Psychology notes BETA

Giles Kisby GE Y1 Psychology

Psychology:

Summer Term:

LECTURES:

Studies will be well introduced in the exam and then any such question would just be asking what the study was showing

16/05/14: Learning Theory: David Murphy

Los (from booklet):

Explain Learning Theory

Understand and be able to explain Classical Conditioning

Understand and be able to explain Operant Conditioning

Differentiate between positive reinforcement, negative reinforcement and punishment.

Define and describe the various schedules of reinforcement.

Define observational learning, describe Bandura’s Social Learning theory, and outline the steps in the modeling process.

Understand and explain approaches to increasing the likelihood of desirable behaviours and decreasing the likelihood of undesirable behaviours.

Notes:

Learning: o “a process by which experience produces a relatively enduring change in an organism’s behavior or capabilities.”

3 elements of a behaviour (..it’s as easy as ABC) o Antecedent (or cue): environmental conditions or stimulus changes that exist before the behaviour of interest, these may be either internal or external to the subject o Behaviour: the behaviour of interest emitted by the subject. Future instances of this behaviour will be influenced by both antecedents and consequences o Consequence: a stimulus change that follows the behaviour of interest

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John Watson: behaviourist point of view saying that only environment is what shapes us

(ignored genetics)

Four basic learning processes: o Habituation/Sensitization o Classical conditioning o Operant conditioning o Observational learning

Four basic learning processes: o Habituation/Sensitization – Learning to notice or ignore

 Habituation: Eg reduced gill withdrawl response of the sea slug; recovery of response if a resting period occurs

 Sensitization: electric shock makes subsequent withdrawl response stronger; ie inc sensitivity to a range of subsequent stimuli

 Relevance: consider when patient report a change in perceived pain o Classical conditioning – Learning what events signal [Antecedents  behaviour]

 “when one thing leads to another”

 Eg ringing bell eventually sufficient to cause dogs to salivate



Response will be lost after a period of non-training

 Eg can get hair loss with placebo chemotherapy!

 Eg A significant proportion (25-30%) of patients undergoing chemotherapy experience anticipatory nausea and vomiting.

 Stimuli



Unconditioned stimulus (UCS): o A stimulus that elicits a reflexive or innate response (the

UCR) without prior learning



Conditioned stimulus (CS): o A stimulus that, through association with a UCS, comes to elicit a conditioned response similar to the original UCR

 Responses



Unconditioned response (UCR): o A reflexive or innate response that is elicited by a stimulus

(the UCS) without prior learning



Conditioned response (CR): o A response elicited by a conditioned stimulus.

 Classical conditioning is strongest when:



There are repeated CS-UCS pairings



The UCS is more intense

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

The sequence involves forward pairing



The time interval between the CS and UCS is short

 Stimulus Generalization

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Similar stimuli will also elicit the CR, but in a weaker form



A tendency to respond to stimuli that are similar, but not identical , to a conditioned stimulus. E.g. responding to a buzzer, or a hammer banging, when the conditioning stimulus was a bell

 Stimulus Discrimination:

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The ability to respond differently to various stimuli. o E.g. A child will respond differently to various bells (alarms, school, timer)

 Example:



“Little Albert” Experiment (Watson & Raynor 1920) o Classical conditioning with stimulus generalisation: fear in response to white rat due to loud sound when he touched rat; extended to white cotton etc via generalisation o Operant conditioning - Learning one thing leads to another [Behaviour  consequences]



Operant conditioning: o the process by which animals utilize trial and error to achieve the desired outcome

 Thorndike’s Law of Effect

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Law of Effect: o A response followed by a satisfying consequence will be more likely to occur  Positive Reinforcement o A response followed by an aversive consequence will become less likely to occur  Negative Reinforcement

 Positive Reinforcement [“bribery”]: occurs when a response is strengthened by the subsequent presentation of a good stimulus



Primary Reinforcers: o stimuli, such as food and water, that an organism naturally finds reinforcing because they satisfy biological needs

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Secondary Reinforcers: o stimuli that acquire reinforcing properties through their

association with primary reinforcers e.g. money

 Negative Reinforcement [“blackmail”]: occurs when a response is strengthened by the removal (or avoidance) of an aversive stimulus



Negative Reinforcer: o the aversive stimulus that is removed or avoided (e.g.

speeding alert)

 “Positive” and “Negative” refer to presentation or removal of a stimulus, not

“good” and “bad”

 Punishment



Aversive / Positive Punishment:

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Giles Kisby GE Y1 Psychology o occurs when a response is weakened by the presentation of a stimulus: VIOLENCE



Negative Punishment / Response Cost: o occurs when a response is weakened by the removal of a stimulus (e.g. “you’re grounded!”)

 Shaping



Complex behaviours are learned in small steps.



Behaviours are rewarded that are increasingly similar to the desired behavior.



Eg successively stringent demands required to give fish to dolphin

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Application of shaping o Parent brushes teeth child holds brush o Child moves toothbrush up and down o Child places loaded toothbrush in mouth and moves up and down. o Parent hold toothpaste child squirts onto brush, puts in mouth and moves up and down. o Child opens toothpaste, squirts on brush, puts in mouth and moves up and down.

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Operant Extinction: o the weakening and eventual disappearance of a response because it is no longer reinforced o Resistance to Extinction:

 the degree to which non-reinforced responses persist

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Operant Generalization: o an operant response occurs to a new antecedent stimulus or situation that is similar to the original one

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Operant Discrimination: o an operant response will occur to one antecedent stimulus but not to another

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Reinforcement schedules o Fixed interval schedule: reinforcement occurs after fixed time interval o Variable interval schedule: the time interval varies at random around an average o Fixed Ratio Schedule: reinforcement is given after a fixed number of responses o Variable Ratio Schedule: reinforcement is given after a

 variable number of responses, all centered around an average

Reinforcement schedules o Continuous reinforcement produces more rapid learning than partial reinforcement

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 The association between a behaviour and its consequences is easier to understand o However, continuously reinforced responses extinguish

more rapidly than partially reinforced responses

 The shift to no reinforcement is sudden and easier to understand o Observational learning – Learning from others

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 Albert Bandura’s Social Learning Theory

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“Occurs by watching and imitating actions of another person, or by noting consequences of a person’s actions; Occurs before direct practice is allowed”

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Observational (vicarious) learning o We observe the behaviours of others and the consequences of those behaviours.

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Vicarious reinforcement o If their behaviours are reinforced we tend to imitate the behaviours

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Steps to Successful Modeling o Pay attention to model o Remember what was done o Must be able to reproduce modeled behavior o If successful or behavior is rewarded, behavior more likely to recur o Bandura created modeling theory with classic Bo-Bo Doll experiments

 All children spent time in a playroom with an adult who modelled either non-aggressive (building tinker toy) or aggressive play (punching and striking the

Bobo doll with mallet)

 Children who observed aggressive behaviour showed a much higher level of aggression towards the doll.

16/05/14: Health beliefs and behaviour: David Murphy


Explain the role of behavioural factors in the aetiology of major diseases.

Define and give examples “health behaviour”.

Explain the role of health education in disease prevention.

Explain the role of learning and habit in health behaviour.

Explain the role of attitudes and beliefs in health behaviour.

Explain the influence of social environment on health behaviours.

Define “self-efficacy” and describe the factors which influence it.

Outline the Health Beliefs Model and the Theory of Planned Behaviour.

Identify effective approaches to modifying health behaviour

Notes:

Behavioural factors in the aetiology of major diseases o 1. Smoking behaviour  lung cancer

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Giles Kisby GE Y1 Psychology o 2. Increased eating behaviour and decreased physical activity behaviour  obesity and obesity related deaths o 3. Alcohol consumption behaviour  disease o Unsafe sexual behaviours  disease

Health behaviour o “Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage” o The Alameda Study

 6,928 residents of Alameda county, CA, completed a list of 7 health behaviours they practised regularly including; not smoking, eating breakfast every day, taking regular exercise etc.

 The sample was followed up nearly 10 years later. The mortality rate in individuals who practised all 7 behaviours was less than 1/4 of that in individuals who practised between 0-3. o What approaches are effective in encouraging people to adopt health behaviours?

 increasing knowledge

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Nutbeam et al (1993) o Smoking: The programme involved specially trained teachers providing teaching sessions spread over a 3 month period. The outcome was evaluated using a self report questionnaire combined with a saliva test. o Effective in increasing knowledge but negligible effect on decreasing smoking rates

 changing cues & reinforcement

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Examples of stimulus control techniques to change eating behaviour: o Don’t keep prohibited foods in the house o Don’t keep biscuits in the same cupboard as tea & coffee o Eat only at the dining table o When meal finished leave the table and put left over food away o Use small plates

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Positive reinforcement intervention Kegels et Kegels et al (1978) o Children given a talk on dental hygiene and then received one of three types of follow up:

 No further input

 Discussion session

 Reward for compliance with programme o Compliance with mouthwash programme assessed over 20 weeks.

 Was seen to improve compliance o Problems with reinforcement programmes

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 Lack of generalization: only affects behaviour regarding the specific trait that is being rewarded

 Poor maintenance after the reward is eventually removed

 Impractical, expensive

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Negative Reinforcement o The effect of fear arousal Janis & Fesbach (1953)

 “avoidance rater than behavioural change”

 High school students given one of three different lectures on dental health.

 Lectures designed to induce low, moderate or high fear.

 Effect on subsequent behaviour measured.

 Result: people in high fear lecture reported greater intention but in fact had the lowest rates of

actually changing their behaviour in practice

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Reason is that the response is often just to ignore the subject entirely due to their negative association with the subject

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 Social Learning = vicarious learning

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Eg pupils watching movies with more instances of smoking matched with their subsequent smoking rates

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Eg pupils match their smoking frequency with those of members of their household

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Social learning interventions o Epstein et al (1990)

 76 Children aged 6-12 years >20% above ideal body weight.

 One of three interventions:

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

Education only

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Education & behavioural strategies

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Education and social learning [involving family]

 Result: social learning gives slower initial effect but it was then maintained for a longer period subsequently

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Ie don’t just change behaviour of that one person; need to change the behaviour of the people around them too.

Health Beliefs [attitudes and beliefs] o Rosentock 1966: Health Beliefs Model

 Uptake of vaccine determined by how threatening they perceive the disease is:

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Perceived susceptibility

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Perceived seriousness

 Also affected by perceived costs and barriers

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“The injection will be painful, I might get side effects, I haven’t go time to go to my GP”

 Also affected by cues

 such as frequent exposure to people with that disease

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 Expectancy-value theory: Rotter (1954)

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The potential for a behaviour to occur in any specific situation is a function of the expectancy that the behaviour will lead to a particular outcome and the value of that outcome” o Expectancy: Bandura 1977:

 Outcome efficacy

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Individuals expectation that the behaviour will lead to a particular outcome

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Eg running would help health

 Self Efficacy

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Belief that one can execute the behaviour required to produce the outcome

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Eg not physically able to get up early to go running

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Factors influencing self efficacy o Mastery experience [success of related things is beneficial, failure is harmful to self efficacy] o Social learning o Verbal persuasion or encouragement o Physiological arousal

 The Theory of Planned Behaviour: (Ajzen 1991)

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Same as prev + Adds idea of subjective norm: = what other people think about the behaviour

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Eg if family accepting of smoking then will mean more likely to continue smoking

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Health Beliefs and Behaviour o Preventing commonest diseases means changing behaviour.

 Behaviour is determined by:

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Knowledge

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Learning

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Beliefs o Changing behaviour

 Identify and remedy any gaps in knowledge

 Identify cues and reinforcers – modify if possible. Consider reinforcement programme as a “kick start”.

 Identify and attempt to modify unhelpful beliefs.

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20/05/14: Developmental psychology: Dr Becky Armstrong


Learning objectives

1. Distinguish the relative influences and interaction of heredity and environment in human development.

2. Describe what and how babies contribute to their own development and the process of reciprocal socialization.

3. Explain how parents can provide a supportive environment for development.

4. Define attachment and describe how disruptions in attachment affect psychological development.

5. Explain Piaget’s stage model of cognitive development.

6. Outline cognitive, emotional and relationship changes during adolescence.

From slides:

To consider the relative influences and interaction of heredity and environment in human development

To describe what and how babies contribute to their own development and the process of reciprocal socialization

To describe how parents provide a supportive environment for development

To define attachment and describe how disruptions in attachment affect psychological development

To describe Piaget’s stage model of cognitive development.

To describe cognitive, emotional and relationship changes during adolescence

Notes:

Good mental health in children (Outline of lecture) o Ability to sustain satisfying relationships (temperament and attachment) o Progressive psychological development (nature via nurture) o Ability to play and learn (play; Piaget) o A moral sense of right and wrong (parenting) o Psychological distress remains within normal limits (a look at adolescence)

What is developmental psychology?

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Giles Kisby GE Y1 Psychology o The changes that occur over time in the thought, behaviour, reasoning and functioning of a person due to biological, individual and environmental influences

Methods of study o Folk theories of psychology o Observation o Experimental methods (Strange situation) o Psychological testing (temperament, IQ) o Correlational studies (correlates of secure attachment)

Observation in developmental psychology o Piaget’s theories originally derived from close observation of his own children o Natural observations in Uganda and US led to conception of strange situation test of attachment o Child psychotherapy training involves weekly infant/young child observation as well as reading of child development papers o RCPCH Child in Mind Course Reflective observations of baby in neonatal unit o Observations in clinic (bringing generalised developmental knowledge to individual child and circumstances)

Physical Development o Maturation: the genetically programmed biological process that governs our growth

 Infants vary in the age at which they acquire particular skills

 Sequence in which skills appear is typically the same across children o Environmental and Cultural Influences:

 Diet

 Enriching environment

 Physical touch

 Experience o Three Basic Principles:

 Biology sets limits on environmental influences

 Environmental influences can be powerful

 Biological and environmental forces interact (e.g. Dynamic systems theory of motor development)

Newborn o Touch:

 By 32/40 skin of foetus sensitive to a hair’s stroke o Sight:

 Responds best to strong contrasts and movement

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 Preference for human face or similar forms e.g. upside down triangle of dots o Hearing:

 Receptive hearing begins 16/40 functional from 24/40

 Foetus learns to recognise mother’s voice and shows preference at birth o Smell and taste:

 Prefer sweet taste o Turn to smell of mother’s milk

 Activates pre-feeding behaviour o Biology ensures that by the time babies are delivered (40 weeks gestation) they are able to recognise their mother as a memory of her has been built up inutero via hearing, smell and taste. o Hearing:

 newborn babies are already familiar with their mothers’ voices when delivered. Prefer their mothers’ voices to the voices of other women when recorded voices were played back o Smell

 Babies seem primed to learn very quickly about the smells associated with their mothers.

 Newborns can recognize the smell of their own amniotic fluid. (Varendi et al

1996)

 Newborns recognise the smell of maternal breast odours (Varendi and

Porter 2002)

 Newborns showed preferred to smell of their mother’s expressed breast milk compared to others’ EBM (Mizuno et al 2004) o Taste

 A newborn senses all of these tastes except one: salt they cannot taste this until about 4 months old (Beauchamp et al 1986)

 Newborns love sugar solutions-the sweeter, the better – Sweetease

 Newborns also seem to like the taste of glutamate, which is found in breast milk (Beauchamp and Pearson 1991). o Sight

 Babies 12 - 36 hrs old shown video playbacks of women’s faces. Preference for watching their mothers’ faces (rather than the faces of strangers).

(Bushnell et al 1989).

 Newborn infants have shown a preference for looking at faces and face-like stimuli (Batki et al 2000; Turati et al 2002).

 Show a preference for faces with open eyes and look longer at happy face stimuli (Farroni et al 2007).

Temperament o Easy infants: eat and sleep on schedule, playful, accept new situations with little fuss

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Giles Kisby GE Y1 Psychology o Slow-to-warm-up: the least active, mildly negative reactions to new situations, adapt over time o Difficult: irritable, fussy eaters and sleepers, react negatively to new situations o Non-linear pattern: extreme temperaments show stability, mid-range temperaments may be more open to change through environmental factors

Reciprocal socialization o Baby: cries, moves, grimaces, smiles, calms, looks o Parent: Mirrors, repeats, interprets, responds o Reciprocal socialization is bidirectional; children socialize parents just as parents socialize children. o The behaviours of mothers and infants involve substantial interconnection, mutual regulation, and synchronization. o Psychologists have a method of testing for this understanding, and it’s called the Still

Face paradigm.

 Baby picks up impassive face of mother and reacts to it trying to get mother to engage and continue the reciprocal socialisation. o Scaffolding:

 The behaviours of mothers / carers and infants involve substantial interconnection, mutual recognition and synchronisation. If parents responses supports or reinforces the infants efforts the infant will build on

this interaction or experience and continue to develop in this area. This is called SCAFFOLDING. Scaffolding can occur in lots of different types of interactions not just parent child.

 parental behaviour that supports children’s efforts, allowing them to be more skilful than they would be if they were to rely only on their own abilities.

 E.g. It is evidenced when parents time interactions in such a way that the infant experiences turn-taking.

 Scaffolding is not confined to parent-infant interaction, but can be used to support children’s achievement-related efforts in school (Vygotsky, zone of proximal development e.g. younger child engaging in pretend play with older child) o So Parents through scaffolding, reciprocal socialisation, provision of a stimulating

and enriching environment (both physiologically and psychologically) give babies the resources to thrive and develop. o An “internal working model” Bowlby (1969) is established through this social process; The baby doesn’t do this on his own but coordinates his systems with those of the people around him

 Babies of depressed mothers adjust to low stimulation and get used to lack of positive feelings. Baby’s of agitated mothers may stay over aroused and have a sense that feelings just explode out of you and there is much you or anyone else can do about it (or they may switch off their feelings all

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Giles Kisby GE Y1 Psychology together). Well managed babies (where there is reciprocal socialisation) come to expect a world that is responsive to feelings and helps to bring intense states back to a comfortable level, through the experience of being supported to do this they learn how to do it for themselves.

 This “internal working model” is the very start of what we call attachment. o Attachment and how disruptions in attachment affect psychological devpt

 Attachment is a theory defined by Bowlby which describes a biological instinct that seeks proximity to an attachment figure (carer) when threat is perceived or discomfort is experienced.

 This sense of safety the child experiences provides a secure base from which they can explore their environment thus promoting development through learning whilst being protected in the environment.

 Process of establishing the attachment bond begins even before birth

(supported by reciprocal socialisation).

 The Internal working models formed inform our expectations and behaviour in wider relationships throughout our lives.

 This process is mediated by “Mind – mindedness” (Meins, 2012). Parents with mind-mindedness treat their children as individuals with minds; they respond as if their children’s acts are meaningful—motivated by feelings, thoughts, or intentions (an attempt to communicate); this ultimately helps the child to understand others’ emotions and actions. o Development of Attachment over 1st Year

 Birth to 3M; prefers people to inanimate objects, indiscriminate proximity seeking eg clinging

 3-8M; smiles discriminately to main caregivers

 8 – 12M; selectively approaches main caregivers, uses social referencing / familiar adults as “secure base” to explore new situations; shows fear of strangers and separation anxiety

 From 12M (corrected age); the attachment behaviour can be measured reliably.

 Strange Situation Test (Ainsworth et al 1978) was designed to present children with an unusual, but not overwhelmingly frightening, experience. It tests how babies or young children respond to the temporary absence of their mothers. Researchers are interested in two things:

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1. How much the child explores the room on his own, and

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2. How the child responds to the return of his mother

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Securely-attached children (65%): o Free exploration and happiness upon mother’s return. o The securely-attached child explores the room freely when

Mum is present. He may be distressed when his mother leaves, and he explores less when she is absent. But he is happy when she returns. If he cries, he approaches his mother and holds her tightly. He is comforted by being held,

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Giles Kisby GE Y1 Psychology and, once comforted, he is soon ready to resume his independent exploration of the world. His mother is responsive to his needs. As a result, he knows he can depend on her when he is under stress (Ainsworth et al

1978).

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Insecurely attached children (35%):

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Avoidant-insecure children: Little exploration and little emotional

response to mother o The avoidant-insecure child doesn’t explore much, and he doesn’t show much emotion when his mother leaves. He shows no preference for his mother over a complete

stranger and, when his mother returns, he tends to avoid or ignore her (Ainsworth et al 1978).



Resistant-insecure (or “ambivalent = mixed feelings”) children: o Little exploration, great separation anxiety and ambivalent

response to mother upon her return. o Like the avoidant child, the resistant-insecure child doesn’t explore much on her own. But unlike the avoidant child, the resistant child is wary of strangers and is very distressed when her mother leaves. When the mother returns, the resistant child is ambivalent. Although she wants to reestablish close proximity to her mother, she is also resentful—even angry—at her mother for leaving her in the first place. As a result, the resistant child may reject her mother’s advances (Ainsworth et al 1978).



Disorganized-insecure children: o Little exploration and confused response to mother. o The disorganized child may exhibit a mix of avoidant and resistant behaviours. But the main theme is one of confusion and anxiety. Disorganized-insecure children are at risk for a variety of behavioural and developmental problems.

Attachment in Child Development o Defined by Bowlby as a biological instinct in which proximity to an attachment figure is sought when the child senses or perceives threat or discomfort o Sense of safety the child experiences supports them to explore their environment so supporting development through learning while protecting from environmental dangers o Process of establishing the attachment bond begins at, or even before, birth

(supported by reciprocal socialisation)

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Giles Kisby GE Y1 Psychology o A theoretically based concept (Bowlby), empirically validated (Ainsworth) o Menatal representations ‘internal working models’ are formed on the basis of early attachment experiences which inform our expectation and behaviour in other close relationships

Strange situation test (Ainsworth) o Secure (65%):

 cry when mother/father leave them in playroom with stranger; seek contact and soothed by parent on their return o Insecure (35%)

 Avoidant: do not appear distressed on separation; neither cling to nor resist parent on return

 Ambivalent: angry and resistive on parent’s return; not easily soothed by parent

 Disorganised: show confused and contradictory behaviours e.g. look away while held, unpredictable crying

 Not due to infant factors (e.g. temperament) as infants show statistically independent attachment to mothers and fathers

Good enough parenting o Even securely attached infant-parent show mismatches in about 50% of interactions o Repair of interaction may be important mechanism o Affect cycle: Positive feelings – negative experience and feelings – recovery of positive affect o Child learns that negative experiences and concomitant feelings can be tolerated and endured o resilience in the face of stress is an ultimate indicator of attachment capacity o Once emotional equilbirium restored, enhancing of positive emotion through interactive play also important in supporting development of curiosity and exploration

The intergenerational transmission of Attachment o securely attached baby: caregiver sensitive to baby’s signals and consistently available to respond to infants’ needs: parent tends to be secure and autonomous in own attachment o insecure

 avoidant babies: caregiver tends to be unavailable or rejecting: parent dismissive of own attachment experiences

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 resistant babies: caregiver sometimes responds to their babies’ need and sometimes does not: Adult insecure and preoccupied about their own early experiences

 disorganized babies: caregiver may neglect or physically abuse their babies, or may suffer from depression: parent unresolved with regard to own past loss or trauma in attachment relationships)

Secure Attachment o Promotes

 Independence

 Emotional availability

 Better moods

 Better emotional coping o Associated with

 fewer behavioural problems

 higher IQ and academic performance o Contributes to a child’s moral development o Reduces child distress o In adolescence and adulthood associated with

 Social competence

 Loyal friendships

 More secure parenting of offspring

 Greater leadership qualities

 Greater resistance to stress

 Less mental health problems such as anxiety and depression

 Less psychopathology e.g schizophrenia o In the school years is associated with:

 Ease of making friends

 Better peer relationships at school

 Positive relationships with teachers

 Better problem solving skills

 High self-esteem

 Self-confidence

 Self-reliance

 Less anger and anxiety

 Higher levels of emotional health o In adolescence & adulthood is associated with:

 Social competence

 Loyal friendships

 More secure parenting of offspring

 Greater leadership qualities

 Greater resistance to stress

 Less mental health problems such as anxiety and depression

 Less psychopathology e.g. schizophrenia

 Less violence and criminal activity

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Summary o Secure attachments formed in infancy are a protective factor leading to resilience throughout the lifespan. o Insecure attachments place the individual at risk but are not causative for later problems.

Benefits of play o Has important positive effects on the brain and on a child’s ability to learn o Engage and interact with world o Create and explore own world o Experience mastery and control o Practice decision-making, planning o Practice adult roles o Overcome fears o Develop new competencies o Learn how to work in group o Develop own interests o Extend positive emotions o Maintain healthy activity level

Cognitive Development: Piaget o Piaget’s Stage Model: proposed that children’s thinking changes qualitatively with age o Results from an interaction of the brain’s biological maturation and personal experiences o Schemas: organised patterns of thoughts and action

 Development occurs as we acquire new schemas and as our existing schemas become more complex

 Process of assimilation (incorporating new experience into existing schema) and adaptation (whereby new experiences cause existing schema to change)

Cognitive Development: Piaget: Piaget’s Stage Model: o Sensorimotor Stage: birth to age 2; infants understand their world primarily through sensory experiences and physical (motor) interactions with objects

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 Principle of Object Permanence develops: the understanding that an object continues to exist even when it cannot be seen

 Gradually increasing use of words to represent objects, needs, and actions

 Learning is based on trial and error (although errors do not become assimilated!) o Preoperational Stage: age 2-7; the world is represented symbolically through words and mental images; no understanding of basic mental operations or rules

 Rapid language development

 Understanding of the past and future

 No understanding of Principle of Conservation: basic properties of objects stay the same even though their outward appearance may change

 Mental Irreversibility: cannot mentally reverse actions

 Animism: attributing lifelike qualities to physical objects and natural events



“the chair got in my way / was trying to hurt me”

 Egocentrism: difficulty in viewing the world from someone else’s perspective



“can’t imagine what the other person is viewing from their position” o Concrete Operational Stage: ages 7-12; children can perform basic mental operations concerning problems that involve tangible (“concrete”) objects and situations

 Understand the concept of reversibility

 Display less egocentrism

 Easily solve conservation problems

 Trouble with hypothetical and abstract reasoning

Limits / Criticisms of Piaget o Outcomes have been replicated in populations around the world o Some researchers query whether children respond as they do to please the adult asking the question o Some argue the (repeated) question is so weird (as the answer is so obvious) the child thinks the adult wants or expects you to change the original answer– when more naturalistic ways of asking the questions were developed children performed much better (Goswami and Pauen, 2005).

Development of children’s concept of death o Under 5s: do not understand that death is final, universal, will take euphemisms concretely, may think they have caused death. o 5 to 10 years: gradually develop idea of death as irreversible, all functions ended, universal/unavoidable, more empathic to another’s loss; may be preoccupied with justice o 10 through adolescence: understand more of long-term consequences, able to think hypothetically, draw parallels, review inconsistencies o Dependent on cognitive development and experience

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Social-Emotional Development o Styles of Parenting: two key dimensions

 Warmth (affection, acceptance) versus hostility

 Restrictiveness versus permissiveness o Authoritative Parents: provide structure, warmth and support autonomy

 Establish clear, consistently enforced rules

 Compliance is rewarded with warmth and affection

 Support autonomy as child develops

 Associated with most positive childhood outcomes o Authoritarian Parents: controlling; cold, unresponsive, and rejecting relationship

 Children have lower self-esteem, are less popular, and perform more poorly in school o Indulgent Parents: warm, caring relationships; no guidance and discipline

 Parents fail to teach responsibility and concern for others

 Children tend to be immature and self-centered o Neglectful Parents: do not provide warmth, rules, or guidance

 Children are most likely to be insecurely attached

 Low achievement motivation, disturbed peer relationships, impulsive, aggressive

 Associated with the most negative developmental outcomes

Adolescence o Puberty: a period of rapid maturation in which the person becomes capable of sexual reproduction

 Puberty is a biologically defined period; adolescence is a broader social construction o In addition to bodily changes, adolescence brings changes in thinking and emotions, family experiences, relations with peers, identity, and social expectations

 Typically encompasses 12- to 18-year-olds

Piaget on adolescence o Formal operational stage o Using logic to solve abstract problems o Develop and test out hypotheses o Project over time o Understand contexts influencing own and other’s reaction o Limitations in solving interpersonal conflicts that entail logical conflicts and contradictions

23

Giles Kisby GE Y1 Psychology o Adolescence is a transitional stage of physical and psychological human development that generally occurs from puberty (biologically defined period of rapid maturation in which a person becomes capable of sexual reproduction) to legal adulthood (a social construction). o Adolescence involves cognitive development and physical growth, as distinct from puberty, which can extend into the early twenties. o Chronological age only provides a rough marker of adolescence. o Transition to Formal Operational Stage; Where Abstract thought emerges.

Adolescent begins to think more about moral, philosophical, ethical, social and political issues that require theoretical and abstract reasoning. o Begin to use deductive logic, or reasoning from a general principle to specific information.

The Adaptive Adolescent Brain o 12 – 25yrs extensive brain remodelling (myelinisation, synaptic pruning – reason for so much sleeping!) o Cognitive changes may help journey from the secure world parent(s) provided to fitting into world created by peers o Thrill seeking o Openness to new experiences o Risk taking o Social rewards are very strong o Prefer own age company o Emotionality becomes less positive through early adolescence o But level off and become more stable by late adolescence o Storms and stress more likely during adolescence than rest of the lifespan but not characteristic of all adolescents.

Adolescence and identity o Search for Identity identified as the key crisis during adolescence (Erikson):

 Children typically define self by physical characteristics

 For adolescents sense of identity has multiple components:



Gender, ethnicity, and other attributes by which we define ourselves as members of social groups



How we view our personal characteristics



Our goals and values

 Culture plays a key role in identity formation



Influences the way we view concepts such as “self” and “identity”

Adolescence and Adulthood o Relationships with Parents and Peers:

 Conflict between teens and parents is not as severe as often assumed

 Parent-teen conflict is correlated with other signs of distress

24




Causal direction is unclear

 Peer relationships increase in importance during adolescence



Friendships become more intimate and involve a greater sharing of problems



Peers strongly influence values and behaviours

Emotional Changes in Adolescence: o Emotionality becomes less positive through early adolescence

 Changes level off and become more stable by late adolescence o 34% show major downward changes; 16% show major upward changes o Storm and stress more likely during adolescence than rest of lifespan; but not characteristic of all adolescents

Achieving adulthood o When does development end? o Driving a car o Having first intimate relationship o Getting married o Deciding on a career o Owning your own home o Having children o Retirement o Time Magazine telephone Poll of 601 emerging adults, ages 18-29. November 1-4,

2004

 61% would describe themselves as an adult

 Almost 2 in 5 (39%) say they are either just entering adulthood or are not there yet.

 Even over the age of 21, about 1 in 4 (27%), do not consider themselves adults.

 How come? 35% reveal that they're "just enjoying life the way it is," while

33% say they're not financially independent yet.

 What defines "adulthood" for these young adults? Many in this age group say "moving out of a parent's house" (22%), "having your first child" (22%) and "getting a good job with benefits" (19%).

25


23/05/14: Perception & Attention: David Murphy


-

-

-

-

-

-

-

Notes:

Learning objectives

Define, and differentiate between, sensation and perception.

Contrast bottom-up and top-down processing of sensory information.

Define Attention and contrast focussed and divided attention

Describe the biological development of perceptual skills, and explain how they are affected by cross-cultural factors, critical periods, and experience.

Outline the stages in Humphreys & Riddoch’s hierarchical model of object recognition.

Define Apperceptive and Associative Agnosia

Sensation and perception o Sensation:

 the stimulus-detection process by which our sense organs respond to and translate environmental stimuli into nerve impulses that are sent to the brain

 “Is there anything out there?”

 For humans is fairly average vs other species o Perception:

 The active process of organizing the stimulus output and giving it meaning

 “What is it, where is it, what is doing?”

 This is the aspect that is superior in humans

Absolute threshold = the lowest intensity at which a stimulus can be detected 50% of the

time

[dhtk]

26


Difference threshold = Just Noticeable Difference (JND) o = The difference threshold is the smallest difference between two stimuli that people can perceive 50% of the time

Attention o Refers to the process of focussing conscious awareness, providing heightened sensitivity to a limited range of experience requiring more intensive processing.

Components of attention o Orientating

 Initially grabbing the attention: affected by intensity, novelty, movement, contrast and repetition also internal factors e.g. when hungry more likely to notice food-related stimuli, threat o Focused attention

 The ability to respond discretely to specific visual, auditory or tactile stimuli. o Sustained attention (vigilance)

 The ability to maintain a consistent behavioral response during continuous and repetitive activity. o Selective attention:

 The ability to maintain a behavioral or cognitive set in the face of distracting or competing stimuli. Therefore it incorporates the notion of "freedom from distractibility." o Alternating attention:

 The ability of mental flexibility that allows individuals to shift their focus of attention and move between tasks having different cognitive requirements. o Divided attention

 Multitasking: The highest level of attention and it refers to the ability to respond simultaneously to multiple tasks or multiple task demands

Stimulus characteristics that affect attention: o Intensity o Novelty o Movement o Contrast o Repetition

Personal factors that affect attention: o Motives o Interests o Threats to well-being

 e.g. Participants are faster at finding a single angry face in a happy crowd than a single happy face in an angry crowd

27


The Cocktail party effect (Cherry 1953) o Don’t hear conversations going on around you at a busy party but can switch between conversations at the cost of losing ability to hear the initial continuing conversation o Is often affected in a traumatic brain injury

Dichotic Listening Task o Even if can’t report on other conversations are still processing the information to some degree o Tested by sending different info to each ear; one not listening to still effect interpretation of the sound that are trying to listen to

 Attended ear:



“They were standing near the bank”

 Unattended ear:



One of the following was presented o “river” o “money”

 Participants interpreted “bank” as

 a riverbank if they heard “river”

 a financial bank if they heard “money”

Attentional capacity model Kahneman (1973) o There is a maximal unchangeable capacity for attention which is filled to diff degree due to contextual factors and it is this that is then divided between tasks

28


Perception o Individual elements of the stimulus are combined to produce a coherent, unified perception. o What are the key principles the brain uses in constructing our perception of the world?

Gestalt principles o The word Gestalt in German literally means "shape" or "figure." o The Gestalt effect refers to the form-forming capability of our senses, particularly with respect to the visual recognition of figures and whole forms instead of just a collection of simple lines and curves.

 Figure-Ground perception



It seems that our visual system simplifies the visual scene into a

figure that we look at and a ground which is everything else and forms the background.



“we are effective at pulling figures from the ground even when the image is very ambiguous and very similar in mammy ways to the background”

 Gestalt principles



Similarity – we tend to group similar elements together to form a distinct percept.



Proximity – The brain tends to group together objects that are close to one another.



Closure – If part of a familiar pattern or shape is missing, our brains will “fill in the gap” to create the perception of a complete object



Continuity – If possible the brain organizes stimuli into a continuous perception.

29


Perceptual constancy o The visual system compensates for the fact that the same object casts a different image on the retina in different light conditions, from different perspectives and at different distances. o The process by which we compensate for and consider these problems is perceptual constancy:

 7 monocular depth cues to create a 3-dimensional depth effect.



1 : Linear perspective



2 : Relative size



3 : Height in the horizontal plane



4, 5 : Texture and clarity



6 : Interposition



7 : Light and shadow o Binocular Depth Cues:

 Require the use of both eyes



Binocular Disparity: each eye sees a slightly different image. o Try catching a ball with one eye shut. o Effect enhanced in 3D movies



Convergence: produced by feedback from the muscles that turn your eyes inward to view a close object

Factors Affecting Perception: o Bottom-up processing

 Perception that consists of the progression of recognizing and processing information from individual components of a stimuli and moving to the perception of the whole. o Top down processing:

 Perception is not only affected by the visual stimulus but also by our experiences and expectations o Top-down and bottom-up processing occur simultaneously and interact with each other in our perception of the world around us.

30


Schema = a mental representation of something

Top-down processing o Perceptual Schema: a mental representation or image containing the critical and distinctive features of a person, object, event, or other perceptual phenomenon

 Schemas provide mental templates that allow us to identify and classify sensory input

 Each of our perceptions is essentially a hypothesis about the meaning of the sensory information

 Allows shortcuts instead of interpreting things from scratch every time

 Are not inbuilt; acquired over time hence people of different cultures interprets things differently



Eg westerners perceive depth with a greater extent / priority than

African cultures

Critical Periods o Certain kinds of experiences must occur if perceptual abilities and the brain mechanisms that underlie them are to develop normally

 Kittens raised in completely vertical environments were unable to see horizontal objects, and vice-versa (Blakemore & Cooper, 1970)

 Must be exposed to certain stimuli during a specific period of life otherwise will fail to later deveop the relavant perception of that object (cats only exposed to vertical lines can’t perceive horizontal lines)

31

Giles Kisby

Object recognition (after Humphreys & Riddoch)

GE Y1 Psychology

Visual Agnosia (literally “not knowing”) o Agnosia = visual not impaired o Apperceptive visual agnosia is characterised by intact visual ability on a basic sensory level, but a defect in early stage visual processing that prevents a correct percept of the stimulus being formed. The patient is unable to access the structure

or spatial properties of a visual stimuli and the object is not seen as a whole or in a meaningful way.

 Problem pulling the object out of the background o In Associative visual agnosia, primary sensory and early visual processing systems

are preserved. The patient can perceive objects presented visually but cannot

interpret, understand or assign meaning to the object, face or word.

 CK (Behrmann, Winocur & Moscovitch) is severely agnosic. He is able to produces accurate drawings…but cannot later recognize the identity of his own drawings.

32


Perception and attention - Summary o Sensation o Components of attention o Gestalt principles o Perceptual constancy o Depth perception o Top-down vs bottom-up processing o Cultural differences in perception o Development of perception o Object recognition and agnosia

33


23/05/14: The perception of physical symptoms: David

Murphy

Los (from booklet): o o o o o o o

- o o

Notes:

Learning objectives

Explain the limitations of a uni-dimensional model of pain.

Outline the Gate Theory of Pain and explain the mechanisms through which the psychological factors influence the experience of pain.

Discuss the lack of concordance of physiological parameters and symptom perception.

Discuss the role of attention in symptom perception (esp pain).

Describe the role of anxiety and mood in symptom perception.

Describe the role of culture and social environment in symptom perception and illness behaviour.

Define the different methods of measuring pain

Define the placebo effect and possible mechanisms of action

Explain the differences between acute and chronic pain.

Descartes’ Concept of “The pain pathway” from L’Homme (1644) o Direct proportionality of stimulus to perception o “If for example fire (A) comes near the foot (B), the minute particles of this fire, which as you know move with great velocity, have the power to set in motion the spot of the skin of the foot which they touch, and by this means pulling upon the delicate thread (cc) which is attached to the spot of the skin, they open up at the same instant the pore (d.e.) against which the delicate thread ends, just as by pulling at one end of a rope makes to strike at the same instant a bell which hangs at the other end.”

34


Perception of symptoms is typically more important than the status of the underlying pathology from the patients perspective o Henry Knowles Beecher (1904 –1976) The relationship between wound severity and pain (1956)

 Disproved Descartes model: showed was not as straightforward and that the perceived meaning of the injury affects perception



Eg End of danger for soldiers vs start of hardship for civillians (see below)



Eg Annual hook-swinging ceremony celebrating end of harvest: celebratory event so pain not felt

 Soldiers in World War II:



49% “Moderate” or “Severe” pain.



32% requested medication.

 Civilians with similar wounds:



75% “moderate” or “severe” pain



83% requested medication

Gate Theory of Pain (Melzack & Wall) o Ascending pain pathway is combined with descending inhibitory pain signalling hence cortical signalling etc can reduce pain perception in certain circumstances o Other peripheral fibres can act to increase or decrease OVR signalling o All pain lies on the Psychogenic / somatogenic continuum and considers both mental and physical aspects for OVR perception

35


Perception and attribution of bodily symptoms o A physical symptom is a perception, feeling, or belief about the state of our body.

(It)….is often-but not always – based on physiological activity. Above all, a physical symptom represents information about our internal state

 Factors affecting perception



1. Attention  inc perception



2. Anxiety  attention  inc perception o Arntz et al (1991): Anxiety in itself is not a key factor in perception; only if subsequently leads to inc attention will it lead to inc pain perception etc



3. Expectation  attention  inc perception o Role of expectancy in pain perception

(Anderson & Pennebaker 1980)

 49 College students participated in an experiment which involved placing one hand in an apparatus consisting of a vibrating piece of sandpaper.

 Participants were told either:



1) That the experience may be painful or



2) The experience may be pleasant

Or



3) Not given any prior information.

36

Giles Kisby GE Y1 Psychology o “Given an undefined state of bodily arousal, individuals will seek and labels, and given a label individuals will seek and find symptoms” Meyer et al (1985)

 Perception of symptoms while jogging on a treadmill



56 male participants walked on a treadmill for 11 minutes on two separate occasions.



On first occasion wore headphones but heard nothing



On second occasion one group heard amplified sounds of their own breathing  perceived more symptoms.



The other group heard street sounds e.g. noise of cars, snippets of conversation  perceived fewer symptoms

Measure of symptom perception eg pain: o 1. Subjective measures

 Verbal measures

 a. Unstructured

 b. Verbal rating scales e.g.



“Mild, Moderate or Severe”

 c. Visual/graphical rating scales o 2. Physiological measures

 Galvanic Skin response

 Heart rate

 Breathing rate o 3. Pain behaviour

 See pic on right

 Use vs neonates

37


Illness representations model (Leventhal et al 1980) o Definition: “A patients own implicit, commonsense beliefs about their illness”

 Identity



Identity can be considered the label of the illness and the symptoms the patients view as being part of the illness

 Cause



Cause is the patients’ views about what may have caused their problem, such as genetic factors, family circumstances, trauma, etc.

 Consequences



Consequences include the effects the clients are expecting from their illness and their views on the outcome

 Time line



Time-line is the clients’ view about how long their problem will last and whether it is seen as acute, chronic or episodic

 Curability/controllability



Cure/control is about the patients’ expectations as they recover from or control the illness o Component Items

 Cause – “A germ or virus caused my illness” “Pollution of the environment caused my illness” “Stress was a major factor in causing my illness.”

 Timeline - “My illness is likely to be permanent rather than temporary” “My illness will last for a long time.”

 Consequences - “My illness has major consequences on my life” “My illness is a serious condition”

 Cure-Control - “There is little that can be done to improve my illness.”

 “My treatment will be effective in curing my illness”

38


Factors influencing illness representations o Previous personal experience

 e.g. previous illness o Social learning

 e.g. Parental modelling o Transmission of information

 (e.g. Medical student’s disease - Mechanic 1962)



Perceiving symptoms of diseases leart about due to focussed attention on details of that state o Culture

 e.g. idea of Imbalance between Hot & Cold food giving problem, Evil eye o Individual differences

 i.e. Personality, health beliefs

Why patients consult when they cough Cornford (1998) o Representations of illness differed between consulters and non-consulters

 Consulters of cough:



Identity – “bronchitis”



Cause – “virus”



Consequences – “worried that cough is putting strain on the heart”



Time-line – “it’s not going away” “it recurred”



Curability – “need antibiotics”

Placebo: o Pain relief from 10mg Morphine vs Saline (Houde et al 1960)

39


Factors associated with placebo response o Patient factors

 no clear “placebo-responder” personality o Therapist factors

 e.g. status of practitioner, confidence in practitioner. o Treatment factors

 injections>pills, larger pills more effective, green & brown most effective colours for pills

 Amanzio et al (2001)



278 patients recovering from thoracic surgery given IV analegics.

Drugs were either given by doctor injecting into cannulae in view of the patient (Open: greater effect resulted) or via a programmed infusion machine (Hidden: less effect).



86 health volunteers underwent ischaemic pain task and given open or hidden analgesic plus Naloxone (an opiate antagonist: cancelled out the placebo effect so suggest endogenous opiates mediate the placebo effect)

40


Possible mechanisms underlying the placebo effect o Classical Conditioning o Expectancy/Anxiety/Attention o Release of endogenous opiates o N.B. Not mutually exclusive

Acute vs Chronic Pain o <1 month

 Usually obvious tissue damage

 Increased nervous system activity

 Pain resolves upon healing

 Serves a protective function o >3-6 months: chronic: other factors come into effect that worsen the OVR pain state

 Pain beyond expected period of healing

 Usually has no protective function

 Degrades health and function

41


23/05/14: Individual differences: Dr Stephen Gunning


Learning Objectives

Outline psychodynamic theory of personality development.

Describe the ‘Big Five’ trait model of personality

Explain how psychometric testing is used in personality measurement

Describe Spearman’s g factor of intelligence and cite evidence that supports it.

Differentiate between crystallised and fluid intelligence and explain how they are affected by aging.

Explain how psychometric tests help differentiate between normal changes in cognition through aging and those caused by disease

Define IQ and explain why it is not always a useful concept to describe an individual’s abilities.

Describe the findings of twin studies on the roles of heredity and environment in intelligence research

Define Simon Baron-Cohen’s Systemising and Empathising Quotients and how they relate to autism.

Notes:

Why important? o Not working with ‘consistent’ phenomena

 e.g. human vs litre of hydrogen o Averaging and need to consider gender, level of physical activity etc

 e.g. metabolic rate

42


Personality: o the distinctive and relatively enduring ways of thinking, feeling, and acting that characterise a person’s responses to life situations o Freud’s Psychoanalytic Theory:

 Studied ‘hysteria’ with Jean Charcot



Believed that symptoms were related to repressed memories and feelings

 Personality is an energy system

 Instinctual drives generate psychic energy, which constantly seeks release

 Three “structures”:



Id (~ hippocampus) o the only structure present at birth o Exists totally within the unconscious mind o Pleasure Principle: seeks immediate gratification and release, regardless of rational considerations and environmental realities



Ego (~ ventrolateral prefrontal cortex) o Operates primarily at the conscious level o Reality Principle: tests reality to decide when and under what conditions the id can safely satisfy its needs



Superego (~ prefrontal) o Last to develop o Contains the traditional values and ideals of family and society o Morality Principle o The Trait Perspective

 Personality Traits: relatively stable cognitive, emotional, and behavioural characteristics of people that help establish their individual identities and distinguish them from others

 A trait is a continuum along which individuals vary, like nervousness or speed of reaction.

43


 We can’t observe traits but infer from behaviour o Eysenck’s Two Factor Model

 Hans Eysenck (1916-1997)

 British psychologist, who, at the time of his death, was the most frequently cited psychologist alive

 Personality theory has two main factors:



Neuroticism or stability – the tendency to experience negative emotions



Extraversion – the degree to which a person is outgoing and seeks stimulation o The Five-Factor Model of Personality

 The big five factors of personality (“supertraits”) are thought to describe the main dimensions of personality—specifically, neuroticism (emotional instability), extraversion, openness to experience, agreeableness, and conscientiousness.

 Use the acronym OCEAN to remember the big five personality factors:

44


 How tested:



Personality Test Example o Openness e.g. “I enjoy philosophical discussions” o Conscientiousness e.g. “I am usually well prepared” o Extraversion e.g. “I am the life of the party” o Agreeableness e.g. “I put other people down” o Neuroticism e.g. “I seldom feel blue”

 The Trait Perspective



Some personality dimensions tend to be more stable over the lifespan than others o Introversion-extraversion remains relatively stable o Openness and extraversion tend to decline with age o Agreeableness and conscientiousness tend to increase with age o Females tend to decrease in neuroticism

 Evaluation



Focuses attention on the value of identifying, classifying, and measuring stable, enduring personality dispositions



Need to focus on how traits interact with each other

45




Some behaviours may be more situation dependant rather than personality dependant o Bandura’s Key Terms

 Reciprocal determinism



Cognitions, behaviours, and the environment interact to produce personality

 Self-Efficacy (person’s expectation of success) is shown to be a strong determinant to of whether able to implement a behaviour change



Ie this can be thought of as separate to their personality



Eg rodger bannister and the 4 min mile: it had shown to be possible so more people had sufficient self efficacy



Four sources of Self Efficacy:



Focuses only on description, not explanation; attempts to explain: o Eysenck proposed a biological, genetic basis for personality traits

 Differences in customary levels of cortical arousal



Introverts are overaroused; extraverts are underaroused

 Suddenness of shifts in arousal



Unstable (neurotic) people show large and sudden shifts in limbic system arousal; stable people do not o Genetic Influences on Personality

 123 pairs of identical twins and 127 pairs of fraternal twins

46


 Measured on “Big Five” personality dimensions

 Results suggest that personality differences in the population are approximately 50% genetically determined. o Personality & Intelligence

 Locus of control



Extent to which people believe they can influence events that affect them

 Which of the ‘big five’ personality traits correlate with intelligence?



Openness, Conscientiousness, Extroversion, Agreeableness,

Neuroticism o Openness positively correlates with measures of verbal intelligence o Conscientiousness negatively correlates with intelligence test scores

 Intelligence:

 the ability to acquire knowledge, to think and reason effectively, and to deal adaptively with the environment



“Intelligence is what intelligence tests measure” (Boring, 1923) o Is defined by how we measure it



Alfred Binet and Théodore Simon o Develop first intelligence test to identify French children that might have difficulty in school o All children follow the same course of mental development, but at different paces

47

Giles Kisby GE Y1 Psychology o Binet-Simon scale measures mental age rather than a chronological age



Lewis Terman o Converts the Binet-Simon scale to suit California children

(Stanford-Binet scale) o Introduced the IQ score (intelligence quotient)

 Term coined by William Stern

 A score of 100 is considered average

 Test-taker’s performance relative to average performance of other’s the same age

 Charles Spearman



Believed intellectual activity involves a general factor (g) and specific factor



Develops factor analysis o People who excel in one area often excel in other areas o Statistical procedure which examines inter-correlations between different tests of mental ability

48


 The Psychometric Approach



Cattell and Horn (1971, 1985) broke down Spearman’s ‘g’ into two distinct but related subtypes (with a correlation of about .50)



Crystallized Intelligence (gc): o the ability to apply previously acquired knowledge to current problems. Will commonly improve with age.



Fluid Intelligence (gf): o the ability to deal with novel problem-solving situations for which personal experience does not provide a solution.

Shows pattern of decline in aging.

 The utility of IQ scores



Is an average of several factors so an abnormality in one may be missed:



This criticism is especially relevant for clinical applications of such tests e.g. Stroke pts o Consider a doctor who devises a limb strength quotient or

LQ by totalling the strength of all four limbs, again with a mean of 100. o Now consider a tennis player who sprains his left ankle reducing his left leg score to 50, but his right leg scores 140 and his right and left arms score 160 and 130 respectively. o His LQ would be 120 – well above average, so no problem, right? (Lezak, 1988)



Changes with age occur so must consider people vs same age:

49

Giles Kisby GE Y1 Psychology o Intelligence is relatively stable with age:

 Stability of Intelligence



Taking the same IQ test at age 11 & age 80: Scottish Mental Survey

1932

Gardner’s Multiple Intelligences o Linguistic Intelligence: e.g. Shakespeare o Logical-Mathematic Intelligence: e.g. Einstein o Spatial Intelligence: e.g. Gaudi o Musical Intelligence: e.g. Lennon.

 Furthermore, Gardner believes cardiologists may have this kind of intelligence in abundance as they make diagnoses on the careful listening to patterns of sounds. o Bodily-Kinaesthetic Intelligence: e.g. Messi o Intrapersonal Intelligence: e.g. Socrates o Interpersonal functioning: e.g. Freud

 More recently he proposed Naturalistic Intelligence, the ability to understand and work effectively in the natural world (Gardner,1999) e.g.

Ray Mears, and Existential Intelligence (Gardner, 2000), the philosophical ability to ponder questions about one’s existence e.g. Sartre.

50


Heredity and Environment o Genetic factors can influence the effects produced by the environment

 Accounts for 1/2 to 2/3 of the variation in IQ

 No single “intelligence gene” o Environment can influence how genes express themselves

 Accounts for 1/3 to 1/2 of the variation in IQ

 Both shared and unshared environmental factors are involved

 Educational experiences are very important o An Example of “Genetic Vs. Environmental” Influences on Intelligence (Plomin et al.

2007): o The Intelligence Controversy: Are IQ Tests Culturally Biased?

 Can’t compare genetics different races in different conditions due to the differences in env factors that will predominate o Gender Differences in Intelligence

 Gender differences in performance on certain types of intellectual tasks, not general intelligence

 Men generally outperform women on spatial tasks, tests of target-directed skills, and mathematical reasoning

 Women generally outperform men on tests of perceptual speed, verbal fluency, mathematical calculation, and precise manual tasks

51

Giles Kisby GE Y1 Psychology o Autism Research

 Autism and Asperger’s syndrome share three core diagnostic features



Difficulties in social development



Difficulties in development of communication



Narrow interests and repetitive behaviour

 They are distinguished by Asperger’s syndrome requiring at least average IQ and that the child spoke on time

 There is a normal distribution of autistic traits in the general population o Sex differences and autism: “extreme male brain”

 Classic autism has a 4:1 male: female ratio

 Asperger’s syndrome has a 9:1 male: female ratio

 Baron-Cohen (2002) explains the social and communication difficulties in autism and Asperger’s syndrome by delays or deficits in empathy whilst explaining the narrow interests with reference to skills in systemising



Empathising consists of both being able to infer the thoughts and feelings of others (‘Theory of Mind’) and having an appropriate emotional reaction



Systemising is the drive to analyse or construct any kind of system i.e. identifying the rules that a govern a system, in order to predict how that system will behave (Baron-Cohen, 2006)

 Empathy Quotient Examples



I get upset if I see people suffering on news programmes.



I can pick up quickly if someone says one thing but means another



I can’t always see why someone should have felt offended by a remark

 Systemising Quotient Examples



I am fascinated by how machines work



I find it very easy to use train timetables, even if this involves several connections



I do not keep careful records of my household bills.

52


 Cohen: 5 types of brain: see booklet for explanation of each type o Criticism: ‘Neurosexism’?

 Env effects: boys and girls given different toys etc to favour diff type of brain



Fine (2010) argues that impossible to exclude contribution of environment and culture



Findings of sex differences reflect bias in gender roles



Science meets politics?

53


23/05/14: Coping with treatment: Dr Stephen Gunning


Learning objectives

Describe with reference to Lazarus & Folkman’s Transactional definition of stress why some medical and surgical procedures are stressful.

Identify strategies to prepare patients for treatment

Describe the two different types of information which can be provided and their relative efficacy in reducing distress.

Describe the effect of perceived control on patient distress.

Define and give examples of problem-focussed and emotion-focussed coping strategies.

Discuss the importance individual differences in preferred coping style and the importance of matching preparation to patient preferred coping style.

Describe the specific considerations for helping children cope with treatment.

Give examples of effective strategies to help children cope with treatment.

Notes:

Transactional definition of stress o Stress is a condition that results when the person / environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available.

Why is patient distress a bad thing? o Moral/ethical responsibility to minimize suffering if possible. o If treatment is distressing there is a greater chance of patients avoiding or not complying. o Distress during treatment related to longer term psychological morbidity. o Distress during treatment related to wide variety of treatment outcomes.

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Problem vs Emotion Focussed coping o Problem Focussed coping

 Efforts directed at changing the environment in some way or changing one’s own actions or attitudes o Emotion focussed coping

 Efforts designed to manage the stress-related emotional physical responses in order to maintain one’s own morale and allow one to function.

1. Increasing predictability o Egbert (1964)

 Randomly allocated 97 patients to receive preparation for surgery or normal care.

 Prepared group reported less pain, used less analgesic medication and their post-operative stay in hospital was an average of 2.7 days shorter. o Procedural vs sensory information: Johnson (1973)

 Procedural information



Information about the procedures to be undertaken

 Sensory information



Information about the sensations that may be experienced.

 Participants (male undergraduates) were given either sensory or procedural information before undergoing a pain task.

 Results showed that the participants given sensory information reported significantly less distress during the procedure

 Patients about to undergo a cholecystectomy were randomly assigned to one of three preparation groups:



Sensory information



Procedural information



Routine preparation

 Results



Both procedural and sensory information led to lower levels of helplessness but only sensory information led to reduced fear.



Length of hospitalization: o General information – 6.7 days o Procedural information – 4.7 days o Sensory information – 3.3 days (Statistically significant)

 Dual process hypothesis



Proposes that procedural and sensory information work in different ways.



Procedural information works by allowing patients to match ongoing events with their expectations in a non-emotional manner.



Sensory information works by “mapping” a non-threatening interpretation on to these expectations.

55

Giles Kisby GE Y1 Psychology o How much information is enough?

 Auerbach (1983)

 40 patients undergoing dental extraction surgery were either given general or detailed information in a pre-operative preparation.

 Krantz Health Opinion Survey administered (assesses desire for information).

 Distress during procedure measured.

 Result: best amount of information really is dependent on patient preference (no absolute correct amount of info to give)

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2. Increasing control o Long term setting: Nursing Home Study Langer & Rodin (1976)

 Floor 1



In a meeting, emphasized to residents that they could make choices and had responsibility:



Could rearrange furniture in rooms.



Could decide what to do in their free times.



Choice of movies.



Offered choice of plant which they looked after themselves.

 Floor 2



Similar meeting—emphasized to residents how staff wanted them to be happy.



Told that staff will ensure rooms are pleasant.



Given a timetable of activities.



Movie night, but no choice.



Given a plant but nurses watered and cared for it.

 Results



On behavioural measures floor 1 residents (enhanced control group) showed greater engagement in activities.



Self report and nurse's ratings showed Floor 1 residents had better

general well being.



Link to mortality: 18 Months later – 15% of Floor 1 residents had died compared to 30% of Floor 2 residents. o Acute setting:

 Dental traffic lights activated during pain by patient and seen by dentist:



Vs pain: Discomfort decreased only if patient signalled and dentist responded



Vs anxiety: information giving alone is sufficient to decrease discomfort o Emotion vs Problem Focussed coping

 Many studies have found that use of emotion focussed coping strategies associated with poorer adjustment and greater levels of depression e.g.

Holahan & Moos (1990)

 However, need to beware of circular reasoning (i.e. those who are more distressed may need to engage in more emotion-focussed coping).

 Optimal coping strategy depends on both the individual’s coping style and also the situation

 Emotion-focussed coping



Examples: o Meditation o Relaxation techniques o Deep-breathing o Distraction o Praying

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 Problem focussed coping:



Directed towards reducing or eliminating a stressor, adaptive behavioural o Coping strategies in an uncontrollable situation (Strentz & Auerbach 1988)

 Airline employees participated in an FBI training programme to train them to cope with hostage situations. Employees were randomly assigned to training in:



Problem focussed coping strategies



Emotional focussed strategies



Control condition – no coping training

 Some weeks later they were unexpectedly kidnapped by FBI agents posing as terrorists and held captive for 4 days.



Emotion focussed was most helpful in the context of uncontrollable situations o Martelli et al (1987)

 46 patients awaiting pre-prosthetic oral surgery

 Administered the Krantz Health Opinion Survey

 Given a 20 minute preparation either emotion focussed or problem focussed or a mixed preparation to people with high or low preference for information

 Results: see below: must adapt tactics to patient

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Giles Kisby GE Y1 Psychology o Effect of social support (Kulik and Mahler (1989)

 Male patients undergoing coronary bypass surgery allocated to share a room with either a pre-operative or post-operative patient.

 Patients who shared with recovering patients left hospital on average 1.4 days earlier.

Helping children to cope with treatment o Presence of parent in treatment

 Level of parental anxiety is highly influential

 Marzo et al (2003) assessed behaviour of children during dental treatment.

Half children had parent present, half did not. 89% of children with the parent out were “fully cooperative” compared to 63% of the group with the parent in.

 Frank et al (1995) found children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety. o Chambers et al (2002)

 120 children aged 8-12 years

 Mothers randomly allocated to training in one of three interaction styles:



Pain promoting (reassurance & empathy etc)



Pain reducing (distraction, humour etc)



No training

[All children underwent a cold pressor task]

 Effect of training on pain experience seen for girls (although not boys)



Pain promoting  inc parental anxiety  inc pain experience by child

59

Giles Kisby GE Y1 Psychology o Modelling intervention for children undergoing surgery Melamed & Siegal (1975)

 Children aged 4-12 years old undergoing operations e.g. tonsillectomy.

 Half of children shown a film “Ethan has an operation” depicting child in hospital. The other half watched a control film.

 Observer rating of verbal and non-verbal anxiety behaviour measured.

 Lower anxiety with those shown the hospital film o Preparing children for treatment

 Studies have found that children under 7 benefit most from information presented shortly before a procedure.

 However, in older children information presented immediately before an event may increase distress (Blount et al 2003). Baldwin & Barnes (1966)

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Giles Kisby GE Y1 Psychology found that older children benefit most from information presented 4-7 days before a procedure.

 However, most parents believed their children should not be given information until the day of the procedure. o Jaaniste et al (2007)

 78 Children aged 7-12 years

 Completed Pain Coping Questionnaire to identify preferred coping strategies

(inc behavioural distraction)

 Underwent a cold pressor task

 One group received an imagery based distraction read to child (50 seconds duration)

 Another group no special preparation

 Results: had shown that they were able to identify the style that was best for them o Combined approach

 Tell: Using simple language and a matter-of-fact style, the child is told what is going to happen before each procedure.

 Show: The procedure is demonstrated using an inanimate object, a member of staff or the dentist him or her self.

 Do: The procedure does not begin until the child understands what will be done.

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23/05/14: Coping with illness and disability: Dr Stephen

Gunning


Learning objectives

Describe with reference to Lazarus & Folkman’s Transactional definition of stress why some medical and surgical procedures are stressful.

Identify strategies to prepare patients for treatment

Describe the two different types of information which can be provided and their relative efficacy in reducing distress.

Describe the effect of perceived control on patient distress

Define and give examples of problem-focussed and emotion-focussed coping strategies.

Discuss the importance of identify individual differences in preferred coping style and the importance of matching preparation to patient preferred coping style.

Describe the specific considerations for helping children cope with treatment.

Give examples of effective strategies to help children cope with treatment.

From slides:

Describe Kubler-Ross’s Stage Theory model of grief

Discuss the evidence for the existence of discrete universal stages of adjustment and give examples of some limitations of stage theories.

Outline the Crisis theory of adjustment, give examples of illness and background factors affecting adjustment and describe the role of appraisal.

Define Leventhal’s five dimensions of illness representations.

Describe how illness representations can influence recovery after illness or injury

Cite evidence that demonstrates how psychological factors can affect outcome in long-term health conditions

Give examples of how psychological interventions can improve coping behaviours and emotional adjustment to illness and disability

Notes:

Transactional definition of stress o Stress is a condition that results when the person / environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available.

Cognitive Appraisal

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Giles Kisby GE Y1 Psychology o For example, when considering an exam you will evaluate how hard it will be and how much it counts (primary appraisal) and how your current knowledge equips you to pass (secondary appraisal) o You will also take into account potential consequences of failing with regards to their likelihood and seriousness o Finally, the psychological meaning of the consequences may be related to your beliefs about yourself or the world, e.g. “I am a total failure if I don’t do well in all my exams”

Stage model: Elizabeth KÜbler-Ross o Reactions to terminal illness o Dr. Elisabeth Kubler-Ross became internationally known in 1969 for her book Death and Dying. o From interviewing dying clients she outlined five reactions of the person facing death:

 Denial

 Anger

 Bargaining

 Depression

 Acceptance o Denial

 The person thinks "This isn't really happening”. They may lie about the situation and tell themselves that this is just temporary and everything will be back to normal soon. It is often used as an attempt to cushion the impact of the source of grief. o Anger

 The person thinks "Why me" or "How could God do this to me“. The person feels generalized rage at the world for allowing something like this to happen. They feel isolated and furious that this is happening to them. They think it's unfair and may feel betrayed. Outbursts of anger in unrelated situations can occur. o Bargaining

 The person thinks "If I do this, I can make it better, I can fix things." One may feel guilt and feel it is their responsibility to fix the problems. They make an attempt to strike bargains with God, spouses, or parents. “I’ll be a good person, if I get another chance” o Depression

 The person thinks "My heart feels broken" or "This loss is really going to happen and it's really sad." At this stage, the person is absorbed in the intense pain they feel from having their world come apart. They can be overwhelmed with feelings of helplessness and sadness.

 “Confronting denial”: IS WRONG (cf MYTHS)

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

“It is often necessary to confront the patient gently but firmly with the reality of his situation and force him into a period of depression

while he works out his acceptance of his loss”

 May fail to exit this phase:



Pollard & Kennedy (2007) o 87 people with spinal-cord injuries assessed at 12 weeks post injury and followed up 10 years later. o At 12 weeks 38% of patients above threshold on depression questionnaire. o At 10 years 35% above threshold. o No statistically significant difference between scores at 12 weeks and 10 years and these were the same people

 Resilience persists and is the norm; are not in danger of a later period of depression o Acceptance

 The person thinks "This did occur, but I have great memories" or "It is sad but I have so much to live for and so many to love." The loss is accepted and we work on alternatives to coping with the loss and to minimize the loss.

Weaknesses of stage models o Don’t account for variability in response o Place patients in a passive role o Fail to consider social or cultural factors o Focus on emotional responses and neglect cognitions and behaviour o Pathologise people who do not pass through stages

Crisis theory: Crisis theory of coping with serious illness (Moos & Schaefer 1982)

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[influences  cognition  behaviours  outcomes] o Factors affecting adjustment [see diagram]

 Illness related-factors:



Unexpected



Cause & Outcome (eg assault)



Prior experience



Pain



Disability caused



Disfigurement / visibility



Uncertainty/progressiveness

 Background/Personal factors:



Age of onset



Gender



SES & occupation



Religious/philosophical views



Pre-existing personality [see below detail]



Pre-existing self esteem



Locus of control



Pre-existing illness beliefs

 Physical and Social environment:



Hospitalisation



Accommodation and physical aids/adaptations



Stigma



Social support o social isolation is a robust predictor of cardiac mortality as in pic o Brummett et al (2001) found that the most socially isolated cardiac pts scored higher on a hostility measure, had lower incomes, and were more likely to be smokers.

65


 However even when these variables were adjusted for, social isolation still remained a robust predictor

of cardiac mortality o Significantly increased risk of cardiac mortality if isolated (1-

3) but no benefit of very big support network

Pre-existing personality: o Boyce & Wood (2011)

 4-Year prospective study of life satisfaction 307 individuals who were newly disabled (from rep. sample of 11,680)

 Different adaptation for high and low Agreeableness: high value gives crisis theory trajectory, low value gives progressive decline as below

 High agreeableness  high life satisfaction at time progresses

 Big Five Personality Traits:

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

Openness to experience: o

(inventive/curious vs. consistent/cautious). Appreciation for art, emotion, adventure, unusual ideas, curiosity, and variety of experience. Openness reflects the degree of intellectual curiosity, creativity and a preference for novelty and variety a person has. o O – not linked to health



Conscientiousness: o

(efficient/organized vs. easy-going/careless). A tendency to be organized and dependable, show self-discipline, act dutifully, aim for achievement, and prefer planned rather than spontaneous behavior.

o C - +2 years life expectancy



Extraversion: o (outgoing/energetic vs. solitary/reserved). Energy, positive emotions, surgency, assertiveness, sociability and the tendency to seek stimulation in the company of others, and talkativeness.

o E – lower rates of CHD



Agreeableness: o (friendly/compassionate vs. analytical/detached). A tendency to be compassionate and cooperativerather than suspicious and antagonistic towards others. It is also a measure of one's trusting and helpful nature, and whether a person is generally well tempered or not.

o A – Hostility associated w/ CHD



Neuroticism: o ( sensitive/nervous vs. secure/confident). The tendency to experience unpleasant emotions easily, such as anger, anxiety, depression, and vulnerability. Neuroticism also refers to the degree of emotional stability and impulse control and is sometimes referred to by its low pole,

"emotional stability".

o N – higher rates of alcohol and smoking; higher symptoms report o Coping process

 Coping appraisal:

67




Definition: “A patients own implicit, commonsense beliefs about their illness”



Considers factors such as o Identity - E.g. “I have a cold, with a sore throat and runny nose” o Cause – “A germ or virus caused my illness” “Pollution of the environment caused my illness” “Stress was a major factor in causing my illness.” o Timeline - “My illness is likely to be permanent rather than temporary”

“My illness will last for a long time.” o Consequences - “My illness has major consequences on my life” “My illness is a serious condition” o Cure-Control - “There is little that can be done to improve my illness.” “My treatment will be effective in curing my illness”

 influence of illness beliefs on recovery: o Petrie et al (1996) found that measures of illness representation after MI were better predictors of return to work than severity of illness

 74 patients with acute MI were asked to draw pictures of their heart (before discharge from hospital)

 Recovery was assessed 3 months later, measuring work, exercise, distress about symptoms and perceptions of recovery

 Patients who drew damage to their heart perceived that their heart had recovered less at 3 months, that their heart condition would last longer and had lower perceived control over their heart condition

 Extent of damage drawn correlated to slower return to work

 Peak troponin-t not related to 3-month outcomes or return to work

 “Drawings of damage predict recovery better than medical variables” o Patients who have weaker belief in the control or cure of heart condition were less likely to attend cardiac rehabilitation (Cooper et al., 1999) o Attributing the cause to ‘stress’ was predictive of mortality 7 years after MI (Weinman et al., 2000) o Cherrington et al. (2004) found that negative illness perceptions were predictive of in-hospital complications in recovery

 Adaptive tasks

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

Tasks related to illness or treatment o Coping with symptoms or disability o Adjusting to hospital environment and medical procedures. o Developing and maintaining good relationships with healthcare professionals.



Tasks related to general psychosocial functioning o Controlling negative feelings and retaining a positive outlook for the future o Maintaining a satisfactory self image and sense of competence o Preserving good relationships with family and friends o Preparing for uncertain future o When fail to do so:

 Depression:



Prognostic studies conclude that CHD pts with depression have 2.0 to 2.5 times higher risk of mortality in first two years



Explanations vary from physiological changes (e.g. platelet activity) to affect on health behaviours (e.g. levels of physical activity)

 Coping Skills



Denying or minimizing seriousness



Seeking relevant information



Learning specific illness related procedures



Setting concrete limited goals



Rehearsing alternative outcomes



Seeking reassurance and emotional support o Importance of social support

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 86 women with breast cancer were randomly assigned to a support group or control – i.e. normal medical care

 Aim was to improve quality of life

 BUT, 48 months later all the women in the control had died whereas a third of the women from the support group were still alive (Spiegel et al. 1989)



NICE recommended treatments in adults with chronic physical health problems o Psycho-education o Group-based skills training o Individual and group cognitive behavioural therapy (CBT) o Treatment of identified specific co-morbid mental health disorders, for example, CBT or anti-depressants for the treatment of depression.

The myths of coping with loss/disease: o Distress or depression is inevitable. / Distress is necessary, and failure to experience people are not at risk of a later period of depression onset o Expectations of recovery

 People prone to neg attitude may have them long term o Reaching a state of resolution

 Not the case for all people eg chronic pain patients – never “resolved” distress is indicative of pathology. / The importance of “working through” the loss.

 As prev resilience determines extent of neg effect on patient and such

70


Not All Downhill! o Many (>30%) people report significant and valuable changes from the experience of the illness.

 Stronger relationships, intimacy, sex life improved

 Sense of purpose and meaning

 Active coping, renewed interests

 Active in self-management of illness

Reaction to diagnosis o “The main thing I remember about being told the diagnosis was an overwhelming sense of relief. At last I had reasons and explanations for feeling so terrible......Looking back I am amazed at all the false explanations I had come up with for the way I had been feeling for the couple of months before going to my GP.

The muscle cramps I had put down to being unfit, and the skin troubles to poor diet. I had given up smoking a few months before, and when I developed an unquenchable thirst, I assumed that I had exchanged one oral addiction for another! What a relief it was to discover that, far from being unfit, inadequate and neurotic I was merely diabetic”

WHO:

WHO definition of Health o “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Quality of life o “Quality of life is defined as the individuals perception of their position in life...It is a broad ranging concept affected in a complex way by a person’s physical health, psychological state, level of independence and their relationship with salient features of their environment”

ICF model: International Classification of Functioning (ICF) o Body Functions - physiological functions of body systems o Body Structures - anatomical parts of the body such as organs, limbs and their components. o Impairments - problems in body function or structure such as a significant deviation or loss. o Activity limitation - the execution of a task or action by an individual. o Participation restriction - involvement in a life situation.

71

Giles Kisby GE Y1 Psychology o Environmental Factors - make up the physical, social and attitudinal environment in which people live and conduct their lives. o Personal factors

Appraisals are often what is important regarding life satisfaction rather than the actual functional status of the individual: o Helplessness

 e.g. “Because of my condition I miss the things I like to do most” o Acceptance

 “I can handle the problems related to my condition” o Disease benefits

72

Giles Kisby

 “My condition has taught me to enjoy the moment more”

GE Y1 Psychology

73


10/01/14: Memory and cognitive aspects of mental health disorders: Dr Alexandra Garfield


Learning Objectives

Define memory and the processes of registration, encoding, storage and retrieval

Describe the components of working memory

Describe the different types of long-term memory

Differentiate between effortful and automatic processing

Define schema and explain how schemas enhance encoding and influence memory construction

Define an associative network

Outline the role of cognitive factors in depression

Notes:

Define memory and the processes of registration, encoding, storage, and retrieval o Memory: defined

 Memory refers to the processes that are used to acquire, store, retain and later retrieve information. There are three major processes involved in memory: encoding, storage and retrieval

74


Memory involves a number of stages: o Input from our senses into the memory system o Processing and combining of received information o Holding of that input in the memory system o Recovering stored information from the memory system (remembering)

Registration o Registration is necessary for storage to take place but not everything that a person registers is stored o Something has to be stored to be retrieved but the fact that it is stored does not guarantee it will be retrieved on a particular occasion

Encoding o More effective encoding into long-term memory increases the likelihood of retrieval o Effortful Processing:

 initiated intentionally

 requires conscious attention o Automatic Processing

 occurs without intention

 requires minimal attention

Depth of processing o In 1975 Canadian psychologists Fergus Craik and Endel Tulving conducted a set of experiments that demonstrated this effect. The experimenters asked subjects to answer questions about a series of words, such as bear, which were flashed one at a time. For each word, subjects were asked one of three types of questions, each requiring a different level of processing or analysis.

 1) asked about the word’s visual appearance: “Is the word in upper case letters?”

 2) asked to focus on the sound of the word: “Does it rhyme with chair?”

 Or

 3) to think about the meaning of the word: “Is it an animal?” o When subjects were later given a recognition test for the words they had seen, they were poor at recognizing words they had encoded superficially by visual appearance or sound. They were far better at recognising words they had encoded for meaning

Storage o There is more than one type of memory store o Each has its own performance characteristics and function o Each is the function of a different neuroanatomical system

Retrieval

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Giles Kisby GE Y1 Psychology o Failed retrieval does not always mean that information is lost from memory o Internal or external retrieval cues can activate information stored in long-term memory o Multiple cues enhance retrieval o Conscious (effortful) or unconscious (automatic)

The Multi-Store Model of Memory: Atkinson & Shiffrin (1968) o 3 classifications of memory based on duration of memory retention:

 Sensory Memory

 (STM) Working Memory

 Long-term Memory o Sensory Memory

 Sensory memory is the earliest stage of memory.

 Sensory information from the environment is stored for a very brief period of time (<1/2 sec for visual info; 3 or 4 sec for auditory info)



Contains more information than can be reported before the memory decays

 We don’t attend to everything.

 Overwritten by subsequent perceptual information

 What we do attend to then passes into our working memory. o Working Memory

 A short-term memory store- but not a unitary store as previously suggested by Atkinson and Shriffin but multi modal.

 limited capacity in terms of information content NOT time



George Miller’s 7 items ± 2



7 for digits, 6 for letters, 5 for words

 Can remember more short words than long words

 Chunking allows more to be remembered



E.g. 1066 can be 4 digits 1-0-6-6 or grouped as a year 1066 battle of

Hastings



Telephone numbers we recall in chunks e.g. 0208 123 4567

 New information pushes out old



Distraction



Long lists

 Rehearsal can maintain information in memory

 Information in store can be actively manipulated, hence ‘Working Memory’



“imagining how a sofa will fit in house”

Multicomponent Model of Working Memory (Baddeley 1974-2003) o Visuospatial Sketchpad (Occipital Lobe)

 Visual o Phonological Loop (Left Parietal)

 Language

76

Giles Kisby o Episodic Buffer

 Combines info from the two

GE Y1 Psychology o Central Executive

 Manipulation of information and direction of attention- driving

 Suppression of irrelevant information and undesired actions

 Supervision of information integration

 Coordination of multiple tasks to be executed in parallel

 Co-ordination of the sub-systems of WM o Visuospatial Sketchpad

 storage of visual and spatial information

 e.g. for constructing and manipulating visual images, for the representation of mental maps o Phonological loop

 storage of auditory/verbal information

 preventing decay by silently articulating contents, refreshing the information in a rehearsal loop

 e.g. phone number/ reading o Episodic Buffer

 Temporarily integrates phonological, visual, and spatial information in a unitary, episodic representation = autobiographical.

 Provides interface with episodic long-term memory

77

Giles Kisby

A Model of Memory:

GE Y1 Psychology

78


Long-term Memory o Store of all things in memory that are not currently being used but are available for use in the future o Allows use of past information to deal with present and the future o Can hold unlimited amount of information o Retrieval from long term memory may be:

 Explicit/Declarative (conscious)

 Implicit/Non-declarative (unconscious) o Types of Long-term Memory:

 Explicit



Episodic



Semantic o Facts and meaning of words

 Implicit



Procedural o Doing up buttons



Emotional conditioning o Arachnophobia



Priming o Racial stereotypes



Conditional o Near hot pan

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Non Declarative Memory o Familiar with something, know how to interact with object or in situation but don’t have to think about it o For actions or behaviours is called procedural memory o Can carry out complex activities without having to think about them e.g. walking, eating

Declarative Memory o Store of our knowledge o There are two separate types

 Episodic



Memory related to personal experience



What we generally think of as ‘memories’



Knowing what you did last night or where you went on holiday

 Semantic



Memory for facts



What we think of as general knowledge



Knowing the capital of France or the colour of a bus

Autobiographical Memory o We learn simple associations before we are born. o Not until aged 2-3 yrs does autobiographical memory develop- we need language to help remember. o Typically aged 6 is when we remember autobiographical events. o 'Reminiscence bump'- we remember the most during later adolescence. o Frontal Lobe development? o Emotionally driven learning? o Important, defining events- love, driving, graduation?

Summary

Type of Memory o Episodic memory o Semantic memory: o Implicit memory: o Prospective memory

Type of Information

Personal memories/ Events

Facts

Skills and procedures

Remembering to do things in the future

How do we remember?

(LO: Define an associative network) o Associative Network

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 Stored ideas are connected by links of meaning, strengthened through rehearsal and elaboration.

 Multiple links to a given concept in memory make it easier to retrieve because of many alternative routes to locate it.

 Each concept represented by a node

 Short link between nodes means nodes more closely related

 Activation of one network leads to spreading activation of related concepts

 Activation of node results in increased ease of activating related

(neighbouring) node

 Works to a lesser extent for indirectly related nodes

Schemas o a mental structure that represents some aspect of the world [“one filing cabinet”] o used to organize current knowledge and provide a framework for future understanding o Automatic not effortful thought o e.g. stereotypes, door schema o Expertise: process of developing schemas that help encode information into meaningful patterns

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Giles Kisby GE Y1 Psychology o For example we will have a schema for weddings, so that when we attend our first wedding we are able to behave in accordance with social norms without having researched it first. o Our schema for wedding will exist even if we have never been to a wedding before, because we will have read about them, heard about them and seen them portrayed in TV shows etc. o False Memories

 Brewer and Treyens (1981) demonstrated that the schema-driven expectation of the presence of an object was sometimes sufficient to trigger its erroneous recollection.

 An experiment was conducted where participants were requested to wait in a room identified as an academic's study and were later asked about the room's contents.

 A number of the participants recalled having seen books in the study whereas none were present. o False Memories

 Of those that remember meeting Bugs:

 62% said they shook his hand

 46% remembered hugging him

 Others remembered touching his ear or tail,

 or even hearing him speak (“What’s up, Doc?”).

Define the misinformation effect o Distortion of a memory by misleading post-event information (role of schema?) o Example: Eyewitness testimony

 Loftus tested whether the language used to question witnesses can change what they actually remembered.

 Subjects see a film depicting car accident or other naturalistic eyewitness event



“How fast were the cars going when they

Smashed/Collided/Bumped/Hit/Contacted each other?”



One week later, participants were asked if they had seen any broken glass. Although there was no broken glass, 32% of the ‘smashed’ condition said they had compared to only 14% of the ‘hit’ condition.

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The Serial Position Effect:

Committing information to memory- how to study for exams

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Giles Kisby GE Y1 Psychology o 1. Rote

 Frequent repetition (verbal)

 Forms a separate schema, not closely linked to existing knowledge

 Least efficient

 Less deep processing o 2. Assimilation

 Fitting new information into existing schema(s)

 Learning by comprehension

 Can only be used where there is link between old and new knowledge

 Deep processing

 Wholly Declarative o PQRST

 P = Preview the information to learn

 Q = Question, write down the questions that you want to be able to answer once finished

 R = Read through information that best relates to questions you want to answer

 S = Summary, summarise the information by writing, diagram, mnemonics, voice recording

 T = Test, try to answer the questions o 3. Mnemonic device

 Artificial structure for reorganising or encoding information to make it easier to remember

 Useful when info doesn’t fit existing into schemas

 Examples: hierarchies, chunking, visual imagery, acronyms

 Need to recall artificial structure to access information

 E.g. Naughty Elephant Squirts Water: compass o 3.Move your body

 Parker and Dagnall: people remembered more words on a learning test when they moved eyes L-R (only for R- Handed).

 Other experiments found acting out idea with relevant hand gestures improved recall.

 Links learning abstract concepts to simple physical movement.

 Short, intense bursts of exercise helps learning- subjects asked to learn new vocabulary performed better if studied after two 3 min runs vs 40 min jog. o Why do we forget?

 Ineffective encoding – information not encoded in the first place

 Decay theory – forgetting occurs because memory fades with time if not used

 Interference theory – forgetting occurs due to competition ‘for space’ from other material either from previously learned or new information

 Encoding Specificity Principle – retrieval will occur depending on how well the retrieval cue corresponds to the memory code o Describe the neural correlates of memory

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 In Alzheimer's disease the hippocampus is one of the first regions of the brain to suffer damage; memory problems and disorientation appear among the first symptoms.

 Damage to the hippocampus can also result from anoxia, encephalitis or medial temporal lobe epilepsy. o Role of the hippocampus

 Older memories remain stable- this sparing of older memories leads to the idea that consolidation over time involves the transfer of memories out of the hippocampus to other parts of the brain.

 This is difficult to test. In some cases of retrograde amnesia, the sparing appears to affect memories formed decades before the damage to the hippocampus occurred, so its role in maintaining these older memories remains uncertain.

 The hippocampus has an important role in the formation of new episodic or autobiogrpahical memories (eg: Squire, Eichenbaum,O’Keefe). Some researchers prefer to consider the hippocampus as part of a larger medial

temporal lobe memory system responsible for general declarative memory.

 Making memory and consolidate knowledge prior to transfer to long term memory o Medial temporal lobes

 HM & CW

 Significant anterograde amnesia for autobiographical information following bilateral Medial Temporal Lobe ablation

 Implicit memory intact- piano playing

 Ie skill based learning occurs in a dif part of brain to other types o Episodic Memory:

 Involves the medial temporal lobes including the hippocampus and parahippocampal cortex o Memory systems:

 Semantic - Knowledge

 Procedural – how to do things

 Working – short term o Other:

 Other brain regions are also important as neural networks develop in the formation and retrieval of long term memories.

 Networks develop by changes in neurotransmitters, growth of new receptors, and new ion channels.

 The same pattern of neurons (network) fire when we recall a memory.

 Every time we recall a memory new proteins are made, changing the network/memory in subtle ways.

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Beck (1963) Thinking and depression: dysfunctional schema: o Recorded psychotherapy sessions with 50 depressed patients. o Identified three recurring themes in the content

 Self – e.g. I’m useless

 World – e.g. My life is unfulfilling

 Future – e.g. Things will never get better

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Giles Kisby GE Y1 Psychology o These became known as the depressive triad o His thoughts:

 Dysfunctional schema: see below

 Negative Thinking Traps



LABELLING: Place a fixed, global label on oneself without considering evidence that leads to a less disastrous conclusion o “I’m a loser” ; “I’m no good.”



OVERGENERALIZATION: Drawing general conclusion based on single incident o “I felt nervous with others at the party; I don’t think I have what it takes to make friends.”



PERSONALIZATION: Inappropriately relating external events to oneself without an obvious basis for making such connections o “She didn’t say hello to me because I must have done something wrong.”



DICHOTOMOUS THINKING: View a situation in only two categories instead of on a continuum o “If I’m not a total success, I’m a failure”

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The effect of induced mood on recall (Teasdale et al 1980) o Subjects:

 43 undergraduate students o Procedure:

 S’s underwent Velten mood induction procedure to induce both elated and depressed mood.

 Presented with series of words e.g. “train, water, meeting” and asked to recall an personal experience related to that word.

 S’s then rated memories on a happy-unhappy scale.

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Clark’s (1986) theory of catastrophic interpretation o Individuals with Panic Disorder interpret certain bodily sensations in a catastrophic fashion o Sensations (esp. those involved in normal anxiety responses e.g., palpitations, breathlessness, dizziness, paresthesias) are considered to be a sign of impending physical or psychological disaster o e.g. palpitations  having heart attack

 7–28% of population will experience an occasional unexpected panic attack

 Only go on to develop Panic Disorder if they develop a tendency to interpret in a catastrophic fashion

 Studies demonstrate that Panic Disorder can be alleviated with cognitive techniques e.g. cognitive restructuring

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Evidence Base for Cognitive Behavioural Therapy (CBT) o CBT has been shown to have significantly lower relapse rates than anti-depressant medications.

 Panic disorder:

 Social Phobia:

 OCD:

 Depression

5% vs 40%

0%

12%

45% vs 33% vs 45% vs 86% o NICE guidelines

 CBT recommended as first line treatment for: Depression, Social anxiety,

PTSD, etc

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10/01/14: Understanding and recall of health care advice and adherence to treatment regimes: Dr Alexandra Garfield


To define the terms “adherence” and “compliance” and describe the limitations of these terms.

To develop an understanding of the scale of non-adherence to health care advice

To describe the clinical and economic consequences of non-adherence

To identify the main causes of non-adherence

To describe the role of failure to understand and recall in non-adherence

To describe ways of improving recall of health care information and enhancing adherence to advice

Notes:

Defining terms o Compliance

 Do they start treatment

 Acting according to request or command (Oxford dictionary). o Adherence

 Do they continue treatment as asked

 “to stick fast to” (Oxford dictionary)

 “the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes– corresponds with agreed recommendations from a health care provider” (WHO 2003) o Self management behaviours

 focus simply on whether target behaviour occurs no assignment of “blame”.

Taxonomy of adherence (Vrijens et al 2012): o Describe the whole process o Monitoring and support for the whole process is required

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-

Macintyre et al (2005) o 173 patients being treated for active tuberculosis. o Nurses and infectious disease physicians rated if patients were ‘‘always compliant,’’

‘‘mostly compliant,’’ ‘‘sometimes compliant,’’ ‘‘rarely compliant,’’ ‘‘never compliant,’’ and ‘‘unsure.’’ o Also took patient rating, urine drug level and colour. o Doctors and nurses assessed patients as ‘‘sometimes, rarely, or never compliant’’ in

11% (19/173) and 7% (12/173) of cases, respectively. Only 50% of patients who were rated non adherent by doctors were also rated non adherent by nurses.

Methods of Measuring Adherence

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Giles Kisby GE Y1 Psychology o Direct methods

 Directly observed therapy

 Measurement of the level of medicine or metabolite in blood

 Measurement of the biologic marker in blood o Indirect methods

 Patient questionnaires, patient self-reports

 Pill counts

 Rates of prescription refills

 Electronic medication monitors

 Measurement of physiologic markers

 Patient diaries

Seriousness of problem: o Watchdog/Health/NOP (2000)

 1137 million prescriptions issued in 2011

 Cost approximately £10 billion

 11% prescribed medications never started

 34% medication courses not completed

 £37.6 Million worth of unused medication handed in to pharmacies each year in the U.K. o Fletcher et al (2010)

 Follow up of nearly 200,000 prescriptions

 Only ¾ ever dispensed o Consequences of non-adherence

 Increased hospital admissions – 20% of all hospital admissions probably due to non-adherence

 Rejection of transplants

 Occurrence of complications

 Development of drug resistance

 Increased mortality

Variability between treatments:

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What are the causes of non-adherence? o That don’t affect:

 No consistent relationship with age, SES or intelligence (Haynes et al 1979,

Ley 1988)

 No consistent relationship with personality variables (Kaplan & Simon (1990)

 Non-adherence not greater in psychiatric patients (Ley 1976) o Factors affecting compliance

 Characteristics of regime

 Patient-practitioner interaction

 Psycho-social variables

Factors affecting compliance

o

Characteristics of regime

o

Psycho-social variables

o

Patient-practitioner interaction

Characteristics of regime

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Giles Kisby GE Y1 Psychology o Physical aspects

 e.g. packaging, font size o Complexity of instructions o Frequency of schedule:

 greater frequency = more likely to forget ie lower adherence seen o Duration

 Adherence is worse for chronic conditions o Cost

 Greater adherence if have paid more for it o Side effects

Patient-practitioner interaction o Communication style

 Communication style



It depends… o On the person (preferred level of involvement) and o On the situation (acute v chronic)

 Szasz & Hollender (1956): three models; is context dependant as to which

is best:



Activity – passivity o Health professional’s role:

 Does something to pt o Patients role

 Passive recipient o Example:

 Trauma, coma patients



Guidance – cooperation o Health professional’s role:

 Tells patient what to do o Patients role

 Co-operator (obeys): “just tell me what to do Dr” o Example:

 Acute infection



Mutual participation o Health professional’s role:

 Helps patient to help him/herself o Patients role:

 Active participant o Example:

 Chronic illnesses o Effect of General Practitioner’s consulting style on patient satisfaction (Savage &

Armstrong 1990)

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 Patients (n=359) attending a group practice in Inner London were randomly allocated to one of two conditions:

 “Sharing” consulting



(e.g What do you think is wrong? What were you hoping I could do?)

 “Directive” consulting style



(You are suffering from..., It is essential that you take this medicine.....”)

 Satisfaction with Dr’s understanding of problem, adequacy of explanation and feeling helped were all measured.

 Patients in the Directive style condition were more likely to report feeling satisfied in all aspects of consultation.



However doesn’t consider what conditions were eg may have just been many acute cases o Wilson et al (2009)

 612 patients with poorly controlled asthma randomly allocated to either normal care or shared decision making where treatment was negotiated to take account of patient goals/preferences.

 Shared decision making was associated with better adherence to medication and clinical outcomes (inc. asthma control and lung function) o Understanding and recall of information: v poor!!!

 7-53% of patients do not understand instructions (Ley 1980)

 But 50% of patients who would like more information do not ask for it (Klein

1979)

 Hospital outpatients recalled on average 63% of the information presented in a consultation. (Ley & Spelman 1967) o Factors affecting recall

 Individual factors



Anxiety



Medical knowledge



Memory impairment

 Type of information and recall



Diagnostic statements – 87%



Information re: illness – 56%



Instructions – 44%

 Presentation factors



Amount of information:

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

Order o Serial Position Effect:



Stressing importance



Specificity – relevance to the person



Mode of presentation o The use of written information

 Most patients would like to receive written information (97% in study by Gibbs et al 1990)

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 The majority of patients report that they do read written information when it is given to them (88%

Gibbs et al 1987)

 Written information leads to increased knowledge

(in over 90% of studies) and adherence (in 60% of studies) (Ley and Morris 1984) o Readability of health information o The Flesch formula is based on the average sentence length in words of any given text and the number of syllables per

100 words. The formula gives a score for reading ease on a scale from 0 (practically unreadable) to 100 (easy to read). o The formula for the Flesch Reading Ease score is: 206.835 –

(1.015 x ASL) – (84.6 x ASW)

 A score of 70-80 is taken to be plain English: about

20 words per sentence and 1.5 syllables per word.

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Presentation factors o Amount of information o Order o Stressing importance o Specificity o Mode of presentation

Psycho-social factors o Health Beliefs (esp Health Belief Model & Theory of Planned Behaviour) o Illness representations o Self efficacy o Social support

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Summary:

Factors affecting compliance o Characteristics of regime

 Complexity

 Duration

 Cost

 Side effects

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Giles Kisby GE Y1 Psychology o Patient-practitioner interaction

 Satisfaction

 Communication style

 Understanding and memory o Psycho-social factors

10/01/14: Social Psychology: David Murphy

Los

Learning objectives o Define Attitudes and discuss the relationship between attitudes and behaviour (NB.

This links to the Health Beliefs session esp. Theory of planned behaviour) o Define prejudice and describe how prejudice is maintained o (NB This links with Cognitive Psychology esp. the effect of schemas) o Define conformity and discuss the factors predicting conformity o Define Group Processes of Social Loafing, De-individuation, Group Polarization and

Group Think. o Discuss the factors which predict helping behaviour including the “bystander effect” o Define “Leadership” and styles of leadership o Discuss characteristics of effective leadership

Notes:

Social Psychology: the study of: o Social Thinking: how we think about our social world o Social Influence: how other people influence our behaviour o Social Relations: how we relate toward other people

Attitudes and Prejudices [dhtk detail] o Attitude: a positive or negative evaluative reaction toward a stimulus, such as a person, action, object, or concept

 Attitudes influence behaviour more strongly when situational factors that contradict our attitudes are weak o Stereotype – Schemas about characteristics ascribed to a group of people based on qualities such as race, ethnicity, or gender. o Prejudice – A negative prejudgement of a group and its individual members o Discrimination – behaviours that follow from negative evaluations or attitudes towards members of particular groups

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Effect of prejudice on perception Ickes et al (1982) o Introduced pairs of college aged men to each other. o Before introduction one of the pair was told that the other was “one of the unfriendliest people I’ve talked to lately”. o The two were then introduced and left alone for 5 minutes. o Those in both conditions were friendly, in fact the pre-warned individuals went out of their way to be friendly and received warm responses. o However, after the encounter those who were prejudiced attributed their partner’s warm responses to their own behaviour. o They also reported more mistrust and dislike for the person and rated his

behaviour as less friendly. o Similar studies have found the effect of prejudiced information persist even when

the participants were told it was randomly allocated.

Social Loafing o Definition - the tendency for people to expend less individual effort when working in a group than when working alone o More likely to occur when:

 The person believes that individual performance is not being monitored

 The task (goal) or the group has less value or meaning to the person

 The person generally displays low motivation to strive for success

 The person expects that other group members will display high effort o Depends on gender and culture

 Occurs more strongly in all-male groups

 Occurs more often in individualistic cultures (eg western culture) o Social loafing may disappear when:

 Individual performance is monitored

 Members highly value their group or the task goal o Max Ringleman, a French Engineer carried out a famous experiment in which he measured the force generated by different numbers of workers pulling on a rope

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Conformity o Factors that affect conformity:

 Group size:



Conformity increases as group size increases



No increases over five group members

 Presence of a dissenter:

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

One person disagreeing with the others greatly reduces group conformity

 Culture:



Greater in collectivistic cultures

 Conformity (Asch 1956)



All in on experiment except one person



Will agree with line length even when clearly wrong; more likely to go with wrong answer if group do

Obedience o The Milgram Experiment (1974)

 One “learner”, one “teacher” – told that experiment studied the effect of punishment on memory.

 Shock generator used to apply punishment

 Shocks grew increasingly intense with each mistake o Factors That Influence Obedience:

 Remoteness of the victim

 Closeness and legitimacy of the authority figure

 Diffusion of responsibility: obedience increases when someone else does the dirty work

 Not personal characteristics

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Group decision making o Often better decision making as an individual than as a group o Groupthink

 the tendency of group members to suspend critical thinking because they are striving to seek agreement

 Symptoms of Groupthink



Direct pressure applied to people who express doubt



Mind Guards: people prevent negative information from reaching the group o Don’t want to be the bearer of bad news



Members display self-censorship and withhold their doubts



An illusion of unanimity is created

 Groupthink most likely to occur when a group:



Is under high stress to reach a decision



Is insulated from outside input



Has a directive leader



Has high cohesiveness o Group polarization

 is the tendency of people to make decisions that are more extreme when they are in a group as opposed to a decision made alone or independently

 suspended critical thinking

 shared responsibility

 de-individualisation

 Factors in de-individuation



Proportional to Group size o Mann 1981 studied incidents of individuals threatening to jump from a building and found that the onlookers only encouraged the person to jump when there was a large group



Physical anonymity o Zimbardo 1970 found that found that when participants were wearing a mask they delivered electric shocks to helpless victims than when they were identifiable



Arousing and distracting activities o e.g. Chanting, dancing etc

Helping o The Bystander Effect: presence of multiple bystanders inhibits each person’s tendency to help

 Due to social comparison or diffusion of responsibility o Concept of de-individuation is also relevant o Darley & Latane Experiment

 Helping student having an epileptic seizure in an adjacent room.

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 87% helped if they believed it was just them and the other student.

 But only 31% helped when they believed they were in a group of 4 people, hardly anyone helped if group was above 4.

 If participant had not acted within first 3 minutes they never acted.

 5-Step Bystander Decision Process (Latané & Darley 1970)



1. Notice the event



2. Decide if the event is really an emergency o Social comparison: look to see how others are responding



3. Assuming responsibility to intervene o Diffusion of Responsibility: believing that someone else will help



4. Self-efficacy in dealing with the situation



5. Decision to help (based on cost-benefit analysis) o Increasing helping behaviour

 Reducing restraints on helping



Reduce ambiguity and increase responsibility



Enhance guilt and concern for self image

 Socialize altruism



Teaching moral inclusion



Modeling helping behaviour



Attributing helpful behaviour to altruistic motives



Education about barriers to helping

Leadership styles (Kurt Lewin) o Autocratic or authoritarian style

 Under the autocratic leadership style, all decision-making

 powers are centralized in the leader, as with dictator leaders.

 They do not entertain any suggestions or initiatives from

 subordinates. o Participative or democratic style

 The democratic leadership style favours decision-making by the group as shown, such as leader gives instruction after consulting the group. They can win the co-operation of their group and can motivate them effectively and positively. o Laissez-faire or “free rein” style

 A free-rein leader does not lead, but leaves the group entirely to itself as shown; such a leader allows maximum freedom to subordinates, i.e., they are given a free hand in deciding their own policies and methods.

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10/01/14: Clinical Decision Making: David Murphy

Los

Learning Objectives o Describe why people are generally very poor at making probability judgments o Contrast System 1 (or “hot”) thinking and System 2 (or “cold”) thinking o Define the most common types of error made in decision making. o Describe how these errors can affect health-related decisions by both patients and doctors o Describe “Anchoring” and the “Framing effect” o Define the “Availability”’ and “Representativeness” heuristics o Describe methods to improve clinical decision making. o Define “algorithms” and discuss their potential benefits and limitations in clinical situations

Notes:

Medical error o An error is defined as the failure of a planned action to be completed as intended

(i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of

planning). o E.g. incorrect diagnosis, failure to employ indicated tests error in the performance of an operation, procedure, or test, error in the dose or method of using a drug. o 1999 report from Institute of Medicine in USA estimated that between 44,000 and

98,000 patients die in hospitals in the USA each year because of medical error. o Wayne Jowett

 Wayne Jowett was diagnosed with acute lymphoblastic leukaemia in 1999 aged 15.

 By June 2000 Wayne was in remission, but still needed three-monthly injections of two chemotherapy drugs - Vincristine (IV) and Cytosine (IT).

 On 4 th January 2001 Wayne was mistakenly given Vincristine intrathecally.

He became slowly paralysed and almost a month later his parents agreed to turn off his life support machine.

 Similar errors involving Vincristine had been made 14 times in Britain since

1985, 11 resulted in death the other 3 in paralysis. The Specialist Registrar involved, Dr Feda Mulhem, was convicted of manslaughter and sentenced to

8 months imprisonment.

 Dr Morton “...said to Dr Mulhem “Vincristine?” Dr Mulhem replied in the affirmative. Dr Morton then said “intrathecal Vincristine?” Dr Mulhem again replied in the affirmative.

107


 Dr Mulhem couldn’t recall if the SHO “...actually said the word ‘Vincristine’” but stated “once again I had clearly fixed in my mind that the drug was

Methotrexate and not a drug for administration other than IT. “

 Can you identify the presence of any of the psychological factors we have come across?



Top down processing re packaging



Obedience



Group

Two systems for decision making (Metcalfe and Mischel 1999/Kahneman 2011) o 1. Hot system o 2. Cold system o The two systems operate as an elephant and the rider – Jonathan Haidt (2006)

Nisbett & Wilson (1977) = example of default processing of people o An experimenter conducted a “consumer study” in a shopping mall. He laid out four pairs of tights in a row and asked consumers to pick out the pair they liked the best.

In reality all four were identical. However, consumers were significantly more likely

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Giles Kisby GE Y1 Psychology to select the far right most pair (even though they were switched around randomly each time). o Moreover when asked about their selection the consumers were able to provide justifications for their choice e.g. sheerness, strength etc. None mentioned the position, indeed when the experimenter suggested that position may have influenced their choice they looked at him as if he was mad! o System 1 (Hot) often controls our actions automatically but system 2 (Cold) is blisfully unaware believing himself to be in charge!

Confirmatory bias and over-confidence Slovic (1973) = example of overestimating their active processing o Experienced horserace handicappers given a list of 88 variables relating to past performance of horses and riders. o Asked to predict outcome of a race based on five most important items, then 10, 20 and 40 most important variables. o Preferentially focus on further stats that enhance their previous hypothesis (ones that do not fit are just explained away)

109


Sunk Cost Fallacy o Arkes & Blumer (1985) Arranged to have season tickets sold to visitors to the ticket booth randomly at full price ($15) or at a discount ($13 or $8) o Then observed frequency of attendance at plays over the season. o Rationally, the price paid for ticket should not influence how often it is used o However, they found that the people who paid a higher price used the ticket more than those who paid the discounted price. o Sunk costs are any costs that have been spent on a project that are irretrievable ranging including anything from money spent building a house to expensive drugs used to treat a patient with a rare disease. o Rationally the only factor affecting future action should be the future costs/benefit ratio but humans do not always act rationally and often the more we have invested in the past the more we are prepared to invest in a problem in the future, this is known as the Sunk Cost Fallacy or the “Concorde Effect”.

Anchoring o Individuals poor at adjusting estimates from a given starting point (probs. & values) o Adjustments crude & imprecise o Anchored by starting point

Probability o Many clinical situations involve making decisions on the basis of probabilities e.g. two or more competing diagnoses, alternative treatments which may be effective etc.

Predictions o I toss a coin and it comes down heads, I toss it again and it comes down heads, I toss it twice more; each time it comes down heads. o If I toss the coin again what are the odds of it coming down heads? (nb it’s not a trick coin)

Gambler's fallacy o The gambler's fallacy is a logical fallacy involving the mistaken belief that past events will affect future events when dealing with independent events. o In clinical situations it could encompass a belief that if one patient in a clinic presents with a rare condition it would be impossible for the next patient to present with the very same condition. o Or alternatively that if not a single patient out of several seen in a speciality clinic then the next patient is more likely to be a true case.

Assessing conditional probabilities o A woman presents to you with a lump in her breast. From your examination, her age and your previous records of similar cases, you estimate that the chance of cancer is low, about 1% (p=.01).

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Giles Kisby GE Y1 Psychology o You send her to the radiologist for a mammogram and the radiologist says the mammogram is positive, indicating cancer.

 But there is a probability associated with the test being right or wrong

 New probability is only 8% for cancer

Framing o Diff judgement if gives lives saved vs number that will die

Representativeness heuristic o Subjective probability that a stimulus belongs to a particular class based on how

‘typical’ of that class it appears to be (regardless of base rate probability) o While often very useful in everyday life, it can also result in neglect of relevant base rates and other errors. The representative heuristic was first identified by Amos

Tversky and Daniel Kahneman. o Medical student at party example

The Availability Heuristic o Probabilities are estimated on the basis of how easily and/or vividly they can be called to mind. o Individuals typically overestimate the frequency of occurrence of catastrophic, dramatic events.

How can decision making be improved? o Recognize that heuristics and biases may be affecting our judgement even though we may not be conscious of them o Counteract the effect of top-down information processing by generating alternative theories and looking for evidence to support them rather than just looking for evidence which confirms our preferred theory. o Understand and employ statistical principles e.g. Bayes Theorem o Use of Algorithms and decision support systems

Algorithms o An algorithm is a procedure which, if followed exactly, will provide the most likely answer based on the evidence. o The rules of probability are examples of algorithms. o Algorithms are most useful in situations where the problem is well defined which excludes most everyday decisions o For the most part, people have to be specially taught how to use them

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Psychology outline:

1 – Learning Theory

Key concepts

Habitualisation and sensitisation o Classical conditioning (basic definition & terminology) o Where one thing leads to another o UCS – stimulus elicits UCR without prior learning o UCR – reflex elicited by UCS without prior learning o CS – stimulus that through association with UCS elicits a CR similar to initial UCR o CR – response stimulated by a CS o Strongest when

 Repeated CS-UCS pairings

 UCS is more intense

 Time interval between CS and UCS is short

 Sequence involves forward pairing o Extinction – where CS gets smaller o Generalisation of stimulus - respond to similar stimuli to CS o Discrimination – respond differently to various stimuli o Operant conditioning (basic definition & terminology) o Behaviour is modified by consequence o Trial and error – Thorndike’s law of effect o Extinction – weakening and disappear of response as no longer reinforced

 Resistance = degree to which non-reinforced response persist o Generalisation – operant response to new antecedent stimulus similar to original o Discrimination – operant response to one, but not another antecedent stimuli o Types of reinforcement (i.e. positive & negative) & schedules of reinforcement. o Positive – response strengthened by subsequent presentation of stimulus

 Primary – stimuli that organism needs e.g food

 Secondary – associated with primary reinforces e.g. money o Negative – response strengthened by removal of aversive stimulus

 E.g. removal of speeding alert o Positive punishment – response weakened by presentation of stimulus o Negative punishment – response weakened by removal of stimulus o Schedules

 Fixed interval

 Variable interval

 Fixed ratio

 Variable ratio

 Continuous = more rapid learning than partial

 Continuous – extinguishes more rapidly than partial o Vicarious conditioning (aka social learning) o Shaping o Observational - Observe behaviour of others and consequences of those behaviours o Vicarious reinforcement – if behaviours are reinforced = more likely to imitate

Key studies:

Pavlov’s Dogs – Classical conditioning – made tuning for cause salivation in dogs

Watson & Raynor (1920) Little Albert Experiment – Classical - loud noise = scared of rat

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Bandura (1961) Bobo Doll Experiment – Observational learning children copied either aggressive/non-aggressive behaviours depending on what they had observed

2 - Health beliefs and behaviour

Key concepts o Definition of health behaviour o Activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage o Effect of education on health behaviour o Nutbeam et al 1993 – education in school increased knowledge levels more so than control. Not much difference in percentage smoking following education/control. o Effect of positive reinforcement and limitations o Kegels et al 1978 – talk on dental hygiene – then either no further input/discussion session/reward for compliance with programme – reward = best compliance.

o Lacks generalisation/poor maintenance/impractical and expensive o Negative reinformement o Jains and Fesbach 1953 – Low/moderate/high fear lectures about dental health. Low = biggest change in behaviour, then moderate, then high fear had least impact. o Expectancy–Value model (basic idea) o Potential for a behaviour to occur in any specific situation is a function of expectancy that the behaviour will lead to a particular outcome and value of that outcome o Definition of self-efficacy and sources of self-efficacy (need to know both) o Belief that one can execute behaviour required to produce outcome

 Mastery experience

 Social learning

 Verbal persuasion/encouragement

 Physiological arousal o Health Belief Model (Need to know the components)

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Giles Kisby o Theory of Planned Behaviour (Need to know the components)

GE Y1 Psychology

3 - Individual differences

Key concepts



Personality theories – Freud and Big Five (Basic outline only) o Openness (decline with age) – correlates with verbal intelligence o Conscientiousness (increases with age) – negative correlation with IQ test score o Extroversion (decline with age) o Agreeableness (increases with age) o Neuroticism (females decrease)



Locus of control (basic definition) o Extent to which individuals believe they can control events that effect them



Definition and limitations of IQ o Ability to acquire knowledge, think and reason effectively and deal adaptively with environment o Normal distribution of IQ

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

Crystallized vs fluid intelligence (definitions and changes with age) o Crystallized - ability to apply previously acquired knowledge to current problems – increase with age o Fluid – deal with novel problem solving situations for which experience doesn’t provide solution – declines with age



Genetic & environmental contributions to IQ (esp. correlations between IQ of sibs) o Genetics influence effects produced by environment – ½-2/3 of IQ variation o Environment influences how genes express – rest of variation in IQ o Shared and unshared environmental factors are involved o Men outperform on spatial/target-directed skill/maths reasoning o Women outperform on perception/verbal/math calculation/precise manual tasks o Monozygotic twins highly similar in IQ – Dizygotic less so – adopted not at all



Baron Cohen’s Empathizing/Systematizing Theory (basic idea only) o Communication difficulties due to shortcomings in empathy with skills in systemising resulting in narrow interests – Autism/Aspergers o Empathising – infer thoughts and feelings of others and having appropriate emotional reaction o Systemising – drive to analyse or construct any kind of system

4 – Developmental psychology

Key concepts o Nature vs Nuture (general idea) o Nature – understanding children as going concerns = respect internal elements contributing to development o Nurture – understanding importance of environment helps protect and facilitate optimal developments o Temperament (general definition) o Easy = little fuss o Slow to warm up = adapt over time (note these are least active) o Difficult = negative and fussy o Reciprocal socialization (what is means) o Sensory development = can recognise the mother when born

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Giles Kisby GE Y1 Psychology o Scaffolding = parental behaviour supporting childs efforts o Development of attachment (outline of the stages & strange situation test) o Strong emotional bond that develops between children and primary care givers over first few years of life – enhances adjustment throughout lives o Strange situation test:

 Child plays with parent

 Stranger enters (child interested in stranger)

 Parent leaves = child distressed

 Parent returns = child happy

 Stranger and parent leave = child distressed

 Stranger returns = cannot console child

 Parent returns = child happy again o Secure response (65%) – child uses parent as source of safety o Insecure (35%) – absent from secure response – individual at risk of later issues (but this is NOT causative for these issues) o Piaget’s model of cognitive development (only basic outline of the stages) o Sensorimotor - birth  2 years

 Differentiate self from objects

 Recognise self as agent of action – begins intentional acts

 Achieves object permanence o Preoperational – 2  7 years

 Language and represent objects by images and words

 Egocentric

 No understanding of principle of conservation

 Cannot mentally reverse actions

 Animinism – attribute lifelike qualities to physical objects o Concrete operational state – 7  12 years

 Basic mental operations with tangible objects and situations

 Reversibility

 Less egocentrism

 Easily understand conservation

 Trouble with hypothetical and abstract reasoning o Understanding of DEATH? o Accommodation vs Assimilation (need to understand definitions) o Assimilation – person takes material into mind from environment, which may mean changing evidence of their senses to make it fit.

o Accommodation – difference made to ones mind or concepts by process of assimilation

– mutual with assimilation, not one or the other.

5 – Coping with treatment

Key concepts o Transactional definition of stress (definition and application) o Stress is condition that results when person/environment transactions lead the individual to perceive a discrepancy between the demands of the situation and coping resources available o Procedural and sensory information and the Dual process hypothesis (definitions) o Procedural = info about the procedure to be undertaken o Sensory = info about sensations that may be experienced

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Giles Kisby GE Y1 Psychology o Dual process hypothesis:

 Procedural info works by allowing patients to match ongoing events with their expectations in a non-emotional manner

 Sensory info works by mapping a non-threatening interpretation onto these expectations o Effect of perceived control on distress o Nursing home study – when given control of living situation, ward 1 were better off than ward 2 who were not given control of living. o Problem focussed and emotion focused coping (definition and examples) o Emotion focussed – meditation/distraction/deep breathing – changing own reaction to a sensor o Problem focussed – seek social support - Reduction or elimination of stressor o Individual differences in coping style (why they are important) o Optimal coping strategy depends on individual coping style and the situation o Strategies for helping children cope with treatment o Parent out of room = more cooperative o Stress correlated with stress shown by parent o Pain reducing behaviours – distraction/humour o Calming anxiety from previous experiences o Timing of information delivery (depending on age of child (<7/>10) o TELL/SHOW/DO o Influence of parental behaviour

Key studies

Auerbach (1983) Amount of information and distress – dental surgery patients given general or detailed info in preop preparation. Those who wanted info and got general reported higher distress than those who didn’t want info and got general. When given specific info, those who wanted info reported lower distress.

Langer and Rodin (1976) Nursing home study (aka the flower power study) – when one ward (1) given choices, and other ward just looked after (2) = floor 1 had greater engagement in activities/better well being/more psych and physically well than floor 2.

Thrash et al (1982) Traffic light study – control group when not given lights reported less distress than when given the opportunity to make a red light flash to indicate pain.

Martelli et al (1987) Problem focussed vs emotion focused coping – mixed coping strategies was equally average in both high/low preference groups. High preference were better with problem based coping. Low preference were better with emotional based learning.

6 - Perception and attention

Key concepts: o Sensation and perception (basic definitions)

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Giles Kisby GE Y1 Psychology o Sensation - Stimulus detection process by which our sense organs respond to and translate environmental stimuli into nerve impulses sent to the brain o Perception – active process of organising the stimulus output and giving it meaning o Bottom-up and top-down processing (what they mean) o Top down – start with larger concept and mental schemas and using this do work down to components of system o Bottom up – Start with small finer details and work up to larger picture o Types of attention (basic outline) o Attention – processing of focusing conscious awareness, providing heightened sensitivity to a limited range of experience requiring more intensive processing o Orientating - e.g. when hungry more likely to recognise food related stimuli o Focussed – respond discretely to specific visual/auditory/tactile stimuli o Sustained – maintain consistent behavioural response during continuous and repetitive activity o Selective – ability to maintain a behavioural or cognitive set in the face of distracting of competing stimuli = incorporates the notion of freedom from distractibility o Alternating – mental flexibility that allows individuals to shift their focus of attention and move between tasks having different cognitive requirements o Divided – highest level of attention and it refers to the ability to respond simultaneously to multiple tasks or multiple task demands (e.g. driving). o Perceptual schemas (definition) o A mental representation or image containing the critical and distinctive features of a person, object, or other perceptual phenomenon o Humphreys & Riddoch’s hierarchical model of object recognition (just the general ideas) o Visual perceptual analysis  viewer centered representation  Visual object recognition  Semantic system  Name retrieval o Apperceptive and Associative agnosias (characteristics of each) o Apperceptive – Intact basic sensory vision - defect in early stage visual processing that prevents a correct percept of the stimulus being formed. Patient is unable to access the structure or spatial properties of visual stimuli and the object is not seen as a whole or in a meaningful way – Visual perceptual analysis and viewer centred representation affected. o Associative – Patient can perceive objects presented visually but cannot interpret, understand, or assign meaning to the object – Visual object recognition system and semantic system affected o Critical periods in perceptual development (just what this means) o Certain experiences must occur if perceptual abilities and the brain mechanisms that underlie them are to develop normally.

o Cultural factors in perception (meaning and example) o Answers differ depending on culture – e.g. Africans believe hunter will kill elephant, whereas westerners will believe hunter will kill antelope (on painting)

7 - Perception of physical symptoms

Key concepts

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Giles Kisby GE Y1 Psychology o Factors affecting perception of physical symptoms (examples) o Attention o Anxiety o Expectation o Gate theory of pain (explanation) o Activating larger neurones by ‘rubbing’ area that is painful has a stimulatory effect on the nucleus gelatinosa releasing endogenous opiods and reducing pain from intial stimuli o Measurement of pain – (3 components and how to measure each) o Subjective – unstructured/verbal rating scale o Graphical rating scale o Physiological measures – HR/BR o NIPS = expression/breathing/cry o Illness representations Model – (Need to know the 5 components) o A patients own implicit commonsense beliefs about their illness

 Identity

 Cause

 Consequence

 Time line

 Curability/Controllability o The placebo effect definition, poss modes of action and influencing factors o Improvement in condition of a sick person that occurs in response to treatment but cannot be considered due to the specific treatment used o Mechanism

 Classical conditioning

 Expectancy

 Anxiety/attention

 Release of endogenous opiods o Influencing factors:

 Patient factors – ‘placebo-responder’ personality

 Treatment factors – injections>pills / larger>smaller pills / green and brown pills

 Therapist factors – status of practitioner o Differences between acute and chronic pain (to be able to list a few differences) o Acute

 < 1 month

 Obvious tissue damage

 Increased NS function

 Pain resolves on healing

 Serves protective function o Chronic

 > 3-6 months

 Pain beyond expected period of healing

 Usually no protective function

 Degrades health and function

Key studies

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Beecher (1956) Wound severity and pain – WW2 soldiers report less pain and request less meds than civilians with similar injuries

Anderson & Pennebaker (1980) Effect of expectancy of perception – told participants that experience would be painful/pleasant/not given any info = post ratings as expected – hurt more in

‘painful group’

Arntz et al (1991) Attention vs anxiety – In High and low anxiety groups – attention reduced pain rating

8 - Coping with illness and disability

Key concepts



Kublar-Ross’s stage theory of adjustment (basic outline) o Denial o Anger o Bargaining o Depression o Acceptance



Lack of evidence for stages o No variability o Places patients in a passive role o Fails to consider social or cultural factors o Focuses on emotional response and neglects cognition/behaviour o Pathologise people who don’t pass through the stages



5 Myths of coping with loss (Wortman & Silver 1989) o Distress or depression is inevitable o Distress is necessary and failure to express = pathological o Importance of ‘working through’ the loss o Expectation of recovery o Reaching state of resolution



Moos’ Crisis Theory of coping with serious illness and applications (basic outline not all detail)

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Key studies

Pollard & Kennedy (2007) Long term follow up in spinal cord injury - Rates of post-traumatic psychological growth were associated with higher levels of psychological distress.

Broadbent et al (2004) A picture of health – illness belief affecting recovery – pt who drew damage to their heart following MI recovered less at 3 months due to perceived damage/duration/control over situation.

9 - Memory and cognitive aspects of mental health disorders

Key concepts o Stages of memory process o Registration  Encoding  Storage  Retrieval

Working memory (Baddeley Model) o Types of memory inc Declarative vs Non Declarative, Episodic vs semantic (what they are) o Declarative is memory that can be consciously recalled whereas non-declarative

(procedural) refers to unconscious memories such as riding a bike. o Declarative is divided into:

 Episodic – memory of autobiographical events/past experiences

 Semantic – conscious recollection of factual knowledge – meanings, understandings, and concepts. o Differentiate between effortful and automatic processing. o Effortful processing – encoding that is initiated intentionally and requires conscious attention o Automatic processing – encoding that occurs without intention and requires minimal attention o Define schema, and explain how schemas enhance encoding and influence memory construction. o Mental framework about some aspect of the world. A mental representation or image containing the critical and distinctive features of a person, object, or other perceptual phenomenon o Can be used in an associative framework – ideas and concepts linked

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Giles Kisby GE Y1 Psychology o Define an associative network o Network of associated ideas and concepts o Activation of one network leads to a spreading activation of related concepts o Priming – activation of one concept by another o Outline the role of cognitive factors in the aetiology and treatment of depression. o Depressive triad – Self/World/Future

Key studies

Loftus and Palmer (1974) Eyewitness testimony – Memory distorted by verbal label/response bias factors

Beck (1963) Thinking and depression:

10 – Adherence to treatment

Key concepts o Definition, prevalence and consequences of non-adherence to treatment regimes o Adherence is rarely ‘all or nothing’ o Medicine possessions ratio o 75% of patients reported non-adherence in 2006 o Consequences:

 Increased hospital admissions

 Transplant rejection

 Complication occurrence

 Drug resistance

 Increased mortality o Factors affecting adherence o Patient/Professional/Treatment o Factors affecting recall of health care information o Individual factors – anxiety/medical knowledge o Presentation factors affecting recall of information o Amount of info/order/stressing importance/specificity/mode of presentation o Effects of written information and importance of readability o Most pt like to receive written info

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Giles Kisby GE Y1 Psychology o Majority don’t read when its given to them o Written info leads to increased knowledge and increased adherence o Flesch formula – 70-80 = plain English. o Ways of improving adherence to treatment o Ask patient about adherence o Simplify regime and packaging o Improve communication and presentation o Identify and modify beliefs o Involve significant others

Key studies

Ley & Spelman (1967) Amount of information and recall – 87% recall diagnostic statements, 56% recall info about their illness, 44% recall instructions.

Ley (1975) Effect of readability on adherence – medication errors higher as understanding of instructions decreases.

11 - Social Psychology

Key concepts



Attitudes and prejudice (definition & self-fulfilling prophesy) o Attitude – positive or negative evaluative reaction towards a stimulus, sich as a person, action, object, or concept o Stereotype – schemas about characteristics ascribed to a group of people based on qualities such as race, ethnicity, or gender o Prejudice – negative prejudgement of a group and its members



Conformity and influencing factors o Adjustment of individual behaviours, attitudes, and beliefs to a group standard o Group size – conform increases as group size increases up to 5 members o Presence of a dissenter – one person disagreeing with the others greatly reduces group conformity o Cultural differences



Obedience and influencing factors o Remoteness of the victim o Closeness and legitimacy of the authority figure o Diffusion of responsibility – obedience increases when someone else does dirty work o NOT personal characteristics



Social loafing and influencing factors o Tendency for people to expend less individual effort when working in a group than when working alone o More likely if:

 Believes performance is not being monitored

 Task is not meaningful to person

 Person displays low motivation

 Expect others to display high effort

 More so in all male groups and in individualistic cultures o Disappear when:

 Individual performance is monitored

 Members highly value group or task goal



Group decision making esp: “Group think”, definition and influencing factors o Group think – tendency of group members to suspend critical thinking because they are striving to seek agreement o Symptoms of group think –

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 Direct pressure applied to people who express doubt

 Mind guards – people who prevent negative info from reaching the group

 Self censorship and withhold doubts

 Illusion of unanimity is created o More likely when – under stress to reach decision/insulated from outside input/has directive leader/has high cohesiveness o Group polarisation – tendency of people to make decisions that are more extreme when they are in a group as opposed to a decision made alone or independently



The bystander effect (5 steps in the process) and how to overcome it o Presence of multiple bystanders inhibits each persons tendency to help

1.

Notice the event

2.

Decide if event is really an emergency

3.

Assume responsibility to intervene

4.

Self efficacy in dealing with situation

5.

Decision to help (based on cost benefit) o Reducing restraints on helping:

 Reduce ambiguity and increase responsibility

 Enhance guilt and concern for self image o Social altruism

 Teaching moral inclusion

 Modelling helping behaviour

 Attributing helpful behaviour to altruistic motives



Education about barriers to helping



Leadership styles (Kurt Lewin) (just basic outline) o Autocratic – don’t entertain any suggestions from subordinates o Participative(democratic) – group decision making – leader gives instruction o Laissez-faire – lets group have freedom regarding group decisions

Key studies

Asch (1956) Conformity – group told to match wrong line – study participant after initially picking correct choice, conformed to group choice and continually picked incorrectly

Darley & Latane – Helping behaviour – Student helped person having fit if on their own, less so if in a group of 4, very few if group was over 4

Milgram (1974) Obedience – learner and teacher – shock generator for punishment and shocks increase with each mistake – 65% gave maximum voltage shock

Ringelman (1913) Tug of war study – measured force generation – 8 people should = 8x the force as one person. Force generated doesn’t increase in linear manner = ringleman effect. More difficult to coordinate and more significantly social loafing.

12– Clinical decision making

Key concepts o Hot and cold system of thinking (definitions and examples of each) (EXAM!) o Hot – Emotional (Simple, Reflexive, Fast, Develops early, Attenuated by stress, stimulus control)

 Drive car on empty road

 2+2

 Detect hostility o Cold – Cognitive (Complex, Reflective, Slow, Develops late, Attenuated by stress, self control)

 Tell someone phone number

 Compare 2 appliances for value

 Complete a tax form o Influence of extraneous factors on decision making o Overestimate probabilities rather than based on calculation o Confirmatory bias (explanation) o Tendency of people to favour information that supports their hypothesis/beliefs

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Giles Kisby GE Y1 Psychology o The sunk cost fallacy (explanation) o If paid a higher price for season ticket, then the ticket was used more than discount o If invested more in the past, more prepared to invest in the future = concorde effect o The anchoring effect (explanation) o Individuals poor at adjusting estimates from a given starting point o Adjustments were crude and imprecise, and anchored by the starting point o Gamblers fallacy (explanation) o Belief that past events will affect future events when dealing with independent events o e.g. believing patient following another has the same rare disease o Conditional probabilities and the use of Bayes’ Theorem o Comparing probabilities to determine clinical risk o The availability and representativeness heuristics (definitions) o Availability – estimates based on how easily they can be called to mind – typically overestimate occurrence of catastrophic effects o Representative – subjective probability that a stimulus belongs to a particular class based on how typical of that class it appears to be – use extraneous factors o Strategies for improving clinical decision making o Recognise heuristics and bias affecting judgement o Counteract effect of top down info by generating alternative theory and looking for new evidence o Understand and employ statistical principles o Use Algorithms and decision support systems

Key studies

Nisbett & Wilson (1977) Effect of extraneous factors on decision making – laid 4 pairs of tights – asked consumers to pick best pair – all picked the pair on the right hand side even thought they were identical. Hot control automatic actions, Cold tried to give rational justification.

Slovic (1973) Confirmatory bias – bookies asked to predict outcomes of a race based on 5 most important itemts, then 10, 20, 40 most important. With more information – bookies more confident, but outcomes are similar in accuracy.

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Psychology notes BETA

Psychology:

Summer Term:

LECTURES:

16/05/14: Health beliefs and behaviour: David Murphy

Los (from booklet):

Notes:

Factors affecting compliance

Characteristics of regime

Psycho-social variables

Patient-practitioner interaction

Psychology outline:

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Psychology notes BETA

Psychology:

Summer Term:

LECTURES:

16/05/14: Health beliefs and behaviour: David Murphy

Los (from booklet):

Notes:

Factors affecting compliance

Characteristics of regime

Psycho-social variables

Patient-practitioner interaction

Psychology outline:

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