Health Psych Exam 3

Front 1

Factors that influence recognition of symptoms:

Back 1

1. Individual differences (e.g. neuroticism)
2. Cultural differences
3. Attentional differences (internal v. external)
4. Situational factors (e.g. saliency, medical sutdents' disease)
5. Stress
6. Mood

Front 2

Commonsense model of illness representations

Back 2

States that people organize their beliefs about symptoms and illnesses due to schemas
--influenced by the media, personal experience, friends and family
--differ in complexity and influence related behaviors
--may include beliefs about the name, causes, consequences, timeline, and cure of an illness
-Also, prior expectations (e.g. PMS) and area of the body affected

Front 3

Lay referral networks
Pros? Cons?

Back 3

An informal network of friends and family who offer their own interpretation of symptoms before any medical treatment or advice is sought. Internet can also play a role in lay referrals.
Pros: easy access, lots of information, many report taking better care of themselves based on internet-based health information
Cons: Access to inaccurate information, financial motivations of websites, unnecessary emotional reactions

Front 4

Delay behavior, list subtypes

Back 4

Not seeking care for (potentially serious) symptoms that have been recognized
Appraisal delay
Illness delay
Behavioral delay
Scheduling delay
Treatment delay
Provider delay (delay be/w seeing provider and getting correct treatment)

Front 5

Why do people use health services when it's unnecessary?

Back 5

Many times, ppl see medical professionals for issues that are better addressed by mental health professionals (1/2-2/3 of patients!)
--Many M.H. disorders, such as depression/anxiety, carry physical symptoms
--Some indiv. have unrealistic standards for health
--Some indiv. somaticize their emotional and psychological distress
--Some indiv. are looking for secondary gains
--Some indiv. malinger

Front 6

How stereotypes/stigmas prevent use of health services

Back 6

(E.g. HIV) perception that individual is responsible for symptoms, or that they are contaminated or "tainted."
Patient may avoid getting tested, may not disclose health status to others and fail to seek treatment for symptoms due to fear of judgment.

Front 7

Types of patient-provider interactions:

Back 7

1. Persuasion
2. Motivational interviewing
3. Shared decision making

Front 8

Persuasion (when should it be used?)

Back 8

Provider raises patient's perceptions of need to intervene and makes recommendations for intervention. A clear recommendation is made with an appeal to peripheral cues (USPSTF guidelines) and central cues (arguments supporting recommendation).
Best to use when outcome of treatment is usually positive and evidence supporting it is good.

Front 9

Motivational Interviewing (MI)

Back 9

Directive, patient-centered counseling style for eliciting behavior change by helping patients explore and resolve ambivalence. Helps create patient-generated attitude change, it enhances motivation and self-efficacy. Involves reflection (repeating, paraphrasing, etc.)
Best to use when outcome of treatment is usually positive and evidence supporting it is good.

Front 10

Shared decision-making (SDM)

Back 10

Both patient + provider express preferences and participate in the decision-making process. Provider helps patient understand health risk and pros/cons/alt/uncertainties surrounding treatment options. Patient weights his/her values regarding the option and engages in decision-making with provider at level they are comfortable.
Most useful when there is not clear "best" treatment.

Front 11

How can PATIENTS hinder the patient-provider relationship?

Back 11

Emotional reactions
Attitudes toward symptoms
LIteracy, numeracy

Front 12

How can PROVIDERS hinder the patient-provider relationship?

Back 12

Inattentiveness/interruptions
Use of jargon v. oversimplification
Nonperson treatment
Stereotypes/stigmas related to diseases
Low cultural competency

Front 13

How does sex of provider affect patient-provider relationship?

Back 13

Females spend more time with patient, engage in more patient-centered communication.
Patients of female PCPs speak more, disclose more bps information, make more positive statements, but are NOT more satisfied with their visit than patients w/ male PCPs.

Front 14

Complementary medicine

Back 14

Using a non-mainstream approach together with (and as a complement to) conventional (generally biomedical) treatment.

Front 15

Alternative medicine

Back 15

Using a non-mainstream treatment in place of conventional (generally biomedical) treatment.

Front 16

Creative nonadherence
Why does it happen?

Back 16

modifying and supplementing a prescribed treatment regimen (e.g. changing dosage level of required medicine to make it last longer)

Front 17

Decision aid

Back 17

Tools (usually interactive guides) to assist patients in making health-related decisions by providing personalized info about risk and addressing personal values.

Front 18

Why does non-adherence occur?

Back 18

-lack of patient understanding
-decision not to comply (creative nonadherence)

Front 19

How can we train provider to improve patient-provider interactions?

Back 19

1. Improve communication skills (verbal + nonverbal)
--e.g., greeting by name, training on how to deal w/ patient emotions
2. Probing for barriers to adherence in the appointment (identify barriers & work thru possible solutions)
3. Cultural competency training

Front 20

How can we train patient to improve patient-provider interactions?

Back 20

1. Preparing questions before appointment
2. Teaching more health literacy in educational settings
3. Encourage more shared decision making, changing norms (decision aids!)

Front 21

BENEFITS of Decision aids

Back 21

Have been found to out-perform standard care in terms of:
1. General patient knowledge,
2. Realistic expectations,
3. Decisional conflict,
4. Participation in SDM,
5. Prop. of patients remaining undecided about treatment following appt.

Front 22

Acute pain

Back 22

Typically results from a specific injury that produces tissue damage, such as a wound or broken limb. It is self-limiting and typically disappears when the tissue damage is repaired.

Front 23

Chronic pain (describe subtypes)

Back 23

Often begins with an acute episode, but does not decrease with treatment and the passage of time.
1. Chronic benign pain: typically persists for 6 mo. or longer and is relatively unresponsive
2. Recurrent acute pain: involves a series of intermittent episodes of pain that are acute in character, but condition persists for more than 6 months
3. Chronic progressive pain: persists longer than 6 months and increases in severity over time

Front 24

Why is it important to distinguish b/w acute and chronic pain?

Back 24

1. Chronic pain often carries an overlay of psychological distress (e.g. anxiety or depression), which complicates diagnosis/treatment.
2. Pain control techniques work well to control acute pain but are less successful with chronic pain, which requires multiple individualized techniques for its management.
3. Chronic pain involves the complex interaction of biopsychosocial components.

Front 25

Chronic pain behaviors

Back 25

behaviors that arise as manifestations of chronic pain, e.g. distortions in posture or gait, facial/audible expressions of distress, avoidance of activity.

Front 26

Nociception

Back 26

Type of pain perception that results from mechanical damage to the tissues of the body

Front 27

Endogenous opoid peptides

Back 27

Opiate-like substances produced w/in the body that constitute a neurochemically based, internal pain regulation system.

Front 28

Counterirritation

Back 28

A pain control technique in which you inhibit pain in one part of the body by stimulating or mildly irritating the other area.

Front 29

Biological factors that influence experience of pain:

Back 29

1. High sensitivity to noxious stimulation
2. Impairment in pain regulatory systems

Front 30

Gate control theory of pain

Back 30

States that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons.

Front 31

Why can pain be a source of tension in the patient-provider interaction?

Back 31

Pain patients often have to deal with negative stereotypes that physicians and other providers hold about chronic pain patients, and this experience may exacerbate adverse psychological responses to pain. Chronic pain generally calls for a multifaceted treatment approach, which often requires more time and effort from the provider.

Front 32

Biological factors that influence the experience of pain:

Back 32

Throughout the body, endogenous opoid peptides function as the natural pain suppression system of the body. They are activated by midbrain stimulation, which produces analgesia. Stress can also induce analgesia and reduce sensitivity to pain.

Front 33

Social factors that influence the experience of pain:

Back 33

Cultural meaning associated with pain can influence the experience of pain (e.g. childbirth).

Front 34

Psychological factors that influence the experience of pain:

Back 34

1. Personality: Chronic pain reliably correlated w/ neuroticism, introversion, passive coping strategies.
2. Psychopathology: Pain reporting + experience of chronic pain pos correlated w/ depression, anxiety, substance abuse disorders.
3. Emotions: Stronger pain experiences assoc. w/ anger suppression, negative emotions in general. Emotional reactions can dampen or exacerbate pain.

Front 35

What are markers of effectively coping w/ chronic illness?

Back 35

1. Incorporation of chronic illness into self-concept
2. Development of informed schema about illness (commonsense model of illness)
--What caused it? Duality of self-blame: negative, but motivating factor.
3. Improved self control + self efficacy beliefs about the illness (exception: when actual level of control is extremely low).

Front 36

How is CBT used to manage chronic illness?

Back 36

Individual therapy for chronic illness generally follows CBT approach.
-Can be tailored to indiv, can target specific problesm related to illness (e.g. fatigue, stress)
-Important elements:
1. Patient education
2. Relaxation/stress management
3. Social support (e.g. group therapy)
4. Family support

Front 37

How can chronic illness negatively impact self concept?

Back 37

1. Physical self - body image plummets during illness
2. Achieving self - can no longer be able to make same achievements thru job, career, or leisure activities
3. Social self: drop in social connections
4. Private self: need to depend on others, and inability to accomplish life goals

Front 38

Quality of life

Back 38

Includes assessment of physical functioning, psychological status, and social functioning (for chronically ill/pained, assesses how much normal life has been compromised)

Front 39

Psychological factors associated w/ chronic illness

Back 39

1. Denial (defense mechanism), adaptive at first, then maladaptive
2. Anxiety
3. Depression
4. Poorer self concept

Front 40

Social factors associated w/ chronic illness

Back 40

1. Financial impact (inability to work, inadequate benefits)
2. Stigmas and/or discrimination (e.g. employees w/ cancer laid off 5x more)
3. Increased dependency on family members
4. Decreased sexual intimacy due to physical and psychological factors

Front 41

Interdisciplinary pain rehabilitation programs

Back 41

Rehabs that aim to help patients increase physical activity levels and muscle strength, decrease pain behaviors, reduce reliance on drugs, and reduce depression/anxiety.