Health Psychology Studies

Becker

• Background: research was conducted when a doctor became interested in why individuals did not go for TB screening even though it was free of charge. It takes into a cost-benefit analysis including factors such as perceived seriousness and susceptibility. 
• Aim: To use the HBM as an explanation of levels of adherence in mothers administering a drug regime to their asthmatic children
• Participants: 111 mothers attending an emergency paediatric facility with their asthmatic children, aged 17 - 54
• Methodology: Quasi experiment
• Procedure: 45 minute interviews conducted with the mothers asking questions about their levels of adherence, perceived seriousness, accessibility of chemists etc. Blood tests then conducted on some children to cross validate the adherence levels.
• Results: Positive correlation found between adherence and the perceived seriousness and susceptibility. Negative correlation between adherence and inaccessibility of chemists and children's complaints. 
• Conclusion: Becker concluded that the HBM was a useful tool to explain health behaviours such as adherence, but also that it was a useful explanation of other non-health behaviours.

Rotter

• Background: Locus of control refers to the causal factor in which an individual attributes the change in behaviour or circumstance. An internal LOC is the person's belief that their own actions caused a change in behaviour, whereas an external LOC is the belief that chance or fate was the causal factor.
• Aim: Internal vs External locus of control
• Participants: Review article of 6 pieces of research 
• Methodology: Lab experiment
• Procedure: Perceptions of ability to control outcomes using reinforcement
• Results: Participants who felt in control were able to cope with potential threats
• Conclusion: An individuals LOC affects many of their behaviours, and is not limited to health behaviours.

Bandura and Adams

• Background: Self efficacy is the conviction that your behaviour influences the outcome 
• Aim: To assess the self-efficacy of partcipants undergoing systematic desensitisation
• Participants: 9 male 1 female snake phobic, aged 19 - 57, volunteers replied to an advertisement.
• Methodology: Quasi Experiment
• Procedure: Self efficacy measured on the General Self-Efficacy Scale before and after the procedure. Avoidance behaviour also assessed before and after the desensitisation, effectiveness analysed.
• Results: Efficacy levels had a positive correlation with snake interaction. Desensitisation was found to be an effective treatment. 
• Conclusion: Systematic desensitisation led to an increase in the participants' self-efficacy, leading them to believe they could cope with the phobic stimulus

Chung and Naya

• Background: Doctors have been found to be inaccurate in estimating their participants' adherence rate, often over estimating their levels.
• Aim: To measure levels of adherence in asthmatics taking oral medication
• Participants: 57 asthmatic individuals
• Methodology: Simple data collection
• Procedure: An electronic TrackCap was used to measure the adherence levels of the participants, this recorded the date and time every time the medication was used. The patients were told that their adherence was being measured but were given no further details.Patients were said to be adhering if the medication was taken twice a day, 8 hours apart. 
• Results: Adherence was found to be quite high at 71%, although the adherence of returned tablets was found to be even higher at 92%
• Conclusion: Adherence to asthma medication regimes is quite high

Bulpit

• Background: Cost-benefit analysis where the costs outweigh the benefits to the individual 
• Aim: To review research into non-adherence in hypertension patients
• Participants: Research articles identifying problems with taking the prescribed drugs
• Methodology: Review article
• Procedure: Hypertensive drug side effects include lack of sexual functioning, sleepiness and reduced cognitive functioning
• Results: in one study, 8% of men stopped taking the drugs due to sexual problems, 15% stopped due to other side effects
• Conclusion: Costs sometimes outweigh benefits, especially with asymptomatic effects

Watt

• Background: There are many ways to improve adherence to a medical regime, reducing costs, using rewards etc
• Aim: To see if the Funhaler would improve compliance to a medical regime in asthmatic children
• Participants: 10 male and 22 female Australian asthmatic children, mean ages of 3.2 years 
• Methodology: Field experiment, Repeated measures design
• Procedure: Participants used the Breath-a-Tech inhaler for a week and a questionnaire was given. They were then given the Funhaler for a week followed by the same questionnaire. The Funhaler whistled and had a spinner which spun when it was correctly used.
• Results: 38% more parents medicated their child the previous day when using the Funhaler
• Conclusion: The Funhaler removed boredom and forgetfulness by reinforcing correct usage, making the regime fun and therefore improving adherence.

Cowpe

• Background: Chip pan fires were the biggest cause of domestic house fires, 
• Aim: To see if media campaigns are effective in reducing chip pan fires
• Participants: Anyone watching ITV between 1976-1984
• Methodology: Field experiment
• Procedure: 60 second long advert showing the consequences of in-attendance and over-filling of chip pan fires.
• Results: Reduction of chip pan fires by 33% initially, 17% reduction six months after the adverts were shown. Awareness increased from 12-28%
• Conclusion: There is a causal relationship between advertising and reduced chip pan fires. However advertising effect decays over time. 

Dannenberg

• Background: Some legislations are effective (eg. the seat belt law), some are not and are revoked.
• Aim: Investigating the impact of passing a law making children wear cycle helmets
• Participants: Children under the age of 16. 7322 questionnaires sent out, 47 schools participating. Law passed in Howard County, Media Campaign in Montgomery.
• Methodology: Field experiment
• Procedure: Questionnaires sent out with a 4 point likert scale.
• Results: After the law was passed, 87% were aware and 38% wore a helmet on their last ride. The law saw a large increase while the campaign saw only a slight increase.
• Conclusion: Legislation has a greater effect than media campaigns.

Janis and Feshback

• Background: Fear arousal's are persuasive messages emphasising harmful consequences. The audience is motivated to accept the recommendations.
• Aim: To study the motivational effects of different fear intensities
• Participants: 150 students, mean age 15
• Methodology: Lab experiment, Independent Measures
• Procedure: Participants split into 3 groups, High fear intensity: emotive language and images, Medium: descriptions with impersonal language, Low: No consequences or emotions, Control group: structure of the eye lecture. Before and after questionnaires filled out. 
• Results: High fear: anxiety = 42%, change = 8%, Low fear: anxiety = 24%, change = 36%
• Conclusion: High fear intensities are not necessarily best, they must suit the target audience

Holmes and Rahe

• Background: Questionnaires, interviews and diaries are often used as self-report measures
• Aim: Life events as stressors
• Participants: 179 male, 215 female, range of educations, ethnicities and religions
• Methodology: Questionnaire
• Procedure: Questionnaires sent out to participants who had previously completed another questionnaire. Marriage given an arbitrary rating of 50 and ps told to base their ratings around this on their own experiences and perceptions of others' experiences. Social Readjustment rating Scale based on the mean scores.
• Results: Death of spouse given 100, Christmas given 12. Correlations high between all participants
• Conclusion: The degree of similarity between groups is impressive and shows agreement

Johansson

• Background: Work is an ambient stressor
• Aim: To investigate the stress levels of workers in a swedish sawmill
• Participants: 14 high risk finishers whose work was machine paced, highly skilled, isolated and responsible for determining the wages of the rest of the factory, 10 low risk cleaners whose work was social, varied, unskilled and self paced.
• Methodology: Quasi experiment, repeated measures
• Procedure: Adrenaline measured 4 times every 24 hours, on work days and rest days. Absenteeism and stress related illness records analysed, self report questionnaires completed.
• Results: Levels of adrenaline higher on work days than rest days. Higher levels of absenteeism and stress related illness in the high risk finishers than in the low risk cleaners.
• Conclusion: A combination of work stressors (repetition, machine pace, responsibility) lead to chronic physiological arousal and therefore stress related illness and absenteeism.

Geer and Meisel

• Background: It is a lack of control over the situation that cause a stressful reaction in individuals
• Aim: The effect of control in reducing stress reactions
• Participants: 60 New York University students
• Methodology: Lab experiment, Independent measures
• Procedure: Group 1: control over the photos, Group 2: no control but made aware what would happen, Group 3: no control or warning. The photos were preceded by a 10 second warning tone and were kept up for 35 seconds. GSR and heart rate electrodes were used to collect data.
• Results: Heart rate electrodes found no significant evidence. Group 2 showed the most stress to the tone. Group 1 showed the least stress to the photos than groups 2 and 3.
• Conclusion: It is likely that stressful impact can be reduced by having control over the situation

Kanner

• Background: Evidence suggests minor stressors can combine into large stressors
• Aim: To compare two methods of stress measurement, the Hassles and Uplifts Scale and the Berkman Life Events Scale.
• Participants: 216 contacted, 109 agree, 9 drop out. California, white, had completed a previous survey.
• Methodology: Longitudinal, Repeated measures
• Procedure: HRS completed for 9 months, LES completed after 10 months, BMS and HSCL completed every month for 9 months
• Results: Men had a positive correlation between life events and hassles, and a negative correlation between life events and uplifts. Women had positive correlations with life events and both. 
• Conclusion: The hassles and uplifts scale is a better symptom predictor

Johansson

• Background: Work is an ambient stressor
• Aim: To investigate the stress levels of workers in a swedish sawmill
• Participants: 14 high risk finishers whose work was machine paced, highly skilled, isolated and responsible for determining the wages of the rest of the factory, 10 low risk cleaners whose work was social, varied, unskilled and self paced.
• Methodology: Quasi experiment, repeated measures
• Procedure: Adrenaline measured 4 times every 24 hours, on work days and rest days. Absenteeism and stress related illness records analysed, self report questionnaires completed.
• Results: Levels of adrenaline higher on work days than rest days. Higher levels of absenteeism and stress related illness in the high risk finishers than in the low risk cleaners.
• Conclusion: A combination of work stressors (repetition, machine pace, responsibility) lead to chronic physiological arousal and therefore stress related illness and absenteeism.

Geer and Meisel

• Background: It is a lack of control over the situation that cause a stressful reaction in individuals
• Aim: The effect of control in reducing stress reactions
• Participants: 60 New York University students
• Methodology: Lab experiment, Independent measures
• Procedure: Group 1: control over the photos, Group 2: no control but made aware what would happen, Group 3: no control or warning. The photos were preceded by a 10 second warning tone and were kept up for 35 seconds. GSR and heart rate electrodes were used to collect data.
• Results: Heart rate electrodes found no significant evidence. Group 2 showed the most stress to the tone. Group 1 showed the least stress to the photos than groups 2 and 3.
• Conclusion: It is likely that stressful impact can be reduced by having control over the situation

Meichenbaum

• Background: SIT has three stages: conceptualisation, skill acquisition and rehearsal, application and follow through.
• Aim: To compare Stress Inoculation Therapy, Systematic Desensitisation and a control group
• Participants: 21 students 17 - 25. Responses to an advert, matched on anxiety levels and gender.
• Methodology: Lab experiment, Matched pairs.
• Procedure:  IQ and Anxiety Adjective tests used. SIT and SD both had 8 sessions. SIT group were taught positivity over negativity and the SD group were taught relaxation techniques. The control group were told they were on the waiting list for therapy.
• Results: Both therapy groups had a significant decrease in stress compared with the control group. The SIT had a greater impact than the SD.
• Conclusion: SIT is a more effective therapy than other techniques in reducing stress.

Budzynski

• Background: Biofeedback is where the individual is taught relaxation techniques which lower physiological stress reactions such as heart rate. They are shown a screen throughout where they can see their heart rate reducing in response to the techniques. Visual feedback, relaxation techniques, repetition and application.
• Aim: To see if biofeedback was effective in reducing stress related headaches, or whether it was a placebo effect
• Participants: 2 male, 16 female. 22 - 44, responses to an advertisement, screened over the phone, psychiatric and medical examination.
• Methodology: Lab experiment, Independent measures.
• Procedure: Group A = biofeedback, B= relaxation and pseudo feedback, C = waiting list. 2 week records of headaches rated on a scale of 0 - 5 (mild - severe). Psychometric tests taken indicating depression, hysteria and hypochondria.
• Results: Group A has less muscle tension than B and only the hypochondria levels of Group A reduced.
• Conclusion: Biofeedback is an effective method in reducing tension headaches

Waxler-Morrison

• Background: Sklar and Amisman found that stress did amplify cancer growth rate
• Aim: To document the influences of social relationships on cancer survival rates in women
• Participants: 133 women aged <55, all with a confirmed diagnosis of breast cancer
• Methodology: Quasi experiment
• Procedure: The women all had differing levels of social support. They were each sent a questionnaire about their demographics, such as social networks, educational levels, familial and other support.
• Results: There were found to be six aspects of social networks linked to survival: marital status, friend support, friend contact, total support, social network and employment.
• Conclusion: The more social support, the greater chance of survival. Though, of course, the type of cancer is the most influential factor.

Schizophrenia

• Distorted awareness and thinking. Delusions (a belief that is maintained despite it being contradicted by reality) and hallucinations (an experience involving the perception of something not present) are common.
• ICD-10: Delusions of control, persistent delusions or hallucinations, incoherence or irrelevant speech, catatonic behaviour, social withdrawal, significant change in aspects of personal behaviour.
• DSM-IV: Two or more of the following - delusions, hallucinations, disorganised speech, at least 6 months in duration, no other explanation such as a developmental disorder or drug use.
• Symptoms can be positive or negative: positive = behaviour is additional to the person's normal appearance, negative = behaviour that is usually normal to the person is removed.

Specific Phobia

• Response to certain objects or situations with fear and dread. Physical signs of this such as sweating.
• ICD-10: psychological syptoms are due to anxiety and are not secondary, fear is restricted to the particular object or situation,the situation is avoided by the indivual when possible, phobia disrupts the person's normal daily life.
• DSM-IV: marked and persistent excessive fear, exposure to stimulus evokes immediate anxiety response, phobic situation is avoided, phobia disrupts the individual's normal life.

Depression

• Persistent feelings of sadness, periods of elation or fluctuations from the two extremes
• ICD-10: Symptoms must be present for at least 2 - 3 weeks, loss of interests and enjoyment, reduced energy, reduced self esteem and confidence, disturbed sleep, reduced apetite.
• DSM-IV: At least 5 of the following, insomnia most nights, tiredness, feelings of worthlessness or guilt, impaired ability to concentrate, recurrent thoughts of death, loss of appetite.

Wender

• Background: Biochemical, Catecholamine, Serotonin and Cortisol hypotheses. Genetic research often looks into monozygotic and dizygotic twins and the occurence of depression, the results never show 100% environmental causes.
• Aim: The contribution of genetics and environment in the aetiology of mood disprders. To investigate the occurence of depression in the biological and adoptive relatives of depressed individuals.
• Participants: Biological and adoptive relatives of 71 depressed participants with a mean age of 43.7. Biological and adoptive relatives of 71 non-depressed participants with a mean age of 44. All removed form their mothers at an early age.
• Methodology: Quasi experiment
• Procedure: Psychiatric evaluations of relatives made independently
• Results: 8 fold increase in the occurence of depression in biological relatives of the depressed adoptees, 15 fold increase in suicide in the biological relatives of adoptees with depression.
• Conclusion: There is a significant genetic link in unipolar depression

Beck

• Background: Looks into negative and irrational thoughts and incorrect inferences. Overlaps with behavioural CBT. Ellis proposed the depressive cognitive triad: overgeneralisation, non-logical inference, dichotomous thinking.
• Aim: To understand how depressed thinking differs to normal
• Participants: 50 depressed participants with psychotic, manic and neurotic depressive reactions.
• Methodology: Self - report, matched pairs
• Procedure: Matched on age, gender and social position. Clinical interviews, free association, formal analysis and thought diaries.
• Results: Clear differences were found between depressed and non-depressed individuals. Low esteem, overwhelming responsibility and paranoya.
• Conclusion: Illogical basis for negative and irrational thoughts characterises depression.

Lewinsohn

• Background: Suggests depression may be learnt through operant and classical conditioning and the social learning theory 
• Aim: To compare the effects of positive reinforcement in depressed and non-depressed participants
• Participants: 30 participants, 10 depressed, 10 with another disorder, 10 as a normal control group
• Methodology: Longitudinal, Quasi experiment, Independent measures 
• Procedure: Over 30 days, took part in 320 activities, these were rated twice on a scale of 1 - 3 on the Pleasant Activities Scale which acted as positive reinforcement, also completed a Daily Depression Adjective Checklist.
• Results: A positive correlation between mood and positive reinforcement was found although there were individual differences
• Conclusion: There is a link between positive reinforcement and mood, some individuals were influenced more than others. 

Karp and Frank

• Background: Antidepressants such as Prozac act upon the neurological system by preventing serotonin being reabsorbed by nerve cells. They assume there is a chemical imbalance.
• Aim: To compare drug, non drug and combined treatments
• Participants: 520 depressed women 1974 - 1992, review of 9 pieces of research
• Methodology: Review article
• Procedure: Drug, psychological, combined and placebo treatments, tested before, after and sometimes as a follow up, with depression inventories
• Results: Combined treatment was no better than drug therapy, although the drug treatment did have a lower attrition
• Conclusion: Combined therapy is no improvement on drug therapy which is effective

Beck

• Background: Event is activated, beliefs are rational or irrational, consequences are desirable or un-desirable. The patient is led to recognise their own faulty cognitions
• Aim: Comparing cognitive therapy and drug therapy effectiveness
• Participants: 44 moderately to severely depressed patients
• Methodology: Lab experiment
• Procedure: Either a cognitive session twice a week or 100 Imipramine capsules and a 20 minute session with a doctor, Self-reports using the Beck Depression Inventory, Hamilton Rating Scale and Raskin Scale.
• Results: The cognitive condition showed a 78.9% improvement while the drug therapy condition only showed a 20% improvement. Attrition was at 5% in the cognitive therapy group yet 32% in the drug therapy group.
• Conclusion: Cognitive therapy is better treatment an is better adhered to.

Lewinsohn

• Background: Based on the assumption that depression is learned and so teaches the patient positive reinforcement for non-depressed behaviour
• Aim: Testing the usefulness of a 'coping with depression' course
• Participants: 69 depressed adolescents aged 15 - 18, from two areas of Oregon, 10 dropped out
• Methodology: Longitudinal, Lab experiment
• Procedure: Over a 7 week period, 14 sessions each at 3 hours long. Group 1 = just the adolescents, 2 = adolescents and their parents, 3 = told they were on the waiting list. Relaxation skills, controlling thoughts, social and conflict solution skills taught. Interviews before and 1, 6, 12 and 24 moths after the course.
• Results: 52% of group 2 were still depressed, 57% of group 1 still depressed. This amount decreases with time.
• Conclusion: Efficient reinforcement can cause changes in negative behaviour.