Reading: Anisman Chapter 1

Question 1

The Tyranny of Illness

Answer 1

• The cause, nature and trajectories of illnesses differ appreciably
• As do the needs of the affected person (support required, whether coping strategies will be effective) which will change across the course of the illness.

-All illnesses effect quality of life and can be influenced by psychological factors.

Question 2

Dealing with Coordinated Systems: A Holistic Perspective

Answer 2

• When it comes to health we need to consider the interconnected nature of the body i.e. a given function can never purely be isolated to one organ alone each has the ability to influence one another.
• This holistic nature means that treatment strategies need to take a broader perspective and treat multiple dimensions of the individual.
• Link between physical and psychological state. Psychological state has the power to influence compliance and success of a given treatment even if the condition would generally be considered as ‘physical’.

Question 3

Multiple Concurrent and Sequential Influences

Answer 3

• Illness can be a result of accumulated poor-health related behaviours e.g. diabetes + heart disease related to dietary influence over decades.
• Even those where there is a genetic factor/ some characteristic that means specific vulnerability lifestyle choices can still have a profound effect on the outcomes and life course of a given illness/ condition.
• Wellbeing influenced by events that happened years earlier (e.g. early postnatal experiences) and can have a flow on effect to illness susceptibility across generations.
• We can all benefit from community actions geared towards healthy living.

Question 4

Evidence based practice

Answer 4

• “The enhancement of decision making and treatment stemming from rigorous research that meets the criteria for valid and reliable methodological consideration, and interpretation of findings based on equally rigorous criteria”.
• Typically involves quantitative analyses (numerical) or qualitative analyses (narrative).
• A place for both study types i.e. qualitative can provide more in depth information than what is given through pure numbers or in some cases it is simply not possible to obtain hard data.
• Importance of knowing when it is appropriate to generalize findings and when it is not

Question 5

What do we mean when we say Health Psychology : Health Psychology Defined

Answer 5

• Psychological + environmental factors (e.g. early life exposure, psychosocial processes) can influence physical illness

-These factors have been overlooked in the past and so were not a focus of previous health interventions. Today it has been shown that psychological techniques and behavioural interventions can go a long way to diminishing physical illnesses and in some cases precluding them from even appearing (substantiating the above claims).

-Attempts made to integrate the disciplines of psychiatry and neurology (between the behavioural and brain sciences).

-Health psychology is inherently multidisciplinary: focuses on the conjoint influences of psychosocial, neurobiological and genetic factors in relation to varied physical illnesses.

Question 6

Clinical Health Psychology

Answer 6

• Health psychology research contributes the knowledge
• Clinical health psychologists might apply this knowledge to the development of therapeutic strategies in order to diminish physical illness or delay the occurrence of pathological conditions for an individual.
• Information is also of use to policy makers/government + educators & public health agencies who are concerned with the influence of psychosocial factors on health outcomes at the population/ community level —> can target campaigns to address either the whole population or a subset.

Question 7

Behavioural Medicine

Answer 7

• Health psychology and behavioural medicine often thought of as interchangeable only subtle differences (potentially behavioural medicine more closely linked to medical disciplines).
• Behavioural medicine = focus on treatments of illness using techniques that involve a biological and psychosocial approach (e.g. hypnosis, biofeedback, OT, rehabilitation medicine).
• Behavioural medicine moves away from a strict medical model recognising the influence that behavioural adjustments can have on health.

Question 8

Psychosomatic Illness: Development (3 catergories)

Answer 8

1) A mental illness and a medical illness are both present and each negatively effects the other

2) A psychiatric problem (e.g. depression, anxiety, post-traumatic stress disorder (PTSD)) develops as a result of a medical illness (e.g. cancer) or its treatment.

3) A psychiatric disturbance is expressed through physical problems (e.g. pain), as in the case of bullied children and adolescents who might exhibit varied physical disturbances

Question 9

Somatoform Disorders

Answer 9

• Physical illnesses solely provoked by psychological factors e.g. body dysmorphia
• Psychological treatments alone could be effective in complete symptom removal.

-Sometimes it is unknown whether an illness is psychosomatic (i.e. physical illness influenced by psychological factors) or somatoform (e.g. physical illness purely caused by psychological factors alone) and the ‘category’ of an illness can change as knowledge progresses.

-This labelling has had a huge impact in the past i.e. diseases thought less legitimate if lack of biological cause was demonstrated. As knowledge is progressing more previously ‘sketch’ illnesses are gaining validity in the eyes of science and the public (e.g. chronic fatigue).

Question 10

A Continuum Between Wellness and Illness

Answer 10

It is isn’t necessarily true that there is a gradual continuum from illness to wellness at least at a conscious level e.g. despite constant tumour growth a patient with cancer might suddenly jump from an impression of wellness/ health to sickness once the tumour has grown enough to effect daily functioning.

Question 11

Effects that illness can have

Answer 11

• Becoming ill can effect self-reliance, sense of independence, shatters illusion of invulnerability, forces life-style chances, diminish ability to work, take care of dependents, cause finical strain, produce pain etc.

-Can form a new identity as a ‘sick person’

Question 12

What is Vulnerability

Answer 12

• Vulnerability = “the susceptibility of an individual to develop certain psychological or physical disturbances in response to external or internal triggers e.g. more vulnerable to getting a cold when tired.”
• Ordinarily our biological systems might act well and the risk of illness may be low/ moderate but when excessive load is placed (either psychological or physical in nature) our weakness is exposed and we are more likely to become ill. What specific illness this is depends on what ‘weaknesses’ the individual possesses.
• If we know in what ways someone is vulnerable might be able to come up with interventions/ behavioural strategies to prevent illness on set.

Question 13

What is Resilience?

Answer 13

-An individual’s propensity to overcome an illness, although it can also be used to refer to the ability of an individual to withstand the effects of stressful events that would ordinarily lead to a pathological condition.”

• What makes someone resilient is complex (may be a combination of factors that need to come together).
• Examples: personality dimensions, strong social identify, effective support network, presence of neuronal processes that favour positive feelings).

Question 14

Difference between Vulnerability and Resilience

Answer 14

• Resilience and vulnerability are not necessarily at opposite ends of the spectrum i.e. the absence of vulnerability does not necessarily mean that illness resilience reigns. Likewise the presence of vulnerability doesn’t mean there is zero resilience (may be able to overcome obstacles that would otherwise lead to illness).

Question 15

Illness Comorbidities + mechanisms by which this occurs

Answer 15

• Many illnesses are linked (e.g. depression and numerous physical illnesses such as heart disease)

-Multiple mechanisms by which this could occur:
1) Depression causes heart disease (precedes)
2) Both depression and heart disease are caused by some other common factor
3) Could be that there are common neurobiological mechanisms that contribute to both.

Mechanism has influence over where the focus for treatment should be.

Question 16

Biomarkers of Illness

Answer 16

If risk of illness can be put in terms of the parameters of one’s own biological markers then this could have a powerful illness on behaviour and treatment approaches

e.g. broad stats on smoking may not have a whole lot of effect in getting an individual to stop but if you could somehow measure the direct effect the habit is having on the lungs at the individual level than it might.

Question 17

Health Psychology Globally: Changing Patterns of Illness
-How do we measure the health of a population?

Answer 17

• There are different ways to measure the health of a population (death rates, length of time before succumb to illness, what percent of children die before a certain age etc.) but these all have their issues.

-In the west illness + cause of death are fairly similar across countries but do vary according to age.

Question 18

Global Health : What big questions should be asked?

Answer 18

-What are the greatest causes of death (or disability)?

-Have these been changing with time?

-What are the implications of this for policy makers?

Question 19

Global Health: What are some parameters by which we can measure?

Answer 19

• DALYs = average duration of disability-adjusted life years.
• YLL= years lost owing to premature mortality

-YLD= years lived with disability

Question 20

Global Health: Difference across countries?

Answer 20

• Might expect in underdeveloped countries that as things improve (better health care, availability of vaccine) the number of contagious illnesses might decline while potential the numbers of illnesses related to health choices (e.g. obesity) might increase.
• In western countries see variability in health according to socioeconomic status (SES) likely due to numerous accumulative factors (diet, exercise, education, access to medical help etc.).
• Life expectancy linked to how much each country spends on health programs (more money = greater lifespan with diminished returns at upper end of curve). Exceptions to this: US spends a hug amount but the life span of its citizens are nowhere near other countries at the top of the curve. Also Russia falls below where it should be for the amount it spent.
  —-> other factors at play (genes, life-styles, healthier environments, other factors).

Question 21

Global health: how have the causes of death changed across time?

Answer 21

• About 100 years ago the major health concerns and causes of death were infectious diseases (influenza, typhoid, fever, cholera, polio), in part because fewer people lived long enough to die of heart disease, cancer, or dementia. In the later part of the 20th century illnesses arise from accumulated health behaviours (noncommunicable diseases) increased markedly.

Question 22

Money doesn’t Buy Happiness, but it keeps Hunger from the Door

Answer 22

• APA conducted study financial worries topped the list of worries for many Americans (in preceding month 72% of Americans had felt stressed about their financial state and 75% believed that this had contributed to their feeling irritable, angry, anxious, demotivated, overwhelmed etc.
• Likely to be even more pronounced in third world/ developing countries

—-> Evidence against the idea that money doesn’t buy happiness

Question 23

Life Span Changes

Answer 23

• Life span increased dramatically accompanied by more years free from serious health problems (attributed to changes in health-related behaviours + improved regulations regarding environmental toxicants).
• Life span in EU countries slightly longer than US. Former soviet Bloc countries the life span is less. Life span in sub-Saharan African countries increased up to the 1990s where AIDS/HIV saw a huge dip now it falls behind western countries by almost 20-30 years.

-Concerns of the returns in infectious illnesses (e.g. SARS, Ebola virus) —> role of drug resistance? This could alter life span.

Question 24

Climate Change and Illness

Answer 24

• Climate change may affect the development and spread of particular diseases through our food and water.
• Increasing temperatures mean salmonella + other bacteria will have greater opportunity to grow and will affect greater amounts of our food supply.
• Heavy rains could cause overflow from sewage plants and affect water supplies leading to further contamination and occurrence of parasites.

-New diseases transmitted by insects emerging

Question 25

Encouraging Behavioural Change

Answer 25

- Health psychology is primarily concerned with changing the health behaviours of individuals in order to prevent the onset of illnesses (e.g. smoking) - Also involved in developing methods to facilitate adherence to recommended treatments of behavioural styles. - Changing well entrenched behaviours is difficult and requires more than simply telling someone what they should or should not do. - We need to know the reasons people engage in counteractive behaviours. In some cases it is about the characteristics of the individual, in other cases it might be that the person didn't necessarily recognise the risks in which case wide spread campaigns to raise awareness might be effective.

Question 26

Changing Patterns of Health Delivery: Curing Health Care Systems

Answer 26

- Responsibility doesn't just fall to front line health care professionals but also to policy makers who determine where resources are dispersed + who has access i.e. health delivery. - Policy makers need to determine the specific needs of the population to make source the resources available meet those needs e.g. COVID virus needed resources to prevent the spread of an infectious disease like masks.

Question 27

Vaccine Hesitancy

Answer 27

- The influence of vaccines has been profound - A lot of false information is out in the media and in scientific journals (since retracted). For example the belief that components of the vaccine cause autism in children. - The tendency to trust people with limited credentials (e.g. actors) rather than experts suggests a distrust in science or potentially confirmation bias (seeking to confirm what you already believe). - A range of reasons for vaccine hesitancy: some irrational, some might want autonomy (individual freedom to make their own decisions). -Government policy able to force parents to vaccinate kids?

Question 28

Medical Acceptance of the role of health psychology

Answer 28

- The role of health psychology in the treatment of physical disorders has largely been accepted as demonstrated by the inclusion of health psychologists on treatment teams. -This has been backed by the experiences of patients who when receiving relevant counselling were more satisfied with treatment, more likely to follow the instructions given regarding what to do following treatment, and their well-being was enhanced accordingly.

Question 29

Focus on the Patient: role for greater patient input in treatment?

Answer 29

- Should we consider the desires of the patients? Patient satisfaction and in some cases the health of the patient improves when they have a say over their treatment plan (i.e. the doctor and the patient work as a team). - May be because it gives them control and lessens recognition of a 'sick person' identity. - Better outcomes when a multidisciplinary team is used that considers the psychosocial factors of illness. -Shift in focus to educate patients going into surgery about what to expect and how to manage post-surgery has had positive outcomes compared to in the past when patients were largely kept in the dark.

Question 30

Including Biopsychological Perspectives of Illness: Multiple Biological Processes Underlying Pathology

Answer 30

- Disturbed biological processes are at play for both psychological and physical illnesses. - Need to be considered at multiple levels of analysis: The behaviour of cells, intracellular factors (what is going on inside the cell), how different brain systems come into play (networks).

Question 31

Implications of health psychology for Treatment

Answer 31

- It's not always possible to 'cure' and illness but diminishing symptoms/ causing a pause in illness progression can still be a fairly good outcome. - If move away from medical model then psychological intervention and treatment strategies might be adopted to improve the outcomes for the patient (depending on the stage of the illness).