Midterm Health Psych PDF

1. Reductionism vs complex systems science a. Reductionism: complex things are best explained by trying to take them apart and reducing them to their fundamental elements. - The brain is explained by chemistry - Someone’s behavior is based on the...

1. Reductionism vs complex systems science a. Reductionism: complex things are best explained by trying to take them apart and reducing them to their fundamental elements. - The brain is explained by chemistry - Someone’s behavior is based on their neurons - The best way to study something is to take it apart, isolate it, control, and experiment - Simple underlying biological explanations - Simple cause and effect relationships a. Cause (Independent variable), effect (dependent variable), other factors (confounding variables) b. Complex systems: a set of components that interact with a context or environment. Components interact to form a system. System interacts with the environment - New properties emerge as systems form (emergent properties) - cannot be predicted from the component parts - Adaptive, multilevel systems- cause and effect involved homeostasis, feedback, adaptation; adapt to changes in environment; feedback loops, dynamic systems, interactions between multiple levels of analysis - Complexity emerges from simplicity Reductionism Complex Systems Focused hypothesis testing action/outcome oriented Understanding → prediction Broad focus How does it work? Prediction → control discovery External validity Narrow focus What works? Internal validity (internal validity is making transformation sure it is testing what it is supposed to test) Both are good. Depends on the circumstance (understanding the obesity epidemic requires complex systems, drug discovery relies on reductionism) 2. Design a clinical trial a. Elements of a clinical trial: research question, primary and secondary endpoints, measurement model, inclusion/exclusion criteria, recruitment, research design, time frame, process/fidelity measurement, implementation, data analysis 1. Question: hypothesis, specific questions you want to answer  2. Primary endpoint: a single outcome that is the main focus of research (ex: weight loss study = body weight, diabetes treatment= blood glucose) 3. Secondary outcomes: what other outcomes are important? (ex: weight loss study= changes in eating habits and exercise behavior, depression study= student’s GPA change) 4. Measurement: make sure measurements are reliable, valid, sensitive, specific; many measurements in psychology have limitations a. Reliability- how stable/error free is the measurement b. Validity- does the measurement really measure what it says it does? c. Specificity- proportion of people without the disease who test negative (maximize true negatives) d. Sensitivity- proportion of people with the disease who test positive (maximize true positives) 5. Mediating variables: variables that are a part of the causal pathway, explains how the independent variable affects the dependent variable (changes in eating behavior → weight loss, changes in self efficacy will change eating behavior (this is the mediating variable)) 6. Moderator variable: a variable that changes the relationship between an IV and DV (age affects the relationship between two variables - age is the moderating variable in this case) 7. Inclusion and exclusion criteria when picking your population, recruitment includes informed consent → recruitment is the hardest part of the study 8. Research design a. Placebo- treatment with no active ingredient b. Attention- match groups on amount of attention c. Nonspecific factors- being listened to or treated kindly d. Usual care- standard care e. Standard therapy- established treatment 9. Assigning people to treatments: random assignment- confounding variables are equalized, only difference is the experimental variables between the two groups 10. Time frame: a. Baseline- measure before treatment b. During treatment measures- process evaluation or fidelity assessment (was the treatment implemented as planned? What exactly was done? Did the patients comply?) c. Post treatment - end of treatment d. Follow up 11. Implementation: management plan, quality control plan, safety monitoring and adverse events B. types of clinical trials - Efficacy trials - Effectiveness trials - Comparative treatment trials  - Prevention trials - Diagnostic trials - Practical clinical trials 3. Designing a prospective cohort study and a case control study a. Prospective cohort study: cohort studies identify risk factors for different health outcomes; prospective collects data now and predicts future disease - Always comparing rates of disease in two groups of people (exposed to the risk factor vs not exposed) - Independent variable: exposure - Exercise - Dependent variable: disease rate (incidence or prevalence) - Weight loss - How to design a study: identify and form a cohort, measure current level of exposure, identify confounding variables, establish a follow up schedule (to see if people have or do not have the disease), compare rates of disease in exposed vs not exposed - Cohort studies need large groups of people and take along time to complete, hard to measure all confounding variables b. Case control study: identify people with the disease and select a matched group of people without the disease to determine exposure to risk factor in the past - Compare cases exposed vs controls exposed - independent variable: presence or absence of disease - dependent variable: past exposure to the risk factor - Good for rare diseases - Uses electronic health record data or interviews c. Example: smoking and cancer - Prospective cohort study: a. exposure= smoking now b. Dependent variable= cancer in the future - Case control study: a. Independent variable: people with cancer and matched group without b. Dependent variable: exposure to smoking in the past (interview or existing data) 4. Extra Definitions to Know - Approaches to behavior a. Organismic: Behavior=f(person); medical model, biogenetic model, psychosomatic - See the person in terms of organ systems, genetics, diagnosis using disease categories, reduce emotion to biology, used to explain mental health illness  - Behavior arises from within a person and is driven by unconscious forces b. Environmentalism: Behavior= f(environment); radical behaviorism - Behavior is all that we can study, stimulus-response relationships (skinner), mostly reductionist because it uses classical and operant conditioning c. Interactionism: Behavior= f(person,environment); biopsychosocial model, social cognitive theory, social ecological model - Biopsychosocial model a. Health is influenced by biology, psychology, social context b. reciprocal determinism c. Very important in the development of modern health psych d. Multiple sources of causality, systems thinking - Social cognitive theory a. Environmental (cues, reinforcement, modeling) b. Cognitive (self efficacy, outcome expectancies, goals) c. Behavior (enactment skills) - Social ecological model a. Person is embedded in dynamic environments made of systems (physical, social, political, economic environments) b. Health is determined by how someone interacts with these systems c. Complex systems science - Major depressive disorder a. Depressed mood most days, no interest in doing anything, impairment in all areas of life - Persistent depressive disorder a. Depressed mood for most of the day for the past 2 years, significant distress and impairment - Why is depression higher in women? a. Higher first onset in women b. Interaction between biological vulnerabilities and environmental pressures c. Hormones and brain differences d. Gender discrimination e. Social roles and expectations - Lazarus cognitive appraisal model of stress a. Primary appraisal- interpretation of the stressor (positive or dangerous or irrelevant?) b. Secondary appraisal- analysis of the available resources (insufficient or sufficient?), where you experience stress or fight/flight c. Coping strategies- overcoming of stress (problem focused or emotion focused) - Types of coping a. Problem focused- how do you fix the problem? b. Emotion focused- is there a way to feel better about it? c. Avoidant coping- denial to acknowledge stress - Stress on health  a. Direct (GAS)- chronic negative emotions, cardiovascular damage, immune system failure b. Indirect (behavioral)- health impact of coping strategies, disruption of healthy behaviors (not exercising during finals or getting drunk after a bad exam) c. Stress buffer- things that protect you from stress (supportive family, spouse, etc.) - Positive reinforcement: reward, stimulus delivered - Negative reinforcement: reward, stimulus removed - Comorbidity (tendency for two conditions to occur together) a. Ex: depression and diabetes - Parasympathetic nervous system - Sympathetic nervous system: fight or flight - General adaptation syndrome (GAS): how chronic long term stress affects the body a. Alarm- body mobilizes its defenses (fight or flight), produces stress hormones, releases cortisol b. Resistance- body reaches a steady state (high HR), body able to withstand or resist the stressor, body may get stronger c. Exhaustion- body’s resources are depleted, immune system fails, no more stress hormones - Social determinants of health: conditions of people’s lives and backgrounds influence health (money, resources- ex:food deserts, etc.) - Agency and self management: organizing time and activities to reach your important life goals, behavioral homeostasis a. Self monitoring, appraisal, behavioral programming, problem solving, operationalized goals - Community engaged participatory research (done in partnership with the community) a. Community is fully engaged in defining the problem and setting goals b. Problems- not a lot of control, multiple sites may be involved/differ - Qualitative research (open ended way of generating rather than testing hypotheses, exploring questions when we don’t know the answers ahead of time) a. Used to explore attitudes, beliefs, opinions, emotions b. Methods- interviews, focus groups, observation, online data collection - Alternative theories: massage therapy, tai chi, yoga, etc.