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283 Cards in this Set
- Front
- Back
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1. What is the definition health?
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A complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity
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2. A hundred years ago the definition was just "absence of disease", why the change?
(Three reasons) |
1. Recognition of psychological disorders and their prevalence
2. Dying from different cause now a days 3. Changes in behavior (i.e. diet) |
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3. What are four changes in the field of health that have occured in the 20th century?
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1. Changing patterns of illness
2. Escalating cost of medical care 3. Changing definition of health 4. Emergence of biopsychosocial model |
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4. What were the three leading causes of death in the USA in 1900?
What do three things do they have in common? |
Pneumonia, Tuberculosis, & Diarhea/Enteritis
1. All treatable now 2. All acute disorders 3. Either get over them or die |
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5. What are the three leading causes of death in the USA today?
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Hearth Disease
Cancer Stroke |
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6. What things do they all have in common?
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1. Chronic diseases
2. Have vulnerability to them (i.e. genetic predisposition) 3. Develop more as one ages 4. Influenced by behavorial and psychological factors 5. Preventable to an extent by lifestyle changes 6. Try to manage them rather than cure them since they are slow, chronic diseases |
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7. What four advances have drastically changed the causes of death over the last century?
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1. Water purification
2. Vaccination 3. Antibiotics |
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8. Why did water purficiation help prevent diseases?
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People would get bacterial infections (i.e. typhoid fever) from water
Chlorinated water and prevented death rates due to typhoid fever |
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9. How did the polio vaccine help lower death rates?
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In 1952: 60,000 cases & 3,000 deaths
In 1979: eliminated from US In 1991: eliminated from Western Hemisphere |
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10. What other vaccines helped lower death rates in children?
Why were there spikes in incidence of measles even after the vaccine? |
Measles, Mumps, and Rubella Vaccine
The spike in incidence was to not having access and hypothesis that vaccinations were related to autism in children (won't get vaccine due to risk of autism) |
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11. What antibiotics discovered in the 1940's helped to change the causes of death over the last century?
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Penicillin (streptococcus) and streptomycin (TB)
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12. How has life expectancy changed from 1900 to 2000?
What single thing is the largest contributor to the increase in life expectancy? |
1900: 47 yrs
2000: 78 yrs Decline in infant mortality (mainly b/c reduced rates of SIDS) |
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13. Are there any health disparities in infant mortality rates in the US?
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African American infants are nearly 3x's as likely as European American infants to die in infancy
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14. Why has our per capita health expenditures in US risen so drastically?
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As people live to middle and old age, they tend to develop chronic diseases that require extended (and often expensive) medical treatment
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15. America spends more than $1000 billion annually on health care. Does this mean our quality of health and life expectancy has improved?
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Massive increase in health costs are NOT associated with improvement in either
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16. What accounts for the great increase in cost?
(Two reasons) |
1. We do a lot of expensive testing
2. We spend a lot on the elderly and sick |
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17. What are two strategies for curbing mounting medical costs?
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1. Greater emphasis on early detection of disease
2. Changes to a healthier lifestyle and to behaviors that help prevent disease *half of the deaths in the US have preventable causes |
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18. What is the biomedical model of health?
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Predominant view in medicine for past 300 yrs (pre-1970's)
Maintains that an illness can be explained on the basis of aberrant somatic processes |
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19. According to this biomedical model, what is health?
What is a problem with this? |
Health is absence of disease
Prevention of disease is more cost effective |
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20. What causes diseases in the biomedical model?
What is a problem with this? |
Diseases are caused by a pathogen and can be treated by a cure
Today we have chronic disease with no cure |
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21. What type of mind-body relationship does the biomedical model imply?
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Mind-body dualism
Psychological and social processes are largely independent of disease processes |
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22. This biomedical model of disease is compatible with what causes of death?
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The leading causes of death that were 100 yrs ago
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23. The biopsychosocial model proposed by Engel maitains that disease is the result of what?
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Result of the interaction of biological, psychological, and social factors
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24. What two things does this model emphasize?
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1. Both health and illness
2. Mind and body cannot be distinguished |
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25. The biopsychosocial model has what two advantages over the biomedical model?
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1. Incorporates not only biological conditions but also psychological/social factors
2. Views health as a positive condition |
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26. What is the systems theory that the biopsychosocial model implies?
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That all levels of organization are linked to each other hierarchically and that changes in any one level will effect change in all other levels
micro <-> macro interaction |
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27. How is disease impacted then?
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Only impact disease through biology (biologically basis)
BUT biology is impacted by (and impacts) psychology and sociology These two levels also impact one another |
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28. What is health psychology devoted to?
(Three things) |
1. Understanding psychological influences on how people stay healthy
2. Why they become ill 3. How they respond when they do get ill |
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29. Health psychology uses the science of psychology to...
(Five things) |
1. Enhance health
2. Prevent & treat disease 3. Identify risk factors 4. Improve health care system 5. Shape public opinion w/ regard to health |
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30. What are the six steps in the research process?
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1. Generating Hypothesis
2. Selection of key variables 3. Selection of research design 4. Selection of sample 5. Hypothesis testing 6. Interpretation & dissemination of results |
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31. What are the two types of hypotheses?
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Experimental (or Alternative) Hypothesis:
A tentative explanation for a phenomenon Null Hypothesis: No difference or relationship between variables being studied |
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32. Which hypothesis do you test to see if you can reject?
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Null Hypothesis
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33. When generating a hypothesis, where do the ideas come from?
(Four places) |
1. Clinical experience
2. Theory 3. Previous findings 4. Intuition |
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34. What are four examples of assessment methods?
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1. Direct observation
2. Self-report 3. Physiological measures 4. Performance on tasks |
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35. Why is it necessary to use more than one method somethimes?
(Three reasons) |
1. Sensitivity: people vary (use a battery of methods)
2. Better representation of complex things 3. Validity |
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36. What is reliability?
What are two ways to determine reliability? |
The extent to which a measuring instrument yields consistent results
Test-retest reliability & inter-rater reliability |
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37. What is test-retest reliability?
What is inter-rater reliability? |
Concordance across time (compare scores on two or more administrations of the same instrument)
Concordance between 2 people (compare ratings from 2 or more judges observing the same phenomena) |
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38. What is validity?
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The extent to which the results are a valid representation of the true relationship
(extent to which instrument measures what it is designed to measure) |
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39. What's a question we can ask when determining construct validity?
How about internal validity? |
Are we measuring the construct we think?
Is the IV responsible for change in the DV? |
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40. What are three threats to construct validity?
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1. Poor operational definitions
2. Specific to kind of test used 3. Test changes measurement itself |
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41. What is a threat to internal validity?
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Inadequate control conditions
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42. What's a question we can ask when determining external validity?
What are two threats to it? |
Do the results apply to the broader population (can you generalize)?
Threats: 1)Sampling bias 2)Wrong target population |
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43. What is meant by 'regression to the mean?'
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Take any dependent measure that is repeatedly sampled, move along it as in a time dimension & pick a point that is "highest" (or lowest) so far.
On average, the next point will be closer to the general trend (or mean). |
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44. What are four research designs in psychology?
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1. Correlational designs (descriptive)
2. Cross-sectional & longitudinal (developmental) 3. Experimental design 4. Ex Post Facto designs |
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45. What do correlational designs tell us?
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The degree of association between 2 or more variables
They are descriptive research designs |
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46. What is the correlation coefficient (r)?
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Any positive or negative relationship between two variables.
Correlational evidence cannot prove causation only that two variables vary together |
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47. What is a cross-sectional study?
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A study that compares two or more groups of people at one point in time
Investigators study a group of people from at least two different age groups to determine possible differences bwt the groups on some variable of interest |
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48. What is a problem that is encountered with cross-sectional studies?
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Cohort Effect
For example, the era in which you grew up in affects the DV not necessarily the age group difference |
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49. What is a longitudinal study?
What are two problems with this type of study? |
A study that follow a group of people over time allowing researchers to identify developmental trends and patterns
Expensive and difficult to do |
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50. What is an accelerated longitudinal design?
What is an advantage of this? |
Start as cross-sectional design and follow each cohort for several years
Helps to determine if you have cohort effects |
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51. What happens in an experimental design?
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You control or manipulate one or more variables (IV) to determine their effect on a second variable (DV)
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52. What are the key features of the experimental design?
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1. Control and experimental group
2. Random assignment 3. Matching 4. Placebos |
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53. Why do you want random assignment?
What is matching? |
It's the best way to ensure there are no pre-existing differences between 2 groups
Make sure 2 groups are equal on some factor that is crucial such as age |
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54. What is a placebo?
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An inactive substance or condition that has the appearance of an active treatment and that may cause participants to improve or change due to belief in the placebo's efficacy
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55. What are nocebo effects?
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Negative placebo effect (adverse effect)
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56. What is an ex post facto design?
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A quasi-experimental study in which you compare 2 or more already existing groups (i.e. gender) that differ in the IV
(can't randomize) Record groups differences in the DV |
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57. Can we infer causation from ex post facto designs?
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No, because we cannot randomize
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58. Are variables manipulated in an ex post facto design?
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No, instead of manipulating IV researchers choose a variable of interest (subject variable) and select participants who already differ on this subject variable
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59. What are the research designs in epidemiology, and which psychology designs are they similiar to?
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1. Observational Studies (correlational studies)
2. Randomized, controlled trials (experimental studies) 3. Natural experiments (ex post facto designs) |
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60. What are observational studies?
What are two types? |
Observational methods look at and anaylze the occurence of a specific disease in a given population (do not show cause of disease)
Retrospective and Prospective studies |
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61. What are prospective studies?
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Begin with a population of disease-free participants and follow them over a period of time to determine if a given condition (i.e. smoking) is related to a later condition (i.e. heart disease)
Like longitudinal studies |
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62. What are retrospective studies?
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Begin with a group of people already suffering from a disease or disorder and then look backward for characteristics or conditions that marked them as being different from people who don't have that problem
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63. What is a case-control study?
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A retrospective study in which people affected by a given disease (cases) are compared to other not affected (controls)
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64. What do randomized, controlled trials usually entail?
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clincial trials
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65. What are natural experiments?
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Researcher can only select the independent variable, not manipulate it
Involves the study of natural conditions that provide the possibility for comparision |
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66. What is prevalence?
What is incidence? |
Prevalence: porportion of the population that has a particular disease at a specific time
Incidence: frequency of new cases during a specific period (usu. 1 yr) |
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67. Which is higher for chronic disease?
What about for acute disorders? |
Prevalence is higher than incidence for both chronic disease and acute disorders
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68. What is absolute risk?
What is relative risk? |
Absolute risk is persons chance of developing the disease (cummulative so every year accumulate more risk)
Relative risk is ratio of the incidence of a disease in an exposed group to the incidence of that disease in the unexposed group |
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69. What is the significance of one's perceived risk vs. their actual risk?
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Accuracy: people tend to underestimate own risk (lower perceived risk)
Implications for changing behavior |
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70. Why is a representative sample important?
Research has been limited to which samples? |
Important to external validity
Much research has been limited to Caucasians, the middle class, adults, and college students |
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71. What is statistical significance?
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Probability that the pattern of data occured by chance (p<=.05)
Statistical significance means it is unlikely to be due to chance |
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72. Whether one sees significant results is related to...
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1. Effect size: how big is the effect
2. Power: the ability to detect a real difference if it one does in fact exist |
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73. Power depends on what two things?
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1. Sample size
2. Variablility (signal to noise ratio) |
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74. What is clinical significance?
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The size of the effect in relation to clinical criteria
*can have one type of significance without the other |
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75. What is the criteria for determing causation between a condition and a disease when an experiment cannot be done?
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1. Dose-response relationship bwt the condition and disease
2. Removal of condition reduces prevalence/incidence 3. Condition precedes disease 4. Biological pathways of link bwt condition & disease 5. Relevant research data consistently reveal a relationship bwt condition & disease 6. Strength of association bwt condition & disease is high 7. Evidence is from well designed studies |
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76. What is dose-response relationship?
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A direct, consistent association betwen an IV (such as behavior) and a DV (such as disease)
In short the more exposure to risk factor, the worse off you are |
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77. How do disease and illness differ?
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Disease: refers to the process of physical damage w/in the body (can exist in absence of label or diagnosis)
Illness: refers to the experience of being sick and having been diagnosed as being sick |
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78. What is illness behavior?
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Consists of the activities undertaken by people who experience symptoms but who have not yet received a diagnosis
Occurs before diagnosis |
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79. What is sick role behavior?
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Behavior of people after a diagnosis for either doctor or self-diagnosis
Activities of sick role behavior are oriented toward getting well |
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80. What are factors that contribute to whether we recognize symptoms?
(Three factors) |
1. Symptom salience
2. Individual differences in attention to symptoms 3. Situation factors (experiences, too busy, bored) |
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81. What are four individual differences that affect our recognition of symptoms and how do they affect recognition?
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1. Neuroticism (high strung): report more symptoms
2. Negative affect/depression: see more going "wrong" 3. Somatic focus: people more in touch w/ their body recognize symptoms more 4. Gender: women tend to be more sensitive to internal signals |
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82. What are factors that influence one's reactions to physical symptoms?
(Eight factors) |
1. Prior experience
2. Expectations 3. Seriousness of symptoms 4. Threshold and tolerance for symptoms 5. Life circumstances at time 6. Cultural background 7. Childhood experiences 8. Cognitive factors |
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83. What are four triggers for seeking help?
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1. Personal factors
2. Symptom characteristics 3. Susceptibility to disease is viewed as high 4. Social context |
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84. What are some personal factors that trigger someone to seek help?
(Three factors) |
1. high stress (more likely to seek help; less likely to be take seriously esp. women)
2. Highly emotional (more likely to complain of an illness) 3. Age, gender, ethnicity, race, and SES |
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85. What are five characteristics of symptoms that would trigger one to seek help?
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1. Visible
2. Perceived severity 3. Extent to which symptom interferes w/ a person's life 4. Frequency and persistance 5. New/different |
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86. What is meant by susceptility to disease and social context?
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Seek help if view self highly susceptible to disease (i.e. I am a smoker/non-smoker...lung cancer)
Social context involves others being supportive of you seeking help |
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87. Who uses health services?
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1. Very young and elderly
2. Women more than men (men tend to go only when perceived as serious) 3. Higher SES more than lower SES |
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88. Why are the poor less likely to use health care even though they are less healthy?
(Four reasons) |
1. Financial reasons (Medicare and Medicaid help with this to some extent)
2. Uninsured 3. Access (have to travel far; have fewer resources) 4. Relationship with doctor may be poor and they may wait longer when at doctors |
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89. What are the five components in conceptualizing a disease?
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1. Identity of the disease
2. Time line 3. Determination of cause 4. Consequences of a disease 5. Controllability of a disease |
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90. Give to reasons for why we use and study models/theories?
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1. Help organize our thinking
2. Highlight important concepts |
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91. What should we expect from models or theories?
What are some limitations? |
Simple but good explanatory power
None are comprehensive; all may not be accurate in some situations |
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92. What does the health belief model predict?
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It predicts health behaviors are determined by our beliefs
These beliefs impact behavior directly (explain it directly) |
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93. What are the four beliefs that should combine to predict health-related behaviors according to the health belief model?
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1. Perceived susceptibility (how likely am I to experience a condition)
2. Perceived severity (what emotional/financial consequences are there if I have...) 3. Perceived benefits (If I do something will it help?) 4. Perceived barriers (Is the prevention/treatment painful, inconvenient, expensive, etc.) |
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94. What other factors reduce the ability of the health belief model to make accuracte predictions?
(Five limitations) |
1. Health risks (can prevention/treatment hurt me?)
2. Personality characteristics 3. Cultural factors (is the alternative culturally acceptable?) 4. SES (is help economically feasible?) 5. Previous experiences |
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95. How can one's personality characteristics be a factor that influences health behavior practices?
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Optimism: perceived susceptibility and severity are determined by the person not just the disease
Personal Control: is my fate under my control or is it not? |
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96. What is the theory of reasoned action?
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The theory of reasoned action assumes we act reasonably based on the expected
outcome(s) our our actions Behavior is directed toward a goal or outcome |
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97. According to the theory of reasoned action what is the immediate determinant of behavior?
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Intention (to act or not act)
Intentions can change over time, therefore, that's why behaviors change |
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98. What two factors shape intentions?
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1. Attitudes
2. Subjective Norms |
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99. What determines one's attitude towards the behavior?
(Two factors) |
1. Behavioral beliefs: consequences of acting
2. Outcome evaluation: evaluation of those consequences as postive or negative |
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100. What is meant by subjective norms?
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One's perception of the social pressure to perform or not perform the action
Will others approve or disapprove of the behavior? *people vary in their level of influence |
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101. What are the key elements in the theory of reasoned action?
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Attitudes toward the behavior and subjective norms, both related to the intention to perform a behavior
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102. Why was the theory of planned behavior developed?
What three components interact to shape people's intentions to behave? |
Developed to deal with issue of imcomplete control
1. Attitude toward the behavior 2. Subjective norm 3. Perceived behavioral control |
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103. What is perceived behavioral control?
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The ease or difficulty one has in achieving desired behavioral outcomes
It reflects both past behaviors and perceived ability to overcome obstacles |
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104. What two components make up perceived behavioral control?
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1. Control beliefs: how difficult is the behavior?
2. Percieved power: can I perform the behavior? |
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105. What are four limitations to the theory of reasoned action and the theory of planned behavior?
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1. Personality & demogphraic variables aren't considered
2. Assumption is made that perceived behavioral control predicts actual behavioral control 3. The longer the time interval bwt intent and behavior, the less likely the behavior will occur 4. Theory is based on assumption that humans are rational and make systematic decisions based on available info (unconscious motive and habits aren't considered) |
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106. What do stage model theorists believe?
Why do they criticize continuum models? |
They believe changes in behavior occur gradually through stages
Criticize continuum models b/c they focus only on predicting outcome behavior |
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107. What is the precaution adoption process model?
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It assumes when people begin new and complex behaviors aimed at protecting themselves from harm, they go through several stages of beliefs about their personal susceptibility
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108. What are Weinstein's seven stages of the precaution adoption model?
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1. Unaware of the hazard
2. Optimisitc bias 3. Realize at risk and that precautions should be taken 4. Action 5. Action unnecessary (branch off here) 6.Behaving to reduce risk 7. Maintain behavior |
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109. What is optimistic bias?
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The belief that other people, but not oneself, will develop a disease, have an accident, or experience other negative events
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110. Why would such a simple model be useful?
(Two reasons) |
1. Matching intervention
2. Treat for appropriate stage |
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111. When does the theory of planned action work?
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When behavior is under strong voluntary control
If other factors (internal or external) are important, the theory cannot account for them |
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112. What is the definition of adherence?
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The extent to which a person's behavior (health behavior/preventative care, treatment) coincides with medical or health advice
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113. How do we measure adherence?
What are some of the disadvantages of these? (Five ways) |
1. Ask the doctor: limited info, overestimate patients' compliance
2. Ask the patient: may lie, measuring may affect adherence 3. Ask others: constant observation may be impossible 4. Pill counting: doesn't address timing 5. Biochemical evidence: some drugs are not easily detected |
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114. If the intent of recommendation is treatment then what % keep apt., take ST meds., LT meds
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40-84 % kept appt
30-75% short-term medication 40-70% long-term medication |
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115. If the intent of recommendation is prevention, then what % keep apt., take ST meds., take LT meds., & diet
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10-65 % kept appt.
20-65% short-term medication 30-70% long-term medication 10-25% diet |
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116. How does adherence matter on an individual level?
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Recurrence of disease
Vaccinations: In 1990, 27600 kids got measles b/c they were not vaccinated |
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117. How does adherence matter on a societal level?
(Four ways) |
1. 20% of hosipital visits are attributed to noncompliance
2. 125,000 deaths 3. TONS of $ in health care 4. Antibiotics (have mutidrug-resistance TB due to ppl not taking antibiotics correctly) |
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118. What are four reasons for why people fail to adhere to medical advice?
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1. Disease characteristics
2. Treatment characteristics 3. Personal characteristics 4. Patient-provider relations |
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119. What is the main characteristic of disease that's a good predictor of adherence?
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PAIN: if your in a lot of pain you bet your ass you'll remember to take you pain meds
*severity actually has little impact |
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120. What are some treatment characteristics that decrease adherence?
(Five things) |
1. Complex regimen (decrease adherence if drugs are taken more than 3x/day)
2. Side effects (severe side effects = less likely to take meds) 3. Longer duration 4. Greater degree of behavioral change is required 5. Infrequent follow-up |
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121. What are some personal factors that affect adherence?
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1. Age (adherence increases with age)
2. Gender (similar except w/ some conditions) 3. Forgetfulness (aging, specific disorders) 4. Health beliefs (will adherence help?) 5. Personality (weak evidence except w/ OCD & hostility) 6. Lack of social support (isolation not good) 7. Lack of resources (can't afford pills) 8. Cultural norms (religious beliefs) |
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122. What is the exception with increased adherence as one increases in age? Why?
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Dip in adherence at adolescents and when very old
Very old have more meds, complex regimens, cognitive problems, decreased mobility, and visual problems Adolescents just rebel (want control over themselves and know best) |
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123. When are women better at adherence than men?
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When it comes to psychiatric orders
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124. What are four reasons regarding patient-provider relations for why people fail to adhere?
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1. Patient satisfaction
2. Poor communication 3. Provider behavior 4. Rapport |
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125. How does patient satisfaction affect adherence?
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If you dislike doctor, adherence goes down
Patients' reports of satisfaction w/ a physician and the physicians' perceptions of the patients' satisfaction were virtually unrelated |
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126. How are there gaps in communication during a 20 minute visit?
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1 minute spent communicating regarding illness or treatment
Physicians consistently overestimate the amount of time discussing illness & treatment and the level of patient understanding |
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127. Why are there gaps in communication?
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1. Diagnostic process and patient's concerns are not always aligned
2. Diagnostic severity, stress, and anxiety can affect communication 3. Medical terminology 4. Language/education/ethnic barriers |
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128. How does diagnostic severity, stress, and anxiety cause gaps in communication?
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If these are low, they more adherent
If these are high, they are less adherent b/c anxiety decreases concentration |
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129. What are some behaviors of the provider that contribute to dissatisfaction?
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1. Not listening
2. Communication of negative affect 3. Use of jargon and technical language 4. Depersonalization of the patient 5. Stereotypes of patients |
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130. Do providers really not listen?
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23% of times patients had time to explain their concerns
69% physician interrupted, directing the patient toward a particular disorder |
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131. What effect does negative affect by provider have on the patient?
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Women who observed a worried physician recalled less info, perceived the situation as more severe, reported more anxiety, and had higher heart rates than women who saw a non-worried physician
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132. What is meant by "good beside manner" or good rapport?
(Three things) |
1. Interpersonal warmth
2. Concern for the patient 3. Confidence in their abilities and care about outcome *This isn't closely related to doc. competence |
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133. What are the three health behavior theories of adherence?
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1. The Behavioral Model
2. Social Cognitive Theory (self-efficacy) 3. The Transtheoretical Model |
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134. The behavioral model is based on what two learning theories?
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1. Classical conditioning
2. Operant conditioning |
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135. How is adherence viewed based upon an operant conditioning perspective?
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Pos. Stimulus
-increase behavior by positive reinforcement (add stimulus) -decrease behavior by extinction (remove stim.) Aversive Stimulus -increase behavior by negative reinforcement (remove stimulus) -decrease behavior by punishment (add stimulus) |
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136. What are the effects of postitive and negative reinforcers?
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They both strengthen behavior
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137. According to the behavioral model, why is adherence difficult?
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Difficult b/c learned behaviors form patterns or habits that are resistant to change
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138. People need help in establishing changes...
What do advocates of the behavioral model suggest? (Three things) |
1. Cues (i.e. reminders of appts.)
2. Rewards (extrinsic like $ or intrinsic like feeling healthier) 3. Contracts to reinforce compliant behaviors |
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139. What is the social cognitive theory?
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It assumes that humans have some capacity to exercise limited control over their lives
Use cognitive processes for self-regulation |
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140. According to Bandura's social cognitive theory, human action is a result from an interaction of what three things?
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1. Behavior
2. Environmental Factors 3. Personal Factors |
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141. What did Bandura call this interactive triadic model?
What does this mean? |
Reciprocal Determinism
Human functioning is a product of the interaction of behavior, environment, and personal factors, esp self-efficacy and other cognitive processes |
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142. What is self-efficacy?
(Three points) |
1. People's beliefs about their capabilities
2. It is situation-specific rather than a global concept 3. Important component of personal factors |
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143. How can one increase (or acquire or decrease) self-efficacy?
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1. Performance (enacting a behavior)
2. Vicarious experience (i.e. modeling) 3. Verbal persuasion (listening to the encouraging words of a trust person) 4. Keeping physiological arousal in check (anxiety decreases self-efficacy) |
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144. What is modeling?
|
Observational learning
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145. According to self-efficacy theory what is the best predictor of accomplishing behaviors?
|
People's beliefs concerning their ability to initiate difficult behavior (such as an exercise program)
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146. What does the transtheoretical model assume?
|
Assumes that people progress as well as regress through five spiraling stages in making changes in behavior
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147. What are the five stages in changing behavior?
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1. Precontemplation: don't see a prob, not thinking bout action
2. Contemplation: awareness of prob & thoughs about change 3. Preparation: thoughts and actions, making specific plans 4. Action: modification of behavior 5. Maintenance: sustain change |
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148. Why is the transtheoretical model important?
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1. Captures the process people go through
2. Explains why some people and/or intervention strategies are unsuccessful 3. Interventions can be geared to fit the person's stage |
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149. What is the most difficult transition to make in the transtheoretical model?
|
Moving people from the preparation to the action stage was more difficult than other transitions
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150. How can adherence be improved?
|
1. Educational procedures
2. Behavioral Strategies a. prompts b. tailoring the regimen to fit habits/routines of patient c. graduated regimen implementation d. contingency (behavioral) contract *ultimate goal=self-regulation |
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151. What are the three ways stress has been defined?
|
1. A response (physical response)
2. A stimulus (life event) 3. A transaction (bwt the environmental stimulus and the person) |
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152. How did Selye define stress?
What was the difference between stress and stessor? |
"Stress is the nonspecific response of the body to any demand made upon it"
Stressor refers to stimulus, whereas stress means the response |
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153. What is the General Adaption Syndrome?
|
GAS - no, not flatulence!
The body's generalized attempt to defend itself against noxious agents |
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154. What were the three stages of Selye's General Adaption Syndrome (GAS)?
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1. Alarm Stage
2. Resistance Stage 3. Exhaustion Stage |
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155. What is the alarm stage?
|
The body initially responds to a stressor with changes that lower resistance
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156. What are the benefits of the alarm stage?
What is the problem? |
Activate sympathetic nervous system so body's defenses are strengthened (adaptive physical reactions in short term)
Problem is modern stressors involve prolonged exposure to stressor and don't require physical action |
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157. What is the resistance stage?
|
If the stessor continues, the body mobilizes to withstand the stress and return to normal
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158. How long does the resistance stage last?
How is one's outward appearance during this stage? |
Duration depends on severity of stressor and adaptive capacity of organism
Outward appearance is normal but physiologically the body's internal functioning is not |
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159. What is the exhaustive stage?
|
Ongoing, extreme stressors eventually deplete the body's resources so we function at less than normal
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160. What characterizes the exhaustive stage?
What does this stage lead to? |
Characterized by activation of the parasympathetic nervous system
Results in depression and sometimes death |
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161. Why was Selye so important?
(Four reasons) |
1. Helped us understand the short-term physiological impact of acute stress
2. Helped solidfy idea that chronic stress can have serious health effects 3. First to propose a pathway through which stress could cause disease 4. Drew our attention to the HPA axis |
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162. What are three physical measures of stress?
|
1. Activation of sympathetic nervous system
(blood/urine/platelet levels of epinephrine and norepinephrine) 2. Cardiovascular changes (HR, BP) 3. Activation of HPA system (blood/saliva levels of cortisol) |
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163. What are some limitations of the response definition of stress?
(Two things) |
1. Ignored psychological factors
2. Ignored emotional component and individual interpretation of stressful event (factors unique to humans) |
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164. What is the stimulus based definition of stress?
|
Events whose advent is either indicative of or requires a significant change in the ongoing life pattern of the individual
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165. What are the sources of stress according to this stimiulus-based definition?
|
1. Environmental
2. Occupation 3. Personal Relationships 4. Health problems (diet, insomia) 5. Thoughts |
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166. What are stimulus measures of stress?
|
Life Events Measures
i.e. Social Readjustment Rating Scale, Perceived Stress Scale (emphasizes perception of events) |
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167. How are life event measures at predicting stress exeprienced?
|
Underestimate the stress that African Americans experience
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168. What are the three assumptions of the Original Life Events Research?
|
1. Stress equals change (both positive and negative events are bad)
2. The impact of life events is linear, additive, cumulative (each event has the same impact as the previous one) 3. Stressful events show equal effects across individuals |
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169. What are some criticisms of stimulus-based definitions of stress?
(Three criticisms) |
1. Individual differences in the way events are experienced are not taken into account (i.e. divorce)
2. Individual differences in stress reporting-events are not the same for everyone (i.e. injury/illness not all equal) 3. Negative events are more salient than positive ones |
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170. What makes events stressful?
(Five things) |
1. Negative
2. Uncontrollable and/or unpredictable 3. Ambiguous 4. Overload 5. Salient |
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171. What is the transactional definition of stress?
|
A particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or he well-being
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172. What are the two key points of Richard Lazarus's view of stress?
|
1. Interpretation of stressful events is more important than the events themselves
2. Individual's perception of event and ability to cope with it determines the degree of stress |
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173. According to Lazarus, the effects that stress has on a person is based upon...
|
1. Person's feelings of threat
2. Person's feelings of vulnerability 3. Ability to cope *not on the stressful event |
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174. What are the psychological factors Lazarus associated with stress?
|
Interpretation and Perception
This is done through appraisals |
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175. When there is a potential stressor what does a person do first ?
|
Make a Primary Appraisal:
Is the event positive, neutral, or negative? If negative, is it harmful, threatening, or challenging? |
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176. After the primary appraisel what does the person do?
|
Make a Secondary Appraisal:
An impression on the person's ability to control or cope with harm, threat,or challenge Are coping abilities and resources adequate? |
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177. When is stress reduced?
|
When a person believes they can successfully cope with situation
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178. What is a reappraisal?
|
Appraisals change constantly as new information becomes available
Can increase or decrease stress |
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179. What are the transactional measures of stress?
|
Percieved stress scale
Emphasizes perception of events |
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180. What are the three components of stress that the scale assesses?
|
1. Daily hassles
2. Major life events 3. Changes in coping resources |
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181. What is the division of the nervous system?
|
CNS: brain and spinal cord
Peripheral Nervous System A. Autonomic Nervous System i. Sympathetic Nervous System ii. Parasympathetic B. Somatic Nervous System: all motor nerves to skeletal muscles |
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182. How do the somatic and autonomic systems differ in their targets?
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Somatic: skeletal muscles (movement)
Autonomic: glands, cardiac muscles, & smooth muscles (i.e. in blood vessels) |
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183. How do the somatic and autonomic systems differ in their means of reaching their targets?
|
Somatic: straight shot to target (no ganglia)
Autonomic: ganglion chain in both sympathetic & parasympathetic |
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184. What is a ganglion?
|
Cluster of neuron cell bodies (relay station)
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185. What are the ganglionic neurons like in the autonomic nervous system?
|
Post-ganglionic neurons are unmyelinated in ANS
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186. What is the neurotransmitter in the somatic system? Is it excitory or inhibitory
|
Acetylcholine
Excitatory |
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187. What is the neurotransmitter that is post-ganglionic in the autonomic system? What does it do?
|
Acetylcholine
Excitatory In sympathetic/parasympathetic |
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188. What is the post-ganglionic neurotransmitter in the sympathetic autonomic nervous system?
What does it do? |
Norepinephrine
Excitory or Inhibitory |
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189. What are the "post-ganglionic" hormones in the sympathetic autonomic nervous system?
|
Epinephrine and norepinephrine
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190. What is the post-ganglionic neurotransmitter in the parasympathetic nervous system?
What does it do? |
Acetylcholine
Excitatory or inhibitory |
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191. What are the receptors for acetylcholine called?
What are the two types of these receptors? |
Cholinergic receptors
1. Nicotinic 2. Muscarinic |
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192. Where are nicotinic receptors found?
|
1. Found on somatic targets (neuromuscular junction)
2. Ganglionic neurons of both sympathetic & parasympathetic 3. The hormone producing cells of the adrenal medulla (chromaffin cells) |
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193. What affect does acetylcholine have on nicotinic receptors?
|
Stimulatory
|
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194. Where are muscarinic receptors found?
What affect does acetylcholine have? |
Found on plasma membranes of parasympathetic effectors
Inhibitory or excitatory (depends on the receptor subtype on the target organ) |
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195. What are the receptors for norepinephrine called?
|
Adrenergic receptors
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196. Where are adrenergic receptors found?
What effect does norepinephrine have? |
Post-ganglionic sympathetic neurons only
Exictes or Inhibits depending on receptors -Alpha 1 & Beta 1 excitation -Alpha 2 & Beta 2 inhibition |
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197. From where do the fibers originate in the SNS?
|
Thoracolumbar region of the spinal cord
(Thoraic and lumber of spinal cord) |
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198. What is the length of the fibers in SNS?
|
Short pre-ganglionic
Long post-ganglionic |
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199. Where are the ganglia located in the SNS?
|
Close to the spinal cord
Chain of ganglia |
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200. From where do the fibers originate in the PNS?
|
Craniosacral region
Brain and sacral spinal cord |
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201. What is the length of the fibers in the PNS?
|
Long pre-ganglionic
Short post-ganglionic |
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202. Where are the ganglia located in the PNS?
|
In the visceral effector organs
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203. What is the response of the sympathetic nervous system?
|
"Flight or Fight" (coined by Walter Cannon)
Physical responses that occur during fear/rage (very quick, rapid response) |
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204. What does the sympathetic nervous system prepare us to do?
|
Physical responses prepare for action
Body's resources are mobilized in emergency, stressful, and emotional situations |
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205. Why do we think the SNS evolved?
|
Evolved as a way of escaping predators
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206. What drives the activation of the SNS?
|
Driven by activation of the sympathetic adrenal medullary pathway
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207. What physical reponses are activated by the SNS?
(Eight things) |
1. Dilates pupils
2. Inhibits flow of saliva 3. Accelerates heart beat 4. Dilates bronchi 5. Inhibits digestion 6. Conversion of glycogen to glucose 7. Secretion of adrenaline and noradrenaline 8. Inhibits bladder contraction |
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208. What is the sympathetic adrenal medullary pathway consist of?
|
1. Activation of sympathetic nervous system
2. Stimulation of multiple organs by neurotransmitters (norepinephrine/little epinephrine) 3. Stimulation of adrenal medulla by ACh 4. Release epinephrine (little norepinephrine) into blood stream - hormones |
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209. What are the cells in the adrenal medulla?
What happens to them? What do they respond to? |
Chromaffin cells
They are innervated directly by preganglionic neurons Responsive to ACh |
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210. What does the adrenal medulla release into the bloodstream?
|
Catecholamines:
-epinephrine -norepinephrine *both are capable of binding to most adrenergic receptors |
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211. What is the "unique" role of the sympathetic nervous system?
How about some examples Balthazar?? |
Regulates many functions/activities not subject to parasympathetic influence.
Such as... the adrenal medulla, sweat glands, and most blood vessels. |
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212. What are four roles of the parasympathetic nervous system?
What is stress associated with - increased or decreased parasympathetic activity? |
1. Relaxation
2. Energy conservation 3. Resting 4. Digesting Decreased dammit! |
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213. How does the sympathetic NS balance bodily functions?
|
Major control over blood pressure and keeps the blood vessels in a continual state of partial constriction
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214. How does the parasympathetic NS balance bodily functions?
Can the sympathetic NS override these effects during times of stress? |
Dominates the heart, digestive system and urinary systems.
Yes, J. Edgar Hoover, they can. |
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215. How does the CNS control the ANS?
What other brain structures control the ANS? |
Through the hypothalamus...which is the main integration center of ANS activity.
Also, subconscious cerebral input via the limbic sys influences the hypothalamus Other controls come from the cerebral cortex, reticular formation, and the spinal cord. |
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216. What/where is the hypothalamus and what does it do?
|
Forms the floor of 3rd ventricle
Main function: homeostasis via set points. Ex: blood pressure, temp, electrolyte balance, and weight. |
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217. How does the hypothalamus control these set points?
|
Through autonomic function, endocrine function, drive, and emotions.
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218. There are many inputs and two main outputs in the hypothalamus. Where are the outputs?
|
ANS via the medulla
Pituitary gland |
|
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219. What is the nickname for the pituitary gland?
|
the master gland....hahahaha.
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220. What does the posterior pituitary gland do?
|
Releases hormones directly into the bloodstream
EX: oxytocin and vasopressin |
|
|
221. What does the anterior pituitary do?
|
Contains the hypophyseal portal system
Releasing factors are secreted by the hypothalamus, and the pituitary releases hormones in response to these releasing factors. EX: ACTH, TSH, GH. |
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222. What two things does the adrenal cortex release?
|
Minerocorticoids and Glucocorticoids
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223. What is aldosterone and what does it do?
|
Helps signal the reabsorption of Na+ into the blood; water follows Na+, and this helps maintain blood pressure.
|
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224. What is cortisol and what does it do?
|
Cortisol is a glucocorticoid that sustains blood sugar and has anti-inflammatory properties. It also impairs immune function at higher levels due to prolonged stress.
|
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225. What is the adrenomedullary response?
|
It is a fast system that activates a person via -nervous system innervation- to increase heart rate, respiration and muscle strength.
|
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226. What is the adrenocortical response?
|
It is a slower system that prepares the body to resist stress via -hormones- to increase energy and decrease inflammation
|
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227. Why are there so many ups and downs in our homeostasis?
|
Due to allostasis and allostatic load
|
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228. What is allostasis?
|
the ability of an organism to achieve stability through adaptation or change (short term)
|
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229. What is allostatic load?
What happens when allostasis is prolonged? |
the amount or persistence of change required
-prolonged or excessive allostasis may be detrimental and lead to damage and disease. |
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230. What is feature #1 of allostasis?
|
1. The brain is integrative center for coordinating behavioral and neuroendocrine responses to challenge.
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231. What is feature #2 of allostasis?
|
2. There are considerable individual differences in coping with challenges; there is a cascading effect of genetic predisposition and early environmental events (i.e. abuse) to predispose the organism to overreact physiologically and behaviorally.
|
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232. What is feature #3 of allostasis?
|
3. Inherent within our response to challenge is the capacity to adapt, often achieving stability through change (allostasis); turning on and off responses efficiently is vital.
|
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233. What is feature #4 of allostasis?
|
4. The cumulative effects of allostasis can be detrimental. It includes responding to stress, but also other challenges that may effect regulation of normal functioning (e.g. gene expression, diet, exercise, smoking, etc...)
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234. What are seven indicators of allostatic load?
|
1. Elevated epinephrine levels
2. Elevated blood pressure 3. Lowered heart rate variability 4. Inability to shut off cortisol in response to stress 5. High waist-to-hip ratio 6. Decreased cell-mediated immunity 7. Decreased volume of hippocampus |
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235. What are the physiological consequences of chronically elevated catecholamines?
(Six things Jimmy Jam) |
1. Suppression of the immune system
2. Raised blood pressure 3. Raised heart rate 4. Cardiac arrhythmias 5. Neurochemical imbalances 6. May affect cholesterol and be involved in atherosclerosis |
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236. What are three physiological consequences of chronically elevated corticosteroids?
|
1. Changes in the immune system - some suppressive.
2. Associated with depression 3. Destruction of neurons in the hippocampus - verbal, memory and concentration problems. |
|
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237. What about the hippocampus? What type of receptors are located there?
|
Lots of glucocorticoid receptors.
Normally, negative feedback on HPA, however, excess glucocorticoids can cause cell death in hippocampus that resembles aging which can lead to depression and PTSD. Fun. |
|
|
238. What is the transactional definition of coping?
|
Lazarus & Folkman
"constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person" |
|
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239. What is the avoidance coping style?
|
Minimizing, changing significance or meaning
|
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240. What is the confrontational coping style?
|
Gathering info, taking action and dealing with stressor
|
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241. What is the problem-focused coping style?
|
Reducing demands, expanding resources
but it can induce unhealthy behaviors e.g. deadline at work |
|
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242. What is the emotion-focused coping style?
|
Efforts to regulate emotions using cognitive and behavioral strategies.
Cognitive: redefine problem to change emotion Behavioral: regulate emotion through behavior |
|
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243. What determine whether a particular strategy/style is effective?
|
Depends upon the goal of the individual
|
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244. What are some characteristics of healthy coping strategies?
Three main thingees... |
1. Role of positive emotions
-helps sustain coping process 2. Positive reappraisal -allows experience of positive instead of negative emotions 3. Emotional approach -Both processing and expressing emotions |
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245. What are some benefits of active coping?
|
Produces better emotional adjustment to chronic stressors.
Better immune function in people with herpes/HIV Longer survival with melanoma |
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246. What are some factors that influence coping?
|
Time
Money Education Job Children Friends SES Presence of positive life events Absence of other life stressors Genetics |
|
|
247. What are the components of social support?
|
STRUCTURAL COMPONENTS
quantity of social relationships FUNCTIONAL COMPONENTS emotional support/advice STRUCTURE AND FUNCTION are only modestly correlated, although both have been related to health outcomes. |
|
|
248. What is a social network?
How are social relationships viewed? |
A social network is assessed by the existence and quantity of social relationships
View social relationships in terms of nodes and ties |
|
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249. What are some characteristics of social relationship webs?
|
Have:
Density Durability Reciprocity Dispersion |
|
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250. What are three problems in measuring one's social network?
|
The mere existence of a relationship assumes that the relationship is supportive - which is NOT true.
It fails to capture the complexity of social relationships Assessment is very time consuming |
|
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251. What is emotional support?
|
Caring, concern and empathy for a person as well as the provision of comfort, reassurance and love.
|
|
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252. What are some other functional types of social support? Define them...
Four of 'em Balthazar... |
Belongingness support
-the availability of social companionship Tangible or instrumental support -direct, concrete assistance Informative/appraisal support -advice, directions, suggestions, feedback Esteem/validation support -affirming self worth |
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253. What is the discrepancy between one's perceptions of social support and the actual availability of one's support?
|
The perceptions of social support are more important that the actual availability of one's support
Thus, the perceived support seems to be a better predictor of well-being. |
|
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254. How is the amount of received support assessed?
What are some problems with this? |
Received support assessed based on the amount of support received in a particular period of time.
PROBLEM Balthazar!!! -the amount of support one receives is positively correlated with how sick that individual is... In other words, the sicker you are, the more support you receive... |
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255. What is the link between social support and health in the Alameda County Study?
What did the study find? |
Alameda County Study
-9 yr follow up of 7,000 residents -Index based on four types of social ties: marital status, number of contacts w/friends and relatives, and church or group membership Found inverse correlation between # of social ties and chance of death. Thus, the # of social ties predicted separate causes of death. |
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256. TRUE OR FALSE?
People with high levels of support are only about 1/4 to 1/2 as likely to die within a designated period of time than people with low levels of support... |
True
|
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257. What about social isolation in the Brummett et al., 2001 study?
What did the study find? |
Brummett et al., 2001
430 patients with coronary artery disease -relative risk of 2.43 if isolated vs. 2.0 if not isolated Thus, social isolation is a MAJOR risk factor for death in both humans and laboratory animals. |
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258. List some further evidence in support of one's psychological well-being as the mediator of the link between social support and health...
|
People are less likely to suffer from psychological disorders if they have high social support
Depressed people have lower social support Found in U.S. and Japan that older adults with social support have lower depression rates and less neurotic symptoms. |
|
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259. What is the link between psychiatric influences in depression and myocardial infarction?
|
Survival curves of patients with depression decline at a faster rate than non-depressed patients
|
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260. Are these effects correlational or causational?
What are some confounding factors here? |
Virtually all research is correlational in this field.
Other possible explanations: -Illness leads to disruption in social support -Third variable causes the association (e.g. hostility) |
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261. Are these alternative explanations likely?
Why or why not? |
No, they are unlikely.
Longitudinal studies still show an association between social support and rates of mortality. Studies still show link when taking other variables into account such as SES and personality. Thus, the effect size is very large here. |
|
|
262. What is the buffering hypothesis?
|
A buffer protects against high stress and therefore against disease.
Evidence suggests that social support is most important in high stress situations Also, secondary appraisal can lead to reduced stress levels. |
|
|
263. What is the direct effects hypothesis?
|
Regardless of stress level, social support influences health and protects against ill effects of social isolation.
|
|
|
264. What kinds of social support help?
|
Marriage
A pet Controllable events (instrumental support) Uncontrollable events (emotional support) People who've been through the event |
|
|
265. What about Rotter's (1966) scale in personal control?
What's the gist of this? |
People either have an internal locus of control or they have an external locus of control
People who feel they have some control over events are better able to cope with stress than people who feel their lives are controlled by others. |
|
|
266. What about the nursing home residents experiment?
(Rodin & Langer, 1977) |
At 3 weeks:
-71% of the control group (no responsibilities) became more debilitated -93% of the responsibility-induced group showed psychological and physical improvement At 18 months: -Responsibility-induced group more healthy, active and social -Mortality rate in responsibility-induced group lower than expected and lower than in the control group (no responsibilities) |
|
|
267. How about negativity and stress..what can it lead to?
Three things... |
1. Trait negative affect or neuroticism (anxiety, depression, hostility)
2. Predisposed to see stressful events as especially stressful. 3. Associated with worse health behavior (drinking, smoking) depression, and poor health? |
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|
268. Is there a "disease prone" personality?
Who suggested this? |
(Friedman & Booth-Kewley, 1987)
Yes, meta-analysis found consistent evidence for an association between negative emotional traits and asthma, arthritis, ulcers, headaches, and coronary artery disease. |
|
|
269. How does negativity compromise health?
|
Negative affect associated with higher levels of cortisol (Van Eck et al., 1996)
Increased psychological and physical symptom reporting, especially when stressed but no evidence of underlying physical disorder Increased illness behavior, and are more likely to use health services... like bugz... |
|
|
270. What about pessimism and one's health? What's it associated with?
|
Associated with less adaptive coping strategies such as:
-Denial and distancing -Focusing on stressful feelings -Giving up -Reduced immunocompetence -Poorer health outcomes |
|
|
271. What about optimism and one's health? What's it associated with?
|
Associated with less stress and depression and more social support
Reduces risk of illness (Scheier & Carver, 1985) Better coping strategies: -Problem focused coping -Seeking emotional support -Emphasizing positive aspects of stressful situations |
|
|
272. What was the gist of the study concerning optimism and recovery in coronary artery bypass surgery?
(Scheier et al., 1989) |
Patients with dispositional optimism recovered more quickly with shorter hospitalization and better quality of life at 6 months follow up.
|
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|
273. What about humor? Does it work?
|
YES!
Norman Cousins (1979) said laughter is one's internal jogging or exercise Newman & Stone (1996) found that humor allowed students to be in a better mood with less tension after watching a stressful movie compared to the group of students with no humor. |
|
|
274. Bottom line...
HOW DOES STRESS AFFECT HEALTH? |
Stress diathesis model
|
|
|
275. What is the stress-diathesis model?
Come on Bartholomew... |
One's vulnerability to a physical or psychological disorder depends on the interplay between one's predisposition to the disorder (diathesis) and their stress experiences.
|
|
|
Describe the allostasis diagram
(draw if necessary) |
Allostasis
|
|
|
Describe the sympathetic adrenal medullary pathway
(draw if necessary) |
samp
|
|
|
Describe the layout of the sympathetic and parasympathetic nervous systems
(draw if necessary) |
PNS SNS
|
|
|
Describe the layout of the somatic and autonomic nervous systems.
(draw if necessary) |
SNS ANS
|
|
|
Describe Selye's General Adapation Syndrome
(draw if necessary) |
GAS
|
|
|
Describe the Social Cognitive Theory (Bandura,1986)
(draw if necessary) |
SCT
|
|
|
Describe the layout of the Health Belief system (Becker & Rosenstock, 1979)
(draw if necessary) |
HBM
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Describe the Biopsychosocial Model (Engel, 1977)
(draw if necessary) |
BPSM
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