A2 Psychology G543 Health

Becker's health belief model

Sample: 111 mothers with children aged 9 months to 17 years, who were interviewed about their health beliefs

Method/Procedure: asked to complete self-report on their adherence to their child's asthma regime. Did blood tests on some children to test validity

Results: Positive correlation between Mother's Health belief and their compliance with regime

Notes: Costs & benefits included disruptions to daily life, accessibility to chemists etc.

Demographic variables: married women more likely to adhere, women with a degree more likely to adhere.

Locus of Control and the Health Belief Model

Locus of control is measured by questionnaire, where statements about health beliefs are given and participants must choose how far they agree or disagree.

3 loci of control:

Internal: take responsability for own health 'I am in control of my own health'

Powerful Others: Doctors of family are responsible for health 'Health professionals control my health'

Chance: fatalistic about health 'If it's meant to be, I will stay healthy'

Bandura's theory of self efficacy

There are 4 influences of self efficacy:

1. Enactive Influences: past experiences of passing or failing will affect confidence

2. Vicarious influences: Comparing self with others who have also passed/failed

3. Persuasory influence: self-efficacy can be enhanced by positive feedback

4. Emotive influences: over-emotive influences may lead to lower self efficacy - needs to be just right

Self efficacy: the belief that one can carry out a behaviour successfully (in terms of health, e.g. giving up smoking, taking a difficult course of treatment, dieting)

Cowpe

Sample: 10 TV regions in UK encluding Granada, Harlech, Tyne Tees & Central TV areas over 1976-1984

Method/Procedure: Chip pan fire prevention adverts shown to area

Results: Over 12 month period, 33% decline in chip pan fires, 34% increase in awareness

Conclusions: Media campaigns work in promoting healthy behaviours

Notes: Overexposion to media campaign can reduce effectiveness due to reduced shock factor, desensitisation, boredom etc

Dannenberg

Sample: 7322 children in 3 Maryland counties

Method/Procedure: 3 conditions: Howard county promoted bike safety by legislation, Baltimore none, Montgomery by and educational campaign. Parents given questionnaire with 4 point likert scale on child's bike helmet usage

Results: 26.1% increase in bike helmet usage in Howard county, 87% children aware of law

Conclusions: Legislation is more effective than educatiional campaigns in promoting healthy behaviours

Janis and Feshbeck

Sample: Freshmen class at US high school

Method/Procedure: given questionnaire on dental health 1 week before lectures. 4 conditions:

1. Strong fear arousal & direct statements

2. Moderate fear arousal & factual statments

3. Minimal fear arousal & neutral information

4. Control (lecture on the human eye similar to condition 3)

Results: 36% change in dental health behvaiours in minimal fear group

Conclusions: Relatively low fear arousal is optimal to promote health

Bulpitt

Sample: Males given medication for high blood pressure

Method/Procedure: Analysed physcially & psychological effects of drug druing 1981-1985. Side effects of drug included erectile dysfunction

Results: in 1981, 15% participants stopped taking the medication due to erectile dysfunction

Conclusions: Interest in short-term gain is more attractive than long-term reward when thinking and acting on health beliefs

Becker's health belief model

Sample: 111 mothers with children aged 9 months to 17 years, who were interviewed about their health beliefs

Method/Procedure: asked to complete self-report on their adherence to their child's asthma regime. Did blood tests on some children to test validity

Results: Positive correlation between Mother's Health belief and their compliance with regime

Notes: Costs & benefits included disruptions to daily life, accessibility to chemists etc.

Demographic variables: married women more likely to adhere, women with a degree more likely to adhere.

Watt et al

Sample: 32 Australian children aged 1.5-6 prescribed standard inhaler for Asthma

Method/Procedure: spent 1 week on standard inhaler & parents completed questionnaire at the end of the week

spent 1 week on funhaler & parents completed questionnaire at the end of the weeks

Results: 38% moere parents medicated child on previous day when using funhaler compared to standard inhaler

Conclusions: operant conditioning (using positive & negative reinforcement) can improve adherence to health behaviours

Johansson

Sample: 24 swedish sawmill workers

Method/Procedure: 2 conditions: 14 high-risk workers - high pace production line, extensive knowledge of product & dangerous equipment.

10 control group - maintenance workers, cleaners etc.

Measured stress by urine samples 4 times a day at work and at home and questionnaires reporting quantitatively mood and wakefulness, alcohol and coffee consumption & social psychological questionnaire

Results: control group stress levels declined throughout day, high risk group increased (felt rushed and irritated, rated lower wellbeing throughout the day)

Conclusions: Work can be a cause of stress

Kanner

Sample: 100 Californians

Method/Procedure: tests sent out a month before study began. Completed hassles rating every month for 9 months, life events rating after 10 months, Hopkins symptoms checklist & Bradburn Morale scale every month for 9 months

Results: hassles correlated positively with psychological symptoms on HSCL

Conclusions: Hassles contribute to stress symptoms more than life events (constant, consistent, less likely to get social support for them)

Geer and Maisel

Sample: 60 psychology students from New York 

Method/Procedure: Participants shown dead car crash victims & response measured by heart monitor and galvanic skin response (sweat). 3 conditions: 

1. control and predictability

2. no control and high predicability

3. no control and no predictability

Results: Group 2 was the most stressed. Heart rate wasn't used as a measure 

Conclusions: Anticipation causes stress

Johansson

Sample: 24 swedish sawmill workers

Method/Procedure: 2 conditions: 14 high-risk workers - high pace production line, extensive knowledge of product & dangerous equipment.

10 control group - maintenance workers, cleaners etc.

Measured stress by urine samples 4 times a day at work and at home and questionnaires reporting quantitatively mood and wakefulness, alcohol and coffee consumption & social psychological questionnaire

Results: control group stress levels declined throughout day, high risk group increased (felt rushed and irritated, rated lower wellbeing throughout the day)

Conclusions: Work can be a cause of stress

Johansson

Sample: 24 swedish sawmill workers

Method/Procedure: 2 conditions: 14 high-risk workers - high pace production line, extensive knowledge of product & dangerous equipment.

10 control group - maintenance workers, cleaners etc.

Measured stress by urine samples 4 times a day at work and at home and questionnaires reporting quantitatively mood and wakefulness, alcohol and coffee consumption & social psychological questionnaire

Results: control group stress levels declined throughout day, high risk group increased (felt rushed and irritated, rated lower wellbeing throughout the day)

Conclusions: Work can be a cause of stress

Johansson

Sample: 24 swedish sawmill workers

Method/Procedure: 2 conditions: 14 high-risk workers - high pace production line, extensive knowledge of product & dangerous equipment.

10 control group - maintenance workers, cleaners etc.

Measured stress by urine samples 4 times a day at work and at home and questionnaires reporting quantitatively mood and wakefulness, alcohol and coffee consumption & social psychological questionnaire

Results: control group stress levels declined throughout day, high risk group increased (felt rushed and irritated, rated lower wellbeing throughout the day)

Conclusions: Work can be a cause of stress

Meichenbaum

Sample: 21 students with exam anxiety

Method/Procedure: 3 groups: waiting list (control), SIT, and systematic desensitisation (SD)

received 8 therapy sessions

Results: SIT group improved the most in test performance and anxiety levels

Conclusions: Cognitive techniques work better than behavioural techniques at managing stress

SIT

1) Initial conceptualisation (identifying stressors and irrational thoughts)

2) Skills aquisition (learning coping strategies and reframing)

3) Application & followthrough (putting techniques into practice in real life situations)

Meichenbaum

Sample: 21 students with exam anxiety

Method/Procedure: 3 groups: waiting list (control), SIT, and systematic desensitisation (SD)

Given PMR training & practice at home while imagining anxious situations 

8 sessions

Results: Found to be better than on waiting list

Conclusions: Behavioural technqiues of managing stress work

Waxler-Morrison

4 types of social support -

Emotional: Offering empathy/concern to let the person know they are valued (+ real life example)

Tangible: Offering financial help, material goods or services as a practical way of helping (+ real life example)

Informational: Providing assistance, guidance or information to help the person problem-solve (+ real life example)

Companionship: Providing a sense of social belonging to get someone to engage in social activites to reduce stress (+ real life example)

Perceived support - recipient's judgement that providers offer effective help during times of need

Recieved support - specific supportive actions offered by providers during times of need

ICD 10 vs DSM V

ICD:

• Developed by WHO
• Mainly used outside outside USA
• Has 10 main groups of mental disorders including schizphrenia, mood disorders etc.
• Specific subcatergories within each group
• Provides a description of main clinical features & diagnostic guidlines

DSM:

• Developed by American Psychiatric Association
• Multi-axial (has different levels of disorders)
• Used in USA
• 5 axes:
  • clinical disorders, personality disorders and mental retardation, general medical conditions, psychosocial and environmental problems, global assessment of functioning

Rosenhan and Seligman

1) Statistical Infrequency - rare in occururance in population, eg schizophrenia

2) Deviation from Social Norms - eg in olden days, homosexuality was deviant

3) Failure to Perform Adequately - Failure to cope with the demands of everyday life eg depression

4) Deviation from Ideal Mental Health - Jahoda's definition of ideal mental health

• Have a positive view of self
• be capable of some personal growth
• be independant and self-rewarding
• have an accurate view of reality
• be resistant to stress
• be able to adapt to environment

Ford and Widiger

Sample: 266 clinical psychologists

Method/Procedure: Sent a written case study of a scenario & had to identify illness from HPD, ASPD & BPD (among others) on a 7 point scale. 3 Conditions: Male, Female or Unspecified.

Results: Unspecified diagnosed most with BPD. Incorrect diagnosis of HPD for ASPD female 16%, male 15%

Conclusions: There is a tendency to diagnose females with HPD and males ASPD, creating gender bias in diagnosis

Notes:

HPD - Histronic personality disorder

ASPD - anti social personality disorder

BPD -  borderline personality disorder

Kendler

Sample: MZ (identical) and DZ (non-identical) twins

Method/Procedure: measured rate of concordance of phobias in twins. If MZ concordance is significantly higher than DZ, there is a genetic component.

Results: Animal Phobia in female MZ twins was 25.9 compared to DZ at 11.0

Conclusions: There is no one explanation - can't ignore environmental factors

Watson and Raynor

Sample: 1 baby boy, 'Little Albert' (had a developmental disorder)

Method/Procedure: Given classical conditioning to create fear of white rat, rabbit, cotton wool and santa claus mask. Used steel bar being hit as UCS.

Results: Managed to create strong fear of rats in Albert after 10 sessions. Wasn't as afraid of rabbit.

Conclusions: Behavioural techniques can cause dysfunctional behaviour

Clark and Wells model

Conclusion: Irrational thinking can cause dysfunctional behaviour

McGrath - Systematic desenitisation

1) Create fear hierarchy - rate/scale phobia most-least fearful - Lucy used 'fear thermometer'

2) Find positive association to act as unconditional stimulus - Lucy imagined being at home with toys & learned deep breathing

3) Start paired association between feared stimulus and positive association - Lucy feared loud noises like balloons popping

4) Gradual exposure using fear hierarchy - usually takes 8-12 sessions - Lucy had 10

After 10 sessions, Lucy's fear of party poppers went from 9/10 to 3/10

Conclusions: Behavioural techniques are an effective way of treating dysfunctional behaviours

Leibowitz

Sample: 80 patients aged 18-50 that met DSM criteria for social phobia, hadn't been on phenelzine for 2 weeks before trial

Method/Procedure: tested using Hamilton rating scale of anxiety and Leibowitz social phobia scale. 4 groups: Phenelzine (anti-anxiety drug), Phenelzine placebo, Atenolol (a beta blocker), Atenolol placebo

Results: Phenelzine group had better scores on anxiety test. No significant difference between atenolol and placebos

Conclusions: Biological treatments are an effective way of treating dysfunctional behaviour

Ost and Westling

Sample: 38 patients in therapy for panic disorder

Method/Procedure: randomly assigned to either CBT or applied relaxation

Results: 74% panic free after treatment, 89% panic free patients after 1 year

Conclusions: CBT is effective and long-term treatment for dysfunctional behaviour

Phobia

• definite, persistent fear of a particular object or situation. provokes immediate response 
• Must be disrupting to everyday life to be considered a phobia

ICD

• highly specific situations, discrete trigger that evokes panic
• all symptoms must be primary manifestations of anxiety
• must be restricted to the presence of particular phobic object or situation
• avoided when possible

DSM

• marked and persistent fear that is excessive or irrational
• exposure provokes immediate response
• person recognises fear as excessive & avoids it
• disrupts normal life

Depression

• reduced concentration, lack of self esteem, pessimism, disturbed sleeping and eating patterns, complaining of 'feeling nothing'. can be expressed as irritability in children

ICD

• depressed mood, loss of interest and enjoyment, reduced energy, marked tiredness after little effort. reduced concentration, reduced self esteem and confidence, guilt and unworthiness, pessimistic view of future, self-harm or suicide, disturbed sleep, diminished appetite
• different severities have different timescales eg. Mild has minimum duration of 2 weeks

DSM

• 5 or more sysmptoms present during same 2 week period & represent a change from previous functioning:
  • Insomnia, tiredness, less ability to concentrate, fidgeting or lethargy, feelings of worthlessness or guilt, recurrent thoughts of death
  • not caused by medication, bereavement  etc

Schizophrenia

• positive symptoms: delusions, hallucinations & thought disorder
• negative symptoms: lack of emotional response, pleasure, motivation

ICD

• One clear (usually two or more) symptom out of: thought insertion, delusions of control, hallucinatory voices, persistent delusions & hallucinations
• two or more less severe symptoms (such as negative symptoms) present for most of the time during 1 month period or more
• different types eg. paranoid, catatonic etc.

DSM

• Two or more symptoms present for significant portion of time during 1 month: delusions, hallucinations, disorganised seepch, disorgansied behaviour, negative symptoms
• continuous signs of disturbance present for at least 6 months.