What is psychological point of compliance and role of compliance in treatment of patient.

1. Dr. Sushma Rathee
assistant clinical psychologist
PGIMER, Chandigarh
email: sushmaratheecp@gmail.com

2.  Social influence describes how our thoughts, feelings,
and behaviors respond to our social world, including
our tendencies to conform to others, follow social
rules, and obey authority figures. Social influence
takes two basic forms: implicit expectations and
explicit expectations.
 Implicit expectations are unspoken rules. Like the
unwritten laws of middle school, implicit expectations
are enforced by group norms.
Social influence

3. 
 The first is conformity, which occurs when you
voluntarily change your behavior to imitate the
behavior of your peers.
 A second form of implicit social influence comes from
social roles, or expectations from a group about how
certain people are supposed to look and behave.
 Explicit expectations are clearly and formally stated—
not at all subtle. There are also two forms of explicit
expectations: compliance and obedience.
Cont…

4. 
 This experiment was conducted to test social influence and
compliance to authority through the utilization of a prison life
situation. After answering a local newspaper ad (calling for
volunteers for a study centered on the effects of prison life), 70
applications were checked for psychological problems, medical
disabilities and crime/drug abuse history and reduced to 24
American and Canadian college students from the Stanford area.
The all-male participant pool was divided into two groups (guards
and prisoners) by flipping a coin.
 The prison was constructed by boarding up both sides of a corridor
in the basement of Stanford's psychology department building.
“The Yard” was the only place were prisoners were allowed to
walk, eat or exercise—actions that were done blindfolded so they
could not identify an exit. Prison cells were located in laboratory
rooms where the doors had been removed and replaced with steel
bars and cell numbers.
Stanford prison experiment:

5. 
 The incarcerated individuals believed they were being kept
in the “Stanford County Jail” because before the
experiment began, they did not know they would be labeled
prisoners.
 On a random day, prisoners were subjected to an authentic
police arrest. Cars arrived at the station and suspects were
brought inside where they were booked, read their Miranda
rights a second time, finger printed and taken to a holding
cells where they were left blindfolded.
 Each prisoner received chains around their ankles and a
stocking (to simulate a shaved head). Additionally, inmates
lost their names and were subsequently referred to by their
ID number
Cont…

6. 
 As the experiment progressed, participants assigned to guard
positions escalated their aggression.
 Although guards were instructed not to hit the prisoners, they found
ways to humiliate/disrupt them via systematic searches, strip
searches, spraying for lice, sexual harassment, denying them of basic
rights (e.g., bathroom use) and waking inmates from their sleep for
head counts. Social and moral values initially held by the guards were
quickly abandoned as they became immersed in their role.
 Due to the reality of psychological abuse, prisoners were released 6
days later, after exhibiting pathological behavior and nervous
breakdowns.
Cont….

7. 
Compliance
Compliance- getting people to say yes to a request
Compliance occurs when people change their behavior as a
result of another person or group asking or directing
them to change.

8. 
 Friendship/liking- “she seems genuine and nice”
 Commitment/consistency- “i’m committed to the
cause.”
 Scarcity- “only one left”
 Reciprocity- “she helped me so I should return
favor”
 Consenus - “everyone else is doing it.”
 Authority- “he seems legitimate.”
Principles underlying compliance:

9. 
 A number of techniques that people use to get the
compliance of others clearly show the relationship of
compliance to the world of marketing, as they refer
to techniques that door-to-door salespersons would
commonly use.

10. 
Compliance Techniques
Tactics based on liking
ingratiation- enhance self or flatter target
personal appeals - appeal to feelings of loyalty,
friendship.
Tactics based on commitment/consistency
foot-in-the-door- small request followed by larger one.
lowballing- changing the deal midstream.

11. 
Cont…
 Tactics based on reciprocity
 door-in-the-face- large request followed by smaller one
 “that’s not all”- sweeten the deal midstream
 Tactics based on scarcity
 playing hard to get- suggesting item is scarce (valuable)
 deadline technique- limited time to buy

12. 
 THAT’S-NOT-ALL TECHNIQUE: In this compliance
tactic, the person doing the persuading makes an offer,
but before the target of the offer can make a decision, the
persuader throws in something extra to make the deal
look even better.
Cont…

13.  This technique relies on the norm of reciprocity, which
basically assumes that if someone does something for a person,
the person should do something in return.
 LOWBALL TECHNIQUE: Another compliance technique, also
common in the world of sales, is called the lowball technique.
In this technique, once a commitment is made, the cost of that
commitment is increased. (In the sense used here, cost does not
necessarily mean money; cost can also mean time, effort, or
other kinds of sacrifices).
Cont…

14. Cont….
 Tactics based on mood
 Negative mood
 negative state relief
hypothesis - The idea that
people engage in certain
actions, such as agreeing to a
request, in order to relieve
negative feelings and to feel
better about themselves
 good mood-
 More likely to comply
 prime happy thoughts
(AIM model)
 Inspirational appeals

15.  Cultural differences exist in people’s susceptibility to these
techniques. For the foot-in-the door technique in particular,
research has shown that people in individualist cultures (such
as the United States) are more likely to comply with the
second request than are people in collectivist cultures (such
as Japan).
 The research suggests that people in collectivist cultures are
not as concerned with being consistent with previous
behavior because they are less focused on their inner
motivation than are people in individualist cultures, who are
more concerned with their inner motives and consistency.
Cultural differences in Techniques:

16. 
 People are more likely to comply when they believe that they
share something in common with the person making the
request.
 When group affiliation is important to people, they are more
likely to comply with social pressure.For example, if a college
student places a great deal of importance on belonging to a
college fraternity, they are more likely to go along with the
group's requests even if it goes against their own beliefs or
wishes.
 The likelihood of compliance increases with the number of
people present.If only one or two people are present, a person
might buck the group opinion and refuse to comply.
 Being in the immediate presence of a group makes compliance
more likely.
Factors That Influence Compliance:

17. 
 People are motivated to achieve their goals in the
most effective and rewarding manner possible. A
person’s desire to respond appropriately to a
dynamic social situation demands an accurate
perception of reality.
 The need to correctly interpret and react to incoming
information is of paramount importance, particularly
to targets of compliance-gaining attempts.
Goal of Accuracy

18.  Whatley et al. (1999) differentiated between the
emotions and related goals associated with public and
private compliance in response to a favor.
 They posited that individuals avoid or alleviate
feelings of shame and fear via public compliance, and
guilt and pity via private compliance.
 The influence of mere arousal, finding that the simple
arousal elicited by performing an interesting task
enhances the likelihood of compliance with a request.
AFFECT AND AROUSAL:

19. 

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24. 
1. Understand each patient’s medication-taking
behaviors.
2. Talk about side effects
3. Collaborate with patients
4. Consider the financial burden to the patient
5. Reduce complexity
6. Follow up with patients
7. Use technology
How to improving patient compliance:

25. 1. Listen to your patients
2. Build a rapport with them
3. Give them relevant information.
4. But don't overload them.
5. Motivate, motivate, motivate them
6. Schedule regular recall periods
7. Don't be a mum and nag them
Cont…

26. 
1. Improve communication between physician and
patient and/or family.
2. Modify or negotiate regimens.
3. Emphasize patient self-management of disease or
illness.
4. Use the simplest effective regimen available. ...
5. Use technology and devices.
6. Develop better communication skills.
General Principles to Enhance
Medication Compliance

27. 