Health & Clinical Psychology
- 4 Healthy Living
- 4.1 Theories of health belief (HBM)
- 4.2 Methods of health promotion
- 4.3 Features of adherence to medical regimes
- 5 Stress
- 5.1 Causes of stress
- 5.2 Measuring stress
- 5.3 Techniques for managing stress
- 6 Dysfunctional behaviour
- 6.1 Diagnosis of dysfunctional behaviour
- 6.2 Explanations of dysfunctional behaviour
- 6.3 Treatments for dysfunctional behaviour
4.1.1 Becker - Health Belief Model
Aim: Use HBM model to explain mother's adherence to a drug regimen for their asthmatic children.
Method: Correlation / Self-report.
Ps: 111 mothers responsible for administering asthma medication to their children. Children were aged between 9 months and 17 years old.
Procedure: Each mother was interviewed with questions designed to provide measures of the HBM and how mothers had handled the latest asthma attack. Compliance was checked by a covert blood sample from their children.
Results: Blood tests from 80 children showed a 66.3% compliance rate. There was a positive correlation between mother's belief of child's susceptibility to asthma attacks and compliance with medical regimen. Furthermore, demographic factors such as the greater the mother's education and if they were married were found to positively correlate with adherence to the medical regimen.
Conclusion: Becker concludes that with both measures, mothers acted in ways predicted by the model. The HBM is a useful model to predict and explain different levels of compliance with medical regimens.
4.1.2 Rotter - Locus of Control
Locus of Control: Considers where people believe the control of their health is located within themselves or within others.
- Internal locus of control: an individual has control of their health themselves.
- External locus of control: an individual does not have control over their health.
Aim: To find out whether locus of control affects our health beliefs.
Method: Review 6 pieces of research in a review article.
Procedure: Rotter reviewed research which had all investigated an individuals perception of the extent to which they could control the outcome of their behaviour.
Results: Ps with an internal locus of control were more likely to show behaviours that would allow them to cope with potential threats than Ps with an external locus of control.
Conclusion: Rotter concluded that locus of control would affect many of our behaviours, not just health behaviours.
4.1.3 Bandura & Adams - Self-efficacy
Self-efficacy: How effective a person believes they can be in changing their behaviour will influence their tendency to try to change their behaviour.
Aim: To apply systematic desensitisation techniques to change a patient's self-efficacy to they come to believe they can cope with a threat.
Ps: 10 snake-phobic patients, 1 male / 9 female aged 19-57, who replied to a newspaper advert.
Procedure: Ps given a series of pre-test assessments to test fear towards boa constrictor and self-efficacy expectations. They then underwent systematic desensitisation which ranged from looking at a picture of a snake to handling a live snake. Ps then given post-test assessment were they were again measured on belief of self-efficacy in coping
Results: In the post test, boa constrictor was used to test changes in self-efficacy and a corn snake used to see if self-efficacy generalised to other snakes.
Conclusion: Desensitisation increased self-efficacy which led to the belief that the P was able to cope with the phobic stimulus which reduced anxiety towards the snakes.
4.2.1 Cowpe - Media Campaigns
Aim: To test the effectiveness of a media campaign in reducing the number of chip pan fire accidents.
Method: Quasi-experiment where a media campaign was shown in 10 UK regional TV areas from 1976 to 1984.
Ps: Those living in the areas covered by the TV media campaign.
Procedure: Each region was shown a TV advert for the initial cause of the fire and how to put it out. 3 areas (Granada, Harlech and Tyne Tees) were shown reminders one year later.
Results: Between 1976 and 1982 there was a % decline in chip pan fires ranging from 7% in the Central area to 25% in the Granada area. A questionnaire showed an increase in the awareness of chip pan fires from 62% in the Yorkshire TV area to 90% after the first adverts.
Conclusion: The advertising proved effective as shown by the reduction in chip pan fires.
4.2.2 - Dannenberg et al. - Legislation
Aim: To review the impact of passing a law requiring cycle helmet wearing in children under 16.
Ps: Children from 47 different schools in Howard County. Two control groups from Baltimore and Montgomery County, all three counties were in Maryland, USA.
Procedure: Questionnaires were sent out to 7322 children in Howard, Baltimore and Montgomery County containing four- or five-point Likert scale questions on a range of topics including bicycle use, helmet ownership & usage, awareness of the law, sources of information about helmets and peer pressure.
Results: Response rates were between 41% and 53% between the counties. Reported helmet usage had increased in Howard county from 11.4% to 37.5% compared with 8.4% to 12.6% in Montgomery county which used educational campaigns. Both were higher than Baltimore county which increased from 6.7% to 11.1%.
Conclusion: Study suggests legislation is more effective than education in changing behaviour.
4.2.3 Janis and Feshbach - Fear Arousal
Aim: To study the motivational effects of fear arousal in health promotion.
Ps: 200 American high school students aged 14-16 divided into four groups at random. Three were experimental groups and one was the control.
Method: Laboratory experiment.
Procedure: 3 groups given a 15 minute lecture on tooth decay and oral hygiene. They were given a questionnaire one week before and after the lecture on oral hygiene. Group 1: Strong fear appeal, group 2: Moderate fear appeal, group 3: Minimal fear appeal and group 4: control group (given a lecture on the human eye).
Findings: The strong fear arousal group showed a net increase in conformity to good dental practices of only 8% which is not a significant difference to the control group, whilst the minimal fear arousal group saw an increase of 36%.
Conclusion: Janis and Feshbach concluded that relatively low fear arousal is likely to be the optimal level for promoting health.
4.3.1 Bulpitt & Fletcher - Reasons for non-adheren
Aim: To review research on adherence in hypertensive patients.
Method: Review article.
Procedure: Previous research analysed to identify the physical and psychological effects of drug treatment on an individual's life.
Results: Anti-hypertensive drugs have many side effects including sleepiness, dizziness and lack of sexual functioning. A study by CURB found that 8% of males stopped taking anti-hypertensive medication because of sexual reasons. Another study found that 15% of patients stopped taking the medication for other reasons
Conclusion: When taking medication, if the costs outweigh the benefits of treating mainly asymptomatic problems, such as hypertension, the patient is less likely to adhere to the treatment.
4.3.2 Becker - Measures of non-adherence
Becker's study which aimed to use the HBM to explain why mother's adhered to a medical regimen for their asthmatic children, used physiological measures as a measure of non-adherence: a covert blood sample was obtained from the mother's children to test for the presence of the child's asthma medication to check compliance.
4.3.3 Watt et al. - Improving Adherence
Aim: To see if using a Funhaler could improve children's adherence to taking asthma medication.
Method: Field experiment.
Ps: 32 Australian children, 10 male / 22 female, with a mean age of 3.2 years.
Procedure: Each P was given a standard asthma inhaler for the first week, and the parents were given a questionnaire to complete on adherence rates. Ps then used the Funhaler for the second week and the parents filled out another questionnaire on adherence rates.
Findings: 60% more children took the recommended 4 cycles of asthma medication per day when using the Funhaler compared to the standard inhaler. Additionally 38% more parents were found to have medicated their children the previous day using the Funhaler compared to the standard inhaler.
Conclusion: Making a medical regimen fun can improve adherence in children as it provides positive reinforcement for correct usage.
5.1.1 Johansson et al. - Causes of Stress in Work
Aim: To investigate whether work stressors increase stress-related physiological arousal and stress related illness.
Ps: 24 workers at a Swedish sawmill. 14 were 'finishers' who had to work at a set pace and whose jobs were complex. The other 10 workers were the control group. These workers were either cleaners or maintenance workers.
Procedure: Ps gave urine samples on arrival at work & at 3 other times each day. Body temperature was measured when urine was collected. Levels of adrenaline in urine was determined. Ps also reported caffeine & nicotine consumption as well as completed a questionnaire concerning mood & alertness. These values were compared to a day spent at home where data was collected from the workers who were asked to stay up as if they were at work.
Results: The high-risk group of 14 'finishers' secreted more stress hormones on work days than on rest days, and higher levels than the control group. The finishers also showed higher levels of stress-related illness such as headaches than the control group.
Conclusion: High risk jobs that require skill and demand responsibility, cause people to feel more stressed than jobs which are less demanding and do not require much skill.
5.1.2 Kanner et al. - Daily Hassles
Aim: To compare hassles and uplifts and life events as predictors of psychological symptoms of stress.
Method: Self-report. Repeated measures design as each P completed the Hassles Rating Scale and the Life Events Scale.
Ps: 100 people, 48 male / 52 female, who had previously completed a health survey in 1965. They were all from California, mostly white and protestant.
Procedure: Ps were asked to complete: Hassles and Uplifts Scale as well as Major Life Events Scale every month for 9 months. They also completed the HSCL (Hopkins Symptom Checklist) and the Bradburn Morale Scale of well-being towards the end of the study.
Results: Hassles were consistent from month to month. For women the more life events they reported the more hassles and uplifts they reported. Hassles frequently correlated positively with the psychological symptoms on the HSCL.
5.1.3 Geer and Maisel - Lack of Control
Aim: To see if perceived control or actual control can reduce stress reactions to adverse stimuli.
Method: Laboratory experiment.
Ps: 60 psychology students from New York uni.
Procedure: Ps were randomly assigned to 1 of 3 conditions and shown images of dead car crash victims. Group 1: given control of how long they saw the images, could terminate it at a press of a button and knew when the next image would appear. Group 2: No control of the image, however they did know when the image was going to appear through a series of tones. Group 3: No control over the images and were not given any timings. Ps had their stress levels measured by GSR and heart rate was measured through ECG monitoring (however ECG data obtained was discarded).
Results: Group 2 showed most stress with the tone, as they knew what was coming but did not have control over the photograph. Group 1 experienced less stress in response to the photograph than groups 2 & 3.
Conclusion: Having control over adverse stimuli reduces their stressful impact.
5.2.1 Geer and Maisel - Physiological Measures
In Geer and Maisel's study into control / perceived control over adverse timuli and stress reactions, physiological measures were used to measure Ps' reactions to being shown photographs of dead car crash victims.
Ps' stress levels in Geer & Maisel's study were measured using GSR and ECG. However the data gathered by the ECG was discarded as it appeared inaccurate.
5.2.2 Kanner et al. - Self-Report Measures
Kanner's study into hassles and uplifts and life events as predictors of stress used the self-report method to gather data from Ps.
100 Ps from California were used in Kanner's study and each were sent questionnaires in the post to complete. These were:
- The Hassles & Uplifts Scale
- The Life Events Scale
- HSCH (Hopkins Symptom Checklist)
- Bradburn Morale Scale
5.2.3 Johansson et al. - Combined Approach Measure
Research into stress combines both physiological and self-report methods. Johansson's study into work stressors uses both physiological and self-report methods.
Physiological: A urine sample was obtained from Ps throughout the duration of the study. This measured daily levels of stress hormones, specifically adrenaline. Body temperature was also measured at the same time urine samples were taken.
Self-report: Ps were also asked to complete a questionnaire throughout the duration of the study on mood and alertness. They were also asked to report caffeine and nicotine consumption.
5.3.1 Meichenbaum - Cognitive (SIT)
Aim: To compare Stress Inoculation Therapy (SIT) with systematic desensitisation and a control group on a waiting list.
Method: Field-experiment. Ps were assessed before and after treatment using self-report.
Ps: 21 students aged 17-25 who responded to an advert for treatment for test anxiety.
Procedure: Each P was tested using an IQ test and were assessed for anxiety using self-report. Ps were randomly allocated to 1 of 3 conditions: SIT therapy (focuses on restructuring faulty thoughts that contribute to stress), systematic desensitisation or they were told they were on a waiting list for the treatment.
- SIT group: Received 8 therapy sessions. They were given positive statements to say to reduce stress and relaxation techniques to use in test situations.
- Systematic desensitisation group: Received 8 sessions.
- Control group: Told they were on a waiting list and would receive therapy in the future.
Results: Ps in the SIT group showed more reported improvement in their anxiety levels, although both therapy groups showed overall improvement compared to the control.
5.3.2 Budzynski et al. - Behavioural (Biofeedback)
Aim: To test the effectiveness of biofeedback techniques in reducing tension headaches.
Methodology: Laboratory experiment
Ps: 18 Americans who responded to a Colorado newspaper article. They were given medical examinations to ensure that the headaches were not caused by a medical concern.
Procedure: Electrodes were placed on Ps muscles and they were then monitored using an EMG feedback machine. There were 3 groups: Group A received biofeedback with relaxation training. Group B received relaxation training with pseudo-feedback. Group C were on a waiting list.
Ps kept a record of their headaches for 2 weeks. Groups A & B were given 16 sessions of relaxation training. Group A were told that the 'clicks' of the biofeedback machine would reflect their muscle tension, whilst Group B were just told to focus on the varying clicks.
Results: At the end of the training, Group A's muscle tension was significantly lower than group B's. Group A also reported significantly less headaches than groups B & C. Groups A & B revealed declines in other symptoms (however the changes were most evident for group A) such as insomnia, apathy & fear of crowds and improvements in social relationships. Use of prescription drugs such as painkillers also decreased in A & B however more so in Group A.
5.3.3 Waxler-Morrison et al. - Social support
Aim: To look at how a woman's social relationships influence her response to breast cancer and survival.
Ps: 133 women referred to a clinic in Vancouver with confirmed diagnosis of breast cancer.
Procedure: Information gathered using questionnaires, interviews and medical records. Questionnaires gathered information on existing social networks and who they were responsible for. Survival rates were checked in 1985.
Results: The 6 aspects of social network significantly linked with survival were: marital status, support from friends, contact with friends, total support, social network and employment. Data from interviews showed that practical help such as childcare, cooking, and transport to hospital was the concrete aspect of support.
Conclusion: The more social networks and support, the higher the survival rate of women with breast cancer.
6.1.1 Categorising Disorders - DSM / ICD
The DSM manual is published by the American Psychiatric Association and is a multi-axial diagnostic system. The DSM considers a wide variety of factors when diagnosing a disorder, these include physical health of the individual, social and environmental problems. The DSM features 5 main categoris of behaviour and illnesses, these include: major clinical syndromes (schizophrenia, mood disorders) and general medical conditions.
The ICD is published by the World Health Organisation and is used throughout the would for diagnosing mental and physical health. Each disorder in the ICD has a description of the main features and any important associated features. It also indicates how many of each features are required to make an accurate diagnosis.
6.1.2 Rosenhan - Definitions of Dysfunctional Beha
Statistical Infrequency - A behaviour is classified as abnormal if it is rare and not often seen in society. E.g. one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal.
Deviations from Social Norms - A person's behaviour is classified as abnormal if it violates the unwritten rules about what is acceptable or expected in a particular social group.
Failure to Function Adequately - A person is considered abnormal if they are unable to cope with the demands of everyday life and live independently in society.
Deviation from Ideal Mental Health - Rather than defining what is dysfunctional, we define what is normal / ideal and anything that deviates from this is regarded as dysfunctional. Jahonda (1958) identified 6 characteristics, including: resistant to stress, a positive view of one's self and being able to adapt to your environment.
6.1.3 Ford & Widiger - Bias in Diagnosis
Aim: To find out if clinicians were stereotyping genders when diagnosing disorder.
Ps: 354 clinical psychologists selected randomly from the national register.
Procedure: Ps were randomly provided with one of nine scenarios and then asked to make a diagnosis. Case studies of patients with antisocial personality disorder (ASPD) or histrionic personality disorder (HSP) or an equal balance of symptoms were given to each clinician. The clinicians were told that the patients were either male, female or the gender was unspecified. The clinicians had to make a diagnosis and rate on a 7-point scale the extent to which they displayed various different disorders.
Results: Borderline personality disorder was the diagnosis made most often across all three case studies when gender was unspecified. ASPD was diagnosed correctly 42% of the time in males but only 15% of the time in females. Females with ASPD were misdiagnosed with histrionic personality disorder 46% of the time but males only 15% of the time.
6.2.1 Watson & Raynor - Behavioural Explanation
Aim: To investigate whether a human baby could develop a fear it did not have previously.
Ps: A young child named 'Little Albert', a nurse's child at a local children's home.
Procedure: 'Little Albert' was presented with a white rat at 11 months old and initially showed no fear and reached out to the rat. At this point researchers struck a metal bar above his head making a loud noise, Albert jumped at the noise. He reached out to the rat and the researcher struck the metal bar once again. This was repeated a number of times. Albert demonstrated various degrees of fear response and negativity when presented with a range of furry stimuli such as a rabbit and a fur coat.
Results: The results after one week demonstrated that 'Little Albert' had acquired a fear of rats as a learnt emotional response.
Conclusion: The researchers concluded that it is possible to classically condition the emotional response of fear. However as 'Little Albert' was removed from the study, there was no means to determine whether his fear of rats diminished over time.
6.2.2 Gottesman & Shields - Biological Explanation
Aim: To review research done on whether schizophrenia is passed on genetically or not.
Ps: 711 different Ps from adoption studies. 210 identical (monozygotic) twins and 317 non-identical (dizygotic) twins in the twin studies.
Method: A review of adoption and twin studies into schizophrenia between 1967 and 1976.
Procedure: Concordance rates calculated in twin studies and incidence of schizophrenia in parents and children in biological and adoptive familes were calculated in the studies.
Results: All 3 adoption studies found increased incidence of schizophrenia in adopted children with a schizophrenic biological parent whereas normal children fostered to schizophrenic parents showed little evidence of schizophrenia. All twin studies found a higher concordance rate for schizophrenia in monozygotic twins than in dizygotic twins. In Gottesman and Shield's own study in 1972, concordance rates were 58% in monozygotic twins meaning if one twin had schizophrenia there was a 58% chance the other twin would have it, compared with a 12% concordance rate in dizygotic twins.
Conclusion: There is significant genetic input into the onset of schizophrenia, but with concordance rates of less than 100%, must be some interaction with the environment involved.
6.2.3 Beck - Cognitive Explanation
Aim: To understand cognitive distortions in patients with depression.
Method: Clinical interviews with patients who were undergoing therapy for depression.
Ps: 50 patients diagnosed with depression, most were judged to be middle or upper class.
Procedure: Face-to-face interviews with retrospective reports of patients' thoughts before the session as well as spontaneous reports of thoughts during the session. Records were kept of the non-depressed patients' verbalisations to compare with those of the depressed patients.
Results: Certain themes appeared in the depressed patients that did not appear in the non-depressed patients. These were low self-esteem, self-blame and anxiety. Depressed patients also regarded themselves as inferior to other in their social or occupational groups, for example: less attractive, less intelligent and less successful as a parent.
Conclusion: Even in mild depression, patients have cognitive distortions that deviate from realistic and logical thinking.
6.3.1 McGrath - Behavioural Treatment
Aim: To treat a girl with specific noise phobias using systematic desensitisation.
Ps: A 9 year old girl with a fear of sudden noises, i.e. party poppers. She had a lower than average IQ however she had no othe psychological problems.
Procedure: Lucy was brought to therapy sessions and constructed a hierarchy of noises that she feared. She was taught breathing techniques and had a hypothetical fear thermometer to rate her level of fear from 1-10.
Results: 1st session Lucy cried and had to be taken home when a balloon was popped. 5th session she wa able to pop the balloon herself and use a cap gun. By the 10th session Lucy's fear ratings on her hypothetical fear thermometer was significantly less than they were at the start of the systematic desensitisation.
Conclusion: McGrath concluded that noise phobias in children are able to be treated through systematic desensitisation.
6.3.2 Leibowitz - Biological Treatment
Aim: To see if the drug phenelzine can help treat patients with social phobia.
Methodology: A controlled experiment.
Ps: 80 Ps aged 18-50 years old, meeting DSM criteria for social phobia.
Procedure: Ps were treated over 8 weeks. They were assessed on social phobia through several rating scales. Ps were randomly allocated to 1 of 4 groups. One was given phenelzine and the other given a matching placebo. The other groups were given either atenolol or an atenolol placebo.
Results: After 8 weeks of treatment, significant differences were noted for the phenelzine groups as they had reported lower levels of anxiety than the placebo group.
Conclusion: Phenelzine is effective in treating social phobia.
6.3.3 Ost and Westling - Cognitive Treatment (CBT)
Aim: To compare cognitive behavioural therapy (CBT) with applied relaxation as therapies for panic disorder.
Method: Longitudinal study, Ps randomly assigned to applied relaxation or CBT.
Ps: 38 Ps with DSM diagnosis of panic disorder. Recruited through newspaper advertisements and psychiatrist referrals.
Procedure: Baseline assessments of panic attacks were taken through questionnaires. Patients also kept a record of every panic attack they had. Each patient was then given 12 weeks of treatment. CBT was used to identify the misinterpretation of physical symptoms and then to generate an alternative cognition in response. Applied relaxation focused on muscle relaxation training.
Results: Applied relaxation showed that 82% of patients were panic free after one year whilst CBT showed that 89% of patients were panic free after one year. These differences were not significant.
Conclusion: Both CBT and applied relaxation worked at reducing panic attacks.