LECTURE 6: OCTOBER 19TH, 2012
TOPIC: GETTING ILLAND SEEKING MEDICALTREATMENT
➔ The psychology of getting sick and then getting help
➔ Perceiving and Interpreting Symptoms
◦ Generally we're not very accurate at it
◦ Complicated by a number of influences
◦ Not good at having a good sense of what is happening inside our bodies and then accurately
making sense of those symptoms
▪ Language – hard to explain how we feel
▪ Example: I having this pain in my stomach –nauseous, burning, cramping, happens
randomly, I do not know what makes it better or worse.
• Terrible ta articulating ourselves
▪ Kids are bad at explaining what they are feeling
▪ We have not evolved enough to perceive our symptoms. Only good at when it is an
extreme or more serious sickness (cancer).
➔ Individual Differences
◦ Some people have more symptoms
◦ There are differences in what people can tolerate
◦ Differ in how much attention is paid to internal states
◦ Internally focused people overestimate bodily changes and experience slower recovery
▪ Personality affects
▪ Neuroticism--predicts quite well how many medical complaints you will report
▪ Monitoring –pay more attention to bodily changes
▪ Panic attacks – have high levels of interoceptive awareness –know when something is
wrong or amiss internally. Have more attacks because they focus on the symptoms such
as heart rate increase and faint feel causing them to get even worse and fall into the fight
or flight response.
▪ Based on whether one sees an increased heart rate as dangerous or not a big deal
because it was probably the coffee they had.
▪ Internally focused people – overestimate bodily changes and experience a slower
recovery in terms of sickness and stress. Heart rate could be average for instance but to
them they perceive it as racing. Example: nervous system may be more hyper aroused
and returns to a normal rate more slowly → could be biological differences.
➔ Personality and Hypertension: Effect of HypertensionAwareness
◦ Refer to graph on ppt.
◦ Study on Personality and Hypertension
▪ Measured people in personality test for neuroticism
▪ Those that were the highest were those who were aware
▪ The second highest were those that were aware they were hypertensive
▪ Difference: whether you aware of your status
▪ Those lower in it do not go to the doctor and therefore are not aware that they are
▪ Those high in it go to the doctor more often and therefore get their blood pressure done
all the time. ➔ Personality and Hypertension Conclusion
◦ Awareness of hypertension status confounds assessment of the association between
personality characteristics and hypertension
▪ Hypertension label → told you are hypertensive therefore act even more neurotic
▪ Self-selection bias → neurotic people go to the doctors more often
◦ Low level symptoms: headaches, fatigue, diarrhea etc → tend to be associated with
depression and anxiety
◦ They could be experiencing these symptoms due to their mental disorder and attributing
them to their organic thoughts.
◦ General stress is associated with greater reports of symptoms
◦ Mood—positive mood associated with fewer symptom reports than negative mood
◦ Those who are stressed either report more symptoms (feel weak and sick) or actually do
have more symptoms
◦ Stress-- muscle tension, gastrointestinal problems (blood diverted away from stomach),
weak immune system. → many ways for stress signs to come across as illness
◦ This is intuitive even without the scientific studies
◦ Physicians are still biased by thinking in biomedical terms. Example: go to doctor and they
always relate your symptoms to a medical issue and do not consider stress and other
personal factors rather than biological.
◦ High number of people suffering from this is due to anxiety and depression
➔ Psychosocial Influences
◦ Prior experience, beliefs and knowledge influence expectations about symptoms
▪ Ignore unexpected symptoms, amplify expected symptoms
▪ Beliefs abut the disease label, causes, time course, and consequences influence symptom
awareness and experience.
• What you are told is going to happen such as being told the symptoms of a drug you
are about to take for a study will cause you to feel like you are showing all
symptoms meanwhile you most likely just took a placebo pill.
• Your perceived notion of symptoms is affected due to the information you obtained.
• Practitioner—you want people to self-monitor which is good but the problem could
be that people have the wrong or misinterpreted information.
◦ Inert substance or treatments
▪ People can experience real symptoms relief
▪ Furthermore taking placebos faithfully is associated with a lower likelihood of death
• There are actual placebo surgeries (people are opened up in a surgery room, but are
not operated on, but then have to heal like normal).
• MIND-BODY CONNECTION
◦ Adherence to placebo makes the difference. Example: take placebo faithfully. If
you are very good at taking your placebo pill everyday and keeping track then
you are also probably someone who follows the good health behaviour practices
outlined by one's doctor.
▪ Maybe faith reduces anxiety and therefore aspects such as your immune functioning would work better
▪ These are very strong correlational studies –do not know cause and affect
▪ Hard to study this: example how would one manipulate faith and make one
person believe more than another.
• Need to control for placebo affect (use a control group that does not get the drug).
◦ Placebo must look exactly like the drug, be taken on the same schedule etc
◦ Example: How does one put a placebo through a psychotherapy trial?
◦ 2 groups: one gets anABC treatment therapy lets say and then the other group
must obtain the same affect → this is not easy.
◦ Example: self-help for eating disorders. One group got self-help solely (no
treatment). How could one control for motivational interviewing? → a therapy
where you interviewed them, had face to face contact, someone listening to the
other, and the therapist does nothing related to motivation, just a simple
interview with questions (psychotherapy placebo). Manipulated their
expectations by saying to both groups that their treatment may be helpful.
• Placebo Surgery
◦ Following normal surgery procedures without actually operating
◦ Problems: risk of infection, risk of death, not very ethical to many
◦ They have to account for these issues. What causes more problems; going
through with the surgery or not doing so?
◦ Informed Consent forms must be signed
◦ Biomedical Ethics
▪ Doctors struggle with this