Health Psychology - Health and Well being Revision Year 1

Pain

Merskey (1979) - ‘An Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’.

Acute or Chronic

Simple-stimulus response Models

Von Frey (1985) - Specificity Theory

• The intensity of Pain is directly related to the amount of tissue involved. Specific sensory receptors are sensitive to specific stimulation. Specific pain receptors transmit signals to a ‘brain centre’ in the brain that produces the perception of pain.

GoldSchneider (1920) - Pattern Theory

• Link between cause and pain is direct, nerve impulses determined by the degree of pain. Any somaesthetic occurred by a particular pattern of neural firing and that the spatial and temporal profile of firing of the peripheral nerves encoded the stimulus type and intensity.

Assumptions:

• Tissue damage causes the sensation of pain

• Psychology is the consequence E.g. Fear, anxiety.

• Pain is automatic

• Psychogenic or organic pain?

Challenges:

• Phantom Limb Pain

• Pain without obvious organic cause

• Placebo effect

• No room for moderation/interpretation

• Psychology has no causal influence

• Sensation of pain is caused by the amount of tissue damage

Beecher (1956) - Individuals with the same degree of tissue damage differed in their reports of pain. 80% of Civilians requested pain relief compared to 25% of soldiers. This suggests variation between individuals - The Anzio Beachhead in World War 2.

Melzack and Wall (1982/65) - The Gate Control Theory

Input to the Gate: Peripheral nerve fibres, descending central influences from the brain, large and small fibres.

• A simple stimulus-response model that acknowledges psychosocial factors.

• A gate in the substantia gelantosa of the dorsal horn

• C fibres and A-delta fibres carry pain signals to the spinal cord. A delta fibres are faster and carry sharp pain signals whilst the C fibres are slower and carry diffuse pain signals.

Physical - (Opening) - Activation of large fibres, injury.

(Closing) - medication, stimulation of small fibres.

Psychological - (Opening) - Anxiety and depression.

(Closing) - Happiness, relaxation, optimism.

Social - (Opening) - Focusing on the pain, boredom.

(Closing) - Concentration and distraction.

Strengths:

• Understands pain as a perception

• The individual is active, not passive

• Understands the role of individual variability

• Role for multiple causes

• Is pain ever organic?

• Pain and Dualism

Weaknesses:

• No location of the gate

• Still a simple-stimulus response model

• Assumes organic basis for pain

• Mind and body - separate processes

Mccaffery and Pasero (1999) - 4 stages of pain

1. Transduction - Free nerve endings of C fibres and A delta fibres respond to noxious stimuli.

2. Transmission - Impulses move from the nociceptor fibres to the dorsal horn in the spinal cord, then from the spinal cord to the brainstem then through connections in the thalamus and cortex.

3. Perception - Perception of Pain

4. Modulation - Involves changing or inhibiting transmission of pain impulses in the spinal cord.

Fordyce and Steger (1979) - Chronic Pain Cycle

Unsuccessful treatment of pain → Increased anxiety → Increase in Pain → Pain increases anxiety → Unsuccessful treatment of pain…

Mcgowen et al (1998) - Correlation between high anxiety and increased pain perception in children with migraines and people with back/pelvic pain.

James et al (2002) - Measured anxiety using a cold pressor test - distractions and low anxiety reduced the pain experience.

Church (2013) - Factors that affect pain - E.g. Cognition (attention, distraction, control, catastrophizing), Behavioural - reinforcement, Environment, age, gender, beliefs (expectations, culture, memory), genetics.

Rotter (1966) - Internal Vs External Locus of control

Internal - More likely to adopt health behaviours because they believe that they are in control of their lives.

External - More likely not to adopt a health behaviour because they believe that external forces are in control of their lives.

• Participants who were given control over situations were more likely to show behaviours that would enable would enable them to cope with potential threats, when compared with those participants who thought that chance or other non-controllable forces determined the effects of their behaviour.

Summary

• Early theories described pain as a simple-stimulus response

• Pain is now seen as a perception

• The Gate Control Theory highlights the role of psychology, but still a simple model for a complex process

• Bourbonnais (2003) - ‘Pain is a subjective and multifaceted phenomenon which is influenced by many factors such as culture, experience and situation’.

Stress

Definition: Any uncomfortable emotional accompanied by predictable biochemical, physiological and behavioural changes.

Acute or Chronic.

Biological Theories

Canon (1932) - Fight or Flight Theory - A short intense emergency stress reaction which is necessary for survival. Immediate response of the body in the pressure of the stressor.

It is an adaptive response therefore has an evolutionary purpose.

SNS releases adrenalin and noradrenalin - stopped if destroyed by other chemicals or PNS becomes activated - attack or escape/muscles become tight/alert to danger/senses heightened etc.

It is the immediate response of…

• The HPA Axis - Hypothalamic, pituitary adrenal system. This is the system which slows the body down and is the prolonged production of cortisol. Involves ACTH.

• Or the Sam Pathway - Sympathetic adrenal medullary. This is the system which speeds up the body and is the prolonged production of adrenalin and noradrenalin. This leads to physiological changes associated with stress.

Vitaline et al (1993) - Some people have greater sympathetic activation then others.

Seyle (1936) - General adaptation syndrome Theory

1. Alarm Reaction - The organism is ready for mobilisation. Provides a burst of energy

2. Resistance - Organism either flees or tries to cope with the stimulus.

3. Exhaustion - The organism has been repeatedly exposed to the stressor and can no longer resist. Energy is depleted. - Rats died at this stage

Clow (2001) - Individual Variability.

• Only activated in extreme circumstances

• Circulating cortisol lowest during sleep

Holmes and Rahe (1967) - Life events Theory

• In a clinical setting - 5000 patients

• Schedule of recent experiences - Life events - 43

• Top 5 events - Death of a spouse, divorce, death of a close family member, personal injury/illness, marriage.

• Involved the social readjustment rating scale.

• As life change units increase (stress), so did the rate of illness

Lichtenstein et al (1998) - Increase in mortality after spousal bereavement - most serious.

Kanner et al (1981) - Daily hassles more predictive of symptoms than life events. 117 Daily hassles and 135 Daily uplifts.

Newman et al (2006) - The role of cortisol activity in stress and eating.

Significant positive associations between number of hassles and snack in-take - high cortisol reactors.

Lazarus and Folkman (1987) - Transactional Model

• Primary Appraisal - Is this stressful? Involves being irrelevant, benign and positive, harmful, a threat and challenging.

• Secondary appraisal - Can I cope with this? Involves evaluating pros and cons of the different coping strategies.

Bandura (1977) - Self-efficacy.

Self-efficacy: One’s belief in one’s ability to succeed in situations or tasks.

• Participants were tested for avoidance towards a boa constrictor

• Systematic desensitisation - relaxation methods where participants are gradually exposed to the stressor.

• The more the participants interacted with the snakes, the higher their level of self-efficacy.

• Raising levels of self-efficacy is an effective technique to help them cope with stressful situations.

Physiological - Chronic stress response - prolonged production of epinephrine and norepinephrine and cortisol - high BP, HR, fat deposits, immune response - changes in disease process e.g. diabetes.

Behavioural - increased smoking, increased alcohol intake, diet - stress eating paradox, decrease in exercise, increase in number of accidents.

Psychological - changes in immune response - psychoneuroimmunology (PNI) - study about taste aversion with rats - Robert Hader 1970’s.

H.I.V - Chronic illness and management

Retrovirus - contains Ribonucleic acid.

• HIV damages the system by killing and infecting T-helper cells

• HIV molecule attached to the CD4 molecule of the T-helper cell

• Then virus then internalises into the cytoplasm of the cell where it copies the cell (multiplying) then enters the nucleus

• The host cell then generates new viral particles that bud off and infect new cells

• Eventually the T-helper cell dies - it damages their ability to signal for antibody production.

Damages the immune system by:

• T-helper cell attacking/stimulating other cells to attack invading cells

• Vulnerable to infection from bacteria, fungi, viruses malignancies and other potential invaders.

• AIDS is diagnosed by presence of unusual infections.

• HIV kills the cells in the lymph nodes and other sites. This throws the immune system off balance

Moos and Schaefer (1984) - Stages of crisis following diagnosis

Changes in identity, changes in location, changes in roles, changes in social support, changes in the future.

1. To preserve a satisfactory and sense of achievement or competence

2. To maintain a psychological equilibrium

3. To maintain positive relationships with family and friends

4. To prepare for an uncertain future

Kalichman (1998) - Higher transmission for receptive partner through vaginal intercourse.

Friedland and Klein (1987) - Possible transmission through the use of dirty needles and blood.

In 2012, an estimated 98,400 people were living with HIV.

Treatment: HAART (Highly active antiretroviral therapy)

• Lowers CD4 levels - prevents HIV replication

• Prevents mother to child transmission

• Decreases risk of infecting others

• Used in order to reduce the likelihood of the virus developing resistance

• Reduces mortality and morbidity rates in HIV infected individuals

Psychological and Social factors of Condom use:

Conscientiousness in drug taking - serious side effects of regimens often complex

Chesney (2003) - Non-adherence associated with risk of death

Dilono et al (2009) - Adherence predicted by medication taking - self-efficacy, negative affect of depression.

Sheeran and Obell (1998) - Homosexual men have an intention to use a condom that’s weaker with casual partner then with steady partner

Interventions to reduce HIV spreading:

• Information and Education about sex E.g. Sex education, programmes to reduce stigma and discrimination, counselling.

• Increasing condom use or treatment/needle exchanges/testing

• Reducing numbers of sexual partners

• Empower people - self-esteem/assertiveness E.g. Interventions to address inequality or laws protecting the rights of people with HIV

• Strengthen communities to safe norms and values

• Improve treatment for STDs (Increase vulnerability)

Why is management important?

Challis et al (2010) - Increases physical functioning, greater confidence, reduces anxiety and lead to improved adherence to treatment and medication regimes.

Ajzen (1991) - The Theory of Planned Behaviour

A social cognition model → An expectancy-value model → Individualist model

Connor and Armitage (1998) - Subjective Norm is weakest predictor

Elliot and Ainsworth (2012) - Descriptive Norms increased validity

Connor and Sparks (2005) - Successful model

Attitudes - Towards the specific act or behaviour. Positive and negative evaluations and beliefs about the outcome of behaviour.

E.g. Does not enjoy exercise, acknowledges benefits as well of risks of not exercising.

Subjective Norms - Our beliefs about what valued others expect us to do. The perception of social norms and pressure to comply.

E.g. People that are important to me will approve of…

E.g. GP and husband encourage exercise but no friends engage.

Perceived Behaviour control - The degree to which the person can control the behaviour - in consideration of internal and external factors.

E.g. Low control, lacks confidence but exercise classes are local. Can overcome potential barriers and challenges.

• Intentions are the best predictors of behaviour

• This model suggests that more favourable attitudes towards a specific act, more favourable subjective norms, and greater perceived behaviour control strengthen the intention to perform behaviour.

Becker and Rosenstock (1970) - The Health Belief Model

Lacks social values → Socialist model

Schwarzer (1992) - A static Model

Perceived susceptibility - A person’s assessment of the likelihood of them getting the illness/condition.

E.g. Believes keeping up behaviours can lead to obesity

E.g. My chances of getting cirrhosis of the liver is high

Perceived severity - The person’s view of how severely they would be impacted if they were affected by the condition/illness.

E.g. Believes it can lead to other health problems and can be avoided

E.g. Cirrhosis of the liver is a serious illness

Perceived benefits - The belief in how effective the advised medication/action will be in mitigating the problems of the condition/illness.

E.g. Diet and exercise could prevent obesity

E.g. Stopping drinking will save money

Perceived barriers - The person’s perceptions of the difficulties they would encounter in taking the proposed actions, including both physical and psychological barriers.

E.g. Embarrassed about lack of knowledge about exercise

E.g. Stopping Drinking will ruin social life

Self-efficacy - The person’s confidence and beliefs in their own ability to take the prescribed actions.

E.g. Build up confidence, allowing positive behaviours

Cues to Action - Prompts that are needed to move the person into the state where they are ready to take the prescribed action.

E.g. Reminders to exercise and rewards at weekends.

E.g. Symptoms of Cirrhosis of the liver - jaundice, vomiting blood etc.

Demographic/psychosocial variables - Age, sex, race, ethnicity, education, social class, socio-economic status.

Becker (1975) - Asthmatic Children - compliance with medical regimes

• Correlation between mother’s beliefs and childs susceptibility to asthma attacks

• Correlation between mother’s perception of the child have a severe attack and her administering the prescribed medication

• Negative correlations between costs of medication, treatment and compliance