Psychological Factors in
Health and Illness
Psychology 49.346B
Winter 2003
Week 8 - March 4
Symptom Perception & Reporting
• Perception è interpretation è reporting
Symptom perception depends upon stable
individual differences and transitory
situational factors
Stress
Situation (boring, active)
Symptom Perception
• Attention to self (isolated)
• Coping style (monitoring vs. blunting)
• Mood (state and trait)
• Bad mood vs. Positive mood
• Neuroticism or Negative Affectivity
» Disability Hypothesis
» Psychosomatic Hypothesis
» Symptom Perception Hypothesis
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Symptom Perception
• Expectations (amplify expected)
• Cognitive Set (salience)
• Accuracy of symptom perception (low)
Symptom Interpretation
•
•
•
•
•
Culture
Prior experience
Learning (sick role)
Common vs. rare
Lay referral network
Symptom Interpretation
• Cognitive representations of illness
• Illness representations or schemas
» Identity
» Consequences
» Causes
» Duration
» Cure
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Symptom Interpretation
• Models of illness
• acute
• chronic
• cyclic
• Disease prototypes - organized conceptions
(e.g., heart disease)
Seeking medical care
Lay referral network
Serious symptom: new, unexpected, painful
Age - age-related, legitimate concerns
Gender
Socioeconomic status
Meaning of symptoms (Gick & Thompson, 1997;
Thompson & Gick, 2000)
Culture
Seeking Medical Care
• Social learning (Whitehead et al., 1994;
Thompson & Gick, 2000)
• Interpersonal crisis, social interference
• Social sanctioning
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Seeking Medical Care
• Stress - Cameron, Leventhal, & Leventhal
(1995)
• ambiguous symptom + chronic stressor à Tx
• unambiguous symptom + recent stressor à Tx
• ambiguous symptom + recent stressor àdelay
Overusing Medical Care
• Stress and emotional responses
• Symptoms of Anxiety
• Symptoms of Depression
• More legitimate to seek medical care
• Secondary gain
• Malingering
Overusing Medical Care
• Worried well
• concerned about physical and mental health
• perceive minor symptoms as serious
• should take care of health
• Somatization
• Many medically unexplained symptoms
• Hypochondriasis
• Illness worry
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Explanations for Somatization,
Hypochondriasis
• Psychodynamic (Freud - repression)
• Amplification (Barsky, 1988)
• Self-handicapping (Smith et al., 1983)
• protect self-worth under evaluation
• Multifactorial model (Kellner, 1985)
• Biopsychosocial factors, illness may not be
known yet
Underusing Medical Services
• Treatment delay
• Nature of symptoms (e.g, pain, bleeding)
• Procrastination, denial coping strategy delay for non-serious or ambiguous
symptoms (Sirois et al., in press)
• Anxiety over symptoms, treatment
• Medical delay
Patient-Physician Interaction
• Practitioners’ behaviours
• Interruptions (Beckman & Frankel, 1984)
• Technical jargon vs. Baby talk
• Depersonalization
• Affect communicated
• Stereotypes
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Patient-Physician Interaction
• Patients’ behaviours
• Neuroticism
• Anxiety
• Experience with disorder
• Respond to different cues than practitioners
• Faulty cues
Patient-Physician Interaction
• Interactive aspects
• Little feedback for practitioner about success
of treatment, or satisfactory personal
relationship
• Negative feedback more common, which is
not helpful for learning
Complementary & Alternative
Medicine: Why People Use it
• Eisenberg, et al. (1993; 1998): 1 in 3 people
has used CM at least once (1993); 46.3% by
1998
• Studies in the U.K. & Europe suggest that
chiropractic, massage, Homeopathy/ Naturopathy,
& acupuncture are among the most popular
therapies used
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Complementary & Alternative
Medicine: Why People Use it
Group work: divide up into groups based
on who has tried CM and who has not
CM users: Recall and discuss what motivated you
to try CM - list all reasons
Never tried CM groups: List and discuss what
might get you to try CM (or if nothing would)
CM Use
• Verhoef et al., 1990
• 10% seeing GI specialist sought CM care
• Felt MD did not listen to concerns
• Skeptical about conventional medicine
• More common in functional disorders (no
definitive diagnosis or treatment)
CM use: Beliefs & Motivation
(Sirois & Gick, 2002)
. Murray & Sheppard(1993): extra time & attention
spent by the alternative therapists was the most valued
aspect of receiving alternative treatment
Dissatisfaction with OM as a Push to try CM (poor
communication, not enough time, OM seen as
ineffective for one’s problem)
More health awareness, more personal control as a
Pull to try CM (CM focuses on preventative health
behaviors, patient involvement)
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Fig. 1. Health Awareness and Satisfaction with Doctors
as a function of client type
4
3.5
OM
Mean Scores
3
NCM
2.5
2
ECM
1.5
1
Health Awareness
Client Type
Satisfaction with doctors
Other factors that influence CM use
• New CM clients are more open to new
experiences than OM clients (& established
CM clients) (Sirois & Gick, 2002)
• CM clients have higher incomes & more
education than OM clients
• (Established) CM clients have more health
problems than OM clients (& new CM clients)
• Mechanism: placebo effects & illusory
correlations?
Placebos
The Origins of Placebos
• from Latin meaning “I shall please”
· ancient placebos included lizard’s blood, swine teeth,
leechings, and most early “medical” practices
· imagination-alteration as a means of cure during the
Renaissance relied upon unqualified belief in the
physician’s words & practices
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The Placebo Effect: Modern
Conceptualizations
• Current definition: A placebo is a substance
or therapy that has no specific activity for the
condition being treated (Shapiro, 1964).
• Placebo effects are often referred to as “non-specific
effects” in contrast to the specific effects expected by
prescribed medical treatment
· Modern placebo effects include sham knee surgery
effects
The Powerful Placebo: Mind over
Medicine?
• Interest in the Placebo peaked after Beecher’s (1955)
classic paper citing the constancy of the placebo
effect as 35.2% (+/- 2.2%)
• Placebo control groups are used in testing the
effectiveness of certain drugs – effects beyond the
placebo group are considered to be due to the “real”
effects of the drug
· Placebo effects are viewed as a nuisance variable or
“noise” that interferes with evaluating a drug’s strength
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