PSY333H1 Lecture Notes - Anorexia Nervosa, Communication Problems, Coronary Artery Disease

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26 Nov 2012
Health Psychology Chapter Summaries
Chapter 1 -- Introduction
Until recently psychologists have dealt almost exclusively with the mind. In recent decades, psychological principles have been
applied to the arena of health.
The definition of “health” is important to defining health psychology. Health is a complete state of physical, mental and social
well-being; it is not simply the absence of illness or disease. Health psychologists are devoted to promoting health,
preventing illness, and identifying correlates and predictors of health, illness and dysfunction
It has long been believed that emotions and mental status interact with physical health. Hippocrates wrote about the physician’s
demeanour as it affects the patient’s will to live. Osler instructed medical students to listen to the patient to find the
proper diagnosis
The focus of this book is primarily on individuals in the context of health, illness and the experience of medical care. There are
many intricacies associated with research, particularly in health psychology. Human beings are vastly complex and
issues related to healthcare, healthcare systems, and healthcare delivery are multifaceted
True experiments [randomized clinical trial] enable researchers to determine causality, but are difficult, sometimes
impossible, to carry out. Correlational studies provide valuable insights, but cannot establish causal
Prospective studies are preferable to retrospective studies because the latter are affected by biases in the ways in which people
remember events
Longitudinal studies are usually preferable to cross-sectional studies because they enable us to distinguish patterns of change
over time from cohort effects
Laboratory studies occur in controlled settings and allow confounding variables to be eliminated, but “realism” may be
sacrificed. Field studies provide more natural responses, but extraneous influences are difficult to control
Random assignment: a method of sorting participants into experimental versus control group, uses random methods so that
each participant has an equal chance of being chosen for wither group
covary: to correlate, to relate in a specified and predictable way
cross-lagged correlation: an assessment of the degree of association between two variables, one of which is viewed as a
lagged value of the outcome variable
state dependent memory: the tendency of people to remember most easily the events of the past connected with the
emotional state they feel as they report
age cohort: a group of people born at the same time who thus share similar experience
Health psychologists work in various settings as consultants on medical teams, as therapists, contributing to public health
promotion programs, and as researchers. Many graduate programs in health psychology exist, but not all health
psychologists were formally trained in such programs
The 20th century is probably the only period in history in which the predominant medical opinion has emphasized a focus on
the body and has neglected the mind as a factor in health. During most of recorded history, illness has been attributed
to magical and unknowable phenomena such as sinful thoughts, possession by evil spirits, and the will of vengeful gods.
Western medicine originated in ancient Greece during the time of greatest intellectual development. Hippocrates built the
earliest foundation for rational medicine
Galen is considered by many to be the greatest figure in ancient medicine because he based diagnosis on anatomy and
In the 15th century, the Renaissance brought intellectualism and rationalism to the realm of medicine
prognosis: the forecast of the course of a disease
diagnosis: the identification of disease using signs and symptoms
dialysis: a process of mechanically filtering toxic byproducts from the blood
auscultation: the process of listening for sounds within the human body
palpation: the application of the fingers with light pressure to the surface of the body to determine the consistency of parts
beneath in physical diagnosis
Around 1990, medicine began to be transformed into a clinical science. Most of the great strides in medicine have taken place in
even more recent years.
During the time of greatest advances in the technical aspects of medicine, it has been easy to forget the human side
Intense focus on the technical side of medicine has prevented a clear distinction between disease and illness. Disease is the
collection of physical findings and symptoms that form a definable disease entity. Illness may or may not
involve definable diseases, but illness upsets the optimal functioning of the individual. the whole patient may
be ignored in an effort to focus on his or her ‘disease’
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general practitioners
Psychological factors are entwined with physical phenomena. The connection is manifested in many ways presented throughout
this book.
Psychological factors are as important as physical ones in understanding the etiology [cause of disease] of a disease or in
carrying out its treatment. There is a delicate interplay between mind and body in the realm of illness
Holistic approaches to healthcare incorporate the mind-body connection and combine Western technology with non-Western
germ theory: illness is caused by micro-organisms
conversion hysteria: the phenomenon in which it is believed that unconscious psychological anxiety is transformed into
physical sympotoms
In the mid-20th century, Dunbar and Alexander paved the way for the field of psychosomatic medicine linking personality
characteristics to specific physical illnesses
Dunbar and Alexander deviated from Freudian ideas regarding some diseases as “converted” from unconscious psychological
anxiety. They proposed specific disease-psychology relationships and a physiological mechanism by which
personality and illness might be linked
Type A Personality: links between this personality and coronary heart disease/disease prone; characterized by negative
emotions such as depression, hostility and anxiety
Type B Personality
Behavioural medicine emerged in the 1970s as a distinct discipline with the goal of applying behavioural science principles to the
maintenance of physical health and the prevention of disease
Because of medical advances, Western society is largely free of many of the diseases of precious centuries; now chronic diseases
are of concern. Medical care needs have changed, and there has been a shift in focus from purely biomedical to
biopsychosocial frameworks
biomedical model: a model that assumes that illness can be fully accounted for by a person’s deviations from the norm on
measurable biological variables
biopsychosocial model: a model that requires that psychological and social factors be included in any attempt to understand
symptoms and the experience of illness
Chapter 2 -- The Process of Medical Care
The goal of this chapter is to examine in detail what occurs when patients consult physicians and other medical professions and
other medical professionals for the diagnosis and treatment of illness. It focuses on the verbal communication
Communication results in both subjective and objective outcomes. Different points of view, or philosophies, underlie effective
and ineffective practitioner-patient communication
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The four premises of medical care that are relevant to our analysis are: Doctors treat patients, not diseases. The body has the last
word. All medical care flows through the relationship between physician and patient. The spoken language is the most
important tool.
Words are extremely powerful tools in medicine; they establish the reality of suffering. Because of their power, the utterance of
words in the medical encounter is a very serious enterprise. Through the process of communication, practitioner and
patient attempt to gain a common understanding of the patient’s illness.
A practitioner’s and /or a patient’s poor communication skills can cause problems in their relationship.
A physician may give a patient very little opportunity to participate in his or her own care either because the physician lacks
communication skills or believes that patient participation is not valuable and not worth the trouble
Sometimes these two reasons reciprocally affect another
Communication uncovers hidden premises. A modern medicine becomes dominated by technology, some medical professionals
tend to give attention to practitioner-patient dialogue.
premises: an assumption on which an argument is based
subcutaneous : under the skin
malignant: cancerous
There are three basic models of the physician-patient relationship:
The Active-Passive Model occurs when the patient is unable, because of his or her medical condition, to participate in care
and make personal medical decisions
The Guidance-Cooperation Model occurs when the physician takes the bulk of responsibility for diagnosis and treatment
The Mutual Participation Model involves physician and patient making joint decisions about every aspect of care
Other model variations define 4 or 5 basic categories. Common to all of them are variations of patient involvement in their care
One important issue in the physician-patient relationship is conflict. Conflict may arise regarding the process of communication
and care, and conflict is a good sign that active collaboration between physician and patient is occurring
The medical encounter is divided into three parts:
The medical history in which necessary info is elicited from the patient; the medical professional must listen actively to what the
patient has to say and tell the patient what to expect from the visit
Patients and physicians are sometimes uncomfortable with the second part of the medical visit, the physical examination,
because of the intimacy of the situation
In the third part of the medical visit, the conclusion, the practitioner makes recommendation. The manner in which this is done
can affect patient satisfaction and patient compliance. Reassurance is an important component of the
Several important problems exist in practitioner-patient interactions. Physicians and patients complain about limited time, and
communication problems arise from differences in the perspectives that practitioner and patient have on the illness
Chapter 3--Communication in the Medical Encounter
Medical practitioners and patients interact in the medical context and affect each other. Physicians and patients agree that there
is not enough time available to satisfy them. Because of their different perspectives, patients and physicians differ
somewhat in what they consider a satisfactory encounter
Several things can make the medical interview more effective:
Patients will be more accurate in their responses if they are helped to remember and if embarrassment is avoided. Interviewers
sometimes inadvertently reinforce poor responses from patients in health interviews
Medical jargon makes speech more efficient when it is used by people who understand it, bit impedes effective communication
between medical practitioners and patients. Jargon confuses those who do not understand the meaning of the
words; it also frustrates them and contributes to their dissatisfaction
When patients do not understand what is wrong with them or what they are supposed to do about it, they are less able to take an
active role in their own care
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