Module: Health Psychology Lecture: Introduction to Health Psychology Date: 19 January 2009

1. Module: Health PsychologyLecture: Introduction to Health PsychologyDate: 19 January 2009 Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick Tel: +44(24) 761 50222 Email: C.Bridle@warwick.ac.ukwww.warwick.ac.uk/go/hpsych

2. Aims and Objectives • Aim: To provide an introduction to the discipline of health psychology and the health psychology module • Objectives: The student should be able to provide a basic description of the … • nature of health psychology, e.g. who and what are studied • levels of clinical application of/for psychology • pathways through which psychological processes influence physical health • structure and content of the module • module requirements, e.g. tutorial tasks

3. What is Health Psychology? • Psychologyis both an academic and applied discipline involving the scientific study of mental processes and behaviour. • Classic definition: ‘… the aggregate of the specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction’ (Matarazzo, 1980) • Pragmatic definition: Health psychology is the study of psychological processes that influence health, illness and health care

4. Implications of Our Working Definition Health psychology is the study of psychological processes that influence health, illness and health care • Four questions: • In who do psychological processes exert influence, i.e. who gets studied? • What types of psychological process are studied? • How do processes influence health, illness and health care? • In what ways can psychology be applied in clinical practice?

5. 1: Psychological Processes in Who? • People who receive health care • Patients: anyone interacting with a health care professional or service • Users: perceived presence of symptoms driving health care use • Consumers: active, and proactive, care seeking by the asymptomatic • People who providehealth care • Providers: professional responsibility to provide care directly to patient • Carers: as above, but without professional responsibility • People who organise health care • Purchasers / managers: who fund and evaluate local service against benchmark quality indicator, e.g. treatment targets • Policy- / Decision-makers: set national-level quality indicators, provide clinical guidance and allocate financial resources

6. 2. Processes Studied in Health Psychology • Multiple developmental influences, in particular • Behaviourism • Social Psychology • Cognitive Psychology

7. Behaviourism Operant conditioning (Skinner) Classical conditioning (Pavlov) Classical conditioning (Watson) • The scientific study of how reward and punishment (stimuli) affect emotion and behaviour (response) • Empirical approach: Vary contingencies of reward and punishment and measure effect on behaviour • Try to explain all behavior without going inside the ‘black box’, i.e. the mind • Behaviour is a conditioned response occurring in the presence of a stimuli • If behaviour is learned, it can also be unlearned / modified through conditioned learning

8. Behavioural Conditioning A Clockwork OrangeAlex given drug to induce extreme nausea (response) whilst also being forced to watch graphically violent films (stimuli) for two weeksAt treatment end, Alex is unable to even think about violence without crippling nausea, e.g. conditioned response in presence of the paired stimuliFiction or reality? This is an example of classical conditioning, and describes the use of aversion therapy.Addiction believed to have its roots in conditioning, e.g. positive stimuli associated with consumption of food, alcohol, drugs, etc.

9. Social Psychology • The scientific study of the way in which people’s thoughts, feelings, and actions are influenced by the social environment • Empirical approach: Vary aspects of social environment and see how this affects thoughts, feelings, and/or behaviour • Posit psychological processes as explanations for observed effects • Classic examples: Obedience

10. Milgram’s Obedience Study • Pain-induced learning (Milgram, 1963) • Procedure: A study about ‘learning’ • Ask questions to another ‘subject’ in the next room • Authority figure instructs subject to administer increasing ‘shock levels’ in response to wrong answers • Question: How obedient will people be? • Obedience measure: Shock level administered • Levels: ‘moderate’, ‘strong’, .very strong’, ‘intense’, ‘danger–severe’, ‘XXX’

12. Obedience • Result: 65% administered highest shock level • Interpretation: Perceived legitimate authority facilitates obedience ‘The ordinary person who shocked the victim did so out of a sense of obligation - an impression of his duties as a subject - and not from any peculiarly aggressive tendencies.’ (Milgram)

13. Obedience in Health Care? • Drug administration • Nurses asked, by Dr on phone, to give patient a non-prescribed and incorrectly dosed drug • Result: • 21 / 22 administered the drug • Interpretation: • Perceived legitimate authority facilitates obedience (Hoffling et al)

14. Cognitive Psychology • The scientific study of basic mental abilities • perception, learning, memory, language, problem-solving, etc. – ‘information-processing approach’ • Empirical approach: Vary information input, measure performance output • Posits psychological processes that account for observed effects • Classic examples: Stroop Effect

15. Name the colour of each block: Start top left, work down and then across • Two measures: (1) response/reaction time, and (2) errors Stroop Effect Easy? • Quick time? • No errors? (Stroop, 1935)

16. This time – coloured words instead of coloured blocks • Name the colour in which the word is written • e.g. ‘table’ the answer / response would be ‘yellow’ Not so easy? • Took longer? • Didn’t finish? • More errors? Answered ‘yes’ to 1 or more above? That makes you .. … NORMAL yellow white pink grey black orangeyellow purple orange green tan red green purple grey orange pink black orange white yellow (Stroop, 1935)

17. Stroop Effect • Result: Fewer errors and faster time to name color alone than in presence of word written in conflicting colour • Explanation: Presence of conflicting colour word interferes with processing ability / task performance • Conclusion: The meaning of a word is processed automatically, without intention

18. Social Psychology + Cognitive Psychology Social Cognition =

19. Social Cognition • The scientific study of how people make sense of their social world: • How they perceive, represent, interpret, and remember information about themselves, others and social groups • Information processing in its social context • Key question: Is the combined total more than the sum of its parts? What does social cognition offer over and above the contributions of social and cognitive psychology?

20. Race of Person Caucasian (White) African-american (Black) W Colour Of Ink B New methodologies:Stroop & Person-perception (Karylowski, et al., 2002)

21. Race of Person Caucasian (White) African-american (Black) Match  Mismatch  W Colour Of Ink Mismatch  Match  B New methodologies:Stroop & Person-perception (Karylowski, et al., 2002)

22. Race of Person Caucasian (White) African-american (Black) Jerry Seinfeld Oprah Winfrey W Colour Of Ink Rosie O’Donnell Bill Cosby B New methodologies:Stroop & Person-perception (Karylowski, et al., 2002)

23. Stroop and Person-Perception • Result: Slower to read ink colour when colour and racial category mismatch than when they match • What do these data actually mean? Reaction Time (ms) Racial categories come to mind automatically Ink Color (Karylowski, et al., 2002)

24. In the Health Context • Social categories are activated automatically during interactions with other people • Interactions and decision-making potentially influenced by stereotypic beliefs and biased knowledge • Helps us understand evidence showing that, for certain social groups, clinicians … • offer less information, less support and are less clinically proficient • provide different treatments, preventive interventions and referral to specialist services

25. 3. Psychology and Health • Dual Pathway Model: Two broad ways in which psychological processes may influence physical health Psychological Processes Physical Health Direct Path Indirect Path Indirect Path Behaviour

26. A Primer • Psychoneuroimmunology (PNI) • Lutgendorf & Costanzo (2003). PNI and health psychology: An integrative model. Brain, Behavior and Immunity, 17, 225-232 • Glaser & Kiecolt-Glaser (2005). Stress damages immune system and health. Discovery Medicine, 5, 165-169 • Antoni et al. (2006). The influence of bio-behavioral factors on tumour biology: pathways and mechanisms. Nature Reviews (Cancer), 6, 240-248

27. Nerves Hormones Psych Processes Nervous System: Physiological Reactivity Psychological Appraisal Chronic Stress GI: IBS, ulcers Psych: cognitive decline, morbidity Sensitivity - more severe RS: impotence, amenorrhea ReS: asthma, hyperventilation Salient Event Cardiovascular System Immune System Endocrine System Essential Hypertension Metabolic dysfunction Lowered immunity Hypervigilance - more events Physical and Psychological Health Status

28. 4. Clinical Application • Three basic levels at which psychological principles (knowledge and techniques) can be applied: • Awareness of patient’s psychological state • Knowledge of basic psychological issues relevant to context (e.g. condition), patient-centred communication • Intervention in the form of brief counselling • Emotional care, motivational support, behavioural advice, informational and educational care • Therapy from relevant psychological therapist • Knowing when and where to refer, screening for ‘caseness’, engaging in/with a care team, follow-up, case management, etc.

29. Module Aims / Objectives • Block 1: Before • to conceptualise the interplay between biological, psychological and social factors in health by considering core psychological constructs underlying health-related behaviours and beliefs. • Block 2: During • to appreciate and consider the use of core psychological constructs to facilitate positive consultation outcomes. • Block 3: After • to recognise the importance of considering post-consultation consequences in the context of ongoing patient care • Block 4: Consolidation • to provide opportunity for structured supported revision and consolidated learning.

30. Module Content

31. Structure * Weeks 3, 6 and 9

32. Requirements • The module is a core module that must be completed satisfactorily in terms of: • Attendance at both lectures and tutorials is compulsory • Assessment, which may includeboth written ESAs and OSCEs • Participation, including the completion of required reading and tutorial tasks

33. Tutorial Tasks • Student-led tutorials involving 4 small-group (4-5 students) presentations, each with two components:  • Integration template: students will select a clinical condition and identify (from the lectures in that block) the psychological factors relevant to the condition • Formative questions: students will develop ESA questions (1 per group per tutorial • The template and ESA questions will be presented to other students for critique and evaluation • Example ESA questions will be • made available to all students for formative assessment / revision purposes at the end of each block • submitted to the WMS ESA question bank  

34. Integration Template Example: Back Pain

35. Additional Information Module Leader: Chris Bridle Office: A0.22 Medical School Building Telephone: (024) 761 50222 Email: C.Bridle@warwick.ac.uk Webpage: www.warwick.ac.uk/go/hpsych • Module staff: • Each tutor available to meet at the end of each tutorial • I will be available to meet at the end of each lecture • Office hours: • I have an open door policy – please don’t abuse it.

36. Conclusions • This session would have helped you to understand the … • nature of health psychology, e.g. who and what are studied • different levels of clinical application for psychological principles • dual pathways through which psychological processes influence physical health • structure and content of the module • module requirements, e.g. tutorial tasks

37. What now? • Familiarise yourself with the module webpage • Obtain / download one of the recommended readings • Organise yourselves into small groups (re: tutorial tasks) • Consider / select a condition on which to develop your integrated template Any questions?