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Biopsychosocial model: physical illness caused by combo of bio, psycho, and sociocultural
factors
Health psychology: how psychosocial factors relate to health and causation, prevention, and
treatment of illness
The Nature of Stress
o Stress = circumstances that threaten well being
o Stress as an Everyday Event
Can include natural disasters to even small events such as misplacing cell
phone, shopping for gifts, etc.
Minor stress doesnt necessarily produce minor effects
Routine hassles can have harmful effects on mental and physical health
Possible because of cumulative nature of stress
o Appraisal: Stress Lies in the Eye of the Beholder
Stress depends on what a person notices, and how they choose to interpret
them
Two different types of appraisals
Primary Appraisal
o Initial evaluation of whether event is irrelevant to you,
relevant but not threatening, stressful
Secondary Appraisal
o More likely to make secondary appraisal if you find event to
be stressful
o Source of coping resources
Ex, primary = whether you saw exam as stressful, secondary = how stressful
is it depending on how ready you are
some people more prone to feeling stressed
anxious people report more stress
Major Types of Stress
o Acute stressors: threatening events that have short duration
Dealing with exam
o Chronic Stressors: long duration, no apparent time limit
Financial strains (debt)
o Frustration
Responding to Stress
o Emotional Responses
Emotions Commonly Elicited
Strong links b/w specific cognitive reactions to stress
o Self-blame leads to guilt, helplessness to sadness,
Some emotions more likely than others
o Common responses to stress are
Annoyance, anger, rage
Apprehension, anxiety fear
Dejection, sadness, grief
People also experience positive emotions in bad circumstances
o People felt positive emotions knowing their family was safe
after 9/11
Narrowing of arteries
Older age, smoking, lack of exercise, high cholesterol, high blood
pressure
Type A personality
Strong competitive orientation
Impatience and time urgency
Anger and hostility
Ambitious people
Type B
Relaxed, patient, easy going, amicable behaviour
Studies usually find association with heart disease and type a, but not as
consistent as expected
But link between anger/ hostility and coronary diseases
o Emotional Reactions, Depression, and Heart disease
Possible that strong emotional reactions trigger heart attracts
Stress trigger increases in inflammation contribute to cardiovascular risk
Depression also factor for heart disease
o Stress, Other Diseases, and Immune Functioning
Possible that stress can undermine immune functioning
Immune response = bodys defensive reaction
Depend heavily on white blood cells, called lymphocytes
Found that immune activity less when in stressful conditions
Other important connections also
Proinflammatory cytokines released when immune system responds to injury
Orchestrate number of activities that play role in killing pathogen and
repairing tissue
Transmission
Transmitted through person to person contact
Sexual contact, sharing needles
Male to female transmission 8 times more likely than female to male
Virus found in tears and saliva
Prevention
More sexual partners = higher risk
Reduce risk by having less sexual contacts
o How Does Health Impairing Behaviour Develop?
Health impairing habits appear slowly
Involve activities that are pleasant at the time
Risks with health impairing habits are chronic disease, aka cancer
Reactions to Illness
o Deciding to Seek Treatment
People with anxiety report more symptoms of illnesses
Roadblocks for treatment include wait times
Also how individuals react to health concerns
Income level, gender, city vs. rural area affect frequency of seeing doctor
City women with high income more likely to visit physician
People tend to delay professional consultation
Misinterpret significance of their symptoms
Fret about looking silly
Worry about bothering doctor
Reluctant to disrupt their plans
Waste time on trivial matters (taking showers, packing clothes)
before going to hospital
o Communicating With Health Providers
Some people leave doctor not understanding what theyve been told
Medical visits usually brief, little time for discussion
Doctors use jargon
o Adhering to Medical Advice
Nonadherence occurs 30-60% of time
Patients can forget about requirements of treatment
Also three other considerations prominent
Anxiety Disorders
o Class of disorders marked by feelings of excessive anxiety
o Generalized Anxiety Disorder
Marked by chronic, high level of anxiety not tie to any specific threat
Not specific
People worry about mistakes and problems
Dread decisions and brood over them endlessly
Usually coupled with physical symptoms trembling, diarrhoea,
dizziness, etc.
o Phobic Disorder
Irrational fear of object/situation that presents no realistic danger
Coupled with anxiety symptoms trembling and palpitations
Acrophobia (heights), claustrophobia (small places), hydrophobia (fear of
water) and various insect phobias most common
o Panic Disorder and Agoraphobia
Panic disorder = recurrent attacks of anxiety, suddenly/ unexpectedly
Victims become apprehensive
Can lead to being scared to leave home agoraphobia
As many as 34% of students suffer from this
Nonclinical panic vs. diagnosable panic attack
o Obsessive Compulsive Disorder
Marked by persistent intrusions of unwanted thoughts and urges for
senseless rituals
Obsessions sometimes inflect harm on others, personal failures, suicide,
sexual acts
People feel like they lost their mind
17% of people without mental disorder reported significant obsession
o Post-Traumatic Stress Disorder (PTSD)
Can come from any traumatic events, including rape, assault, automobile
accident, natural disaster, etc.
Sometimes it doesnt surface until much later on
Traumatic experiences much more common than previously thought
Intensity of individuals reaction at time of event is researched
Intense reaction during event tend to go on to show elevated
vulnerability to ptsd
o Etiology of Anxiety Disorders
Biological Factors
Stress
Dissociative Disorders
o Disorders in which people lose contact with consciousness or memory,
disruptions in sense of identity
o Dissociative Amnesia and Fugue
Serious memory deficits
Dissociative amnesia = sudden loss of memory for important personal
info that is too extensive to be due to normal forgetting
Dissociative fugue = people lose memory for entire lives along with sense
of personal identity
o Dissociative Identity Disorder
DID involves coexistence in one person of two/ more personalitys
Used to be called multiple personality disorder
Each personality will have different name, memories, traits,
Often mistaken for schizophrenia
Various personalities unaware of each other
Most patients have history of anxiety/mood/ personality disorders
o Etiology of Dissociative Disorders
Little is known about this extreme reaction
cognitive reactions
people who ruminate about depression remain depressed longer
than those who try to distract themselves
Interpersonal Roots
o Do experience relapses
Third group endures chronic illness
o Etiology of Schizophrenia
Genetic Vulnerability
in
normal
Social
Communication
Repetitive behaviour
Social impairment leads to autistic aloneness
Limited theory of mind
Echolia = mimic what they heard from others and repeat it
Usually have OCD, ritualistic acts
Higher order repetitive behaviour
Interest in specific topics, games, TV
Treatment difficult and specialized, early intervention recommended
Treatment can be expensive
Psychological Disorders and the Law
o Insanity
Insanity and insanity laws
Insane person cant be held accountable on account of mental disorder
Criminal acts must be intentional
Various rules in making decisions in court
MNaghten rule
Insanity exists when person cant distinguish from right and wrong
not criminally responsible on account of mental disorder
If found NCRMD defendant discharged, conditional discharge, or ordered
to a psychiatric facility
Automatism: should not be held responsible if you had no control over
behaviour
Culture and Pathology
o Is Equivalent Disorders Found around the world?
Most agree that principal categories of psychological disturbances are
identifiable in all cultures
Abnormal behaviour in western culture usually abnormal behaviour in
others
But theyre degree of strangeness can vary
Culture bound disorders = abnormal syndromes found only in few
cultural groups
Windigo and anorexia nervosa
o Are Symptom Patterns Culturally Invariant
The more a disorder has a biological component, the more it tends to be
expressed in various cultures
But depending on culture or area can be expressed differently
Agreement on goals
Client centred therapy provide three conditions
o Genuineness, therapist honest with client
o Unconditional positive regard, think of client as person,
provide warmth and care
o Empathy, understand clients world
Therapeutic Process
Reflect statements to clients with clarity
Emotion focused couples therapy
o Relationship not providing for attachment needs of
relationship partners
o Therapies Inspired by Positive Psychology
Prozac
Few side-effects
Valuable to OCD, panic and anxiety
Gradual effects
They may however increase risk of suicide
When compared to placebo, there is risk of suicide, from 2% to
4%
Suicide risk peaks in month prior to people beginning treatment
though
Controversial
Critics say
o Not as effective as advertised
o Drugs overprescribed, patients overmedicated
o Side effects underestimated
Some promise to it
Minimal side effects
Deep Brain Stimulation (DBS)
Electric surgically implanted in brain, connected to implanted
pulse generator, electrical currents delivered to brain adjacent to
electrode
Treatment of motor disturbances with Parkinsons, tardive
dyskinesia, seizures
Current Trends and Issues in Treatment
o Blending Approaches to Treatment
No rule that client must be treated with one approach
Often doctor uses several
Depressed person use cognitive therapy (insight), social skills training
(behaviour) and antidepressant medication (biomedical)
Most used to depend on one system
Eclecticism = drawing ideas from two or more systems of therapy instead
of committing to just one system
Two common approaches: theoretical integration and technical
eclecticism
Theoretical integration: two or more systems combined to take
advantage of strengths of each
Technical Eclecticism
o Borrowing ideas, insights, techniques from various
sources, tailoring strategy to unique need of patient
o Increasing Multicultural Sensitivity in Treatment
Psychotherapy emerged in Europe and north America
Reflected western culture, not universal
Psychological disorders in other cultures attributed to supernatural forces
Victims seek help from priests/shames/healers
Efforts to mix western psychotherapy with non-western cultures has
mixed success
North America minorities underutilize therapy
Various barriers include
Cultural barriers
o Cultural groups reluctant to turn to formal assistance
o Rely on informal help from family and friends
o More likely to report physical symptoms than
psychological
Language Barriers
o Effective communication needed
o Communication problems makes it awkward
Institutional barriers
o Majority of therapists are trained in treatment of white,
middle class patients
o Not familiar with other cultures
o Ill-advised treatment
Doctors need to be sensitive to various cultures
Pan Amerindian healing popular in aboriginal people
Strong therapeutic alliance needed
Crucial for minorities
Institutional Treatment in Transition
o Mental hospital = medical institution specializing in providing inpatient care for
psychological disorders
o Disenchantment with Mental Hospitals
Hospitalization often contributed to development instead of curing it
Facilities were underfunded
Overcrowded and understaffed
Personnel were undertrained
Delivered minimal care
Community mental health movement emerged in 1960s
Local community based care
Reduced dependence on hospitalization
Prevention of psychological disorders
o Deinstitutionalization
Transferring treatment of mentally illness from institutions to community
based facilities that emphasize outpatient care
Emergence of drug therapies
Deployment of community mental health centres
Now people placed in hospitals for only brief periods of time if at all
Mixed reviews
People have benefited by avoiding hospitalizations
But, patients suffering from chronic disorders have nowhere to go when
they are released
Large population of homeless mentally ill people
o Mental Illness, the Revolving Door, and Homelessness
Message Factors
One sided argument
Two sided argument
Better to concentrate on your strong arguments
Adding weak arguments hurt
Appeals to fear
o Effective
Truth/ validity effect = finding that repeating statement causes it
to be perceived as more valid or true
Mere exposure effect = repeated exposure to stimulus promotes
greater liking of stimulus
Receiver Factors
Researches havent found any personality traits that are reliably
associated with susceptibility to persuasion
Stronger attitudes resistant to change
Confirmation bias
Individual members fail to share info that is unique to them
Group cohesiveness strength of liking relationships linking
group members to each other and to group itself
Can facilitate group productivity, but groupthink risk high when
groups highly cohesive
Groups cohesiveness discussion lead to group polarization,
strengthening dominant view
Social Neuroscience
o A Neuroscience Perspective on Social Psychology
Approach to research and theory in social psychology, integrated models
of neuroscience and social psychology to study mechanisms of social
behaviour
Examines humans in social context, not isolated units of analysis
Use positron emission tomography (PET), fMRI, event related potentials
(ERPs), study of lesions, Transcranial magnetic stimulation (TMS), to
examine mental mechanisms that create, frame, regulate, and respond to
experience of social world
o Topics in Social Neuroscience
Understanding/ controlling oneself, understanding others, social
psychological phenomena
Theory of mind, aggression, attributions, social cognition, self and selfjudgment, social psychology of mental health, cognitive dissonance,
attitude change
Possible to examine neuro correlates of political attitudes using MRI
scans
Explicit versus implicit social judgments and evaluations
Explicit = conscious and controlled thought, implicit automatically