Module:. Health Psychology Lecture:. Revision Session Date: Module: Health Psychology Lecture: Revision Session Date: 27 April 2009 Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick Tel: +44(24) 761 50222 Email: C.Bridle@warwick.ac.uk www.warwick.ac.uk/go/hpsych

Aims and Objectives To provide an overview of the module and to provide you with a framework within which you can organise your revision for the module … in 12 or so slides!

Psychological Processes Background Factors Stable Factors Social Factors Situational Factors Stuff Psychological Processes Physiological Reactivity Biological Systems Biological & other Hereditary

Dual Pathway Model Two broad ways in which psychological processes may influence physical health Psychological Processes Physical Health Direct Path Indirect Path Indirect Path Behaviour

Nervous System: Physiological Reactivity Psychological Appraisal Nerves Hormones Response Nervous System: Physiological Reactivity Psychological Appraisal Chronic Stress GI: IBS, ulcers Psych: cognitive decline, morbidity Sensitivity - more severe RS: impotence, amenorrhea ReS: asthma, hyperventilation Salient Event Cardiovascular System Endocrine System Immune System Essential Hypertension Metabolic dysfunction Lowered immunity Hypervigilance - more events Physical and Psychological Health Status

Framework Background factors: the context in which individuals live, e.g. S-E-S Stable factors: relatively enduring and resistant to change, e.g. negative affect Social factors: resources available through social relations, e.g. social support Situational factors: give meaning to salient events and respond to demands, e.g. appraisal and coping Distal Proximal We bring with us, to any situation, the cumulative influence of background, stable and social factors, which we combine in various ways to form an understanding of our current situation. In most cases, our understanding of the situation determines our behaviour within it.

All of these behaviours are driven by beliefs ... Behaviour and Beliefs Health behaviour: Smoking; alcohol misuse; excessive revision; sedentary lifestyle; neglect of preventive behaviours, etc. Illness behaviour: Seeking medical help; adherence; denial; service (over)use; Dr shopping, etc. All of these behaviours are driven by beliefs ... ... that form our understanding, guide interpretation and give meaning to the behaviour in a particular situation

Situation-Specific Beliefs Health beliefs Many models describing the relationship between antecedent beliefs and health behaviour Common, evidence-based beliefs: personal relevance, self-efficacy, intention/motivation, outcome evaluation Illness beliefs At least 5 dimensions of belief: Identity; Cause; Time; Consequence; Control-Cure Illness beliefs predict not only illness behaviour, but also prognosis independently of illness severity Understanding, predicting and changing behaviour is dependent upon identifying the beliefs that promote and maintain the particular behaviour

Stable Individual Differences Explanatory styles: Psychological processes involved in explaining the causes of negative events - past Emotional dispositions: Psychological processes involved in both the experience and expression of emotion - present Generalised expectancies: Psychological processes involved in formulating expectations in relation to future outcomes - future Stable, individual differences reflect our tendency to interpret things in a particular way. They influence / predict beliefs, behaviour and health-related outcomes.

Poor communication negatively affects patient health Consultation People judge adequacy of care by the manner in which it is delivered and not by its technical quality Patients highlight the doctors use of blocking behaviours as main problem, e.g. interrupting; depersonalisation; use of jargon Poor communication has numerous adverse effects for patient health: poor adherence, cancellation of follow-up/referral, low future use Poor communication negatively affects patient health

Revision Approach: Concept driven Biopsychosocial: Psychological processes and physical health outcomes; mechanisms of action; effects Theory: Illness representations; Stages of change (TTM); transaction model of stress and coping Processes: Stress; Coping; Behaviour change; Motivation; Illness perception Practice: Communication; Screening; Motivating patients to change; Supporting change; Stepped care / pathways

Things you should know: Screening Common psychological conditions, e.g. depression, alcohol abuse and smoking For each condition: Relevant signs, symptoms, effects Screening questions to ask Differential diagnosis - what and how Options and opportunities for treatment - psychological v's pharmacological; generalist v's specialist?

Other Things to Know Psychological intervention: Broad aims of psychological intervention (ABC); types of psychotherapy available Stages of change: Name, description, order, e.g. pre-contemplation = not thinking of changing Relapse: Factors influencing relapse and methods to prevent it, e.g. developing proactive coping skills Coping: Brief description of coping dimensions, the effect of coping (what it does) and the determinants of coping Somatisation/Chronic illness: Characteristics; principles of assessment, treatment and management

What now? In your tutor (sub-)groups, now or later: Screening: Select ONE condition and answer questions / provide information Select ONE topic from the list of 'Other Things to Know' and answer questions / provide relevant information Complete ONE integrated question examples from module webpage Formulate ONE question re: any of the above Any Questions?