Health Psychology

PSY 289
March 3
 Outline
• Syllabus review & introductions
• General course expectations
• Unit 1: Introduction to Health Psychology
– Defining the field
– Social ecological model
– Macro-social influences on health, Health disparities
– Mind-body connections, Biopsychosocial model
– Methodology and research methods in health
psychology
 Contact information
• Instructor
– Steri Elavsky
– 2.46 FSS
– [email protected]
– 606168831
– Consultation hours by appointment
 What is Health Psychology?
• Let´s start with some thought questions
– How would you define Health Psychology?
– What do we mean by health?
– What determines health?
– What role does psychology play in health?
– What do health psychologists do?
 What is Health Psychology?
• Health psychology is an interdisciplinary field
concerned with the application of
psychological knowledge and techniques to
health, illness, and health care (Marks et al., 2011)
• It is wholistic, concerning itself with both
physical and mental health
 History of Health Psychology

1973 – the Board of Scientific Affairs of the

APA appointed a task force to study the
potential for psychology’s role in health
research.
1978 – APA established Division 38, Health
Psychology
1982 – the journal Health Psychology began
publication
 Thought question
• How does Health Psychology differ from?
– Psychosomatic medicine
– Behavioral medicine
• How about other related fields?
– Epidemiology
– Public health
– Sociology….
 Aims of Health Psychology
• Promotion and maintenance of health (health
habits)
• Prevention and treatment of illness (clinical)
• Identification of etiological and diagnostic
correlates of health and illness (research)
• Analysis of the health care system and health
policy formation (political)
(Matazarro, 1982)
 What do we mean by health?
• Health is most commonly defined in terms of
absence of disease, but may be better viewed
as an illness/wellness continuum (attributed to John,
Robins, Maslow 1972-1975)
 What is health?
• Health is a state of well-being with physical,
cultural, psychosocial, economic, and spiritual
attributes, not simply the absence of illness
• To be healthy, one´s biological needs must be
satisfied, as well as one´s needs to
interconnect with others and be autonomous
Health as needs satisfaction

Maslow (1943)
Different models of health

Class, employment,
Behavior, beliefs, ethnicity, environment,
coping, stress, pain trauma

The Biopsychsocial Model

(Engel, 1977)
Viruses, bacteria,
genetics, ….
 Models of health
Biomedical Model Biopsychosocial
• Reductionistic • Macro-level as well as micro-
level factors considered
• Single-factor • Multiple factors
• Assumes mind – body • Mind and body interact,
dualism (two separate influence each other
entities, not affecting each • Focus both on health and
other) illness – both have mental and
• Emphasize illness over social components
health • Main focus on health
• Main focus on curing illness (prevention)
 Discussion
• Have you been to another country?
• Consider any differences between that county
and your own (e.g., access to health care,
transport, sanitation, smoking regulation, diet,
levels of exercisem etc.)
• How might these differences explain any
differences in patterns of health and illness?
 Social Ecological Model

https://www.cdc.gov/nccdphp/dnpao/state-local-programs/health-equity/framing-the-issue.html
Dahlgren & Whitehead’s “Health Onion” (1991)
 Tha Macro-Social Environment and
Health
• Health, illness, and motality vary based on
geographical location, time, SES, ethnicity/race,
and gender.
– SES is more important as determinant of health than
ethnicity – however, one must consider the interplay
of income, education, and occupation
• Dramatic increases in world population with
negative impacts on poor nations
• The greatest influence on health for the majority
of people is poverty
 Poverty
• Poverty is a factor in disease rates & decreased
life expectancy
• For example, in the US, disproportionate
numbers of African-Americans, Latinos & Native
Americans are poor
• Access to medical care is a factor that makes
poverty a health risk
• Poverty is associated with poorer health habits
• Poverty puts poorer classes at increased risk for
disease
 Health inequalities by geographical location

• Geographical location

http://www.un.org/en/development/desa/population/publications/pdf/mortality/WMR2013/World_Mortality_2013_Report.pdf
 Health inequalities by geographical location

http://www.un.org/en/development/desa/population/publications/pdf/mortality/WMR2013/World_Mortality_2013_Report.pdf
 Health inequalities by geographical location

http://www.un.org/en/development/desa/population/publications/pdf/mortality/WMR2013/World_Mortality_2013_Report.pdf
Health inequalities by geographical location
Health inequalities by geographical location
MEN WOMEN

http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx?cancer=lung
Health inequalities by geographical location
Content source: National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation
Health inequalities by SES

WHO (2010)
 Health inequalities by SES

http://www.who.int/gho/ncd/risk_factors/obesity_text/en/
 Health inequalities by SES

• Multiple disadvantages accumulate with low

SES
– Families, schools, neighborhoods
– Peer groups
– Parental support systems, parental workplaces
– Social policy
 Health inequalities by SES

• Psychosocial explanations for social variations in health

– Perceived inequality
– Stress
– Lack of control
– Less social connection
• Material explanations for social variations in health
– Reduced income
– Reduced access to services
• Political explanations for social variations in health
– Political philosophies, social policies
 Health inequalities by gender

http://www.citymetric.com/horizons/life-expectancy-england-isnt-falling-were-reaching-upper-limit-638
 Health inequalities by gender

• Men have shorter lifespans and are more

likely to die from different causes
• Women live longer but have greater morbidity
and utilize health care services more
• What are the likely explanations for men’s
shorter life expectancy?
What do health psychologists do?
• Clinical health psychologist
– Clinical psychologist with expertise in health (stress,
pain, coping; rehabiliation for patients with chronic
illness; etc.)
• Professional health psychologist
– Trained in health psychology (research, teaching,
consulting)
• Academic health psychologist
– PhD in a health-related psychology area (academic
position)
Rationale for Health Psychology
 Causes of Death
FIGURE 1. The ten leading
causes of death in the
United States in 1900 and
1997.

From the following article:

Changing patterns of
infectious disease
Mitchell L. Cohen Nature
406, 762-767(17 August
2000)
doi:10.1038/35021206
 Preventable causes of death
• Assignment 1
 Deaths with preventable causes
• In 1990, more than 1 million deaths (about
half the deaths in the U.S.) had preventable
causes*
Tobacco 400,000 Deaths 19%
Diet & Physical 300,000 14%
Inactivity
Alcohol, firearms, 200,000 9%
sexual behaviors,
motor vehicles &
illicit drugs

McGinnis & Foege (1993)

 Research Methods in Psychology
• Health Psychology is a science
• Goal of Science
– To explain, understand, and predict behavior through
systematic theory building
– Systematic, controlled, empirical (unbiased)
– Designed to challenge veracity of commonly held
myths
• Theory
– General rule or principle about the relationships
among variables that describe and predict behavior
 Scientific Method
• SYSTEMATIC
– Does the relationship hold under all conditions?
• CONTROLLED
– Potential external influences are taken into account and
“controlled” so as not to influence key relationships
• EMPIRICAL
– Relationships are based on observation (must be objective
evidence to support the relationship)
• CRITICAL
– The methods is open to rigorous evaluation by the
researcher and other scientists… ensures reliability of
conclusions
 Some Important Terms
• CONSTRUCT
– A concept defined for scientific purpose
– You cannot see constructs…inferred through behavior
• OPERATIONAL DEFINITION
– Defining constructs in observable and measureable terms
• RESEARCH SETTINGS
– Studies … often involve observation of relationships in
naturalistic settings
– Experiments … involve manipulation of variables as well as
observing them – often involve control groups and are
conducted in controlled settings (labs)
 Validity
• The extent to which theoretical relationships can be
consistently demonstrated
Internal Validity
• The extent to which we have confidence in a
relationship between two variables
External Validity
• Degree to which results of a study are generalizable to
other situations and populations
Which is more important?
 Summary
• Scientific method is:
– Highly reliable
– Systematic and controlled
– Objective and unbiased
• This leads to it being:
– Reductionistic – experiments are isolated to
smaller parts (no “big picture”)
– Lacks external validity (generalizability)
– Conservative (slow to evolve)
 Importance of theory
• Basis for effective techniques lies in the theoretical substrate
of the discipline of psychology

• Development of new therapies/interventions depends upon

this theoretical basis

• Application to complex or new problems requires a

theoretical basis
– E.g. Walby (1970) … systematic desensitization for phobias
previously thought untreatable.

• Causal processes and mechanisms of change

 Importance of Empiricism
• Evaluation of the efficacy of treatments
• Empirical justification for claims
• Delineation of limits of claims (rarely unequivocal)
– Success rates, breadth of response, long-term outcome

• Study of predictors of outcome

• Best practice protocols
 Research Methods
• “Health” involves many variables - hard to research
• But research does not have to be perfect to be useful!

• Types of research design…

– Experiment
– Ex post facto design (quasi experimental)
– Single-subject
– Correlational
– Retrospective
– Prospective (longitudinal)
– Epidemiology
 Experiment
• Manipulate independent variable and measure dependent
variable
• Able to determine causality
• Example: randomized controlled trial (RCT)
• Characteristics of a good experiment…
– .
– .
– .
– .
– .
 Experiment
• Manipulate independent variable and measure dependent
variable
• Able to determine causality
• Example: randomized controlled trial (RCT)
• Characteristics of a good experiment…
– Random sampling
– Random assignment
– Valid manipulation of independent variable
– Valid and reliable measurement of dependent variable
– Control extraneous variables
WHY?
 Placebo
• Active treatment
– substance or procedure that is explicitly directed at the
symptoms of the condition in question.
• Placebo
– substance or procedure that does not specifically target the
condition being treated
• Provide about 35% of improvement for a variety of
conditions.
– Physical conditions - headaches, warts, etc
– Psychological conditions - pain, depression, etc
Example – Depression
Cognitive-Behaviour…...…………. 65-70%
Antidepressant medication………. 65%
Placebo drug……………………… 30%
 Implications for research
Double-blind trials
1. Diagnosis
2. Intervention Independent variable

Experimental group Placebo group Control group

(active drug) (inert drug) (no pills)

3. Assess on relevant dependent variables

4. Follow-up (long-term gains)

OFTEN NOT POSSIBLE IN BEHAVIORAL INTERVENTIONS

 Quasi-experiment
• Not always able to manipulate the independent
variable
– Ethical and practical reasons

• Not able to determine causality

– Groups self-select (no random assignment or
manipulation)
– Observe dependent variable
– Able to identify “risk factors”
 Correlational designs
• Observe two (or more) variables

• Data analysis
– Simple correlations (2 variables),
– Path analysis/structural equation modeling
(multiple variables)

• Not able to determine causality

– Able to identify “risk factors”
– Correlational studies are often misunderstood
 Prospective studies
• Begin with whole population and observe over time
– Initially healthy

• Cross lagged correlations

• Problems…
– Expensive
– Time consuming
– Attrition rates
 Epidemiology
• Scientific discipline that considers the various factors
determining the frequency, distribution, and cause of a disease
or disorder
• Risk Factor = any characteristic or condition which occurs with
greater frequency in people with a disease than people
without.
• Morbidity = disease
– Incidence = number of new cases in a specified time interval
– Prevalence = total # of cases in a specified time interval
• Mortality = death
– # of deaths to a known cause
– (premature death = death before age 75)
 Class Activity
We are interested in whether higher levels of
physical activity are associated with better
cognitive functioning.
1. Design an ex-post facto (quasi-experimental)
study to test this. What can you conclude?
2. Design a “true” experiment. What can you
conclude?
 Assignment 2
• Start in groups today
• Please take notes
• Write assignment individually based on
provided instructions