Psychology Revision

1. Psychology Revision Health Psychology

2. Biopsychosocial approach to stress Biological Stress can be caused by: Any change to bodily rhythms e.g. stress Cziesler found that sift workers had several problems: Cognitive problems Irritability Tiredness Physical symptoms e.g. indigestion They cannot adapt to the changing bodily rhythms However, not all people who have this interruption get stressed, and stressed people don�t always have disruptions to their bodily rhythms People�s perceptions of stress is different Seyle (1996): GAS Alarm Reaction � the HPA (Hypothalamus Pituitary Access) and SAM (Sympathetic Adrenal Medullic) Resistance � depends on coping style (emotion/problem focused), personality, gender/culture Exhaustion � reduced resistance to infection, heart and circulatory disorders, depression and helplessness, anxiety The body concentrates on the ST � when adrenaline is released, it diverts energy from processes that focus on LT processes (e.g. digestion)

3. Physiological Response to Stress The adrenal gland is split into two parts, adrenal-medulla (inside) and adrenal cortex (outside). Cortisol reduces inflammation and increases energy (released from adrenal gland. Adrenaline increases heart-rate. Automatic Nervous System � responsible for autonomous responses within the body. Sympathetic � �fight or flight� response (consists of adrenal-medulla). Para-sympathetic � calming down (the reverse effect of adrenaline - heart-rate, digestive etc). Canon (1914) found that when rats were injected with hormones, they were dying. However, the control group (who still received injections) also died, and concluded that it was a results of the stress of injections that caused the death. Selye (1956) introduced the idea of General Adaptation Syndrome (GAS), which consisted of 3 parts; 1 � Alarm Reaction (adrenaline, high levels of arousal), 2 � Resistance (drops down after a peak level of arousal, not outwardly stressed but still high levels of adrenaline in the body ? takes little to become stressed again), 3 � Exhaustion (you cannot maintain this level of arousal, energy is low.). The fight or flight response is no longer as necessary in the world today � it doesn�t help with the kind of stress we experience today.

4. Physiological Response to Stress

5. Direct effect of Prolonged Stress Suppression of the immune system White blood cells are made in the thymus gland, and stress leads to the reduction of this gland ? cells that fight in the infection Cohen et al (1993) tested 154 men and 266 women to see the affect of stress on the immune system using a life event questionnaire. They looked at the people in hospital to see the correlation between the questionnaire and hospitalisation. They were given a cold via a nasal spray, and those who were most stressed couldn�t fight it off. Kiecott-Glaser (1987) measured the effect of stress on the immune system using high risk groups: medical students, unhappily married women and recently separated women., and long-term carers of Alzheimer's patients. They found lower number of white blood cells in participants who were more stressed. Other effects Increased level of cortisol can damage the neurons in the hippocampus ? increased levels of cortisol can effect ST memory The pituitary gland was also affected (which controls hormone production) and so stress can affect menstruation and libido

6. Direct Effects of Prolonged Stress Direct mechanical effects. Blood vessels become weaker where they join, increasing the risk of haemorrhage. The increased pressure causes pits and scars on the inner surface of vessels. The released fat and glucose get caught in these, which clog-up, and lead to heart disease and attack. Watson et al. (1998) kept monkeys in isolation. The stress induced caused them to develop heart disease and die. Suppression of immune system White blood cells are made in the thymus gland, and stress leads to the reduction of the thymus gland (due to corticosteroids) ? cells that fight infection.

7. Social Factors Any change causes stress Periods of exams etc also cause stress Lack of social support Armets (1987) studied culture American-Italians have lower stress due to larger family networks Vogele (1997) found that men and women have different social support networks, and respond differently to it Men suffer more from stress � die earlier, heart disease etc Their trigger is hairline (I.e. it takes less for them to become stressed) They produce more adrenaline, and it takes them longer to calm down, perhaps due to the evolutionary role of the male (hunting etc) It may also be due to the social support networks, that differ between men and women Lynch (1977) found that married people live longer, and they have someone else to share problems with Kim and McKendry (1998) looked at a spectrum of different races in the UK. They found Asian-American women had less stress due to the stronger family and religious ties

8. Social Factors James proposed John Henrism, who was a black athlete who pushed himself to the physical limit, and died of exhaustion. James argued that black people who lived in a high stressed environment (high levels of crime and unemployment, low income) had a high score on the John Henry scale (the correlation). Those who thought they could overcome all of their problems were more stressed. Living in a racist society meant that they may not be able to overcome everything (�glass ceiling�) Adams et al (1999) found black college students from affluent backgrounds (with more social support) were less stressed than black students from poorer backgrounds Schwarzer et al (1994) looked at migrants from E to W Germany. 235 migrant participants were studied and found two factors � job status and levels of social support � were particularly significant. Better status and social support meant less stress, even with poor job status but high social support they were still less stressed Holmes and Rahe measured stress via a life events scale (SRRS)

9. Psychological Factors Anxiety Can be a cause of stress Older people have non-directed anxiety, and therefore are more stressed Personality Type Friedman and Rosenman (1974) believed in personality types A and B. This theory implies that personality stems from behaviour (not vice versa) and therefore can be changed. A: competitive, goal and time orientated, busy, impatient, irritable and easily annoyed etc. B: lesser versions of type A. Although other research refutes these findings, it was later added that if type A personalities have �cynical hostility� then the research applies Evans also believed there was a type C: people who repress things (and they are more prone to cancer)

10. Psychological Factors Initially, F & R found that type A were most prone to stress-related illness and heart disease. However, after initial correlation, Ragland and Brand (1998) found that after 22 hours (critical time for secondary attack) type A personality types were easier to change due to their goal-orientated nature at finding new behaviour. Type A people may experience more stress not directly because of their personalities but because they expose themselves to more stressful situations, e.g., they may have more pressurised jobs, or find queuing more annoying than most, or cause more conflict with others because of their abrasive, competitive, aggressive personalities.

11. Psychological factors & stress Hardiness Kobasa (1979) studies business executives & found that some executives were less stressed than others. Those who were less stressed tended to share 3 key characteristics: Commitment � a sense of purpose & involvement Control � a belief that their actions could influence events in their lives Challenge � a perception of change as positive & an opportunity for growth rather than threat. Rhodewalt & Zone (1989) looked at depression ratings for women with low & high hardiness scores. They found that �hardy� women suffered lower rates of illness & depression after undesirable life events than non-hardy women. These women also seemed to differ in their interpretation of of life changes. Other studies have also shown that hardiness seems to provide a �buffer� against stress, e.g., Bartone (2000) & members of the armed forces during the first Gulf War in 1991. It seems unlikely that a single personality factor like hardiness can explain all the effects and extent of stress on individuals. Hardy people may simply be more likely to engage in healthy behaviours and so avoid stress, I.e., it has an indirect effect on stress. Many studies are correlational studies and so cannot establish cause-and-effect relationships.

12. Psychological Factors Control Brady and Weiss (1958) � �executive monkeys�. 2 monkeys wearing harnesses; 1 executive, 1 non-executive. Both received electric shocks, but executive monkey had the power to stop the shocks, but they would only sometimes work. The other monkey had no control, but still received that shock. The executive monkey was most stressed because they did not know if they were in control or not, and died. Weiss (1978) � used executive rats, who also had a button. They were conditioned to associate a buzzer with pressing the button. They therefore believed that when they heard the buzzer they could stop the shocks. The rats were less stressed when they could hear the buzzer, and knew they could stop the shock.

13. Psychological Factors Control Glass and Singer (1972) � 2 groups, put into a room with uncontrollable levels of noise. 1 had a button they believed would turn it down (even though it didn�t). They were less stressed due to their perceived level of control. Sapolski (1984) � repeated with rats using foot shocks. Half had a lever to reduce shocks. Eventually the lever didn�t work, but they were still less stressed due to their perceived level of control. Hiroto and Seligman � �noisy fan� � 2 groups of students, both do cognitive tests with the same �noisy fan�. 1 group were told they cannot turn the fan off. The other was told they could, but shouldn�t. The latter group felt they had more control, and performed better in cognitive tests.

14. Psychological Factors Control (Cited in) Cardwell argued in different types of control: Behavioural Control � behaving in a way that will do something about a situation Cognitive Control � being able to use effective, rational thinking strategy. Cohen (1986) emphasises the importance of this when dealing with stress, Decisional Control � being able to choose between different courses of action Informational Control � being able to gain information Retrospective Control � being able to make sense of what happened in the past Rotter (1966) � �locus of control� � internal and external. Internal � you feel you have control over events in your own life A strong internal locus of control means less stress External � other people will control your life or fate Relying on others, makes more stress

15. Psychological Factors Self-efficacy How competent you feel you are at something A mixture of SLT and learning � believing we can model successfully and learn from their behaviour This depends on: Past experience Cognitive perception of the potential to do something People with high levels of self-efficacy are better at coping with stress Bandura believed it�s good for people to have their SE above what they actually are, so there�s always something to strive for

16. Psychological Factors Defence Mechanisms Freudian defence mechanisms can be used to deny the stressful situation. It is a ST strategy that will not help solve problems in the LT Rationalisation can also be used to reduce stress, but ignores the underlying cause. Suppression can bury things under the surface They require psychic energy, which may mean the behaviour will surface later in neurotic behaviour

17. Psychological Factors Coping Strategies Problem Solving Sarafeno (1994) believed in 2 different strategies: Problem focusing A stressful situation in which you look at the problem head-on, and focus on the causes of the problem directly Emotion focusing Involves looking at emotional responses Lazarus and Foltzman suggest that we resort to emotion focusing when we cannot deal with a problem directly (e.g. crying, drinking, putting on a �happy face�)

18. Psychological Factors Coping Strategies Cognitive Distortion Trying to change the way you think about a situation A mixture of cognitive distortion and problem-focused approach is direct action Emotion-focused approaches should only be used when the problem cannot be faced head-on Problem-focused approaches are best because they eradicate the problem, not deny it. Belief Systems Dichotomous Thinking When thinking patterns are either totally one way, or totally the other. There is nothing in between. (e.g. a person will believe if they aren�t a total success, then they must be a total failure) Irrational Thinking Developing irrational thinking patterns

19. Stress Inoculation Resources in coping Social support Men have more friends ? larger social support networks However, women use them more effectively Billings and Moose looked at 200 married couples, and found husbands and wives used problem-focused strategies. Wives and people of lower SES used an emotion-focused approach Meichenbaum � stress inoculation in 3 stages 1 � Conceptualisation � think about causes of stress 2 � Skills training � develop problem and emotion focused strategies 3 � Application and follow-up � learning to apply the newly acquired strategies.

20. Drugs Rosenburg and Seligman define substance abuse as: Heavy, daily use Compelled to keep taking the substance Problems with social life due to the drugs Strong dependency Difficulty in holding down relationships Long-term use

21. Substance Abuse Psychological Dependence � when a user feels that a drug is necessary for their health and well-being. Use is continued despite knowledge of its negative health or social consequences, despite efforts to reduce consumption. Relapse � when substance use begins again after a period of abstinence or remission Salience Euphoria Physical Dependence � when the body adapts to a drug to the extent that it shows tolerance and withdrawal Tolerance � increasing amounts of drug are needed to achieve the same desired effect Withdrawal � the body suffers from detrimental effects when the substance is stopped

22. Drugs Dopamine Linked to the feeling of reward for experience like food, water and sexual activity. When dopamine receptors are blocked, the �reward� section of the brain is not active, and so behaviour is not repeated Stimulants of dopamine inhibit it�s reuptake, so it�s affects last longer After dopamine stimulation, the body negative feedback cycle means that less dopamine is released after, so uses of stimulants end up �crashing�, as the body produces ;ess natural dopamine This can be responsible for the addiction, through negative reinforcement (to take away this �crashing� effect) Serotonin Associated with emotional functioning and perception of light and colour Affected by hallucinogens, but naturally responsible for elevated mood associated with pleasurable activities Drugs that increase the serotonin in the body: Induce pro-social behaviour (�hug-drug�) Intensify perception of light, colour and sound Increase body temperature and heart-rate

23. Drugs Alcohol Effect on neurotransmitters Lowers levels of noradrenaline receptors in the brain, resulting in drowsiness and impaired sensory functioning It is popular due to these amnesic affects Short-term effects Psychological Lowers social inhibitions Allowing behaviour such as sociability, enjoyment or aggression Lowers reaction time, co-ordination, memory and alertness Physical Increases inhibitory effects of neurotransmitter GABA (responsible for inhibiting responses in the body) ? suppressing arousal centres ? slowing cognitive functions, and affecting movement and balance in the cerebellum

24. Drugs Alcohol Long-term effects Psychological Psychological dependence forms, which can cause major disruption to normal social, occupational and recreational activities. Depression Sarafino (1994) found that 10% of drinkers in the US abuse alcohol Physical Cirrhosis memory loss increased vulnerability to infection (up to 2x) Severe withdrawal symptoms Can impair dendritic branching of neurons Inhibits flow of sodium across neuron membrane, affecting electrical transmission Decreases serotonin activities

25. Drugs Alcohol Withdrawal and Relapse Abstinence when highly dependent on alcohol leads to delirium tremens, which includes intense anxiety, irritability, nausea, headaches, body tremors and frightening hallucinations. In most severe circumstances, death can result from this withdrawal Strong cravings and impulses to drink lead to frequent relapse

26. Drugs Heroin Effect on Neurotransmitters Heroin increases dopamine activity Although GABA decreases dopamine activity, opiates block the cells that produce GABA. Without the release of GABA, there is nothing blocking the release of dopamine Short-term effects Psychological Intense feelings of euphoria and pleasure Followed by longer-lasting, pain-dulling and numbing effects Physical Heroin binds with the body�s natural pain-killing enkephalin and endorphin receptor sites (because it has a similar structure that mimics the neurotransmitter) It then breaks down into morphine, which has similar, but less powerful effects

27. Drugs Heroin Long-term effects Psychological Psychological dependence forms that causes life disruption Increased and persistent anti-social behaviour to gain the drug to avoid the withdrawal symptoms of depression and anxiety Physical Prolonged use leads to a fast physical addiction The brain adapts by producing less natural endorphins and enkephalins Kendall and Hammen (1995) found that experienced users could tolerate 5000% higher dose than first-time users There can be death by overdose, and sharing needles can results in HIV

28. Drugs Heroin Withdrawal and tolerance Withdrawal symptoms can occur as quickly as 6 to 8 hours after the last dose, usually lasting about a week (peaking within 2 days) Symptoms vary depending on the tolerance reached Can include such withdrawal symptoms such as Physical discomfort Diarrhoea Chills Goosebumps on the skin Twitching on extremities (e.g. leg twitching) Irritability With this intense physical strain, relapse is very common Evaluation With all drugs, risk of relapse after withdrawal or physical dependency decreases with age, and is triggered by high-risk situations (e.g. social pressures, modelling of use or conflict, negative emotional state etc.)

29. Biological Explanations Chemical Transmissions Neurons A neuron is a cell that is used to send electrical impulses throughout the body. It consists of a soma (cell body), the dendrites, the nucleus, and the axon, which is covered by a myelin sheath (which allowed insulation of the axon, and allows fastest, most efficient signals to be carried) Neural receptors are the area on the post-synaptic neuron, that receive the signal from the previous neuron. They are like the �lock� that the �key� (neurotransmitter) fits into. They allow reactions to be stimulated by the neurotransmitters. Electrical transmission involves signals being sent through an axon by electrostatic forces. Chemical transmission involves neurotransmitters crossing the synaptic gap. Nervous system Divided into CNS and peripheral nervous system PNS is sub-divided into somatic nervous system (controlling voluntary movement) and autonomic nervous system (ANS - controlling involuntary movement) The ANS consists of the sympathetic nervous system (preparing body for action), and the parasympathetic nervous system (restoring normal bodily function � opposite to sympathetic branch) The Endocrine system A series of of glands that release hormones into the body The function is to maintain consistent state of the body

30. Biological Explanation of drugs effect Electrical Transmission Due to the gradient of concentration and electrostatic attraction, K and Na try to swap, and take their charge with them A sodium-potassium pump pumps out Na and K on a ratio of 3:2, to keep the balance during the resting potential Action potential The charge becomes +ve, and the partially permeable membrane widens, allowing more Na to get in, and no K to get out. The neuron becomes +vely charged � depolarisation It needs to return to a polarised state in order to send more messages, so as more ions leave, the pump begins to work again Anaesthetics Novocain � attaches itself to Na+ gates opening, to stop Na+ entering. No signals can be sent, therefore no pain messages can be sent. Scorpion venom � works by keeping the Na+ gates open, and closes K+ channels, so the membrane remains +vely charged, and cannot send any message Chloroform � opens K+ gateways very wide, so the K+ can escape, and membrane does not become +vely charged, and so no messages are sent

31. Biological Explanation Chemical Transmissions Neurochemicals pass over the synaptic terminals on to the receptor sites in the post-synaptic terminals When the action potential reaches the end of the axon, the depolarisation causes the stimulation of the vesicles within the pre-synaptic terminals The vesicles move towards the end membrane of the terminal, and they merge with the membrane, releasing their contents into the synaptic cleft It attaches to the receptor site on the next neurone, and the message is passed on There are two- types of receptor sites on both the pre- and post-synaptic terminal Autoreceptors detect released neurotransmitters that has not been absorbed, and stop further release Heteroreceptors respond to neurotransmitters by either exciting or inhibiting presynaptic terminal ? increasing or decreasing release of neurotransmitter Each neuron only produces a limited number of neurotransmitters

32. Factors affecting drug abuse Learning theory/Behaviourism Drugs are either positively reinforcing, they give us feelings we enjoy and so want to repeat; or they are negatively reinforcing, they take away feelings of unpleasantness, such as stress or withdrawal effects. Social learning theory suggests we learn by modelling others, e.g., family & peers Operant conditioning can explain why we maintain drug habits, but not why we might acquire in the first place, for instance, people�s first experience of smoking or alcohol is often not pleasant. Evidence for patterns of addictive behaviour in families can be explained by genetics.

33. Factors affecting drug abuse Cognitive factors � we may have certain beliefs, attitudes and expectations regarding drugs which can influence our behaviour. We may develop certain cognitive �constructs� for the outcomes of drug use. E.g., Fromme et al (1997) suggests that early experiences or observations of alcohol use tend to have positive rather than negative outcomes, therefore, giving rise to certain expectations regarding alcohol use.

34. Factors affecting drug use Psychological factors Euphoria � people associate certain drugs with intense pleasure. This pleasure is often short-lived so people have to continue to take the drug in increasing amounts, due to tolerance, to experience the same euphoric feelings, and this can lead to physiological & psychological addiction. Personality characteristics � Research by McCann & Ricaurte (1993) compared the personalities of 30 ecstasy users with 28 non-ecstasy users. The ecstasy users were less hostile & showed greater restraint & control � aspects of behaviour thought to be mediated by serotonin, a neurotransmitter affected by MDMA. However, it may be that MDMA affects personality this way, rather than certain personality types being drawn to this particular drug. Sensation seeking is a personality trait associated with risky behaviour, including drug taking. Research by Zuckerman (1994) has shown that sensation seeking individuals can be characterised by a willingness to take financial, physical, social & legal risks in order to fulfil desire to find & engage in novel, complex & intense sensations & experiences. Sensation seekers seem to be more likely to smoke, abuse alcohol & use cannabis.

35. Factors affecting drug addiction Social/cultural factors Society�s attitudes & cultural norms regarding drugs can have a profound affect on drug misuse. Seemingly behaviours associated with excess amounts of alcohol are at least partially learned. In the West drunken people become depressed, aggressive & lose self-control; however, in Tahitians are peaceful & civil when under the influence of alcohol (MacAndrew & Edgerton, 1970). Sussman & Ames (2001) have shown that drug abuse is higher in areas closer to major drug distribution centres (like New York & Los Angeles), I.e., ease of acquisition is a factor in abuse. Frone (2003) has shown that workplace availability can also be a risk factor in drug abuse, especially on-the-job alcohol & cannabis use. Wills et al (1996) found that ads linking smoking to social popularity & sensation-seeking cues were influential in the onset of smoking. However, Rushton (1997) suggests that research on young people fails to consider individual�s own drug knowledge & insight. People have different drug use �careers� making it hard to identify specific cultural trends. Despite being exposed to similar cultural and social influences, not everyone abuses drugs or uses drugs in the same way to the same effect. Studies by Blaxter (1990) & Power et al (1991) have shown a relationship between social class & alcohol consumption, with young working class being worst affected.

36. Health-education Programmes AIDs is the 4th largest killer in the US of 24-44 year olds. Promotion focuses in 3 areas: safer sex, not sharing needles, and not getting pregnant when infected. Early AIDS campaigns focused on fear � fear arousal - & provided information about Aids �Don�t die of ignorance�. More recent campaigns have concentrated on safer sex & the use of condoms as a barrier to HIV infection. They have focused on changing the behaviour of heterosexuals, who are currently the fastest growing risk group. Anti-smoking campaigns � Warner (1977) found only a small reduction in smoking (4-5%) following the health scares & awareness of the risks of smoking in the US in the 1950s & 60s. Anti-smoking campaigns focus on prevention, workplace smoking & social inoculation (where children are exposed to high-status, non-smoking models, so that when they are exposed to peers who smoke they will have some immunity against their social influence).

37. Health Education Programmes Fear Appeals Janis and Feshbach found that fear campaigns have a curvilinear effect. They are effective to a point, and then it reduces again With highest fear, they focused much more on the effects than preventative measures, With low fear, they did not feel it was important enough to change Rogers (1990) found that fear-arousing messages by themselves are not enough, people need to realise they can do something about the situation. Witt and Allen (2000) believed you need a combination of fear and self-efficacy (belief they can do it) in a campaign for it to be successful Yale Model of Communication Zimbardo (1977) found when you�re sending a message, there are certain things about it and it�s delivery that are really important e.g. factual source, credibility, attractive presenters, trustworthiness. Message needs to be powerful, direct, short, vivid and clear. If it�s a receptive audience, it can be a one-sided message, if they�re not, two-sided. If they�re well-educated, two-sided. If you want changes to stick you need participation

38. Health Education Programmes If programmes are to be effective in raising awareness & changing attitudes, Taylor (1995) suggests they should: Be colourful, vivid & virtually statistics free Come from an expert source Discuss both sides of the issue Have strong arguments at the beginning & end (primacy & recency effect) Be short & clear Not be too extreme Have explicit rather than implicit conclusions It is also effective to use case histories, I.e., to feature real life examples & individuals, e.g., recent anti-smoking campaigns.

39. Health Promotion Campaigns (HPC) Backman (1988) had a HPC aimed at students about drugs. They were given information to discuss in groups. This made them remember more They benefited from having someone of their own age to relate to give them message. Working in groups allowed a census to form, which influence the peer pressure on young people. The aim was to create an anti-drug conformity. Sussman (1995) found teacher-led session were less effective than participation. Gonel (1993) looked at workplace health promotions. A smoking ban was introduced at the workplace. They used a questionnaire, and measured CO2 levels in blood and breath (inter-rater reliability). They did these tests at the start, and 6 weeks later. They found that after an initial dip in smoking, people went back up to their usual level of smoking. ? campaigns worked in the short-term only, so it needs negotiation to get people to notice. Fraquhar (1977) looked at 3 small communities in the USA. 2 were exposed to mass-media campaigns for 2 years. (1 control) They found a slight improvement in the 2 communities, but it was not cost-effective. Those most at risk had 1-to-1 counselling, and had best results ? 1-2-1 support needed to make the campaigns effective in the long-term. Needs high internal locus of control to work

40. HPC HPCs have been effective in changing attitudes (e.g. AIDs) Ingham et al. (1991) found teenagers have vague ideas about the warnings they are given about condoms, and may not have the social confidence to insist their partners or negotiate. They don�t target self-efficacy Woolford and Wan found safe-sex had the biggest barrier of self-efficacy, and wearing a condom could �ruin the moment�. Teens may be inexperienced and lack confidence. Campaigns about AIDs ignore the social factors Influential factors in the success of HPC are: Self-efficacy Defence mechanisms Locus of control Support

41. Health promotion Mass media appeals can reach a large audience Strategies from HBM & TRA can be applied TV campaigns to reduce smoking & alcohol consumption have been relatively unsuccessful People may not feel personally vulnerable or sufficiently motivated to change their behaviour Promotion campaigns often ignore social & personality factors in risk taking behaviour. Even when a campaign has been successful in raising awareness and changing attitudes, people often find it hard to translate attitudes & intentions into action. Stroebe (2000) argues that campaigns often, as a result of stressing personal responsibility for health, engender a culture of blame, where individuals are blamed for their own health problems, e.g., this is a characteristic of AIDS campaigns. Health promotion campaigns can be undermined by conflicting messages from peers, family advertising & the media.

42. Health Promotion Ellis (1962) put forward the A,B,C,D,E paradigm of cognitive-behavioural factors: A � Activated experience (trigger) B � Beliefs C � Consequences D � Disputing (irrational beliefs) E � Effect (of therapy) Prevention Primary aims to prevent bad health from arising, e.g., through better hygiene, diet, exercise, immunisation. Secondary is encouragement of early treatment & early diagnosis, e.g., screening campaigns. Tertiary is treatment for a condition e.g. drugs to make things bearable

43. Barriers to Primary Prevention Social Factors Friends, family etc. � behaviour is learnt, habits are hard to break No immediate consequences, therefore, little incentive to take immediate action Lack of knowledge People are unrealistic about their own level of health & overly optimistic about their own health Oxford students were unrealistic in their own health and chance of catching HIV despite being in a high risk groups e.g: Intravenous drug users Unprotected sex High promiscuity People assume their actions can prevent the problem, and if they�ve had no experience of it they will have no particular cues to take action People often need encouragement, reassurance & advice to take action Action needs to be taken early to get children into good habits; however, children�s limited cognitive abilities means that they cannot appreciate the benefits of good health behaviours Cognitive dissonance can play a part in primary prevention.

44. Barriers to secondary prevention Mant (1994) some doctors are concerned that there are screening programmes to discover problems before there is effective treatment for these problems. Some screening programmes can create undue anxiety, I.e., false-positive results, e.g., Down Syndrome Screening programmes depend on cost-benefit analysis: the cost of screening needs to be outweighed by the benefits of early detection For screening programmes to be effective they need high uptake rates, this requires strong levels of support and acceptance from the general public, which is not always forthcoming.

45. The Health-Belief Model Based on 4 factors Perceived vulnerability: Whether you think you�ll get the illness, based on: How much at risk you think you are Demographic factors (age, gender, race etc) Psychological Factors (e.g. personality factors � type A/B) Previous knowledge of the problem Pros and Cons of action (perceived benefits & perceived costs or barriers to taking action) � do the benefits outweigh the costs? Perceived seriousness � perceived seriousness of being affected by health problem Cues to action � e.g., media campaign, health issue (e.g., being short of breath running for the bus) Support for HBM Becker and Rosenstock (1984) found that people with a healthy diet also tended to practice safe sex, brush their teeth, have vaccinations, have regular dentist appointments and exercise regularly. This proves they do consider themselves at risk, and found benefits outweigh the risks. Abraham et al. looked at 300 Scottish teenagers through questionnaires. They found that although they perceive themselves to be at risk from AIDs, they did not wear condoms because they believed they decreased pleasure and made things awkward. This shows evidence for the costs outweighing the benefit.

46. Criticisms of HBM Smedslund (2000) argues that it is a circular argument ? pointless. It�s only true by definition ? needs a test to verify e.g. you have beliefs to feel vulnerable, but you have beliefs because you feel vulnerable We engage in health behaviour through a complex set of cognitive processes I.e. thinking rationally about susceptibility and risks, however not always thinking in terms of cost/benefit analysis, e.g., HBM cannot realistically be applied to basic health behaviours like cleaning teeth. Places a lot of emphasis on the individual, and not enough on social, environmental and economical factors Ignores emotional factors like embarrassment, fear or denial Ignores alternative cognitive explanation e.g. self-efficacy, locus of control (? =?? likely to engage in healthy behaviour) and cognitive dissonance (2 conflicting ideas) Methodological problems � questionnaires: demand characteristics, lying, harder to generalise etc. Each researcher has different variables. Self-identity � your view of yourself e.g. if you can see yourself as fit, you don�t mind ? can be a mediating factor Anticipated regret � engaging in some behaviour and feeling guilty may encourage you not to behave in a certain way

47. Criticisms of HBM HBM doesn�t acknowledge a person�s susceptibility to a condition (Abraham) Smoking/safe�sex messages involves being heard more than once to be effective ? HBM only works in the ST In terms of health behaviours, people may not think rationally Some experiences are socially dynamic, and HBM only accounts for behaviour individually, e.g., wearing a condom involves a process of negotiation/discussion with the other person involved in sexual activity. Health behaviours often involved interaction with others; such interactions involve social �scripts� which may or may not be adequate for the behaviour involved.

48. Theory of Reasoned Action (TRA) TRA (Fishbein and Ajzen, 1975) later became Theory of Planned Behaviour (Ajzen, 1985, 1991) It is another social cognition model that aims to predict the likelihood of following a health campaign (their health behaviour) This theory is based on two principles: Attitude The beliefs about the behaviour are important, and whether you think it will be rewarding Subjective Norms How you think other people would respond to the behaviour is also important. This is based on social pressure/norms. These two factors put together create an intention ? whether to act of not. Perceptions on whether to act or not are also based on self-efficacy (Bandura, 1977), which states that a person�s perceived ability to implement behaviour change is also significant.

49. Support for TRA Bagozzi (1981) studied the TRA, looking at people�s willingness to give blood after a promotional campaign. Ps completed a questionnaire, and their intentions were recorded (before campaign). The found that attitudes about giving blood did predict whether they gave blood or not. Criticism of TRA Rise (1992) found that intentions of Norwegian teenagers did correlate with their behaviour (condom use), however, they also measured previous experience, and found that this was a more positive correlation ? TRA is not a complete explanation Conner and Sparks (1995) also found that TRA was not a complete explanation. They founds it accounted for 43-46% of variance in the intention to perform health behaviour ? this is still quite a lot. Intentions do not always predict actions/behaviour TRA does not take account of an individual�s level of confidence in their ability to succeed, I.e., their own perceived behavioural control (believing that you can or cannot perform a behaviour). Ajzen (1985/91) has subsequently updated TRA to take perceived behavioural control (or self-efficacy) into account: this revised theory is called The Theory of Planned Behaviour. NB., Use both HBM, TRA & primary prevention when considering health education programmes, such as effective campaigns for increasing AIDS awareness & reducing smoking.

50. Overall Evaluation of HBM & TRA Self-prediction is important and isn�t included e.g. how people think their health behaviour will go Behavioural willingness isn�t included How willing people are to do something Perceived need is ignored How badly people feel they need to give up Both models assume we make rational decisions. However, they can be influenced by emotion (particularly with health behaviour) Cognitions are separated from each other, but they are really linked (e.g. self-efficacy and perceived need) Methodological issues Questionnaires E.g. if the questionnaire doesn�t mention self-efficacy, participants won�t either ? researchers won�t think it is involved when it is Demand characteristics � they will think about something when they are asked about it, but perhaps wouldn�t have before Cognitions without context Ignore previous behaviour, and social/environmental factors e.g. social norms, peer group influence