大三上課件心理1medical psychology-introduction八年制

MedicalPsychology

(Introduction)

SongRanran(宋然然),phDAssociateProfessorSchoolofPublicHealth,TongjiMedicalCollege,HUSTE-mail:Whatispsychology?Psychologyisthescientificstudyofthebehaviorofindividualsandtheirmentalprocesses.Whatispsychology?Psychologyisthescientificstudyofbehaviorandthemind.ScientificenterpriseSystematic,objectivemethodsBehaviorAnyactivitythatcanbeobservedRecorded,andmeasured.

MindAllconsciousandunconsciousmentalstates.PredictwhatwillhappenSystematicallyobserveeventsDoeventssupportpredictionsLifeBeforePsychologyRenéDescartes(1596-1650)Philosophyasksquestionsaboutthemind:Doesperceptionaccuratelyreflectreality?Howissensationturnedintoperception?Problem-No“scientific”wayofstudyingproblemsPhysiologyaskssimilarquestionsaboutthemindSCIENTIFICMETHODPsychologyIsBornWilhelmWundt(1832-1920)FirstExperimentalPsychLab(1879)Focusesonthescientificstudyofthemind.WWinsiststhatPsychmethodsbeasrigorousasthemethodsofchemistry&physics.Wundt’sstudentsstartlabsacrossUSA(1880-1900)Psychology(pre-1920)WilhelmWundt(1832-1920)Physiologist&PerceptualPsychologistFounderofPsychologyasaScienceExperimentsEdwardTitchner(1867-1927)StudentofWundtFormedYatCornellIntrospectionWilliamJames(1842-1910)Philosopher&PsychologistFormedYatHarvardPsychologyUnderstandingMentalProcessesBehaviorismScientificPsychologyshouldfocusonobservablebehavior.JohnWatson(1878-1958)IvanPavlovPsychtheScienceofBehaviorStimulusResponsePsychologyMentalProcessescannotbestudieddirectlyLittleAlbertarabbit,adog,andafurcoatconditioned"LittleAlbert"bybystrikingasuspendedsteelbarwithahammerItwasacasestudyshowingempirical

evidenceofclassicalconditioninginhumans.First,theintroductionofaloudsound(unconditionedstimulus)resultedinfear(unconditionedresponse)—anaturalresponse.Secondly,theintroductionofarat(neutralstimulus)pairedwiththeloudsound(unconditionedstimulus)eventuallyresultedinfear(unconditionedresponse).Finally,thesuccessiveintroductionsofonlyarat(conditionedstimulus)resultedinfear(conditionedresponse).Therefore,learningwasdemonstrated.Heredirectedtheanimal’sdigestivefluidsoutsidethebody,wheretheycouldbemeasured.Inhisinitialexperiments,Pavlovrangabellandthengavethedogfood;afterafewrepetitions,thedogsstartedtosalivateinresponsetothebell.Pavlovcalledthebelltheconditioned(orconditional)stimulus(CS)becauseitseffectsdependonitsassociationwithfood.[6]Hecalledthefoodtheunconditionedstimulus(US)becauseitseffectsdidnotdependonpreviousexperience.Likewise,theresponsetotheCSwastheconditionedresponse(CR)andthattotheUSwastheunconditionedresponse(UR).classicalconditioningPsychology(1920s-1960s)JohnB.Watson(1878-1958)BehaviorwithoutReferencetoThoughtTheRAT&S-RPsychologyB.F.Skinner(1904-1990)BehaviorismwithaTwistThePIDGEON&TheSkinnerBoxPsychologyScienceofObservableBehaviorBehaviorismAnoperantconditioningchamber

SkinnerboxAnoperantconditioningchamberpermitsexperimenterstostudybehaviorconditioning(training)byteachingasubjectanimaltoperformcertainactions(likepressingalever)inresponsetospecificstimuli,suchasalightorsoundsignal.Whenthesubjectcorrectlyperformsthebehavior,thechambermechanismdeliversfoodoranotherreward.Insomecases,themechanismdeliversapunishmentforincorrectormissingresponsesStructuralismvsFunctionalismWilliamJames(1842-1910)AnalyzeconsciousnessintobasicelementsandstudyhowtheyarerelatedIntrospection-self-observationofone’sownconsciousexperiencesInvestigatethefunction,orpurposeofconsciousnessratherthanitsstructureLeanedtowardappliedwork(naturalsurroundings)StructuralismFunctionalismWilhelmWundtUnconsciousexpressedindreams&“slipsofthetongue”Freud&PsychoanalysisSigmundFreud(1856-1939)ProposetheideaoftheUNCONSCIOUSThoughts,memories&desiresexistbelowconsciousawarenessandexertaninfluenceonourbehaviorPsychoanalyticTheoryattemptstoexplainpersonality,mentaldisorders&motivationintermsofunconsciousdeterminantsofbehaviorCognitivePsychologyNoamChomsky“Language”Adventofcomputers(late1950s)providesanewmodelforthinkingaboutthemindCognitivePsychologistsreturntothestudyoflearning,memory,perception,language,development&problemsolving

Cognitionthementalprocessesinvolvedinacquiring,processing,storing&usinginformationPsychology(1960s-1990s)PsychologyScienceofBehavior&MentalProcessesCognitiveYSigmundFreud(1856-1939)TheDynamicUnconsciousMindPsychoanalysisComputersasMetaphorforMindStudyMindthroughInferencesDrawnFromObservableBehaviorDifferentPerspectivesinPsychologyBiologicalPsychologyBehavioral/ClinicalPsychologyCognitivePsychologySocial-CulturalPsychologyBiologicalPerspectiveFocusHowthebodyandbraincreateemotions,memories,andsensoryexperiences.SampleIssuesHowdoevolutionandheredityinfluencebehavior?Howaremessagestransmittedwithinthebody?Howisbloodchemistrylinkedwithmoodsandmotives?Behavioral/ClinicalPerspectiveFocusHowwelearnfromobservableresponses.Howtobeststudy,assessandtreattroubledpeople.SampleIssuesHowdowelearntofearparticularobjectsorsituations?Whatisthemosteffectivewaytoaltercertainbehaviors?Whataretheunderlyingcausesof:AnxietyDisordersPhobicDisorderspulsiveDisordersCognitivePerspectiveFocusHowweprocess,storeandretrieveinformation.SampleIssues

Howdoweuseinfoinrememberingandreasoning?Howdooursensesgovernthenatureofperception? (Iswhatyouseereallywhatyouget?)Howmuchdoinfants“know”whentheyareborn?Social-CulturalPerspectiveFocusHowbehaviorandthinkingvaryacrosssituationsandcultures.SampleIssuesHowarewe,asmembersofdifferentracesandnationalities,alikeasmembersofonehumanfamily?Howdowediffer,asproductsofdifferentsocialcontexts?Whydopeoplesometimesactdifferentlyingroupsthanwhenalone?PsychologistsmustbeskepticalandthinkcriticallyWhatistheevidence?Howwasitcollected?

PsychologyisEmpiricalPsychconclusionsbasedonresearchNOTtraditionorcommonsenseKnowledgeacquiredthroughobservationPsychIsTheoreticallyDiverseTheoryDreamsBiologicalPsychologyPerspectiveClinicalPsychoanalyticPerspective

AsystemofinterrelatedideasusedtoexplainasetofobservationsWhatCausesBehavior?BehaviorBehaviorisShapedbyCulturePersonalSpaceValueofEducationPunctualitySocialNormsInfluenceofHeredity&EnvironmentNatureversusNurturePerceptionIsSubjectiveInternalInformationPriorExpectationsCurrentMentalStateExperienceExternalInformationActualWords/ActionsImageReflectedfromObjects“Sound”WavesBothDetermineOurExperienceoftheWorldWorkInPsychology(?)Universities&Colleges27.2%Elementary/SecondarySchools4.2%Hospitals,Counseling,Clinics,etc.22.3%Business,GovernmentorConsulting12.1%IndependentPractice33.1%ThegoalsofpsychologyDescribingwhathappensMakeaccurateobservationsaboutbehaviorExplainingwhathappensFindregularpatternsinbehavioralandmentalprocessesPredictingwhatwillhappenThelikelihoodthatacertainbehaviorwilloccurControllingwhathappensMakebehaviorhappenornothappenPsychology’sRoleinHealthProblemsinthehealthcaresystemMedicalcostscontinuetoriserapidlyThepatternsofillnessaffectingpeoplehavechanged“Theperson”inhealthandillnessLifestyleandillnessPersonalityandillnessMedicalpsychologyisthebranchofpsychologywhichconcernswiththeapplicationofpsychologicalprinciplestothepracticeofmedicine.TodiagnosethediseaseTotreatthediseaseTopreventthediseaseWhatismedicalpsychology?ItisacrossdisciplinepsychologymedicineMedicalPsychologyWhatfieldsdoesmedicalpsychologystudy?BasicstudyreferredtothemedicineTheinfluenceofpsychologyandphysiologyBrainmechanismofpsychologicalprocessSomepsychologicalbehaviorsreferredtothediseasesCauseofdiseases,eg,personalityandhypertensionDuringthediagnosisandtherapyClinicservices:nursing35

medicinemodelBiomedicalmodelBiopsychosocialmodelBackgroundofBio-psycho-socialmedicalmodel:

1.Changesindiseasepatterns.2.Psycho-socialfactorsarethemainpathogenicfactors.3.Adjustmentofbodyandmindhelpspreventingdiseases.4.Thedemandsonmentalhealthincrease.37

《武漢市人群健康狀況報(bào)告》(2008年)，該報(bào)告中指出，武漢市居民總體健康狀況不斷提高。疾病譜發(fā)生重大變化，惡性腫瘤成頭號(hào)殺手去年，武漢市居民的死亡率為5.5‰，前三位死因依次是：惡性腫瘤、腦血管病和心血管病。每4個(gè)成人中就有1個(gè)胖子

超重肥胖，吸煙及被動(dòng)吸煙，飲酒，體力活動(dòng)及體育鍛煉不夠，飲食習(xí)慣不合理和心理壓力大，是影響武漢市居民健康的六大行為危險(xiǎn)因素。

武漢市成人超重率為23.6%，較往年增多，平均每4個(gè)成人中就有1個(gè)胖子，高于全國(guó)平均水平。且年齡越高，文化程度越低，其肥胖率越高。與男性相比，女性40歲以后更容易發(fā)胖。每2個(gè)成年男性就有1人抽煙

武漢市18歲以上居民吸煙率為25.6%（男性為49.1%，女性為2.6%），即成年男性每?jī)扇司陀幸蝗顺闊?。還有四分之一的成年人在遭受“二手煙”的危害。成人飲酒率為18.7%，在全國(guó)處于較高水平。

武漢市居民以輕體力勞動(dòng)為主，參加體育鍛煉的比例僅為三分之一。39

BMJ：擠公交上班有助減肥多元線性回歸分析結(jié)果表明，與使用私人交通工具相比，公共或主動(dòng)交通的通勤模式在男性及女性中均能顯著、獨(dú)立預(yù)測(cè)低BMI。在充分校正模型后，公共或主動(dòng)交通通勤模式的男性BMI分別比私人交通通勤組男性低1.10（95%CI0.53to1.67）和0.97（95%CI0.40to1.55）；而女性分別低0.72（95%CI0.06to1.37）和0.87（95%CI0.36to0.87）。研究人員設(shè)計(jì)了兩個(gè)試驗(yàn)。第一個(gè)試驗(yàn)選擇了160名具有平均BMI（身體質(zhì)量指數(shù)）的本科女學(xué)生。然后將這些人分成兩組，一組既觀看食品類(lèi)廣告，也觀看其它類(lèi)型的廣告；另一組只看非食品類(lèi)廣告。隨后，讓她們完成一個(gè)未完成的單詞列表，這些單詞都可能與食物相關(guān)，以此來(lái)檢測(cè)她們對(duì)食品的認(rèn)知程度。第二個(gè)試驗(yàn)與第一個(gè)試驗(yàn)方法完全相同，不同的是這次選擇的參與者是124名超重或者肥胖的女性。兩個(gè)試驗(yàn)中，所有觀看食品廣告的人寫(xiě)出的與食品相關(guān)的單詞更多，表明廣告確實(shí)能夠增加人對(duì)食物的認(rèn)知。但是，研究人員還發(fā)現(xiàn)了一個(gè)特別有趣的現(xiàn)象，只有試驗(yàn)二中超重或肥胖的受試者觀看食品廣告后，與對(duì)照組相比，顯示出更強(qiáng)的想吃的欲望，而試驗(yàn)一中的參與者想吃的欲望并沒(méi)有增加。電視廣告似乎更容易對(duì)肥胖的人產(chǎn)生直接的效果。ThegoalsofmedicalpsychologyThecausesanddetectionofillnessThepreventionandtreatmentofillnessImprovinghealthcaresystemandhealthpolicy47TheoriesofmedicalpsychologyPsychodynamictheoriesBehaviorismtheoriesHumanistictheoriesCognitivetheoriesPsychodynamictheoriesUnconsciousprocesses—themajorcausesofbehaviorcomefromthatpartofthemindwhichwehavenodirectawarenessPsychodynamicconflict—differentpartsoftheunconsciousmindareinconstantstruggle．49ConsciousUnconsciousSuperegoPreconsciousIdEgoInformationwhichcaneasilybemadeconsciousThoughts,feelings,urges,andotherinformationthatisdifficulttobringtoconsciousawarenessInformationinyourimmediateawarenessrealityprinciplecontainsvalueandidealspleasureprincipleBehaviorismtheoriesBehaviorismbelievespsychologyshouldexamineonlywhatcanbedirectlyobservedandmeasured.ThetwoversionsofthebehavioralapproachtodayarethebehavioralviewofB.FSkinnerandsociallearningtheory.InSkinner’sview,personalitysimplyconsistsofthecollectionoftheperson’sobserved,overtbehaviors;itdoesnotincludeinternaltraitsorthoughts.Humanisticperspectives

Thehumanisticperspectiveemphasizestheperson’scapacityforpersonalgrowth,freedomtochooseone’sowndestiny,andpositivequalities.CarlRogers(1902-1987)andAbrahamMaslow(1954,1971)weretwooftheleadingarchitectsofthehumanisticperspective.Thecognitivebehavioraltreatment-CBT53Howtostudythemedicalpsychology?What’sit?Itis...54observationstudysurveystudypsychologicaltestexperimentstudy……55observationstudyItcanrecordthedatainwaysthatavoidsubjectiveinterpretationsResearcherscannotcontrolthesituationandsocannottestthecause-and-effecthypotheses.5657surveystudyAsurveyisanattempttoestimatetheopinions,characteristics,orbehaviorsofaparticularpopulationbyinvestigatingarepresentativesample.InterviewQuestionnairesCellphone…58psychologicaltest59experimentstudyItisaresearchmethoddesignedadvantagetoanswerquestionsaboutcauseandeffect.Itpermitstheresearchertocontrolconditionsandsoruleout-toaslargeanextentaspossible-allinfluencesonsubjects’behaviorexceptthefactorsbeingexamined.Explorethebrainactivationofthechild聲母識(shí)別和韻母識(shí)別任務(wù)示意圖聲母交換和韻母交換任務(wù)示意圖

RDGroup

ControlGroup

Duringdeepprocessing,differentwaysintheleftprefrontallobesrespondAbranchofmedicalpsychologypsychiatryandmentalhealthphysiologicalpsychologyclinicalpsychologyandconsultingpsychologybehavioralmedicinepsychosomaticmedicinehealthpsychologynursingpsychologyabnormalpsychologyPsychologyshouldinvestigatethebrain,nervoussystem,endocr