Module: Health Psychology Lecture:Introduction to Health Psychology Date:19 January 2009

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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: C.Bridle@warwick.ac.uk www.warwick.ac.uk/go/hpsych. - PowerPoint PPT Presentation

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  • 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: C.Bridle@warwick.ac.uk www.warwick.ac.uk/go/hpsych

  • Aims and ObjectivesAim: 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 studiedlevels of clinical application of/for psychologypathways through which psychological processes influence physical health structure and content of the modulemodule 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 DefinitionHealth psychology is the study of psychological processes that influence health, illness and health careFour questions:In who do psychological processes exert influence, i.e. who gets studied?What types of psychological process are studied?How do processes influence health, illness and health care?In what ways can psychology be applied in clinical practice?

  • 1: Psychological Processes in Who?People who receive health carePatients: anyone interacting with a health care professional or serviceUsers: perceived presence of symptoms driving health care useConsumers: active, and proactive, care seeking by the asymptomatic People who provide health careProviders: professional responsibility to provide care directly to patientCarers: as above, but without professional responsibility People who organise health carePurchasers / managers: who fund and evaluate local service against benchmark quality indicator, e.g. treatment targetsPolicy- / Decision-makers: set national-level quality indicators, provide clinical guidance and allocate financial resources

  • 2. Processes Studied in Health PsychologyMultiple developmental influences, in particular BehaviourismSocial PsychologyCognitive Psychology

  • BehaviourismThe 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 behaviourTry to explain all behavior without going inside the black box, i.e. the mindBehaviour is a conditioned response occurring in the presence of a stimuliIf behaviour is learned, it can also be unlearned / modified through conditioned learning

    Operant conditioning (Skinner)

    Classical conditioning (Pavlov)

    Classical conditioning (Watson)

  • Behavioural ConditioningA 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 PsychologyThe scientific study of the way in which peoples thoughts, feelings, and actions are influenced by the social environmentEmpirical approach: Vary aspects of social environment and see how this affects thoughts, feelings, and/or behaviourPosit psychological processes as explanations for observed effectsClassic examples: Obedience

  • Milgrams Obedience StudyPain-induced learning (Milgram, 1963)Procedure: A study about learningAsk questions to another subject in the next roomAuthority figure instructs subject to administer increasing shock levels in response to wrong answersQuestion: How obedient will people be? Obedience measure: Shock level administeredLevels: moderate, strong, .very strong, intense, dangersevere, XXX

  • ObedienceResult: 65% administered highest shock levelInterpretation: 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 administrationNurses asked, by Dr on phone, to give patient a non-prescribed and incorrectly dosed drugResult:21 / 22 administered the drugInterpretation:Perceived legitimate authority facilitates obedience

    (Hoffling et al)

  • Cognitive PsychologyThe scientific study of basic mental abilities perception, learning, memory, language, problem-solving, etc. information-processing approachEmpirical approach: Vary information input, measure performance outputPosits psychological processes that account for observed effectsClassic examples: Stroop Effect

  • Stroop Effect(Stroop, 1935)Name the colour of each block: Start top left, work down and then acrossTwo measures: (1) response/reaction time, and (2) errorsEasy?Quick time?No errors?

  • This time coloured words instead of coloured blocks Name the colour in which the word is writtene.g. table the answer / response would be yellowyellowwhitepinkgreyblackorange yellowpurpleorangegreentanredgreenpurplegreyorangepinkblackorangewhiteyellow(Stroop, 1935)Not so easy? Took longer? Didnt finish? More errors?

    Answered yes to 1 or more above?

    That makes you .. NORMAL

  • Stroop EffectResult: Fewer errors and faster time to name color alone than in presence of word written in conflicting colourExplanation: Presence of conflicting colour word interferes with processing ability / task performance Conclusion: The meaning of a word is processed automatically, without intention

  • SocialPsychology+CognitivePsychologySocial Cognition=

  • Social CognitionThe scientific study of how people make sense of their social world: How they perceive, represent, interpret, and remember information about themselves, others and social groupsInformation processing in its social context Key question: Is the combined total more than the sum of its parts?

    What does social cognition offer over and above the contributions of social and cognitive psychology?

  • New methodologies:Stroop & Person-perception(Karylowski, et al., 2002)

  • New methodologies:Stroop & Person-perception(Karylowski, et al., 2002)

  • New methodologies:Stroop & Person-perception(Karylowski, et al., 2002)

  • Stroop and Person-PerceptionResult: Slower to read ink colour when colour and racial category mismatch than when they matchWhat do these data actually mean?Reaction Time (ms)Ink Color(Karylowski, et al., 2002) Racial categories come to mind automatically

  • In the Health ContextSocial categories are activated automatically during interactions with other peopleInteractions and decision-making potentially influenced by stereotypic beliefs and biased knowledgeHelps us understand evidence showing that, for certain social groups, clinicians offer less information, less support and are less clinically proficientprovide different treatments, preventive interventions and referral to specialist services

  • 3. Psychology and HealthDual Pathway Model: Two broad ways in which psychological processes may influence physical health PsychologicalProcessesBehaviourPhysicalHealthIndirect PathDirect PathIndirect Path

  • A Primer Psychoneuroimmunology (PNI)Lutgendorf & Costanzo (2003). PNI and health psychology: An integrative model. Brain, Behavior and Immunity, 17, 225-232Glaser & Kiecolt-Glaser (2005). Stress damages immune system and health. Discovery Medicine, 5, 165-169Antoni et al. (2006). The influence of bio-behavioral factors on tumour biology: pathways and mechanisms. Nature Reviews (Cancer), 6, 240-248

  • PsychologicalAppraisalSalientEventEndocrine System Immune SystemPhysical and PsychologicalHealth StatusNerves

    Hormones

    Psych Processes

    MetabolicdysfunctionCardiovascular SystemNervous System: PhysiologicalReactivityLoweredimmunityEssentialHypertensionHypervigilance - more eventsSensitivity - more severeChronicStressGI: IBS, ulcersRS: impotence, amenorrheaReS: asthma, hyperventilationPsych: cognitive decline, morbidity

  • 4. Clinical ApplicationThree basic levels at which psychological principles (knowledge and techniques) can be applied:Awareness of patients psychological state Knowledge of basic psychological issues relevant to context (e.g. condition), patient-centred communicationIntervention in the form of brief counsellingEmotional care, motivational support, behavioural advice, informational and educational care Therapy from relevant psychological therapistKnowing when and where to refer, screening for caseness, engaging in/with a care team, follow-up, case management, etc.

  • Module Aims / ObjectivesBlock 1: Beforeto conceptualise the interplay between biological, psychological and social factors in health by considering core psychological constructs underlying health-related behaviours and beliefs.Block 2: Duringto app