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1. 543 Health & Clinical Psychology Candidates should: - ã Be able to describe and evaluate the areas in the light of psychological theories, studies and evidence;…
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  • 1. 543 Health & Clinical Psychology Candidates should: - • Be able to describe and evaluate the areas in the light of psychological theories, studies and evidence; • Always seek to apply psychological methods, perspectives and issues; • Actively seek to apply theory and evidence to the improvements of real-life events and situations; • Explore social, moral cultural and spiritual issues where applicable; • Consider ways in which the core areas of psychology (cognitive psychology, developmental psychology, physiological psychology, social psychology and the psychology of individual differences), studied in the AS course, can inform our understanding of Psychology and Health 1
  • 2. 543 1) Healthy Living Theories of Health Belief The main approach in this area is cognitive psychology. It is interested in how people think about health behaviours. There are many compelling and logical arguments for adopting a healthy lifestyle, however many of us choose to ignore them. Why? 1. Health Belief Model Becker & Rosenstock developed this model in 1970. It is based on a cost-benefit analysis. Perceived Seriousness – ‘Will it actually kill me?’ Perceived Susceptibility – ‘Am I likely to get it?’ Other factors that affect out decisions are demographic variables such as age, income, sex, occupation, education, family size etc. Becker investigated compliance with a medical regimen for asthma in mothers with asthmatic children. He discovered a positive correlation between a mother’s belief about her child’s susceptibility to asthma attacks and compliance with the medical regimen. Two demographic variables also correlated with compliance: - marital status and education. Why do you think mothers with a partner and a higher level of education were more likely to comply and ensure they administered their child’s medication? 2
  • 3. 543 Health Belief Model (HBM) A person will adopt a healthy behaviour If they If they are perceive a If the reminded threat to benefits by internal Demographi their health outweigh and/or c variables if they don’t the costs external adopt it ‘cues’ Perceived Perceived seriousnes susceptibility s will will increase increase the threat the threat Task: Draw a diagram of the HBM and apply it to why teenagers might or might not binge drink at the weekends. Evaluation: - What are the strengths and weaknesses of this model of Health Behaviour? 2. Locus of control Rotter’s (1966) theory is a very simple, reductionist theory. Locus of control can be either internal or external. Internal Locus of Control – A belief that you are directly responsible for your own health and can make a difference by changing your lifestyle. 3
  • 4. 543 External Locus of Control – Your health is in someone else’s hands e.g. Doctors, parents, genes, fate or religion etc. James (1965) found that male smokers who gave up and did not relapse had a higher level of internal locus of control than those who did not successfully quit. There was not a significant difference for female smokers who cited factors such as possible weight gain as more influential. Task: - Choose a health issue such as diabetes, heart disease, breast cancer, smoking, drinking, drugs etc. Explain how locus of control theory would explain the adoption of healthy behaviours. Evaluation: - This theory is very reductionist. What other factors might affect the adoption of healthy behaviours? 3. Self-efficacy Bandura (1977) expanded on the locus of control theory which he felt was only concerned with outcomes; self-efficacy is a person’s actual conviction that their own behaviour will make a difference. Self-Efficacy means how effective a person thinks they will be at successfully adopting a healthly behaviour. Bandura suggests that there are a number of factors that affect a person self-efficacy: - • Previous Experiences – how successful were you in the past e.g. quitting smoking • Vicarious experiences – The success of others • Verbal persuasion – Others telling you, you can do it • Emotional arousal – Too much anxiety (pressure) can reduce a person’s self-efficacy. Task: - Give examples for each of the four factors above for both success and failure at losing weight. 4
  • 5. 543 Methods of Health Promotion 1. Media Campaigns Task: - In groups list any recent media campaigns you can remember that promote healthy lifestyles e.g. smoking, drinking, sexually transmitted diseases etc. Remember that media campaigns can also involve banning the advertisement of certain products. Do you think they were affective? If not, why not? What issues are involved? 2. Legislation On the 1st July 2007 legislation was passed to ban smoking in all enclosed public places and workplaces. On the 1st October 2007 the legal age for buying cigarettes increased to 18. What affect has this legislation had? Is it an effective way to change health behaviour? What other health legislation has been put in place recently? Use the internet to find further examples. 3. Fear Arousal Both the risks of smoking and drink driving have addressed by fear arousal tactics. Putting graphic images on packets of cigarettes and media campaigns that focus on the severe health implications have been tried. On the whole they have little impact. Why? Psychologists suggest we become desensitised, we feel that it will happen to others, not us. Task In groups design a health promotion campaign. Decide which aspect of health you would like to concentrate on. You need to think about lifestyle, diet and the role of health professionals. You must include psychological theory. Features of Adherence to Medical Regimes You need to produce: - • A leaflet Exam Questions • A poster 1) • A PowerPoint • Written evaluation of how effective you think your campaign would be and (a) Describeproblems would be faced (500 words) what how one method of health promotion has been used. (10) • A presentation summarising the above lasting 10-15 minutes (professionally delivered without notes) 5
  • 6. 543 Adherence to Medical Regimens Some people choose not to follow medical advice? Why? Ley et al (1973) suggests that some patients have problems remembering the instructions they are given by medical professionals. However, often patients weigh up the relative costs and benefits, in a similar way to that seen in the HBM. Bulpitt et al (1988) studied men with hypertension (high blood pressure). The drugs given can cause erectile dysfunction. Hypertension has no real short-term adverse effects, but in the long term can lead to heart disease and stroke. Curb et al (1985) found 8% of men discontinued treatment because of sexual problems. Patients are less likely to adhere to medical regimen when their current condition is asymptomatic (without symptoms, but with a long term health risk). The risk of side-effects is seen to outweigh the benefits. What other factors would affect this decision? Measures of non-adherence How do we know whether or not patients are taking their medication? Task Consider the following three methods and draw up a table for the strengths and weaknesses of each one. 1. Self-report 2. Pill and Bottle counts 3. Biochemical tests e.g. blood and urine. Improving adherence using behavioural methods Given the high cost of medication that is prescribed but not taken, in addition to the health costs of people not adhering to regimes, the importance of this area of health psychology can be seen not only in healthier patients, but in less wastage of resources. 6
  • 7. 543 Watt et al (2003) Aim To see if using a Funhaler could improve children’s adherence to taking asthma medication Method A Field experiment with a repeated measures design, each participant had one week using a normal pMDI inhaler and one week using the Funhaler. The participants were 32 Australian children (10 boys and 22 girls) with a mean age of 3.2 (between 1.5 and 6years old). They had all been diagnosed with Asthma and their parents had given informed consent. Each child was given the standard inhaler for the first week and the funhaler (inhaler with incentive toys such as a spinner and whistle which work best when the child breathes deeply) for the second week. Parents completed a questionnaire at the end of the second week. Findings 38% more parents were found to have medicated their children the previous day using the funhaler compared to the standard inhaler. Conclusions Making a medical regimen fun can improve adherence in children. Evaluation: - How would you criticise the sample? The design? The measure of adherence? Would this work in adults? What problems can you see in making medication fun? 7
  • 8. 543 Exam Questions 1. (a) Describe one theory of health belief (10) (b) Evaluate one theory of health belief (15) 2. (a) Describe how one method of health promotion has been used. (10) (b) Review the effectiveness of health promotion methods. (15) 3. (a) Describe one technique which could be used to measure adherence to medical regimes and give an example from a research study. [10] (b) Discuss problems psychologists might have when trying to improve adherence to medical regimes. [15] 8
  • 9. 543 2) Stress Causes of Stress The first big question is what is stress anyway? It is a term we read about in the papers almost daily. As a society we are supposedly suffering from this thing, it costs the country millions of pounds a year in days off work and stress related illness not to mention broken marriages, arguments and neglected children. We tend to think of stress as something `out there`. Subjectively it feels as if there is just too much to do, or too much being expected of us. We feel unable to cope and if it goes on for too long we may even become ill. 50 years ago the term was not really used. People would get tired, they might have been unhappy, but they probably would not have said they were stressed. So is stress what happens to us or is it more about the way in which we choose to think about what happens to us? If we make different choices in life can we reduce stress? Is stress just a modern term for unhappiness? We might also ask whether stress is always a bad thing? Is a lack of stress stressful?! Lazarus and Folkman (1984) define stress as:- “A pattern of negative physiological states and psychological responses occurring in situations where people perceive threats to their well being which they may be unable to meet.” Firstly, how stressed are you?!! Task 1. Complete a stress questionnaire to find out how stressed you are and how good you are at coping with stress. 2. How could you criticise the methodology of a questionnaire as a way of measuring stress levels? 9
  • 10. 543 In this section we will look at three causes of stress: - Work, Life events & Hassles and lack of control. We will also look at and evaluate different methods used by psychologists to measure stress. Work Why is work seen as stressful? Are some jobs more stressful than others? What makes certain jobs more stressful than others? Johannson (1978) – Swedish Sawmil Aim To measure the psychological and physiological stress response in two categories of employees. Method This was a natural experiment (could also be classed as a case study) using an independent measures design. The participants were 24 workers at a Swedish Sawmill. 14 were classified as being in a high stress risk group, these were the finishers. The finishers had to work at a set pace, governed by the production line, their work was complex and required a great deal of knowledge. They were also responsible for their own and their team’s wages and worked in social isolation. So their jobs were repetitive, constrained, socially isolated, but also complex and very responsible. The other group of 10 workers were classified as the control group (low risk of stress) they were cleaners or maintenance workers. Each participant was asked to give a daily urine sample, body temperature was checked and they were asked to complete a self-report about mood, alertness and caffeine and nicotine consumption, when they first arrived at work and a further four times during the day. Baseline readings were taken at home before the study started. Results In the first urine sample of the day, the high risk group had adrenaline levels twice as high as their baseline and these continued to increase throughout the day. The control group had a peak of 1.5 times their baseline in the morning and this declined during the rest of their shift. 10
  • 11. 543 In the self-report, the high risk group felt more rushed and irritated than the control group. They also rated their well-being as lower than the control group. Graph to show levels of adrenaline in urine throughout the four sample times 250 % of adrenaline compared to 200 baseline High Risk 150 100 Control 50 0 1 2 3 4 Urine Sample Time Conclusions The repetitive, machine-paced work, which was demanding in attention to detail and highly mechanised, contributed to the higher stress levels in the high risk group. Evaluation A major advantage of this study is that it measures stress in two ways: - physiological (adrenaline levels and self-report), this increases the reliability of the study. Johannson was an occupational psychologist and used his findings to suggest ways in which the working lives of the finishers could be made less stressful. What suggestions would you make for changes to working practices? What are the limitations of this study? 11
  • 12. 543 Life Events and Hassles Life changes are significant changes in a person’s life which disrupt their normal routines. They include both positive and negative events, events which are seen as desirable and undesirable. A number of researchers argue that life events are a major source of stress. Holmes & Rahe – Social Readjustment Rating Scale (1967) (SRRS) Aim: - The main aim for this study was to construct an instrument for measuring stress. Holmes and Rahe defined stress as the amount of change an individual has had to deal with during a particular period of time. They claimed that the degree of stress is related to both physical and psychological illness. People are more likely to show symptoms following periods of stress. The greater the stress the more serious the illness. Procedure Holmes and Rahe examined the medical records of 5,000 patients (all American service men). From these, they put together a list of 43 life events which seemed to precede (come before) illness. They told 100 people (‘judges’) that ‘marriage’ had been given an arbitrary value of 500. The judges then had to give a number to each of the other life events, indicating how much readjustment they’d involve relative to marriage. So, death of a spouse was judged (on average) to require twice as much readjustment as marriage. The average (mean) of the numbers given to each event was then divided by 10. The resulting values became the weighting (numerical value) of each life event. For example, the weighting for death of a spouse was 100 (1000 divided by 10). The amount of life stress a person has experienced in a given period (e.g. 12 months) is measured by the total number of life change units (LCUs). These units are calculated by adding the mean values (in the right hand column of the table on the next page) associated with the events the person has experienced during that time. The ranks (left hand column) simply denote the order in which the life events appear in the SRRS. (NB- When participants are given the SRRS, they’re presented only with the list of life events without mean values and asked to tick the ones that apply to them. See notes on Kobasa later for a study that has used SRRS) 12
  • 13. 543 Findings Most life events were judged to be less stressful than getting married. But 6, including death of a spouse, divorce and personal injury or illness were rated as more stressful. Holmes and Rahe found that people with high LCU scores for the preceding year were likely to experience some sort of physical illness the following year. For example, someone scoring over 300 LCU s had about an 80% Conclusion Holmes and Rahe concluded that stress could be measured objectively as an LCU score. This, in turn, predicts the person’s chances of becoming ill (physically and / or mentally) following the period of stress. Stress and illness are not just correlated. Stress actually makes us ill. 13
  • 14. 543 Evaluation Task 1. Look at the list of life events, see if any apply to you and work out your LCU 2. Ingroups, complete the evaluation of Holmes and Rahe. Youneed to consider:- Is this SRRS useful? • Are any of the events ambiguous? • Are any missing? • What about their sampling? • Does it matter if change is unpredictable or not? Did Holmes • and Rahe take this into account? • Are all life events viewed the same by people- think about divorce? • Could the relationship between life events and illness be the other way round? • The data is retrospective- people are asked to recall the last 12 months- why is this a problem? STRENGTHS WEAKNESSES 14
  • 15. 543 Daily Hassles & Uplifts Some researchers have suggested that daily hassles lead to more stress and are a better predictor of health problems than life events. Daily hassles are ‘irritating, frustrating, distressing demands that to some degree characterise everyday transactions with the environment’ (Kanner 1981) – i.e. the straw that broke the camel’s back! Task Write down 10 things that, for you, are daily hassles and uplifts Daily hassles Daily uplifts 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Kanner et al (1981) Aim To compare Hassles and Uplifts and Life Events as predictors of psychological symptoms of stress Procedure 100 Californians (mostly white, protestant with at least 9th grade education) completed a hassles and uplift rating scale every month for nine months and a life events rating scale (SRRS) after 10 months. Their psychological symptoms of stress were measured using the HSCH and Bradburn Morale Scale every month for 9 months. (NB all of these are self-report measures). Findings Hassles were consistent from month to month. For men life events correlated positively with hassles and negatively with uplifts. For women, both hassles and uplifts were positively correlated with life events. Hassles correlated positively with psychological symptoms than life events. Conclusions Hassles are a more powerful predictor of psychological symptoms of stress than life events. 15
  • 16. 543 Evaluation: - What problems can you see with this study, how would you criticise it? Lack of Control One of the most stressful things we can experience is that feeling of having absolutely no control over our situation. Why is this so stressful? Geer & Maisel Aim To see if perceived control or actual control can reduce reactions to aversive stimuli. Method 60 psychology undergraduates were shown pictures of dead car crash victims and their stress levels were measured using galvanic skin response. Group 1 were given actual control over how long they were exposed to the picture, they could press a button to terminate and each picture was preceded by a tone (predictability & control). Group 2 were warned that pictures were 60 seconds apart and were preceded by a tone. However, length of exposure was controlled by group 1 (predictability, no control). Group 3 were just told they would see pictures from time to time, again length of exposure was controlled by group 1 (no predictability and no control). Participants had a baseline GSR taken when they were relaxed, measurements were then took at the onset of the tone, during the second half of the tone and during exposure to the pictures. Results Group 1 (predictability & control) experienced the lowest stress response as measured by the GSR, compared to groups 2 & 3. Group 2 showed most stress in response to the tone. 16
  • 17. 543 Conclusi
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