CAIE A2 Level Psychology Health Psychology PDF

CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM ZNOTES.ORG UPDATED TO 2023-2025 SYLLABUS CAIE A2 LEVEL PSYCHOLOGY...

CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM ZNOTES.ORG UPDATED TO 2023-2025 SYLLABUS CAIE A2 LEVEL PSYCHOLOGY SUMMARIZED NOTES ON THE THEORY SYLLABUS Prepared for Nayeon Lee for personal use only. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 1 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Verbal Communication (Mckinlay, 1975; Ley, 1988) 1. The Patient-Practitioner Relationship 1.1. Practitioner and Patient Interpersonal skills Non-Verbal Communication (Mckinstry & Wang, 1990) Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 2 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Evaluation: General Doctor’s beliefs will have a deterministic e!ect on Mckinstry and Wang patients’ behaviour This study utilized a wide representative sample By underestimating their comprehension, doctors from di!erent doctors and clinics. may bring a situation at patients may have a hard This reduces demand characteristics, as shown by time understanding the fact that some patients claimed that the doctor’s Mckinlay attire was not important. Mckinlay’s findings have great application to However, if a photograph of a female doctor in a everyday life, suggesting that doctors should use formal suit was part of the choices, the preference understandable terminology to their patients, as for the female doctor in the white coat to be less some patients, may not understand some terms apparent This study also displays individual and situational There could be pressure for women to conform to a explanations as there are individual di!erences in stereotype, for example, there were more objections the patient’s knowledge, as well as situational towards a female in jeans over a male. factors that the doctors may expect when consulting Mckinlay with patients The usage of blind scorers and clear interviews Mckinstry and Wang ensured the validity of the data gathered Mckinstry and Wang’s findings show individual and The procedure is also standardized, which can situational explanations, as some patients may have increase reliability individual preferences on their doctor’s attire The interview assured that only the doctors would be “tested”, this ensured that participants are not 1.2. Practitioner Style and Diagnosis psychologically harmed by being reassured Ley Practitioner style: Doctor and patient-centred Ley’s proposals have great application in improving (Byrne and Long, 1976; Savage & Armstrong, 1990) doctors’ practices Focused on the interactions between patients and Issues and Debates: practitioners Byrne and Long (1976) Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 3 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Investigated the interactions between patients and Compared the e!ect of directing and sharing styles of practitioners consultation Tape recorded and analysed about 2,500 medical They used randomised allocation to conditions to test consultations in several countries how satisfied patients felt when undergoing these They found that each practitioner tended to use a approaches consistent style for all patients being treated A random sample of 359 participants between the Most of the styles were classified as either doctor- ages of 16 to 75 presenting any symptoms were centred or patient-centred eligible They commented that few doctors could reflect on Each patient was asked for their consent to have the dynamics and process of the consultation their consultation recorded From the tape recordings, they recognised six phases Patient satisfaction was measured by two that doctors went through in this consultation questionnaires that asked about the quality of process: communication in the consultation and any thoughts Establishes a relationship with the patient immediately and one week later Attempts to discover the reason for the patient’s From 200 results, they found that both consultation attendance styles had high ratings Conducts a verbal or physical examination or However, directing consultations had reported more both satisfaction with their doctor’s explanation The doctor, the patient or both of them consider This implies that authoritarianism and certainty are the condition elements of the doctor’s style that satisfy the patients The doctor, and occasionally the patient, details the most. further treatment Ends the consultation Practitioner Diagnosis: Type I and II Errors Most of the 2,500 consultations underwent this process Type I Error: the practitioner diagnoses a patient as sick Doctor-centred consultations tend to ask closed when he is actually healthy questions that require brief answers such as ‘yes’ or Type II Error: the practitioner diagnoses an ill person as ‘no’ healthy They also focused on the first problem the patient Type I and II errors may occur at any point throughout a gives patient’s illness from screenings, consultations and Doctor-centred doctors also tend to ignore any other treatment stages problems that the patient might have had Screenings involve cheap tests that are given to large Patient-centred doctors had a less controlling role populations, many of whom will not manifest any clinical They tend to ask open-ended questions such as ‘Can indications of disease, such as smears you describe the situation when pain occurs?’ Testing is a much more expensive and mostly invasive These questions allow the patient to relate more procedure that is given to those who manifest clinical information and introduce new facts that can be indications of disease and are most frequently applied to pertinent confirm a suspected diagnosis. They also avoided medical jargon and allowed the patient to participate in decision-making Disclosure of Information (Robinson & West, 1992) Savage and Armstrong (1990) Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 4 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Investigated whether computerization leads to greater Byrne and Long disclosure compared to paper questionnaire The usage of tape recordings only recorded the Recruited 33 male and 36 female participants from a usage of verbal cues. This ignores non-verbal cues Genito-urinary (GU) clinic in England such as bodily gesture and interpersonal skills Ages ranged from 15 to 49 years, with a mean of 27 As there was a large amount of recordings used years around the world, Byrne and Long’s study is They were randomly assigned to either computer generalizable to di!erent populations interview or paper interview As all consultations are recorded, the researchers can It consists of a comparison of the data collected from the gather a lot of qualitative data to be analysed, but it computer interview and the patient questionnaire can be too subjective and reduced reliability Due to withdrawal and computer errors, 37 participants Savage and Armstrong are in the computer condition and 32 in the paper This research used an independent measures condition design. This means that participants are in either of Participants were asked to complete their case histories two conditions. This may introduce confounding through either a computer or paper-based questionnaire variables as other patients may prefer using After this, the patients underwent a consultation with computers over paper as a form of disclosing their doctor, complete with a physical examination information Data collected were from the doctor’s interview, with three specific data: Issues and Debates: Number of symptoms reported Number of reported previous attendances at the GU For both Byrne and Long & Savage and Armstrong’s clinic studies Number of sexual partners the patient had in the last The findings for Byrne and Long, as well as Savage 12 weeks and Armstrong have relevance to everyday life, Found that both paper and computer interviews yielded suggesting that doctors should be aware of their more symptoms than doctor’s interview communication style when dealing with a patient The mean number of sexual partners increased in the These studies display individual and situational computer condition explanations on why patients can prefer di!erent Data is not statistically significant styles of their doctors’ consultation styles Computer interviews will elicit more information from There is also cultural bias when considering the patients than paper questionnaire with regard to findings of communication techniques. Some personal symptoms cultures could prefer a direct approach when Suggests that patients are unwilling to disclose all their handling a doctor. Both studies were conducted in symptoms within a consultation the West. Computer-based interviews are elicited to support the doctor’s diagnosis 1.3. Misuse of Health Services Evaluation: Patients may sometimes misinterpret their illnesses delay their treatment, or seek medical advice. This section will also deal with two disorders: hypochondriasis (a fear of illness) and Munchausen syndrome. Delaying Treatment (Safer et al., 1979) Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 5 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Investigated the likely factors that can influence delays in seeking medical treatment Conducted a study in waiting rooms of four clinics in a large inner-city hospital Interviewers approached patients waiting for a doctor or nurse They were asked if they were going to tell the doctor about a new symptom If the patient was presenting new symptoms, they were asked to take part in the study 93 patients (38 males, 55 females) with an average age of 44 years were interviewed They were asked about their symptoms and their reactions to the symptoms, as well as the length of their Munchausen Syndrome (Aleem & Ajarim, 1995) delay The interview lasted for 45 minutes Characterised as physical or psychological symptoms Safer et al. identified three stages of delay: that are intentionally produced in order to assume sick Appraisal Delay – defined as the number of days role that elapsed from the day the patient first noticed Named after Baron Munchausen, a famous German their symptom up till the day that they concluded aristocrat, known for telling unbelievable tales of his they were ill exploits Illness Delay – the time it takes between realizing People with this condition intentionally produce or that patient is ill and deciding to seek medical advice pretend to have physical or psychological symptoms of Utilisation Delay – the time it takes between seeking an illness medical advice and actually doing so Their main intention is to play sick and have others care for them Misuse: Hypochondriasis (Barlow & Durand, 1995) Patients su!ering from Munchausen Syndrome may spend years going from one doctor to another while Persistent fear of serious medical illnesses pretending to have an illness People with this disorder believe that normal sensations They may pretend to have psychological symptoms or minor symptoms as a sign of illness with a negative (hearing voices), physical symptoms (pain and aches), or outcome try to make themselves ill by infecting themselves For example, a person may fear that perspiring can lead There are four ways in which these patients behave: to heart attack It is often accompanied by several mental illnesses, such Lying about symptoms as obsessive-compulsive disorder, phobias and Tampering results somatisation disorder Self-infliction (cutting or burning) Hypochondriasis is a chronic illness that can begin at any Aggravating pre-existing symptoms time of a person’s life, especially within the age range of 20 to 40 years Aleem and Ajarim (1995) Despite being classified as a somatoform disorder Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 6 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Case study of a 22-year-old female university student Delaying treatment who was referred with painful swelling over the right Safer et al.’s findings have good application in breast everyday life as practitioners can put interventions From the age of 17, she had been seen by hospitals to stop such delays regularly for issues relating to her menstrual cycles Hypochondriasis She developed symptoms similar to deep vein Understanding hypochondriasis can further support thrombosis and was referred to medications, which did the development of treatment programmes that not work can reduce the number of times a patient presents Soon after the swelling, she reported swelling in her himself to a medical check-up groin area This reduces costs and prioritizes those who really Following physical examinations and investigations, she need medical attention was diagnosed with hematoma For both Hypochondriasis and Munchausen Syndrome She was treated with antibiotics, but surgical drainages Mental illnesses such as Hypochondriasis and were needed as she developed abscesses Munchausen Syndrome may have individual and At this stage, doctors were suspicious of the cause of situational explanations towards their origin. For abscesses example, there have been suggestions stating that Upon finding a syringe with faecal matter, the woman childhood trauma, as well as personality disorders, was confronted and left the hospital angrily may cause these illnesses. The Nature versus nurture debate is also Evaluation considered as there could be biological and psychological triggers (e.g. hormone release) to these Delaying Treatment illnesses Safer’s study uses self-reports to explain why Majority of research on hypochondriasis and patients delay their treatment. There are issues with Munchausen Syndrome have been conducted on validity as patients can answer desirably Western patients, which can lead into cultural bias The sample used in this study is large and represents in understanding these disorders and the both male and female populations. This has high development of these treatment programmes. population validity, which can allow the researcher to generalize the findings to the general population 2. Adherence to Medical Issues and Debates: Advice 2.1. Introduction A major issue to consider with adherence to medical requests is the behaviour we ask somebody to do. These types of requests can be categorized into: Requests for short-term compliance Requests for positive additions to lifestyle Requests to stop certain behaviours Requests for long-term treatment Adherence: following advice given by a medical practitioner Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 7 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Decides that they don’t need Patient treatment. 2.2. Types of Non-Adherence and Why The patient does not understand the Patients Don’t Adhere treatment. The patient decides the cost of There are many reasons why patients cannot always adhere treatment is more than the benefits. to medical advice. Non-adherence can fall into two Social support and demographic factors categories: patient-based and doctor-based behaviours. Treatment The treatment programme is time- programme consuming and expensive Types of Non-Adherence and Problems Caused by Access to treatment programmes is not easy Non-Adherence The doctor does not stress the Health care provider importance of treatment Non-adherence to medication is a complex healthcare The doctor does not give adequate problem. details on how to administer the drug The causes can be related to the patient, treatment and the type of health care provided Rational Non-Adherence (Bulpitt, 1994) As a consequence, patients do not benefit from correct diagnosis and treatment, increasing morbidity and Rational Choice Theory is a framework for understanding mortality and modelling why an individual will behave in a Morbidity: incidence of disease across a population particular way Mortality: rate of death in a population Rational: based on or in accordance with reason or Here are some possible ways that a patient may not logic adhere to medical requests Claims that people weigh the costs and benefits of a certain treatment Before Poor description of the treatment If costs are higher than benefits, an individual would not treatment programme change their behaviour to adhere to medical requests During Takes more or less of a drug than has been treatment prescribed Bulpitt (1994) reviewed several studies involving a cost- Take the drug at a di!erent time than benefit analysis when deciding on the course of action instructed that patients would take May not complete prescription Drug treatment for hypertension in elderly patients was Only attend some clinics and follow-up considered by the researcher appointments. Found that both the EWPHE AND SHEP studies had Not completing exercises (physical therapies) many health risks to drug treatment in the elderly, such May end their course of treatment early or as gout, changes in bowel movements and chest pain After treatment fail to attend sessions The MRC trial for elderly patients found that coronary May revert straight back to behaviours that events reduced by 44% with a mixture of prescribed were changed through the treatment drugs Bulpitt concluded that the benefits of treating combined Non-adherence can also be influenced by the patient’s systolic and diastolic hypertension in elderly patients context of the treatment provided. outweigh the disadvantages When considering the benefits of antihypertensive treatment, it is important to consider benefits other than stroke reduction He also referred to the di"culty in measuring cost- benefit interactions in individuals Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 8 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Health Belief Model (Becker and Rosenstock, 1974) In 1974, Becker developed the Compliance Model, building heavily on the Health Belief Model It aims to predict when a person will engage in It was used to explain why a patient might comply with preventive health behaviours medical requests The likelihood that individuals will follow medical advice The model can predict factors that would influence the depends on two assessments that they make: evaluating likelihood of a patient adhering to a medical request the threat and a cost-benefit analysis Perceptions of the patient’s mother are examined as it When evaluating a threat, several factors can influence a was believed that the mother would usually be the one person’s perceived threat of illness, including: who will decide on whether the child is sick or not Perceived Seriousness The Compliance Model introduces the concept of health Perceived Susceptibility motivation Cues to Action It considers both negative (physical threat) and positive The cost-benefit analysis looks at whether the perceived aspects (awareness of health concerns) benefits exceed the perceived costs The second concept introduced is that of the incentive The barriers may include: value of adherence Financial (e.g. prescription charges are too These are factors about the illness that contribute to the expensive) decision to adhere, such as the child’s vulnerability and Situational (e.g. di"cult-to-access clinic) the degree of harm Social (e.g. don’t want to face ageing) This model is supported by a study conducted in 1971 Benefits can include: where a random sample of 125 cases were drawn from a Improved Health population of children being treated in the Comprehensive Child Care Clinic at a large teaching Relief from anxiety hospital Reducing health risk The children were aged from six weeks to ten years and were all placed on a course of liquid oral antibiotics and a follow-up visit An hour-long interview was conducted with each patient after the doctor’s appointment Adherence was operationalised by asking the name of the medication, the number of times a day it should be given and the date of flow-up appointment The results showed that mothers who adhered to various aspects of prescribed treatment were more interested in their child’s health and were concerned about the present illness They perceived illness as a substantial threat to the child but had confidence in the physician’s ability and medication to reduce the threat Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 9 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Issues and Debates: Objective: Pill Counting (Chung & Naya, 2000) Individual-Situational Debate: reasons why patients could not adhere may vary between Tested compliance with treatment featuring an oral individual and situational explanations asthma medication using the MEMS Track Cap Situational explanations would often revolve 57 patients (32 male) formed the sample around environmental factors that can a!ect The sample had a history of asthma adherence, such as levels of education, income A 12-week followed an initial screening of two to three and family networks weeks treatment period Individual factors put more emphasis on Participants were instructed to take the asthma personality factors of the individual, as well as a medication twice a day cost-benefit analysis At the start of treatment, they were given 56 tablets with Applications to everyday life: a one-week supply to spare Doctors can use these reasons to stress the Tablets were dispensed in screw-top bottles fitted with patient’s gains by following the medical advice by TrackCap medication event monitoring system reducing the costs (MEMS) device Cultural Bias There can be di!erent factors exclusive to other The MEMS is composed of two parts: countries that can a!ect adherence to medication A standard plastic container (e.g. economic status) A lid containing a computer chip that registers the time of opening and closure of the container 2.3. Measuring Non-Adherence Patients were then scheduled to return to the clinic every three weeks for four more visits Self-Reports (Riekart & Droter, 1999) During these visits, comparisons of tablet counts and TrackCap monitoring Self-report measures involve asking the patient or the Each patient was told, “Take one tablet in the morning doctor if the patient if he is following their treatment and one tablet in the evening, approximately 12 hours programme apart. Do not take the tablets at mealtimes.” The validity of self-reports is limited because of the Median adherence was 89%, according to TrackCap challenges associated with gaining information without events response bias On days when patients took two tablets, the mean time between doses was 12 hours and 34 minutes, with tablets taken eight to 16 hours apart on 86% of treatment days On tablet counts, median adherence was 92% Biochemical Testing (Roth & Caron, 1978) Copyright © 2024 ZNotes Education & Foundation. 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This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 10 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Considering the relative merits of a variety of methods Investigated how obtaining a prescription refill history that can be used to investigate adherence could identify poor adherence to asthma medications Suggests that self-reports from patients are correct when 116 children with asthma were interviewed by their they say that they are taking little or no medicine parents or caregivers on a visit to the clinic Self-reports are overly estimated when patients say that One of the questions asked them was if measures of they are taking their medicine regularly estimated adherence on a checklist and a question on Doctors usually overestimate patient’s intake of medicine where they obtained the medications Reliability in keeping appointments is not a good Adherence was operationalised by calculating the measure of adherence number of dosages refilled divided by the number of States that pill counts provide an indication of self-intake, doses prescribed over up to a period of 365 days but it cannot be presumed that the pills were taken The patient’s doctor was asked to make a judgement Medication monitors indicate when, as well as whether, about their adherence by estimating if patients were the medication was removed from the container taking the required dosage of their inhaler based on case Blood and urine testing usually provides a reasonably history and clinical judgement good indication of the amount of medicine taken Information provided by pharmacies was 92% accurate Clinical responses or side e!ects can be indications that Mean adherence was 72%, 61% and 38% for the three medicine is taken di!erent inhalers prescribed to patients in the study Biochemical tests that measure drugs can be used to Doctors were able to identify 21 of 49 patients who monitor drugs, and metabolites can be used to monitor refilled less than 50% of their dosages plasma concentrations of a number of drugs used in the Three of 11 patients used their inhalers excessively cardiovascular system Biochemical testing can be used to monitor adherence to medical treatment and empirical evidence has shown that adherence for prescriptions are higher with frequent urine monitoring These measures are reliable and objective Repeat Prescriptions (Sherman et al., 2000) Copyright © 2024 ZNotes Education & Foundation. 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This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 11 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Issues and Debates: Reviewed a selection of studies of practitioners and Applications to everyday life: Understanding the hospital patients e!ectiveness of such measures of non-adherence Found that 28% of patients in the UK had low satisfaction can allow us to identify the most reliable methods for ratings of the treatments they received investigating adherence Dissatisfaction was even higher in hospital patients, with Validity: Self-reports can be questioned as patients 41% giving low satisfaction ratings of their treatment can sometimes be prone to lying about their Ley suggested that patients are “information seekers” adherence levels who want to know the details of the treatment and their Physical measures of adherence are more objective, disorders as they use biological characteristics (e.g. levels of the He suggested that dissatisfaction came from a lack of drug in the blood) as a form of measurement emotional support, as well as the doctor’s Riekart and Droter use children as participants. understanding, lack of information when prescribing This means that their data may be more prone to drugs or the failure to explain the patient’s disorder demand characteristics by answering desirably. The more information the patient receives, the more that It is important to question the ethical concerns he can be satisfied within the study, most notably, protection and Despite research on non-adherence being conducted, informed consent there were no reported changes in adherence level. Evaluation: Self-reports Atreja et al. (2005) reviewed the current literature Self-reports are a quick way to identify adherence regarding adherence and developed the SIMPLE levels. mnemonic that brings all the elements of successful These are applicable to both drug and treatment adherence methods that an intervention should have programmes Simplifying regimen characteristics However, self-reports can be prone to social Imparting knowledge desirability Modifying patient beliefs Pill Counting Patient and family communication A reliable method for measuring the number of Leaving the bias pills taken per interval Evaluating adherence However, it does not track what the user does to the drug, whether they consume it or dispose of it Behavioural Techniques Biochemical An objective method of measuring adherence However, it can be very costly and time- consuming It may also involve invasive procedures if blood, saliva or urine is needed Repeat Prescriptions Using this measure only informs the researcher that the pills are collected from the pharmacy 2.4. Improving Adherence Improving Adherence (Ley, 1988; Atreja et al., 2005) Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 12 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Acute and Chronic Organic Pain Acute pain begins suddenly and is usually sharp in quality This can be a warning of disease or a threat to the body Acute pain can be caused by many events, including: Surgery Broken bones Dental work Burns or cuts Labour or childbirth They can either be temporary and not severe or severe and can last for weeks An image of the Funhaler used in Watt et al. (2003) Chronic pain persists regardless of the healing of the injury These studies display the e!ectiveness of behavioural Pain signals remain active for a long time techniques that can be used to increase adherence. Physical e!ects include tense muscles, limited mobility, a Issues and Debates: lack of energy, and changes in appetite Practical Applications: Emotional e!ects include anxiety, anger, fear of re-injury, The concepts and theories discussed have good and depression application to doctors These can interfere with a person’s life Longitudinal Research: Yokley & Glenwick’s study Common chronic complaints include: takes a longitudinal approach to research to Cancer pain studying adherence to medical requests. This allows Headaches researchers to see the impact of an intervention over Low back pain a long period of time. Arthritis pain Usage of children: Watt et al. illustrate how Psychogenic pain (pain not due to past injury) psychological reinforcers in the form of turning an inhaler into a fun experience can improve the child’s Neurogenic pain (pain due to nerve damage) use of their inhalers Chronic pain can be caused by trauma, injury or Evaluation: infection. Yokley & Glenwick’s study was conducted on a large sample. This gives out a high population of validity Specificity Theory (Descartes) Yokley & Glenwick’s study participants may also bring ethical concerns about informed consent and The body has a sensory system for perceiving pain deception. It contains its own special receptors for detecting pain As the researchers asked parents to come in an stimuli and its own area of the brain actual setting, this can give ecological validity and can When a noxious event stimulates pain, a signal travels to be generalized to other populations. the centre of the brain, where the pain is perceived 3. Pain Gate Control Theory (Melzack, 1965) Suggests that pain is a combination of sensory 3.1. Types and Theories of Pain experience and psychological gates that can increase or decrease the perception of pain Argues that the nerve impulses that produce pain pass through a series of gates on their way to the brain These gates are influenced by the messages descending from the brain and other information Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 13 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Psychogenic Pain (Phantom Limb Pain) This method is the preferred approach to pain measurement Caused, increased or prolonged by mental, emotional or There are multiple tools used to assess pain reliably, but behavioural factor there is no accepted criterion standard Caused by psychological pain Pain intensity, pain quality, and pain location must be Headaches, back pain and stomach pain are the most considered when discussing a patient’s experience of common types of psychogenic pain pain Phantom limb pain refers to ongoing painful sensations Pain location is measured by asking patients to identify that come from a removed limb the area of the body where they are experiencing pain After amputation, the amputee may continue to have For those who have di"culties verbalizing the location of awareness that the removed limb is still part of them and pain, such as children, an outline of the body can be they experience sensations linked to it used on which the patient marks the location of the pain These sensations are also present when children are An example of this can be seen in the Pediatric Pain born without one of their limbs, suggesting that Questionnaire phantom limb pain is ‘hard-wired’ Pain Intensity can be measured through several di!erent means such as psychometric measures, Melzack (1992) reviewed evidence on phantom limbs observations or measuring the impact of pain (counting and noted several remarkable features: the number of painkillers the person is taking) Phantom limbs have a vivid sensory quality and Pain Quality is measured by self-report measures, precise location in space which consider the level of unpleasantness of two Phantoms have a wide range of sensations, such as measures (deep and surface pain) and several warmth and itchiness descriptions A phantom arm would hang down when the person The second part of the McGill Pain Questionnaire uses sits or stands but moves in coordination with other this method of measurement limbs Sometimes, a limb gets stuck in an unusual position Psychometric Measures and Visual Rating Scales Patients perceive phantoms as an integral part of (McGill Pain Questionnaire) their body Phantom is also experienced by some people with Visual Analogue Scale (VAS): Usually appears as a spinal injuries 100mm line with descriptors at either end Wearing artificial arms or legs enhances the phantom Scores can be measured by recording the distance from the starting point to the mark It occurs in 90% of amputees, with itching as the most This allows scores to be compared over time common pain As pain is subjective and internal experience 3.2. Measuring Pain measurement is usually carried using patient self-reports such as the McGill Pain Questionnaire (Melzack, 1975) The McGill Pain Questionnaire is the first proper Self-Report Measures (Clinical interview) self-report pain-measuring instrument Patients are asked to tick the word in each of the 20 sub-classes that best describe their pain Based on this, a Pain Rating Index (PRI) is calculated Patients are also asked to indicate the location of pain on a body chart Behavioural and Observational Methods (UAB Pain Behavior Scale) Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 14 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Observations of the patient’s behaviour when he Uses six faces to measure pain experiences pain The faces ranged from 0 (no hurt) to 10 (hurts worst) Behaviorists claim that people can behave in certain ways when they are in pain Sample behaviours can include: Complaints Gestures Postures As a result, they developed pain behavioural scales, such as the UAB Pain Behavior Scale. Garra et al (2010) were able to demonstrate significant Tracks the severity of chronic pain over time di!erence in the visual analogue scale for each of the Ten types of questions note certain behaviours, and Wong-Baker FACES Scale each item is rated on a three-point scale (0, 0.5, 1) The visual analogue scale was found to have an excellent The higher the score, the more marked the pain- correlation in older children with acute pain and had a associated behaviour and the greater the level of uniformly increasing relationship with Wong-Baker impairment. FACES Scale Patients can get a score of between 0 and 10 Issues and Debates: Specificity theory is reductionist, as it only explains 3.3. Pain Measures for Children the source of pain biologically All theories of pain have good applications to Pediatric Pain Questionnaire (Varni and Thompson, everyday life as they can help practitioners 1987) understand why we perceive pain and develop treatment programmes that can help patients The PPQ is a multidimensional questionnaire for assessing childhood pain, with separate forms for the 3.4. Managing and Controlling Pain child, parents and doctor This questionnaire is heavily based on McGill Pain Medical Techniques Questionnaire and assesses the perceptions of patient’s pain experience in a child-friendly format Surgical treatments are used whenever medications do Children are first asked to encircle words that best not relieve pain describe their pain and must choose three words that Such treatments can involve cutting nerve pathways or best describe the experience of their pain making lesions in certain areas in the brain The child was also asked to rate how they feel at the time Surgical treatment is usually recommended for people on a continuum as well as rating the worse pain they had with terminal illness on the same scale There are also several physical therapies that can be Finally, they are asked to pick four colours to mark the used to ease and manage pain severity of pain and colour the part of their body that hurts depending on their colours picked These include: Manual Therapies such as massages Wong-Baker Scale Mechanical Therapies such as ultrasound Heat Treatments such as microwave diathermy Cold Treatments such as ice packs Electrotherapy such as electrical nerve stimulation Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 15 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Biochemical treatments such as analgesics and There has been a growing acceptance of the value of painkillers can be used to manage pain. psychological interventions An analgesic or pain killer is any member of a group of These can include relaxation, biofeedback, cognitive drugs used to achieve analgesia coping skills, mental imaging and counselling Analgesia – relief from pain Cognitive redefinition is where an individual attempts Analgesics act in various ways on the central nervous to alter their thinking to replace the thought of systems apprehension The type of medicine to use depends on the location of This approach is related to distraction therapies the pain Cognitive redefinition involves the patient replacing pain- All painkillers have side e!ects related thoughts with more positive thoughts For pain associated with inflammation and headaches, Attention management is often included in cognitive paracetamol or anti-inflammatory pain killers. behavioral treatments (CBT) Pain caused by sensitive nerves can be treated with Patients may have di!erent responses to attention depression medications strategies and individual di!erences in what diversion The most popular chemical treatment is aspirin. techniques are e!ective as pain relief methods Aspirin and other similar drugs such as ibuprofen have The core method of attention diversion to divert three therapeutic actions: attention from pain by refocusing or directing attention Against pain to something unrelated to pain Against inflammation According to the Gate Control Theory, attention diversion Against fevers can help close the gates and reduce the perceptions They work on the damaged tissue causing the pain Deliberately using imagery, attention diversion and They also have no known e!ect to the nervous system mindfulness to cope with pain can take many forms The only drawbacks of aspirin is the number of side Patients su!ering from chronic pain reportedly claim e!ects such as gastric irritation and bleeding, as well as that engaging in an enjoyable activity is the most deafness e!ective method of diversion Opiates inhibit pain messages from raveling to the brain Morley, Shapiro and Biggs (2004) developed a training They close the gate, preventing pain signals from getting program which taught patients how to use attention to the brain diversion strategies such as: Morphine and similar drugs such as fentanyl are the Usage of imagery and mindfulness: creating a vivid strongest painkillers and pleasant image to concentrate Some medications come in a patch but they all work in Basic attention management: brief relaxation, similar ways internal and external attention focus Opiates can only be prescribed after consultation with a Pain coping strategies: coping self-statements, signal general practitioner and dosages would be closely breathing monitored Discussion on dealing pain and relationship to pain and its chronic nature Psychological techniques: cognitive strategies Attention diversion and mindfulness: focus on the details of the experience, mindfulness, breathing exercises Intense pain and flare-ups Pain transformation images In the first time period until a three month follow up, pain intensity reduced significantly Alternative Techniques Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 16 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Stress: happens when we feel that we are not in control of Acupuncture events in our lives and can come in many forms, either Is derived from Ancient Chinese medicine positive or negative. There are multiple causes and sources Fine needles are inserted into certain sites of the of stress. body for therapeutic or preventative purpose Western acupuncture is the use of acupuncture after 4.2. Sources of Stress a medical diagnosis Research has shown that acupuncture can stimulate Many factors can trigger stress in a person nerves under the skin and in muscle tissue One way to investigate the causes of stress is through This leads into the production of pain-relieving investigating environmental changes which can cause substances such as endorphins stress Traditional acupuncture is based on the belief of Qi For many people, stress is so common that that it has Qi is said to be a ‘life force’ that flows through the become part of their life body in channels called meridians Positive e!ects of stress can include motivation, as well When Qi cannot flow freely in the body, sickness can as assisting in performing well under pressure result The top five sources of stress, according to the American They believe that acupuncture can restore the flow of Psychological Association include: Qi 1. Money (76%) Transcutaneous electrical nerve stimulation (TENS) 2. Work (70%) Battery-operated device that has leads connected to 3. The economy (66%) sticky pads called electrodes 4. Family responsibilities (59%) When the machine is switched on, the electrodes 5. Relationships (55%) passes small impulses to areas of the body where you experience muscle pain These impulses can reduce pain signals passing along 4.3. Physiology of Stress and E!ects on nerves and can help the individual relax Health It is also suggested that electric impulses can stimulate endorphins Concerns about the responses of the person to the Health care professionals have reported that TENS stressor can help some people, although it depends on the Based on arousal individual and the condition being treated Issues & Debates: Arousal refers to a general physiological state in which Methods of controlling pain must not be reductionist the sympathetic division of the autonomic nervous For example, the biomedical approach explains and system is activated. treats pain in a simplistic way Sympathetic Nervous System: the autonomic The most useful application that comes from our nervous system that controls the internal organs and understanding of pain relief will come from plays a role in keeping the body’s internal combining both physiological and psychological environment stable techniques. Cognitive techniques are the most useful, as patients The sympathetic division rouses the body to action can apply these techniques anywhere. through activating physiological mechanisms which produce and maintain alertness and energy 4. Stress GAS Model (Selye, 1936) 4.1. Introduction Copyright © 2024 ZNotes Education & Foundation. All Rights Reserved. This document is WWW.ZNOTES.ORG authorised for personal use only by Nayeon Lee at Nahar International School on 18/12/24. https://znotes.org/caie/a2-level/psychology-9990/health-psychology/the-patient-practitioner-relationship/ Page 17 of 29 CAIE-A2 Level-Psychology - Health Psychology 18/12/24, 4:03 PM CAIE A2 LEVEL PSYCHOLOGY Immediate responses to stressful events generate a high Life Events (Holmes and Rahe, 1967) arousal level Selye observed that long-term adaptation to stress Investigated what makes a life event stressful followed a three-stage pattern, known as the General Used case histories and interviews to study a large Adaptation Syndrome (GAS) number of people who su!ered extreme stress GAS is a term describing the body’s short and long-term Developed a social readjustment scale from these case reactions and adaptations to stress to restore material homeostasis Using 394 participants, researchers were able to rank 43 Homeostasis: the control of internal conditions, e.g. events on their scale temperature and blood conditions The events ranged from most stressful (death of spouse, n = 100) to least stressful (minor violations in law, n = 11) The three stages of Selye’s GAS are: Alarm: prepares the body’s resources for the Personality (Friedman and Rosenman, 1974) stressful response Resistance: the body adapts to the stressor and Believes that stress comes from the individual’s physiological arousal declines but is still above personality normal Type A an