Workgroups Health & Medical Psychology
Workgroup 1: Health and Medical Psychology
There are three forms of prevention. Primary prevention is a method to keep people healthy for as long as possible. The target group of this form of prevention is healthy people. Secondary prevention focuses on finding early signs of an illness. This is done by screening and early treatment. The symptoms that may occur are still reversible at this stage. The target group for secondary prevention is (healthy) people with an increased risk of developing a certain condition. Tertiary prevention is based on the prevention of symptoms growing worse and rehabilitation. The people who this type of prevention is aimed at have already developed a certain condition.
It is important to support healthy behaviour. This is because health behaviour is related to mortality and morbidity. In the 1900s the main cause of death were infections, like flue and lung infections, tuberculoses, measles and typhus. Now, in the 2000s, the main cause of death are chronic diseases, like heart diseases, cancer, diabetes and kidney diseases. Another reason why it is important to change behaviour is because socio-demographical differences in health behaviour increase social economic differences, which is partly responsible for life expectancies between groups. A third reason why it is important to change behaviour is because prevalence of risk behaviours is high. Finally, health behaviour is not always an informed choice. People are not always aware of their unhealthy behaviour, like picking unhealthy food in the supermarket because it is placed on the shelves which are well visible, or the size of plates in restaurant which trick your mind in the portions of your food.
Example: Why do some people smoke and others do not?
In this workgroup we tried to figure out some determinants of (un)healthy behaviour. These factors can occur on individual level, social level and in a social context.
Determinants can be influencable or not. Factors which cannot be influenced are age, gender, SES, ethnicity and personality. Those which can be influenced are explained in the models explain during the first lecture.
Examples of individual level factors are operant conditioning, expectations of outcomes, lack of other coping strategies (smoking is the only thing to get me calmed down), attitude, beliefs and priorities. Examples of social level factors are peer pressure, social norms and upbringing. Examples of factors in a social context are availability of certain services and alternatives, stimuli (commercials) and costs.
Workgroup 2: Health and Medical Psychology
Health Belief Model
The Health Belief Model is a model based on fear and it is used to explain and predict health-related behaviours. According to this model, people’s beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behaviour. Demographic variables, like age, race, cultural background and education all influence health related factors like perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and health motivation.
Perceived susceptibility is the subjective assessment of risk of developing a health problem. People who are more susceptible of developing health problem X will perform behaviours and actions to reduce their risk of developing it. For example: condom use to reduce the chance of getting unwanted pregnancies or an STD.
Perceived severity is the subjective assessment of the severity of health problem X and its potential consequences. People who perceive health problem X as serious are more likely to engage in behaviours to prevent the health problem from occurring or worsening. For example: condom use to reduce the chance of getting unwanted pregnancies or an STD.
Perceived benefits are the benefits that may occur when engaging in certain behaviour to prevent health problem X from occurring. For example: condom use from protection and not getting unwanted pregnancies or an STD.
Perceived barriers are subjective barriers which occur related to certain behaviour. For example: wanting to use condoms, but feeling awkward buying those.
Cues to action are cues which increase the chance of engaging in a certain behaviour. For example: condom use because you have had an STD before.
Social Cognition Theory
The Social Cognition Theory describes how one’s expectations are related to their performed health behaviour and their risk behaviour. Health behaviour has different coping functions, like problem solving, feeling better, avoidance, time out and prevention. According to this theory, there are multiple factors which influence self-efficacy judgements (“I can do this”). These factors are performance accomplishments (e.g. things you have learned from past experiences), vicarious experiments/modelling by others (e.g. seeing that your friends do not play video games as often as you do), social persuasion (e.g. coaching and evaluative feedback, your parents supporting you to engage in certain behaviours) and physiological and emotional states (e.g. when you play video games very often and experience back pains from your sitting position). An overview of this model is given on slide 41.
Theory of Reasoned Action and Theory of Planned Behaviour
The Theory of Reasoned Action describes how beliefs, attitudes, perceptions and expectations about behaviour X in a social context can lead to a certain behaviour.
The Theory of Planned Behaviour has an additive part to the theory of reasoned action. According to this model, perceived internal and external control factors may lead to perceived behavioural control, which then lead to behaviour intention and
.....read more Workgroup 4: Chronic diseases
This week is about chronic diseases. A chronic disease is a long-term disease which won’t go away. Examples of chronic diseases are RA, diabetes, heart diseases, (most types of) cancer, asthma, psoriasis, epilepsy, Crohn’s disease, Bechterew’s disease and multiple sclerosis. Apart from physiological consequences, psychological consequences may occur as well, like stress, anxiety, depression and anger.
The stress coping model says the degree to which a chronic illness is considered a source of psychological stress depends on individual personal resources, social resources and life goals. Individual adaption processes to stressors are describes by stress coping models. Personal and interpersonal influenced on appraisals and stress responses are coping styles, personality, cognitions, emotions and social support.
Coping styles are interdependent and can occur together as seemingly oppositional strategies to create the overall coping response. They can change dynamically according to the context.
- Problem focused: to reduce demands of stressor or increase personal resources (e.g. confronting the source of stress)
- Emotion focused: managing the emotional response (e.g. by venting anger)
- Approach oriented: e.g. attending to source of stress
- Avoidance: e.g. distraction
Workgroup 5: Interview
Interview
During a first interview the psychologist talks to the patient about their chronic disorders or their medical somatic complaints. It is an interview to orientate what you can mean to the patient and their complaints, to get an overview of their complaints and to develop a treatment plan. The role of the psychologist is to take away any uncertainties and insecurities by giving information, making the patient trust the psychologist and by supporting the patient, and it is important to gain as much relevant information as the psychologist can.
An intake form can be seen as a memory backup.
A quick overview of the interview:
- Reception and introduction
- Anamnesis
- Open style: complaints
- Taking initiative: other important aspects in life, like background and current functioning
- Asking questions which have remained unanswered so far
- Ending
Reception and introduction
During this part it is important to gain the patient’s trust. This can be done by small talk, introducing who you are and what you do, give a brief explanation of what will be done today and telling the patient what you already know and check if that information is correct.
Anamnesis
During the anamnesis you as a psychologist want to know more about the patient and their background. You ask questions about when their symptoms started to develop, how they developed, how often they occur and you ask about other somatic complaints. You also ask how the patient feels about the complaints and how they influence their daily lives, and how they deal with their symptoms. Apart from that, you also want to know whether the patient lives alone, has a partner, if they have experienced any big life events, if they have received any psychiatric service in their past and so on.
Ending
During the final part of the interview you give a brief summary of what you have talked about with the patient. You also ask if they have any expectations and how they have experienced the interview. Besides, you tell them what is going to happen next and you give the patient the opportunity to ask you any questions.
During the interview
During the interview you must ask as many as you can about the illness and how it correlates with the patient and their life. Encourage them to speak and ask both open and closed questions. Reflect their feelings, summarise, make their comments clear and repeat. Also it is important to create structure in the interview.
Make sure not to use difficult words, since the patient might not understand those. Watch out with using words like ‘poor’, ‘your problem’ and ‘patient’.
Workgroup 6: Stress and stress management
Stress influences functioning on different levels: cognitive, emotional and physical. These three levels of functioning all influence each other as well, causing a vicious cycle.
Stress management is an intervention which can break this vicious cycle, by influencing physical processes, giving more feelings of control, changing cognitions and reducing anxieties. During the workgroup three types of stress management are practiced by students, which have been prepared prior to the workgroup. Each student has prepared an intervention for their patient.
Progressive relaxation is about first tensing your muscles and then relaxing them.
Applied relaxation is based on progressive relaxation. However, this type of relaxation is only about relaxing your muscles. The goal is to teach the patient a new coping strategy (relaxing your muscles) and then having the patient being able to apply this new coping strategy in any (stressful) situation. It is also called release-only relaxation.
Mindfulness is a form of meditation, originating from Buddhism. It is about doing things with 100% focus and focusing on the very moment, instead of focusing on the past or the future. During mindfulness, the patient has to let go of bad thoughts and the patient must let thoughts come and go without judging those.
You start the stress management interview with an intro, in which you can ask how things have gone since last time you spoke, give a brief summary of last time you spoke, tell the patient what is going to happen today and you can answer any questions the patient has before you start.
During the interview it is important to sit in a comfortable position (both for you as for the patient), to have the patient close their eyes (unless they don’t feel comfortable to), for you to have a monotone voice and to speak calmly and to have breaks in-between what you have to say, so the patient can adjust.
When finishing up the interview, you ask how relaxed the patient is feeling and evaluate together. Give brief instructions for doing the relaxation at home and give a brief summary of what you have done today. Also answer any questions the patient has.
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