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Richard J.Contrada

9/6 Main Points - Changes in Health/Disease Pattens - Evolutionary and … - Reduction of acute infectious diseases - Ascendences in Chronic disease over time Acute Infectious diseases of early 1900s: - Each caused by a single microbe o “one germ one disease” o Thought they could stop it if they found the one germ - No way to: o Avoid exposure o Prevent infection o cure - Infection often fatal without cure - Eventually controlled by: o Public Health advances:  Safer food, waste, waste management, working conditions o Medical advances  Diagnosis, prevention (vaccines), treatment Chronic diseases that are now prevalent: - Develop slowly, persist, recur over long time period, come and go - Often degenerative - Often can be controlled but not cured - Multiple determinants include: o Specific(lifestyle) behavioral/psychosocial factors  Smoking, diet, exercise, stress -> stress o Not caused by a single germ Greater life expectancy (from 40 to 70 years) - Reduced infant mortality - Greater survival beyond infanthood - The result: aging of the population HIV/AIDS: infectious condition, emerged late in the 1900s - Exposure to virus difficult to prevent through either public health or biomedical intervention o Cant enforce safe sex - Has evolved into a more chronic condition from an acute infectious condition Chronic conditions that appear to reflect infections: Infectious diseases can lead to chronic conditions - Heart disease - Ulcers - Cancers Re-emergence of infectious diseases? Evolutionary Context: Human Nature - Human nature: our evolved biological structure - Biology – culture - Does the changing health pattern reflect changes in human nature? o Can it explain changes in disease patterns; obesity epidemic - Human nature has probably not changed much if at all since 1900 - What has changed is the relationship between human nature and the world in which live - Evolution did not select for long life - Biological structure that aided adaptation in our ancestors may be harmful in today’s world o Fight/flight response  Does not help psychological threats, known to promote heart disease o Certain disease promoting genes  Sickle sell used to fight against malaria, no longer needed - Evolution did not prepare us to adapt to many health threats we currently face o Developed to handle short term stress not long term stress - Health Psychology must take human nature into account - Globalization: communication, economics - The U.S. and other “WEIRD” nations o Western, educated, industrialized, rich, democratic - National economics/politics of health/health care affects it by: o Quality o Access o Utilization o Cost o Inefficiency - Health psychology must take politics and economics into account o Must inform policy to make change Theoretical Models also Guide Research - Philosophical and religious - Scientific - We form our own, personal mental models that guide everyday thinking - These personal mental models are often shared within a society - Innate capacity to theorize What is Health? - Views of the nature/causes of health/disease have changed dramatically throughout history - They have changed between how broad or narrow they are defined Health Psychology reflects a broad biopsychosocial model of Health - Biomedical o Disease is organic o Single cause o Health is the absence of disease - Bio-Psycho-Social o Involves whole person o Multiple causes o Health is more than the absences of disease o Formed the basis of health psychology AView that it too broad? Ryff & Singer - Core features of “positive Human Health” o What are they? o Do they stretch the meaning of “health” too far? Dimensions Included in Broad Views of Health - Physical - Social - Intellectual - Emotional - Environmental - Spiritual Health is more than the absence of disease The biopsychosocial model: biological, psychological, and … Levels of analysis: molecular – cellular – organs/systems – interpersonal/behavioral/psychological – macro social/historical/environmental What is Health Psychology? - Abetter simpler definition: psychological behavioral influences on: o Staying healthy o Getting sick o Responding to being sick - When did health Psychology emerge? o APADivision on health psychology created in 1978 “Behavioral Medicine”: two different meanings - All health science with a psychological component - Behavioral/psychological treatments for physical health problems o Stress management o Smoking cessation Specific Problems for Health Psychology - Prevention - Diagnosis - Treatment o Psychological/behavioral treatment o Underuse of treatments that work o Treatment adherence Schneiderman: What Have We Learned? - Psychosocial and behavioral risk factors and protective factors -> the “What” o What are they? o What kinds are there? o What are some examples - Disease mechanisms/pathways -> The “how” - Psychosocial and behavioral interventions -> The “what can be done” Agining/Lifespan Development - Age is associated with o Biological and psychological changes o Changes in health issues - Aging of the population: o Ascendance of age-related health problems o Magnified by treatment advances  Greater survival following health crises  Treatments given to older/more vulnerable patients 9/10 Theory and Research Methods - Goals of science o Describe o Predict o Explain – the better your explanation, the better your able to predict o Control - Theory: set of interrelated statements, summarized knowledge o Basic assumptions  Sometimes ignored or looked over o Concept definitions o Relationships between concepts o Relationship statement Evaluating Theory - Comprehensive - Logical - Parsimonious (simple, but not too simple) - Agrees with more basic science - Agrees with previous empirical research (data/facts) - Generates ideas/research - Disconfirmable – needs to be possible to show that they are incorrect - Practically useful - As important and useful as theory is, it can easily be misused: o “favorite” or popular theories can receive unfairly good treatment Discussion - Conclusions o - Explanations o - Cautious/critical 9/13/13 Psychosocial and behavioral risk factors - Disease mechnisms (pathways) o Indirect/behavioral o Direct/psychophysiological Health Behaviors (primary prevention) - Actions/inactions when healthy Illness Behaviors (secondary Prevention) - Actions/inactions with symptoms of illness - After diagnosis: Sick Role Behaviors o Societal expectations  What patients typically do or do not do  Patients should and should not do Behaviors can appear on both sides Belloc and Breslow - Put health behavior on the map Behavioral patterns are more influenciall on health than genetic factors Health Behavior Theories - There are many different models/theories o Try to explain behavior and guide efforts to change behavior - They have many similarities o Most are concerned with perceived health threats and perceptions of threat reduction o Have to think changing behavior will reduce threat - Most reflect a rational, value-expectancy approach: o Value – people consider utility of behavior (how good/bad it is). Will it do me any good? o Expectancy – people consider probabilities ( how likely are good/bad effects) How likely will it work? - Two kinds of models o Variable-focused models o Stage models Variable- Focused Models Health Belief Model - Key Features o Early and influential o Originated in public health o Basis: a simple conception of relevant beliefs Main constructs and Paths - Everything was mainly belief and values - Demographic variables o Age,sex,race - Cues toAction o Advice from others o Public health warning - May be only temporary Theory of reasoned Action - Key Features o Considered relevant to all behavior o Originated in social psychology o Basis: distinctive conceptions of attitude and norm; assumption that action is intentional o Attitude toward a behavior, likes and dislikes, positive or negative evaluation o Subjective norm for behavior, what do others expect me to do Theory of Planned Behavior - Perceived control added to Theory of ReasonedAction o The ease/difficulty in achieving desired outcomes  Reflects past behaviors  Reflects perceived ability to overcome obstacles  Very similar to Bandura’s Self-Efficacy construct - Self-Efficacy: your confidence in your ability to perform a specific behavior to obtain a desired outcome - Outcome expectancy: confidence that if a specific behavior is performed correctly a desired outcome will be attained Protection Motivation Theory - Starts with the health belief model - Adds intention from theory of reasoned - New models create new ideas and borrow ideas from older models Stage Models - Precontemplation, contemplation, preparation, action, maintenance Unrealistic Optimism – Summary List of Major Models Variable-Focused - Are the theories comprehensive> o Try to be in terms of behaviors explained - Are they parsimonious o Way too simple  Societal, environmental, institutional factors  Much psychological science • Makes it seem like most people are rational when they are not  Non-health-related motivations • Competence, autonomy, relatedness  Biological processes - Agrees with more basic science? - MAYBE BUT DO NOT TAKE MUCHADVANTAGE OF IT Limitations of the Models - Agree with empirical research? o Fail to predict behavior really well - Generate ideas/research? o Research yes but not ideas - Disconfirmable? o Not really; model parts are interchangeable - Practically useful? o Modestly successful interventions - Other issues o Measurement problems o Explanation o Lack coherence 9/17/2013 Assignment: 1. I’d do nothing about it until it came back again 2. I’d ask my parents for advice, probably get it checked out 3. I’d try to get ahold of some medicine to help me 4. I’d take the day off and try to rest it away 5. I cant let this go on I need to get better Howard Leventhal: Professor at Rutgers, Theoretical Model(s): Commonsense Self-Regulation - One model or several? - Asingle general model that continues to evolve? - Major themes: o Process-focused (versus variables, stages) o Parallel processes of cognition and emotion o Self-regulation o “commonsense” (lay) models of illness threats TheoreticalAnalysis of PROCESSES OF DELAY IN Seeking Health Care Notice symptom – I am sick – I need care – care is worth seeking – enter treatment - Could have stopped at stage model but took into consideration what people thought during the process Parallel Processes in Fear Appeals and Persuasion Public Health announcement – used to scare and or prevent drug use - Early studies of health communication: o Showed patients scary x-rays or lungs o Than showed them how to get their own x-rays taken - This work led to parallel process view: o Learning theory: fear reduction is reinforcing - Replaced by the parallel process view: o Threat causes both cognitive and emotional responses - Threat -> Fear: emotion, by itseld, has little effect on health behavior - Threat + action plan -> cognition has a greater effect on Extended Parallel Process Model - Must promote effective danger control to be useful - Promoting too much fear control is not useful Significane of Leventhal’s Parallel Process View Self Regulation - Acharacteristic of living systems as well as artificial systems o Systems theory - Feedbackloop – control of the organism in terms or stored values within the system - Self reflexive: self-regulating system controls itseld Problem Representation – create a picture of the situation, what do you think is going on Two Parallel Processes: Cognitive - HIV is a virus; medicine can cure colds Emotional - AIDS is scary; low fat food is boring Symptoms – subjective Signs – objective number Problem Representations - Developed in response to a particular illness episode - They reflect pre-existing disease prototyes o Default: acute (e.g., infection, injury) - Change over time in response to self-regulation activity New Developments in… Current research: find out what patient is thinking - Patient model = Physician Model =Actual Model o Both need to be on the same page (and the right page) 9/20 Over-utilization – use it when it cant do anything for them and they don’t need it What determines… - Lower SES people can only use the emergency room which can be innefective and expensive Race/Ethnicity/Religion - May use health care less because of specific cultural beliefs - May use health care less because of lower SES (SocioEconomicStatus) Psychological Factors - Health Behavior Models o Health beliefs, attitudes, social norms, intentions, ect. - Social Psychological o Gender-role expectations: “real men do not need doctors” o Stigma: guilt/embarrassment and sexual health - Personlity and mood o Neuroticism, hypochondriacism, may increase use  By increasing attention to symptoms and negative interpretations Additional factors - Leventhal’s Commonsense theory o Disease prototypes: “heart disease is a man’s disease” women don’t think they will get it o Lay models: cognitive/emotional response to illness episodes - Previous experience o Shelley taylor story about the Italian family/hodgkin’s disease o Doctors plyed it off, thought they were paranoid o Highly common disorders are sometimes discounted - Lay Referral network o Family and friends who are consulted before treatment seeking - Internet/Social media o Easier to Goals for patient-Practitioner Relationship - Accurate diagnosis o Usually not doctors goal, could have multiple cuases but a single type of treatment - Compliance/ adherence to treatment o Nonadherence is a major health problem, estimates range from 15% to 93% Poor Communication - Doctors don’t communicate well with patients Jargon - Another Interrupting/directing - Only 23% of patients were allowed to finish their answer when asked what the problem was - In 69% of visits doctor interrupted, and led them to a diagnosis - 18 seconds Note: - Baby talk and depersonalization Stereotypes, Predudice… - Physicians give less information to: o Blacks o Hispanics o Low SES - Physicians have negative perceptions of: o Elderly o Obese/overweight 9/27/2013 Stress - Well intergrated with psychological science but more intergration is needed o Especially with emotion Stress and Health - Note: behavior and stress are not entirely separate, they interact: smoking, wating, alcohol, drugs Defining Streess and Coping - What is stress in everyaday language? o What does it mean to be:  “under stress?’  “stressed”  “Stresssed out” o What about words like:  Fear, anxiety, distress?  Tension, pressure?  Frustration, anger? - What does it mean to cope? o Dealing or managing with stress - What is successful coping? Stress: Three Main Approaches to Stress - Biological: disease mechanisms - Environmental: events/conditions - Psychological: Cognitive-affective and behavioral processes Flight or Flight: Mechanisms - Adrenal Medulla o Slower but stronger o Endocrine = ductless, hormone travels in circulatory system Having too much cortisol will make you sick, Seyle thought it was running out of it that made you sick. Hypothalamus stops circulatingACTH when too much cortisol is detected Mason – GAS response mainly to psychological stimulus Reccent Developments - Allostasis: “maintaining stability through change” o Homeostasis is too static o Maintaining a steady state requires variability o Steady is a range of values, not a single point o Stability requires a balance of many systems 10/1/2013 Coping: Managing/Dealing with stress Methods ofStress Research Laboratory Reasearch (pioneered by Lazarus - Usefu lto demonstrate: o Primary ap
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