Unit G543 – Health and Clinical Psychology

Overview – G543 Healthy living Stress Disorders and Dysfunctional Behaviour Approaches Methods Issues Debates

What is health psychology? Any ideas? Defined as ‘the scientific study of psychological processes related to health and health care’ ( Freidmann and Adler, 2007) ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity’ (WHO) Concerned with how different factors (I.e. lifestyle or social context can influence illness and well being Key aim: to promote understanding of appropriate behaviour that leads to a healthier lifestyle Trauma, reduction of diseases, eating well, unhealthy behaviours (smoking) or becoming stressed

Relies on empirical research to support theories and models Health interventions and promotion Application Healthier society, longer lives, less public spending Mental health Diagnoses Causes Treatments Therapies – individual differences

Overall Objectives

Healthy Living - Specification

Healthy Living Theories of health belief Methods of health promotion Features of adherence Healthy living is…..the way people live their lives A health behaviour is….something people do in order to improve health A lifestyle is….pattern of health behaviour Why do some people behave in healthy behaviours and others don’t?

Approaches – apply to healthy living Behaviourist Cognitive Biopsychologists B – behaviour and and environment what sort of background and experiences or circumstances make someone make healthy choices as opposed to those who don’t C – thought processes – beliefs, weigh up odds, pros and cons, strong internal belief and faith Bio- brain structure and genetics links with personality or temperament that make them more prone to being overweight or those who make life changes Why do some people choose to ignore the importance of health behaviours?

Health Belief Model Health belief model - background Originally developed in 1950s by Rosenstock to explain why some people took up the offer of free screening for tuberculosis and others did not Used in the 1960s To explain why the NHS (free healthcare in Britain) and free health screening in the US were not having a positive impact on certain aspects of health HBM focuses on individual and situational factors that explain health related behaviours

Health Belief Model: Becker 1978 A person will adopt a health behaviour If they perceive a threat to their health if they don’t adopt it Perceived seriousness will increase the threat Perceived susceptibility will increase the threat If the benefits outweigh the costs If they are reminded by internal and/or external cues: media campaigns, lay advice, reminders from GP’s, magazine articles Depending on demographic variables: age, race, ethnicity, class, gender, peers, personality, social pressure, prior knowledge of the disease

HBM – what is it actually for? It is used to predict the uptake of health behaviours based on several factors The more factors that are present in a particular situation, the more likely you are to behave healthily Health behaviours include giving something up (smoking), refusing to try something (drugs), regularly checking your health (self-examination), regularly preventing problems (brushing your teeth)

The health belief model HBM – rests on the assumption that people will engage in healthy behaviour if they understand that a health problem will arise if they do not Perceived Threat: Perceived susceptibility Perceived severity Perceived benefits Examples? How bad can it be? How likely am I to be affected? Scenario 1 – someone that smokes 20 cigarettes a day Scenario 2 – someone who uses sun beds twice a week for one hour Scenario 3 – someone who drinks half a bottle of wine a day What’s in it for me? Positive consequences?

The health belief model Perceived barriers Influences that discourage a change This is so difficult! Scenario 1 – someone that smokes 20 cigarettes a day Scenario 2 – someone who uses sun beds twice a week for one hour Scenario 3 – someone who drinks half a bottle of wine a day Costs - Money and time

The health belief model Cues to action Examples? Mediating factors Demographic variables Socio-psychological variables Health Motivation Self efficacy External factors Prompt a desire TV programme, relative dying/falling ill HBM – rests on the assumption that people will engage in healthy behaviour if they understand that a health problem will arise if they do not

Activity - 10 minutes One person in each group to open up work sheet 1 Use this presentation, the textbook (pg. 101) to apply the health belief model to one of these scenarios Scenario 1 – smoking 20 cigarettes a day Scenario 2 – excessive use of a sun bed Scenario 3 – binge drinking

Becker (1978) Compliance with a medical regime for asthma Aim To use the health belief model to explain mother’s adherence for their asthmatic children. Approach: Cognitive and social factors with demographic variables such as education, family size and occupation Method and Design: correlation between beliefs reported during interviews and the compliance with self-reported administration of asthma medication Participants and procedure: 117 mothers asked only 111 took part (7 white participants) Baltimore USA 17-54 years old Children – 9 months – 7 yrs.

Covert evaluation of compliance Interview – 45 mins Mother’s general health motivations Attitudes and views about asthma and consequences Provide measures of the HBM’s dimensions Perception of their child’s susceptibility to illness and asthma Beliefs about its seriousness and interference (education, activities, embarrassment, mother’s activities) Faith in doctors and effectiveness of medication Covert evaluation of compliance Blood test (finger stick) – t confirm validity of self report Test presence of theophylline – substance basic to all asthma medication prescribed to the children taking part Only available for 72% 80 of the participating mother’s Reports of medical administration compared to lab findings Correlation of 0.913 – arguing validity of mother’s statement

Becker’s Results Discuss results – make notes Positive correlation between mother’s belief about child’s susceptibility to asthma attacks and compliance with regimen Positive correlation between mother’s perception of child having a serious asthma condition and compliance with regimen Negative correlation between costs and compliance These costs included: Disruption of daily activities Inaccessibility of chemists Child complaining about medication Prescribed schedule for administering the medication 2 demographic variables that correlated with compliance were marital status and education

Conclusion: HBM is a useful model to predict and explain different levels of compliance with medical regimes Evaluation – Issues and debates Class discussion (making notes) pg. 103

Evaluation Becker Generalisability Reliability Validity Ethics

Debates: Approach Reductionism/holism Any others?

Homework Describe the Health Belief Model. (10) Due next lesson

Rotter (1966) Internal vs External Locus of Control Background – Rotter 1950s Aspect of personality Reductionist theory The extent to which individuals believe they can control events that affect them Influential in explaining individual differences in psychology –especially health behaviours Group work to research locus of control (books, powerpoint, psychteacher.co.uk, etc.) Groups to discuss - but make individual notes Every one to feedback one aspect regarding locus of control to the class Nature Vs Nurture Stable underlying personality construct OR Largely learned Some evidence that psychological and educational interventions have been found to shift towards internal locus of control

Locus of Control Take the Locus of control test here: http://www.psych.uncc.edu/pagoolka/LocusofControl-intro.html Guided by “reinforcements” (rewards and punishments) Through these individuals come to hold beliefs about what causes their actions Locus of control orientation Outcomes of actions are contingent to what we do (internal) Or events outside of control (external control) Unidimensional continuum – range external to internal

High internal locus of control: feel that their actions are their own choice and responsibility Low: actions results of factors outside of their control (i.e. luck or fate) High internal LOC, Low external LOC : health is In MY hands. I can eat healthily and go to the gym 3 times a week. Success/failure is due to my own efforts High external LOC, Low internal LOC: Things in my life are controlled by luck, chance or religion. There is no point in me going to the gym. Doctors will help me if I get ill. My health is in their hands and fate will decide.

Rotter (1966) Internal vs external locus of control Aim: Examines the degree by which individuals believe their health is controlled by internal or external factors Approach: Cognitive Method: Review of 6 pieces of research into individuals perceptions of ability to control outcomes based on reinforcement Results: Participants with internal LOC were more likely to show behaviours that would enable to cope with a threat than those with external LOC Conclusions: LOC can effects many different behaviours not just health James et al (1965) smokers who give up and didn’t relapse had a higher level of internal LOC Women- with no significant difference between internal and external LOC would take other factors into consideration such as weight gain (other factors play a part not just LOC) Internal LOC – can control it, beat it and survive

Evaluation Rotter Generalisability Reliability Validity Ethics

Recap - Internal or External? A person believes they can beat heart disease through a better lifestyle Someone believes God will decide if they will survive their heart transplant A parent believes that healthy eating for their child is the responsibility of the school A woman stays out of the sun to avoid skin cancer A man thinks he can still smoke as no one else in his family got cancer despite all smoking

Task Write a paragraph criticising the methodology

Self Efficacy Bandura and Adams (1977) The belief one can successfully engage in a behaviour to produce the desired outcome Faith in your ability to do something impacts your actual ability to do it Note: closely related to the locus of control theory however there are important differences Locus of control is concerned with what/who produces a particular outcome Self efficacy is the conviction that one’s own behaviour will influence the outcome

High Self Efficacy Low Self Efficacy Avoid challenging tasks View challenging problems as tasks to be mastered Develop interest in the activities in which they participate Stronger sense of commitment to interests/activities Recover quickly from setbacks/ disappointments Avoid challenging tasks Believe that difficult tasks are beyond their capabilities Focus on personal failings Quickly lose confidence in their abilities

Self-Efficacy Relate to health…. Example? Cognitions that determine whether health behaviour change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures. Effort to change risk behaviour Persistence to continue Self efficacy has been found to be one of the most important factors of an individual’s ability to successfully negotiate health changes.

Self-Efficacy Bandura – four sources affecting self-efficacy Worksheet mix and match – term with definition Experience Modelling Social persuasions Physiological factors Bandura – If someone believes they can cope they will try harder to overcome obstacles If they master their fear self-efficacy

Bandura and Adams (1977) Analysis of self-efficacy theory of behavioural changes Efficacy expectation – affects behaviour a person can successfully do whatever is required to achieve outcome Previous experiences Vicarious experiences Verbal persuasion Emotional arousal All affect efficacy expectation Social, situational, temporal factors could influence cognitive appraisal Example – public speaking Self efficacy is not simply explained by personality

Bandura and Adams (1977) Analysis of self-efficacy theory of behavioural changes Aim: to assess the self-efficacy of patients undergoing systematic desensitisation Approach: Cognitive Type of data: Quantitative and qualitative Method: controlled quasi-experiment (patients with snake phobias) ACTIVITY

10 snake phobics 9 females 1 male 19-57 yrs old Replied to an advert in paper Pretest: To test level of fear using rating scales 1-10 – testing how frightened they would be to approach the Boa constrictor Avoidance behaviour Self efficacy – tested using 100 point probability scale for how likely they felt they would succeed

Systematic desensitisation Phobia treatment Anxiety hierarchy Move up step by step – using relaxation techniques Client forms positive associations

Systematic desensitisation – a standard desensitisation programme was followed where patients were introduced to a series of events involving snakes and at each stage were taught relaxation. Post test - Each patient was again measured on behaviours and belief of self-efficacy in coping.

Findings & conclusion Higher levels of post-test self-efficacy were found to correlate with higher levels of coping behaviour with snakes. The boa constrictor was used to test changes in self efficacy Corn snake used to see if self-efficacy generalised to other snakes Desensitisation enhanced self-efficacy levels, which in turn lead to a belief that the participant was able to cope with the phobic stimulus of a snake.

Pairs - discuss evaluation (pg.108)

Evaluation Pairs - discuss (pg.108) Study G R A V E

Relate these studies to health psychology Links to AS Griffiths (1994) Bandura (1961) Milgram (1963) Cognitive styles Cognitive processes affect behaviour Regular gamblers way of thinking about gambling, weighing odds and explaining away losses different to non gamblers Situational explanations Bashing bobo Social learning theory Obedience Behaviour depends on certain situations Relate these studies to health psychology

Knowledge check What does self efficacy mean? What factors influence self efficacy? What were the conclusion in Bandura and Adam’s study?

Tasks & Recap Health Belief Model: Write a paragraph describing why ETHICS is an issue in this study. Locus of control: Write a paragraph answering the following question: Is Locus of control a good predictor of healthy behaviour? Homework Read up on: How can health professionals use the media to encourage healthy living? Find an example of a media campaign related to health Everyone to feedback next lesson

Timed Question Describe self-efficacy as a theory of health belief. (10) 12 minutes 15 with extra time For third class before introducing media.

Peer assessment Use the mark schemes I have handed out and also bear in mind this extract from the examiners’ report. Give a www and an ebi Give a mark When you get it back read it through – do you agree/disagree? Write up on your feedback sheet, don’t forget to include how you will improve (put ‘PA’ next to the mark)

Recap - Health Belief Therapies Becker (1978) Compliance with a medical regime for asthma Rotter (1966) Internal Vs external locus of control Bandura and Adams (1977) Analysis of self-efficacy theory of behavioural change Brief summary on pg. 109