient with bad news and went straight into treatment options--> information uptake= 0, important to have significant other there

Percentage of Canadians who are physically active over time

-consistently around 50% of Canadians from 2001-2014 -men constantly higher than women across the graph -no increasing trend, staying stagnant

CHAPTER 10: psychologists role in the hospitals

-consult with patients specialists like cardioogists to provide diagnostic and counseling services -assess clients need for and provide psychological preparation to cope with surgery/ other procedures -help patients adhere to treatment -provide behavioral programs for improving clients self-care skills and compliance after discharge -assist in rehabilitation processes

Cortisol response to acute stress

-cortisol is released when something stressful happens to us and then slowly we return to baseline--> e.g. Trier social stress test, or training day vs competition day in ballroom dancers (training day= low cortisol, competition day= high cortisol, both return to baseline)

Social network diversity study by Cohen

-counted diversity of social ties and understood the types of support they provided Ss = 276 healthy volunteers -Methods: Gave nasal drops containing common cold viruses (Ss stayed in lab) -Results: 40% got clinically ill -People with fewer than four types of social relations were over four times more likely to catch cold than those with six or more types. -"Not only were they less susceptible to developing colds, they produced less mucus, and shed less virus."

CHAPTER 13: Alzheimer's disease

-dementia refers to the progressive loss of cognitive functions that occur in old age -most common form of dementia is AZ, a brain disorder characterized by deterioration of attention, memory, and personality -causes? tangled nerve and protein fibers called lesions, genetic defects may cause these to occur -risk factors: low education, prior strokes, no alcohol use, sedentary lifestyle, high body weight, hypertension, high cholesterol -no preventative treatment but some medications may slow its progression -

Action Plan

-determine your goals and describe how you will meet them

Coping Plans

-develop strategies to overcome barriers -more likely to succeed -IF it rains...THEN.. I will do my activities this way

Chapter 8 textbook: what type of diets are associated with cancer?

-diets high in saturated fat and low in fiber and fish are associated with the development of cancer (particularly of the colon and prostate cancer) -cancer experts recommend people to: maintain healthy weight, consume little fatty meats, each much fish, vegetables,fruit, high fibre breads and cereals to reduce cancer risk

CHAPTER 10: the right to die in Canada

-direct medical intervention to cause death, discussed in terms of euthanasia or physician-assisted suicide -with euthanasia there is typically more direct involvemnet of a physician by means of administering life ending drug -physician assisted suicide typically requires the life-ending drug to be self-administered -patient must express a desire to die early and meet a number of criteria -most cases, prognosis must be less than 6 months

Person-Environment Fit

-disparities between a person's capacity (e.g. loss of mobility) and environmental demands (poor indoor/outdoor environment) can result in necessary accommodation and or relocation

2 key points of lecture

-distinction btwn inactive and sedentary -canadians, esp older adults are at risk of being both inactive and sedentary

CHAPTER 9: Problem with specialized doctors all treating a patient separately?

-doctors who specialize in different areas don't communicate with each other -the contact with the patient is impersonal because they're often just performing a few tests

CHAPTER 10: nosocomial infection

-each year 5% or 1.7 million American people acquire an infection a person contracts while in the hospital setting and tens of thousands of people die from this

CHAPTER 10: evolution of the hospital

-earliest establishment: ancient Greek temples where sick would pray/ receive cures/ advice from the God Aesculapis -Roman military established seperate barracks for their sick and disabled soldiers -Christian monestaries- sick people, orphans, poor, travelers who needed lodging e.g. Hotel Dieu of Lyons -18th and 19th century revisions: began to restrict admittance to the sick and "worth poor"--> people who could make contributions to society. The poorhouse was for handicapped and mentally deficient whether or not they needed medical care. Also hospitals became more specialized with different wards -middle & upper class usually cared for at home -by early 20th cent hospitals had a much more positive reputation -now, 3 million in-patients per year in canada for acute conditions

Chapter 1 textbook: Eracdication of the Beothuk and Sadlermiut Inuits upon invasion with disease

-early settlers exposed indigenous populations to smallpox, cholera, diptheria, measals, and influenza--> these diseases did not exist in north America previously -high death rate bc: First nations had never been exposed to these diseases (lacked natural immunity) and immune functions were limited by a low degree of genetic variation -this had lasting effects on generations, compacted by bad conditions on early reserves

Dementia video clip:

-early signs of Alzheimer's--> constant misplacing of items e.g. finding keys placed in the fridge -also mood swings, difficulty orienting oneself, loss of words to express oneself

vicarious influences on pain threshold determinations: electric shock example

-electric shock given, increased current intensity over time, also brought in confederate and asked them to rate the electric shock at the same time -confederate either represented themselves as very tolerant or shock intolerant -when paired with shock tolerant person the participant accepted more shocks before reporting pain -when paired with shock intolerant person, the participant accepted less shock before reporting pain -did social context truly influence the experience of pain? turns out, yes!

Textbook Chapter 5: Relationship-focused coping

-emotion or problem focused coping intended to manage or maintain social relationships during stress, such as trying to bolster eachothers emotional needs

Chapter 8 textbook: how to stop your child from becoming overweight

-encourage regular physical activity and restrict TV watching -dont use unheathful food rewards for eating a non-preferred food, use praise as a reward instead -decrease buying high cholesterol and sugary food, avoid fast food restaurant -use fruits/ nuts as desert and rich cakes/ other deserts as celebratory or once-a-week treat -make sure the child eats a healthful breakfast (with few eggs) and does not have high calorie snacks at night--> metabolism decreases over the day -monitor the childs BMI and discuss with his or her physician

Perceived Stress Scale (Sheldon Cohen: integration of stimulus, response, & transactional

-environmental demands (Stressful life events)--> demands appraised as stressful (precieved stress)--> negative emotional response--> Poor health decisions & behaviors e.g. eating fast food OR Activation of SAM & HPA --> Disease Related Physiological Changes (e.g. immune, cardiovascular)--> Increased risk of disease onset or Disease Progression In the last month, how often have you been upset because of something that happened unexpectedly? How often have you felt nervous/stressed? Things going your way? Resources to cope? Things in your control? 0=never 1=almost never 2=someones 3=fairly often 4=very often Low Stress: 15% of people <10 points Average: 70% of people 10-23 points High Stress: 15% of people 24 points+

Chapter 8 textbook: binge eating

-episodes in which a person eats far more than most people would in a fairly short period, like a couple of hours, and feels unable to control their behavior during that time

CHAPTER 15: enhancing illness prevention and treatment

-escalating costs of healthcare and there is a need to contain them. We need to prevent chronic illness and help manage it more efficiently. With advances in technology and research this will become easier.

Socioeconomic Position and Stress Whitehall II Video Clip- Stimulus definition of stress

-every job in civil service is ranked in precise hierarchy -lower in the hierarchy= higher risk for cardiovascular disease, higher in the hierarchy= much better health -less control= more stressed -everyone in this company had same benefits plan -same like Canada where everyone has equal access to healthcare -these people are privileged by having higher education, they also have secure jobs (unlike lower-level jobs) -therefore, this must be an underestimation of the true effect-- we are looking at the hierarchies at the very top with individuals who are priviledged enough to have an MA or PhD.

Social support and gender differences: Women tend to

-maintain more emotionally intimate relationships -mobilize more social support when needed -provide more frequent and more effective social support to others -Both men and women tend to prefer women as confidants

Likelihood of pain encounter

-everyday pain (bruises, cuts): inevitable throughout life span, typically self-limiting (healing) -acute clinical pain (injuries, diseases, surgery)- lifetime incidence: virtually inevitable, typical short time cycle, but risk of chronic pain -chronic pain (chronic diseases, terminal illnesses, medically unexplained- no known physiological basis, can't identify physical pathology): 20-30% of the canadian population, greater in vulnerable populations e.g. the elderly, intellectual disabilities, mental health problems and this persists over time

Psychological risk factors for pain:

-excessive emotional reactions (debilitating anxiety and fear of pain (25%) or depression 40%) -destructive thinking (catastrophizing: magnification, rumination, helplessness) -behavioral maladjustment (excessvie avoidant behavior and inactivity) -deteroirating social relationships (stress in relationships, perceived injustice, reinforcement for pain/illness behavior, social isolation)

Chronic stress and cognition video clip:

-experiments on chronically stressed rats: -hippocampus--> learning and memory -stressed rats had much fewer dendrites and lower volume of dendrites in the hippocampus -chronic stress changes brain circuits leading to memory impairment

CHAPTER 9: users of the health care system (gender)

-females have higher rates, regardless of whether they have a family physician or not -difference remains even when pregnancy related visits aren't counted -why? women develop more acute health problems, men more hesitant to admit symptoms) -* also interesting to note that in Canada most users of healthcare system are more advantaged (less Low SES individuals, new immigrants (not old), and aboriginals in use of the system bc of various barriers)

Fight or Flight video clip (Response definition of stress)

-fight or flight: withdraw from danger or fight it out -the cortex recognizes a stimulus, amagdala--> hypothalamus, organizes response--> message to spinal chord--> adrenal medulla-> adrenaline, inc. sugar, heart rate and energy to muscles -fight or flight not always appropriate in modern day -this is still our biological response even if that is not the way were currently dealing with stress

CHAPTER 11: old theories of pain

-first theory of pain purposed that if an appropriate stimulus activates a receptor, the signal travels to the spinal chord and then the brain and sensation results -specificity theory: body has separate system for perceiving pain -pattern theory: no separate system for pain, people feel pain when certain patterns of neural activity occur & only occur with intense sitimulation ---> ** dont explain the psychological complexities of pain

Textbook Chapter 6: stages of change model

-focus is on the person's readiness to change--> people in different stages show different psychological characteristics from other stages -way to progress through stages appropriately: describe in detail how they would carry out the behavior change AND plan for problems that may arise

Research in action: return to everyday activity in the community and at home REACH

-for women 55+ -study aimed to reduce sitting time, inc physical activity & balance and strength -trying to help people who were not meeting guidelines to meet guidelines -six sessions 1) sitting less 2) making a change 3) from action to habit 4) making activity EASY 5) active transport (gave everybody bus tickets) 6) taking your habits home: Staying active -USED: goals & planning, feedback & monitoring, and associations (cues) -people started to perceive their identity around exercise

Twin Studies on Epigenetics

-genetically identical mice can weigh very different amounts bc of the gene agouti (tiny chemical tag, called methyl group shuts down agouti gene and inhibits their function or proteins impair expression) causes differences between mice of same genetics -eprigenetics not permament, can change during critical periods like puberty or pregnancy -fat mouse did not get the agouti gene turned off by methyl group, this can be manipulated by giving pregnant fat mouse diet high in methyl groups to produce healthy babies -there is much more genetic similarity in young twins vs old twins, epigenetic differences accumulate over time especially as their lifestyles differ from each other -lifestyle/ environment can modify genetics -EXAMPLE STUDY: Sample: 40 monozygotic twins aged 3 to 74 years -Quantification of DNA methylation- much more overlap of genes in young twins and much less overlap of twins at higher ages (pronounced differences due to jobs, preferences, stressors, health habits) -Self-reports of health, health behaviors, and substance use make sense of these differences. ENVIRONMENT INTERACTS WITH GENES TO PRODUCE DIFFERENT HEALTH TRAJECTORIES. -now the question is how to undue epigenetics and alter methylation patterns

Chapter 8 textbook: hypothalamus monitors three hormones

-ghrelin: secreted and carried in the blood to the hypothalamus when energy intake is low or the stomach is empty -leptin: regulates circuits in the hypothalamus that stimulate and inhibit eating and metabolism -insulin: regulates sugar in the blood, conversion of glucose to fat, and storage of fat in adipose tissue

What are the most appropriate BCTs to include in interventions?

-goal setting was most commonly used -feedback effective for long term maintenance of physical activity in adults 55-70 years -total of BCTs or the number of self-regulatory BCTs not related

SES and stress clip

-health outcomes laregely affected by SES, vigilent, stressful lifestyles= greater release of stress hormones and this takes a drastic toll on the body over time

Textbook Chapter 4: Marriage and health outcomes

-health protective role of marriage occurs more for men and women who think their marital quality is high -research on middle-aged men and women shows higher rates of heart disease in unmarried people -married people show lower blood pressure, people in unhappy marriages show higher blood pressure than single people -simply being married is not everything; quality matters.

CHAPTER 9: lay referral network and recommendations to the symptomatic person

-help interpret persons symptom -give advice about seeking medical attention -recommend a remedy -recommend consulting another lay referral person

CHAPTER 13: Psychosocial interventions for people with chronic conditions: interpersonal and family therapy

-help people change the ways they interact with and perceive their social environments by gaining insight about their feelings and behavior towards others -family therapy: meet as a group and draws on cognitive, behavioral, and interpersonal methods to examine and change interaction patterns

Textbook Chapter 7: alcoholism and heredity

-heredity plays a much stronger role when the abuse begins before age 25 than after -people with family history of alcoholism appear to develop a tolerance to alcohol, drinking increasing amounts to feel the same effects -people with a specific gene pattern experience stronger cravings after having a drink than other individuals -people at high genetic risk find alcohol more rewarding -some gene patterns seem to protect against alcohol abuse

Textbook Chapter 6: conscientiousness is linked to

-higher fitness level, health food consumption, mammogram testing, self-reported health -LOWER alcohol use, drug use, risky driving, risky sex, tobacco use

Textbook Chapter 6: HIV incidence

-highest in subsaharan Africa, south and southeast asia, eastern europe and central asia -over 50% of people with HIV are female -decreasing incidence of male-to-male anal sex transmission -main concern is unsafe sex, males who are circumsized have a lower risk

CHAPTER 10: the impact of the bottom line in hospitals

-hiring too few nurses -treat people quickly, discharge in good health -keep patients for less than 30 days (short stay or acute care hospitals), decrease in admissions and lengths of stay after 1990 why? -more procedures done on outpatient basis, efficient medical procedures, emergency room diagnoses are made more quickly, patients released at earlier stages of recovery

Textbook Chapter 6: why do people have unsafe sex?

-if they are promiscuous/ under the influence -riskier sex if parents reject them for their sexual orientation -queer teens more likely to drink alcohol and engage in risky sex if they live in a religiously intolerant community -unmarried partners less likely to use condoms if they perceive the relationship to be serious -decision-making in sexual situations is often subject to non-rational processes -low self efficacy to use ciondoms -people embarressed to buy condoms/ put them on wrong -longer life span has led to unrealistic optimism in many people

CHAPTER 14: Coronary Heart Disease

-illnesses that result from the narrowing and blocking of the coronary arteries -angina pectoris is pain that is produced by reductions in oxygenated blood taken to the heart (ischemia), may be felt in arm, back or neck -myocardial infarction- "heart attack" -risk factors for heart disease: age-45+, higher in men, stress, obesity, diabetes, higher in aboriginals and blacks, genetic, hypertension, high LDL low HDL is strongest risk factor, smoking is a close second -psychosocial risk factors: anger, anxiety, depression, low social support, job stress, divorce -preventative measures: balloon angioplasty- balloon inserted into blocked artery and metal stint is put in place to keep artery open OR bypass surgery: directs blood flow around the diseased section of artery with healthy vessel taken from another part of a persons body. Ppl who have actually had heart attacks get similar treatment. -women less likely to participate in cardiac rehabilitation than men -BCT is effective in reducing depression in cardiac patients

life expectancy at birth by sex 1920-2011

-in 1920s life expectancy was roughly 60 years old -in late 90's/ early 2000's life expectancy was roughly 80 years old -women continuously live a longer life than men across the chart--> this is a direct result of gender differences e.g. risky accidents, dealing with stress, healthy lifestyle -the gender gap is now closing--> men may be catching up by leading healthier lifestyles

Textbook Chapter 6: Interdisciplinary perspectives on preventing illness with tooth decay as a case study- Behavioral influence

-in this approach, we would promote tooth brushing and flossing by providing information and deomonstrating the techniques

Challenges with pain control, assessment failures, & treatment failures:

-inadequate control of pain: acute, chronic, and terminal illness -assessment failures frequent: poorly recognized, under estimated -treatment failures commonplace: not treated, inadeuately treated, mistreated

Chapter 8 textbook: why do people eat what they eat?

-inborne processes: e.g. new born babies like sweet tastes and avoid bitter tastes, brain chemicals can bias people to eat fatty foods and brain pleasure centers are activated when they do -person's skills: ability to regulate food buying/ eating -environment/ experience: 1) with greater exposure, like certain kinds of food more 2) some foods are more available 3) the more fast food restaurants in a neighborhood, the more people eat it 4) people more attracted to food if others like it 5) portion sizes are "super-sized"

Textbook Chapter 7: other impacts of smoking

-increase chances for Chronic obtrusive pulmonary disease -increase in respiratory infections like pneumonia -more susceptible to acute infections like a cold

Age-Related Changes in Wellbeing?

-increases in well-being from the 35 age range up to the 74 age range -as people age into their 70's they seem to report higher well-being -this is the well-being paradox (how is it possible that everything goes downhill but well-being increases?)

Final Video Clip: Marion

-increasing physical activity a small amount in older adults results in major differences at the population level -walking is preventative for disease

Age- Related Changes in Cognition

-inductive reasoning, spatial orientation, perceptual speed, numeric ability, verbal ability, verbal memory declines over the lifespan -cognitive decline starts happening in the late 20's but people can compensate! Doesn't hit a threshold until much later in life (more significant decline starts around 60)

CHAPTER 13: Psychosocial interventions for people with chronic conditions: Education, social support an behavioral methods

-information about the disease is very important, interventions can be helping in informing people/ changing their behavior -social support can come from family/ close others or support groups -behavioral methods: tailoring the regimen to make it as compatible as possible with the person's habits and activities

CHAPTER 9: what is stronger placebo affect associated with?

-injections over pills, capsules over tablets, larger pills, more pills/ larger dosage, branded pills over generic ones, costly pills over cheap ones --> expectation is a key mechanism & so is classical conditioning.

Textbook Chapter 3: factors of a person involving appraisal of events

-intellectual, motivational, personality characteristics e.g. self esteem and belief system

Intervention Diagram

-intervention--> physical activity & social engagement & cognitive stimulation---> more stength and balance, less falls, less insulin resistance, lower BP, more social support (meet other adults), more self-efficacy, higher cognitive reserve (changes in brain structure and function)---> impact physical function, global function, quality of life, cognitive function, reduced health care costs

CHAPTER 11: How to asses pain in self report measures?

-interview methods (history, affects, impairments etc) -pain rating scales and diaries (e.g. visual analogue scale, numeric rating scale, verbal rating scale, and pain diaries) -pain questionnaire ( assess affective/ emotional, sensory, and evaluative components of pain e.g. McGill Pain Questionnaire)

Types of Primary Stress Appraisals: Harm/loss (person-environment transaction)

-involves actual physical or psychological loss -psychological damage that has already been done

Textbook Chapter 6: breast cancer and self-examination

-is ineffective! -only mammograms are affective for breast exmaination, which is why the Canadian Cancer Society recommends women between 50-69 to have a mammogram every two years

CHAPTER 11: What does stimulating the PAG do?

-it activates seratonin which in turn activates inhibitory neurons --> endorphin (endogenous opiod) at pain fibres--> which inhibit substance P and there is no pain!

CHAPTER 9: users of the health care system (age)

-largest numbers in children (checkups, vaccinations, infectious disease) and people in old age (rise in chronic disease)

Effects of Oxytocin on Stress Reactivity Results MEN- Response to stress

-largest spike in cortisol: no support and placebo (saline spary) -least pronounced response: Social support and oxytocin spray -other two conditions: social support and oxytocin equally helpful in reducing release of cortisol and stress response

Textbook Chapter 7: smoking and cardiovascular disease

-leading cause of death worldwide -the more cigarettes people smoke, higher likelihood of getting cardiovascular disease -people smoke when under stress, raising their CHD risk -smokers also tend to have other lifestyle habits that inc their CHD risk like sedentary lifestyle -how does smoking have an effect on CHD? nicotine constricts blood vessels and inc heart rate, cardiac output, and BP. Carbon monoxide reduces availability of oxygen, which may cause damage -+smoking= + cholesterol and arterial plaques

CHAPTER 9: patient centered

-less controlling role -ask open-ended questions -avoid medical jargon -allow participants to enter into decision making process -more common in female physicians and they take 10% longer on average with clients

Textbook Chapter 7: varying ethnicity and drinking in canada

-less regular and semi-regular drinking for on-reserve natives (12% lower than canadian population) -but of the on-reserve natives, the people who do drink heavy drinking on a weekly basis is more common -drinking higher for canadians of european descent -lower drinking for ethnic minorities in Canada

CHAPTER 9: benefits and downfalls of home healthcare

-less taxing to the Canadian tax payer--> less costly -elderly individuals may have insufficient help from children/ relatives when engaging in home health care

Future outlook: Demographic Changes in the Western World

-life expectancy is increasing in the West e.g. average in US is 79, 81.5 in Canada, and 83 in Japan (highest life expectancy and lowest reproduction rate in the West) -healthcare funding as a function of age (increase dramatically in the later stages of life, high treatment costs). If we extend life expectancy this means that the final years of life are shifted, not increase in costs

Close to death, life satisfaction

-life satisfaction declines rapidly, 10 years to death shows decline in life satisfaction, 5 years to death= significant decline in life satisfaction

Above age 70, life satisfaction

-life satisfaction starts declining (70 to age 100)

Healthcare trends across the lifespan

-little helathcare attention required from birth until the age of 65 where healthcare needs rise substancially until 90+ -2/3 of healthcare spending is for those above 65 (chronic disease is costly)

Chronic Stress and Cardiovascular Risk Chart

-longitudinal study: followed caregivers -psychological stress associated with negative health outcomes, but the relationship goes away once you take into account the health behaviors the person engages in

Chapter 1 textbook: how does personality affect health/ disease?

-low levels of conscientiousness: more likely to die at earlier ages like from cardiovascular disease -high levels of positive emotions: tend to live longer -high levels of anxiety, depression, hostility or pessimism at risk for developing heart disease and may die earlier

Textbook Chapter 7: why do people relapse

-low self-efficacy: experiencing a lapse may lead to confidence loss and people will see this as a personal failure -negative emotions or poor coping: people lack good coping skills because they use substances when difficulties arise, especially in the case of stress -high craving -expectation of reinforcement: people relapse if they think using the substance again would be rewarding -low motivation: lower levels of readiness -interpersonal issues: those that have social networks that promote substance use are worse off SPECIFIC TO SMOKING -people's belief that smoking will harm their health decreased (coping strategy), and gaining weight

Life expectancy at birth, by sex, neighbourhood income quintiles

-lowest income life expectancy for men in canada: 75 years -highest income life expectancy for men in canada: 80 years -trend is the same (lower income= die earlier) in women but not as drastic -this trend is due to stress (like multiple jobs), access to healthcare and healthy lifestyles NOT related to biology

Primary Support for middle-aged women:

-mainly their relative (mostly sister), then their friends, then spouse, 'other', co-worker', about 4.3% no support

Primary Support for middle-aged men:

-mainly their spouse, then relatives, friends, 'other', co-worker, about 9% no support -2/3 report spouse is primary support system

Perceived Stress & Colds (Cohen et al., 1991): Stress and Viral Infection : integration of stimulus, response, & transactional

-majority of people had detectable levels of the virus in their nose -people with fewer stress life events were less likely to get sick and had less severe symptoms

Treatment adherence: antibiotics chart

-majority of people who did not finish their antibiotics didnt because: 1) they felt better, 2) side effects 3) other 4) forgot/couldnt be bothered etc

Dying to be thin video clip:

-male eating disorders increasing in number -France has banned size 0 models in fashion shows -there are many advocates for eating disorders e.g. Jane Fonda

Experimental Methods "the golden standard"

-manipulated variable (independent variable) -measured outcome (dependent variable) -random assignment to experimental and control group -cause and effect are clear BUT--> Low ecological validity -Does the experimental manipulation have relevance to real life? Perhaps the controlled environment does not represent real life -Practical issues -We can't always manipulate or produce our independent variables of interest in health psychology (e.g. can't randomly assign people to diseases or personality)

Textbook Chapter 6: abstinence-violation effect

-many individuals who quit a behavior experience a lapse and this can destroy their confidence in remaining abstinent and precipitate a full relapse

Smoking Interventions: Nicotine-Replacement Therapy

-many treatments are multi-modal -Nicotine gum is disliked because the nicotine is absorbed very slowly -Transdermal nicotine patches release nicotine in steady doses -Nicotine-replacement therapy produces significant smoking cessation

Textbook Chapter 3: Measuring stress through physiological arousal

-measure BP, heart rate, respiration rate, galvanic skin response--> or recorded simitaneously by a polygraph -biochemical analyses of bodily fluid: corticosteroids ie cortisol or cathecolamines ie epinephrine and norepinephrine

Treatment adherance video clip

-medication compliance difficult with older adults--> they may forget (dementia), they don't like the side effects, people keep their faith in Jesus (not in medicine). Compliance issues? Need family help to ensure compliance, put pills in a box and monitor if they're empty, simplify drug dosage (e.g. two drugs one pill) and use less pills. The doctor must listen and adapt their strategy to the patient (requires a relationship) and this can be complicated by multiple diagnoses e.g. diabetes, high BP, dementia

Textbook Chapter 5: gender differences in coping

-men more likely to use problem focused, women more likely to use emotion focused -but when sexes are similar in occupation and education there is hardly any gender difference

CHAPTER 11: How to asses pain in psychophysiological measures?

-mental or emotional processes as reflected by changes they produce in physiological activity e.g. EMG: measures electrical acitivty in muscles which reflects their tension or EEG for brain activity

Textbook Chapter 4: why is support not always helpful?

-might be wrong kind of support -might convey the reciever is inadequate (unasked for support)

CHAPTER 9: what does adherence depend on? 1) illness or regimen

-more difficult to change long standing habits e.g. smoking, drinking -more complex treatments= less adherence -complicated tasks (as with Kidney disease) -duration: compliance declines over time -bad side effect: lowered adherence -costly? Lower adherence -double standard of adherence: practitioners describe patients with chronic illness as no more likely to adhere to treatment plans, but chronic illness patients describe themselves as adhering better than patients with acute illness

Freud's contribution to biopsychosocial model:

-more emphasis on the mind in disease -he proclaimed you cannot dismiss a patient bc there is no biological rooting of their disease -Unconscious conflicts lead to physical disturbance -The person is freed from anxiety because the conflict has been converted into a physical symptom

Textbook Chapter 6: Problems in promoting wellness- factors in the community

-more likely to stick with unhealthful behaviors if promoted by the community e.g. large number of fast food restaurants can be detrimental

CHAPTER 9: patient-provider interaction and severe conditions

-most patients want substancial information and involvement when it is a severe condition -women want more than men and younger adults want more than older adults -people with an active role in recovery adjust better to recovery period and recover faster

Stages of Change Intervention Strategies

-motivational enhancement strategies--> assessment and treatment matching--> relapse prevention & relapse management

Canada has changing disease patterns

-move from acute diseases to chronic disease (disease occurs years/ decades before the individual's death) -many years where person is in need of support before death

Canadian population tree (or bean)

-moving toward a bean shape--> there are aging baby boomers and fewer and fewer children being born

Chronic illness: A sample case

-multimodal treatment of haemophilia (genetic disorder that causes difficulty in blood clotting) -Ross lives in rural community in Eastern Canada (120 of 7500 live there with haemophilia) -they treat him with team-based model -social worker, community health nurse, public health nurse, doctor, physiotherapist cross consult with eachother -assessing cause of chest pain in haemophiliacs is difficult (there are complications)--> they do blood tests, see physiotherapists (stresses prevention e.g. joint protection) -his condition impacts his work, leisure time, he worries a lot

CHAPTER 13: Arthritis

-muscoskeletal disroders affecting the body's muscles, joints, and connective tissues near the joints -osteroarthritis: joints degenerate bc of wear and tear, risk inc with age and body weight -fibromyalgia: pain and stiffness in muslces and other soft tissues -rheumatoid arthritis: extreme inflammation of joint tissues and also affects the heart, blood vessels, and lungs when it reaches advances states -arthritis prevalence greater in older generations, in women

Future outlook-Focus on prevention & Reducing the role of inactivity and obesity as risk factors for chronic diseases

-must change focus from curing people to promoting health -people who meet activity guidelines or exceed them develop chronic disease LATER than people who do not meet them -put the money where the evidence is: get people to become more active, eat healthy, reduce stress, stop smoking etc.

CHAPTER 15: identifying evidence-based inverventions and cost-benefit ratios

-must consider whether a treatment will indeed save more money in the long run -the bottom line is often considered when thinking about implementing psychosocial programs at work or the medical setting -evidence based treatments: interventions or techniques with strong efficacy that has clear support across many high quality studies -many psychological interventions for promoting health and helping patients cope have the potential for producing far more benefits than costs--> future analyses should be completed to ensure the implementation of these interventions

Solid Evidence on a Goal-Behavior Gap

-must people struggle when they try to put their goal into action, particularly with effortful behavior such as physical activity -there are barriers to physical activity

CHAPTER 11: gate control theory of pain

-neural gate can be opened or closed in varying degrees thereby modulating incoming pain signals before they reach the brain -gating mechanism located in the spinal chord -A delta and C fibers send pain signal to spinal chord, transmission cells then send signals to the brain -then people perceive pain! -what controls opening and closing of the gate? 1) amount of activity in pain fibers 2) the amount of activity in the other peripheral fibers 3) messages that descend from the brain (e.g. anxiety, boredom)

CHAPTER 9: what does adherence depend on? 2) person

-no difference between people of specific personal and demographic characteristics (such as age, gender, social class, race, religion) -when factors are combined e.g. gender plus social class there is a stronger association to compliance -some people display rational non-adherence: not adhering to a treatment based on valid reasons, regardless if they are medically sound -people with low cognitive function/ problems remembering = less adherence -depression linked to low adherence -people with high self-efficacy= better adherence -social support can be good or bad (people often meet over food drinks, but helpful family can promote treatment adherence) -low concientiousness= low adherence

Textbook Chapter 7: smoking and cancer

-non-smokers live longer than smokers -researchers have produced cancer in lab animals by administering cigarette tar -tar is the likely carcinogen causing cancer in cigarettes -smoking correlated with: lung, mouth, esophagus, prostate, b;adder, kidney cancer -lung cancer is the deadliest form of cancer in North America

Smoking: A Brief History

-number one killer in Canada--> impacts cancer, cardiovascular disease -A sophisticated habit of the male gentry -1940s : Large number of women smoke, Advertised as symbol of feminine sophistication -1964: First U.S. Surgeon General's warning is issued, Male smoking declines, female smoking increases (as impacted by women's movement, wanted to engage in prestigious behaviors) -1994: Female teen smokers, 22.9%, Male teen smokers, 28.8% -about 1/4 of all canadians still smoke

Self report measures:

-numeric scales 0-10 -poker chip tool -the "oucher" -colored analogue scale -faces pain scale

Chapter 8 textbook: components of lifestyle intervention programs

-nutiriton and excersize counselling, self-monitoring (record keeping), stimulus control techniques (shopping with list, storing food out of sight), altering the act of eating (chewing very slowly), behavioral contracting (rewards for sticking to diet) -most successful if doing it with another person, rewarding people for not engaging in sedentary lifestyle is quite effective

Obesity in Canada

-on average about 23% of Canadians fall into obese category--> different for various age groups (least obesity in age range 18-19)

Chapter 1 textbook: Aaron Antonovsky's health and wellness continuum

-on the continuum, death is at one end and optimal wellness at the other -he argues that as long as we are still breathing we are in some way still healthy -we should revise our focus to give more attention to how people stay healthy rather than what causes them to be ill

Traditional biomedical perspective

-one to one correspondence to injury/disease--> correlation low, pain experience far more than activity in peripheral nociceptors -focus on somatosensory mechanisms (specificity theory)--> reductionistic biological explanation, affect, cognition and social phenomena not secondary (these are important!) -medical focus upon pharmacological, surgical or interventional control--> misses important therapeutic targets (affect, cognition, behaviour etc), multidisciplinary treatment is actually superior to exclusive biomedical

CHAPTER 9: how to improve adherence

-orient patients to the disease process and the reason for treatment, simplify verbal instructions, use written instructions, have patient repeat instructions in own words, enhance person's self efficacy, motivation, and opportunities for social support, keep record of adherence (self-monitoring), have the patient state explicitly that they will comply, motivational interviewing, tailoring the regimen (compatible with patients activities), providing prompts/reminders, behavioral contracting (practitioner, family and client negotiate treatment activity and goals)

COPE Norms

-other college students seem to use active coping, then positive reinterpretation, lastly, mental disengagement

Textbook Chapter 7: lifetime prevalence rate of alcoholics

-over 17% of adults in North America become alcohol abusers

Textbook Chapter 7: quitting substance without therapy (smoking)

-over 60% of those who try to quit smoking eventually succeed -people who smoke heavily reported that it was much harder -smokers who are likely to succeed: have decided that they want and are ready to quit, feel confident that they can succeed, have smoked less than a pack a day, experience less stress, feel less nicotine dependence and experience less craving for tobacco and fewer severe withdrawal symptoms, highly motivated by intrinsic factors, willing to try again if they dont succeed

sources of pain judgements:

-pain specific behavior--> Protective actions (withdrawal reflexes, avoidance behaviour, pain-related disability) Communicative actions (e.g., self-report, cry, facial activity) -context--> Tissue insult (e.g., falls, invasive procedures) Presence of other conditions likely to instigate distress (e.g., fatigue, hunger) -biomedical data--> Tissue damage (e.g., injuries, diseases) Physiological measures -patient characteristics--> Health status, sex, age, ethnicity, developmental status, temperament, medical history, etc.

CHAPTER 9: study showing symptoms by suggestion

-participant & confederate got/did not get spray that would cause itchiness/ drowsiness but really spray was inert -if participant watched confederate yawn/itch then they self reported more of these symptoms than when the confederate did not display these behaviors (bc they got no spray)

CHAPTER 9: outcomes of patient provider mismatch in terms of participation/ information disclosure

-patients experience more stress during unpleasant medical procedures -clients less likely to follow practitioners advice -dissatisfaction and interpersonal discomfort can lead to switch in doctors

Chapter 8 textbook: Body Mass Index

-people classified as overweight if their BMI is 25+, obese if their BMI is 30+, healthy weight 18.5-24.9, underweight= below 18.5

What is stress for one person can be stimulation for somebody else

-people keen to put themselves into short term exciting situations -different stimului mean different things to different people

Textbook Chapter 6: Problems in promoting wellness- Individual

-people percieve some healthful behaviors as more inconvenient/undesirable -long standing behaviors that may be addictions -people need the cognitive resources to determine what is/is not healthy -need self efficacy regarding their ability to make a change -sickness can affect people's energy levels/ motivation

Socio-Emotional Selectivity Theory

-people re-visit priorities as time horizons shift (younger adults are more exploratory-- want to meet new people, learn new things. As people realize time in life is finite in older age, people focus on meaningful experiences and social interactions with people they care about) -Time lived versus time left •Motivational shifts in line with anticipated time horizons •Open-ended future time-perspective: Gaining new knowledge, meeting new people •Limited future time-perspective: Emotional meaning, close relationships •Empirical Evidence •Fung, Carstensen, and Lutz, 1999 •Carstensen& Fredrickson, 1998 -e.g. recruited HIV men from San Fransisco area in their 80s and 90s who had limited outlook on life, when asked about how they wanted to spend their time they wanted to spend time with people they care about -second group: when she asked individuals prior to handover of hong kong to Chinese from commonwealth they had limited life perspective and after they had open-ended future time perspective because now they had certainty and could navigate their life accordingly

Textbook Chapter 4: internal locus of control

-people who believe they have high control over their successes and failures

Textbook Chapter 5: exercising and link to health

-people who exercise report less anxiety, depression, tension -less reactivity to stress are are less likely to be hypertensive -exercise enhances recovery from stress, lower blood pressure

Frontal lobes and pain

-people with damage/ deterioration in the frontal lobes deal with pain more poorly because they cannot regulate their pain through the frontal lobes

Textbook Chapter 6: Problems in promoting wellness- interpersonal factors

-people within same household may have different visions of healthful behaviors and their own motivations/ desires

Textbook Chapter 4: psychophysicological disorders

-physical symptoms or illnesses thar result from interplayof physcosocial and physiological processes e.g. ulcers and inflammatory bowel disease, irritable bowel disease -stress related to all of these diseases

CHAPTER 9: doctor centered treatment style

-physician asks questions that require only brief answers and focused on the first problem the person mentioned -intent on establishing link between initial problem and organic disorder

Textbook Chapter 6: potential reasons for why women live longer

-physiological reactivity: release of stress hormones, inc in BP during high stress is exacerbated in men -estrogen delays heart disease -men smoke & drink more -males more likely to use drugs, eat unhealthy diets, become overweight, engage in risky driving & sexual activity -females more likely to consult a physician when they feel ill -work environments of males = more hazardous than those of females -interestingly, women have higher rates of acute illnesses

Demographic changes across the globe

-populations are getting OLDER -the percent of the population who is 60+ will dramatically increase from 2015-2050 (where a large section of the globe will have populations that are 30% or more of 65+ individuals, including canada) -this is reason to celebrate, that within the next 20 years group of 65+ will double but there are challenges to the healthcare system and the tax payer

Home Practice

-posture, balance, talking to a friend about practices

Stages of change model

-pre-contemplation--> thinking about change--> preparing to change--> making changes--> maintaining changes--> stable safer lifestyle or relapse

Textbook Chapter 3: Cognition and stress

-preoccupation with worries about failure can lead to memory loss and attention defecit e.g. heightened stress during exam causes you to forget answer to question you studied well

CHAPTER 13: Psychosocial interventions for people with chronic conditions: relaxation and biofeedback

-progressive muscle relaxation and biofeedback are effective ways to control stress and anxiety

Association:

-promts/cues in their environment that cues them to be active -motivation gets you started, habit keeps you going -e.g. while brushing your teeth, do a one leg stand

Textbook Chapter 6: methods for promoting health

-providing information (sometimes only listing the neagtive aspects of a behavior is not helpful unless the person already wants to change the unhealthy behavior bc often ppl dont want to change their ways) -tailored content (tailored to the person to try to get them to change their behaviors) -motivational interviewing to help people resolve their ambivalence in changing a behavior -the use of social praise for older adults (younger than grade 3 prefer monetary/ candy rewards)

CHAPTER 10: assessing emotional adjustment in patients

-psychologist may use questionnaires focusing on a single disorder e.g. anxiety--> they involve less expenses and shorter interview -OR Minnesota multiphasic personality inventory: true-false format to a wide range of questions that has 10 scales for assessment of psychiatric disorder (incl hypochondriasis, dperession, and hysteria)

CHAPTER 15: improving efforts for helping patients cope

-psychosocial interventions are being applied more and more to patients in pain clinics, hospitals and other medical settings. -growing role of psychologists in the hospital setting and will likely expland for people with chronic health problems like heart disease and arthritis

Textbook Chapter 6: Interdisciplinary perspectives on preventing illness with tooth decay as a case study- environmental measures

-public health officials might support municipalities adding fluoride to water supplies

Stress processes in physics

-put new material into a machine that would allow a certain amount of pressure on it -observe how it behaves under certain amounts of pressure -elastic region: pressure put on material w/o it changing--> performs optimally -plastic region: changes in material--> not in its original state -fracture point: so much pressure that the material breaks

Textbook Chapter 7: strategies for quitting smoking

-quit cold turkey -use oral substances like candy/mints -most tried to go it alone w/o involving other people, but some used a buddy system or used bets with others -most used cognitive strategies like telling themselves i dont need a cigarette -a minority of individuals provided themselves with material rewards for sticking with their plan -quitting cold turkey has better outcomes

Perceived support is more important to health outcomes than received support

-received support: this is support that is enacted. Can cause more stress--> now you have responsibility to reciprocate the help you recieved -perceived support can be more important for your health: getting help w/o noticing it can be the most beneficial (you don't have to pay anyone back)

CHAPTER 11: The process of pain perception involves three phenomena

-referred pain: pain originating from internal organs is perceived as coming from other parts of the body -pain can occur with no detectable basis: neuralgia (injury to a peripheral nerve), causalgia (pain orginates in an area of the body where they had previously been wounded and can start with very minor perturbance of the area), and phantom limb pain -peoples experience of pain depends on its meaning

Textbook Chapter 6: factors in health related behavior LEARNING

-reinforcement: can be added or taken away e.g. nickel for brushing teeth or cure of headache by taking asprin (removal of headache) - extinction: conseqences that maintain a behavior are extinguished -punishment: when we do something that brings an unwanted consequence the behavior tends to be supressed -people also learn form operant conditioning, modeling, there are heredity factors -over time, healthful behaviors become habit

Textbook Chapter 7: Processes leading to dependence

-reinforcement: positive (something is added like a rush), negative (something aversive is taken away e.g. pain) -avoiding withdrawal: want to avoid unpleasant symptoms e.g. Delirium tremons--> intense anxiety, temors, hallucinations when blood alcohol levels drop -substance-related cues: internal and external envionment trigger (cue) the body through classical conditioning (associations), research to show that dopamine triggers the salience of an event related to drug taking -expectancies: ideas about the outcome of their behavior e.g. thinking about drinking as fun or as leading to a hangover -personality: impulsive, high in risk taking, high in senstation- seeking, low in self-regulation (controllability to achieve a goal, whilst being unmonitored) -genetics: heredity influences addiction e.g. twin studies on nicotine addiciton and alcohol adiction. If one member of a same sex pair of twins is an alcoholic the risk for the other is twice as great if they're identical

Alameda County Study (Belloc & Breslow, 1972)

-representative sample for the region -capture a point in time where they were likely to be healthy, in their 30s -interested in onset of disease in 50s, 60s, and 70s -health measure, realtionships, personality, housing, income, SES -Three different age groups 30-49 yo, 50-59, 60-69 -linked people in someone's network to the percentage of people that had died from all causes -individuals with the most social ties, had the lowest risk of death (they survived at later age categories) -fewest social ties were more likely to have passed away

Textbook Chapter 4: genetics, social support, and health

-research shows that genetic factors may influence both the development of social support and future health

Immediate roadside prohibitions

-saves lives, 260 lives saved since september 2010

CBC News: Home care for elderly family members can't be done alone

-seniors advocate says one third of unpaid family caregivers are stressed to the point of breakdown -much support is happening in an informal way--> cannot ignore this, caregivers must be also taken care of

Increasing Healthy eating habits at school video clip

-shown that children with poor nutrition are more susceptible to heart disease, type two diabetes, obesity

Smoking increases risk of:

-single greatest cause of preventable death (obesity is a close second) -heart disease -lung cancer -chronic bronchitis -respiratory disorders -damage and injuries due to fires and accidents -lower birth weight in offspring, and retarded fetal development

Chronic stress and cognition: chart

-small sample of 50 women in Quebec -took 24 hour cortisol trying to index overall secretion -linked it to memory complaints -when individuals had high levels of stress, showed subsequent incidence of memory complaints -antagonists can undo some of the negative effects on the hippocampus

Textbook Chapter 7: health promotion and education around drugs

-social influence approaches: focus on training skills to help individuals resist social pressures to smoke including videos, modelling of role playing, announce your decision to not smoke -life skills training approaches: address general social, cognitive, and coping skills including skills for coping with anxiety and methods for being assertive -10-15% fewer of youth smoke if given these interventions

Textbook Chapter 4: stress prevention model

-social support may be helpful because it can provide advice or resources that to help us avoid exposure to stressful events and circumstances

Chapter 1 textbook: 19th century and infectious agents

-still greatest threat to Canada's settlers -at the time of confederation tuberculosis or consumption was the greatest cause of death in canada -by end of 19th century death from infectious disease began to drop rapidly -death from TB declined by 60% by the turn of the century -somewhat due to the introduction of vaccinations BUT MOSTLY DUE TO PREVENTATIVE MEASURES such as improved personal hygeine, greater resistance to disease (owing to better nutrition), public health innovations (like building water purification systems and sewage treatment)

Hasnon, Ashe et al : intersection between the built and social environments and older adults mobility

-street and community level factors associated with older adults walking behavior -older adults walking associated with places in community

Perceived Stress & Colds (Cohen et al., 1991): Stress and Colds : integration of stimulus, response, & transactional

-stressed people more likely to get infection and have more severe symptoms

CHAPTER 11: How to asses pain in behavioral measures?

-structured clinical sessions: UAB Pain behavior scale for use by nurses doing their standard routines, patient performs several activities and rates their behaviors such as mobility -everyday activities: family members/ key others are very important in making these everyday assessments. They are trained to observe when the individual is in pain and the impairments they suffer by noting: the pain behaviors, amount of time person exhibits them, how people react to their pain.

CHAPTER 9: health belief model and seeking medical care

-symptoms initiate a decision making process about seeking medical care, this involves: -assessing perceived threat suggested by the symptoms (this involves cues to action, perceived susceptibility, perceived seriousness) -assessing perceived benefits: people determine if perceived benefits outweigh perceived barriers *there are also other important variables in seeking health care (some studies have shown week correlations with health belief model)

How can you help antibiotics do their job?

-take as directed -finish the full prescription even if you're feeling better -help prevent antibiotic resistance

Standard Psychosocial Stress Test (TSST) chart- Response to stress

-takes about 20 minutes for cortisol to show up in spit (actually corresponds to experience during task) -pronounced peak in cortisol after exposed to the stress (lag in biological response because HPA axis is slow) -difference in response between men and women -1.5/2 hours to return to baseline levels

Movie clip: Coping in a Social Life Context

-tango clip illustrates people working together, what one person does effects the other, emotions involved, were able to anticipate what the other person will do, know each others strengths and weaknesses to operate together

Picture introducing class: "stress testing materials"

-test for strength of a new product- must be safe for use in products -stress is a term that is borrowed from natural science

Types of Primary Stress Appraisals: Threat (person-environment transaction)

-the anticipation of harm or loss -allows to anticipate and prepare for the future

Textbook Chapter 3: Allostatic load

-the effects of the body adapting repeatedly to stressors such as fluctuations with hormones like cortisol and epinephrine that accumulate over time is called allostatic load -factors contributing to allostatic load: -amount of exposure to stress -magnitude of reactivity to stress: some ppl show lrgr increases in blood pressure/stress hormones than others -rate of recovery: how quickly you return to baseline -resource activation: resources used in physiological strain are replenished by various activites, most important is sleep

Types of Primary Stress Appraisals: Challenge (person-environment transaction)

-the event is perceived as stressful -the focus is on positive excitement -refers to the person's confidence in overcoming difficult demands

Chapter 8 textbook: where is the highest prevalence of obesity/ overweight populations in canada?

-the maritimes and the territories, NFL and Labrador have highest obesity rate for Canadian men, Nunavut has highest rate for Canadian women -obesity highest among first nations populations, the euro descent, then asians & africans

The Long Arm of Stress: Dutch hunger winter--> Holland- Response to stress

-the nation starved during this time while they were occupied -tracked down 2400 possible participants -analyzed those born during and those concieved after the famine -exposed to stress in fetal life and still suffering the consequences -stress hormones in moms blood affect the fetus -brain chemistry is affected and ability to learn, vulnerability to psychiatric disorders

CHAPTER 11: organic vs psychogenic pain

-the pain we experience that is clearly linked to tissue pressure/ damage is organic pain -psychogenic pain: there is no organic origin/ tissue damage that can be detected and it may be the result of a psychological process BUT this hurts too! -virtually all pain involves both of these

Percentage of Current Smokers in Canada, Aged 15 Years or Older

-there is a downward trend of smokers in Canada -overall in the past men smoked more than women (still true) -much higher rates of smoking in the 60's (about half of the population), now about 20% of the population smokes -there is only a small minority of high shcool aged children smoking now -the 24-34 age group appears to smoke the most in recent times -the 55+ age group has low smoking frequency

CHAPTER 15: Expanding psychologists roles in medical settings

-there is increasing collaboration between medical staff and psychologists to treat patients -this is exemplary of the biopsychosocial approach

Chapter 8 textbook: obese vs normal weight participants and their perceptions of health

-they both rated themselves as a 7 on the scale for health -their actual health depends on their degree of obesity (e.g. 32 BMI vs 26 BMI), fitness, and distribution of fat (hypertension is more common in people with central adipose tissue, usually measured by the waist to hip ratio)

CHAPTER 11: congenital insensitivity to pain

-this disorder can reduce or eliminate people's ability to sense pain -they may report only a tingling or itching sensation for severe pain

Six Blind Men and an Elephant (a poem)

-to understand health we need to look at different aspects, not just zooming in on one specific thing (as in the poem when each blind man was looking at an individual element of the elephant e.g trunk, knee, ear etc) -we must work together to understand the whole elephant -this is representative of the different designs in research methods -You have to understand the strength and limitations in each method -No single method is perfect, we have use interpersective -Findings must be replicated across samples of different composition and different methods

CHAPTER 10: childrens age and main cause of distress in the hospital

-toddlerhood and preschool: immobilization= stress and they also experience separation distress from home/ parents -young children may transition to despair in the hospital and anxiety once they have been taken home -school-age children: distress from lack of personal control, increased cog abilities mean they worry about treatment and the outcome, loneliness from estrangement from friends and schoolmates, get embarassed more easily

Biopsychosocial Factors in Development and Maintenance of Health Compromising Behaviors: Biological factors

-tolerance: increased frequency of use and higher doses over time -withdrawal- negative effects of cessations of addictive behaviors

CHAPTER 13: Diabetes

-too much glucose in the blood over a long period of time results in hyperglycemia, which is the mark of diabetes mellitus -in the condition of diabetes, abnormal levels of glucose accumulate in the blood because the pancreas does not produce sufficient insulin/ the body no longer responds normally to insulin -type one diabetes: develops in childhood/ adolescence. Autoimmune processes have destroyed cells of the pancreas, need injections of insulin -type 2 diabetes: pancreas produces some insulin might not require insulin injections, most manage glucose with diet and medication -heredity also plays a role and so does smoking

CHAPTER 9: Complementary and alternative medicine (CAM)

-trying to prevent/ treat illness with practices/ products such as massage or herbal methods that are not a part of conventional medicine -complimentary if used along conventional treatments -alternative if used in place of them -70% of Canadian adults use CAM (vitamin and mineral supplements the most common)

Chapter 8 textbook: genetics and the role of obesity

-twin and adoption studies have consistently found a genetic link in obesity -evidence is mounting for a role of epigenetic processes in obesity -genes have been identified in humans and animals that are linked to obesity (FTO, which affects the feeling of satiation and MC4R, which is associated with preferring and consuming high fat

Early example of psychosomatics and asthma

-up to the 1970s there was no medication for asthma. It was seen to be caused by psychosocial factors e.g. stress in the family -now we have substances to combat acute attacks but asthma gets worse when kids live in a stressful environment (there are true impacts of the psychosocial)

Self Report Measures: the good

-valuable tool: homo sapiens crowning achievement, permit accurate accounts of experiences, assay impact of analgesics or other palliatives, methodologically convenient

CHAPTER 9: how does canada rank in terms of overall performance, physicians per 10,000 people, and out-of-pocket care expenses

-very well (30th of 191 countries), Italy is number 2

Chronic stress and cogition: Hippocampus chart

-volume of hippocampus declines greatly in AZ patients, this is linked to stress

Standard Psychosocial Stress Test (TSST) clip one- Response to stress

-wait for 30 min: then normal level of stress hormone cortisol assessed to achieve resting state -then put through one of the two stressful situations -then cortisol measured again

How to reduce the 4th age? Reducing the role of inactivity and obesity as risk factors for chronic diseases

-want to compress amount of time in 4th age or poor-quality health -we need activity interventions -people who meet physical activity guidelines push back age of chronic disease (obese and sedentary others are much more likely to get chronic disease earlier) -inactivity and obesity: increases diabetes risk, cognitive decline (AZ, Parkinsons, huntingtons), atherosclerosis, risk factor for cancer

recommeneded physical activity guidelines

-we do not engage in sufficient physical activity to meet guideline recommendations -about <30% of older adults are sufficiently active to meet recommendations (assessed though self report) -<15% of adults 40-79 are meeting physical activity guidelines (with accelerometry) -16% of older adults report meeting strength recommendations (<10% if mobility limitation) -we mat not be able to engage in sufficient physcial activity to meet guidelines

Invisible support

-when one receives help from another, but is unaware of it, that help is most likely to benefit the self--> this can be the most effective type of support. You are getting help from someone without knowing it (dont feel guilty)

Textbook Chapter 7: substance abuse disorder

-when use is accompanied within a year by two or more of about a dozen characteristics e.g. showing tolerance for the substance, strong cravings, failing to fofill important obligations, putting oneself or others at risk for injury, substance related legal difficulties like getting arrested

CHAPTER 9: mass psychogenic illness

-widespread symptom perception across individuals, even though tests indicate their symptoms have no medical basis -usually begins with event e.g. unusual scent and then someone fainting --> it spreads but there is no cause -why does this occur? high stress, common physical sensations, expectations, modelling of the symptoms

Textbook Chapter 7: gender differences in drinking

-women metabolize alcohol at slower rates than males do -weekly frequency of drinking higher among male university students -approx 78% of all canadians drink

Textbook Chapter 3: differential experience of men and women in stress

-women report more major and minor stressors than men--> women typically have higher workloads ie: second shift -men show greater reactivity then women when psychologically stressed, also take longer than women to return to baseline

Effects of Lactation on Stress Reactivity Results-Response to stress

-women who breastfed before stress test had lower cortisol in their spit than the women who just held the baby -oxytocin supresses cortisol response

Textbook Chapter 5: promising areas of research on important coping methods:

1) Engaging positive emotions to soften or balance against feelings of distress 2) Finding benefits or meaning in the experience 3) engaging in emotional approach- actively process and express their feelings 4) accomodating to a stressor- e.g. adapting your environment for a chronic pain condition

Pain expression as a two stage process:

1) Reflexive, automatic: Reflexive, spontaneous, automatic-->Ancient (conserved), lower brain (mirror neurons). It is intuitive, emotional, Visceral, gut reactions reactive to immediate events, less subject to voluntary control, observed during acute pain and exacerbations of chronic pain 2) Reflective, considered, intentional, conscious--> Homo sapiens, higher brain, executive processes (memory, judgment, decision-making processes). It is vulnerable to cognitive biases, subject to voluntary control and planning, intent to influence, calls upon memory, judgement, decision making processes, permits retrospective accounts

Textbook Chapter 3: Sources of stress within the family

1) addition to the family e.g. worrying about money, marital relationship, temperment of the baby 2) Marital stress and divorce: marital disruptions increase ones risk of serious health problems 3) family illness, disability, and death

Textbook Chapter 3: Sources of stress within the person involving three types of conflict

1) approach approach: two appealing goals that are incompatible ex. trying to stick to a diet when offered treats 2) avoidance avoidance: choice between two undesirable situation ex. treatment options for disease that are both unfavorable 3) approach avoidance: single goal or situation that has attractive and unattractive features ex. individuals who smoke cigarettes and want to quit

Chapter 8 textbook: two criterion for judging weight

1) attractiveness 2) healthfulness

Chapter 8 textbook: the chemical components of food

1) carbohydrates - simple and complex sugars that are major sources of energy 2) lipids- "fats" provide energy for the body, incl saturated, polyunsatured, and cholesterol, no more than 30% of cals from fat is recommeneded 3) proteins - important to the body's synthesis of new cell material, composed of amino acids 4) vitamins- organic chemicals that regulate metabolism and functions of the body. Used in converting nutrients to energy, producing hormones, breaking down toxins 5) minerals- inorganic substances like calcium, which are important for body development

Deaths: 10 Leading Causes in Canada

1) cardiovascular disease including stoke 2) cancer 3) diseases of the respiratory system including influenza, pneumonia, chronic obtrusive pulmonary disease 4) Hereditary and degenerative diseases of the central nervous system 5) endocrine and metabolic diseases, including diabetes 6) Unintentional injuries 7) Disease of the digestive system 8) mental disorders 9) genital and urinary disease 10) infectious disease and parasites * lots of these conditions are chronic - these are overall causes of death

CHAPTER 10: clinical methods for saying goodbye

1) choosing the time and place: pick time and place that offer privacy at least for several minutes 2) broaching the topic and checking for acceptance: politely and respectfully bring up potential for death and obtain their permission for this topic 3) frame good-bye as an appreciation of the relationship: let the person know they are valued 4) address possible awkwardness and emotion 5) ongoing commitment: make sure the person does not feel abandoned

Textbook Chapter 4: Type A behavior Patterns

1) competitive achievement orientation- always in competition with others 2) time urgency- constant struggle against the clock 3) anger/hostility- easily aroused 4) Vigorous vocal style- speak loudly and rapidly -complete contrast to type B who are more laid-back -Type A personality can be conveyed with 15-20 minute interview that asks questions that provoke particular repsonses -increased risk for coronary heart disease

Chapter 8 textbook: lifestyle intervention research conclusions

1) decrease initial body weight by 7% to 10% in 4-6 months 2) most effective in lowering weight and maintaining the loss when they provide meal replacements/ structured meal plans 3) many maintain low weight (even though some gain alot of the weight back within the first year)

CHAPTER 10: five stages of dying in terminal illness

1) denial (can be a valuable first reaction by giving patients time to mobilize other coping strategies 2) anger (resent others who are healthy and may show anger in outbursts) 3) bargaining (try to change situation through a deal, e.g. with God) 4) Depression (grieve for things they had in the past and things they will miss in the future) 5) acceptance (feel calm and ready for death)

CHAPTER 14: helpful cognitive adjustments when dealing with chronic illness

1) finding meaning: determining a purpose of the illness or by rethinking their attitudes/ priorities 2) gain sense of control over their illness: engaging in activities that reduce risk of their condition getting worse, increasing knowledge about their care 3) restore self-esteem: compare themselves with less fortunate people

Textbook Chapter 3: Sources of stress within the community

1) jobs and stress: 1/4 working canadians describe job as highly stressful--> workload can be too high and stress of evaluations is significant. Helping professions can lead to burnout: emotional exhaustion and lack of enthusiasm for job that one once had 2) environmental stress: environmental noise, SES, violence exposure

Textbook Chapter 3: 5 characteristics of stressful situations

1) life transitions (passing from one life condition to another) 2) Difficult timing (events happen earlier/later in life than usual) 3) Ambiguity (lack of clarity in a situation e.g. unclear information about health status and treatment options) 4) Low desirability (some circumstances underirable to virtually all ppl ex. losing ones house) 5) Low controllability (circumstances outside of ones behavioral or cognitive influence ex not being able to do anything about back pain)

Textbook Chapter 4: how does chronic stress effect health

1) may increase health-compromising behaviours such as alcohol and cigarette use 2)changes in the body's physical systems, such as secretion of cathecholamines and corticosteroids--> damage to heart, blood vessels, lower immune functioning

CHAPTER 9: researchers fight for inclusion of primary prevention in the chronic care model

1) organization of care (explicit priority to primary prevention) 2) clinical info systems (data in clients files regarding need for preventative services) 3) delivery system design (physicians initiate preventative interventions) 4) decision support (organization provides staff with guidelines, training, and reminders to identify clients who need intervention and carry it out) 5) self management support 6) community resources (self-help organizations)

Textbook Chapter 6: secondary prevention

actions are taken directly to identify and treat an illness or injury early with the aim of stopping or reversing the problem e.g. seeking medical help when you have stomach pain and then seeking medication/ diet changes

CHAPTER 11: how many canadians experience chronic pain anually?

1/10, approximately 1.5 million people

CHAPTER 9: adolescents and health concerns

1/4th of adolescents said they would forego a medical treatment if their parents had to find out

Chapter 8 textbook: most active age group

10-13 year olds, exercise generally tapers off across the lifespan with women exercising less than men

CHAPTER 9: average size of nursing home in America?

100 beds

Chapter 8 textbook: classification of hypertensive

140 systolic/ 90 diastolic -19% of Canadians are hypertensive, sodium plays the biggest role in this

CHAPTER 9: what percent of Canadians don't have a family doctor?

15%, more common among men

Causes of Death: 1900 and just one century later

1900: most common cause of death= bacterial infection e.g. influenza and pneumonia, TB 2000: cancer, cardiovascular disease--> risk can be reduced with healthy lifestyle. These diseases are not typically cured, but managed.

Technological Strides Separate Mind From Body: Giovanni Morgagni

Autopsies-- created the first anatomical atlas e.g. what does the heart do?

The Mind-Body Relationship: Humoral Theory by Galen

4 Humors(circulating fluids in the body) -Yellow Bile: Choleric; chronically irritable and angry **this is comparable to Type A personality today. -Black Bile: Sad, melancholic, depressive -Blood:Sanguine, optimistic, cheerful -Phlegm:Calm, listless -He also looked at animal models to locate certain types of diseases

CHAPTER 10: psychosocial adjustment to illness scale

4 point scale used, assesses 7 psychological characteristics of the clients life --> helps understand the adjustment problems of medical patients

Time-Sampling Research Example Dietzan et al 2008

51 dual-earner couples with young children -Time spent in intimacy -Current affect quality -Saliva samples for cortisol -6 x day for 1 week -Chronic problems at work -Intimacy buffered negative effect of work stress on salivary cortisol--> things as little as hug/kiss could have health promoting effect -The association between intimacy and lowered cortisol levels was mediated by positive affect (effect is stronger when you account for pos affect, weaker when you dont account for it) -Real world relevance of positive couple interactions -Daily life processes may accumulate -Neither work stressors nor intimacy are easy to recreate in the lab

Dyadic coping in the context of prostate cancer

59 couples coping with prostate cancer -Time-sampling (once a day for 14 days) -Negative affect -Stressful events (disease stressors and other stressors) -Dyadic coping

Chapter 1 textbook: how many years will the average Canadian spend in good health?

80

POST MIDTERM ONE

:)

See Slide for chart on expression of person in pain

:)

Textbook Chapter 6: Primary prevention

actions taken to avoid disease or injury

what is a great job to attain anticipating future population needs?

A geriatrician is a medical doctor who is specially trained to meet the unique healthcare needs of older adults. e.g. medication mixing, dealing with chronic disease

Social Support: The stress buffering hypothesis

A protective factor (Such as social support) buffers the impact of environmental demands on the individual and, thus, lowers the stress response -social relationships influence health by protecting people from stress -this model says that: it doesn't matter if you're apart of a large network but you need to have social support from a few people to choose from -you do not need anyone to receive support when you are not stressed but when you get stressed you need to have resources to mobilize

Chronic Illness: When the Patient is a Child

Chronic disease of a child affects the whole family -Children may be confused (don't understand why their parents are putting them through painful procedures) -Children are exposed to isolating and scary procedures -Chronic disease management may be challenging in adolescence

Couples Coping with Chronic Disease: The Sample Case of Rheumatoid Arthritis (RA)

Compared to those married to healthy individuals, spouses of those with RA -people who were married to those with RA: -Greater risk for depression -Experience more loneliness * chronic disease can lead to struggles and estrangement of individuals and other couples will grow as a result of it

OECD Countries prevalence of overweight adults

About half of all canadians are overweight Worse populations?: Mexico (highest overweight population), then USA, then Aus, then England Better populations?: Spain, Italy, France, Switzerland, Korea (best!)

CHAPTER 14: HIV/AIDS

Acquired immune deficiency syndrome: infectious disease caused by HIV and is shared through blood and semen. It is a worldwide epidemic. -causes immune system impairment leaving patients subject to opportunistic diseases -most new cases are heterosexual individuals -in North Americans, rates are highest among those in the 20-49 age range -higher rates in men--80% of cases are men, death rates higher among White men, but women rates higher in black and aboriginal women -HIV--> several years & T cell reduction--> Aids -AIDS is still fatal to many, if untreated most die within 3 years of the diagnosis - main treatment uses antiretroviral agents - highly active antiretroviral therapy, very effective but very expensive and not available worldwide, requires strict adherence of medication -psychosocial intervention can reduce anxiety and depression and enhance immune function -interventions can also help bereaved survivors who have difficulty adapating to the loss of a loved one

Average Minutes of Daily Moderate to Vigorous Physical Activity by Age

Age group: 6-10 11-14 15-19 20-79 6-10 = highest amount of exercise in this group, peaks at recess and in after school activity 20-79= flat line, lowest amount of exercise

Factors Affecting Symptom Recognition

Age: Young adults feel invulnerable -Cultural Differences: "A guy from the state of Texas..." -Situational Factors: Busyness makes people less aware -Individual Differences in Personality: Some people are consistently more likely to notice symptoms (Neuroticism, Conscientiousness) -Mood: Positive mood: "I'm feeling good"; less access to illness-related memories, Negative mood: rumination about symptoms, perception to be vulnerable to future illness

Stimulus Definition of Stress: Holmes and Rahe (1967) Association between life events and health SOCIAL READJUSTMENT RATING SCALE

Classic study of association between life events and health -IE top of scale is death of spouse, divorce, marital separation, jail term, death of family member etc -Many replications -Correlations in the .3 range between major life stress and illness (weak correlation)--> people deal with stress differently and thus health consequences are different -Here there are Problems with retrospective self-reports and normative ratings e.g. change in responsibility at work could be more or reduced responsibility

Alcohol Consumption Steadily Increases in BC

As measured from 2002 to 2008, alc consumption has increased across canada

Sympathetic reaction to stress (response)

Autonomic nervous system kicks in

Palliative Care

Comfort/Supportive Treatments

Chapter 8 textbook: how does physical activity protect cardiovascular health?

BP: lower systolic and dystolic BP, less likely to develop hypertension -lipids and inflammation: exercise improves serum lipid levels- it raises HDL and lowers LDL and reduces information -reactivity to stress: fit individuals show lower heart rate and blood pressure reactivity to stress

Example of biopsychosocial model

Biology: There is a history of cardiovascular problems in your family e.g. parents and uncles have had strokes/ heart attacks. It is family-related. -Psychological: The steps that you are taking to reduce stress in your life personally and in the workplace -Social: cultural context, your SES, and the healthcare system

Cognitive appraisal: Secondary appraisal (person-environment transaction)

Concerned with a person's evaluation of his/her ability to cope with the situation ̈What can I do about it? ̈Do I have resources for coping?

The Mind-Body Relationship: Descartes

Cartesian Dualism: The mind and body are separate entities but could communicate through the Pineal gland -popularized dissection of animals again because he proposed animals have no spirit -Also described the mechanics for how sensation occurs

The rise of health psychology: Impacts of the field on chronic vs acute disease over time

Changing patterns of illness: -Acute Disorders: Short term medical illnesses with clear onset in the early 1900's -Examples: diarrhea, pneumonia TO Chronic Disorders -Slow-developing diseases -Often these cannot be cured, only managed -Psychological/social factors are often involved -extended period of coping with chronic diseases

Projected life expectancy at birth by sex, by Aboriginal identity (cultural identity impacts)

Chart looks at Aboriginals vs rest of the population of canada -life expectancy for inuit man: 64, Average male canadian: 79, this is a difference of 15 years -for females the result is less drastic but still present (with inuit individuals with the worst outcome, as with the men) -aboriginal status greatly impacts health outcomes -this is not related to biology, related to issues of poverty (many living like they're in the 3rd world)

Future Directions: Epigenetics

Environmental factors can alter gene expression even making identical twins different from one another -Plausible biological pathway linking environment and health -e.g. case of epigenetics: Tessa Rosenbaum and the dutch hunger winter study--> individuals who were exposed to stress hunger winter had an up-regulated stress response system (their bodies responded to the fact they were going to be born into unfavorable circumstances but this promotes inc.. cotrisol, changes in receptors, and greater susceptibility to chronic disease e.g. diabetes)

Perceived Stress & Colds (Cohen et al., 1991): Dependent measures : integration of stimulus, response, & transactional

Daily: Clinical symptoms: sneezing, watery eyes, nasal stuffiness, cough -put used Kleenex into plastic bag for researcher to analyze -Infection via nasal wash--> looking for virus in the nasal wash -After 28 days: -Antibody titers in blood

Chronic stress and cognition

Damage to the Hippocampus -Loss of dendrites -Reduction in volume -Consequences: Memory problems

Middle Age and death

Death becomes more common -Premature death E.g. heart attack or stroke -Most people say they would prefer: Sudden, painless death

Are There Stages in Adjustment to Dying? Kϋbler-Ross's 5 Stages

Denial -Anger -Bargaining -Depression -Acceptance

Alcohol in University

Drinkers who reported problems: 50% had hangovers, 27% missed class, 32% did something they regret, 25% forgot where they were/what they did, 20% engaged in unplanned sexual activity, .3% got injured

Old Age and death

Dying is not easy, but it may be easier in old age -Initial preparation may have been made -Some friends and relatives have died -May have come to terms with issues of advancing death -Elderly typically die of degenerative diseases -Terminal phase is shorter than it is for those who are dying at younger ages

Textbook Chapter 7:where is highest incidence of smoking?

Europe: 41% of european men, 22% of european women -average amount of cigarette = 14

Cognitive appraisal model (tranactional model of stress)

Event--> Evaluation of event-->Event is threatening or demanding--> Stress activation of sympathetic system OR Event--> evaluation of event--> Event is not threatening or demanding--> No stress

Tend and Befriend conclusions- Response to stress

Evidence for important role of oxytocinin buffering stress -Not limited to women

Sudden Death Disadvantages

Family members may be: Estranged, no hope for reconciliation -Poorly prepared to cope financially with the loss

Eating Disorders:Psychological Factors

Patients with Eating Disorders: -seek self-esteem and perfection via thinness -Maintaining factors -Concern about weight and shape -Cognitive distortions -Family factors/stress -Difficulty tolerating dysphoric mood states -Physiological and psychological effects (e.g. Set Point Theory (when you have a certain weight for a long period of time we tend to return to it)-metabolic effects of dieting)

Canadian Physical Activity Guidelines

For adults 18-64 Years -to achieve health benefits, adults aged 18-64 years should accumulate at least 150 minutes of moderate to vigorous intensity aerobic physical activity per week, in bouts of ten minutes or more--> not just focused on people at the gym but getting in some physical activity in many different ways -it is also beneficial to add muscle and bone strengthening activitites using major muscle groups, at least 2 days per week -more physical activity provides greater health benefits

Health Promotion: An Overview

General philosophy :Good health is a personal and collective achievement, Helping people maintain healthy lifestyles -Cost effectiveness: Less costly than treatment of disease -Occurs through individual efforts, interaction with the medical system, mass media, and legislation e.g. not permitting smoking in restaurants, creating walkable neighbourhoods

Longitudinal study advantages

Good method for determining lead-lag associations (speaks to the temporal order of certain things) -Can examine long-term effects within same individuals -stronger than cross-sectional in terms of the conclusions that we can draw

Stress response starting in the brain

HPA axis-- supports initial response by making sure we have enough glucose in our body so we can run away -also shuts everything down that is not needed at that point -Hypothalamus-->CRF-->Petuitary--> ACTH-->adrenal gland-->cortisol

Chapter 1 textbook: Lay person definition of health (as found in dictionaries)

Health as the absence of 1) objective signs that the body is not functioning properly, such as high blood pressure, or 2) subjective symptoms of disease or injury such as pain or nausea

World Health Organization's Definition (1948) of Health

Health is a complete state of well-being: -Physical well-being -Mental well-being -Social well-being -Health is not merely the absence of disease or infirmity. -This state of optimum health is called "wellness"

Fundamental Assumption of Health Psychology and the biopsychosocial model

Health is the consequence of the interplay between biological, psychological, and social factors

Textbook Chapter 4: self efficacy

People decide whether or not to attempt a goal according to: -outcome expectancy (that the behavior, if properly carried out, would lead to a favorable outcome) -self-efficacy expectancy (that they can perform the behavior properly)

Canadian Alcohol & Drug Use Monitoring Survey (2011)

High-risk drinking -Chronic: Women > 10 drinks/week, > 2 drinks/days most days -Men> 15 drinks/week > 3 drinks/day most days -Acute -on any single occasion (Binge): Women > 3 drinks, Men > 4 drinks -in the 15-24 age group ~ 22% chronically drank ~18% drank acutely over the past week -in the 25+ age group ~18% drank chronically, ~12% drank acutely over the past week -the difference between men and women is due to metabolism

The Mind-Body Relationship: A Brief History (Two Perspectives)

Holism: Mind and body are a part of the same system (Hippocrates) Dualism: Mind and body two separate systems (Plato)

Lazarus' Transactional Model of Stress

How does the individual know when the environment taxes or exceeds his/her resources? -Cognitive appraisal -Proposes that the interpretation of stressful events by the individual is more important than the events themselves -personal reflection on the resources that they have to deal with the stressor

Early Psychosomatic Medicine

Illness is the result of underlying emotional chronic conflicts that surface in the form of physiological symptoms -Psychoanalysis -Focuses on psychiatric treatment -Ex: Hypertension is connected to an inability to express feelings of anger in an appropriate manner -Divided the world of illness into two types: medical and psychosomatic -Psychosomatic is everything that could not be explained otherwise

Why the difference in OCED countries weight?

In Europe, less people own cars- they take the metro/bus/walk to work and other activities. -Healthy foods like dairy and fruits&veggies are subsidized= cheaper

Textbook Chapter 4: hardiness

People who believe they have control, comittment (sense of purpose and involvement in events, activities, and people in their lives), and challenges (view changes as incentives for growth rather than threat).

The impact of the germ theory of disease

In the 19th century, micro-organisms were discovered as causes of disease -Emphasis on biology as a sole cause of disease -Search for "magic bullet" -Dualism

Textbook Chapter 5: Beta Blockers

Inderal- reduce anxiety and blood pressure (they block activity stimulated by epinephrine and norepinephrine in the PNS)

Health compromising behaviors:

Smoking, alcohol consumption •Poor eating habits, obesity

Social support: The direct effects hypothesis

Social support directly protects health (in the same way regardless of stress levels and even when there is no stress) -social support protects health regardless of stress -social support---> health

Are There Stages in Adjustment to Dying? Kϋbler-Ross's 5 Stages: positive praises and criticisms

Kϋbler-Ross's work is invaluable -description of dying patients' reactions -pointing out counseling needs - she drew our attention to the different needs patients have once curative approaches have no affect -breaking taboos -Criticisms: -No universal stages -importance of anxiety -Dying is a complex and individual process -not science based, based on hundreds of stories she drew from patients with terminal cancer

Alcohol Interventions in University

Learning to control drinking versus eliminating alcohol -Skills Training--> Identify circumstances when drinking to excess occurs, Placebo drinking, Learning "drink-refusal skills" , Consuming nonalcoholic beverages while others are drinking, Alternating alcoholic and nonalcoholic drinks -Changing social norms

Technological Strides Separate Mind From Body: Medicine

Looked more to laboratory and less to the mind-- people were looking for the "magic bullet"--> agent to get rid of bacteria

Intervening with Children/Adolescents and their health

Socialization influences early health habits -Socialization -Parents and social institutions -Adolescents may ignore early training

The Child Survivor

May expect the dead person to return -May believe a parent left because the child was "bad" -May feel "responsible" for a sibling's death

Technological Strides Separate Mind From Body: Anton van Leeuwenhoek

Microscopy--> with the advent of the microscope, people were able to see, track, and differentiate disease --> biological origins of disease could be visibly studied -humoral theory scrapped -this is when the biomedical model arose: physical diseases can be explained by disturbances in physiological processes

How does stress get under the skin? Model of Allostatic load

Model of Allostatic Load: -Physiological regulatory systems accommodate environmental demands -Help adapt to internal and external challenges -Key to adaptive functioning, but... -Repeated activation of physiological systems leads to wear and tear -May result in cumulative dysregulation of physiological systems -Price paid by the body to meet life's challenges

Textbook Chapter 7: who comprise alcoholics?

Most are married, living with families, and employed -people in lower SES and homeless are at higher risk -risk sharply increases in young adulthood and declines afterward

Smoking rates across Canada

Most smoking: Nunavut, N.W.T, Yukon, then the maritimes and prairies, BC= lowest -20% of Canadians 12 years and older smoke

Drinking and driving prevalence in canada

National average: 11.6% -BC falls around average 13.2% -SK has the worst prevalence 19.2% -NL=best at 6.8% -this frequency is what puts people into action to stop drinking and driving and lower national alcohol consumption and risk taking behavior that accompanies it--> why changes happen!

Criticisms of Response Definition of Stress in regards to men and women

Not all responses to stress are uniform -Differences between men and women--> there are certain circumstances where it is adaptive for females to pair up together and ward off danger because you cannot leave your young (tend and befriend) -men studied more in stress research because women go through cyclical changes throughout her cycle

Transactional Model of Stress (3 steps)

Noxious Environmental Stimuli--> Cognitive Appraisal--> Response of the organism/ person

Textbook Chapter 4: Five factor model of personality

Openess to experience (intellectual curiosity, flexibility) Concientiousness (high self control, orgnaized, purposeful) Extroversion (outgoing, gregarious) Agreeableness (altruistic, helpful, high empathy) Neuroticism (tendency to experience negative emotions like anxiety and irritabiluty) - link to health= higher neuroticism linked to higher cortisol levels

Does spouse depression influence patient disease outcomes? Rheumatoid Arthritis

Pain and Depressive Symptoms in Couples Dealing with Rheumatoid Arthritis: -135 couples in which one spouse had RA -Each member of couple completed 2 questionnaires/ interviews--> 1 year apart -Sample Characteristics: 73% female, Mean age 62, M duration RA: 2 yrs -Spousal characteristics: 71% male, mean age 63, M relationship length 31 yrs -Materials used: Center for Epidemiological Studies Depression Scale (CES-D) e.g. Indicate how often you felt this way during the past week: "I felt depressed," Rheumatoid Arthritis Disease Activity Index (RADAI): RA activity in past 2 months, RA activity today (tenderness & swelling), Pain today, Fatigue in the last week

Does spouse depression influence patient disease outcomes? Rheumatoid Arthritis RESULTS

Pain and Depressive Symptoms in Couples Dealing with Rheumatoid Arthritis: -Spouse Depression predicts Patient Disease Activity--> contributes to a rise in arthritic symptoms -Patient depressive symptoms related to disease activity one year later -Depressed spouses less likely to provide satisfactory support (less able to provide helpful strategies) -Depressed individuals tend to be critical and hostile towards spouses

Jordan's Prciniple

Passed in response to the case of Jordan, a 4 y.o. boy with extensive healthcare needs at home -He was first nations, residing in Mantoba and the management of his health condition was very expensive -he passed away before this legislation was produced -Bill: Services have to be provided to the patient FIRST, later on it will be determined who will pay for it (provincial or federal)

Patients' Beliefs

Patients must integrate their illnesses into their lives -Develop a realistic sense of the illness -Patients need to adopt an appropriate model for their illness -People develop theories about where their illness came from -Self-blame (e.g. lung cancer in a smoker or ex-smoker) -Are patients who believe they can control their illness better off? -Yes, but when real control is low, efforts to induce it may backfire (people who can't change the scope of their illness e.g. terminal cancer)

The social communication model of pain

Person in pain: When a physical trauma (real or perceived occurs) biological substrates & personal history and immediate context interact to form the personal experience of pain, including thoughts, feelings, and sensations. Biological substrates & personal history and immediate context also interact to form a pain expression: self-report, nonverbal behavior (this is encoding) Caregiver: biological substrates & personal history and immediate context interact to generate a pain assessment (sensitivity, knowledge, biases, beliefs). This is decoding. Biological substrates & personal history and immediate context interact to manage pain (professional identity and experience). This impacts the personal experience of the person in pain.

Goal: Quality of Life

Physical Well Being -Psychological Well Being -Social Well Being -Spiritual Well Being

Health promoting behaviors:

Physical activity, fruit and vegetable consumption

Coping with Stress: Problem-Focused

Problem-Focused Coping: Changing the situation--> Thinking of options, Making a plan OR Changing ourselves--> Seeking information, Learning new skills -All geared towards doing something about the problem so that it goes away

Patient-Provider Communication: Use of jargon

Problem: Use of Jargon -Patients don't understand many terms that providers use -Jargon may be used: To keep the patient from asking too many questions -To keep the patient from discovering that the provider is uncertain about the problem -As a carryover from technical training

Patient-Provider Communication: Not listening

Problem:Not Listening -Beckman and Frankel (1984) Study -74 office visits studied (video taped) -In 23% of the cases patients finished explanations -18 second average before the physician interrupted the patient -Note: Physicians KNEW they were being recorded

Informational support

Providing knowledge--> this often comes from professionals e.g. explaining a medical procedure

Future Directions: Health Disparities

Public health care system •Still pronounced differences in morbidity and mortality among subgroups of the Canadian population •Age, gender, socio-economic status, ethnicity

Quality of Life: Traditional view (medical perspective)

Quality of life measured in terms of "hard facts"--> e.g. can they perform the activities of daily living, is the patient still living? -Does not do justice to patient perceptions

How many servings of fruit and vegeatbles should you be getting a day?

Roughly 7 across the lifespan

CHAPTER 9: what does adherence depend on? 3) interactions between practitioner and patient

STUDY found that: Half of patients didn't know how long to continue meds 2) physicians didn't provide needed info 3) clients asked few questions 4) more explicit doctors directions, more people complied -cultural sensitivity is necessary -patient centered style preferred -warmth, concern, and communication of information are very important

Dyadic Associations in Wellbeing: Seattle Longitudinal Study

Sample •35 years of longitudinal data from 178 SLS couples •Up to 6 measurement occasions •M age at T1 = 48 years (SD = 14.5); M marriage duration at T1 = 26 years (SD = 14.5); M number of children at T1 = 3 (SD = 1.6) -Measures •Happiness: "Would you describe your life until the year X (current study wave) as being..." "very happy" (1) to "very unhappy" (5) •Covariates: Age, education, number of children, length of marriage -charted how spouses answers related to other spouse

Perceived Spousal support study:

Sample •49 married couples: older adults (age 60+) from Atlanta, Georgia •Caucasian = 91.8%; African American = 8.2%; 82.5 % = at least some college •M age = 72 years (60-83), M marriage duration = 42 years (1 -59) -Procedure: Baseline Assessment--> 9 day time sampling phase -Measures: Baseline: perceived spousal support, Time Sampling: momentary affect and ache symptoms -Analysis: Multi-level models

Matching Hypothesis (variation of buffering hypothesis, but it is quite distinct)

Shelden Cohen -The most effective type of support depends upon the specific dimensions of the stressor. -Co-worker support is a match for work stress -Informational support is a match for exam stress -Tangible support is a match for parenting stress

what is smoking related to? Messaging around smoking in the past and today?

Smoking is related to cardiovascular disease and cancerous diseases -recognized for many years the detrimental impacts of smoking -old messaging: relating patients cigarette of choice to their doctors -recent messaging: claiming to miss the functioning of their lungs

Transactional Model of stress

Stimulus--> Primary appraisal(harmless leads to no stress /threatening leads to secondary approach)--> secondary appraisal (determination of resources)--> coping (may be adequate leading to no stress/ coping mechanisms inadequate= stress) . This process is dynamic, you need to re-visit the stimulus and see if things have improved -e.g. time sampling could be used here--> what methods are they using to deal with stress and is their mood improving?

Response Definition of Stress Recap

Stress -->Physiological (biological) response to noxious stimulus Non-specific response-->No matter what the noxious stimulus, physiological response should be the same

Stimulus Definition of Stress

Stress = a noxious stimulus -Examination via checklists

Response Definition of Stress

Stress: Physiological response to noxious stimulus -Non-specific response: No matter what the noxious stimulus, physiological response should be the same -focus here is on biological stressors

Social support: Structural and functional aspects

Structural aspects -How many contacts? -Friends vs. Relatives vs. Co-workers?--> may operate via main or direct effects -Functional aspects -Perceived availability of support? -Perceived quality of support?-->operate through stress-buffering mechanisms

Cross-Sectional Self-Reports

Studies naturally existing phenomena, tries to capture phenomena without changing them -Single time-point -Subjects look back in time and report their experiences and feeling over a specific time interval -Commonly used method in psychological research -Example: Survey on stressful life events and health (Holmes & Rahe, 1967) : Developed to allow judges to rate events, Ratings = amount of event-related life change, Higher scores are associated with a higher risk of illness e.g. Death of spouse=100 points, divorce 73 points, closer to bottom of list: minor violations of the law=11 points -Correlation between stressful life events and disease (not cause and effect)

The Adult Survivor

Survivor's routine -Before death filled with illness-related activities -After death, it is hard to remember what one used to do -Has to take on new and unfamiliar tasks -Grief: A response to bereavement involving a feeling of hollowness, Often marked by preoccupation with the dead person -Difficult for outsiders to appreciate the degree of a survivor's grief - whereas, there are other cultures (italy: catholic) they will dress in black for a year, that's an outward sign that people will treat with respect

Chapter 1 textbook: the interaction of systems in the biopsychosocial model

THE WORLD: social systems like society, community, family THE PERSON: Psychological systems like cognition, emotion, and motivation AND Biological Systems like organs, tissues, cells -They all interact with eachother

The General Adaptation Syndrome: alarm - Response to stress

The body's defences against a stressor are mobilized through activation of the sympathetic nervous system -Fight or flight -Adaptive emergency response

Planning

The bridge between goals and behavior

Textbook Chapter 4: personal control and health

The multidimensional health locus of control scale: -internal health locus of control- control of health lies within you -powerful others health locus of control- the belief that ones health is controlled by others, like a physician -chance locus of control: the belief that luck or fate controls health -personal control can help people adjust to becoming seriously ill (ex less depression) -also more effort made towards rehabilitation

Illness delay:

The time between recognizing that a symptom implies an illness and the decision to seek treatment

Appraisal delay:

The time it takes a person to decide that a symptom is serious

what is coping?

Things we think and actions we take to ameliorate the negative aspects of a stressful situation (whether successful or not)

Textbook Chapter 4: types of social support: Companionship support

This type Hoppmann sees as confounded with emotional support -companionship support: availability of others to spend time with the person, thereby giving them a feeling of membership in a group of people who share interests and social activities

Discovery of Penicillin by Alexander Flemming

This was the "magic bullet" that scientists had been looking for -He studied staph bacteria in petri dishes and observed that mould killed the surrounding bacteria in the dish -this discovery was later picked up by researchers at Stanford and the discovery of penicillin was made -this discovery cut out 2/3 of diseases that killed people

Response Definition of Stress: General Adaptation Syndrome

Three stages: -Alarm --> Physiological mobilization for action -Resistance-->Body tries to adapt -Exhaustion-->Breakdown of the organism

The Long Arm of Stress: Tessa Roseboom- Response to stress

University of Amsterdam -Dutch Famine Birth Cohort Study -Exposure to nutritional deprivation in utero--> identified the children who were born after the Dutch hunger winter -compared kids born 1 year before or concieved after the dutch hunger with the children who were in utero during the dutch hunger winter -Increased risk of depression and schizophrenia -Increased cardiovascular risk (Twice the risk) -Increased diabetes risk -Lower cognitive performance in old age

Textbook Chapter 5: benzodiazepines

Valium and Xanax decrease neural transmission in the central nervous system

Problems with the Response: Definition of stress

Variation in responses to stress -From person to person-->Individual responses are influenced by personality, perception, & biological constitution -From stimulus to stimulus stress may vary -Limited role given to psychological factors-->Appraisal is important -Stress is assessed as an outcome-->What about anticipation of a stressful occurrence? There can be anxiety leading up to an event.

Response Definition of Stress: Fight or Flight

Walter Cannon (1932) when an organism perceives threat: -Fight: Aggressive response -Flight: Withdrawal -Adaptive: Allows quick response to threat

Chronic Stress and Cardiovascular Risk

Wear and tear on blood vessels -Consequences: -Hypertension -Risk for heart disease and stroke

Emotional Responses to Chronic Illness: Depression

When the acute phase of chronic illness has ended -Then full implications begin to sink in -Assessing depression is challenging in the context of chronic disease

BMI in women and men in Canada 2007-2009 ages 18-79

Women: half of Canadian women are a normal weight, half are obese of varying degrees -Men: about 1/3 of men are a normal weight, 2/3 are obese of varying degrees -people tend to report lower weight than true so these figures may be skewed and actually more negative than what is depicted

Smoking Interventions: Social Support and Stress Management

Would-be ex-smokers enlist support from others in their efforts to stop -A strong image of oneself as a "nonsmoker" helps treatment effectiveness

Chapter 8 textbook: what is the leading cause of death for individuals under 45?

accidental injury -e.g. car accidents can be reduced by mounting an extra brake light above the trunk of vehicles and risk of traffic mishap is 4x more likely after person uses phone even if its hands free

Children's Understanding of Death, Under 5

Young children (< age 5 years) associate death with sleep -Death is not thought of as final -Curious about death -Not frightened or saddened

CHAPTER 14: Cancer (Leading cause of death worldwide)

a disease of the cells characterized by uncontrolled cell proliferation that usually forms a malignant neoplasm -five types: carcinomas- malignant neoplasms in cells of the skin and lining of body organs (85% of cancers), melanomas- neoplasms of a special type of skin cell that produces melanin, lymphomas- cancers of the lymphatic system, sarcomas- malignant neoplasms of the muscle, bone, or connective tissue, leukemias- cancers of the blood-forming organs -highest death rate from neoplasms in the lungs -cancer is caused by the interplay of genetic, environmental e.g. ultraviolet radition, and behavioral e.g. smoking, and psychosocial factors e.g. stress -risk of cancer increases with age, higher rates among males -tests for detecting cancer: blood and urine tests, radiological imaging e.g. MRI, biopsy where small piece of tissue is taken out -treatment for cancer: surgery, radiation, chemotherapy (people receive powerful drugs usually orally or by injection that kill cancerous cells)--> vomiting often results in learned food aversion -most common form of child cancer- leukemia

A proposal for the definition of pain:

a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components. -distressing is a more powerful term, adds cognitive and social components, removes the requirement that pain can be described

CHAPTER 10: hospice care

a medical and social support system to provide an enriched quality of life- through physical, psychosocial, and spiritual care- for terminally ill people and their families

Textbook Chapter 7: behavioral methods for treating substance abuse--> scheduled reduction

a method in which the person used the substance only at specified regular intervals and these intervals get longer and longer accross the days

Textbook Chapter 7: behavioral methods for treating substance abuse--> self monitoring

a procedure in which people record information pertaining to their problem behavior such as how often they smoked or drank and the circumstances

Textbook Chapter 7: when was prohibition

began in 1920

Textbook Chapter 4: behavioral control

ability to take concrete action to reduce a stressor

Textbook Chapter 4: cognitive control

ability to use thought processes or strategies to modify the impact of a stressor

CHAPTER 11: function of nalaxone

acts in opposition to endogenous opiods and opiates, prevents them from working as pain killers

Textbook Chapter 7: addiction

addiction: is a primary, chronic disease characterized by inability to consistently abstain, and diminished recognition of significant problems. Like other chronic diseases, addiction can involves cycles of relapse and remission.

CHAPTER 9: adherence

adhering to a practitioners advice in a collaborative treatment plan

Textbook Chapter 6: Well-behavior

an activity people untertake to maintain/ improve current good health and avoid illness--> this also depends on motivation

Textbook Chapter 6: symptom based behavior

an activity people who are ill undertake to determine the problem and find a remedy e.g. complaining about stomach pain, seeking help from medical practitioner --> people seek help/ healthcare assistance at different rates ie: motivation, money problems, hypochondirac or the opposite

Chapter 1 textbook: pandemic

an epidemic that has increased to international or worldwide proportions

Textbook Chapter 6: lapse

an instance of backsliding

Behavior Change techniques:

an observable, replicable, and irreducible component of an intervention designed to alter or redirect causal processes that regulate behaviour [...] an 'active ingredient" -goals and planning (action plans) -problem solving (coping planning) -activity monitoring -association (e.g. cues to do activity) -.....

ISAP definition of pain:

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage -strengths: emphasizes subjective experiences, recognizes sensory and emotional aspects, acknowledges perception of tissue damage as essential, broadly applicable in scientific and clinical settings -problems: clinical pain almost always more than "unpleasant" -focus on sensory and emotional features neglects other important features -phrase "described in terms of such damage" is ambiguous -focus on self-report excludes all those unable to do so (infants, young children, people with intellectual disabilities)

CHAPTER 10: most common emotion for medical patients?

anxiety -there is reduction in anxiety for surgery if the individual is placed in a room with a person who has already had the surgery -higher levels of anxiety before surgery can impair people's physical recovery

Textbook Chapter 6: Health behavior

any activity people perform to maintain or improve their health regardless of their percieved health status or whether their behavior actually achieves that goal -research suggests people's health status influences the type of health behavior they perform & their motivation to do it

Chapter 1 textbook: variable

any measure of people, objects, or events that may change--> independent and dependent

Sedentary Behavior:

any waking behavior characterized by an energy expenditure < 1.5 metabolic equivalents while in a sitting or reclining posture -prolonged sitting in transit, at home and in leisure time -operationalized as sitting time

Free access to bus 1 day/ week for older adults in Halifax

benefits for older adults to use public transit and get exercise

CHAPTER 9: when do most individuals report that heat becomes painful

between 44 and 46 degrees C

Chapter 8 textbook: binge eating disorder

binge eating behavior alone , occur at relatively high frequency and cause distress

the biopsychosocial model of pain

biology, psychology, social contexts overlap to make wellbeing

CHAPTER 10: blame and helplessness in the hospital setting

blame: people self blame and blame others. Blaming is related to poor adjustment, but is more strongly associated with blaming other -many people in the hospital learn helplessness and do not try to exert control when it becomes available, this may increase with time in the hospital

CHAPTER 10: hospital hierarchy

board of trustees--> hospital administrators & medical staff (Each of these two have their own hierarchy) -medical doctor/ chief of staff--> nurses--> allied health workers (physical therapists, dieticians etc)---> orderlies

Chapter 8 textbook: isotonic excersize

builds strength and endurance by the persons moving a heavy object, exerting most of the muscle force in one direction e.g. weight lifting

Chapter 8 textbook: isokinetic excercise

builds strength and endurance, moving object in multiple directions

Chapter 8 textbook: isometric exercise

builds strength rather than endurance, muscle force against an immovable object e.g. chair lift

Sitting vs physcial activity

can offset the negative impacts of sitting for 8 hours/day at work by engaging in physical activities 60-75min a day

CHAPTER 11: pain is learned by _________ and pain behaviors are strengthened by ________

classical conditioning, operant conditioning

Textbook Chapter 5: problem solving training

clients learn strategies for identifying, discovering, inventing effective ways to address problems

Textbook Chapter 7: behavioral methods for treating substance abuse-->competing response

competing response substitution involves performing and rewarding a behavior that is incompatible with the problem behavior e.g. taking a shower right after breakfast instead of having usual coffee and cigarette

CHAPTER 14: Stroke

condition in which damage occurs in an area of the brain when the blood supply to that area is disrupted, depriving it of oxygen -causes: ischemic stroke: damage when the blood supply in a cerebral artery is sharply reduced or cut off OR hemorrhagic stroke: blood vessel ruptures and bleeds into the brain -risk factors: middle age +, similar rates in men and women, high BP, hypertension, cigarette smoking, diabetes, family history, atrial fibrillation, drug/ alc abuse, -people who survive strokes generally suffer some degree of motor, sensory, cognitive or speech impairment--> occupational therapy can help regain some functions -many people return to work after having a stroke, often with reduced hours

CHAPTER 11: Three common types of chronic pain- chronic progressive pain

continuous discomfort that becomes increasingly intense as the underlying condition worsens

CHAPTER 13: Psychosocial interventions for people with chronic conditions: cognitive methods

coping methods, problem solving training, cognitive restructuring,

Chapter 8 textbook: what diseases is obesity associated with?

coronary heart disease, diabetes, hypertension--> people can modify this by watching weight in childhood and eating balanced diet with high glycemic loads (will be digested a rate that makes you eat less later on )

benefits of light physical activity?

dec BP, lower BMI, decrease arterial stiffness, reduced mortality, increase stability, greatest effect for ppl with low cardiovascular fitness

Chapter 1 textbook: main cause of death in the present?

degenerative or CHRONIC diseases such as heart disease, cancer, stroke--> develop and persist over a long time (this is because people are living to older ages where they are more likely to contract them)

CHAPTER 10: principle coping mechanism in terminal illness?

denial

Textbook Chapter 6: Interdisciplinary perspectives on preventing illness with tooth decay as a case study- preventative medical efforts

dental professionals can remove calculus from teeth and repair cavities

CHAPTER 13: crisis theory

describes factors that help people adjust to chronic health problem -illness-related factors e.g. disfigurement, background and personal factors e.g. hardy/ resilient personality, physical and social environmental factors e.g. social support helps coping with illnessIMPACT -the coping process: cog appraisal- addressing the significance of the illness in their life, which formulates adaptive tasks: 1) tasks related to the illness or treatment e.g. adjusting to medication 2) tasks related to general psychosocial functioning e.g. maintain positive outlook, coping skills e.g. setting reasonable goals IMPACT -outcome of crisis e.g. family must adapt (make reasonable changes) and maintain quality of life

Chapter 1 textbook: 17th, 18th, 19th cent. America what did people mainly die from?

dietary (e.g. malnutrition) and infectious causes (harmful microorganisms)

CHAPTER 10: womens distress post injury/ illness

difficult time adjusting to disfigurement such as facial injuries or losing one of their breasts

Chapter 8 textbook: set point theory

each persons body has a certain set weight that it strives to maintain, involves the hypothalamus--> when body derives from the set point it increases or decreases eating & metabolism

Textbook Chapter 5: biofeedback

electomechanical device monitors the status of a persons physiological processes, such as HR or muscle tension and immediately reports that info to the individual. This enables the person to gain voluntary control over these processes though operant conditioning.

Textbook Chapter 6: what behavioral response was particularly important in SARS outbreak in Toronto?

empathetic responding

Chapter 8 textbook: aerobic exercise

energetic physical activity that requires high levels of oxygen over extended time

Activity Monitoring

establish a method for the person to monitor and record their behaviors as part of a behavior change strategy

Textbook Chapter 7: nicotine regulation model

established smokers continue to smoke to maintain a certain level of nicotine in their bodies and to avoid withdrawal symptoms

Chapter 6: healthful behaviors and life expectancy

exercising, eating high fruit & vegetable diet, not smoking, not drinking to much can lead to living an extra 12 years than someone would otherwise

Textbook Chapter 4: as people move into old age what is their locus of control?

external -women also typically have higher rates of external locus of control, perhaps through socialization

CHAPTER 11: 4 types of pain behaviors

facial or audible expression of distress, distorted ambulation or posture, negative affect, avoidance of activity

Textbook Chapter 6: relapse

falling back into ones original pattern of undesriable behavior

Textbook Chapter 5: Progressive muscle relaxation

focus attention on specific muscle groups while alternately tightening and relaxing these muscles

CHAPTER 9: chronic care model

focusing on secondary and tertiary prevention

Three lenses through which we looked at health impacts on varying populations:

gender, SES, cultural heritage

CHAPTER 10: infection control nurse

has the most direct role in curbing the spread of disease, being responsible for detecting and recording instances of nosocomial infections and taking measures to prevent them

CHAPTER 10: where are most North Americans when they die?

hospitals

Key messages: of second part of lecture

important to describe types of BCT -BCT taxonomy is an online resource to support the classification of behaviors

Chapter 1 textbook: epidemic

incidence of infectious disease has increased rapidly

Human brain mechanism of pain perceptions and regulation in health and diseas

includes midbrain, frontal lobes (prefrontal area)

Chapter 8 textbook: fat cell hyperplasia

individuals who develop too many fat cells, when these people try to lose weight their fat cells shrink and send out metabolic signals that the body is strarving, increasing hunger and reducing metabolism

Why pain? Functions of pain

intrapersonal: warns about tissue damage or stress, motivates escape/avoidance, learn about dangerous situations. Highly conserved in course of evolution; systems serving these functions in ancient species

Textbook Chapter 3: factors of a situation involving appraisal of events

involve strong demands, are imminent, undesirable and uncontrollable, involve major life transitions, or occur at unexpected time in lifespan

Textbook Chapter 6: Tertiary prevention

involves actions to contain or retard damage to prevent disability or recurrence e.g. if you have arthirits, doing exercise for physical therapy

Retrospective response biases: photo comparisson

left side: painting of the house where famous painter grew up-- drawn several decades later. He had to leave when Italy was governed by Musulini. He impression was bright and sunny right side: photograph taken by photographer shows vastly different scenery, more crowded and darker -this illustrates retrospective response biases and SUBJECTIVITY. Reported through the eyes of a specific person

Medically Assisted Dying

legal in Canada as of June, 2016

recommendations for children and screen time

less than 2 hours a day of "screen time" for children and youth

CHAPTER 9: what is the main concern with canadas primary health model?

long wait times

CHAPTER 9: correlation between people's HR, BR, degree of congestion self-reports and physiological measures

low correlation -individuals have trouble perceiving external symptoms

other opportunities for exercise

low intensity exercise in which your heart rate is normal and you can speak or even sing normally e.g. grocery shopping, household work

Chapter 1 textbook: define morbidity

means illness, injury, or morbidity, basically any detectable departure from wellness

CHAPTER 10: "problem patients"

more active in their sick role, little cooperation, voicing many complaints, very dependent and emotional -when people are very ill this behavior is typically understandable to the medical staff -but other problems take up more time and attention than their conditions seem to warrant

CHAPTER 10: mens distress post injury/ illness

more distressed by illnesses that reduce their vigor/ physical capabilities

CHAPTER 14: life threatening illness and the initial issue of concern

mortality. -patients often show optimistic attitudes and hope they will be cured but begin to view their plans for the future more tentatively. Switch from avoidance coping to active, problem solving coping.

Mouse vs monkey vs humans and pain perception

mouse diverged from our tree 100 m.y.a

CHAPTER 13: Nervous system injuries: spinal chord

neurological damage to the spine that results in the loss of motor control, sensation, and reflexes in associated body areas. May be caused by disease or injury. -if chord is severed in neck region tetrapalegia results- paralyzed from neck down -if a lower portion is severed paraplegia results. If the chord isnt completely severed, partial function remains. -people who survive the first 24h of a SCI have a long life ahead, ten years later 85% are still living

Chapter 1 textbook: prevalence

number of cases, such as of a disease or of persons infected or at risk. Includes both continuing (previously reported) and new cases at a given moment in time

UK BusPass: effects on older adults

older adults increased bus use and decreased risk for obesity -community dwelling women (70-93) who met physical activity guidelines were five times more likely to use transit

Three Ways to Define Stress:

organisms response, environmental stimulus, person-environment interaction (difficulties in amounting the resources to deal with daily life)

CHAPTER 11: referred pain

pain as perceived as coming from other parts of the body

CHAPTER 9: external environment and pain report

people are more likely to notice internal sensations or physical symptoms when the environment is boring or lacks information than when the environment captures their attention--> this translates to lifestyles e.g. boring vs exciting job, living alone vs. living with people

Textbook Chapter 6: theory of planned behavior

people decide their intention in advance of most voluntary behaviors and intentions are the best predictors of what people do (this is an expanded version of the theory of reasoned action) 3 intentions influence people's behavior: 1) attitude regarding the behavior --> whether or not the behavior is a good thing to do. Attitude is based on two expectations, the outcome of the behavior and how rewarding the outcome would be 2) subjective norm: judgement reflects the impact of social pressure or influence on the behaviors acceptability or appropriateness--> others opinions and motivations to comply 3)percieved behavioral control: person's expectation of success in performing behavior--> similar to concept of self-efficacy

CHAPTER 9: Iatrogenic conditions

people develop health problems as a result of medical treatment, can result from physician's error or from undesirable side effects -medical errors have been estimated to cause up to 24,000 deaths a year in canada

CHAPTER 9: nacebo phenomenon

people experience side effects of an active drug even when these side effects can't be explained by the drug

Textbook Chapter 5: modeling

people learn by observing what others do and the consequences of their behavior

Textbook Chapter 4: external locus of control

people who believe that their lives are controlled by forces outside of themselves

CHAPTER 10: reactance

people's angry responses when they feel controlled or that their freedom is threatened ie: in the hospital setting

Textbook Chapter 6: theory of planned behavior potential problems

peoples intnetions and behaviors are not strongly related -doesn't include persons prior experience with the desired behavior

CHAPTER 11: stimulation of which brain region can be analgesic?

periaqueductal grey area (called stimulation-produced analgesia)

CHAPTER 9: what can be done to improve communication between patients and practitioners?

physicians interviewing skills show improvements from training programs that teach how/ when to summarize information, ask questions, and check for comprehension -patients can improve communication too by filling out a form about their symptoms before seeing doctor--> generates questions

Textbook Chapter 6: conflict theory

presents a model to account for both rational and irrational decision making and the impact of stress -takes into account whether something is a risk or opportunity (e.g. free program to quit smoking) -risk hope and adequate time are important for any major decision and contribute to coping that is either hypervigilant (feel they have no time) or vigilant (feel they have time, leads to more rational decisions)

Textbook Chapter 7: behavioral methods for treating substance abuse--> stimulus control

procedures address the antecedents by altering elements of the environment that serve as cues and lead a person to perform the problem behavior e.g. not hanging out with friends who drink in front of you

Chapter 1 textbook: define epigenetics

process in which chemical structures within or around the DNA govern how and when a gene acts -environment can change the epigenetic process e.g. exposure to chemicals, bacterial and viral infection, dietary elements -for example, gene activity in MZ children is quite high when they are young and becomes more differentiated over time--> lifestyles start to change -epigenetic chnages influence a persons response to stress, ability to learn and remember, development of health problems etc

Tangible assistance

providing material support, services, money, goods -ex. babysitting

Emotional support:

providing reassurance, warmth and nurturance--> comfort when under stress

Chapter 8 textbook: what are the consequences of being an overweight teenager?

puts people, especially girls, at risk for development of depression and anxiety disroders

CHAPTER 13: Epilepsy

recurrent, sudden seizures that result from electrical disturbances of the cerebral cortex, common form is the tonic-clonic/ grand mal -tonic: body rigid, person loses consciousness, clonic: 2-3min muscle spasms and twitching -risk factors: family history, head injury, and other brain disorders -anxiety may increase likelihood/ severity of an attack -treatment: anti-convulsive medication

Textbook Chapter 5: systematic desensitization

reduces fear and anxiety. This is based on the view that fears are learned by classical conditioning. Systematic desensitization reverses this learning by pairing the feared object or situation with either pleasant or neutral events

Textbook Chapter 7: relapse prevention method

relapses develop through the cognitive events of the abstinence violation effect that follow a lapse -the cognitive events involve guilt and low self-efficacy -clients take the following steps: 1) learn to identify high risk situations 2) acquire competent and specific coping skills e.g. coping with stress 3) practice effective coping skills in high risk situations under a therapists supervision e.g. problem drinker may go with therapist to a bar and practice ways to not drink

CHAPTER 10: "good patients"

relatively cooperative, uncomplaining, stoical

CHAPTER 11: Three common types of chronic pain- Chronic recurrent

repeated and intense episodes of pain separated by periods without pain

Chapter 8 textbook: sugar and addiction

research on rats indicates its almost as addictive as illicit drugs like cocaine -health officials have recommended diets in which there is no higher suagr intake than 5% of all calories per day

CHAPTER 13: asthma

respiratory disorder involving episodes of impaired breathing when the airways become inflamed and obstructed -asthma triggers can include personal factors e.g. having respiratory infection/ being anxious, enviornmental conditions e.g. air pollution, physical activities e.g. strenuous exercise ALSO stress can make asthma worse -treatment? avoid triggers, anti-inflammatory medication, exercise

protective psychological factors:

self efficacy: confidence in one's ability to follow a course of action that will accomplish desired outcomes (e.g. control pain) -pain coping strategies: relaxation, distraction, commitment, redefinition -readiness to change: willingness to take an active role -acceptance: patients lives often consumed by unsuccessful effort to eliminate pain--> willingness to experience pain, willingness to be active despite pain

CHAPTER 10: Million behavioral medicine diagnostic

self-report test that assessing psychological factors and decision making issues that are known to be relevant for medical patients e.g. coping style, negative health habits, stress management

Self report measures: the bad

serious limitations: speech only partially reflects complexities experience (rrequires sincere motivation) -reflects perceived best interests (impression management, easy to cheat) -requires cognitive, linguistic, and social competence

CHAPTER 13: initial reactions to a chronic condition

shock and then reality begins to intrude as symptoms get worse and additional diagnoses confirm the condition

Textbook Chapter 7: psychological dependence

state in which individuals feel compelled to use a substance for the effect it produces, without necessarily having a physical dependence --> help them adjust to life and feel good, spend a lot of time attaining the substance

CHAPTER 10: burnout

state of psychosocial and physical exhaustion that results from chronic exposure to high levels of stress and little personal control, very common among health care professionals -tend to have lob job satisfaction, high levels of absenteeism, job turnover, alcohol and drug abuse. -risk for developing heart disease -they experience emotional exhaustion, depersonalization (more common in doctors, less in nurses), perceived inadequacy of professional accomplishment (more in nurses, less in doctors)

Textbook Chapter 5: stress inoculation training

teach people skills for alleviating stress 1) clients learns about nature of stress and how to react to it 2) acquires behavioral and cognitive skills, such as relaxations and seeking social support 3) practices coping skills with actual or imagined stressors

Textbook Chapter 7: behavioral methods for treating substance abuse--> behavioral contracting

technique used for spelling out conditions and consequences regarding the problem behavior in writing

CHAPTER 9: Hypochondriasis

tendency for individuals to worry excessively about their health, monitor their bodily sensations closely, frequent medical complaints, believe they are ill even when practitioners say they are not. This increases with neuroticism.

Chapter 1 textbook: theory and a strong example

tentative explanation of why and under what circumstances certain events occur e.g. Leading cause of heart disease is that excess cholesterol is depoisted in artery walls. Narrows passage of blood to heart--> causing tissue damage. -this theory is: clearly stated, brings together and organizes known facts, relates information that previously seemed unrelated, enables us to make predictions, such as what would happen if cholesterol levels were reduced

Chapter 8 textbook: why do people gain weight as they get older?

the adipose tissue that is put on adds up, both increase in cell size and cell numbers--> fat -adults put on weight at certain time e.g. pregnancy, around holidays without taking it all off and it accumulates over the years -physical activity and metabolism decline with age

Textbook Chapter 6: health belief model

the likelihood that a person will take preventative action- perform some health behavior- depends directly on the outcome of two assessments he or she makes. 1) threat (percieved seriousness, perceived susceptibility, cues to action e.g. being reminded about potential health problem) 2) pros and cons of taking the action e.g. having to take time off of work

Losses in the Fourth Age: Behavior

the majority of the oldest old shows ... -multimorbidity (3 or more chronic health conditions) -increased losses in the positive side of life (well-being)

Chapter 1 textbook: incidence

the number of new cases, such as illness, infection or disability reported during a period of time

Medical Delay:

the time between making an appointment and receiving appropriate care

CHAPTER 9: commonsense models

these models affect our health-related behaviors and involve 4 basic components of how people think about disease: -illness identity (name/symptoms of the disease) -causes & underlying pathology (ideas about how one gets the disease and accompanying psychologyy) -timeline (how long disease takes to appear/lasts) -consequence (seriousness, effects, outcomes) * affect health by ppl w/ incorrect illness ideas less likely to adopt preventative behaviors, seek treatment, follow medical advice, & less likely to return to work quickly 2) as illness persists, people have lessened personal control

CHAPTER 11: men and womens reactions to pain

they have similar pain thresholds but different reactions e.g. women give higher ratings than men for pain in cold-pressor tests and this may result from differences in endogenous opiods

CHAPTER 10: depersonalization

treating the person as if he or she were either not present or a person

CHAPTER 10: palliative care

treatment focused on reducing pain and to improve quality of life

Pain empathy model:

two major groups of contributors: -bottom up processes: instigated by events and behavior of person in pain: activation of cognitive representation and affective experience -top down processes: e.g. observers beliefs, attitudes, personal learning experiences (such as prior experience with pain, pain socialization, shared knowledge, observer's pain catastrophizing) -Relationships, e.g., family, health care professionals, competitors

Types of social support: Unasked-for support

unasked-for support and unsolicited advice can imply incompetence and undermine self esteem--> this is true of older adults: if you help them w/o them asking for help you are communicating that you don't think they're capable of the task

CHAPTER 9: chronic fatigue syndrome

unexplained, persistent severe fatigue -at least 6 months -other symptoms can include sore throat and head aches

Textbook Chapter 7: physical dependence

when the body has adjusted to a substance and incorporated it into the "normal" functioning of the body's tissues. This state has 2 characteristics: -tolerance: processes by which the body increasingly adapts to a substance ans requires larger and larger doses of it to achieve the same effect, at some point, these increases reach a plateau -withdrawal: unpleasant physical and psychological symptoms people experience when they discontinue or markedly reduce using a substance on which they had become dependent. Can include anxiety, irritability, intense cravings, hallucinations, tremors -potential for physcial dependence depends on the drug e.g. heroin very high, marajuana and LSD low

Canadian Strengths in the area of pain research

worldwide reputation for leadership in pain research, with contributions to psychosocial research widely recognized -gate control theory of pain

inactivity

you have not met physical activity guidelines

Active travel

•Active travel = walking and cycling •Public transportation includes train, shuttle, bus etc (this is walking interrupted) •Important opportunities to increase physical activity

The Influence of Psychosocial Factors: Successful Aging

•Maximizing the number of years spent in good health •Promoting an active engagement with life •Fostering independence

Stimulus Definition of Stress: Holmes and Rahe (1967)

•Subjects report past events (6 months/1 year/18 months) •Checklist of Events: Schedule of life experiences, Developed to allow judges to rate events, Ratings = amount of life change caused by event, Ratings from 0 to 100 •Higher scores are associated with a higher risk of illness e.g. death of spouse highest 100 points

Is problem-focused always better than emotion-focused coping?

•Weisz et al., Journal of Consulting and Clinical Psychology, 1994 •Children with cancer interviewed about coping strategies for painful medical procedures •Outcomes: Procedural pain and anxiety (distress), Behavioral problems