Health Psychology

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Health Psychology

• Lecture 2
• Theory and Research

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Lecture 2 - Outline

• Part 1
• Theory and Research
• Part 2
• Placebo Effects
• Part 3
• Assignment 1

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Theory

• Example Heart disease is due to excess levels of
  cholesterol
• Provide a framework for simplifying and
  describing data in a meaningful way
• A set of related assumptions from which, by
  logical deductive reasoning, testable hypotheses
  can be drawn
• Theories are judged in terms of their usefulness
• Clearly stated?
• Bring together known facts?
• Enable us to make predictions?

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Theories are useful!

• Shelly Taylor (1990). American Psychologist, 45,
  40-50.
• As a field, health psychology has made
  substantial contributions to the understanding of
  healthy behaviors and to the comprehension of the
  myriad factors that undermine health and often
  lead to illness.
• Much of the strongest work has involved
  providing theoretical and conceptual frameworks
  that elucidate the (non)practice of health
  behaviors, the role of stress in affecting
  illness and illness behavior these theoretical
  conceptualizations constitute major contributions
  inasmuch as they are often lacking in traditional
  medicine and medical practice.
• For example, it is difficult for physicians to
  understand why 93 of patients fail to adhere to
  certain aspects of their treatment regimens
  social psychological models not only make sense
  of these data but suggest ways of ameliorating
  them.

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Health Belief Model

• Cognitive-behavioral model (cognitive influence
  on behav.)
• Readiness to seek preventative health care is
  shaped by 4 core beliefs
• Perception of SUSCEPTIBILITY to disease
• (perceived personal vulnerability)
• Perceived SEVERITY of disease
• Perceived BENEFITS of action
• Perceived COSTS of action

(Rosenstock, 1966)
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Health Belief Model

• Readiness to Take Action Perceived Threat
• Readiness to Change Behavior Perceived Benefit
  of Taking Action (Threat Reduction)
• Cost-Benefit Analysis

Perceived Threat
Perceived Benefit
Likelihood of Acting


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Health Belief Model - Evaluation

• No place for emotions (fear, denial)
• Assumes people make rational choices
• Best predictor of actual behavior barriers to
  health practices
• Overall shows moderate predictive power
• Works moderately well for dental visits, safe
  sex, etc

Perceived Threat
Perceived Benefit
Likelihood of Acting


Cues to Action (internal/external)
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Health Belief Model
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Theory of Reasoned Action

• Azjen and Fishbein (1980)
• Cognitive-behavioral model (cognitive influence
  on behav.)
• Behavioral INTENTION is the best predictor of
  behavior (!)

Attitudes
Subjective Norms
INTENTION
BEHAVIOR
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Theory of Planned Behavior

• Azjen (1985)
• Cognitive-behavioral model (cognitive influence
  on behav.)
• Behavioral INTENTION is the best predictor of
  behavior (!)

Attitudes
Subjective Norms
INTENTION
Behavioral Control
BEHAVIOR
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Theory of Planned Behavior
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Summary - Cognitive Approaches

• Cognitive approaches are good at predicting
  behavior requiring conscious decisions (e.g.,
  going to dentist), but not good when when
  behavior becomes habitual (e.g., substance
  abuse).

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Learning Theory Approaches

• Focus on situations and rewards, not cognitions
• Health behavior habits controlled by cues
• not necessarily under conscious control
• Broad-spectrum or multimodal approaches

Reward (R)
BEHAVIOR (B)
Situation (SD)
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Research in Health Psychology

• the ideal health psychologist is a competent
  and highly trained individual equipped to
  intervene at both the individual and community
  levels, and who is able to conduct high quality
  research
• (Richards, 1992)

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Research

• Body of scientific evidence
• Largely free of self-serving bias
• evolutionary rather than revolutionary
• typically takes time and develops gradually
• Research in response to theory (tentative
  explanation)

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Research in Health Psychology

• Health involves many variables - hard to
  research
• Numerous misleading claims (e.g., carcinogenic
  personality )
• But research does not have to be perfect to be
  useful!
• Types of research design
• Experiment
• Ex post facto design (quasi experimental)
• Single-subject
• Correlational
• Retrospective
• Prospective (longitudinal)
• Epidemiology

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Experiment (controlled clinical trial)

• Manipulate independent variable and measure
  dependent variable
• Able to determine causality
• Characteristics of a good experiment
• .
• .
• .
• .
• .

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Quasi -Experiment (ex post facto)

• Not always able to manipulate the independent
  variable
• Ethical and practical reasons
• Not able to determine causality
• Groups self-select (no random assignment or
  manipulation)
• Observe dependent variable
• Able to identify risk factors

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Correlational Designs

• Observe two (or more) variables
• Data analysis
• Simple correlations (2 variables),
• Path analysis/structural equation modeling
  (multiple variables)
• Not able to determine causality
• Able to identify risk factors
• Correlational studies are often misunderstood

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Prospective Studies

• Begin with whole population and observe over time
• Initially healthy
• Cross lagged correlations
• Problems
• Expensive
• Time consuming
• Attrition rates

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Epidemiology

• Scientific discipline that considers the various
  factors determining the frequency, distribution,
  and cause of a disease or disorder
• Risk Factor any characteristic or condition
  which occurs with greater frequency in people
  with a disease than people without.
• Morbidity disease
• Incidence number of new cases in a specified
  time interval
• Prevalence total of cases in a specified time
  interval
• Mortality death
• of deaths to a known cause
• (premature death death before age 75)

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Treatments and Interventions
3 elements of a treatment/intervention 1) Assump
tions / Goals (Theory!) 2) Techniques
(Theory-driven) 3) Treatment Evaluation a)
Outcome - is the person better? b) Process -
why is the person better?
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3) Treatment Evaluation

• Experiment (controlled clinical trial)
• Manipulate independent variable and measure
  dependent variable
• Able to determine causality
• Characteristics of a good experiment
• Random sampling
• Random assignment
• Valid manipulation of independent variable
• Valid and reliable measurement of dependent
  variable
• Control extraneous variables
• Placebo effect

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Placebo
Active treatment substance or procedure that is
explicitly directed at the symptoms of the
condition in question. Placebo substance or
procedure that does not specifically target the
condition being treated
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Placebo Effect

• Provide about 35 of improvement for a variety of
  conditions.
• Physical conditions - headaches, warts, etc
• Psychological conditions - pain, depression, etc
• Example - Depression
• Cognitive-Behaviour.... 65-70
• Antidepressant medication. 65
• Placebo drug 30

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Why the placebo affects

• Expectancies
• Anticipation of the emotional and physiological
  response
• Non-Specific Factors
• Features, or incidental elements, common to all
  therapeutic interventions
• Eg - doctor-patient relationship, hope,
  suggestion, expectancies
• Demand Characteristics
• Classical Conditioning

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Can a placebo have a negative effect?
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Can a placebo have a negative effect?

• Nocebo effect - the flipside of the placebo
  effect
• case study shes a TC!
• Inert pills can produce negative side effects
• experiment reactions to a poisonous plant

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Placebo effect

• limitations of the placebo effect
• ethical considerations
• implications for research

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Implications for Research

• Double-blind trials (Sarafino, p. 26)
• Diagnosis
• Intervention Independent variable
• Assess on relevant dependent variables
• Follow-up (long-term gains)

Experimental group (active drug)
Placebo group (inert drug)
Control group (no pills)
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Implications for Research

• Results if the drug is effective!

Illness
Experimental group (active drug)
Placebo group (inert drug)
Control group (no pills)
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Tutorial Assignment 1

• Practice exercise
• Effect of herbal extracts on health

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Empirical Evidence

• Hoodia Weight-Loss Pill
• A few years ago South African scientists
  discovered the plant contained a previously
  unknown molecule, which has since been christened
  P 57.
• You can find pills containing Hoodia extract
  advertised on the Internet.
• Would you give this pill to patients who want to
  lose weight?
• Educated doctors need to know
• .
• .

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Practice Exercise - Modern Juice

• add a supplement to boost your health!
• Vitamin C (with potent antiviral and
  antibacterial properties, vitamin C plays a vital
  role in strengthening the immune system,
  especially with regard to preventing and treating
  the common cold)
• Echinacea (organic herbal extract, mobilizes the
  immune system response to bacterial invaders by
  increasing the production of white blood cells)
• Royal Jelly (the sole food of the queen bee, this
  premium quality extract is a super-nutrient and
  well-known booster of immune function and is rich
  in protein, vitamins, and enzymes)
• Organic Wheatgrass (nutritional scientists have
  hailed it as the most powerful blood, tissue, and
  colon cleanser. As it detoxifies the liver and
  kidneys, it enriches the blood with an array of
  vitamins and minerals. 1 or 2 oz a day helps
  maintain a strong immune system)

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Practice Exercise - Modern Juice

• add a supplement to boost your health!
• Hawaiian Spirulina (an organic blue green
  micro-algae which contains high doses of 10
  readily assimilated essential nutrients.
  Beneficial for stress-related mental and physical
  fatigue and iron deficiency)
• Panax Chinese Ginseng (considered the most
  stimulating of all ginsengs. Helpful to relieve
  stress and fatigue, and to improve mental and
  physical performance, stamina, and exercise)
• Kava Kava (a sacred plant extract from the pepper
  plant, native to the South Sea islands. Promotes
  a deep restful sleep, pain relief with sedative
  effects and muscle relaxation)
• Ginko Biloba (an anti-oxidant rich herb that has
  a scavenging effect on free-radicals. It
  increases dopamine, which aids in memory and
  mental alertness)

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Practice Exercise - Modern Juice

• We are interested in whether the consumption of
  juice supplements is related to improved health
  and greater resistance to illness.
• Boost immune system
• vitamin C, echinacea, royal jelly, wheatgrass
• Relieve stress
• Hawiian Spirulina, Ginseng, Kava, Ginko Biloba
• Design a correlational study to test this. What
  can you conclude?
• Design a true experiment. What can you
  conclude?

What will you measure, how will you measure it?
(reliability and validity)
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Design a Correlational Study/True Experiment

• Hypothesis/Rationale
• Participants
• Measures
• Predictor variable
• Outcome variable
• Mechanism
• Procedure/Design
• Data analysis
• Conclusions

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Term Paper 1

• We are interested in whether higher levels of
  physical activity are associated with lower
  cholesterol levels.
• Design an ex-post facto (quasi-experimental)
  study to test this. What can you conclude?
• Design a true experiment. What can you
  conclude?
• Maximum Length 1000 words
• Due date Monday, October 4
• References Sarafino (pp. 25-32, 241-242)