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PSY333 Lec 5

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University of Toronto St. George
Sayyed Mohsen Fatemi

Lecture 5- Decisions in Health 9/26/12 2:07 PM • Impacts of stress • Cognitive (lack of concentration) • Emotions(higher irritability) • Behavioral (lose motivation, difficulty communicating), • Physiological(insomnia, chronic fatigue syndrome, Epstein bar illness) • Psychological signs of stress (anxiety, panic attacks) • Mindlessness and stress • You have to be mindful when dealing with stress and go through each step • When you’re stressed and mindless, you have disengagement from self- mind is so preoccupied with stress • As a result of lack of engagement, you are susceptible to acute, chronic forms of stress • You look at the issue from different perspectives-- it allows you to get disengaged from the encumbrance of stress • You have the possibility of going through recuperation- see your self in a process of proactive involvement • Eustress: not bad stress (acceptance& adaptation- Guru test) • Distress you can prevent: Breathing • Biofeedback and mindfulness o Biofeedback= people can control their automatic systems § How shift in perspective can have an influence on rhymes and rhythms § The power of suggestion § Tyranny of should- gives you lot of stress- the search for approval is unrealistic- you feel perturbed inside- release yourself from this o Reframing the situation can help deal with stress Decision making in the medical world {difficult at best & impossible at worst} • Three primary areas of study in social cognition relevant to your health • 1) Attribution theory= your arm hurts- is it arthritis or do you just sleep funny o Global attribution • 2) Judgmental heuristics= rules to make such info useful • 3) Decision making • What do these areas suggest regarding your health • 80% of errors made in the medical field are cognitive errors • 1 in 7 diagnoses are incorrect • Too much information, so we use heuristics • There’s a long process before you get your medicine when unwell- there’s a plethora of places where this can go wrong! • Judgmental Heuristics • 1) Hypothesis confirmation: seek and you shall find mindless blindness to what doesn’t fit o Doctors from a single perspective make more errors because of their mindlessness o Ex. 8year old girl with severe headaches; doctor diagnoses that its stress related and sinus--- symptoms get worse and doctor realizes that he missed a tumour!! o Schemas may hamper the process of further mindfulness- you don’t see anything except for those schemas o ALWAYS look for info about the opposite hypothesis- don’t act from one single hypothesis- don’t get yourself through your analysis o Don’t get caught up with labels o Midterm question about this? • 2) Representativeness: How similar is this instance to the population o Ex. Female who keeps losing weight- doctors diagnose her as anorexic, she actually has celiac o Its easy to go from a single case to general; hard to go from general to specific o Decrease prejudice by increasing discrimination • Arzy 2009 (slide 11) o Young girl had a ski accident and complains of pain- actually had non-hodgkin’s lymphoma § 1) misleading prominent details § 2) Told to beware of misleading details § 3) Detail trivial § Result 1 and 2 misdiagnosed in 90% when asked to omit the detail, it dropped to 30% § The details can be seen as cause and effect instead of details o Regression to the mean § There’s always a regression to the mean § When we receive compliments or insults realize that next time you will probably move towards the mean • 3) Availability o The ease at which something comes to mind- the more frequent, salient, important, recent, memorable etc. o Can make us mindless because of schemas that are most available o Ex. In winter, if doctor has just seen 10 patients with the flu, more likely to diagnose you with it too § Avoid relying solely on automatic processes § Premature cognitive commitment o Not just information, but ease of recalling § Ex. Which is more likely, words that start with k or have k as the third letter? § When in pain, its hard to remember feeling fine § State dependent memory § Episodic (last time went to Paris), Procedural, Semantic memory (recall concept) § Assumption for aging: as go up the ladder of aging, they lose the power of remembering things--- but those people could remember emotionally connected memories better § When people remember things in emotional content, they remember it faster and better • 4) Commission bias: many believe it is better to do anything than do nothing • 5) Emotional biases: If a patient is very fond of you he may misdiagnose of life threatening disease o Ex. Groopman, didn’t want to do a full examination because didn’t want to disturb patient’s sleep, so overlooked a symptom that would easily be caught in an exam o Transference= when patient finds you interesting and as a result become infatuated and it has an influence on her process of recuperation o Counter-transference= when doctor becomes infatuated with patient • 6) Gifts to doctors o Can influence doctor • 7) Advertising bias or one size fits all bias- absolute not as probabilities, ignore individual differences • 8) Familiarity bias- too many new drugs on the market, the doctor sticks with what they normally use • 9) Self-protection bias- make the hospital/ self rich ex. Spinal fusions-- typically unnecessary); order tests to avoid law suits • 10) Who you see is what you get o Each specialist uses their own tools even though examining the same problem • 11) More is better: more information is not necessarily better if searching for one hypothesis. Overconfidence- more info>confidence even if the info is redundant and possible evidence for the wrong hypothesis • 12) Pluralistic ignorance o We see other’s behavior as freely chosen and therefore representative of their beliefs o Prentice & Miller (1993)- student drinking and pluralistic ignorance- students feel uncomfortable but assume others don’t. Patients feel fine but assumes others don’t. Patient feels fine but assumes others with the same disorder don’t and thus attend only the problems • 13) False consensus effect- I hurt so everyone with this must hurt--- therefore we wont make steps to make it better o Alternative version- if this is all everyone can do, I guess I cant do more • 14) Regression o People regress toward their own mean o “Every time I get praised, I mess up” o Schaffer § Teacher trying to get students to arrive on time- reprimanding those who were late was more effective than praising the one who were early o Medicine: symptoms not too bad, once it gets much worse, take medicine, get better § Problems: ú A) Learning- sometimes the medicine does work ú B) Need to remember past information- but going forward, which behavior should we remember? The fact is probably that some past pain… • 15) Helson- how we feel depends on how we expect to feel Karsten- o prime a different, healthy, context and feel differently • 16) Perseverance- Woman at Harvard- how long is long enough to require professional medical care • 17) Resemblance- but on which dimensions? Different symptoms suggest different disorders o Lack of resilience in changing our personal models- but when should we or doctors change • 18) Conjunction fallacy: hot coffee. Have you ever awakened feeling almost paralyzed and that there was someone else in the room (41%) o We often give misleading information when reporting our symptoms • 19) Illusion of validity o Incomplete feedback. A diagnostic sign (ex. Chest sounds for pneumonia) may be correlated with those who took the chest x-ray but not in those that didn’t. Since Dr. Only received feedback from the first group they may believe the symptom is more diagnostic than it is.
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