Unsom Block 1: Human Behavior Part 1

Front 1

Functional Analysis

Back 1

Allows you to understand behavior in context, focusing behavior change, and sort through pt. history

Baseline - pre-intervention - not very much exercise

Intervention - include intervention - pair exercise w/friend

Baseline - remove intervention - still exercising but not as much

Front 2

ABCs

Back 2

Antecedent - how behavior is cued, external or internal

Behavior - the behavior frequency/duration

Consequences - how we learn from consequences (reinforcement, punishment) of our behavior.

Front 3

Positive Reinforcement

Back 3

Anything that increases the probability of the behavior it follows.

Front 4

Negative Reinforcement

Back 4

Behavior that is strengthened by the consequence of stopping or avoiding a negative condition

Front 5

Punishment

Back 5

Weakens the behavior it follows

Front 6

Extinction

Back 6

Removal of reinforcement altogether. Eliminates the incentive for unwanted behavior by withholding the expected response.

Front 7

Classical (Respondent) Conditioning

Back 7

UCS - Food
UCR - salivation from food
UCS - tone with food;, that becomes CS - associates food with tone
CR - salivation from tone

Front 8

⬆behavior

Back 8

Reinforcement - consequence that increases the rate of behavior it follows

Task Analysis - reak down a task into smaller steps and reinforce after each step

Shaping - task analysis for a specific behavior

Premack "Grandma's Law" - highly valued reinforcer if engaged in low probability behavior (vegetables then dessert)

Cueing - giving a signal that sets off behavior

Front 9

⬇behavior

Back 9

Extinction - ignoring reinforced behavior to reduce the frequency of that behavior

Time out - neg. punishment for neg. behavior, resulting in loss of pos. reinforcers for a certain time period

Over-correction and restitution - pos. punishment for neg. behavior, resulting in engaging in an effortful activity for a brief period

Desensitization - feared stimulus gradually presented least to most feared. relaxation is paired w/ each stimulus until no more fear

Punishment - neg. behavior followed by consequence that results in dec. of probability of that behavior.

Front 10

L-E-A-R-N

Back 10

Listen w/ sympathy and understanding to the pt's perception of the problem

Explain your perceptions of the problem and your strategy for treatment

Acknowledge and discuss the diff./simil. between these perceptions

Recommend treatment while remembering the pt's cultural paramters

Negotiate agreement. Understand the pt's perception so that treatment fits into their cultural framework

Front 11

Culturally Conscious

Back 11

Awareness of disparities/injustices in the world in which medicine is practiced

Front 12

Culturally Humble

Back 12

Lifelong process of self-reflection and self-critique

Front 13

Culturally Competent

Back 13

Set of academic/personal skills that allow us to increase our understanding/appreciation of cultural differences between groups.

Front 14

Adherence

Back 14

Extent to which a patient takes a medication as prescribed by their health care providers

Worst for preventative regimens in asymptomatic patients

Slightly better for chronic regimens in symptomatic pop

Best for time limited regimens in acutely ill patients

Front 15

Barriers to Adherence

Back 15

Complexity
High cost
Difficulty remembering schedules
Lack of understanding
Not feeling sick
Side effects
Embarrassment/Stigma
Depression
Health literacy
Belief Systems

Front 16

Adherence Interventions

Back 16

Patient Education
Directyly Observed Therapy (DOT)
Dosing Schedules
Improved Communication
Acceptance and Commitment Therapy (ACT)

Front 17

Health

Back 17

Absence of disease or disability

Front 18

Disease

Back 18

Process caused by environmental trauma, biological malfunction or identifiable agent of substance

Front 19

Sickness

Back 19

Can look/feel sick w/o disease

Front 20

Illness

Back 20

How a person behaves and feels, how patient perceives disease, and how family/community responds.

Front 21

Integrated Science Model

Back 21

Psychosocial phenomena functionally connected to biological w/common universal principles.

5 Domains
- Biological
- Behavioral
- Cognitive
- Sociocultural
- Envrionmental

Each domain influenced by genetic determinates, learning process, past experience

Front 22

Stress

Back 22

Challenges to homeostasis.

Responds thought biological reactivity, behavioral/cognitive/sociocultural reactivity.

Front 23

Hippocratic Oath

Back 23

Did not require physician to inform pt. or follow pt wishes.

Front 24

Pt. Bill of Rights

Back 24

Informed consent - pt has right to know all tx options, full/accurate and understandable explanations of all risks

Front 25

Accurate Empathy

Back 25

Pts list kindness, understanding, interest, and encouragement as primary expectations of physicians.

Sympathy - feeling and experiencing emotions expressed by pt.

Front 26

Transerfernce

Back 26

Bringing beliefs, expectations, and perceptions from previous relationships into current life experience. (Pt. perceives physician as overbearing parent based on past)

Front 27

Countertransference

Back 27

Inappropriate reaction of doctor to pt. (Physician sees pt. as someone from past, perceives them as that.

Front 28

Biopsychosocial Model

Back 28

Illness and health are products of biological, psychological, and social factors (including spiritual and cultural domains)

Front 29

Freud

Back 29

Behavior motivated by unconscious biological urges, instincts and drives.

Behavior influenced by unconscious memories that are kept from awareness by defense mechanisms

Channeled through:
Id - reservoir for psychic energy, drives, and impulses by biologic needs

Ego - Intermediary w/ world, reality principle and energizes logical thinking/learning

Super-ego - conscience, assures ego actions socially/morally correct

Psychosexual development
Oral (0 - 1yr) - Energy - mouth, lips, tongue. Adult fixation - smoking, eating, social contact

Anal (1 - 3yr) - Energy - anal sphincter, bladder, toilet training. Adult fixation - excessive orderliness or obstinate, retentive behaviors

Phallic (3 - 6yr) - Aware of sexual differences, pleasure from self-stim. Develop oedipal/electra conflict. Adult fixation - problems w/sexual relationships

Latency (6 - puberty) - Sexual strivings suppressed by super-ego, channeled into acceptable behaviors

Genital (puberty - adulthood) physiologic maturation w/underlying goal of reproduction through sexual relationship

Front 30

Erikson

Back 30

Focuses on society rather than family as setting in which drives are expressed

Eight “Ages” of Psychosocial Development
Basic Trust vs. Basic Mistrust (birth - 1 yr) - correlates with oral stage

Autonomy vs. Shame and Doubt (1 - 3 yr) - correlates with anal

Initiative vs. Guilt (3 - 6) - correlates with phallic stage

Industry vs. Inferiority (6 - 12) - corresponds with Latent stage

Identity vs. Role Confusion (12 - 20) - corresponds with beginning of genital stage

Intimacy vs. Isolation (20 - 40) - moves from self centered focus to affiliation and partnership

Generativity vs. Stagnation (40 - 65) - individuals become teachers of the next generation

Ego Integrity vs. Despair (65 - death) - acceptance of ones life, with its successes and failures

Front 31

Social Learning Theory

Back 31

Learning = observation and imitation of the behavior of others

Behaviors that are reinforced are repeated.

Extinction of maladaptive behaviors requires elimination of the reinforcers and/or pairing those behaviors with noxious consequences

Development is the result of an ongoing interaction between the individual and the environment

Front 32

Piaget

Back 32

Children have 2 cognitive functions - organizational ability and adaptive ability.

Organize world by putting experiences → concepts → schemas.

Assimilation - experiences are interpreted and acted on within the framework of an existing schema
Accommodation - schemas are altered to fit disconfirming experiences that cause disequilibrium between cog. understanding and external reality.

Four Major Stages of Cognitive Development
Sensorimotor stage (birth to 2 yr) - progression from reflexes to repeating acts to combining acts to solve simple problems. object permanence established

Preoperational stage (2 to 7 yr) - children learn symbols and language, problem solving is intuitive rather than logical and rational, analytic thinking is poorly developed.
conservation - fail to recognize that a given substance is the same amount, no matter what shape (liquid transfer from tall to thin glass)
compensation - inability to consider multiple dimensions of a problem simultaneously and appreciate the interaction between them

Concrete Operational Stage (7 to 12 yr) - Child can conceptualize the world from an external point of view, thinking becomes dynamic, relational, reversible.
transitivity - mental arrangement of dimensions of objects
seriation - ability to appreciate relationships among objects in a serial order

Formal Operational Stage (12 through adulthood) - Thinking characterized by ability to use abstraction.
hypothesis formation - tangible and intangible problems can be solved through complex reasoning

Front 33

Kohlberg

Back 33

Stages of Moral Development
Preconventional morality - children in sensorimotor and preoperational stages of cognitive development. Focus on personal benefit

Conventional Morality - children in concrete operational stage. moral judgments are based on the fulfilling the expectations of others. intent becomes a more important factor than outcome

Post Conventional Morality - people who are in the formal operational stage. Judgments are based on personal adherence to principles. Laws are judged with regard to their conformity with obligations and contracts. Self-chosen ethical principles of justice, respect. Can see problems from all other perspectives involved.

Front 34

Stages of Change

Back 34

Pre-contemplation - no intention of changing w/in next 6 mo
Contemplation - intends to change w/in next 6 mo
Preparation - intends to change w/in next 30 days
Action - changed for <6 months
Maintenance - change for > 6 months

Front 35

Motives for Change

Back 35

Indifferent motives - does not care
External motives - does not want to disappoint someone (relapse when external motivator is gone)
Introjected motives - sense that they should change, internally conflicted (relapse when internal motivator is gone)
Integrated motives - initiation/maintenance of behavior change is self-regulated and driven by patient's values/motives

Front 36

Motivational Interviewing

Back 36

Building motivation to change

Strengthening commitment to change

OARS

Front 37

Motivational Principles

Back 37

Support and respect autonomy

Understand patients' perspective

Adopt a positive, non-directive stance

Elicit patients' problem-solving skills

Maintain long-term engagement

Front 38

PIC NIC

Back 38

Positive Immediate Certain, Negative Immediate Certain

P/N, I/F, C/U