Health and Clinical

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  • Created on: 18-03-15 19:24

Theories - Becker

Cognitive model which identifies factors of an individuals healthy lifestyle. It has 4 inter-related components, perceived threat, barriers and benefits, cue to action, demographics. The study by Becker looks at the HBM. 

Aim; Test the ability of HBM to explain a mothers differential compliance with a drug regime for their asthmatic children.

Sample (111 mothers aged 17-54, their children aged 9 months - 17)

Procedure; Correlations in self report. for some p's blood tests were conducted. interviews were conducted and lasted 45 minutes on demographic factors regarding family life and faith in doctors. 

Results; Positive correlation with mothers belief in childs susceptibility of asthma and attacks and compliance. Positive correlation between mothers perception of seriousness of asthma and giving the prescription to the child. 

Conclusion; The sample was small and only collected from an asthma clinic. It is not represensative of a population therefore the results are not able to be generalised to a population.

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Theories - Rotter

Cognitive model which identifies whether an individual believes they control their health - internal factors or whether someone else controls their health - external factors. If you believe you have no control then 'fate' will decide the theory is deterministic as locus on control will predict your health behaviours or the lack of them. 

Aim: Research into Internal locus 'vs' External locus. 

Procedure: Review article. Self Report 6 pieces of information into individual perceptions of ability to control outcomes based on reinforcement. 

Sample: 116 Adult members of a overeaters club. Caucasian - range of social classes completed a questionaire consisting of 20 questions measured on a likert scale to measure satisfaction.

Results: Consistent indication that participants who felt they had control over the situation are more likely to show behaviours that would enable them to cope with potential threats. Males have a higher degree of satisfaction therefore greater weight loss. External ques influence peoples eating habits

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Theories - Bandura

Self efficacy simply means how effective a person think they will be at successfully adapting to a health behaviour. There are three key factors: Vicarious experiences/verbal persuasion, emotional arousal

Procedure:  Quasi Experiement with patients with a snake phobia

Sample: 10 snake phobia - recruited throught advertisment  - 9 F, 1M, 19-57years old. Assesed before for fear arousal by giving oral rating on a likert scale of 1 -10

Findings: Higher levels of post-test self efficacy were found to correlate with higher levels of interation with the snake

Conclusion: Desentatisation enhanced self-efficacy levels leading to the being able to cope

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Methods of Health Promotion - Cowpe

Aim: To test effectiveness of advertising campaigns and test effectiveness of information that is provided when trying to prevent fire and what to do when it occurs

Sample: People living in those areas within

Method: Quasi experiment - ten UK regigional TV areas 1976 and 1982 - Analysis on chip pan fire reports and two qualitative surveys

Findings: The net decline in each area iver the 12 month period of the campaign was between 7% (Central) and 25% (Granada). The questionaires showed an increase in the awareness of chip pan fire advertising from 62% to 90% after the first adverts and 96% after the campaign.

Conclusion: The advertising proved effective as shown by the reduction in chip-pan fires. Viewers are less likely to be influenced by it if over exposed.

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Methods of Health Promotion - Dannenberg et al

Aim: To review the impact of the passing of a law requiring cycle helmet wearing on children

Sample: 47 School - They were aged 9-10, 12-13, 14-15, Control group already had bicycle safety- 7322 were sent questionaires. Indpendent measures design each child falling naturally into categorises by their counties.

Procedure: Natural - USA children under 16 required approved safety. Questionaire had a four point likert scale - bicycle use, helmet ownership, awareness (parents were asked to help) 

Findings: Response rate was 41-52%. Most children were aware. 38% were helmet last time they used their bicycle. 14% did not know law existed.

Conclusion: Large increase to helmet wearing. Passing legislation has more effect than educational campaigns alone.

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Methods of Health Promotion - Janis & Feshbeck

Aim: To investigate consequences on emotions and behaviour of fear appeal in communications

Sample: One US High School Class - mean age 15yrs - divided into four groups (mild, moderate, strong, control-lecture on human eye)

Procedure: Independent measures design. Questionaire given 1 Wk before/immediate afterwards/ 1 Wk afterwards

Findings: Strong fear seen in more postive light and had net increase in conformity of 8%. The net increase was 22% for the moderate fear group and 36% in the minimum fear group. No strong difference between the strong fear group and the control group.

Conclusion: Minimum fear was the most effective form lecture with more conformity. Strong fear lecture did increase emotional arousal and postive feedback.

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Features of adherence - Bullpitt et al

Aim: To review research on adherence in hypertensive patients

Procedure: Review article of research identifying problems with taking drugs for high blood pressure. Research anyalsed to identify the physical and psychological effect of drug treatments in a persons life.

Findings: Anti-hypertension medication can have many side effects, including physical reactions and affect cogitive functioning.

Conclusion: When the cost of taking medication, such as side effect, outweigh the benefits of treating a condiction that has no symptoms of illness or disease there is less likelihood of the patient adherence to their treatment.

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Features of adherence - Lustman et al

Aim: To access the efficacy of the anti-depressent Fluoxetine in treating depression by measureing glycemic control.

Sample: 60 patients - type 1, type 2 diabetes with depression

Procedure: Random controlled double blind study. Patients randomly assigned. Assessed through psychometric test and measured adherence through GHb levels (indicates glycemic controls).

Findings: Patients given Fluoxetine lower depression and GHb improving adherence.  

Conclusion: Measuring GHb in patients with diabetes indicates adherence improve regimes. Greater adherence with patients less depressed.

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Features of adherence - Watt et al.

Aim:  To see if using the funhaler can improve childrens adherence to taking medication for asthma

Sample: 32 Australian children - 10M, 22F - All have been diagnosed with asthma and prescribed medication. Parents gave informed consent

Procedure: Repeated measures design as each participant had one week using the normal pMDI inhaler breath-a-tech then one week using the funhaler. Parent wre given a questionaire with matched questions for both halers at the end of each week of use of inhaler.

Findings: 38% more parents were found to have medicated their children the previous day when using the funhaler compared to the existing treatments.

Conclusion:  Reasons for childrens non adherence - boredom, forgetfulness and apathy. Therefore making medical regimes fun childrens adherence increase.

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Cause of Stress - Johansson

Aim: To measure the psychological and physiological stress response in two categories of employees.

Sample: 24 workers at a Swedish sawmill: 14 finishers (repetitive, machine-paced work, wages relied on quick working) and10 maintenance workers and cleaner (control group).

ProcedureQuasi-experiment. Data were collected through physiological measures of chemicals in urine and self-report of mood. Independent measures design. Each participants gave a daily urine sample four times throughout the day and once when they arrived at work. They also gave self-report of mood and alertness, plus cafffeine and nicotine consumption. Their baseline measurements where taken on a day when they were at home.

Findings: First day, the high-risk group had adrenaline levels twice as high as their baseline and this continued to rise throughout the day. The control group had a peak level of one and a half times their baseline but this decreased throughout the day. The high-risk group described themselves as more irritated than the control group.

Conclusions: The repetitive, machine-paced work which was demanding in attention to detail and highly mechanised, contributed to the higher stress levels in the high-risk group.

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Cause of Stress - Kanner

Aim: To compare the Hassles and Uplifts Scale and the Berkman Life Events Scale as predictors of psychological symptoms of stress.

Procedure : A repeated design in that each participant completed the Hassles rating scale and the Life Events scale. They then assessed their psychological symptoms of stress using the Hopkins Symptom Checklist (HSCL) and the Bradburn Morale Scale.

Participants: 100 people who had previously completed a health survey in 1965. They were from California, were mostly white, protestant, with adequate or above income and at least 9th grade education.

Procedure: The participants were asked to complete the hassles rating, the HSCL and the Bradburn Morale Scale every month for 9 months and the life events rating after 10 months.

Findings: For women, the more life events they reported, the more hassles and uplifts they reported. For men, the more life events they reported, the more hassles and fewer uplifts they reported.

Conclusions: Hassles are a more powerful predictor of psychological symptoms than life events.

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Cause of Stress - Geer and Maisel

Aim: To see if perceived control or actual control can reduce stress reactions to aversive stimuli.

Design60 psychology students from New York University. Independent measures - Group 1: actual control, actual predictability. Group 2: no control, actual predictability. Group 3: no control or predictability.

Procedure :Lab experiment, in which participants were shown images of dead car-crash victims, and their stress levels were measured by galvanic skin response (GSR) and heart-rate electrodes. Each participants had a soundproofed room and their GSR machine calibrated for 5 minutes so that a baseline measurement could be taken.

Findings: The heart-rate monitors proved inaccurate and so the data from these were discarded. The predictability only group  (Group 2) showed the most stress because they knew what was coming but couldn't control it. Group 1 showed the least stress because they could terminate the photo themselves. 

Conclusion: Participants showed less GSR reaction, indicating less stress, when they had control over the length of time they looked at the disturbing pictures. It is likely that being able to terminate this reduces their stressful impact.

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Measureing Stress - Geer and Maisel

Re-Read Geer and Maisel study of stress reaction on participants

Ptps stress levels were measured by GSR and heart rate electrodes

Each recording was performed in a sound and electically shielded room to ensure the project would not interfer with data.

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Measuring Stress - Geer and Maisel

Re-Read Geer and Maisel study of stress reaction on participants

Ptps stress levels were measured by GSR and heart rate electrodes

Each recording was performed in a sound and electically shielded room to ensure the project would not interfer with data.

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Measuring Stress - Holmes and Rahe

Aim: To create a method that estimates the extent to which life events are stressors.

Methodology: A questionnaire design to ascertain how much each life event was felt to be a stressor.

Participants: 394 subjects from a range of backgrounds.

Procedure: Each participant was asked to rate a series of 43 life events. Marriage was given an arbitrary rating of 50 and each event was to be judged as requiring more or less readjustment.

Findings: The final SRRS (social readjustment rating scale) was completed based on the meanscores allocated by the participants. Correlations were high between every group except white/black.

Conclusions: These events are mostly ordinary (some are extraordinary, such as going to jail, but are all Westernised). There are also some socially desirable events which reflect the western values of materialism, success and conformism.

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Measuring Stress - Johansson

Re read Johansson study

Physiological measure: each participant gave urine sample 5x a day for adrenaline levels, body tempreture was also measured

Self Report: Each participants - say how much caffeine and nicotine they had consumed, listed emotions and feelings (sleepiness, well-being, irritation and effeciency

Qualtitative and Quantitative data

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Managing Stress - Michenbaum

Aim: To compare SIT with standard behavioural systematic desensitisation and a control group.

Participants: 21 students who responded to an advert for treatment of test anxiety.

DesignMatched-pairs design with random allocation to the SIT therapy group, the waiting list control group or the standard systematic desensitisation group. Gender was made to be equal in each group and anxiety levels were matched. A field experiment where students were assessed before and after treatment using self-report and grade averages.

Procedure: Each participants did an IQ test and answered the Anxiety Adjective Checklist. The SIT group had eight therapy sessions using the 'insight' approach. They were then given some positive statements to say and relaxation techniques to use. In the systematic desensitisation group, they were given eight therapy sessions with progressive relaxation training which they practised at home. The control group were on a waiting list.

Findings: Participants in the SIT groups showed more reported improvement in their anxiety levels, both therapy groups showed overall improvement compared with the control group.

Conclusions: SIT is effective in reducing anxiety  due to the added cognitive component.

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Managing Stress - Budzynski et al

Aim: To see if previous research on biofeedback as a method of reducing tension headaches was due to the placebo effect or whether biofeedback was effective.

Design: Independent measures. Group A had biofeedback sessions with relaxation training and EMG feeback. Group B had pseudofeedback. Group C were on a waiting list. 18 people who replied to an advertisement, from Colorado.

Procedure: Lab experiment. Data collected through EMG feedback machine with electrodes on muscles producing a graph of muscle tension. Participants did questionnaire about their headaches. For 2 weeks, patients recorded their headaches, and rated them from 0-5. Also tests for depression, hysteria and hypochondria. Groups A and B had 16 sessions of training. Both groups told to practise relaxation at home. Group C told they begin training in 2 months. Participants recorded their headache activity, after 3 months they completed self-report tests.

Findings: Group A's muscle tension was significantly lower than Group B's by the end of training and was still lower 3 months later. The tests showed high levels of hysteria, depression and hypochondriasis for all groups at the beginning. Group A showed significant reduction in hypochondriasis. Drug usage in Group A dropped more than Group B.

Conclusions: Biofeedback is effective when training patients to relax.

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Managing Stress - Waxler-Morrison et al

Aim: To look at how a women's social relationships influence her response to breast cancer and survival.

Methodology: A quasi-experiment with women who were diagnosed with breast cancer. The information was gathered using 18 interviews and questionnaires, and examination of medical records.

Participants: 133 pre-menopausal women, attending a breast cancer clinic in Vancouver.

Design: Independent design of women with different levels of existing social networks.

Procedure: The questionnaire included questions on their educational level, who they wereresponsible for (i.e. children), contact with friends and family, perception of support from others.

Findings: The six aspects of social network significantly linked with survival were: marital status,support from friends, contact with friends, total support, social network and employment

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Diagnosis - ICD + DSM - Categorising Disorders

DSM-IV: compiled by over 1000 people. Empirical research used to support criteria. Main diagnostic tool in the USA. Multi-axial tool (more holistic than ICD) including global functioning. Classifications e.g. dementia, learning disorders. Only mental disorders.

ICD-10: published by World Health Organisation (WHO). Used around the world. Physicaland mental disorders. Checklist style diagnosis (more reductionist than DSM). Categories e.g.dementia, schizophrenia.

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Diagnosis - Rosenhan and Seligman

Statistical infrequency (difficult to use alone, may include behaviours such as high IQ)

Deviation from social norms (if society does not approve of a behaviour it could be seen as dysfunctional: differences between societies)

Failure to function adequately (e.g. OCD, agoraphobia)

Deviation from ideal mental health (Jahoda's ideal mental health: you should have a positive view of yourself, be capable of some personal growth, be independent and self-regulating, havean accurate view of reality, be resistant to stress, be able to adapt to your environment.)

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Diagnosis - Ford and Widiger

Aim: To find out if clinicians were stereotyping genders when diagnosing disorders.

Method: A self-report, health practitioners were given scenarios and asked to make diagnoses based on the information. The IV gender of patient in the case study and DV was the diagnosis 

Participants: 354 clinical psychologists randomly selected from the National Register in 1983.

Design: Independent design. Each participant was given a male, female, unspecified case study.

Procedure: Participants were randomly provided with one of nine case histories. Case studies of patients with antisocial personality disorder (ASPD) or histrionic personality disorder (HPD) or an equal balance of symptoms from both disorders were given to each therapist.

Findings: ASPD was correctly diagnosed 42% of the time in males and 15% in females. Females with ASPD were misdiagnosed with HPD 46% of the time.

Conclusions: Practitioners are biased by stereotypical views of genders, as there was a clear tendency to diagnose females with HPD even when their case histories were of ASPD. There was also a tendency not to diagnose males with HPD. The characteristics of HPD (a pattern of excessive emotional behaviour and attention-seeking) could be seen as gender specific.

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Explanations - Watson and Raynor

Aims: To see if it is possible to induce a fear of a previously unfeared object, through classical conditioning. To see if the fear will be transferred to other similar objects. To see what effect time will have on the fear response.

Methodology: A case study on Little Albert.

Procedure: Session 1: The rat and the steel bar were presented together. Albert jumped and fellforward at the shock of the noise. Session 2: The rat alone was enough to provoke crying and crawling away (fear response). Session 3: Other similar objects were presented which provoked a similar response. Session 4: After 5 days Albert was brought back, where the response was similar to the rat, rabbit and dog. Session 5: 1 month later Albert was tested with similar object stimuli which showed the fear response.

Conclusions: Time does not remove the fear response. It is possible to condition fear through classical conditioning. Transference of the fear can be made to similar objects. Albert was taken out of the experiment after session 5 so Watson and Raynor could not de-condition him.

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Explanations - Gottesman and Shields

Aim: To review research on genetic transmission of schizophrenia.

Methodology: A review of three adoption and five twin studies into schizophrenia between 1967 and 1976.

Procedure: The incidence of schizophrenia in adopted children and monozygotic twins was made by comparing biological parents and siblings and adoptive parents and siblings in the adoption studies. In the twin studies the concordance rates of when both twins were diagnosed with schizophrenia was compared.

Findings: All three adoption studies found an increased incidence of schizophrenia in adopted children with a schizophrenic biological parent, whereas normal children fostered to schizophrenic parents and adoptive parents of schizophrenic children showed little evidence of schizophreia. All twin studies found a higher concordance rate for schizophrenia in monozygotic than dizygotic twins.

Conclusions: There is obviously a significant genetic input into the onset of schizophrenia, but with concordance rates less than 100% there must be some interaction with the environment.

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Explanations - Beck et al

Aim: To understand cognitive distortions in patients with depression.

Method: Clinical interviews with patients who were undergoing therrapy for depression.

Participants: 50 patients diagnosed with depression.

Design: Independent design as the patients were matched with a group of 31 non-depressed patients undergoing psychotherapy.

Procedure: Face-to-face interviews as well as diaries of their thoughts.

Findings: Certain themes appeared in the depressed patients that did not appear in the nondepressed patients. These were low self-esteem, self-blame, overwhelming responsibilities and desire to escape, anxiety caused by thoughts of personal danger, and paranoia and accusations against other people. Some patients felt themselves unlovable and alone.

Conclusions: Even in mild depression, patients have cognitive distortions that deviate from realistic and logical thinking. These distortions related only to depression.

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Treatments - McGrath

Aim: To treat a girl with specific noise phobia using systematic desensitisation.

Method: A case study of Lucy, aged 9, who had a fear of sudden loud noises.

Procedure: Lucy was brought to the therapy session and the programme was explained to her and her parents. Lucy made a hierachy of feared noises. She was taught breathing and relaxation, and told to imagine herself at home with her toys. She had a hypothetical 'fear thermometer'. As she had the stimulus of the loud noise, she paired it with relaxation, deep breathing and imagining herself at home, which would naturally lead to her to feel calm.

Findings: At the end of the first session Lucy cried when the balloon was burst at the other end of the corridor and had to be taken away. By the end of the fourth session, Lucy was able to endurea balloon being burst 10 metres away with mild anxiety. In the fifth session she held a deflated balloon. At the end of the session she could pop a balloon herself. By Lucy's last session (10) her fear thermometer had gone from 7/10 to 3/10 for balloons and 9/10 to 3/10 for party poppers.

Conclusions: It appears that noise phobias in children are amenable to systematic desensitisation.

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Treatments - Karp and Frank

Aim: To compare drug treatment and non-drug treatments for depression.

Method: A review article of previous research, concentrated on women with depression.

Procedure: Depression was analysed using a variety of depression inventories, and patients were tested generally prior to treatment, after treatment and in some cases after a period of time as a follow up. Some health practitioner assessments of symptoms were also used by some of the research.

Findings: Many studies found that adding psychological treatments to drug therapy did not increase the effectiveness of the drug therapy. Occasionally studies did show less attrition when combination therapies were used. This means that people were more likely to continue with treatment if cognitive therapy was given in addition to drug therapy.

Conclusions: Although it would seem logical that two treatments are better than one, the evidence does not show any better outcomes for patients offered combined therapy as opposed to only drug therapy, showing the effectiveness of drug therapy on depression.

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Treatments - Beck et al

Aim: To compare the effectiveness of cognitive therapy and drug therapy.

Methodology: Controlled experiment with participants allocated to one of two conditions.

Design: Independent measures with random allocation to the cognitive or drug conditions.

Participants: 44 patients diagnosed with depression.

Procedure: Patients assessed with three self reports before treatment using Beck Depression Inventory, Hamilton Rating Scale and Rasking Scale. For 12 weeks, patients either had a 1 hour cognitive therapy session twice a week or 100 Imipramine tablets.

Findings: Both groups showed significant decrease in depression stymptoms. The cognitive treatment group showed significantly greater improvements on self-reports and observer based ratings: 80% compared with 20% of those with drug therapy. The drop out rate was lower in the cognitive therapy group.

Conclusions: Cognitive therapy leads to better treatment of depression, shown by fewer symptoms reported and observed, and also better adherence to treatment.

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