1. Test question: Which factors influence symptom reporting?

2. Medical Psychology Lecture24.02.2011. Control Perception and Learned Helplessness

3. Perceived Stress and Health Stress caused by negative interpretations of events can directly affect our immune systems, making us more susceptible to disease (Cohen et al, 1991). Even mild stressors can lead to a suppression of the immune system (Cacioppo, 1998).

4. A dilemma with no way out • A 45-year-old man found himself in a totally unbearable situation and felt forced to move to another town. But just as he was ready to make the move difficulties developed in the other town that made the move impossible. In an anguished quandary, he nonetheless, boarded the train for the new locale.

5. Halfway to his destination, he got out to pace the platform at a station stop. When the conductor called, „All aboard”, he felt he could neither go on no return home; he dropped dead on the spot. He was travelling with a friend, a professional person, with whom he shared his awful dilemma. Necropsy showed myocardial infarction. (Seligman, 1975, 179)

6. What makes people perceive a situation as stressful? The amount of control one believes to have over the event is an important variable. Perceived control is the belief that we can influence our environment (whether we experience positive or negative outcomes).

7. Pessimistic vs. optimistic attribution styles A. Internal vs. External Cause B. Stable vs. Transitory Cause C. Global vs. Specific Cause

8. Dimensions associated with control perception

9. Health Locus of Control There is a lot which I can do to control my symptoms.SELF • There is very little that can be done to improve my illness. CHANCE • My treatment will be effective in curing my illness. OTHERS

10. Effects of perceived control on mental health: Rape victims who believed that they had control over outcomes in their lives experienced less depression and showed fewer symptoms of post-traumatic stress 6 months or more after the event.

11. Perceived control is culturally specific? The relationship between perceived control and psychological distress is much higher in Western cultures than in Asian cultures. Individualism vs. collectivism!

12. Behaviour control Cognitive control Decision control Information control Doing breathing exercises following surgery Focusing on the benefits of a noxious medical procedure Choosing between two types of surgery Learning the side effects associated with treatment Types of control (examples)

13. „Too much” perceived control? People sometimes blame themselves for their illness, even to the point where they do not seek effective treatment.

14. Self-efficacy makes you more healthy? It influences people’s persistence and effort at a task People with high self-efficacy experience less anxiety and their immune system functions more optimally.

15. The less control people feel it is more likely that the event will cause physical and psychological problems.

16. Spitz Foundling Home Studies (1945) - Orphaned babies, all material needs met - Did not have an emotional care-giver - Extremely high levels of grief - Very susceptible to disease - High mortality rate René Spitz (1887-1974)

17. Factors affecting mortality after stroke • Specific negative attitudes, such as fatalism or helplessness/hopelessness (Lewis et al 2001) • The absence of specific positive attitudes, such as optimism, enjoyment of life, sense of personal worth (Ostir et al 2001)

18. thinking of yourself as a worthless person life is entirely hopeless life isn’t worth living possibility that you might make away with yourself at times you couldn’t do anything because your nerves were too bad wishing you were dead and away from it all idea of taking your own life kept coming into your mind Depressive symptoms after stroke: components of the GHQ*-D subscale *General Health Questionnaire (Goldberg, 1975)

19. GHQ-28 D subscale items which predict stroke mortality • feeling a worthless person • feeling life not worth living

20. Learning experiments with dogs Martin Seligman 1965

21. Control and Immunocompetence Dogs exposed to stressor (shock) Group A: Believes has control Group B: Believes has NO control Stress --> ACTH pathway --> adrenal stimulation --> cortisol --> opioids Opioids suppress the immune system Less control --> more stress --> more opioids --> lower immunocompetence.

22. Uncontrollable noise experiment (Hiroto and Seligman, 1975)

23. Symptoms of Learned Helplessness • Passivity • Difficulty learning that responses produce relief • Dissipates in time • Lack of aggression • Weight loss, appetite loss, social and sexual deficits • Norepinephrine depletion and cholinergic activity • Ulcers and stress

24. The collapse or death of a loved one • An 88-year-old man, without known heart disease, became upset and excited, wringing his hands upon being told of the sudden death of his daughter. He did not cry but kept asking, „Why has this happened to me?” While talking with his son on the phone he developed acute pulmonary edema and died just as the doctor reached the house. (Seligman, 1975, 178)

25. The Recovery Locus of Control Scale(Partridge and Johnston, 1989) • How I manage in the future depends upon me, not on what other people can do for me. • It’s often best just to wait and see what happens. • It’s what I do to help myself that’s really going to make all the difference • my own efforts are not very important, my recovery really depends on others.

26. Optimism Scale Scheier, M.F., Carver, C.S., & Bridges, M.W. (1994)

27. "The aim of Positive Psychology is to catalyze a change in psychology from a preoccupation only with the worst things in life to also building the best qualities in life.„Martin Seligman