PSYCHOLOGY

Psychology is the scientific study of mind and behavior. The word “psychology” comes from the
Greek words “psyche”, meaning life (mind, soul or spirit), and “logos”, meaning study or
explanation.
Most psychologists work in research laboratories, hospitals, and other field settings where they
study the behavior of humans and animals.

MIND:
This is the ability to think or feel emotions.
Parts of the Mind
1. Conscious Mind
Store of thoughts, memories and feelings that one is aware of.
2. Unconscious Mind
Part of the mind which contains thoughts, memories and feelings that cannot easily be brought to
conscious.
3. Preconscious Mind
Store of memories, thoughts and feelings that can easily be brought to the conscious.
The function of your subconscious mind is to store and retrieve data.

Psychology as Science
It is a science because it involves use of scientific methods in studying minds of people for their
behavior. For example;
i. Observation iii. Research
ii. Experiments iv. Recording
Psychology broke away from philosophy and physiology and emerged as a separate discipline.
The first psychological laboratory was established by a German philosopher and psychologist
Wilhelm Wundt (Father of Psychology).
Schools of thought or psychology were;
1. Structuralism
This was established with a goal to find units or elements which make up the mind.
2. Gestalt psychology
According to this school, mind could be thought of as re-suiting from the whole pattern of
sensory activity.
3. Functionalism
This emphasize that psychology should do what mind and behavior do.
4. Behaviorism
Psychology should be restricted on behavior of people and animals.

Scope of Psychology Operation

  It describes all types of life activities
 It studies and describes behavior of living organisms
 It employs to all living creatures
 It studies not only human behavior but also human experiences, language etc.

Application of Psychology
i. Education v. Guidance and Counselling
ii. Military vi. Politics
iii. Human relationship and self- vii. Criminology
development viii. Business and Industry
iv. Medicine
PSYCHOLOGY AND HEALTH
Wellness and illness are as a result of several different interrelated factors affecting a person’s
life of which psychological factors carry the biggest percentage i.e.
 Stress and anxiety levels  Poor coping mechanisms
 Attitudes  Beliefs
 Life styles  Cultural practices

Relevance of Psychology
 It helps us to understand our selves and build self-confidence for self-improvement.
 It helps health workers to understand attitudes, psychological problems, beliefs, needs,
values for personality characteristics of patients in a better way and attend to them.
 It helps to understand abnormal behavior and help the health workers in management of
mental illnesses.
 It helps to enrich careers and understand other people by providing knowledge and skills
on how to correctly and rightfully deal with other people around us.
 It provides knowledge and skills that help patients face and adjust to situations that occur
unexpectedly.
 Provides knowledge and skills to health workers to adjust to their professions for success
in their careers.
 Provides communication skills that enable health workers to effectively communicate
with patients of different beliefs and value.
 Helps us to identify ourselves in distinctive cultural groups thus respect the person’s
culture.
 Helps in strengthening/building a cooperative relationship between a patient and health
care team.
 Provides knowledge to identify socio-psychological aspects of disease in terms of
society, culture and ethnical influence.
 Provides us with knowledge to understand and determine how the body and mind work.
 BRANCHES OF PSYCHOLOGY
1. Social Psychology
This is the scientific study of how individuals think, feel and behave in regards to other people
and how individual’s thoughts, feelings and behaviors are affected by other people.
Social psychology seeks to explain and understand social behavior and looks at diverse topics
including group behavior, social interactions, leadership, nonverbal communication, and social
influences on decision-making.

2. Sociology
Sociology is a social science that studies human societies, their interactions, and the processes
that preserve and change them. It does this by examining the dynamics of constituent parts of
societies such as institutions, communities, populations, and gender, racial, or age groups.
Sociology also studies social status or stratification, social movements, and social change, as
well as societal disorder in the form of crime, deviance, and revolution.

3. Developmental Psychology
Focusses on human development from birth to death. Tries to study mental, physical and social
growth from prenatal period through to childhood, adolescence, adulthood to old age.
Developmental psychology focuses on how people change and grow throughout the entire
lifespan. The scientific study of human development seeks to understand and explain how and
why people change throughout life.

4. Abnormal Psychology
This is the study and treatment of abnormal behavior e.g. drug abuse, alcoholism, personality
disorders.
Abnormal psychology is the area that looks at psychopathology and abnormal behavior. Mental
health professionals help assess, diagnose, and treat a wide variety of psychological disorders
including anxiety and depression.
Counselors, clinical psychologists, and psychotherapists often work directly in this field.

5. Cognitive Psychology
Cognitive psychology is the branch of psychology that focuses on internal mental states. This
area of psychology is centered on the science of how people think, learn, and remember.
Psychologists who work in this field often study things such as perception, motivation, emotion,
language, learning, memory, attention, decision-making, and problem-solving.

6. Behavioral Psychology
This is branch concerned with a study of observable actions. Behavioral psychology, also known
as behaviorism, is a theory of learning based on the idea that all behaviors are acquired through
conditioning.
People often utilize behavioral strategies such as classical conditioning and operant conditioning
to teach or modify behaviors. For example, a teacher might use a system of rewards in order to
teach students to behave during class.

7. Biopsychology
Biopsychology is a branch of psychology which is focused on how the brain, neurons, and
nervous system influence thoughts, feelings, and behaviors.
People who work in this field often study how brain injuries and brain diseases impact human
behavior. Biopsychology is also sometimes referred to as physiological psychology, behavioral
neuroscience, or psychobiology.

8. Clinical Psychology
Clinical psychology is the branch of psychology concerned with the assessment and treatment
of mental illness, abnormal behavior, and psychiatric disorders.
Clinicians often work in private practices, but many also work in community centers or at
universities and colleges. Others work in hospital settings or mental health clinics as part of a
collaborative team that may include physicians, psychiatrists, and other mental health
professionals.

9. Comparative Psychology
Comparative psychology is the branch of psychology concerned with the study of animal
behavior. The study of animal behavior can lead to a deeper and broader understanding of human
psychology. This area has its roots in the work of researchers such as Charles Darwin and
Georges Romanes and has grown into a highly multidisciplinary subject.

10. Educational Psychology

Educational psychology is the branch of psychology concerned with schools, teaching
psychology, educational issues and student concerns. Educational psychologists often study how
students learn or work directly with students, parents, teachers, and administrators to improve
student outcomes. They might study how different variables influence individual student
outcomes.

11. Experimental Psychology

Experimental psychology is the branch of psychology that utilizes scientific methods to research
the brain and behavior. Many of these techniques are also used by other areas in psychology to
conduct research on everything from childhood development to social issues. Experimental
psychologists work in a wide variety of settings including colleges, universities, research centers,
government and private businesses.

12. Forensic Psychology

Forensic psychology is a specialty area that deals with issues related to psychology and the law.
Those who work in this field of psychology apply psychological principles to legal issues. This
may involve studying criminal behavior and treatments or working directly in the court system.
Forensic psychologists perform a wide variety of duties, including providing testimony in court
cases, assessing children in suspected child abuse cases, preparing children to give testimony and
evaluating the mental competence of criminal suspects.

13. Health Psychology

Health psychology is a specialty area that focuses on how biology, psychology, behavior and
social factors influence health and illness. Other terms including medical psychology and
behavioral medicine are sometimes used interchangeably with the term health psychology. The
field of health psychology is focused on promoting health as well as the prevention and treatment
of disease and illness.

14. Personality Psychology

Personality psychology is the branch of psychology that focuses on the study of the thought
patterns, feelings, and behaviors that make each individual unique. Classic theories of
personality include Freud's psychoanalytic theory of personality and Erikson's theory of
psychosocial development. Personality psychologists might study how different factors such as
genetics, parenting, and social experiences influence how personality develops and changes.

15. Sports Psychology

Sports psychology is the study of how psychology influences sports, athletic performance,
exercise and physical activity. Some sports psychologists work with professional athletes and
coaches to improve performance and increase motivation. Other professionals utilize exercise
and sports to enhance people’s lives and well-being throughout the entire lifespan.

TERMINOLOGIES USED IN PSYCHOLOGY

1. NORMS
These are social rules which specify how people should behave in specific situations.
In other words, norms are regarded as collective representations of acceptable group conduct as
well as individual perceptions of particular group conduct. For example;
i. Obedience to authority
ii. A woman hiding the fact that she has conceived
According to the psychological definition of social norms' behavioral component, norms have
two dimensions: how much a behavior is exhibited, and how much the group approves of that
behavior.
Importance of Norms
i. Promote good behavior in the society
ii. They maintain good interpersonal relationships among members of the society.
 iii. They promote harmony in the society.
iv. They provide structure and balance to the activities of group members.
v. Help group members to retain their membership and strengthen their associations
with the group.
vi. Serve as rules of conduct (Dos and Don’ts)
vii. They help to maintain order in the society.

2. VALUES
Anything considered to be of importance to a given group of people in the society.
In ethics, value denotes the degree of importance of some thing or action, with the aim of
determining what actions are best to do or what way is best to live (normative ethics), or to
describe the significance of different actions. What makes an action valuable may in turn depend
on the ethical values of the objects it increases, decreases or alters.

3. BELIEFS
These are convictions held by a person or persons about something. Convictions reflect truth of
something even if it may not be the case.
Belief is the state of mind in which a person thinks something to be the case with or without
there being empirical evidence to prove that something is the case with factual certainty.
Another way of defining belief sees it as a mental representation of an attitude positively
oriented towards the likelihood of something being true.
For example
i. Belief in witchcraft
ii. Belief in God
Importance of Beliefs and Values
i. Help to shape personal goals and motives
ii. Promote harmony in the community
iii. Promote discipline and good manners in the society
Relevance of Beliefs and Values in Clinical practice
i. Relevant in the healing process
ii. Relevant in decision making regarding health matters
iii. Relevant in Counselling and Guidance
iv. Relevant in Health Education

4. CUSTOM
These are the usual ways of doing things. It can also be defined as a way of behaving or a belief
that has been established for a long time among a group of people.
5. CULTURE
This is the way of life of a particular group of people or members of the society. It include
norms, values, beliefs, customs, knowledge, patient care, forms of entertainment, dressing, ways
of eating, marriage practices, religion, ceremonies, level of technology.
"Culture encompasses religion, food, what we wear, how we wear it, our language, marriage,
music, what we believe is right or wrong, how we sit at the table, how we greet visitors, how we
behave with loved ones, and a million other things."
a. Cultural Universal
These are values or modes of behavior shared by all human cultures. Cultural universals are
those guiding principles of human civilization that are so central to human identity that we can
find them, in some form, in all societies - past and present - around the world.
For example;
i. Language; There is no culture without language
ii. Family systems; all cultures have a recognizable form of family systems.
iii. Marriage; All cultures have institutions of marriage.
iv. Religion; All cultures have religions or religious rituals.
b. Cultural Diversity
Cultural diversity (also known as multiculturalism) is a group of diverse individuals from
different cultures or societies. Usually, cultural diversity takes into account language, religion,
race, sexual orientation, gender, age and ethnicity.
These are cultural differences which distinguish societies from one another.
c. Cultural Relativism
Cultural relativism is the idea that a person's beliefs, values, and practices should be understood
based on that person's own culture, rather than be judged against the criteria of another.
Cultural Relativism is the view that moral or ethical systems, which vary from culture to culture,
are all equally valid and no one system is really “better” than any other. This is based on the idea
that there is no ultimate standard of good or evil, so every judgment about right and wrong is a
product of society.
d. Ethnocentrism
This is the attitude that one’s culture is superior to others; one’s own beliefs, values and behavior
are more correct than others and that other people and cultures can be evaluated in terms of
one’s. Ethnocentrism is the tendency to think of your own culture as the norm and to defend your
culture as the only valid worldview. It is a common phenomenon and it is found in many
cultures.
e. Cultural competence
Cultural competence is the ability to understand, communicate with and effectively interact with
people across cultures. Cultural competence encompasses, being aware of one's own world view,
developing positive attitudes towards cultural differences and gaining knowledge of different
cultural practices and world views.
Characteristics of Culture
 Culture is shared, it is social but not individual
 Culture is learned through experience, imitation and communication
 Culture is symbolic; Symbols are things or behaviors to which people give meaning.
 Culture is transmitted vertically or horizontally. Vertical- generation to generation,
meanwhile horizontal- from group to group/society to society.
 Culture varies from society to society
 Culture is dynamic
 Culture is continuous and cumulative
Functions of Culture
 It regulates conduct and prepares human beings for group life through the process of
socialization.
 It defines values, attitudes and goals
 It provides behavior patterns and relationships with others
 It defines the meaning of situation
 It creates new needs and interests in individuals
 It provides solutions to complicated things

6. PREJUDICE
Prejudice is a baseless or unjustified and usually negative attitude toward members of a group.
Common features of prejudice include negative feelings, stereotyped beliefs, and a tendency to
discriminate against members of the group.
Different Types of Prejudice
Prejudice can be based on a number of factors including sex, race, age, sexual orientation,
nationality, socioeconomic status, and religion. Some of the most well-known types of prejudice
include:
a. Racism
Racism is the belief that a particular race is superior or inferior to another, that a person’s social
and moral traits are predetermined by his or her inborn biological characteristics. Racial
separatism is the belief, most of the time based on racism, that different races should remain
segregated and apart from one another.
b. Sexism
Sexism is prejudice or discrimination based on a person's sex or gender. Sexism can affect
anyone, but it primarily affects women and girls.
It has been linked to stereotypes and gender roles, and may include the belief that one sex or
gender is intrinsically superior to another.
c. Classicism
Class discrimination, also known as classism, is prejudice or discrimination on the basis of social
class which still occurs in societies around the world today.
It includes individual attitudes, behaviors, systems of policies, and practices that are set up to
benefit the upper class at the expense of the lower class or vice versa
d. Homophobia
The homophobia definition is the fear, hatred, discomfort with, or mistrust of people who are
lesbian, gay, or bisexual. Biphobia is fear, hatred, discomfort, or mistrust, specifically of people
who are bisexual.
e. Nationalism
The strong belief that the interests of a particular nation-state are of primary importance. Also,
the belief that a people who share a common language, history, and culture should constitute an
independent nation, free of foreign domination.
f. Religious prejudice
Religious prejudice means negative attitudes or behavior between people of different religious
groups because of their differing religious beliefs. Different religions have different beliefs,
practices, and leadership structure.
g. Ageism
Ageism (also spelled "agism") is stereotyping of and discrimination against individuals or
groups on the basis of their age.
Ageism in common parlance and age studies usually refers to negative discriminatory practices
against old people, people in their middle years, teenagers and children. There are several forms
of age-related bias such as;
 Adultism is a predisposition towards adults, which is seen as biased against children,
youth, and all young people who are not addressed or viewed as adults.
 Jeunism is the discrimination against older people in favor of younger ones. This
includes political candidacies, jobs, and cultural settings where the supposed greater
vitality and/or physical beauty of youth is more appreciated than the supposed greater
moral and/or intellectual rigor of adulthood.
h. Xenophobia
Xenophobia is the fear and distrust of that which is perceived to be foreign or strange.
Xenophobia can involve perceptions of an in-group towards an out-group and can manifest itself
in suspicion of the activities of others, and a desire to eliminate their presence to secure a
presumed purity and may relate to a fear of losing identity.

7. DISCRIMINATION
Discrimination is the behavior or actions, usually negative, towards an individual or group of
people, especially on the basis of sex/race/social class, etc. This means treating a person unfairly
because of who they are or because they possess certain characteristics. If you have been treated
differently from other people only because of who you are or because you possess certain
characteristics, you may have been discriminated against.
For example;
i. Denial of services to patients
ii. Financial discrimination
 iii. Giving substandard treatment
iv. Disregarding patients for the right of informed consent

8. STIGMA
This is a sign of being socially unacceptable resulting in to isolation, rejection, blame, shame etc.
For example;
Many people have fears, prejudices or negative attitudes about HIV. Stigma can result in people
living with HIV being insulted, rejected, gossiped about and excluded from social activities. At
its extreme, stigma can drive people to physical violence.

9. FOLKWAYS
These are norms regarded as useful but not very essential for the society of which violation
brings about mild punishment.
Folkways, sometimes known as “conventions” or “customs,” are standards of behavior that are
socially approved but not morally significant.

10. BUREAUCRACY
This refers to a system for controlling or managing a country, company, or organization that is
operated by a large number of officials employed to follow rules carefully.
Bureaucracy can also be defined as working in a way that has many steps to complete a task and
very strict order and rules.
Organizations in the public and private sector, including universities and governments, rely on
bureaucracies to function.

HEALTH-SEEKING BEHAVIOUR
Health-seeking behavior has been defined as a “sequence of remedial actions that individuals
undertake to rectify perceived ill-health.”

1. Health behavior
Refers to a person's beliefs and actions regarding their health and well-being. As a good example
of this, some people's health behaviors jive well with promoting and maintaining a healthy
lifestyle. People on their best health behavior: Do not smoke or use any other tobacco products.

Healthy Behaviors for a Healthier Lifestyle

 Increase Activity for Weight Loss and Wellness.
 Avoiding Fad Diets.
 Developing Healthy Sleeping Habits.
 Understanding and Managing Stress.
 Making Healthy Shopping Trips.
 Healthy Hydration.
 Proven Relaxation Techniques.
 2. Illness behavior
Refers to any actions or reactions of an individual who feels unwell for the purpose of defining
their state of health and obtaining physical or emotional relief from perceived or actual illness.
This includes;
o Seeking for help o Taking medicines
o Consulting doctors o Giving up responsibilities

3. Pain behavior
This is the way that we can see that someone is in pain. There are various types of pain behavior
ranging from the obvious limping, rubbing and guarding to perhaps less obvious pain behaviors
such as pain drawings and filling in questionnaires.
Thus, behavioral observation–based assessment is optimal in these patients.

Common pain behaviors are as follows:

a. Facial expressions: b. Verbalizations/vocalizations:
 Frowning,  Sighing, M
 Grimacing,  Moaning,
 Distorted expression,  Calling out,
 Rapid blinking.  Asking for help,
 Verbal abuse.
4. Sick-role behavior
Refers to the activity undertaken, for the purpose of getting well, by those who consider them-
selves ill.

Components of the sick role

 The sick person is excused from normal social responsibilities.
 The sick person is not held responsible for his or her condition.
 The sick person must recognize that being ill is undesirable and must want to recover.
 The sick person is obligated to seek medical care and cooperate with physicians.

FACTORS INFLUENCING HEALTH SEEKING BEHAVIOR

 The extent to which symptoms are perceived as serious i.e. person’s estimate of the
present and future probabilities of danger
 The extent to which symptoms disrupt family, household tasks and work
 Frequency of the appearance of signs and symptoms, their persistence and recurrence.
 Social meanings, social effects and feelings attached to particular illnesses e.g. HIV
 People’s perception of health
 Lack of information and knowledge about dangers of the illness
 Basic needs that lead to denial
  Competing possible interpretations that are assigned to the symptoms once they are
recognized
 Low decision making powers among patients
 Availability of treatment resources, physical proximity and monetary costs
 Feelings of stigma and humiliation upon certain illnesses like HIV, epilepsy, TB etc.
 Cultural beliefs that people hold about diseases.

CULTURE AND HEALTH

FACTORS AFFECTING THE HEALTH OF AN INDIVIDUAL
1. Belief
Different cultures have different beliefs regarding the cause of diseases. For example sickness in
some culture is thought of as produced by evil spell. Such belief may reduce the importance that
people attach to drug therapy and this in turn may create an impact on one’s health.

2. Cultural Practices
Different cultures have different cultural practices that can have either positive or negative
effects. Mutilation may cause scars leading to complications during child birth.

3. Diet
Culture influences a person’s diet and food preparation which has an effect on his health.

4. Preferences and decisions

Culture may have an influence on the patient/s preferences and decisions regarding health
matters.

5. Individual’s perceptions of symptoms

Culture has an influence on the extent to which symptoms are perceived as either serious or not.

6. Communication
Culture has an influence on the way we communicate and adhere to treatment.

7. Perception of health and illness

Culture may have an influence on people’s feelings upon certain illness.

8. Attitudes
Culture has an influence on people’s attitudes within their lives on sensitive matters regarding
their health.

SOCIAL ASPECTS OF DISEASES

 1. Poverty
This usually causes a lot of unsatisfactory conditions that are stressful thus leading to mental and
physical illness.

2. Lack of social support

Lack of social support is associated with higher level of anxiety, depression and low levels of
coping mechanism.

3. Unemployment
Loss or lack of job leads to loss of self-esteem and failure to satisfy one’s needs. This is closely
linked with mental, physical and social problems.

4. Poor working conditions

Poor working conditions where employees are exposed to carcinogens, microorganisms,
accidents and stress are both associated with both mental and physical illnesses.

5. Lack of education.
Low levels of education are associated with low income, job insecurity, poor sanitation practices,
and poor methods of disease prevention and lack of information on matters regarding health.

6. Crowded housing
Is linked to increased levels of infectious diseases, injuries and noise thereby affecting one’s
health.

BEHAVIOURAL FACTORS AFFECTING HEALTH

1. Smoking
It increases the risk of having lung cancer, bronchitis predisposing factor for heart diseases.

2. Alcohol
Causes liver cirrhosis, high blood pressure, degeneration of brain cells, sexual dysfunction and
social problems.

3. Lack of exercise
Mainly by people of higher social class, it is associated with heart diseases.

4. Poor diet
Diet high in saturated fatty acids (meat, eggs, oil) may cause heart diseases and stroke.
F 1oods high in refined sugars contribute to obesity and dental caries

5. Prostitution
Associated with sexually transmitted diseases such as HIV, Hepatitis B, and UTI etc.

EMOTIONS
Refer to display of feelings in response to events in the environment.

Functions of Emotions
Can cause us to move and take actions
Prepare and motivate us to respond adaptively to a variety of situations
Enable us to communicate our feelings and intentions more likely that others to respond to
us.

COMPONENTS OF EMOTIONS
1. Cognitive component
Is responsible for the interpretation of a situation which determine s the specific emotions we
feel.

2. Physical Component
This is the psychological arousal that accompanies an emotion.

3. Behavioral Component/Expression
This is the outward expression of the emotions.

EXPRESSION COGNITION

EMOTION

PHYSIOLOGY

PRIMARY AND SECONDARY EMOTIONS

1. Primary Emotions
These are emotions we feel first as a response to a situation. For example;
 Fear  Surprise
 Sadness  Relief
 Anger  Disgust
 Joy

2. Secondary Emotions
These appear after primary emotions. For example; A man feeling ashamed as a result of
becoming anxious. Or a woman becoming embarrassed when she expresses anger.
 THEORIES OF EMOTIONS
1. James - Lange Theory
One of the early theories proposed by researchers was known as the James-Lange theory of
emotion. Proposed independently by psychologist William James and physiologist Carl Lange,
the James-Lange theory of emotion suggests that emotions occur as a result of physiological
reactions to events.
Stimulus Body response (Physical response) Emotional response
2. Cannon - Bard Theory
The Cannon-Bard theory of emotion, also known as the Thalamic theory of emotion, is a
physiological explanation of emotion developed by Walter Cannon and Philip Bard. Cannon-
Bard theory states that we feel emotions and experience physiological reactions such as
sweating, trembling, and muscle tension simultaneously.
3. Schechter-Singer Theory (Cognitive Theory of Emotion)
Also known as the two-factor theory of emotion, the Schechter-Singer Theory is an example of a
cognitive theory of emotion. This theory suggests that the physiological arousal occurs first, and
then the individual must identify the reason for this arousal to experience and label it as an
emotion. A stimulus leads to a physiological response that is then cognitively interpreted and
labeled which results in an emotion.
4. Cognitive Appraisal Theory (Lazarus theory of emotion)
According to appraisal theories of emotion, thinking must occur first before experiencing
emotion. According to this theory, the sequence of events first involves a stimulus, followed by
thought which then leads to the simultaneous experience of a physiological response and the
emotion.
5. Evolutionary Theory of Emotion
It was naturalist Charles Darwin who proposed that emotions evolved because they were
adaptive and allowed humans and animals to survive and reproduce.
Feelings of love and affection lead people to seek mates and reproduce.

CHARACTERISTICS OF EMOTIONS
1. Every emotion is followed by a physiological change.
2. Emotion is accompanied by a feeling of pleasantness and unpleasantness, following
physiological change.
3. Emotions are subjective and purely individual
4. Emotion is a tripolar response
5. Emotions have a wide range and are not restricted to a particular age.
6. Emotions rise abruptly
7. Emotions have swings
8. An emotion mostly rises when the organism faces a difficult situation or when the basic
need is challenged or is not satisfied.
PHYSIOLOGICAL BASIS OF EMOTIONS
When we experience an intense emotion for example fear or anger, the hypothalamus is activated
and sends impulses to the sympathetic nervous system which in turn stimulates the adrenal gland
to release adrenaline and noradrenaline.
These are associated with the following changes;
1. Increased blood sugar level
2. Increased heart rate and blood pressure that compensate for the needs of the body.
3. Stimulation of conversion of fats and proteins to sugar
4. Increased blood flow to the muscles which ensure sufficient supply of oxygen
5. Suppression of activities of digestion
6. Hair on the skin become erect.

EMOTIONAL AROUSAL
Emotional Arousal is a state of heightened physiological activity. This includes having strong
emotions like anger and fear and we go to the emotional arousal state in response to our daily
experiences. For example the fight, flight or freeze response is a state of emotional arousal.

EMOTIONAL RESPONSES, REACTIONS TO ILLNESSES

1. Shock
Sudden upset of mental or emotional balance.
2. Fear
Emotional response to an expectation or danger, harm, or unpleasantness.
3. Sadness
Felings of despair, helplessness and isolation
4. Guilt
May arise from the belief that excessive demands are being placed on relatives or friends.
5. Anger
Pateints become irritable and aggressive.
 IMPORTANCE OF STUDYING EMOTIONS
1. Knowledge of emotions help us to identify emotions that patients are feeling.
2. Help us to show respect for the patient’s feelings
3. Help us to identify the causes of emotional reactions among patients.
4. Help us to identify and address the emotional needs of patients.
5. Help us to show acceptance of the patient’s behavior to due emotional reactions.
6. Equip us with knowledge of understanding emotional changes during illnesses and
particular conditions like pregnancy and thus helping patients to have a positive
experience.
ATTITUDE
This is the tendency to behave or think in a certain way.

Components of Attitude
Every attitude has three components that are represented in what is called the ABC model of
attitudes: A for affective, B for behavioral, and C for cognitive.

1. Affective/Emotional Component
Affective component is the emotional or feeling segment of an attitude. It is related to the
statement which affects another person.
It deals with feelings or emotions that are brought to the surface about something, such as fear or
hate. Using the above example, someone might have the attitude that they love all babies because
they are cute or that they hate smoking because it is harmful to health.
2. Behavioral Component
Behavior component of an attitude consists of a person’s tendencies to behave in a particular
way toward an object. It refers to that part of attitude which reflects the intention of a person in
short run or long run.
Using the above example, the behavioral attitude maybe- ‘I cannot wait to kiss the baby’, or ‘we
better keep those smokers out of the library, etc.

3. Cognitive Component
The cognitive component of attitudes refers to the beliefs, thoughts, and attributes that we would
associate with an object. It is the opinion or belief segment of an attitude. It refers that part of
attitude which is related in general knowledge of a person.
Typically these come to light in generalities or stereotypes, such as ‘all babies are cute’,
‘smoking is harmful to health’ etc.

Functions of Attitude
1. Adjustment Function
Attitudes often help people to adjust to their work environment. When employees are well
treated, they are likely to develop a positive attitude toward management and the organization.
 2. Ego-Defensive Function
The ego-defensive function refers to holding attitudes that -protect our self-esteem or that justify
actions that make us feel guilty.
This function involves psychoanalytic principles where people use defense mechanisms to
protect themselves from psychological harm. Mechanisms include denial, repression, projection,
rationalization etc.

3. Value-Expressive Function
Whereas ego defensive attitudes are formed to protect a person’s self-image, value-expressive
attitudes enable the expression of the person’s centrally held values.
Central values tend to establish our identity and gain us social approval thereby showing us who
we are, and what we stand for.
4. Knowledge Function
The knowledge function refers to our need which is consistent and relatively stable.
This allows us to predict what is likely to happen, and so gives us a sense of control. Some
attitudes are useful because they help to make the world more understandable.

Characteristics of Attitude are;

Attitudes are the complex combination of things we tend to call personality, beliefs, values,
behaviors, and motivations.
It can fall anywhere along a continuum from very favorable to very unfavorable.
All people, irrespective of their status or intelligence, hold attitudes.
An attitude exists in every person’s mind. It helps to define our identity, guide our actions,
and influence how we judge people.
Although the feeling and belief components of attitude are internal to a person, we can view
a person’s attitude from his or her resulting behavior.
Attitude helps us define how we see situations, as well as define how we behave toward the
situation or object.
It provides us with internal cognitions or beliefs and thoughts about people and objects.
It can also be explicit and implicit. Explicit attitude is that we are consciously aware of an
implicit attitude is unconscious, but still, have an effect on our behaviors.
Attitudes cause us to behave in a particular way toward an object or person.
An attitude is a summary of a person’s past experience; thus, an attitude is grounded in direct
experience predicts future behavior more accurately.
It includes certain aspects of personality as interests, appreciation and social conduct.
It indicates the sum total of a man’s inclinations and feelings.
An attitude is a point of view, substantiated or otherwise, true or false which one holds
towards an idea, object or person.
It has aspects such as direction, intensity, generality or specificity.
It may be positive or negative and may be affected by age, position, and education.
Formation and Development of Attitudes
 Attitudes are formed in the context of the individual’s wants. The individual in trying to
satisfy his wants, develops attitudes.
 Families help in the formation of attitudes, they control rewards and punishments, their
approval and disapproval of certain activities lays the foundation for the formation of
favorable and unfavorable attitudes towards that activity in the child.
 Group affiliations help in the formation of individual’s attitudes, peer group is a very
important source of attitude formation.
 Mass media e.g. newspaper, journal books, movies, social media etc. help in the formation
and development of an individual’s attitudes.
 Attitudes can be formed due to outcome of some experience e.g. if you have had unhappy
in a hospital, your attitudes towards hospitals in general will be negative.
 Attitude may be formed through imitation. This is done by imitating readymade attitudes or
prejudiced attitudes towards things e.g. racism is an attitude that some people imitate from
others.

ATTITUDE CHANGE
It is difficult to change the attitudes that have been established. But it is necessary to modify
unhealthy or irritational attitudes for learning new things.

How to change a person’s Attitudes

 Provide information that contradicts the attitude without any suggestion and persuasion to the
person concerned e.g. giving information about cancer and smoking.
 Providing positive models – setting ideal persons or examples in the society e.g. teachers,
nurses, doctors, lab. Technicians etc.
 Rewarding the correct attitudes or reacting back negatively for the incorrect attitudes.
 Inducing individuals to state publicly an opinion or attitude that runs counter to their own
private attitudes.
 Encouraging self-perception of one’s own attitudes and behavior
 The group support for the change should be obtained.
 Provide an opportunity for much closer contact with the object/person concerned. Let the
person learn through it and modify his own attitude.
 By adding a new belief or changing the old one he or she is holding so as to reduce cognitive
dissonance (discomfort).
 Decision taking

Good Attitudes in Health Care Service Delivery

Empathetic Respect Care
Love Support
Non judgmental Kindness
Importance of Good Attitudes in Health Service Delivery
 Mortality rate will be reduced (Death Rate)
 Morbidity rate will be reduced (Suffering from disease)
 Increased utilization of health services
 Reduced complications
 Promotes positive relationship between health workers and patients

ATTITUDES AND BEHAVIOUR

Attitudes are our expressions of the likes and dislikes towards the people and objects. They
determine or guide our behavior in social situations
Attitudes determine our lifestyles e.g. feeding habits, smoking, drug abuse, prostitution etc.
Attitudes determine which social groups to join (political groups, religious groups, peer
groups etc.) and all these exert powerful influence on our behavior and health.
Attitudes determine the way one thinks about himself and his personal behavior.
Attitudes determine the way we think about members of a particular group which in turn
influence our behavior and health.

Health Workers Implications of Attitude

 Health workers should recognize his/her attitudes and prevent them from interfering with
health care delivery.
 Health workers should try to understand patients’ attitudes about themselves, their illness
and future life so that effective care can be provided.
 The health care worker should try to find out the causes of unfavorable attitudes and
change them into favorable ones as they help in treatment and recovery.
 The health worker needs to develop and cultivate professional attitude which will
contribute to his/her success in the work.

Attitudes have been found to predict behavior best when;

 They are strong and consistent; Strong and consistent attitudes predict behavior better
than weak and ambivalent ones.
 They are specifically related to the behavior being predicted.
 They are based on the person’s direct experience
 The individual is aware of his or her attitudes
 They are reflected on one’s basic values.

STRESS
Stress is a state that occurs when people encounter events that they perceive as endangering their
physical or psychological well-being.
Stress is the body's way of responding to any kind of demand or threat. When you sense danger
—whether it's real or imagined—the body's defenses kick into high gear in a rapid, automatic
process known as the “fight-or-flight” reaction or the "stress response." The stress response is the
body's way of protecting you.

Causes of stress
 Natural disaster e.g. Landslides, earthquakes and floods
 Manmade disasters e.g. wars, major fires and serious transport accidents, assaults e.g. rape.
 Changes in life e.g. death of spouse or family member or relative, divorce, fired from job,
retirement, change in financial state, pregnancy, illnesses and disabilities etc.
 Conflicts e.g. conflicts between employee and employer
 Events like exams
 Personality – People with type A personality are more prone to stress than type B
personality.
 Failure to relate well with others
 Concerns about one’s weight

Characteristics of people with stress

 Insomnia  Loss of appetite  Anger leads to
 Fatigue  Forgetfulness aggression
 Loss of weight  Anxiety  Isolation
 Poor concentration

Concepts of stress
 Stress is a universal phenomenon
 Stress can have both positive and negative effects
 Stress is produced by change in the environment that is perceived as a challenge, threat, and
danger.
 Stress affects the whole person in all the human dimensions
 Perception of stress and response to it are highly individualized
 When a person faces the stressor, responses are referred as coping strategies, coping
responses or coping mechanisms.

Effects of stress
1. Direct physiological effects
 Heart diseases  Damage of blood vessels
 Peptic ulcers  Damage of body organs
 Hypertension  Vaginal infection
 Decreased immune system  Sexual dysfunction

2. Harmful behaviors
o Increased smoking and alcohol use o Decreased sleep
o Decreased nutrition o Increased drug use
 o Prostitution
3. Indirect health related behaviors
 Decreased compliance with medical advice
 Increased delays in seeking medical care
 Decreased likelihood of seeking medical advice

GENERAL ADAPTATION SYNDROME (GAS) – HANS SELYE, 1945

In 1936 Hans Selye created the stress model "General Adaptation Syndrome", which thoroughly
explains the stress response and how aging and disease are caused by chronic exposure to stress.
The General Adaptation Syndrome is a model that is comprised of three elements or phases
which describe the body’s response to stress:

Stage 1: Alarm Stage

The first stage of the general adaptation stage, the alarm reaction, is the immediate reaction to a
stressor. In the initial phase of stress, humans exhibit a "fight or flight" response, releases the
“stress” hormones such as adrenaline, noradrenaline and cortisol which prepares the body for
physical activity. However, this initial response can also decrease the effectiveness of the
immune system, making persons more susceptible to illness during this phase.

Stage 2: Resistance
During this phase, homeostasis begins restoring balance and a period of recovery for repair and
renewal takes place. The stress hormone levels may return to normal but you may have reduced
defenses and adaptive energy left. If a stressful condition persists, your body adapts by a
continued effort in resistance and remains in a state of arousal. When the body finds itself
repeating this process too often with little or no recovery this moves one into the final stage.

Stage 3: Exhaustion
During this phase, the stress has been persistent for a longer period. The body starts to lose its
ability to combat the stressors and reduce their harmful impact because the adaptive energy is
exhausted. The body's resistance to the stress may gradually be reduced, or may collapse quickly.
Generally, this means the immune system, and the body's ability to resist disease, may be almost
totally eliminated. Those who experience long-term stress may succumb to heart attacks or
severe infection or other diseases due to their reduced immunity.

COPING WITH STRESS

This refers to the thought and behavior we use to handle stress.

COPING STRATEGIES
1. Emotion-Focused Coping (EFC)
Emotion-focused coping is a type of stress management that attempts to reduce negative
emotional responses that occur due to exposure to stressors.
Negative emotions such as fear, anxiety, aggression, depression, humiliation are reduced or
removed by the individual by various methods of coping.
EFC strategies are divided into;
a) Behavioral Strategies
 Emotional support seeking from friends, relatives, health workers and be able to talk to
them about the stressful experience.
 Physical or relaxation activities to get our minds off a problem
 Exposure therapy- Encourage the patient to repeatedly talk about his trauma with a
therapist or health worker, patient will learn to get control of his thoughts and feelings
about his trauma.
 Group therapy- Patient is encouraged to talk about a stressful event with others who have
had a similar experiences.

b) Cognitive Strategies
 Encourage patient to identify thoughts about the world and himself that make him feel
afraid or upset.
 Encourage positive thoughts and avoid negative thoughts.

2. Problem-Focused Coping
Problem-focused coping is that kind of coping aimed at resolving the stressful situation or event
or altering the source of the stress. It is easier for those who are less depressed.
Problem counselling
Five stages of problem counselling include;
i. Define the problem
ii. Generate alternative solutions
iii. Weighing the alternatives in terms of costs and benefits
iv. Choosing one among them
v. Implementing the selected alternative

3. Ego Defense Mechanisms/Defense Mechanisms

(Sigma Freud and Anna Freud)
Defense mechanisms operate at an unconscious level and help ward off unpleasant feelings (i.e.,
anxiety) or make good things feel better for the individual.
Among the purposes of ego defense mechanisms is to protect the mind/self/ego from anxiety or
social sanctions or to provide a refuge from a situation with which one cannot currently cope.

Purpose of Defense mechanisms

 Reduce or eliminate anxiety
 Resolve mental conflict
 Protect one’s self-esteem or sense of security
Can be healthy if used in small doses and on short term basis because over usage can breakdown
a person’s personality.

Commonly used Defense Mechanisms

1. Repression
Repression is the unconscious blocking of unacceptable thoughts, feelings and desires. E.g. A
widow blocking memories about her husband’s suicide out of awareness.
2. Suppression
Dealing with stress by intentionally or voluntarily thinking about disturbing problems, feelings,
experience (consciously hiding a fact, unaccepted feelings). E.g. Student who failed in exam,
states he is not ready to talk.
3. Regression
Regression is the reversion to an earlier stage of development in the face of unacceptable
thoughts or impulses. E.g. A wife going to her mother every time she has a problem with her
husband.
4. Denial
Denial is the refusal to accept reality or fact, acting as if a painful event, thought or feeling did
not exist. E.g. refusing to accept that you have a serious illness like HIV/AIDS.
5. Displacement
Displacement is the redirecting of thoughts feelings and desires directed at one person or object,
but taken out upon another person or object. E.g. a man blaming the doctor for the death of his
wife instead of blaming himself for not having taken his wife to the hospital early enough.
6. Reaction Formation
Reaction Formation is the converting of unwanted or dangerous thoughts, feelings or desires into
their opposites. E.g. a mother who feels guilty about not liking her child, may over protect the
child.
7. Projection
Projection is the misattribution of a person’s undesired thoughts, feelings or desires onto another
person who does not have those thoughts, feelings or desires. E.g. a surgeon blaming a nurse
who helped him in the surgery.
8. Rationalization
Rationalization is putting something into a different light or offering a different explanation for
one’s perceptions or behaviors in the face of a changing reality. E.g. a husband who feels guilty
about leaving his wife because he does not enjoy her company may falsely say that she is shy
and she would not enjoy going out.
9. Sublimation
Sublimation is simply the channeling of unacceptable desires, thoughts and emotions into more
acceptable ones. E.g. playing sports to rechannel aggressive desires.
10. Intellectualization
Gain detachment from an emotional threatening situation by dealing with it in abstract
intellectual terms. E.g. A doctor detaching himself from the suffering of the patients.
 11. Compensation
Compensation is a process of psychologically counterbalancing perceived weaknesses by
emphasizing strength in other arenas. E.g. A student who is weak in class may compensate by
becoming the school’s champion in sports.
12. Identification
This is the unconscious adoption of the characteristics of activities of another person in order to
reduce pain or separation or loss.

Implications of Defense Mechanisms

 Persistent use is harmful and makes us unable to face problems
 Enable a person to resolve conflicts
 Many are a means of compromising with forbidden desires, feelings of guilt.
Relevance in Health Practice
 Helps to recognize and understand maladaptive defense mechanisms that patients use.
 Helps to appreciate what patients go through
 Helps us to work with patients to encourage adoptive behaviors and discourage
maladaptive ones.
PERSONALITY
Personality refers to individual differences in characteristic patterns of thinking, feeling and
behaving. Or it is the stable and personal behavioral characteristics of an individual.

PERSONALITY DEVELOPMENT
This refers to enhancing and growing one’s inner and outer self to bring about a positive change
in life.
Elements of Personality
 Stability  Consistence  Uniqueness
Why study personality
 Helps us to know the origin of personality
 Helps us to assess personality and predict how patient will react or respond to illness and
treatment.
 Helps us to deal with others
 Helps us to manage personalities that cause serious problems to other people.

TYPES OF PERSONALITY
A. HIPPOCRATES CLASSIFICATION
The Four temperament theory is a proto-psychological theory that suggests that there are four
fundamental personality types: sanguine, choleric, melancholic, and phlegmatic.
1. Sanguine Personality
 Optimistic  Social  Easy going
 Happy  Talkative  Lively
 2. Phlegmatic Personality
 Calm  Passive  Careful
 Even-tempered  Slow  Reliable
3. Melancholic Personality
 Sad  Pessimistic  Unsocial
 Quiet  Anxious
4. Choleric Personality
 Active  Irritable  Aggressive
 Restless  Impulsive  Excitable

B. SHELDON’S CLASSIFICATION OF PERSONALITY

Sheldon classified people according to three body types. These are:
1) Endomorph Personality
Have highly developed viscera, but weak somatic structures – fat, soft, round.

Characteristics
Easy going Affectionate
Sociable Fond of eating

2) Mesomorph Personality
Balanced development of viscera, and strong somatic structure – muscular

Characteristics
 Self-confident  Loves risks and  Bold tempered
 Passion for adventure
muscular activity  Energetic

3) Ectomorph Personality
Weak somatic structure as well as undeveloped viscera – thin, long, fragile (like Leptosomatic
type)
Characteristics
 Pessimistic  Unsociable  Reserved

C. KRETSCHMER’S CALSSIFICATION
His classification system was based on three main body types:
 Asthenic (thin, small, weak);
 Athletic (muscular, large–boned);
 Pyknic (stocky, fat)
1. Asthenic type
Slender body, long neck, long, flat chest and abdomen, and poor muscular development.
 Excessive competitiveness  Aggressiveness.
 2. Athletic type (Balance body)
Broad shoulders, deep chest, flat abdomen, thick neck, and good muscular development.
Optimistic Adjustable Energetic
3. Pyknic type (Fat Bodies)
 Sociable  Easy going
 Jolly  Good natured

D. CARL G. JUNG’S CLASSIFICATION OF PERSONALITY

Carl Gustav Jung was a Swiss psychiatrist whose research was deep-rooted in psychoanalysis
He studied personalities and clustered people into introverts and extroverts.

EXTROVERTS INTROVERTS
Interested in the world around them Interested in their own feelings and
(outgoing personality) thoughts than in things outside them
Sociable Solitary life
Talkative Quiet and reserved
Optimistic Pessimistic
Easily excited by things Dislike excitement
Generally impulsive They look before they leap
Gregarious Fond of books rather than people
Socially active/Dynamic Shy
Fond of practical jokes
Less reliable More reliable

NB: there are very few people who are purely extrovert or introvert. Most of us have qualities of
both types (Ambiverts). Ambiverts act like extroverts in social situations and introverts when
alone.

E. ALLPORT’S CLASSIFICATION OF PERSONALITY

According to Gordon Allport, your personality is made up of the traits you possess. A trait is a
personal characteristic we have which stays generally the same overtime and is resistant to
changing.

ASCENDANT DESCENDANT
Tendency to dominate a situation Submissive
Sociable Socially aloof
Optimistic Pessimistic
 PERSONALITY TYPES AND HEART DISEASES
The Type A personality types behavior makes them more prone to stress-related illnesses such as
CHD, raised blood pressure, etc.
Type A individuals are aggressive, ambitious, controlling, highly competitive, preoccupied with
status, workaholics, hostile, and lack patience. Type B people are relaxed, less stressed, flexible,
emotional and expressive, and have a laid-back attitude.
TYPE A PERSONALITY TYPE B PERSONALITY
Hard driving and competitive Non competitive
Impatient Patient
Sense of time urgency Less hurried
Irritable Less angered
Talkative Reserve
Take on multiple activities with deadlines to meet Don’t
Perform tasks near their maximum capacity Work harder when given a deadline
Don’t easily bear stress Bear stress easily

PERSONALITY THEORIES
1. PSYCHODYNAMIC THEORIES
A) PSYCHOANALYTIC THEORY- SIGMUND FREUD’S THEORY OF
PSYCHOSOCIAL DEVELOPMENT.
i) Freud emphasized the unconscious factors as the basis for motivation and behavior.
ii) Freud organized personality into three major structures, systems or components; id, ego
and superego.
Id
This is the personality component made up of unconscious psychic energy that works to satisfy
basic urges, needs, and desires. The id operates based on the pleasure principle, which demands
immediate satisfaction of needs. It presents at birth up to about 4 years of age.
Ego
Your ego is your conscious mind, the part of your identity that you consider your "self."
It operates on reality principle. Modifies irrational elements of the id. Maintains harmony
between id, superego and the environment.
Superego
Mature and moral part of individual’s personality.
Judges whether the actions are right or wrong (assists ego in the control of id impulses).
It is the moral and judicial part of personality.
Obeys perfection principle.
 He believed that psychic energy influences mental functioning and personality and
originates in the id.
 Personality develops through five stages.
 Over or under satisfaction at a specific stage causes fixation.
 FREUD’S STAGES OF PERSONALITY DEVELOPMENT
STAGE X-TICS SUCCESSFUL UNSUCCESSFUL
TASK COMPLETION
COMPLETION
Oral Stage ۰ Mouth is source of Oral satisfaction Mistrust ۰ Alcoholism
(0 -2) or satisfaction, sucking, Smoking ۰ Talkativeness
(0-1) yrs. suckling Nail biting Greed
Drug addiction
Anal ۰ Pleasure around the anus. Bowel and ۰ Constipation.
Stage (2- ۰ Sensual pleasure in muscle bladder control ۰ Excessive concern for
3) or (1-3) control, bladder, rectum and Good to let habits cleanliness and orderliness.
yrs. anus. ۰ Obsessive compulsive
disorder
۰ Perfectionism
Phallic (3- ۰ Pleasure around genital Becomes aware ۰ Homosexuality
7) or (3-5) organs. ۰ Learn sexual of sexuality ۰ Promiscuity
yrs. identity. ۰ Lust for sex
۰ Oedipus complex ۰ Sexual identity problem
(romantic feelings towards ۰ Difficulty in accepting
mother) authority
۰ Electra complex girl
develops romantic feelings
towards father.
Latency Absence of sexual interest Learn to socialize ۰ Solitary life.
(7-11) or ۰ Egocentralism. ۰ Inability to
(5-13) yrs. conceptualize. ۰ Lack of
motivation in school or job
Genital Satisfactory relationships Sexual maturity ۰ Fear of those of opposite sex
(11- with the opposite sex ۰ Premature ejaculation
Adulthood ۰ Lust for sex
or 13- ۰ Unsatisfactory relationship
Puberty

B) ERIKSON’S THEORY OF PSYCHOLOGICAL DEVELOPMENT

Erik Erikson (1902 – 1994) was a German psychoanalyst who extended Freud’s work.
 Described personality development throughout the entire lifespan. While focusing on social
and psychological aspects in the life or cognitive life stages.
 Described formation of personality through five stages. Each stage is dependent on
completion of previous stage and life task.
STAGE VIRTUE TASK POSITIVE CONSEQUENCE
 RESOLUTION UNSUCCESSFUL
TASK COMPLETION
Infant Trust Hope Viewing the world Sense of security Suspiciousness
Vs. Mistrust as safe and reliable, Feeling of frustration
0-1yr relationships as Withdrawal
nurturing, stable Lack of confidence
and dependable Trouble with personal
relationship.
TODDLER Will Achieving a sense Sense of Low self esteem
Autonomy of control and free independence Dependency on
Vs. shame will substances or people
and doubt 2-
4yrs
PRESCHOOL Purpose Beginning Balance between Passive personality
initiative Vs. development of spontaneity and Feelings of guilt.
Guilt 4-5yrs conscience learning restraint Remain followers feel
to manage conflict nuisance to others.
SCHLAGE Competence Emerging Sense of self Unmotivated
industry Vs. confidence in own confidence Unreliable
inferiority 6- ability taking Inferiority feelings
12yrs Pleasure in
accomplishment
Adolescence Fidelity Formulating a sense Unified sense of Confusion
identity Vs. of self and self Rebellion
role confusion belonging Substance abuse
13-19yrs Difficulty keeping
personal relationship
Regression- child play
behavior
Young- Love Formulating adult Form close Emotional immaturity
Adulthood loving relationships personal Deny need for personal
Intimacy Vs. and meaningful relationships which relationship
Isolation (20- attachments with is comfortable Isolation
24) or 20 – others. Depression
40) yrs. Loneliness
Middle adult Care Being creative and Promote well-being Inability to show
Generativity productive of others concern for any one, but
Vs. Focus is on self
Stagnation establishing family Feeling of stagnancy
(25 – 64) or and guiding the Feeling of
(40-64) yrs. next generation dissatisfaction with the
relative
Lack of productivity
Maturity Ego Wisdom Accepting Sense of Feeling of hopelessness
integrity Vs. responsibility for satisfaction with Depression
Despair late one’s health and life well lived Despair
adulthood life Guilt

C) ALFRED ADLER
We strive to achieve superiority as a way to develop our personalities.

D) CARL G. JUNG
Believed that a successful person brings opposing parts of a person together – pleasant and
unpleasant qualities of personalities.

2. HUMANISTIC THEORIES
When personality development focusses upon development of self, it is called humanism.
Humanists like Carl Rogers and Abraham Maslow believe that each is creative and responsible,
free to choose and each strives for fulfilment or self-actualization.
Carl Rogers believed that everyone should be given unconditioned positive regard.

3. TRAIT – TYPE THEORIES OR BIOLOGICAL THEORIES

Traits are relatively stable characteristics that cause an individual to behave in a certain ways.

a) Hans Eysenck’s Theory (Factor Analytic Trait Theory)

Emphasized the role of genetic factors and neurophysiological factors, in explaining individual
differences in behavior (cerebral cortex, ANS, limbic system, reticular system)
Eysenck's theory of personality is based on three dimensions:
i. Introversion vs. Extroversion
ii. Neuroticism vs. Stability
iii. Psychoticism vs. Socialization.

4. LEARNING THEORIES OF PERSONALITY

Learning is through imitation (social learning theory)
a) According to psychologist Albert Bandura and colleagues (1977), a major part of human
learning consists of observational learning.
According to Bandura, observational learning takes place in four steps;
i) Pay attention and observe another person’s behavior
ii) Remember the behavior
iii) Reproduce the action
 iv) Being motivated to carry out the behavior
Other theorists include;

b) Dollard and Miller’s Learning theory of personality

The concept of habit, which represents a stable Stimulus-Response connection (SR), is crucial to
this position. In fact, most of the theory is concerned with specifying the conditions under which
habits form and are dissolved

5. COGNITIVE DEVELOPMENT (JEAN PIAGET)

(INTERLECTUAL DEVELOPMENT)
It is about the nature and development of human intelligence i.e. how young people think, reason
and understand and how they change overtime.

CONCEPTS OF COGNITIVE DEVELOPMENT

a) Schema
Intellectual structures that classify events as they are seen by the organism into groups according
to common characteristics e.g. dog schema.
b) Assimilation
This is the cognitive process by which a person fits new events or stimuli into the existing
schemata.
c) Accommodation
Creation of new schemata or modification of old schemata
d) Equilibrium
State of balance between assimilation and accommodation

STAGES OF COGNITIVE DEVELOPMENT

i) Sensorimotor Stage (0-2 Yrs.)
 Operate by reflex actions
 Acquire knowledge through sensory experience and manipulation of objects
 Develop object permanency (existence of something)
ii) Pre-Operational Stage (2-7 Yrs.)
Develop symbolic representation
Egocentric thinking (selfish way of thinking that everything belongs to them)
Perceptual dominates cognitive evaluation (take things the way they see them).
Irreversible thinking
iii) Concrete Operations (7-11 Yrs.)
 Logical thinking
 Classify objects according to size, color, shape and quantity.
iv) Formal Operations (Adolescence through Adulthood)
Abstract thinking- moral, philosophic ethical, social and political issues.
MORAL DEVELOPMENT
 Morality refers to standards of good behavior.
LAWRENCE KOHLBERG’S DESCRIPTION OF MORAL DEVELOPMENT
Kohlberg decided that moral development consisted of six stages in three levels.
LEVEL 1 STAGE 1 – (Morality of punishment and obedience)
PRE- Children blindly obey superior authority in order to avoid punishment.
CONVENTIONAL STAGE 2 – (Morality of naïve instrumental hedonism or instrumental
MORALITY relativist
Children obey in order to gain concrete rewards
LEVEL 2 STAGE 3- (Morality of maintaining good relations)
CONVENTIONAL Morality evolves to a more conventional level that cares for others. Good
MORALITY behavior is whatever pleases others.
(ADOLESCENCE STAGE 4 – (Morality of maintaining social order)
STAGE) Laws and moral rules are seen as instrument for maintaining social order.
Rules and laws are upheld simply because they are rules and laws.
LEVEL 3 STAGE 5 – (Morality of social contracts)
POST- Post-conventional morality affirms people’s agreed-upon rights.
CONVENTIONAL Individual’s rights can sometimes take precedence over laws.
SATGE 6 – (Morality of universal ethical principles)
Morality follows what one personality perceives as basic ethical principle.
Moral action is determined by our r inner conscious and may not be in
accordance with public opinion or society’s laws.

PERSONALITY ASSESSMENT METHODS

Personality Assessment is a proficiency in professional psychology that involves the
administration, scoring, and interpretation of empirically supported measures of personality
traits and styles.
The following methods can be used;
 Interview  Personality inventory
 Observation  Projective techniques

PERSONALITY DISORDERS
A personality disorder is a type of mental disorder in which you have a rigid and unhealthy
pattern of thinking, functioning and behaving.
A person with a personality disorder has trouble perceiving and relating to situations and people.
The types are grouped into three categories:
 Suspicious – paranoid, schizoid, schizotypal and antisocial.
 Emotional and impulsive – borderline, histrionic and narcissistic.
 Anxious – avoidant, dependent and obsessive compulsive.
For each type, a diagnosis will not be made if you have only one or two of the characteristics.
1. Paranoid Personality Disorder
  Suspicious  Argumentative
 Mistrust of other people  Self-important
 Search for hidden meanings and hostile intensions in everything others say and do.

2. Schizoid Personality Disorder

 Detachment and social withdrawal  Emotionally cold
 Introspective  Prone to fantasy

3. Histrionic Personality Disorder

Short-lived enthusiasm and readily become bored and discontented
Pervasive pattern of excessive emotionality
Fleeting adventures- enjoy novelty, search restlessly for new experience
Lack of consideration for others and selfish preoccupation
May use emotional blackmail and demonstrative suicide attempts for other people to
comply with their wishes.

4. Antisocial Personality Disorder (ASPD)

You will be at least 18 years old. You may:
 Put yourself in dangerous or risky situations, often without considering the consequences
for yourself or for other people
 Behave dangerously and sometimes illegally
 Behave in ways that are unpleasant for others
 Feel very easily bored and act on impulse
 Behave aggressively and get into fights easily
 Do things to get what you want, putting your needs above theirs
 Feel no sense of guilt if you have mistreated others

5. Borderline Personality Disorder (BPD)

You may:
 Feel very worried about people abandoning you, and would do anything to stop that
happening
 Have very intense emotions that last from a few hours to a few days and can change quickly
 Not have a strong sense of who you are, and it can change depending on who you're with
 Find it very hard to make and keep stable relationships
 Act impulsively and do things that could harm you (using drugs or driving dangerously)
 Have suicidal thoughts or self-harming behavior
 Feel empty and lonely a lot of the time
 Get very angry, and struggle to control your anger.

6. Narcissistic Personality Disorder

You may:
 Believe that there are special reasons that make you different, better than others
 Have fragile self-esteem, so that you rely on others to recognize your worth and your needs
 Feel upset if others ignore you and don’t give you what you feel you deserve
 Dislike other people’s successes
 Put your own needs above other people’s, and demand they do too
 Be seen as selfish and ‘above yourself’
 Take advantage of other people.

7. Avoidant (or Anxious) Personality Disorder

You may:
 Avoid work or social activities that mean you must be with others
 Expect disapproval and criticism and be very sensitive to it
 Worry constantly about being ‘found out’ and rejected
 Worry about being ridiculed or shamed by others
 Avoid relationships, friendships and intimacy because you fear rejection
 Feel lonely and isolated, and inferior to others
 Be reluctant to try new activities in case you embarrass yourself.

8. Dependent Personality Disorder

You may:
 Feel needy, weak and unable to make decisions or function properly without help or support
 Allow others to assume responsibility for many areas of your life
 Agree to things you feel are wrong or you dislike to avoid being alone or losing someone's
support
 Be afraid of being left to fend for yourself
 Have low self-confidence
 See other people as being much more capable than you are
 Be seen by others as much too submissive and passive.

9. Obsessive compulsive Personality Disorder (OCPD)

You may:
 Need to keep everything in order and under control
 Set unrealistically high standards for yourself and others
 Think yours is the best way of making things happen
 Worry when you or others might make mistakes
 Expect catastrophes if things aren’t perfect
 Be reluctant to spend money on yourself or others
 Have a tendency to hang onto items with no obvious value.

FACTORS INFLUENCING PERSONALITY DEVELOPMENT

1. Genetics
Behavioral characteristics may have hereditary origin thus causing personality problems.

2. Emotional factors
Lack of love or warmth due to parental separation, maternal death or divorce may cause
antisocial behavior.

3. Parental child rearing practices

Poor parental child rearing practice may cause personality problems like dependence,
aggressiveness and good practices lead to positive behavior like good social skills, independence
and assertiveness.

4. Child experiences of one’s body parts

These influence one’s later personality according to Sigmund Freud

5. Nature of the environment

Rich environment promotes good behavior like curiosity, self-confidence, independence and
poor ones cause passiveness, quietness and unhappiness.

6. Culture
Cultural norms are influential determinants of one’s behavior.

COUNSELLING AND GUIDANCE

Counselling are services that help people to solve their own problems.
Guidance is the presentation of information and advice to people on how to solve a problem.

COUNSELLING GUIDANCE
Initiated by the client Mainly initiated by the instructor
More personal and intimate (closeness) Less personal and intimate
More private and confidential Less private and confidential
Less structured More structured
Client centered Instructor centered
Deals with perception, feelings and motivations. Mainly based on facts and principles

FORMS OF COUNSELLING
1. Individual Counselling: -
This is offered to serious personal problems that require high levels of confidentiality. For
example; Fear of disclosure of results/problems to another person.
2. Group Counselling
This is offered to more people with a common concern or interest at the same time.
Situations when group counselling is necessary
 i) During the pretest HIV counselling in crowded situations where counselors are few.
ii) During preventive HIV counselling
iii) Group of pregnant women during antenatal visit when getting information about
PMTCT, VCT before testing.
iv) Peer support groups for positive pregnant women following HIV testing.

Types of counselling
Here are some of the most common types of counselors:
 Marriage and family counseling.  Mental health counseling.
 Guidance and career counseling.  Substance abuse counseling.
 Rehabilitation counseling.  Educational Counseling.

Who should do counselling?

 One who trained in counselling (professional counselors)
 One with good communication skills and positive attitude.
 One with interest and time to help people with problems

Who needs counselling?

 People who may be worried about their sero (HIV) status.
 People with multiple partners
 Patients with chronic diseases like arthritis, cardiovascular disease such as heart attacks
and stroke, cancer such as breast and colon cancer, diabetes, epilepsy and seizures,
obesity, and oral health problems.
 Relatives and families of AIDS, disability, chronic diseases etc.
 People with social family problems.
 Those who have lost their sexual partners or loved ones.
 Those who have multiple partners. Etc.

Counselling environment should be;

Clean
Airy/ well ventilated
Quiet
Private
Cool/warm
Physically comfortable
Free from dust, pollution and foul smell
Safe for client (where he/she feels secure)
Accessible to client and counsellor
 QUALITIES OF A GOOD COUNSELOR
i. Communication Skills
Effective counselors should have excellent communication skills. Counselors need to have a
natural ability to listen and be able clearly explain their ideas and thoughts to others.

ii. Acceptance (Non-judgmental)

Being nonjudgmental and accepting are important attributes in any of the helping professions.
Professional counselors must be able to "start where the client is at."

iii. Empathy
Counselors help people through some of the most difficult and stressful times of their lives. They
must be able to display empathy – the ability to feel what another person is feeling

iv. Problem-Solving Skills

Counselors must have excellent problem-solving skills to be able to help their clients identify
and make changes to negative thought patterns and other harmful behaviors that might be
contributing to their issues.

v. Rapport-Building Skills
Counselors must possess a strong set of interpersonal skills to help establish rapport quickly with
clients and develop strong relationships. They must give their undivided attention to clients and
be able to cultivate trust.

vi. Flexibility
Flexibility in counseling is defined as the ability to adapt and change the way you respond to
meet your clients' needs.

vii. Multicultural Competency

Multicultural competency means that you try to relate to and understand your clients regardless
of their race, ethnicity, religious or political beliefs or socioeconomic background.

viii. Emotional Stability and Maturity

Counselors should be free from unnecessary emotions e.g. anxiety, crying, worries, anger. Tame
your personality to fit in the required attitudes of the client.

ix. Knowledge
Counselors should be well trained and equipped with basic skills.

x. Warmth and Caring

Showing a true welcoming posture and readiness to help and offer support. Approachable,
honest, trustworthy etc.
 xi. Genuine and sincerity
Ability and willingness to be open, real and consistent in relationship with the client, give time,
attention and be “real” rather than not just being in a professional role.

Importance of counselling
 Helps clients to make informed decisions about their problems
 Helps clients to make appropriate planning
 Equips clients with problem solving skills
 Helps clients to cope with different situations
 Helps clients to adjust to new circumstances e.g. unfamiliar environment like hospital,
bereavement, marriage, school life etc.
 Helps clients to give up unsatisfactory way of life and adopting a healthier one e.g. giving
up dependence on alcohol or drugs

PROFESSIONAL ETHICS IN COUNSELLING

Ethics are a set of moral principles or rules of conduct for an individual or group.
Maintaining good ethics is being consistent with the principles of correct moral conduct
constantly.
Good ethical behavior implies treating others with respect, care, compassion, justice and fairness
in all aspects of life.

Importance of Ethics
Ethics are very important for the profession because they help to;
 Build confidence/trust in the profession
 Ensure uniformity within the profession
 Ensure discipline within the profession.
 Maintain a healthy relationship within the profession and other professions and clients.
 Serve as security for the professionals and other clients.

Counselling just like other professions has a legal set of conduct, which includes the following;
1. Respecting the client
Regardless of who the client is, his/her behavior, the client has come to you for help and
deserves to be treated as a human being of worth.
The counsellor has a responsibility to help his/her client feel okay about themselves and to
increase their feelings of self-worth.

2. Giving the client precedence

When a client comes to a counsellor, there is an implied contract with him or she to provide the
confidential help required. Counsellors frequently experience a sense of conflict between their
responsibilities to the client, the employing agency and to the community. However, the
counsellor’s responsibility to the client must take precedence.
 3. Ensuring competence
A counsellor has the responsibility to ensure that he or she gives the highest possible standards of
service to the clients. This calls for adequate training and supervision.

4. Making appropriate referral

When a client’s needs cannot be adequately met by a counsellor, then that counsellor has the
responsibility to make appropriate referral in consultation with the client.
Counsellors should be knowledgeable about the available services for referral and networking.

5. Limits of the client-counsellor relationship

There should be a limit to the client-counsellor relationship. This relationship should be purely
professional. The relationship must avoid creating any suspicions or temptations.

6. Avoiding self-promotion
It is unethical for a counsellor to make claims about him/herself, or his or her services, which are
inaccurate or cannot be authenticated. Counsellors who do this not only put their clients at a risk
but may also face the possibility of prosecution.

7. Ensuring safety
Counsellors should take all reasonable steps to ensure their own safety and ensure that their
health is not compromised.

8. Responsibility to other counsellors

Counsellors must not conduct themselves in their counselling-related activities in ways which
undermine the work of other counsellors. Professional counsellors should respect each other and
should work in harmony with fellow counsellors.

9. Termination of counselling
It is not ethical to terminate counselling at a point where the client still needs further help. If for
some unavoidable reason, then a suitable referral must be made to another counsellor.

10. Following legal obligations

Counsellors and every other member of the community need to operate within the law. As a
counsellor, you therefore need to familiarize yourself with the relevant legal requirements e.g. if
your client is an offender or a victim, legal action must be undertaken.

11. Keeping confidentiality

Confidentiality is one of the most important ethical issues for a counsellor. Clients must feel
secure after knowing that the information they have shared will be treated with a high degree of
confidentiality.
 12. Being exemplary
The counsellor’s personal lifestyle should incorporate and reflect all the characteristics of a good
counsellor. The counsellor must not be alcoholic, engaged in domestic violence or other forms of
behavior not consisted with family harmony. He/she should be a model of leadership in the
community who others could easily consult for guidance.

PRINCIPLES OF COUNSELLING
These refer to a set of norms that guide implementation (standards). Principles aim at ensuring
quality services.
Importance of Principles
 Ensure quality of the services
 Smooth implementation of the activities
 Act as safety measures
 Ensure cost effectiveness
These are the universal principles that counselors are expected to know and practice;
1. Individualism
People prefer to be treated as individuals rather than a case or type. While dealing with a client,
do not treat him/her as person of a particular type, religion, and region though they might face
similar circumstances.

2. Self-expression of feelings
All human beings need to be given the opportunity to express their feeling including negative
ones. Client’s self-expression enables the counsellor to understand the client’s situation from the
client’s perspective.

3. Self-reflection
It is important to think about your own attitudes, beliefs and values and how these might impact
on the way you interact with people or the service you provide. For example, your religious or
social beliefs might lead you to treat some women differently or unfairly if you do not agree with
how they live their lives.

4. Creating a Rapport with the Client

Establishing and maintaining rapport with a client is vital to the encounter and achieving positive
outcomes (1). This can begin by creating a welcoming environment and should continue through
every stage of the client encounter, including follow-up.

5. Client’s self-determination
Direct efforts towards helping clients identify and fulfill their goals as well as needs within the
limitation of their capacity, potential and circumstances. Proceed as if the best solutions to
client’s problems are to be found within client self.

6. Impartiality
A counsellor should not take sides or blame any client on what is happening in their lives or the
problems they are facing. The counsellor should always take a neutral stand while handling
clients and controls personal; values from influencing the way you deal with clients.

7. Controlled emotional involvement

If a counselor cannot control his/her feelings, the client then doubts whether the counsellor is
able to help him/her. Such emotions or feelings may include crying, quarrelling, developing
sexual feelings etc.

8. Self-awareness
Thus involves knowing one’s strong and weak areas.
It is important for a counselor to know where his/her strong and weak areas are, which helps
him/her to determine what kind of situation he/she can handle effectively with a client and which
he/she cannot take on. Refer the client.

COMMUNICATION SKILLS
Communication
This is when two or more people exchange messages using verbal or nonverbal language.
Communication happens because two people want to share information, ideas, thoughts, feelings
etc. and get another person’s feedback.
Communication is when a person sends a message to another person with the hope and desire of
receiving a response through appropriate channel.
The way a person communicates with another will affect how the other person reacts; E.g.
Aggressive communication will trigger an aggressive or defensive response.

Types of communication
1. Verbal Communication
It utilizes the spoken word, either face-to-face or remotely (over the phone). The medium of the
Message is oral. Verbal communication is essential to most interactions, but there are other
nonverbal cues that help provide additional context to the words themselves. Pairing nonverbal
communication with the spoken word provides a more nuanced message.

2. Nonverbal Communication
To be effective communicators, we need to align our body language, appearance, and tone with
the words we’re trying to convey. These things are often communicated through facial
expressions, hand gestures, posture and even appearance, all of which can convey something
about the speaker.
 3. Written Communication
In contrast to verbal communications, written communications are printed messages which
include memos, proposals, e-mails, letters, training manuals, and operating policies. They may
be printed on paper, handwritten, or appear on the screen.

Top 10 Communication skills

1. Listening
Being a good listener is one of the best ways to be a good communicator. Active listening
involves paying close attention to what the other person is saying, asking clarifying questions,
and rephrasing what the person says to ensure understanding ("So, what you're saying is…").

2. Nonverbal Communication
Your body language, eye contact, hand gestures, and tone of voice all color the message you are
trying to convey. A relaxed, open stance (arms open, legs relaxed), and a friendly tone will make
you appear approachable and will encourage others to speak openly with you.

3. Clarity and Concision

Good verbal communication means saying just enough – don’t talk too much or too little. Try to
convey your message in as few words as possible. Say what you want clearly and directly,
whether you're speaking to someone in person, on the phone, or via email.

4. Friendliness
Through a friendly tone, a personal question, or simply a smile, you will encourage your
coworkers to engage in open and honest communication with you. It's important to be nice and
polite in all your workplace communications.

5. Confidence
It is important to be confident in your interactions with others. Confidence shows your
coworkers that you believe in what you’re saying and will follow through. Exuding confidence
can be as simple as making eye contact or using a firm but friendly tone.

6. Empathy
Even when you disagree with an employer, coworker, or employee, it is important for you to
understand and respect their point of view. Using phrases as simple as "I understand where you
are coming from" demonstrate that you have been listening to the other person and respect their
opinions.
7. Open-Mindedness
A good communicator should enter into any conversation with a flexible, open mind. Be open to
listening to and understanding the other person's point of view, rather than simply getting your
message across. By being willing to enter into a dialogue, even with people with whom you
disagree, you will be able to have more honest, productive conversations.
 8. Respect
People will be more open to communicating with you if you convey respect for them and their
ideas. Simple actions like using a person's name, making eye contact, and actively listening when
a person speaks will make the person feel appreciated. On the phone, avoid distractions and stay
focused on the conversation.

9. Feedback
Being able to appropriately give and receive feedback is an important communication skill.
Managers and supervisors should continuously look for ways to provide employees with
constructive feedback, be it through email, phone calls, or weekly status updates.

10. Picking the Right Medium

An important communication skill is to simply know what form of communication to use. For
example, some serious conversations (layoffs, changes in salary, etc.) are almost always best
done in person.

BARRIERS TO COMMUNICATION
A communication barrier is anything that prevents you from receiving and understanding the
messages others use to convey their information, ideas and thoughts. These include;
 Fatigue
 Lack of interest in the information
 Poor listening skills
 Past experiences with the client
 Home or work problems
 Fear to communicate to certain people or groups of people
 Lack of communication experience
 Negative attitudes towards the sender of the information
 Emotional Barriers and Taboos.
 Noise and other distractions
 Unpleasant environment
 Problems with technology or equipment.
 The use of jargon. Over-complicated, unfamiliar and/or technical terms.
 Lack of attention, interest, distractions, or irrelevance to the receiver
 Differences in perception and viewpoint.
 Physical disabilities such as hearing problems or speech difficulties.
 Physical barriers to non-verbal communication. Not being able to see the non-verbal
cues, gestures, posture and general body language.
 Language differences and the difficulty in understanding unfamiliar accents.
 Expectations and prejudices which may lead to false assumptions or stereotyping.
 Cultural differences.