Health Psychology and Human Diversity PDF 2024-2025

Health Psychology and Human Diversity Health and Illness Related Behaviour Dr. Yousif Ali Yaseen MBCHB, FIBMS (PSYCH) Consultant Psychiatrist & Assistant Professor in Psychiatry College of Medicine – University of Duho...

Health Psychology and Human Diversity Health and Illness Related Behaviour Dr. Yousif Ali Yaseen MBCHB, FIBMS (PSYCH) Consultant Psychiatrist & Assistant Professor in Psychiatry College of Medicine – University of Duhok 2024– 2025  What are health and illness related behaviours? T Anything that may promote good health or lead to illness, e.g. Smoking i Drinking Drug use 3 Taking exercise Eating a healthy diet Safer sex behaviour Taking up screening activities Adhering to treatment regimens etc.!  Theories / Models To Help Understand People’s Health And Illness Related Behaviours Learning Theories – Classical Conditioning (Pavlov) – Operant Conditioning (Skinner) – Social Learning Theory (Bandura) Cognition and Social Cognition Models – Cognitive Dissonance Theory (Festinger) – Health Beliefs Model (Becker) – Theory of Reasoned Action/Planned Behaviour (Ajzen & Fishbein) Stages of Change Model – Transtheoretical Model (Prochaska and DiClemente)  Learning Theories Classical Conditioning (Pavlov) Operant Conditioning (Skinner) Social Learning Theory (Bandura) Classical Conditioning (Pavlovian Conditioning) Ivan Pavlov was a Russian Physiologist (1849 –1936) Founder of Classical conditioning & modern behavior therapy  Classical Conditioning (Pavlovian Conditioning) (food) UCS UCR (salivation) (bell+ food) UCS+CS UCR (salivation) (bell) CS CR (salivation) Behavior shaped through association of new stimulus to original one that provokes a ‘natural’ or reflex response. Learn to give the same response to a new stimulus. Ivan Pavlov 1849 –1936 Classical Conditioning (John Watson) Conditioned fear response, generalization E.g. ‘Little Albert experiment’ learned fear of animals https://youtu.be/5duLMjaTL0U  John Watson American Psychologist 1878–1958  Health related behaviours and association Break from work (UCS) feel relaxed (UR) Break & cigarette (UCS & CS) feel relaxed (UR) Cigarette (CS) feel relaxed (CR) Associative learning can be barrier to changing health behaviour e.g. smoking associated with taking a break and relaxing / coffee / pleasant social environment Conditioned behaviours - habit  Classical Conditioning And Changing Health Behaviour Aversive techniques in smoking/alcohol misuse = pair behaviour with unpleasant response – e.g. smoke holding – e.g. alcohol + medication to induce nausea (nausea is result of medication + alcohol but comes to be associated with alcohol (CR)) Classical Conditioning And Changing Health Behaviour Break unconscious response elastic band on cigarette packet! Classical conditioning is also used to help people overcome phobias.  BF Skinner American Psychologist More Learning Theories 1904–1990 Operant Conditioning People/animals act on the environment and behaviour is shaped by the consequences behaviour reinforced (increases) if it is – rewarded (+R) positive reinforcement – a ‘punishment’ is removed (-P) negative reinforcement behaviour decreases if it is – punished (+P) aversive – a reward is taken away (-R)  Skinner Box (Operant Conditioning Chamber)  Operant Conditioning, examples A professor tells students that if they have perfect attendance all semester, then they do not have to take the final comprehensive exam. By removing an unpleasant stimulus (the final test), students are negatively reinforced to attend class regularly. A teen girl does not clean up her room as she was asked, so her parents take away her phone for the rest of the day. This is an example of a negative punishment in which a positive stimulus is taken away.  Operant Conditioning, examples Key way that we learn all the time Rewards and punishments to shape behaviour – Computer games – Child behaviour  Operant Conditioning and Changing Health Behaviour Applied Behaviour Analysis (ABA) is an approach to understanding and changing children's behaviour. ABA aims to help children increase positive behaviour and reduce negative behaviour. It does this by reinforcing or rewarding positive behaviour so that it's more likely to happen again. Save up cigarette money for holiday  Classical and operant conditioning based on simple stimulus- response associations No account of cognitive processes, knowledge, beliefs, memory, attitudes, expectations etc. No account of social context. "Stimulus response, stimulus response! Can't you ever think?"  Albert Bandura Canadian-American psychologist More Learning Theories 1925 - 2021 Social Learning Theory Social behavior is learned by observing and imitating the behavior of others. People can learn vicariously (observation/modelling) Bandura and the Bobo Doll experiments  Social Learning Theory People behave in certain ways to achieve desired goals/outcomes People motivated to perform behaviours: – that are valued (expectancy) – that they believe they can enact (self-efficacy) Modelling more effective if models high status or ‘like us’ (value/ability)  Social Learning Theory & Health Promotion Influence of media figures, role models (e.g. smoking) Important for health promotion campaigns (e.g. Robbie and self examination for testicular cancer) Robbie Williams For some mental illnesses, like addiction, this might mean that a person develops a disorder by watching other people be rewarded for that disorder. Self efficacy / Health Locus of Control  Self efficacy / Health Locus of Control Among adults, external locus of control is associated with negative health outcomes, whereas internal locus of control is associated with favorable outcomes.  Cognition and Social Cognition Models Cognitive Dissonance Theory (Festinger) Health Beliefs Model (Becker) Theory of Reasoned Action/Planned Behaviour (Ajzen & Fishbein) Cognition and Social Cognition Models Cognitive dissonance refers to a situation involving conflicting attitudes, beliefs, or behaviors. This produces a feeling of mental discomfort. Focus on cognitive factors in health-related behaviour (knowledge, beliefs, attitudes, expectations etc.) Leon Festinger American Social Psychologist Early health promotion based on: 1919 –1989 Cognitive Dissonance Theory (Festinger, 1957) Providing health information (usually uncomfortable!) would create mental discomfort (fear!) and prompt change in behaviour But information provision alone not enough / fear can be counterproductive More complex models of cognition and behaviour required  Dissonance reduction can be achieved by: 1. Changing cognition 2. By changing actions 3. Or selectively acquiring new information or opinions. To use Festinger's example of a smoker who has knowledge that smoking is bad for his health, the smoker may reduce dissonance by: 1. Choosing to quit smoking, 2. By changing his thoughts about the effects of smoking (e.g., smoking is not as bad for your health as others claim), 3. Or by acquiring knowledge pointing to the positive effects of smoking (e.g., smoking prevents weight gain). Cognition Models: Health Belief Model - HBM (Becker 1974) Is a theoretical model (1950s) that can be used to guide health promotion and disease prevention programs. It is used to explain and predict individual changes in health behaviors. It is one of the most widely used models for understanding health behaviors. Beliefs about health threat - perceived susceptibility - perceived severity Action Beliefs about health-related behaviour - perceived benefits Cues to - perceived barriers Action  Social Cognition Models: Theory of Reasoned Action/Planned Behaviour (TRA/TPB) Icek Ajzen (1942-) Social Psychologist TRA developed by Ajzen and Fishbein (1980), later developed & expanded into Theory of Planned Behaviour (TPB) Theory of Planned Behavior/Reasoned Action suggests that behavior is determined by Martin Fishbein (1936- 2009) Social *intentions, attitudes (beliefs about a behavior), Psychologist *and subjective norms (beliefs about others’ attitudes toward a behavior).  Theory of Reasoned Action/Planned Behaviour: 3 key elements Cognitive factors – person’s own attitude towards the behaviour Social factors – ‘social norms’ (e.g. brushing teeth a good idea since bad teeth not seen as attractive to others) – ‘salient others’ friends / peer group with views held as important to person Perceived control (added in TPB) – may have attitudes and norms that lead to an intention to behave in a healthy way, but if you don’t believe that you can implement the behaviour then you are unlikely to try Theory of Reasoned Action/Planned Behaviour belief about outcomes Attitude evaluation of outcomes toward normative beliefs behaviour ! Subjective Behavioural motivation to comply Behaviour norm intention individual control barriers and facilitators Perceived control Stages of Change Model – Transtheoretical Model -TTM (Prochaska and DiClemente) James O. Prochaska Carlo C. DiClemente  Stages of Change (Transtheoretical) Model (Prochaska and DiClemente 1984) Cognition Models (HBM , TRA/TPB etc) all assume that each cognitive component of decision making for health occurs in same time frame / parallel. The way people think about health behaviours, & willingness to change their behaviour, are not static Stages of change model - 5 stages which people may pass through over time in decision making / change NOT predicting what influences health behaviour, BUT describing process of changing health behaviour , identify what can help at different stages  Stages of change model Preparation Action Contemplation Precontemplation Maintenance Relapse TTM with smoking 1. Pre-contemplation: I’m a smoker and not worried about it 2. Contemplation: Been coughing lot recently. Maybe it’s the smoking? 3. Preparation: I’ll try to cut down gradually until I quit 4. Action: I am smoking 1 cig per day less than the day before until I get down to zero 5. Maintenance: I’ve not smoked for 3 months Relapse: Just the odd cigarette when I’m in the pub won’t hurt - I’ll cut back again (? cycle back to 3 Preparation stage) Intervention must be appropriate to the stage the person is at.  Summary Different models offer different ways of understanding health-related behaviours Learning Theories: behaviours learned and maintained through association, positive consequences, and observation of others. Cognition and Social Cognition Models: beliefs and attitudes, social norms, and perceptions of control play an important part in behaviour too. Stages of Change Model: people pass through different stages of willingness to change; efforts to change health related behaviour need to be appropriate to the stage a person is at.  Conclusions Theories and models each have their own strengths and weaknesses, but perhaps each can add part of the jigsaw! – Most models designed to look at populations not individuals – However, may identify useful questions to ask individuals (but don’t pre-judge individuals based on group membership) – Different models may be most helpful with different behaviours and contexts Behaviour is complex and dynamic – Influences interact and may change over time – It is not helpful to ‘blame’ people for their behaviour, and against GMC guidelines to allow patients’ ‘lifestyle’ choices influence treatment – Health education is only one part of the solution – We need to understand barriers to change in order to help people overcome them Thank You for Your Kind listening