Blok G&M 1ste Ba Medische Psychologie Hoofdstuk 1 Informatieverwerking.pdf

# Introduction to psychology and medical psychology This section introduces psychology as the scientific study of behavior and its causes, highlighting medical psychology's role in addressing psychological issues linked to physical health. ### 1.1 What is psychology? Psychology is defined as the scientific study of the causes and consequences of human behavior. This involves the study of both directly observable behaviors (actions) and indirectly observable behaviors, such as thoughts and feelings, along with the underlying biological and neuropsychological processes. Psychology aims to investigate and explain general characteristics of human behavior, while also considering individual and group differences, as well as both normal and problematic behavior [7](#page=7). ### 1.2 Psychology versus psychiatry While both fields deal with the mind and brain, they have distinct approaches and focuses [8](#page=8). * **Psychology:** * Belongs to the human sciences [8](#page=8). * Studies the mind and brain, focusing on mental processes such as perception, attention, information processing, interpretation, memory, and learning [8](#page=8). * Examines mental content, including cognitions, emotions, and behavior [8](#page=8). * Addresses concepts of normality and illness [8](#page=8). * **Psychiatry:** * Belongs to the medical sciences [8](#page=8). * Studies the brain and mind, with a specific emphasis on structure and neurobiological processes [8](#page=8). * Focuses on illness and psychiatric disorders [8](#page=8). ### 1.3 Subspecializations within psychology Psychology is a broad field encompassing various subspecializations, often stemming from its main degree pathways [9](#page=9). * **Main Degree Pathways:** * Clinical Psychology [9](#page=9). * Theoretical and Experimental Psychology [9](#page=9). * Business Psychology and Personnel Management [9](#page=9). * **Subspecializations (particularly within Clinical Psychology):** * Medical psychology [9](#page=9). * Cognitive psychology [9](#page=9). * Behavioral psychology [9](#page=9). * Personality psychology [9](#page=9). * Neuropsychology [9](#page=9). * Social psychology [9](#page=9). * And others [9](#page=9). ### 1.4 What is medical psychology? Medical psychology is a specialization within psychology that concentrates on the research and treatment of psychological problems and complaints associated with physical illnesses or conditions [10](#page=10). * **Key areas of focus include:** * Assisting individuals in coping with chronic illnesses such as diabetes or multiple sclerosis (MS), which may involve adapting lifestyle changes, managing loss of physical abilities, and maintaining independence [10](#page=10). * Addressing difficult grief processes, depression, and suicidality in the context of illness [10](#page=10). * Helping individuals process acute and life-threatening conditions like cancer or cerebrovascular accidents (CVAs) [10](#page=10). * Investigating memory problems resulting from brain trauma or severe depression [10](#page=10). * Managing unhealthy eating behaviors associated with overweight conditions [10](#page=10). * And a variety of other related issues [10](#page=10). ### 1.5 The perspective of medical psychology Medical psychology views illness and health problems as significant stressors that carry substantial psychological consequences. The field's primary focus is on the research and treatment of these psychological problems, complaints, and their resulting impacts [11](#page=11). > **Tip:** Medical psychology bridges the gap between physical health and mental well-being, recognizing that a bodily ailment can profoundly affect a person's psychological state and vice versa [11](#page=11). --- # Information processing and cognitive psychology This topic explores how mental processes and information processing are central to understanding human thoughts, feelings, and behaviors, with a particular focus on the principles of cognitive psychology. ### 2.1 Background of cognitive psychology The contemporary field of psychology is strongly influenced by cognitive psychology. In the late 1950s, psychologists began to place more emphasis on the role of cognitions in the origin and maintenance of psychological complaints. The core assumption is that behavior cannot be fully understood without considering the mental processes that precede it. This perspective highlights the importance of information processing, suggesting that psychopathology arises from the way individuals select, interpret, and process information [13](#page=13). #### 2.1.1 The human brain as an information processing system The human brain is conceptualized as an information processing system, analogous to a computer. Key processes involved are [14](#page=14): * **Input:** Information is received through the senses (perception) [14](#page=14). * **Internal Processing:** This information is processed internally through interpretation, thinking, and reasoning [14](#page=14). * **Storage and Output:** The information may be stored (memory) and leads to a response (behavior) [14](#page=14). Cognitive psychology studies mental processes such as perception (including attention), information processing, and memory, as well as mental content like thoughts, feelings, and behavior [14](#page=14). #### 2.1.2 Key terms and concepts * **Cognitions:** This refers to the collection of mental processes and activities used in perceiving, interpreting, remembering, and understanding information. Cognitions encompass thinking, self-talk (both conscious and automatic), mental imagery, factual knowledge, memories, values, norms, and the selection processes involved in perception [15](#page=15). * **Information processing:** This describes the processes involved in acquiring, storing, and reproducing knowledge or information. It involves three primary mental processes: perception, processing, and memory. Cognitive psychology examines how information processing influences emotions, behavior, and physiological processes, and vice versa [16](#page=16). * **Schemas:** These are memory structures that store relatively stable knowledge representations, forming a composite of knowledge about a particular subject. Schemas are developed throughout life based on early experiences and can include knowledge in the form of language, visual information, actions, rhythm, and bodily sensations. For example, a schema for "eating" involves a vast amount of knowledge, much of which may be difficult to articulate or even unconscious. Without schemas, memory would consist of disconnected memories and thoughts [17](#page=17). * **Operation of schemas:** External information or mental events can activate a schema automatically, often without conscious awareness. For instance, hearing a noise at night can trigger a schema. Cognitive psychology posits that information processing is guided by schemas. Schemas influence which information is perceived and which is ignored (e.g., hearing your own name at a party). They also influence how perceived information is interpreted and processed into new meanings (e.g., interpreting a yawn). Schemas are considered normal, functional, and integral to the G-chain/schema [18](#page=18). > **Tip:** Schemas act as mental frameworks that help organize and interpret new information, making cognitive processing more efficient. However, they can also lead to biases and misinterpretations if they are rigid or inaccurate. ### 2.2 The G-chain/schema and its influence on behavior The G-chain, or G-schema, illustrates the interconnectedness of events, cognitions, feelings, and behavior. This model emphasizes that it is not the situation itself that determines our feelings, but rather how we interpret that situation [19](#page=19) [21](#page=21). * **Components of the G-chain:** * **Event/Sensation:** The external stimulus or internal awareness [19](#page=19). * **Thoughts/Cognitions:** The mental interpretations and beliefs about the event [19](#page=19). * **Feelings/Emotions:** The emotional responses triggered by the cognitions [19](#page=19). * **Behavior:** The actions resulting from the thoughts and feelings [19](#page=19). * **Consequence:** The outcome or effect of the behavior [19](#page=19). This model is applicable to both conscious, planned behavior and unconscious, automatic behavior [20](#page=20). > **Example:** If you interpret hearing a dog bark as a threat (cognition), you might feel fear (emotion) and walk away (behavior). Conversely, if you interpret the same bark as a sign of playfulness, you might feel happy and approach the dog. * **Examples illustrating the G-chain:** * **Event: Barking dog** * **Person 1:** Thought: "It will bite." Feeling: Fear, tension. Behavior: Walks away [22](#page=22). * **Person 2:** Thought: "Beautiful animal." Feeling: Joy. Behavior: Approaches [22](#page=22). * **Event: Seeing a group of people looking at you at a party** * **Person 1:** Thought: "They are laughing at me." Feeling: Insecurity, tension. Behavior: Leaves [23](#page=23). * **Person 2:** Thought: "They don't know me and are wondering who I am." Feeling: Neutral. Behavior: Approaches and initiates contact [23](#page=23). #### 2.2.1 Cognitive psychology and psychological disorders When information processing becomes distorted or dysfunctional, it can lead to psychological disorders. Cognitive psychology posits that psychological problems are characterized by distorted or dysfunctional thinking habits that influence feelings and behavior, forming a problematic G-chain [24](#page=24). #### 2.2.2 Examples of systematic distortions/thinking errors These are common cognitive biases that can lead to maladaptive thoughts, feelings, and behaviors: * **Black-and-white thinking (all-or-nothing thinking):** Perceiving situations in extremes, with no middle ground [25](#page=25). * Example: "Nothing I do ever works," "Everyone is against me" [25](#page=25). * **Catastrophizing (predicting the worst):** Being certain that a negative outcome will occur [25](#page=25). * Example: "At that party, no one will like me" [25](#page=25). * **Overgeneralization:** Drawing broad negative conclusions from a single event [25](#page=25). * Example: "I never succeed at anything" [25](#page=25). * **Mind reading:** Assuming one knows what others are thinking without sufficient evidence [25](#page=25). * Example: "I saw him thinking that" [25](#page=25). * **Personalization:** Taking events or others' behavior very personally [26](#page=26). * Example: "My boss didn't say good morning, he must be angry with me" [26](#page=26). * **Emotional reasoning:** Believing that one's feelings are factual evidence [26](#page=26). * Example: "I feel like he doesn't like me, so it must be true" [26](#page=26). * **Selective abstraction (selective attention):** Focusing primarily on negative aspects while ignoring positive or neutral information [26](#page=26). * Example: "What a terrible day" [26](#page=26). * **Negative filtering (disqualifying the positive):** Twisting neutral or positive information into a negative interpretation [26](#page=26). * Example: Interpreting a good performance as purely due to luck [26](#page=26). ### 2.3 Information processing and mental processes Information processing involves the handling of stimuli through various mental processes, including perception, interpretation, and memory. These processes link sensations and events to cognitions, feelings, behavior, and their consequences [28](#page=28). * **Key mental processes in information processing:** * **Perception (including attention):** The initial intake and selection of sensory information [29](#page=29). * **Processing/Interpretation:** Making sense of the perceived information [29](#page=29). * **Memory:** Storing and retrieving information [29](#page=29). These processes interact with cognition, emotion, and behavior, forming a continuous cycle [29](#page=29). --- # Perception and memory This section explores how we process external and internal information through perception and store, retain, and retrieve it via memory. ### 3.1 Perception Perception is the process by which external and internal stimuli are received and interpreted. External stimuli come from the outside world via our senses, including auditory, visual, olfactory, gustatory, or tactile input. Internal perceptions, or interoception, relate to bodily sensations, thoughts, feelings, and moods, which we are not necessarily conscious of [30](#page=30). Crucially, perception is not an objective and passive process. It involves selection, is often unconscious, includes implicit perception, and fills in gaps to form logical wholes. Individual perception can vary significantly marking the beginning of interpretation [31](#page=31). > **Tip:** Perception is an active construction, not a direct recording of reality. Pareidolia serves as an excellent example of our rapid interpretive abilities. It is an innate tendency of the brain to assign meaning to unclear and random perceptions. This form of illusion allows us to perceive recognizable things within ambiguous stimuli and has a survival function. The fusiform gyrus, for instance, is responsible for our exceptional ability to detect faces. Examples include the "holy toast" and the "ball illusion," where urologists mistook a man's testicular pain for a contorted face on an ultrasound [35](#page=35) [36](#page=36) [37](#page=37). Perception can be understood as two complementary processes: * **Bottom-up processing:** This is a stimulus-driven process originating from reality, involving the raw data received through our senses [39](#page=39). * **Top-down processing:** This process is guided by pre-existing knowledge and schemas, acting as an interpretative filter over the perceived data. It is influenced by individual variations, personal preferences, characteristics, and even psychopathology [39](#page=39). The stronger the bottom-up process, the less influence the top-down process has, and vice versa [39](#page=39). ### 3.2 Memory Memory is the capacity to retain information encompassing three key aspects: storage, retention, and retrieval. The information we store can take many forms, including images, thoughts, personal memories, smells, music, procedures, fantasies, and expectations [40](#page=40) [41](#page=41). #### 3.2.1 Types of memory Memory is generally categorized into three main types: * Sensory memory * Short-term/working memory * Long-term memory ##### 3.2.1.1 Sensory memory Sensory memory is the initial stage of memory processing, occurring in the senses and along the sensory nerve pathways to the brain. It consists of rapidly decaying traces of sensory stimuli. Our senses pick up far more information than we can utilize, and these impressions are fleeting. Its primary function is to hold information just long enough to decide which input merits attention and is important enough for the working memory, acting as a gatekeeper that filters out unimportant stimuli [43](#page=43). Sensory memory has a large capacity but a very short duration. It can hold 12 to 16 items for approximately a quarter of a second. This process is automatic and does not involve attention or consciousness. Sensory memory is closely linked to sensory receptors for visual and auditory stimuli [44](#page=44). * **Iconic memory:** Storage for visual information [44](#page=44). * **Echoic memory:** Storage for auditory stimuli [44](#page=44). ##### 3.2.1.2 Working memory/Short-term memory Working memory, also known as short-term memory, is the second stage of memory. It retrieves relevant information from sensory memory and integrates it with items already stored in long-term memory. It acts as a central regulatory system that distributes attention and manages conscious planning and control of actions. Both auditory and visual information are processed, and an episodic buffer facilitates the transition to long-term memory [45](#page=45). The capacity and duration of working memory are limited. It can hold information temporarily for seconds to a few minutes. Its capacity is relatively small, typically holding 7 items with a variation of 2. This capacity can differ between individuals and for different types of information. When working memory becomes overloaded, older items are lost. If it is entirely filled with information demanding our attention, we may fail to notice new, important information [46](#page=46). ##### 3.2.1.3 Long-term memory Information from short-term memory, often repeated sufficiently, is transferred to permanent or long-term memory through a process called consolidation. Information in long-term memory is stored for very extended periods, with the assumption that once in LTM, it remains permanent. However, memory traces can fade, making information less accessible, and older knowledge can be overwritten by new knowledge. Retrieval of stored knowledge involves recalling or searching for it (retrieval), which can manifest as recognition or recollection. Forgetting often occurs due to a lack of retrieval cues [47](#page=47). Long-term memory is divided into two main categories: * **Declarative (Explicit) memory:** Consciously accessible knowledge [48](#page=48). * **Non-declarative (Implicit) memory:** Unconsciously accessible knowledge [48](#page=48). ###### 3.2.1.3.1 Declarative (Explicit) memory In declarative memory, knowledge is explicitly and consciously present. This knowledge can be recalled consciously as images, facts, or feelings, and we "remember" it. Declarative memory includes two sub-types [49](#page=49): * **Episodic memory:** This stores personal events and is autobiographical [49](#page=49). * **Semantic memory:** This holds meanings and facts, such as vocabulary, how to perform tasks (e.g., cooking an egg), general knowledge about the world, and knowledge of language [49](#page=49). ###### 3.2.1.3.2 Non-declarative (Implicit) memory Knowledge stored in non-declarative memory is implicitly and unconsciously present. Its sub-types include [50](#page=50): * **Procedural memory:** This is memory for skills, including motor skills like cycling, swimming, driving, or reading [50](#page=50). * **Priming:** Exposure to a stimulus (a "prime") influences the response to a later stimulus without conscious awareness of the connection. For example, the smell of freshly baked bread in a supermarket might increase the likelihood of buying bread [50](#page=50). * **Conditioning:** This will be further discussed in the chapter on Learning/Behavioral Psychology [50](#page=50). #### 3.2.2 Accuracy of memory Memory accuracy can be compromised by errors: * **Omission errors:** Information that was perceived and stored but cannot be retrieved and is unintentionally omitted. Examples include amnesia (organic due to brain injury, or dissociative due to psychological disorders affecting autobiographical memory) "overgeneral memories" in depression, and memories of traumatized victims [52](#page=52). * **Commission errors:** Information that is unintentionally added and does not stem from personal perception or memory, though the individual genuinely believes it does. Examples include pseudo-memories and confabulations (delusions, often associated with frontal lobe injuries) [52](#page=52). > **Tip:** Be aware that memories are not perfect recordings and can be subject to distortion and fabrication. #### 3.2.3 Emotional impact on memory Emotional arousal can significantly enhance memory. An experiment by Cahill et al. demonstrated this, where participants who heard an emotionally charged story (a boy having a serious accident) without a beta-blocker (which blocks stress hormones like adrenaline and noradrenaline) remembered it best and most vividly compared to those who heard a neutral story or received a beta-blocker. This indicates that emotions influence our memory and recollections [53](#page=53). #### 3.2.4 Olfactory memory The brain's pathway for smell is unique compared to other senses. Unlike vision, hearing, touch, and taste, which are routed through the thalamus (a filter for conscious processing), smell travels directly to the limbic system, specifically the amygdala (emotions) and hippocampus (memory). This direct connection means that scents are more directly linked to emotions and memories [54](#page=54). * **The "Proust effect":** Smells can evoke strong, emotionally charged memories [55](#page=55). * Olfactory memory is stable but difficult to verbalize. Scent memories fade more slowly and are harder to articulate because the olfactory system has limited connections to language areas like Broca's or Wernicke's areas [55](#page=55). * **Recognition vs. recall:** We are good at scent recognition (identifying a smell when present) but poor at scent recall (consciously retrieving a scent memory without the stimulus). Olfactory memory works best in a "cued" manner, activated by the scent itself, rather than spontaneously [55](#page=55). | Sensory Modality | Characteristics | Associated Memory | | :--------------- | :--------------------------------------------------------------------------- | :----------------------------------------------------- | | Visual | Very detailed; fades quickly | Recognition of faces, places | | Auditory | Good for rhythm, tone, language | Remembering voices, melodies | | Gustatory | Strongly emotional but often dependent on smell | Memory of specific dishes | | Tactile | Less precise but important for emotional or painful memories | Memory of touch or pain | | Olfactory | Strongly linked to emotion and autobiographical memory; difficult to verbalize; often spontaneously activated by a stimulus | "Proust effect": scent evokes vivid memory and emotion | --- # Information processing in illness and patient examples This topic examines how patients process information related to their illness or physical condition, highlighting the interplay of cognitive schemas, emotions, and behaviors in clinical encounters [57](#page=57). ### 4.1 The significance of information processing for patients The way individuals cope with illness or acute, life-threatening conditions is strongly linked to how they select, interpret, and process information. For patients, understanding their cognitive schemas – which encompass thoughts, emotions, and behaviors – and their underlying mental processes such as perception, attention, and memory is crucial. Investigating a patient's cognitive schema can yield significant insights into their experience [57](#page=57). ### 4.2 Patient examples and schema interactions The document provides two detailed examples illustrating the interaction between patient and healthcare professional schemas in clinical settings. #### 4.2.1 Case study: Patient with aphasia A speech therapist is treating a patient with aphasia resulting from a cerebrovascular accident (CVA). After several sessions and the development of a treatment plan, the patient misses their fourth appointment [58](#page=58). ##### 4.2.1.1 Speech therapist's schema * **Thoughts:** The therapist might think, "She's not motivated," "She seemed unmotivated in earlier sessions, often sighing during exercises," and "I shouldn't put further effort into this" [59](#page=59). * **Feelings:** Irritation [59](#page=59). * **Behavior:** Not initiating contact with the patient and letting the situation be [59](#page=59). ##### 4.2.1.2 Patient's schema * **Thoughts:** The patient might think, "The exercises during the initial sessions were really difficult; I couldn't do them," "I will always have this problem; it can't improve anymore," and "Continuing is pointless" [60](#page=60). * **Feelings:** Anxiety, hopelessness, sadness [60](#page=60). * **Behavior:** Not attending the appointment [60](#page=60). #### 4.2.2 Case study: Patient with chronic heart condition A patient with a chronic heart condition is admitted to cardiology for the fourth time in eighteen months. Despite being generally friendly, agreeable, willing, and cooperative in previous interactions, the patient becomes increasingly quiet, curt, and shows little cooperation with treatment, such as restricted fluid intake, on the fourth day of admission. The patient reacts angrily to these requests, exclaiming, "Why must I suffer? This makes no sense". This change in demeanor is also evident in interactions with their family [61](#page=61). ##### 4.2.2.1 Healthcare professional's schema (nurse) * **Thoughts:** The nurse might think, "This man is suddenly unfriendly," "What is going on?" "Did I say or do something wrong?" and "I don't know how best to handle this" [62](#page=62). * **Feelings:** Uncertainty [62](#page=62). * **Behavior:** Remaining quiet during interactions with the patient, seeking little engagement [62](#page=62). ##### 4.2.2.2 Patient's schema * **Background:** The patient had recently received an official diagnosis of heart failure and a brochure that included information on a mortality rate of 100% after three years [63](#page=63). * **Thoughts:** The patient might think, "It's over for me," "I only have three years to live at most," "I shouldn't make any more effort," and "I won't tell my family because this will cause them much sadness too" [63](#page=63). * **Feelings:** Gloom, hopelessness, loneliness [63](#page=63). * **Behavior:** Withdrawing, being quiet, becoming agitated more quickly [63](#page=63). ### 4.3 Conclusion It is essential to acknowledge the complexity of these interactions. Healthcare professionals should recognize that patients often have a complex set of cognitive schemas. While we often infer thoughts and feelings from the behavior of others, we do not truly know what they are thinking or feeling. The behavior of others can appear simple, but it is often determined by a complexity of factors, just as our own behavior is. Furthermore, healthcare professionals must be aware that they also possess their own complex schemas, and their thoughts significantly influence their own feelings and behaviors, and vice versa [64](#page=64). > **Tip:** When interacting with patients, try to understand that their reactions might stem from complex cognitive and emotional processes related to their illness, rather than a simple interpretation of the situation. > **Tip:** Be mindful of your own cognitive schemas as a healthcare professional, as they can influence your perceptions and interactions with patients, potentially leading to misunderstandings or suboptimal care. --- ## Common mistakes to avoid - Review all topics thoroughly before exams - Pay attention to formulas and key definitions - Practice with examples provided in each section - Don't memorize without understanding the underlying concepts

| Term | Definition | |------|------------| | Psychology | The scientific study of the causes and consequences of human behavior, encompassing both observable actions and internal mental processes like thoughts and feelings, as well as the underlying biological and neuropsychological processes. | | Medical Psychology | A specialization within psychology focused on the research and treatment of psychological problems and complaints associated with illness or physical conditions, aiding individuals in adapting to chronic diseases, managing lifestyle changes, and coping with loss and depression. | | Cognitions | The collection of mental processes and activities involved in perceiving, interpreting, and remembering information, encompassing thoughts, beliefs, perceptions, and memories. | | Information Processing | The processes involved in acquiring, storing, and retrieving knowledge and information, which cognitive psychology studies in relation to its influence on emotions, behavior, and physiological processes. | | Schemas | Memory structures containing relatively stable knowledge representations about a specific topic, formed through life experiences, which influence how individuals perceive, interpret, and process new information, often automatically. | | Bottom-up Processing | A stimulus-driven process where raw sensory data from the environment is processed, forming the basis of perception and cognition. | | Top-down Processing | A process influenced by existing knowledge and schemas, which acts as an interpretive framework for processing incoming sensory information, allowing for individual variations and personal biases to shape understanding. | | Sensory Memory | The initial stage of memory that holds fleeting traces of sensory stimuli for a very short duration, acting as a filter to decide which information warrants attention for further processing. | | Working Memory | The second stage of memory that actively holds and manipulates relevant information from sensory memory and retrieves information from long-term memory, playing a central role in conscious planning and controlling actions. | | Long-Term Memory | The stage of memory responsible for the permanent storage of information, which can be recalled or recognized later, although accessibility can vary due to fading or overwriting by new information. | | Declarative Memory | A type of long-term memory that stores consciously accessible knowledge, including facts and personal events, further categorized into episodic memory (personal experiences) and semantic memory (facts and meanings). | | Non-Declarative Memory | A type of long-term memory that stores knowledge implicitly, not consciously accessible, including procedural memory (skills and habits) and the effects of priming and conditioning. | | Pareidolia | An innate tendency of the brain to assign meaning to unclear and random perceptions, often resulting in the perception of recognizable patterns in ambiguous stimuli, such as seeing faces in inanimate objects. | | G-Chain/Schema | A model illustrating the interconnectedness of thoughts (cognitions), feelings (emotions), and behavior, often activated by a stimulus or sensation, leading to a specific consequence or outcome. | | Olfactory Memory | Memory associated with the sense of smell, which is uniquely processed in the brain, directly linking to emotional and memory centers, often evoking strong emotional and autobiographical recollections. |