Lecture 1 - Sakari Lemola - 2019 PDF

Preview

Summary

Sakari Lemola - 2019...

Description

Health Psychology Lecture 1

Research Focus 1: Sleep and positive development in adolescence Background - sleep has evolved early during phylogeny  Mice: 20h sleep  Adult man: 7-8h of sleep  Cats: 13h sleep  Fruit flies: 10h sleep  Giraffes: 2h sleep  Every animal has to sleep – it has to play a particular role  When we are sleep we are vulnerable, we lose our consciousness and cannot escape so sleep must play a fundamental sense otherwise it would not make sense from an evolutionary perspective Functions of sleep  Energy conservation and regeneration of the body (Siegal, 2005; Gumustekin et al, 2004)  Memory consolidation (Diekelmann & Born, 2010)  Wound healing is faster whilst sleeping Sleep deprivation leads to impairment of:  Working memory and attention (van Dongen et al, 2013) o Most immediately impacted  Impulse control and emotional regulation (Killgore et al, 2008) o No longer good at regulating negative emotions and more prone to anxiety Sleep is an active state: Body and mind are being prepared to meet the next day’s requirements. How much sleep o adolescents need?  Adolescents sleep need in unrestricted environments (e.g. summer holiday)

  

8.5-9.5 hours (SD=0:25h) Long hours – need more sleep than adults to perform at their best No reduction across puberty, 15yr olds need as much as 10yr olds.

How much sleep do adolescents actually get? Sleep duration before school days

Sleep duration on weekends

11 year old students (N=176) 9:45h (9:00pm-6:45am) (Lemola, Schwarz +Siffert, 2012)

10:45 (10:15pm-9:00am)

15 year old students (N=2716) (Perkinson-Gloor, Lemola + Grob, 2013)

10:00h (00:45am-10:45am)

8:00h (10:30pm-6:30am)

Changes in sleep habits during adolescence  Later bedtimes  Shorter sleep duration due to school start times  Larger difference between weekday and weekend sleep duration  More daytime tiredness Possible reasons:  Biological changes related to puberty o Melatonin secreted at later time point  Psycho-social factors o Electronic media consumption o Flat screens – blue spectrum of light, delays melatonin secretion and circadian rhythms Sleep duration and positive development in adolescence Adolescents with longer sleep duration show more optimism They also show…  Less daytime tiredness (d=-0.34)  More self-control (d=0.23)  Higher levels of wellbeing (d=0.24)  Better math grades (d=0.16)  Better German grades (d=0.15) The differences are between longer sleep duration (8-9h) and short sleep duration (0.20) regarding sleep duration, insomnia problems and depressive symptoms  In the extreme group of media use (>80th percentile)  Sleep duration on week days increased… o Intervention = +22mins Control =+1min (d=0.36, p=0.16) Discussion:  More intensive interventions might lead to stronger effects Outlook: Smartphone assisted sleep hygiene intervention  Activity monitoring with smartphone applications/ wearable sleep or fitness trackers  Individualised sleep hygiene feedback by smartphone applications  Exploiting the benefits of new technologies (electronic advisor) Take Home Message:  Many adolescents sleep too little

 

Consequences may include: – Increased daytime tiredness – Impaired well-being and self-control – Poor school performance We try to address these problems by: o Interventions on a structural level (e.g., by delaying school start times) o Interventions on an individual level (e.g., by improving sleep hygiene)

Research Focus 2: Long-term outcomes of early life adversities Preterm study  Follow-up of very preterm born children (n≤96) (birth years 2001-2006)  Term-born control group (n≤94) Socio-emotional development and mental health factors looked at:  Sleep: EEG and Actigraphy  HPA-Axis: Cortisol in saliva and hair – stress hormones  Cognitive development: WISC IV, CANTAB Tests  Motor development (e.g. GaitRite)  Neuroimaging (VBM-MRI, DWI/DTI, R-fMRI) Current Study wave: Socio-emotional development and mental health in adolescence (Wave 3) Additional focus: • Daily activity and physical exercise • Blood measures: BDNF, Immune system markers • Treatments are distressing to pre-term children but need to find out how it affects adolescence and adulthood

Research focus 3: Predictors of health and well- being across the life-span

• • • •

Look at risk factors: family structure during childhood – how they are raised General life satisfaction Looked at differences in life circumstances – employment, occupation, partnership status etc. Group with single parent were more likely to be unemployed, less occupational prestige, lower physical health, family visits etc.

Module Overview and Organisation ______________________________________________________________ Outcomes: • Discuss the ways in which psychology can contribute to improve health • Demonstrate knowledge of models and evidence how health behaviours contribute to physical and mental health • Demonstrate knowledge of mechanisms how physical and mental health are connected • Compare and critically discuss methodologies used in health psychology research • Discuss the topics covered in relation to theories and debates in health psychology • Identify and consider critical aspects in health communication Introduction to Health Psychology Definitions of Health “Health is a state characterised by anatomic integrity; ability to perform valued family, work, and community roles; ability to deal with physical, biological and social stress; a feeling of well-being; and freedom from the risk of disease and untimelydeath.” (Curriculum Development Project, 1982)  Person and environment links – perform according to what one would expect from them and also to cope with a certain level of stress  Feeling of well-being – take this as separate point  One can be physically healthy with good mental health but may have lower level of well-being “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ (WHO, 1946)  May be difficult to say someone is completely physically, mentally and socially well “Health is the condition of being sound in body, mind, or spirit.“ (Merriam-Webster, 2017)  Simple definition “Health, in human beings, is the extent of an individual’s continuing physical, emotional, mental, and social ability to cope with his environment.” (Encyclopaedia Britannica, 2017)  Person-environment interaction Definitions of Wellbeing “There is no universally accepted “definition” of mental well-being. This is probably because mental wellbeing may have different connotations for different individuals, groups and cultures. For some, it may be the notion of happiness or contentment. For others it may be the absence of disease. For some it may be economic prosperity. It could be based on the goals sought to be achieved and the challenges placed on an individual or a culture. It also may mean the absence of negative determinants in the life of an individual or a community.” (WHO, 2017) Definition of Subjective Wellbeing





Cognitive-evaluative = life satisfaction o Global = taking everything into account o Specific = with work/relationships/leisure time etc. o Better to use global scores o When you average specific domains it comes close to the global life satisfaction Affective: distinguish between positive and negative o People can be high in both – emotional o People can be higher in positive and lower in negative o May be a correlation but not very strong o People may have high levels of negative but may report their life satisfaction is high, so not a very high correlation between global and negative o Not perfect correlations

How did the concepts of health and illness change over time? The Biomedical Model • Characterised the scientific way of thinking in the 19th century. • Health and illness as conditions of biological organisms • Idea that illness is something external (germs, bacteria or virus that make us sick/genetic) • Cause of illness: genetically, external • Health – illness as dichotomous variable o Health = absence of disease o E.g. classification system ICD-10 o Someone has a diagnosis, or is not sick and is healthy • Illness as abnormality • However, it depends on the cultural context what is considered to be normal (Example: Homosexuality was only dropped as a mental illness in DSM-lll-R in 1987) • Only somatic treatments as biological causes of illness o Drug/biological measure to improve health • As a consequence: individual is conceived as passive o Have to wait to see the doctor who will prescribe drugs From the Biomedical Model to the Biopsychosocial Model • Achievements of the biomedical model: advances in the area of infectious diseases • Causes of illness and death have changed o Successes of the biological model o Drug success to treat diseases e.g. antibiotics o The leading causes of death have changed due to drug treatment o Modernly, non-infectious diseases are the leading causes of death o The risk can be reduced by changing diet, increasing exercise, stopping smoking for example

•

Engel (1980) criticised the biomedical model o Psychological and social factors are also important for origin and development of diseases

Leading causes of death in the U.S. 1900 vs. 2011

Increases in health care cost in the UK The percentage of national income being spent on health care has increased, which more than doubled to now 7-8% The amount of health problems such as mental have led to a burden on society Health psychology shows how health behaviours can change health in society

Biopsychosocial Model  Continuum vs. dichotomy o Continuum between being healthy and ill  Multidimensionality of health and illness o Several dimensions  Health vs. illness also depends on the subjective perception o If we followed the biopsychosocial model, it would follow one dimension o Positive = sick, negative = healthy o If someone has a negative test result and feels ill, it is somatoform disorder o This model allows for the feeling of well-being or illness Research Example: Illness and its Subjective Perception

 

 

   

Positive Emotional Style Predicts Resistance to Illness After Experimental Exposure to Rhinovirus or Influenza A Virus (Cohen et al., 2006) Research question: What is the effect of a positive emotional style (PES) (more optimistic) on the resistance to a common cold? o Do psychological factors play a role in whether or not someone gets sick? Participants: 95 men, 98 women, Age: 21-55 years Experimental design:

Low PES – low in optimism were more likely to develop a fever particularly when exposed to rhino virus – 40% Those with high PES – lower levels of infection/fever symptoms in both viruses Clear main effect of PES which was a protective factor for symptoms of flu and difference of rhinovirus which was more aggressive Looked at symptom BIAS score – looked at whether someone felt sick despite not having a fever, or if someone feels well despite having a fever o Low PES – those who didn’t have a fever said they felt sick and suffered from flu symptoms o High PES – negative values so even those who did have a fever didn’t complain

Conclusion:  A positive emotional style influences the development of common cold and its symptoms  PES plays a role in whether you tend to exaggerate symptoms  Psychological factors did play a role in this experiment Biopsychosocial Model  Active role of the individual in health promotion (also related to recovery and rehabilitation) o Can improve our health and become healthy sooner than someone who does not follow these health behaviours  Illness: interaction between biological, psychological and social factors o

The Importance of Psychosocial Factors Based on the Example of Epilepsy

 

The best treatments may not achieve their goals Neurological factors may prove important but they operate in the social setting

Comparison of Biomedical and Biopsychosocial Models Biomedical

Biopsychosocial

One dimensionality of health/illness

Multidimensionality of health/illness

Biological dimension

Biological, psychological, social dimension

Objective criteria

Subjective and objective criteria

Dichotomy

Continuum

Passive individual

Active individual

Health psychology attributes an active role to the individual The role of health inequalities  Emphasis on the active role of the individual can be a double-edged sword  Importance of considering ecological, economical, and socio- cultural factors  Effects of income, education, and work context on health

  

The relationship is stronger in men than women The higher your SES, the more likely you will live long Work conditions in the poor and risk of accident from crime affect men more severely than women – 15 years lower Possible causes:  Differences in health behaviours (e.g. smoking, diet, exercise)  Differences in stress and risk exposure  Differences in access to medical, cultural, and social resources Definition and Topics in Health Psychology Definition of Health psychology: “... the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, and the identification of etiologic and diagnostic correlates of health, illness, and related dysfunction.” (Matarazzo, 1980). Topics include psychological processes that are important for:  Promotion and maintenance of health  Prevention of illness  Health care and rehabilitation Health psychologists study how behaviour, cognition, emotions, motivation, personality can influence health. Key issues include:  Which behaviours play a role in promotion and maintenance of health?  How to effectively prevent illnesses  Which factors play a role in promoting quality of life in case of illness?

Five important topics of health psychology by Weinmann (1990)!  Risk behaviours (e.g. smoking)!  Behaviours promoting or maintaining health (e.g. physical exercise)!  Health and illness believes and cognition (e.g. knowledge about diseases) !  Health communication and decision-making ! Coping with illness (e.g. individual coping strategies)! Definition and Topics in Health Psychology! Health psychology is an applied subdiscipline in psychology. However, two main directions can be distinguished:  Applied health psychology o E.g. Development and evaluation of health promotion programmes!  Basic research fields! o Mechanisms of health-related behaviours o Models of health behaviour o Role of social factors o Role of personality

History of Health Psychology  Since the 1980s an independent discipline  Drastic increase of chronic-degenerative diseases  Increase in the knowledge on the role of risk behaviours  Cost explosion in health care  1978: Formation of the professional society Division of Health Psychology!  Health Psychology as official journal of the APA Division Health Psychology and Related Disciplines Disciplines dealing with the relationship between psychology processes and health/illness Clinical Psychology  Focus on mental illness  Overlap with health psychology involves e.g. theories of mental health problems, such as cognitive theories of depression and anxiety disorders Psychiatry  Focus on clinical disorders including medical treatments  Overlap with health psychology similar as for clinical psychology  Psychosomatics o Mind-Body relations —> bio-physiological aspects of psychological processes Behavioural Medicine  Biomedical and psychosocial models of disease development and maintenance  less focused on prevention

Public Health  Interventions on a community and health care system level to improve health and disease prevention  Same goals as health psychology, more focused on political/ societal changes  Health warnings on cigarette packets – how do these affect health? What do health psychologists work?  Work and organisational psychology: occupational health promotion, coaching  Community psychology: communal health promotion, prevention of disorders, coping with chronic diseases  Educational psychology: school health promotion  Environmental psychology: health promotion by changing the environment  Traffic psychology: accident prevention  Prevention and health promotion  Health promotion for children and adolescents at school – Occupational health promotion  Rehabilitation and patient education  Promoting self-help  Patient counselling  Health information (e.g. via social media)  Training for health care professionals in prevention and health promotion  Training for health care professionals in health communication...