Dr Saadiyah Rao Senior Lecturer School of Public Health Dow University of Health Sciences

Psychology

is science of behaviour and

cognition Definition: is the aggregate of the specific educational, scientific and professional contributions 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 and the analysis and improvement of the health care system and health policy formation (Matarazzo, 1982)

It

applies psychological principles to the scientific study of health, illness and health related- behaviours Knowledge developed in this field includes psychological, social and cultural influences on development , diagnosis, treatment and rehabilitation of ill and injured people

Behavioural

medicine: is an interdisciplinary field of medicine concerned with the development and integration of knowledge in the biological, behavioural, psychological, and social sciences relevant to health and illness. The term is often used interchangeably, and incorrectly, with health psychology

Has

provided techniques useful in changing behaviors that affect health and illness. Is committed to keeping people healthy rather than waiting to only treat them when they become ill. Has contributed a solid foundation of scientific methods for studying such behaviors.

There

are two view points about health 1.Biomedical model of health: represents illness/injury are biological problems with biological solutions i.e only physical self is affected and must be treated. -Based on molecular biology. -It is most successful against infectious agents

2.

Biopsychosocial model of health: assumes illness/injury has biological, psychological and socioculture components, therefore management should take all into account. -based on multiple factors -guiding perspective used in health psychology

Biology Genetic variability Anatomy Physiology

Pathogens Germs Toxins

Behavioural risk factors Diet Exercise Smoking Safe sex Wearing seat belts in the car, etc.

Social Family Society Friends, etc.

Psychological

component

Behaviour (adoption and maintenance) Emotional (feelings) Cognition (thoughts, beliefs, and attitudes)

Personality characteristic ways of thinking and

feeling

1:

Stress and coping: biopsychosocial determinants of stress and how these factors influence coping style 2: Health behaviours: health psychological theories relating to why we act in various healthy ways 3: Issues in health care: complexities of dealing with chronic and terminal illnesses and psychological factors influencing interactions btw doctors & patients

3

major areas of activity: 1: Research into psychological aspects of behaviour relevant to health 2:Application of psychological concepts and knowledge to problems arising in health system 3:Teaching relevant psychological material to non-psychologist who work within health system

Health behaviour refers to the behaviour that is guided by health purposes or reinforced by health outcomes -any specific behaviour that maintain and enhance health -many daily behaviours influence our health -most health problems are caused by unhealthy behaviour

Sick

role behaviour : describes changes in behaviour when an individual is acknowledged to be ill

Most

behaviour theories are based four different determinants: 1.Reflex: involves relatively inflexible and un-modifiable patters of response that are characteristic of a species

2.Habit:

conditioned responses involved in avoidance of harmful substances or health promoting behaviour 3.Customs: major component of culture 4.Rational choice: leads to rational behaviour where various alternative responses are considered and consequence of each is appraised.

Health psychology deals with behaviour of patients as well as with behaviour of health care providers and behaviours range from common things like eating and exercise to more complex behaviours such as submitting some one to painful test or caring for sick relative. Giving such diversity in health behaviour that no single theory or model can fully explain all behaviours

classical

and operant conditioning are two important concepts central to behavioural psychology. result in learning but the processes are quite different.

both

Given by Ivan Pavlov Derived from respondent

conditioning in his famous experiments of food & salivation in dogs The process of pairing environmental events with unconditioned stimuli that elicit reflexive responses. Over time, these new environmental events elicit a conditioned reflex response in the absence of any other stimuli. Involves placing a neutral signal before a reflex Focuses on involuntary, automatic behaviours

pairing

a previously neutral stimulus (such as the sound of a bell) with an unconditioned stimulus (the taste/sight of food). This unconditioned stimulus naturally and automatically triggers salivating as a response to the food, which is known as the unconditioned response. After associating the neutral stimulus and the unconditioned stimulus, the sound of the bell alone will start to evoke salivating as a response

example,

a boy who had unpleasant experiences in school now feels anxious when in the school

Proposed by BF Skinner Behaviours are controlled

by their

consequences An operant is a voluntary behaviour used to obtain a reinforce or avoid a punisher Events preceding the behaviour are called antecedent stimuli It can be used to teach new type of behaviour as well as to increase or decrease the frequency, duration and intensity of certain behaviours By skipping his last class and leaving early (operant) he feels a reduction in his anxiety

Four techniques to modify operant learning 1.Positive Reinforcement: occurs when the behaviour is followed by a stimulus that increases the probability that behaviour will be repeated a stimulus such as food or a sugar solution can be delivered when the rat engages in a target behaviour, such as pressing a lever 2.Punishment: is the presentation of an aversive stimulus following the behaviour and effect is to decrease such behaviour

-effects of punishment are limited

when a behaviour (response) is followed by a stimulus, such as introducing a shock or loud noise, resulting in a decrease in that behaviour.

3.Negative Reinforcement: behaviour is reinforced by removing or terminating an aversive stimulusa loud noise continuously sounding inside the rat's cage until it engages in the target behaviour, such as pressing a lever, upon which the loud noise is removed 4.Extintion: is caused by the lack of any consequence following a behaviour. When a behaviour is inconsequential (i.e., producing neither favourable nor unfavourable consequences) it will occur less frequently. When a previously reinforced behaviour is no longer reinforced with either positive or negative reinforcement, it leads to a decline in that behaviour

Behaviour

modification: describes interventions to start, stop or change behaviours Greatest challenge for health psychologist Health psychologist devise theories and models about behaviour change and then health promotion interventions are based on these theories Changeable behaviour includes feelings and thoughts as well as actions.

Modification

of health behaviour is in two direction either an intervention is designed to encourage people to begin a healthy behaviour like regular exercise Or indented to stop an unhealthy behaviour such as smoking Most effective methods of behavioural change have their roots in respondent and operant learning theories

Health

Belief model (HBM) -one of earliest theories -focused on thought process people experience when considering making a behavioural change -assumes that human are rational & will change health related behaviour after logical thinking -people will take action to protect their health if they believe they are prone to serious threat

Two

important parts: -peoples beliefs about seriousness of a health/safety risk -their perceived susceptibility to the risk -perceived susceptibility: refers to peoples beliefs about the likelihood of their actually experiencing the illness as a result of risk

-people weigh the seriousness, susceptibility and benefits of changing behaviour against difficulties involved in making change -example: smoking is labelled as risk factor for death from cancer -Acc to HBM, smokers will consider the seriousness of lung cancer & their susceptibility to the disease. They will weigh health benefits of stopping against difficulty of giving up

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-

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an idea of internal & external factors has been added to the model ( cues & motivation) example: smokers may develop persistent cough (internal factor) that may encourage them to stop their children (external factor) may say they are afraid that their parents will die from lung cancer due to smoking

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has been applied to many type of behaviour modifications, including smoking, alcohol abuse, immunizations, health check ups, cancer screening

Decision making based on the health belief modelSerious? Susceptible ? Benefit? Barriers? Behaviour I think I will check regularly when I will take shower and mark it in calendar

Q:how serious Q:how likely I Q:what are Q:what is is the risk? am to develop the benefits of stopping me? cancer? checking ?

A: cancer is very serious

A:very likely as I m young male and my grand father died of it

A:early diagnosis increases the likelihood of cure

A:learning how to do it and remembering to do it

American cancer society recommends monthly testicular self examination for young men. This behaviour may reduce the risk of cancer

Theory

of Planned behaviour(TpB): behaviour is influenced by 1) beliefs about the outcome of behaviour 2) beliefs about expectations of the others 3) control believes about what factors might influence the success of behavioural change -when people have resources and opportunities they are more likely to believe they can successfully change their behaviour

-example: theory applied to reduce risk of cardiovascular disease by exercising on regular basis 1- Believes and attitude about out come: I have heard that the sign of heart disease is shortness of breath on exertion. I feel short of breath when I climb stairs. My father died of heart attack at age of 55. May be I can improve my chances of living longer by starting exercise

2- Believes about others attitude: My family would be upset if I died soon. 3-Control believes: I can take out 30 mins between classes to walk. I will miss cafeteria and friends but they will understand. I know I have self discipline to walk -Intention: I am going to do it -Behaviour: now walks for 30 mins btw classes (friends decided to join)

Theory

of reasoned action(TRA): that people take action if they believe a behaviour change will achieve a desirable outcome and that other people whose opinion is important also believe the change is desirable -acc to TRA peoplepl also consider likelihood of the goal being achieved

-example: a man believes that having alcohol every evening makes him relaxed and more loving to family but one evening his family tells him that they dislike it, in fact he smells bad and they feel embarrass in front of others -acc to TRA, he is more likely to stop if his attitude towards his behaviour becomes negative, he knows others disapprove his behaviour and he believes he has self control necessary to change

-many variables affect planned behaviour & reasoned action including past experiences, personality, age, gender, education, income and religion

Perceived

behavioural control: (modification of theory of reasoned action) the idea that humans are more likely to intend to change their behaviour if they believe they have the will and strength to do so

Transtheoretical

Model of Change: suggests that people go through a series of stages or phases when altering their behaviour -stages: 1)pre-contemplation: when a person is not thinking about changing behaviour 2)contemplation: when thinks about making change and weight pros & cons (including their & others attitude)

3) preparation stage: gets ready to implement the change 4)action or making change: actually changes behaviour 5)maintenance stage: adhere to change 6)termination: end of problem behaviour -people move through stages in spiral fashion and may regress to earlier or even to initial stage

Example:

Application of Transtheoretical model to reduce the risk of diabetes: stage-1 pre-contemplation: every other day I eat fast food stage-2 contemplation: mom told me my cousin has developed DM and I am of same age, I dont want to develop. Doctor asked her to cut back calories and exercise, so I should also consider this

stage-3

Preparation stage: I should find out about health class and take admission. I should find places where low fat diet is available stage-4 action or making change: I have joined the classes and started taking low calorie food stage-5 maintenance stage: In one year I have lost 15 kg stage-6 termination: I am sticking to this change

Relapse

prevention: -important concept in behaviour change therapy -efforts to avoid a lapse or reversion to pervious unhealthy behaviour -when planning a behaviour change expect relapses to occur -being aware of possibility of a relapse makes it possible to plan to avoid risky situation

-central to relapse prevention is planning & developing methods of coping in situation that pressure people to return to a behaviour they want to stop -relapse can be caused by psychological factors such as feeling lonely, bored, angry or stressed -relapse can also occur by social & cultural reasons like repeated ads

-Interventions could be at individual or community level. Community based: Change accomplished through changing socio cultural environment - health behaviour change can be carried at national, provincial or local level through changes in law - example: smoking banned at public places - drunk driving

Self-directed

behaviour change: is based on believe that people can change themselves is a tool that people can use to change their own behaviour Self-directed behavioural change has different categories

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Self-monitoring: Keeping records ones own behaviour If practised carefully provides many benifits This is act of change that encourages people to continue to work on the problem Example: Smokers who monitor their cigarette smoking usually cut down Over weight who monitor their eating behaviour But the effects are temporary

Goal

specification: Goals that are highly specific are more likely to be achieved -however they should be realistic and behaviour can only be gradually change -in deciding what is realistic, self monitoring records are useful

Stimulus

control: is term giving to the set of procedures that seek to alter the antecedent stimulus that control behaviour -Antecedent stimuli can be any of the three environments-physical, social and private

Self-reinforcement:

the subject delivers to himself a consequence, dependent on his behaviour these strategies are considered most powerful method of behaviour change Social

support: comes from the ppl who care for concerned individual

Health

psychology: Biological, Psychological & Sociocultural Perspective by Margaret Konz Snooks Health psychology: An introduction to behaviour and health. 4th edition by Linda Brannon & Jess Feist Health psychology: A cultural approach by Regan A.R.Gurung Text book of preventive & social medicine.3rd edition by Piyush Gupta