Welcome to lesson five, health psychology.
Let’s move to slide two and begin. Health psychology primarily had a
behavioral focus, looking at issues such as stress, pain, risk factor
modifications, inherent or compliance, chronic illness, vices such as
smoking, drinking and eating and exercise.
Let’s move to slide three and discuss each of these in turn. Pain. One
of the most interesting aspects of pain that health psychology has
studied is phantom limb pain. In phantom limb pain, this is chronic pain
in absent body parts. Almost all amputees report sensation. About 13.71%
report these sensations as pain. This usually happens only if there’s a
loss of a body part as an adult. Children who are born without body
parts or who have been amputees since infancy typically don’t
experience phantom limb pain. This is because they’re missing neural
activity, so the pain messages do not become inhibited.
Let’s move to slide four. Gate control theory is one health psychology
theory of pain. Acute pain can often be controlled or stopped for
stimulation of unrelated large confusion. For example if you stub your
toe rubbing your thigh will ameliorate the pain you feel in your toe.
Let’s move to slide five. Retraction is another method we use to deal
with certain
ailments. For example if you’re choking, we often tell children to raise
their arms or if you hiccup hold your breath or engage in a variety of
other cures typically these work because they distract you from the
sensation of choking or the sensation of hiccupping.
Let’s move on to slide six. Helping with stress and pain. While some
health psychologists are concerned with what causes pain, many others
are concerned with how we can help others cope. One technique is
hypnosis. Hypnosis can work to help reduce stress and pain. However, it
works primarily in those who are not suggestible that is people who are
not easily hypnotized by working as a
placebo. Relaxation training is another method that is quite successful
at reducing stress and pain. Relaxation training can be used to lower
blood pressure and after a relaxation training session, if the person
continues to engage in procedures they learn, the results can last up to
three or even twelve months later. Biofeedback is another way in which
health psychologists have learned that people can deal with stress and
pain. Biofeedback is typically using some sort of measuring device that
gives you feedback about the biology. That is things such as your
heart rate, your breath rate, your blood pressure and so on. By
concentrating on relaxing and watching those numbers fall, you learn
what specific behaviors lead to decrease in your heart rate, increasing
your heart rate and so on and learn to modify your behavior in response
to biofeedback. Finally there’s behavior modification. For some people,
especially those who are experiencing pain, it’s going to be reinforced by
others. But if you constantly complain about a backache, this actually
exacerbates the pain and you’ve been rewarded for this behavior, which
means you may complain about it more and therefore continue to have the
pain and express it more than it actually is being experienced
physiologically. How can you do behavior modification to reduce pain?
Simply don’t reinforce pain communication. If you feel that someone
is perhaps expressing pain that is not real or that they are feeling only
mildly and they’re exaggerating how much it hurts or how frequently or
how much of a stressor it is for them, you can simply not reinforce the
pain communication by not responding.
Let’s move on to slide seven. How we conceptualize illness is also a
large part of health psychology. First we often go to the doctor not
because we aren’t sure what’s wrong with us, but because we have a
variety of symptoms. Once the doctor then identifies the disease, we
have an identity that goes along with it. If the doctor tells us we have
a cold, we begin to feel symptoms that are congruent with that label. If they tell
us that we have cancer, we feel symptoms congruent without labels.
Whatever we’re told we have, we then automatically begin to report
physiological symptoms that are congruent with the label. Another
important aspect of conceptualizing illness is a timeline. Is it a short
term illness, a long term illness, how long will it take you to get over
it; will you get over it, is it curable or treatable? And finally
consequences of the disease can also be conceptualized. For example if
you believe there is no cure or know that there is no cure for your
illness, this may lead to a sense of helplessness and therefore you will
not seek health care in the future. Treatable, but not curable diseases,
are often very difficult to manage because people failed to seek health
care due to feelings of helplessness. And finally the cause of the
disease. For some illnesses we try to put someone at fault, especially
for diseases that you catch from others. For example perhaps you should
wash your hands more or hang out with people who are more healthy. There
are also folk-lore reasons that people believe cause disease. For example
your grandmother may have told you that going outside with your hair wet
will cause you to catch pneumonia or the flu. The causes of the diseases
seem to be your fault, then you’ll act very differently than if it is
something that you had no control over.
Let’s move on to slide eight. How we conceptualize the sick role is
also important in understanding health psychology. Often sick role is
identified by these three things. First being sick is not the sick
person’s fault. When a child gets chicken pox, we don’t blame the child.
Finally being sick relieves the sick person’s normal responsibility.
That is once you’ve been identified as someone who is sick or managing
the sick role, it is frequent that you will then be relieved of your
normal responsibilities, not be required to do chores, be able to turn
work in late and so on. And finally the third part is that a sick person
will take steps to get well. When someone has been identified as sick,
we expect them to adhere to certain regimes so they take their medicine,
they do what the doctor recommends, they rest, they appear to be making
an attempt to become well.
Let’s move on to slide nine. Another role that’s important for people
who find themselves involved in the health care system is the hospital
patient role. People who become hospital patients are expected to obey
rules, they are expected to endure non-person treatment, being referred
to by their illness, being referred to by a case number, or as
a patient of some doctor. They will also endure lack of information and
a loss of control. If they’ve woken up in the middle of the night, their
sleep and eat times will be managed by the hospital staff.
Let’s move to slide ten. What happens if you’re a bad patient? You
refused to obey the rules, you seek out information. This may exacerbate
the illness, primarily because it compromises care from the medical
staff. A very bad patient is someone who actually rejects the medical
treatment, for example, signing oneself out of the hospital without
doctor approval. In addition if you’re a bad patient and that you are
willing to stay there but complain a great deal or upset the medical
staff, then they typically will not give you the same level of care that
they give patients who are considered good patients.
Now let’s move to slide eleven and discuss who the good patients are and
what the outcomes are for them. They do receive more attention from the
hospital staff, but they have an increased sense of helplessness.
Because the staff has seemed so caring, they often are not being allowed
to do things on their own and may develop the sense that they are
helpless. And passiveness. This can include withholding important
information. They assume that the doctors know what they’re doing and so
even as they’ve had some symptom in the ensuing hours, that the doctor
doesn't ask, the patient doesn’t tell them. Finally this can move to
depression. A depletion of norepinephrine which then leads to
compromised immune functions. Giving up control typically involves
losing some sense that one is worthy or one is helpful or able to
control their lives. This often leads to a depression and depression in
turn begins the depletion of norepinephrine which finally will
compromise the immune function and often make that person more ill.
Let’s talk about the special case of children in slide twelve. When
children have to undergo some sort of medical procedure, only about 1/3
get psychological preparation. Parent anxiety is a huge factor in how
much anxiety the children will experience. Parents who find themselves
at the hospital caring for a child who’s having to undergo some sort of
medical procedure, or even just a doctor’s visit, may engage in constant
reassurance. Everything’s going to be fine, you have nothing to worry
about, mommy’s here, you’ll be ok, etc. However, this is often not a
very effective way to reduce a child’s anxiety. Why is mom so concerned
that I would be concerned and so if mom needs to reassure you this much,
it must be quite a big deal. You must be supposed to be nervous and
children will often rise to this demand. Things that you can train
children to do are things such as self-talk, relaxation training and
peer models and these have all been shown to work better than Valium at
reducing the anxiety of the child. In one study, they had videotapes
that they showed children with an adult and a peer going through the
same procedure and discussing it with a child or no video. In addition
the parents were either present when the child watched the tape or not.
What they found was that the tapes were effective, especially when the
parents were present. In some cases this indicates that it probably
alleviates anxiety on the child by alleviating parental anxiety. More so
than alleviating the child’s anxiety directly.
Let’s move on to slide thirteen. First of all, in the inherent
compliance literature, you will notice that compliance is the term that
is typically used in studies that were done in the early part of the
1900s. However we now use the word adherence because it implies that
people are willingly engaging in these activities and not simply
complying because an authority told them to. If we look at appointments
as one instance
of adherence, we find that people attend about 75% of appointments that
they schedule for themselves. However, if the doctor or the nursing
staff make an appointment for you, only about 50% of those are attended.
In addition, treatments differ in terms of how much the patient will
adhere to the treatment depending on if the treatment is perceived to be
a cure for the illness or preventative. About 77% of the people will
adhere to a cure treatment, while only 63% adhere to preventative
treatment. Finally how long you wait in the waiting room will also
indicate how much you will adhere to the doctor’s advice. If you wait
more than one hour, we only see adherence rates at about 40%. Less than
30 minutes, 80%.
Let’s move to slide fourteen. What about taking medicine. Typically we
take our medicine when we have physical symptoms. Once the physical
symptoms abate, we stop taking our medicine. One clear example is
antibiotics that take 14 days at 2 or 4 doses a day. People typically
stop taking the antibiotics as soon as the physical symptoms stop, as
opposed to taking the antibiotics as prescribed, which is until the
pills are gone. How long the treatment lasts also indicate how often or
if people will take their medicine. If the duration of treatment is
short, some people are better at adhering to medicine regimen. In
addition the complexity of the treatment will also influence adherence
rate. For people who have a prescription for one pill a day, about 88%
of people are able to take that one pill per day. For four pills a day,
the adherence rate drops to 39%. Chewed pills based on daily rhythm are
much frequently taken. If you have a pill that you take when you get up,
after a meal or right before bedtime, these pills have a better chance
of being taken than pills that occur at other times during the day or
have to occur before people eat.
Let’s move on to slide fifteen. So who does not take their medicine?
People who have no social support are very unlikely to take their
medicine. This includes people who live alone, without a lot of friends
or family to remind them to take the medicine or to whom they feel
responsible. So those with no social support often suffer simply because
they don’t have anyone to help them or remind them or to explain to them
why its important that they take their medicine. We also don’t take
medicines that we don’t think are healthy, low response efficacy. This
is a huge problem especially with some mental illnesses. Someone will
start taking medicine because they’re depressed. For example an
antidepressant. Once they begin to feel better, they aren’t having the
problems, and so they don’t really believe that the pills are doing all
that much for them, they don’t feel extremely better at the time, they
feel somewhat better, so they have a low response efficacy, they don’t
believe that the response is effective. In addition if there are
cultural norms that you should not take medicine or that you should take
alternative medicine, then typically you don’t take medicine, and
finally people who are not obsessive compulsive don’t take their
medicines.
Let’s move to slide sixteen. So what do you get from your doctor? If only
some of us are taking the medicine, what about the other things the
doctor says during the visit. First of all you should know the doctor
believes that you will adhere. They typically over-estimate adherence.
If we look at diagnosis in terms of minor and severe diagnosis, telling
them you have some level of anxiety. You’ve presented some symptoms to
the doctor and you’re waiting for the outcome. If the doctor returns
with a severe diagnosis, this will increase your anxiety. You’re so
worried and upset that you’ve just been told you have cancer or diabetes
or some other very large illness, some severe diagnosis. This will
decrease the amount of attention you’re able to pay to the doctor’s
advice. Similarly, if it’s a minor diagnosis so they come back and they
say it’s nothing, it’s probably temporary low blood sugar, a little bit of
anemia, something like that, your anxiety will decrease. Oh good it’s
nothing much to worry about. Which in turn decreases the amount of
attention you pay to the doctor. After all what he’s saying isn’t all
that important, it’s just a little thing.
Let’s move on to slide seventeen. When the doctor is talking to you,
he’s doing something that is routine for him or her and he is being
relaxed. However, the patient is not in a relaxing situation. Especially
for men, going to the doctor can be quite stressful. Patients are often
unfamiliar with jargon or procedures. In fact, 52% of patients cannot
correctly report what the doctor wanted them to do. However, this is
moderated by the confidence you have in the doctor. The more confidence
you have, the more listening you do. This is important for elderly
patients. As elderly patients come to doctors, they find that the
doctors are often very young; perhaps their children’s age or even
younger and they typically do not want to listen to these young
whippersnappers, as it were, and will not listen very closely, therefore
be not likely to engage in the procedures that would actually help them
to live healthier lives.
Let’s move to slide eighteen. What about chronic illness. First of all,
when we are diagnosed with a chronic illness, the sick role becomes
inappropriate. That is, you cannot be alleviated from your normal
responsibilities for the remainder of your life. You’ll have to find
some way to cope, some way to take control and some way to live. Coping
strategies that we develop for how to be sick often don’t work. If you
have a chronic illness, it’s unlikely that a few days of bed rest,
increase orange juice intake and doing other things that you typically
associate with what it means to be sick won’t work. In addition, chronic
illness puts relationships under stress. Chronic illness doesn’t usually
happen just to individuals, but to families. People’s spouses,
girlfriends, boyfriends, children, parents are all impacted when one of
the family members is diagnosed with a chronic illness, especially when
there is uncertainty. For example, cancer or incurable diseases. We
don’t know how much time is left, we’re not sure if this is a death
sentence, is it possible flu, how much worse will it get, what will
the effects be? Typically when someone’s diagnosed with a chronic
illness, they like to have at least one other family member there to
hear what the doctor has to say. However, that doesn’t always happen and
it leads to uncertainty, not only to the patients who according to slide
sixteen, is obviously very anxious and unable to pay attention, but also
uncertainty on the part of the other family members. This can be
especially hard for children as well. Parents and adults rarely tell
children what’s going on when one of them is chronically ill. They don’t
often like to discuss dad’s illness or mom’s chronic illness, with a
child. This can lead them to be uncertain. Children often associate the
hospital with scary things and want to know why their parents are going
there or so often. In addition the age of onset can be critical in terms
of how people will deal with chronic illness. As we age, it becomes
easier to deal with chronic illness. After all the time that we'll have
to endure is shorter than if you’re diagnosed with a chronic illness
at the age of five, ten, fifteen years old.
Let’s move to slide nineteen. Another major issue that is often
researched by health psychologists is weight and body fat. Remember when
you’re talking about weight issues, eating disorders and so on, the
issue is typically body fat and not weight, not an absolute value of
pounds. The idea of set point is that there is an internal thermostat
working on the basis of fat. Metabolism slows down when you’re fat
drops, not pounds, but fat. Your metabolism will speed up if fat
increases. This keeps you at some sort of set point. The set point is
not one specific number, but usually a range with about ten pounds on
either side. That is, you can’t gain a lot more weight than your set
point will allow and you can’t lose a lot more weight than your set
point will allow.
Let’s move to slide twenty and discuss some research. In World War II
they took conscientious objectors, primarily people who objected to the
war for religious reasons and did a series of what they called the
starvation experiments. They had 36 men weigh regularly for three
months. They measured the caloric intake. Most of these men were eating
approximately 3500 calories per day. They then induced half rations to
reduce the body weight to 75%. What they found is that all the men
rapidly lost weight, but then further reduction of caloric intake was
required. The men became very irritable, they could no longer meet in
groups, they became very physically aggressive. Remember these were
people who previously were religious objectors to the war because they
don’t believe in violence. They were apathetic, they neglected their
appearance and lost interest in sex.
Let’s move on to slide twenty-one. After about six months with these
half rations, they found that they begin to re-feed the participants.
What they found that even after re-feeding, the people remained obsessed
with food and ate whenever they were permitted as opposed to when they
were actually hungry. Most people gained back their loss and a few more
pounds. They remained preoccupied with food and never returned to their
pre-starvation mood levels.
Now let’s move to slide twenty-two. They also have done weight gain
study. These were done on normal prisoners. They fed them quite well and
limited physical activity, again to try to make people gain weight. They
were expected to gain 20 or 30 pounds. Typically double calories were
needed to gain weight and some never were able to gain the whole 20 or
30 pounds, even when they were consuming 10,000 calories per day. Again
all of this is evident for the set point. Your body has limits to how
much weight it will let you gain and how much weight it will let you
lose. Again, once the weight was gained, it was easily lost for all but
two men who had a family history of obesity.
Let’s move to slide twenty-three. So can you be fat and healthy. It’s
absolutely possible. Remember that some amount of body fat is necessary,
especially for women. However, the distribution of fat on the body can
be important. Carrying a great deal of weight in the torso area can be
an indicator of poor health. Typically this means that there’s fat
gathering in an area around your heart and this can cause problems. So
what is the health part. This primarily has to do with cholesterol. This
is typically more of a problem for men than women, at least until
menopause. Estrogen tends to protect the heart from cholesterol buildup
until menopause, when estrogen levels drop, at which time women become
just as likely as men to suffer from heart disease. In addition,
extremely overweight people increase the stress on their joints and this
can lead to illnesses such as premature arthritis.
Let’s move to slide twenty-four. What about fat and fit. When you ask
people how they would like to change their body shape, typically men say
exercise and women say diet. The male option is typically thought of
bulking up and that is why women refrain from doing it. There is some
risk many people become exercise addicted, they become obsessed with
going to the gym and increase the amount of time they spend there beyond what is
necessary in order to maintain the body image they would like. It does
decrease depression and socially imposed guilt. People feel like they’ve
been to the gym, there’s no reason that they can’t have the shape, eat what
they want and so on. However, there’s not a lot of social approval for
exercise. When you tell people that you exercise, when they compliment
you on how good you look, they often go oh wow and they aren’t very
impressed with that. People like to hear that others have been able to
maintain some sort of body image through means that does not involve
exercise. Therefore, it’s not often approved of. What about dieting;
this is the female option. It’s very rare that people are able to
maintain any sort of body image that they enjoy without some yo-yo
effect. And remember changes in body weight and fat are harmful to the
body. You’re much healthier to maintain a weight that’s slightly above
what the insurance skills indicate, rather than go up and down
frequently over your life span.
Finally, on slide twenty-five, we’re going to discuss disordered eating.
The two most common types of eating disorders that you probably have
heard about are anorexia nervosa and bulimia. Anorexia nervosa is the
most fatal psychological disorder. It’s a fat fear. Think of something
you’re afraid of. For example, spiders. Now imagine that that’s
something that lives inside of you, right under your skin and that you
feel like you can see it. This is the level of anxiety that most
anorexia nervosa patients have about fat. There’s no guilt. Being
anorexic is often socially supported, that is when people begin to be
anorexic, they show weight loss and typically in our society, anytime
someone shows up and they’ve lost some weight, we typically comment wow
you look great and at first, they typically do. This quickly fades into a
more skeletal body image, which very few people find attractive.
However, no one yells at someone for not eating, but no one wants to
admit they ate a whole pizza last night. This is what makes bulimia more
treatable. There is some reinforcement to the extent that people tell
them again when they start to lose weight, wow you look really good.
Therefore it reinforces the behavior because what made them look good is
the bulimia, they continue to do this. It is more treatable because no
one wants to admit they threw up, but unlike anorexia where admitting
you skipped dinner and lunch and breakfast is not typically met with any
sort of disapproval. The other reason that bulimia might be easier to
treat is it’s quite expensive to buy enough calories in order to binge
and purge, therefore it’s not easy to maintain without suffering some
financial distress or without other people knowing.
This concludes our lecture on health psychology. Keep in mind that there
are entire courses on health psychology and that we’ve only covered a
very, very brief portion of this topic. Thank you.
