Module: Health Psychology
Lecture: Introduction to Health Psychology
Date: 19 January 2009
Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick
Tel: +44(24) 761 50222 Email: [email protected] www.warwick.ac.uk/go/hpsych
Aims and Objectives
Aim: To provide an introduction to the discipline of health psychology and the health psychology module
Objectives: The student should be able to provide a basic description of the …
nature of health psychology, e.g. who and what are studied
levels of clinical application of/for psychology
pathways through which psychological processes influence physical health
structure and content of the module
module requirements, e.g. tutorial tasks
What is Health Psychology?
Psychology is both an academic and applied discipline involving the scientific study of mental processes and behaviour.
Classic definition: ‘… the aggregate of the specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction’ (Matarazzo, 1980)
Pragmatic definition: Health psychology is the study of psychological processes that influence health, illness and health care
Implications of Our Working Definition
Health psychology is the study of psychological processes that influence health, illness and health care
Four questions:
1. In who do psychological processes exert influence, i.e. who gets studied?
2. What types of psychological process are studied?
3. How do processes influence health, illness and health care?
4. In what ways can psychology be applied in clinical practice?
1: Psychological Processes in Who?
People who receive health care Patients: anyone interacting with a health care professional or
service Users: perceived presence of symptoms driving health care use Consumers: active, and proactive, care seeking by the
asymptomatic
People who provide health care Providers: professional responsibility to provide care directly to
patient Carers: as above, but without professional responsibility
People who organise health care Purchasers / managers: who fund and evaluate local service
against benchmark quality indicator, e.g. treatment targets Policy- / Decision-makers: set national-level quality indicators,
provide clinical guidance and allocate financial resources
2. Processes Studied in Health Psychology
Multiple developmental influences, in particular
Behaviourism
Social Psychology
Cognitive Psychology
Behaviourism
Operant conditioning (Skinner)
Classical conditioning (Pavlov)
Classical conditioning (Watson)
The scientific study of how reward and punishment (stimuli) affect emotion and behaviour (response)
Empirical approach: Vary contingencies of reward and punishment and measure effect on behaviour
Try to explain all behavior without going inside the ‘black box’, i.e. the mind
Behaviour is a conditioned response occurring in the presence of a stimuli
If behaviour is learned, it can also be unlearned / modified through conditioned learning
Behavioural Conditioning
A Clockwork Orange
Alex given drug to induce extreme nausea (response) whilst also being forced to watch graphically violent films (stimuli) for two weeks
At treatment end, Alex is unable to even think about violence without crippling nausea, e.g. conditioned response in presence of the paired stimuli
Fiction or reality? This is an example of classical conditioning, and describes the use of aversion therapy.
Addiction believed to have its roots in conditioning, e.g. positive stimuli associated with consumption of food, alcohol, drugs, etc.
Social Psychology
The scientific study of the way in which people’s thoughts, feelings, and actions are influenced by the social environment
Empirical approach: Vary aspects of social environment and see how this affects thoughts, feelings, and/or behaviour
Posit psychological processes as explanations for observed effects
Classic examples: Obedience
Milgram’s Obedience Study
Pain-induced learning (Milgram, 1963)
Procedure: A study about ‘learning’ Ask questions to another ‘subject’ in the
next room
Authority figure instructs subject to administer increasing ‘shock levels’ in response to wrong answers
Question: How obedient will people be? Obedience measure: Shock level
administered Levels: ‘moderate’, ‘strong’, .very strong’,
‘intense’, ‘danger–severe’, ‘XXX’
Obedience
Result: 65% administered highest shock level
Interpretation: Perceived legitimate authority facilitates obedience
‘The ordinary person who shocked the victim did so out of a sense of obligation - an impression of his duties as a subject - and not from any peculiarly
aggressive tendencies.’ (Milgram)
Obedience in Health Care?
Drug administration Nurses asked, by Dr on phone, to give patient a non-
prescribed and incorrectly dosed drug
Result: 21 / 22 administered the drug
Interpretation: Perceived legitimate authority facilitates obedience
(Hoffling et al)
The scientific study of basic mental abilities
perception, learning, memory, language, problem-solving, etc. – ‘information-processing approach’
Empirical approach: Vary information input, measure performance output
Posits psychological processes that account for observed effects
Classic examples: Stroop Effect
Cognitive Psychology
Stroop Effect
(Stroop, 1935)
Name the colour of each block: Start top left, work down and then across
Two measures: (1) response/reaction time, and (2) errors
Easy? Quick time? No errors?
yellowwhitepinkgreyblack
orange yellow
yellowwhitepinkgreyblack
orange yellow
purpleorangegreen
tanred
greenpurple
purpleorangegreen
tanred
greenpurple
greyorange
pinkblack
orangewhiteyellow
greyorange
pinkblack
orangewhiteyellow
This time – coloured words instead of coloured blocks Name the colour in which the word is written
e.g. ‘table’ the answer / response would be ‘yellow’
(Stroop, 1935)
Not so easy? Took longer? Didn’t finish? More errors?
Answered ‘yes’ to 1 or more above?
That makes you ..
… NORMAL
Stroop Effect
Result: Fewer errors and faster time to name color alone than in presence of word written in conflicting colour
Explanation: Presence of conflicting colour word interferes with processing ability / task performance
Conclusion: The meaning of a word is processed automatically, without intention
SocialPsychology + Cognitive
Psychology
Social Cognition=
The scientific study of how people make sense of their social world:
How they perceive, represent, interpret, and remember information about themselves, others and social groups
Information processing in its social context
Key question: Is the combined total more than the sum of its parts?
Social Cognition
What does social cognition offer over and above the contributions of social and cognitive psychology?
New methodologies:Stroop & Person-perception
Race of Person
Colour
Of Ink B
W
African-american (Black)African-american (Black)Caucasian (White)Caucasian (White)
(Karylowski, et al., 2002)
New methodologies:Stroop & Person-perception
Race of Person
Colour
Of Ink B
W
Match
Mismatch
African-american (Black)African-american (Black)
Mismatch
Match
Caucasian (White)Caucasian (White)
(Karylowski, et al., 2002)
New methodologies:Stroop & Person-perception
Race of Person
Colour
Of Ink B
W
Bill Cosby
Oprah Winfrey
African-american (Black)African-american (Black)
Rosie O’Donnell
Jerry Seinfeld
Caucasian (White)Caucasian (White)
(Karylowski, et al., 2002)
Result: Slower to read ink colour when colour and racial category mismatch than when they match
What do these data actually mean?
Stroop and Person-Perception
React
ion T
ime (
ms)
Ink Color(Karylowski, et al., 2002)
Racial categories come to mind automatically
In the Health Context
Social categories are activated automatically during interactions with other people
Interactions and decision-making potentially influenced by stereotypic beliefs and biased knowledge
Helps us understand evidence showing that, for certain social groups, clinicians …
offer less information, less support and are less clinically proficient
provide different treatments, preventive interventions and referral to specialist services
3. Psychology and Health
Dual Pathway Model: Two broad ways in which psychological processes may influence physical health
PsychologicalProcesses
Behaviour
PhysicalHealth
Indirect Path
Direct Path
Indire
ct Pa
th
A Primer
Psychoneuroimmunology (PNI)
Lutgendorf & Costanzo (2003). PNI and health psychology: An integrative model. Brain, Behavior and Immunity, 17, 225-232
Glaser & Kiecolt-Glaser (2005). Stress damages immune system and health. Discovery Medicine, 5, 165-169
Antoni et al. (2006). The influence of bio-behavioral factors on tumour biology: pathways and mechanisms. Nature Reviews (Cancer), 6, 240-248
PsychologicalAppraisal
SalientEvent
Endocrine System Immune System
Physical and PsychologicalHealth Status
Nerves
Hormones
Psych Processes
Metabolic
dysfunction
Cardiovascular System
Nervous System: Physiological
Reactivity
Loweredimmunity
EssentialHypertension Hypervigilance
- more events
Sensitivity - more severe
Chro
nic
Stre
ss
GI: IBS, ulcers
RS: impotence, amenorrhea
ReS: asthma, hyperventilation
Psych: cognitive decline, morbidity
4. Clinical Application
Three basic levels at which psychological principles (knowledge and techniques) can be applied:
Awareness of patient’s psychological state Knowledge of basic psychological issues relevant to
context (e.g. condition), patient-centred communication
Intervention in the form of brief counselling Emotional care, motivational support, behavioural advice,
informational and educational care
Therapy from relevant psychological therapist Knowing when and where to refer, screening for
‘caseness’, engaging in/with a care team, follow-up, case management, etc.
Block 1: Before to conceptualise the interplay between biological, psychological
and social factors in health by considering core psychological constructs underlying health-related behaviours and beliefs.
Block 2: During to appreciate and consider the use of core psychological
constructs to facilitate positive consultation outcomes. Block 3: After
to recognise the importance of considering post-consultation consequences in the context of ongoing patient care
Block 4: Consolidation to provide opportunity for structured supported revision and
consolidated learning.
Module Aims / Objectives
Lecture Assumption
Health psychology Tells us what we already know but in a language we can’t understand
Health behaviour and beliefs People will protect, not damage, their health if they know the facts
Illness behaviour and beliefs Patients consult when they think they are ill, and adhere to advice
Consultation They get ill, we consult, I treat, and they get better – simple
Preventive medicine Patients willingly engage with & benefit from preventive protocols
Psychological medicine Weak medicine for weak people – a waste of time and resources
Addiction, change & relapse A social problem with an individual solution – just say no, or stop
Stressful medicine Patients are content when referred to an expert for specialised care
Chronic illness & somatisation Challenging patients – no, more like challenging patience
Revision session Students welcome the opportunity to consolidate their learning
Question and answer Students will consider course material & formulate sensible questions
Bank holiday Self-directed learning
Module Content
Structure
Time Mins
Lecture 1345 – 1500 60 – 75
Break - 15 – 30
Self-study 1515 – 1645 75 – 90
Tutorial* 1515 - 1645 75 – 90
* Weeks 3, 6 and 9
Requirements
The module is a core module that must be completed satisfactorily in terms of:
Attendance at both lectures and tutorials is compulsory
Assessment, which may include both written ESAs and OSCEs
Participation, including the completion of required reading and tutorial tasks
Tutorial Tasks Student-led tutorials involving 4 small-group (4-5 students)
presentations, each with two components: Integration template: students will select a clinical condition
and identify (from the lectures in that block) the psychological factors relevant to the condition
Formative questions: students will develop ESA questions (1 per group per tutorial
The template and ESA questions will be presented to other students for critique and evaluation
Example ESA questions will be made available to all students for formative assessment /
revision purposes at the end of each block submitted to the WMS ESA question bank
Learning Domain Knowledge, Skills and Abilities
1. Science:
Basic / Clinical Anatomy of the spine / Effect of spinal cord injury at different levels; Radicular syndromes
Psychological Biopsychosocial models of disease, pain, self-management; Gate theories of pain; PNI link between pain and depression
Aetiologic/Pathologic Accidental injury / Pathology of spine disease – disc disease, spine infection, ankylosing spondylitis
Social / Ethical Loss of work; Disproportionate use of scarce resources; Social isolation; Learned helplessness; Treatment of pain
2. Diagnosis
Symptoms / Signs Back pain/stiffness; Radicular syndromes; Back deformity
Skills / Investigation Screening MS examination; Detailed regional MS and neurologic examination / Basic haematological tests; X-rays; MRI
3. Management:
Therapeutic skills Treatment of chronic diseases; Psychological pain management;
Medication / Operation Simple analgesics; NSAIDS / Indications for operation
Rehab / Follow-up Musculoskeletal/occupational therapy / Stepped care; Time-limited treatment with follow-up from referral
Prevention/Pub Health Health and Safety; Workplace educational programmes; Injury prevention
Integration Template Example: Back Pain
Additional Information
Module Leader: Chris Bridle
Office: A0.22 Medical School Building
Telephone: (024) 761 50222
Email: [email protected]
Webpage: www.warwick.ac.uk/go/hpsych
Module staff: Each tutor available to meet at the end of each tutorial I will be available to meet at the end of each lecture
Office hours: I have an open door policy – please don’t abuse it.
Conclusions
This session would have helped you to understand the … nature of health psychology, e.g. who and what are
studied
different levels of clinical application for psychological principles
dual pathways through which psychological processes influence physical health
structure and content of the module
module requirements, e.g. tutorial tasks
What now? Familiarise yourself with the module webpage
Obtain / download one of the recommended readings
Organise yourselves into small groups (re: tutorial tasks)
Consider / select a condition on which to develop your integrated template
Any questions?
