Health Psychology

Course code – SSYP2433

Course Instructor
Dr Sana Anwar Lashari

McGraw-Hill/Irwin © 2012 McGraw-Hill Companies, Inc. All rights reserved.

 What is Health Psychology
Health Psychology:
Exciting and relatively new field devoted to
understanding psychological influences on
how people stay healthy, why people
become ill and how they respond when
they do get ill

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 “a complete state of physical, mental and social well-being
and not merely the absence of disease or infirmity”

McGraw-Hill/Irwin © 2012 McGraw-Hill Companies, Inc. All rights reserved.

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 Health Psychologists focus on:
➢ Health promotion and maintenance
Health habits – promote exercise
➢ Prevention and treatment of illness
Manage stress – high stress environment
➢ Etiology and correlates of health, illness and dysfunction
Seat belts, alcohol, smoking, coping
➢ The health care system and the formulation of health
policy
Health institutions, professionals

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 • Research

Scope of • Practice

Health • • Individual and community

levels
Psychology • • Prevention of physical
illnesses and health promotion;
treatment of and adjustment to
physical illnesses.
 Patients with coronary heart diseases (CHD):
• • Health psychologists can help these patients change
behaviors (reduce health-compromising behaviors and
increase health-enhancing behaviors) to reduce the
likelihood of future attacks
• • Health psychologists also teach these patients relaxation
Examples of techniques to reduce stress that affect the risk of further
heart problems
• • Health psychologists help patients modify Type A
Health behaviors and hostility
• • Health psychologists also help these patients deal with
Psychologist depression and anxiety that are common among CHD
patients

s at Work • Prevention of CHD:

• • Efforts to reduce health-compromising behaviors and
increase health-enhancing behaviors among those with risk
factors for CHD e.g. hypertension, high serum cholesterol
• • Help in designing heath promotion campaigns in
community that target at changing risk factors for CHD
(e.g. anti-smoking and anti-obesity campaigns)
 Cancer
• • Working with cancer patients:
• • Health psychologists help patients dealing with emotional adjustment
problems, including depression and anxiety
• • Pain management
• • Group psychosocial interventions for reducing stress, improving social
support, dealing with treatment side effects, and reducing rate of recurrence
Examples of Prevention:

Health Changing health-compromising behaviors (e.g. smoking)

among high-risk individuals
Psychologists
Designing public campaigns:
at Work • Cancer awareness

Encouraging participation in screening programs

Reducing cancer-related behaviors

Historical
Development
The Mind-Body Relationship: A Brief
History
In perspective of ancient Greeks Disease was believed
to be:
- Evil spirits entering the body
- The result of the imbalance of blood, black bile,
yellow bile and phlegm
Passionate temperament, sadness, angry disposition, laid back approach

- God’s punishment for evil-doing

Advances in science looked to bodily factors rather

than the mind as bases for health and illness
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 • Ancient Greeks:
• • Hippocrates developed the humoral theory of
illness; later elaborated by Galen
• • Disease caused by an imbalance of the four
humors: blood, black bile, yellow bile, and phlegm;
humoral imbalance also have an impact on the mind
• • Treatment involved restoring balance among the
humors
• • Mind and body as separate entities
• • But Hippocrates did believe that health includes
both physical and emotional aspects
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 • Middle Ages:
• • Disease seen as God’s punishment for
wrongdoing
• • Cure consisted of torturing the body to drive out
the evil
• The Renaissance and After:
Historical • • Mind and body as separate entities to severe the
ties between mysticism and disease – mind-body
Development dualism
• • Development of microscopy, autopsy, antiseptic
techniques and anesthesia
• • Rejection of the humoral theory
• • Biomedical Model, for the next 300 years
• • All disease or physical disorders can be explained
by disturbances in physiological processes
resulting from injury, biochemical imbalances,
bacterial or viral infection and the like
Historical Development:
Emergence of Health
Psychology

Challenges to the biomedical model led to the

development of:
• Psychosomatic Medicine
• Behavioral Health
• Behavioral Medicine
• Health Psychology
 • Freud: unconscious psychological conflicts as the cause
of certain physical disturbances
• Conversion hysteria
• Established that repressed feelings, experiences and
conflicts becomes converted into physical problems
such as paralysis and blindness
Psychosomatic • Psychological intervention needed in treatment of
physical problems
Medicine • Dunbar and Alexander:
• Personality: ulcer-prone personality: excessive need
for dependency and love
• Alexandra: 7 psychosomatic illnesses
• Peptic ulcer, asthma, essential hypertension,
hyperthyroidism, rheumatoid arthritis,
neurodermatitis, and colitis
 • The study of physical problems in which the
cause is psychological rather than physical
• 1930: the National Research Council began
publishing the journal Psychosomatic
Medicine
Psychosomatic • Criticism:
• Too simplistic: disease caused by
Medicine interaction of a variety of factors rather
than a particular repressed conflict or
personality type alone
• Psychosomatic approach to illness much
more useful than the concept of
Psychosomatic illnesses
 • Maintenance of health and prevention
of illness in currently healthy individuals
through the use of educational inputs to
change behaviors and lifestyle

Behavioral • Role of behavior in determining one’s

health status
Health
• Integration of the mind and body
Behavioural Medicine
• Integration of the
behavioral sciences with
the practice and science • Interdisciplinary
of medicine (Gatchel,
Baum, & Krantz, 1989)

• Role of behaviors
• Challenges the • • Evaluation, prevention and
biomedical separation of treatment of physical disease
or physiological dysfunction
the body and the mind

• Focus not only on

treatment as in the
• Heavily related to
biomedical model, but
behaviorism
also in the prevention of
illness
Health Psychology
• Based within psychology
• Division of Health Psychology
formed within the American
Psychological Association in 1978
• Draws upon knowledge from other
subfields in psychology including
clinical, experimental, and social
psychology
• A role for the mind in both the
cause and treatment of illness
 • Psychology influences on health:

• Direct pathway

E.g. physiological effect of stress on

CHD and cancer

Health • Indirect pathway

Health related behaviors e.g. smoking,

Psychology diet, exercise

Impact on vulnerability to illness

• Reactions to illness

E.g. delayed help-seeking

 Changing patterns of disease and increase in life expectancy

• • From Acute Infectious Diseases to Chronic Diseases

• • Differences in cause, course, treatment and impact (individual and the
Factors family) of acute and chronic disease
• • Re-emergence of the significance of infectious diseases: AIDS, SARS, bird
flu etc.

Contributing • • Decrease in age of onset of certain diseases

Advances in medical technology and research

to the
Growth of Increasing health care costs & disease burden

• • The importance of prevention

Health Increased acceptance and acknowledgement by medical

personnel

Psychology? Demonstrated contribution to health

• • Changing health-compromising behaviors, pain management, treatment

adherence, dealing with treatment side effects.
• • The limits of medicine
 Mind-Body Interface & Biopsychosocial
Approach

Prevention of Disease and Promotion of Health

in addition to Intervention and Treatment

Health The Role of Behaviors and Lifestyle Factors

Psychology
Application of Psychological Theories and
Methodologies

Working on Both the Individual and

Community Levels
 • What is Health?
• Hippocrates:
Health as a natural balance of both physical
and emotional aspects, mediated by a
harmonious mixture of the humors
I. Mind-Body Mind-Body Interface
• “The reason why a sound body becomes ill,
Interface or an ailing body recovers, very often lies in
the mind” Gaub (1747), professor in medicine
• “There is much ‘physical’ in ‘mental’
disorders and much ‘mental’ in ‘physical’
disorders” DSM-IV-TR (2000)
Psychological Problems and Physical
Illness
Five forms of relationship:
1. Psychological factors as causes of physical illness
2. Psychiatric disorders presenting with physical symptoms
3. Psychiatric consequences of physical illness
4. Psychiatric and physical disorder occurring together by
chance
5. Psychiatric problems with physical complications (e.g.
deliberate self-harm, alcohol and substance abuse, eating
disorders)
 Role of Psychology in Health and Illness

• Stress

• Behaviours

• Help-seeking

• Adjustment to physical illnesses

• Adherence to treatment
 • World Health Organization (1948),

“a complete state of physical, mental,

Biopsychosocial and social well-being and not merely
Approach the absence of disease of infirmity”

• Therefore, health is achieved with a

balance of physical, mental, and social
well-being.
 What is Psychological Health?

Criteria of psychological health suggested by Capuzzi and Gross (1997):

• Self-acceptance and self-esteem
• Self-knowledge
• Self-confidence and control
• Clear (though slightly optimistic) perception of reality
• Courage and resilience
• Balance and moderation
• Love of others
• Love of life
• Purpose in life
 Disease versus Illness

• DISEASE: DEVIATION FROM ~ WHAT THE DOCTOR • ILLNESS: THE DISCOMFORT ~ WHAT THE PATIENT IDENTIFIES
HEALTH IDENTIFIES AS AN THE PATIENT EXPERIENCES AS SYMPTOMS AND FEELS
ABNORMALITY IN HEALTH (FEAR, DISTRESS, ETC.)
 1. Primary prevention
• Modification of risk factors (e.g.
smoking, drinking) before illness onset
• Health promotion efforts are a form
of primary prevention
2. Secondary prevention
• Interventions aimed at detecting
illness at an asymptomatic stage so that
II. Prevention its progression can be haltered or
retarded
• E.g. screening
3. Tertiary prevention
• Treatment interventions once an
illness has manifested itself to prevent it
from worsening
• Rehabilitation of patients
 Health Promotion

• Good health is a personal and collective responsibility

• The importance of good health habits and healthy
lifestyles
• Concerted effort of individual, medical personnel,
health psychologists, government, and the mass media
 Behavior and mortality
• 50% of mortality from the 10
leading causes of death is due
to behavior
• Tobacco consumption
III. Role of accounts for 30% of all cancer
Behaviours in deaths (90% of lung cancer
Health and Illness deaths)
• Alcohol: 3%
• Diet: 35%
• Reproductive and sexual
behavior: 7%
• 75% of all deaths due to
cancer related to behaviors
 Role of Behaviors

Behavioral risk factors associated with the 5 leading causes of death:

1. Heart disease: smoking, high dietary cholesterol, lack of exercise
2. Cancer: smoking, high alcohol use, diet
3. Stroke: smoking, high dietary cholesterol, lack of exercise
4. COPD (Chronic lung diseases): smoking
5. Accidents: alcohol/drug use, speeding, not using seat belts
Role of Behaviors
Role of Obesity:
• 10% reduction in weight among men between 35 to 55 would
lead
• 20% decrease in coronary heart disease
Degenerative arthritis
GI cancer
Diabetes
Stroke
 Role of behaviors

• And consider the role of behaviors in these health conditions as well:

• Infectious diseases
• AIDS, STDs
• SARS
• Hepatitis B
• Diabetes
• Hypertension
• Obesity
 Longevity Factor

• Sleeping 7-8 hours a day

• Having breakfast every day
• Not smoking
• Rarely eating between meals
• Being near or at prescribed weight
• Having moderate or no use of alcohol
• Taking regular exercise Belloc & Breslow (1972), Belloc (1973), Breslow & Enstrom (1980)
• Prospective longitudinal study of 7000 people
• Health status of those over 75 who practiced all 7 health habits were comparable to those aged 35 to
44 who practiced less than 3
• At 9.5 years follow-up: Men practicing all 7 health habits had mortality rate of only 28% that of men
practicing 0 to 3 of the health habits, women practicing all 7 health habits had mortality rate of only 43%
that of men practicing 0 to 3 of the health habits
 • For men: total life expectancy
increases by 6.6 years; life expectancy
Daily diet, free from CVD increases by 9 years;
life expectancy with CVD decreases by
risk of CVD, 2.4 years

and • For women: total life expectancy

increases by 4.8 years; life expectancy
Longevity free from CVD increases by 8.1 years;
life expectancy with CVD decreases by
3.3 years Franco et al. (2004).
 Kasl & Cobb (1966):
Types of • Health Behavior: behavior aimed
at preventing disease (e.g
Health- healthy diet)
• Illness Behavior: behavior aimed
Related at seeking remedy (e.g. seeing
the doctor)
Behaviors • Sick Role Behavior: any behavior
aiming to get well (e.g. rest,
medication)
 Matarazzo (1984) further defined health behaviors in terms of
Health impairing habits:
either:
Health • “behavioral pathogens”
• habits
Health that willbehaviors:
protective deteriorate health (e.g. high fat diet,
• behaviors that will maintain health (e.g. enough sleep
Behaviors • “behavioral immunogens”
smoking, substance abuse)
everyday, regular exercise, attending health checks, seeking
health information, using headsets while driving/not talking on
mobile phones at all while driving)
IV. Models • Attributional Theories

and • Cognition and Social Cognition Models

Theories in • Learning Theories:

• • Classical Conditioning

Health • • Operant Conditioning

• • Social Learning

Psychology • Cognitive-Behavioural Approaches

 • Changing
• Coping with
behaviours
medical
• • Increase procedures
• • Decrease

Applications
• Stress
of These • Coping with pain
management
Methods For
• Improving
treatment
adherence
 • Attributional Theories

Models of • Cognition Models:

Health • • Health Belief Model (HBM)

• • Protection Motivation Theory (PMT)

Behavior • Social Cognition Models:

Change • • Theory of Planned Behaviour (TPB)

• • Health Action Process Approach (HAPA)

• Transtheoretical Model of Behavior Change:

The Stages of Change Model
 What Works and What Doesn’t
V.
• 1.) The message
Community- • • Colorful and vivid
• • Avoid jargons
Based • • Case histories
• • Very extreme messages should be avoided
Intervention • • For illness detection behaviors:
emphasizing the problems
s for • • For health promotion behaviors:
emphasizing the benefits
Behavior • • Use of fear? - useful but need to be
coupled with effective ways to change the
behavior that the audience is capable of
Change following
 2.) The communicator
• • Credibility – expert, trustworthy, prestigious

V. • • Likeability
• • Similarity to audience

Community- 3.) How the message is communicated

Based • • Strong arguments should be presented at the beginning and end

of the message, not in the middle
• • Short, clear and direct
Interventions • • State conclusions explicitly

for Behavior 4.) The audience

Change • If audience is already receptive of change: include

supporting only

• If audience is not receptive: discuss both sides of the

issue
 Summary

1. Health psychology examines psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill.
The field focuses on health promotion and maintenance; prevention and treatment of illness; the etiology and correlates of health, illness, and
dysfunction; and improvement of the health care system and the formulation of health policy.
2. The interaction of the mind and the body has concerned philosophers and scientists for centuries. Different models of the relationship have
predominated at different times in history.
3. The biomedical model, which has dominated medicine, is a reductionistic, single-factor model of illness that treats the mind and the body as separate
entities and emphasizes illness concerns over health.
4. The biomedical model is currently being replaced by the biopsychosocial model, which regards any health disorder as the result of a complex interplay
of biological, psychological, and social factors. The biopsychosocial model recognizes the importance of interacting macrolevel and microlevel
processes in producing health and illness. Under this model, health is regarded as an active achievement.
5. The biopsychosocial model guides health psychologists in their research efforts to uncover factors that predict states of health and illness and in their
clinical interventions with patients.
6. Th e rise of health psychology can be tied to several factors, including the increase in chronic or life-style-related illnesses, the expanding role of
health care in the economy, the realization that psychological and social factors contribute to health and illness, the demonstrated importance of
psychological interventions to improving people’s health, and the rigorous methodological contributions of health psychology researchers.
7. Health psychologists perform a variety of tasks. They develop theories and conduct research on the interaction of biological, psychological, and social
factors in producing health and illness. They help treat patients with a variety of disorders and conduct counseling for the psychosocial problems that
illness may create. They develop worksite interventions to improve employees’ health habits and work in medical settings and other organizations to
improve health and health care delivery.