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Lecture 1  The scientist practitioner

Lecture 2  The scientist practitioner Information processing  we are constantly bombarded with information  need to have a filter and check whether the information is plausible, aligns with existing beliefs and whether the source (where it has come from and see whether trustworthy) Everyday bias  Clinical experience (recall) Risks Evidence based practice vs clinical reasoning Alternatives to EBP Clinical questions  descriptive, predictive and causal EBP process (5 steps) PICO questions Sensitive vs specific search Indicators of bias

Lecture 3  Introduction to psychology and health psychology

What is psychology? 

Study of human behaviour and mental processes

Psychodynamic perspective

   

19th century  Sigmund Freud when treating people for physical problems couldn’t always identify physical causes underlying some of the problems First to think there might be other causes to physical problems not assigned from something going on in the body Interpret dreams, look back at childhood, hypnosis, free or word association Iceberg (a lot underneath the surface that may be influencing our behaviours)

1st model  psychodynamic perspective

We all have conscious wishes and desires that we are aware of but also unconscious urges below the surface we aren’t aware of 

 

Though unconscious and conscious processes in conflict with one another and that we might repress down some of the unconscious urges which we might perceive as negative things (sexual, aggressive) Mind as an iceberg Childhood experiences are formative

Behaviourist

Mind as a blank slate, don’t care about what’s going on in the brain, more about the inputs and outputs     

Learn an association in a similar way to animals Going against psychodynamic perspective Deemphasised the mind and study behaviour because we can measure and test behaviour Cannot easily measure and test what is going on in the mind 2 theories of learning came from this  Pavlov’s classical conditioning and Skinner’s operant conditioning

By focusing on behaviour that is observable, can fully understand everything we want to know about the way people are learning  

Mind as a blank slate Impacted by experiences in life

Theories of learning 1. Pavlov classical conditioning 2. Skinner operant conditioning

Humanistic perspective

    

Popularised by Maslow and Rodgers View of human experience saying that people are striving towards reaching their fullest potential aiming to become self actualised What makes different from other animals Person centred therapy  Rodgers  unconditional positive regard Milk carton  cream rising to top, seeking to reach self actualisation

Cognitive perspective

      

Roots in philosophy Being able to think means you can gain knowledge People could arrive at knowledge about the world without having to necessarily experience things Noam Chomsky Mind as a computer Way we interpret stimuli affect outcomes and behaviours produced Brain  computer panel, we do care what’s going on as may influence behaviours

Evolutionary perspective     

Historical roots in natural selection Charles Darwin Natural selection  animals or people behave in way that is evolutionarily adaptive and important for their survival How evolution shaped the mind and human behaviour Life is a race for survival and reproduction

Models of psychology

2 key emerged from behavioural perspective 

Learning  change in an organisms responding based on experience

Classical conditioning (pavlovian conditioning)    

Before any learning, take dog and give it bowl of food there is a natural salivation response Unconditioned response = salivation to food Conditioning stimulus = bell Repeated patterns of unconditioned stimulus (food) with the bell

Bell rings = conditioned stimulus = salivation = conditioned response Condition a response and use extinction  eventually remove association if you use bell and salivation but no food Operant conditioning  

Instrumental conditioning Two kinds of outcomes  reinforcement or punishment

Reinforcement      

Add something that increases behaviour = positive E.g. going to gym and getting a lot of praise or encouragement from trainer Remove something to increase behaviour = negative, bad mood but if get exercise and this removes the negative mood = negative reinforcement Decrease behaviour by adding something or removing something Add something that decrease behaviour = positive punishment e.g. wash kids mouth if swear Remove something that decreases behaviour = negative punishment, e.g. fave gym class attend but the good gym instructor goes then you might not go to that class again

Lecture 4  History of health and health Psychology History of health Prehistoric times  

Trephination  6500 BCE Voluntarily to remove evil spirits

Ancient Greece and Rome    

First written ideas about health and disease and disease processes Hippocrates humoral theory  4 fluids in the body Mind body problem  whether mind and body combined or two separate entities Galen’s dissections

Certain animals had pathologies that were localised to one part of the body Middle ages  

Church influence Cadaver research prohibited  thought disturb soul preventing further advances

Disease or illness result of God’s punishment Renaissance 

Connection between the mind and body

 

Pineal gland Soul could live without body when we die

Psychology and health  

Lifestyle play key role in health and wellbeing Modifiable factors of cardiovascular disease such as physical activity and diet

Health psychology   

1970s and 80s Matarazzo identified 4 goals of health psychology

Lecture 4  Concepts and theories of Health Behaviour

Why models and theories? Biopsychosocial framework    

Health is the dynamic interplay of biological, psychological and social factors Psychological  Thoughts, emotions and feelings Social  family, community and culture Biological  genetics, physiological systems and physical functioning

Concepts and theories 1. Locus of control Beliefs about what causes a particular outcome, internal (belief of personal control over outcome), external (outside forces determines the outcomes) External locus of control  two  powerful others (people who are influential in knowledge of particular behaviour or belief e.g. health beliefs  powerful people are health professionals, nurses etc) and chance (luck or faith influences outcomes in your life) Get a cold External locus of control  seek advice or write it out thinking it’s due to chance Powerful others  doctors appointment Chance  nothing you can do about it  take a sick day or wait to get better Internal locus of control  take medicine to get better 2. Self efficacy theory 3. Self determination theory

Measuring health locus of control

1. 2. 3. 4. 5.

Internal External  chance External  powerful others Chance Powerful others

Locus of control and exercise Internal control  4th quartile  80% more likely to be regular exercisers compared to those in 1st quartile Powerful others  less emphasis on powerful others less likely to exercise than people less likely to seek advice Self efficacy theory Perceived capability or how confident you are to perform a particular activity in a particular circumstance Influenced by characteristics of situation and how you perceive your personal abilities Environment  track runner could perform well on the track but have a low self efficacy that they will be able to perform a run in the snow Self-efficacy Influenced by different factors 1. Past performance  how well you’ve performed previously in similar situations e.g. successful in the past 5 years, have more confidence they will do well

2. Vicarious experience  visualise different situations, imagining it happening increases their confidence in their ability to perform it 3. Social persuasion  endorsement from coach, more confident to complete task 4. Physiological and affective states  HR and sensations of the body you are consciously aware of 5. Affective states  mood, depending on feeling may reduce confidence in performing a task Measuring self efficacy  scale Self efficacy theory  

Multiple components e.g. specific to being able to fit and schedule exercises in versus being able to perform them when you actually get to the gym Self efficacy = perceived capability

Someone who feels like they are strong and finish their workout every time but can actually find it difficult to get to the gym and do it in the first place  

Low self efficacy for scheduling exercise High self efficacy for actual task itself

Self efficacy is associated with better performance in a wide variety of domains, greater self efficacy is associated with better engagement with exercise, mindset is that you have the confidence in your own abilities to participate Association between their beliefs and how much they exercise  

Moderate positive correlation  the more self efficacy more likely to regularly attend exercise Higher self efficacy, more regularly in exercise and at a higher intensity

Increasing self efficacy 1. Past performance  when performed well or observe others 2. Vicar

1. 2. 3. 4.

Past performance Vicarious experience Social persuasion Physiological and affective states

Self-determination theory Theory of motivation 3 basic psychological needs (ARC) 1. Autonomy (ability to choose, independence) 2. Competence  feeling your good at tasks 3. Relatedness  feeling your connected to other people and have close personal relationships Motivation types 1. Intrinsic  within doing something we enjoy 2. Extrinsic  pressure from others  particular outcome or task would be useful

Integrated regulation  confirms your sense of who you are e.g. see yourself as a runner  part of your identity Identified regulation  doing something In order to achieve a personal goal e.g. running city to surf Introjected regulation  feel a sense of obligation e.g. studying for an exam External regulation  doing something to get a reward or avoid punishment Motivation

1. 2. 3. 4. 5. 6.

External Identified regulation Amotivation Intrinsic Introjected Integrated regulation

Motivation and exercise and intrinsically linked More self determined the motivation, the better the exercise outcomes

Building intrinsic motivation Competence  build sense of confidence (master skills) Autonomy  build intrinsic motivation  give people control over outcomes, more control over exercise session or perception of choice (give choice between 2 exercise which target same target group of muscle) Relatedness  around the environment the exercise is taking place in and making sure environment is supportive, change environment to improve relatedness, focus on enjoyment of exercises

Reasons for exercise divided into 7 subscales Appearance reasons vs health and fitness reasons



Appearance usually associated with negative things e.g. restrict food

Lectures 5 and 6 Lecture 5 Models of Health behaviour Theory of reasoned action

   

Was developed to predict voting behaviour in the US They found that attitudes around voting and subjective norms around voting predicted people’s intention to vote Main principle  best predictor of whether someone will engage in a particular health behaviour is their intent to engage in that behaviour For most behaviours we do  we intend to do them before we do them

Two components that are thought to be related to behavioural intention  include someone’s attitude towards the behaviour and subjective norms Attitude toward the behaviour

 

Individuals beliefs about the consequences of that behaviour, whether it’s good or bad Will health behaviour be good or bad, will it have consequences

Subjective norms

  

What do others close to me think Do I care about their opinions What individuals perception about people who are important to you think

Example of Theory of reasoned action

The best predictor of whether someone wear’s a seatbelt is their intention to wear a seatbelt  influenced by their attitude towards wearing it (is it comfortable or uncomfortable, subjective norms  what friends and family think about them wearing the seatbelt  then determine subsequent behaviour If we know about someone’s attitudes and subjective norms able to predict how someone is likely to behave e.g. if we wanted to target someone health’s behaviours, could target their attitudes to change their behaviours, or influence their perception of subjective norms Theory of planned behaviour

Perceived behaviour control

  

Like self efficacy and locus of control How much control do I have over behaviour? Takes own perception into account

Perceived behaviour control  willpower  i.e. need to refuse cravings i.e. you know health risks, your friends and family are supportive and want you to quit, however hard to refuse cravings Health beliefs model Perceived threat  perceptions of the risks associated with not engaging Outcome expectations  perceptions of what will happen if you do engage in that behaviour influenced by perceived benefits and barriers

Perceived threat  influenced by susceptibility (how likely to suffer) and seriousness (if they do, how bad will the consequence be)



When both susceptibility and seriousness are high  higher perceived threat

Outcome expectations Benefits (what are the good things that will come out of doing this behaviour) and Barriers (what are the things making it difficult to engage in that behaviour) Example

Limitations of these models Intention behaviour gap  we intend to do things that we don’t actually do How big is the gap?



47% ‘gap’ between intentions and actions

Limitations of these models

   

Intentions don’t always equal behaviours  intention behaviour gap Assumes people are rational Don’t account for habitual behaviours Don’t account for some

Health beliefs models



Doesn’t have perceived control

Cues to action

 

Reminders in our environment that are meant to prompt us toward a certain behaviour e.g. office areas fire alarm reminder Placement above toaster  reminder to stay right there and not burn the toast

Health motivation Transtheoretical model

 

Stages of change model that focuses more on the motivational component Different stages they go through to change their behaviour

Precontemplation

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No recognition that the problem exists or some recognition but no intend to change within 6 months

Contemplation



Intend to change within 6 months

Preparation



Getting ready to change within a month

Action



Engaging in change behaviours

Maintenance



Engaged in behaviours for at least 6 months

1. 2. 3. 4.

Precontemplation  I don’t need to exercise regularly Maintenance  ive been exercising for a long time and plan to continue Action  I’ve started exercising within the last 6 months Preparation  I’ve set up a day and time to start exercising regularly within the next few weeks

Transtheoretical model Stages of change

Health action process approach

Risk perception = perceived threat Limitations of these models



Social influences  affect behaviour

Social influences and exercise

 

Real or imagined pressure to change one’s behaviour Can be positive or negative

Social support

  

Perception that you have others you can turn to help when needed Amount of support exerciser feels they receive from their network More support  related to greater exercise engagement

Types of social support 1. Tangible practical support  i.e. dropping kid at sport  makes it easier to engage in the activity 2. Emotional support  encouragement and empathy 3. Informational support  availability of info, advice, feedback  Technique tips 4. Companionship support  availability of others to exercise with 5. Validation support  availability of others to compare oneself with e.g. workout  both people found it difficult to workout  validates experience Measuring social support

  

Network size Quantify by type Social support related to exercise behaviour

Companionship support  friends or dogs to walk with

Individual and group influences

 

Partner support  emotional and companionship support Parent support  various kinds of support and important in all ages

Individual and group influences

  

Fitness instructor/professional Informational, emotional and companionship support Can help with adherence

Attendance rate  higher with supervision Instructor teaching style

 

Social supportive and autonomy supportive leadership Greater self efficacy, enjoyment, energy and adherence, confidence in instructor (group exercise classes)

Transformational leadership

    

Idealised influence  acting as a role model, participate in activity, do it with the people Inspirational  enthusiasm and optimism Intellectual stimulation  trying to engage people with problem solving and allowing some choice Individualised consideration  demonstrating care for people in the session and recognising their individuality and cater for the differences Greater self efficacy, physical activity intentions, intrinsic

Lecture 6  behaviour change Goal setting

1. Set goal  outline what you want to achieve, avoid vague goals  I want to be fitter, I want to exercise more Goal setting theory 1. Goals should be challenging yet realistic  keeps it interesting and they can be done 2. Goals should be very specific 3. Exercisers should receive feedback regarding progress (could be external by coaches or training partners, or they could be monitored by the exerciser themselves) Complex behaviours  important to break down into mini goals Smart Goals

Specific  what you want to achieve is really precisely outline Outcome based goal  one where outcome is what they are looking for in the end e.g. want to increase distance run from 5 to 10km Behaviour based goal  achieve certain frequency of behaviour e.g. want to go to 3x week to gym Achievable Relevant  is the goal meaningful Time bound  specify timeframe for the goal

When setting a goal, consider the client’s opinion to ensure autonomy and choice for the client, consider meaningfulness of the goal 2) Develop plan The more specific the plan, the better. The purpose of planning is to the bridge the intention action gap. Planning is the missing link that moves people from intending to do something and actually doing it. Move from motivational phase (where you decide to do something) to volitional phase (where your ...