Health PsychologyHealth Psychology

Chapter 12: Chapter 12: The Role of Health Psychology The Role of Health Psychology

in Heath Care Settingsin Heath Care Settings

Nov 26-28, 2007Nov 26-28, 2007Classes #38-39Classes #38-39

Patient SymptomsPatient Symptoms

Attentional FocusAttentional Focus– Internal vs. ExternalInternal vs. External– Awareness vs. UnawarenessAwareness vs. Unawareness

Athletes Athletes –Playing with pain – some canPlaying with pain – some can–Probably externally focused Probably externally focused

Attentional FocusAttentional Focus

SensitizersSensitizers– Actively monitor an aversive event and react to itActively monitor an aversive event and react to it– Scan themselves and environmentScan themselves and environment– Seek out information and think about stressSeek out information and think about stress

– Likely to seek help earlyLikely to seek help early RepressorsRepressors

– Ignore then deny health related issuesIgnore then deny health related issues– Look through life with rose-colored glassesLook through life with rose-colored glasses– ““Don’t worry be happy”Don’t worry be happy”

– Not likely to seek help earlyNot likely to seek help early

Illness RepresentationsIllness Representations

Our personal views on health and illnessOur personal views on health and illness– Includes:Includes:

Identity of the illnessIdentity of the illness CausesCauses Timeline Timeline ConsequencesConsequences ControllabilityControllability

Illness Identity: Illness Identity: Patient’s Label and SymptomsPatient’s Label and Symptoms

Pain Pain

NauseaNausea

BreathlessnessBreathlessness

Weight LossWeight Loss

FatigueFatigue

Stiff jointsStiff joints

Sore EyesSore Eyes

HeadachesHeadaches

Upset StomachUpset Stomach

Sleep difficultiesSleep difficulties

DizzinessDizziness

Loss of StrengthLoss of Strength

Cause: Internal or External ReasonsCause: Internal or External Reasons

How would you classify the following?How would you classify the following?– A germ or virus caused my illnessA germ or virus caused my illness

– Diet played a major role in causing my illnessDiet played a major role in causing my illness

– Pollution of the environment caused my illnessPollution of the environment caused my illness

– My illness is hereditary - it runs in my familyMy illness is hereditary - it runs in my family

– It was just by chance that I became illIt was just by chance that I became ill

– Stress was a major factor in causing my illnessStress was a major factor in causing my illness

Timeline: Course of the illnessTimeline: Course of the illness

My My illnessillness will last a short time will last a short time

My My illnessillness is likely to be permanent rather than is likely to be permanent rather than temporarytemporary

My My illness illness will last a long timewill last a long time

ConsequencesConsequences

MyMy illness illness is a serious condition is a serious condition

My My illnessillness has had major consequences on has had major consequences on my lifemy life

My My illnessillness has become easier to live with has become easier to live with

My My illnessillness has not had much effect on my has not had much effect on my life. life.

My My illnessillness has strongly affected the way has strongly affected the way others see me.others see me.

Control/CureControl/Cure

My My illness illness will improve in timewill improve in time

There is a lot which I can do to control my symptoms.There is a lot which I can do to control my symptoms.

There is very little that can be done to improve my There is very little that can be done to improve my illness. illness.

My treatment will be effective in curing my My treatment will be effective in curing my illnessillness. .

Recovery from my Recovery from my illness illness is largely dependant on chance is largely dependant on chance or fate. or fate.

What I do can determine whether my What I do can determine whether my illnessillness gets better or gets better or worse.worse.

Some influences on illness perceptions Some influences on illness perceptions and seeking treatmentand seeking treatment

Personal experiencePersonal experience– A patient’s prior experience with the illness is big factor A patient’s prior experience with the illness is big factor

on perception and sometimes symptomson perception and sometimes symptoms– See Ruble (1972) study on PMS (page 365)See Ruble (1972) study on PMS (page 365)

AgeAge– Child: yesChild: yes– Elderly: yesElderly: yes– Everyone else: noEveryone else: no

Gender differencesGender differences– Women: yesWomen: yes– Men: noMen: no

See page 367 for some clear gender difference See page 367 for some clear gender difference examplesexamples

Some influences on illness perceptions Some influences on illness perceptions and seeking treatmentand seeking treatment

Socioeconomic StatusSocioeconomic Status– If you’re sick do you get help?If you’re sick do you get help?

High SES – yesHigh SES – yes Low SES – noLow SES – no

– Why is this the case?Why is this the case? Cultural FactorsCultural Factors

– Lay Referral SystemLay Referral System Likely to be used by those not trusting Likely to be used by those not trusting

traditional Western medicinetraditional Western medicine

Delay BehaviorDelay Behavior

Safer (1979)Safer (1979)– Appraisal delayAppraisal delay– Illness delayIllness delay– Behavioral delayBehavioral delay– Scheduling delayScheduling delay– Treatment delayTreatment delay

Misusing Health ServicesMisusing Health Services

Lets look at two “abnormal psych” illnessesLets look at two “abnormal psych” illnesses– Somatization DisorderSomatization Disorder– HypochondrasisHypochondrasis

Both of these are in DSM-IVBoth of these are in DSM-IV

Somatization DisorderSomatization Disorder

Diagnostic CriteriaDiagnostic Criteria– To be diagnosed a person must have reported To be diagnosed a person must have reported

at least the following:at least the following: Gastrointestinal symptoms (2)Gastrointestinal symptoms (2) Sexual symptoms (1)Sexual symptoms (1) Neurological symptoms (1)Neurological symptoms (1) Pain (4 locations)Pain (4 locations) These symptoms cannot be explained by a These symptoms cannot be explained by a

physical disorderphysical disorder

Somatization DisorderSomatization Disorder

Key pointKey point: : – It’s a chronic, recurrent, multi-symptom syndrome… It’s a chronic, recurrent, multi-symptom syndrome…

here are some…here are some…– Vomiting, abdominal pain, nausea, bloating, diarrhea or Vomiting, abdominal pain, nausea, bloating, diarrhea or

constipation, pain in arms or legs, back pain, joint pain, constipation, pain in arms or legs, back pain, joint pain, pain during urination, headaches, shortness of breath, pain during urination, headaches, shortness of breath, fainting, fatigue, palpitations, chest pain, dizziness, fainting, fatigue, palpitations, chest pain, dizziness, amnesia, difficulty swallowing, vision changes, paralysis amnesia, difficulty swallowing, vision changes, paralysis or muscle weakness, sexual apathy, pain during or muscle weakness, sexual apathy, pain during intercourse, etc. etc. etc. intercourse, etc. etc. etc.

Somatization DisorderSomatization Disorder

Sex differenceSex difference– F > M F > M – Primarily a female disorder with about 1% Primarily a female disorder with about 1%

suffering from this disordersuffering from this disorder

OnsetOnset – Usually by age 30 but its seen from childhood Usually by age 30 but its seen from childhood

on up on up

A typical scenario…A typical scenario…

Typically, patients are dramatic and emotional when Typically, patients are dramatic and emotional when recounting their symptoms, often referring to them as recounting their symptoms, often referring to them as "unbearable," "beyond description," or "the worst "unbearable," "beyond description," or "the worst imaginable" imaginable"

Patients become extremely dependent in their personal Patients become extremely dependent in their personal relationshipsrelationships

They increasingly demand help and emotional support and They increasingly demand help and emotional support and may become enraged when they feel their needs are not may become enraged when they feel their needs are not being metbeing met

They are often described as exhibitionistic and seductive They are often described as exhibitionistic and seductive and self-centeredand self-centered

In an attempt to manipulate others, they may threaten or In an attempt to manipulate others, they may threaten or attempt suicideattempt suicide

These patients “doctor-shop”…These patients “doctor-shop”…

Often dissatisfied with their medical care, Often dissatisfied with their medical care, they go from one physician to another… they go from one physician to another… – What would be a recommended route for What would be a recommended route for

these patients to choose insofar a these patients to choose insofar a medical/mental health care is concerned???medical/mental health care is concerned???

They usually don’t go and further than They usually don’t go and further than their General Practitioner…their General Practitioner…

Bottom line: Bottom line: – Psychologists and psychiatrists rarely manage Psychologists and psychiatrists rarely manage

the majority of patients with somatoform the majority of patients with somatoform disorders -- this difficult undertaking falls disorders -- this difficult undertaking falls predominantly on general practitioners predominantly on general practitioners

HypochondrasisHypochondrasis

Unrealistic belief that a minor symptom reflects a Unrealistic belief that a minor symptom reflects a serious diseaseserious disease

Excessive anxiety about one or two symptomsExcessive anxiety about one or two symptoms Examination and reassurance by a physician Examination and reassurance by a physician does does

notnot relieve the concerns of the patient relieve the concerns of the patient

They believe the doctor They believe the doctor has missedhas missed the the real reasonreal reason

HypochondrasisHypochondrasis

SymptomsSymptoms adversely affect social and adversely affect social and occupational functioningoccupational functioning

DiagnosisDiagnosis is suggested by the history and is suggested by the history and examination and confirmed if symptoms examination and confirmed if symptoms persist for at least 6 months and cannot be persist for at least 6 months and cannot be attributed to another psychiatric disorder attributed to another psychiatric disorder (such as depression)(such as depression)

HypochondrasisHypochondrasis

Gender differenceGender difference – More common in women than men (I couldn’t More common in women than men (I couldn’t

find any stats though)find any stats though)

OnsetOnset – Usually in 30’sUsually in 30’s– But seen in all age groupsBut seen in all age groups

Other Misuses of Health SystemOther Misuses of Health System

MalingeringMalingering– Secondary benefits of playing the sick roleSecondary benefits of playing the sick role– They are faking itThey are faking it– Its hard to separate those telling the truth (for Its hard to separate those telling the truth (for

example chronic fatigue syndrome) from those example chronic fatigue syndrome) from those that are notthat are not

– Unless of course you see someone whose Unless of course you see someone whose receiving workman’s comp playing tackle receiving workman’s comp playing tackle football at the parkfootball at the park

But will they follow doctor’s orders?But will they follow doctor’s orders?

Factors Predicting AdherenceFactors Predicting Adherence Good MoodGood Mood Perceived ControlPerceived Control Preference for TreatmentsPreference for Treatments Provider VariablesProvider Variables Degree of DifficultyDegree of Difficulty CommunicationCommunication

Patient-Provider CommunicationPatient-Provider Communication

Problems include:Problems include:– Initial consultation too vagueInitial consultation too vague– Lack of infoLack of info– Felt rushedFelt rushed– Patients listeningPatients listening– Prejudicial Patient StereotypesPrejudicial Patient Stereotypes– Might also have to do with attachment stylesMight also have to do with attachment styles

Secure individuals show the highest amount of Secure individuals show the highest amount of confidence and trust in their doctors confidence and trust in their doctors

Health Care SystemHealth Care System Defined as all activities whose primary purpose is to promote, Defined as all activities whose primary purpose is to promote,

restore, or maintain healthrestore, or maintain health

The U.S. is the only major industrialized nation in the world The U.S. is the only major industrialized nation in the world lacking government-run or subsidized universal health care lacking government-run or subsidized universal health care

In the United States, around 84% of citizens have health In the United States, around 84% of citizens have health insurance, either through their employer (60%), purchased insurance, either through their employer (60%), purchased individually (9%), or provided by government programs (27%) individually (9%), or provided by government programs (27%)

Certain publicly-funded health care programs help to provide Certain publicly-funded health care programs help to provide for the elderly, disabled, children, veterans, and the poor, and for the elderly, disabled, children, veterans, and the poor, and federal law ensures public access to emergency services federal law ensures public access to emergency services regardless of ability to pay. regardless of ability to pay.

Americans without health insurance coverage at some Americans without health insurance coverage at some time during 2006 totalled about 16% of the population, or time during 2006 totalled about 16% of the population, or 47 million people47 million people

Some recent changes…Some recent changes…

Managed CareManaged Care– HMOsHMOs– PPOsPPOs

Higher CostsHigher Costs

HospitalizationHospitalization

Patient dissatisfactionPatient dissatisfaction Medical errorsMedical errors Loss of controlLoss of control DepersonalizationDepersonalization

Control is key…Control is key…

Preparing for HospitalizationPreparing for Hospitalization– Need to increase:Need to increase:

Informational ControlInformational Control Cognitive ControlCognitive Control Behavioral ControlBehavioral Control

CreditsCredits

http://www.leeds.ac.uk/lihs/documents/presentations/chronic%20illness%20mahttp://www.leeds.ac.uk/lihs/documents/presentations/chronic%20illness%20manchester2.ppt#1nchester2.ppt#1