Introduction to Health Psychology

1
Introduction to Health Psychology

• What is health psychology?
• What questions does it address?

2
What is Health Psychology?

• Concerned with the ways in which we, as
  individuals, behave and interact with others in
  sickness and in health.
• What are the physiological bases of emotion?
• How do they relate to health and illness?
• What is stress?
• Can certain behaviours predispose us to
  particular illnesses?
• Can educational interventions prevent illnesses?

3
When How did Health Psychology begin?

• Conference in USA in 1978
• Creation of a section devoted to health
  psychology in the American Psychological
  Association (APA) in 1979
• British Psychological Association (BPA) only set
  up a section in 1986, which was formerly
  recognised in 1997.
• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease and infirmity. WHO 1946. The holistic
  nature of health was thus emphasized.

4
Matarazzos 1980 definition

• Health psychology is the aggregate of the
  specific educational, scientific and professional
  contributions of the discipline of psychology to
  the promotion and maintenance of health, the
  prevention and treatment of illness, the
  identification of aetiologic and diagnostic
  correlates of health, illness and related
  dysfunction and the analysis and improvement of
  the health care system and health policy
  formation. This definition has become widely
  accepted.

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Historical and Cultural Origins

• Basic ideas and concepts have been around for a
  long time
• Relationship between mind and body
• Study of psychosomatic disorders owes much to
  Freud.
• Attempts to relate distinct personality types to
  particular diseases with a causation hypothesis
  have largely been abandoned in favour of a more
  behavioural or biological approach, which seeks
  to employ interventions derived from behavioural
  medicine.
• Changing patterns of illness and disease

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Changing Patterns of Illness Disease

• Contageous diseases and infections now contribute
  minimally to illness and death in the Western
  World.
• Major breakthroughs in science have reduced
  prevalence of smallpox, rubella, influenza and
  polio.
• Most deaths now caused by heart disease, cancer
  and strokes.
• These diseases, studies suggest, are a by-product
  of life-style.
• By 1970s health spending in Western countries was
  getting out of control. Governments began to
  explore disease prevention and health promotion.

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Major Causes of Death in (21st

• Those in which behavioural pathogens are the
  single most important factor. These are personal
  habits such as smoking, excessive drinking,
  over-eating and not exercising which can
  influence the onset and course of a disease.
• Fighting diseases endemic in different parts of
  the world can be affected by behaviour and
  attitude e.g. malaria.

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The Biomedical Model

• Diseases come from outside the body and invade
  it, causing internal physical changes or
• Diseases originate in the body as internal,
  involuntary physical changes.
• Diseases are caused by chemical imbalances,
  bacteria, viruses or genetic pre-disposition.
• Individuals are not responsible for their
  illnesses, which are from biological changes
  beyond their control. People who are ill are
  victims.
• Treatment should consist of vaccination, surgery,
  chemotherapy or radio therapy, all of which aim
  to change the

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The Biomedical Model continued

• Physical state of the body.
• Responsibility for treatment lies with the
  medical profession,
• Health and illness are qualitatively different.
  You are either healthy or ill there is no
  continuum between them.
• Mind and body function independently of each
  other. The abstract mind relates to feelings and
  thoughts and is incapable of influencing physical
  matter.
• Illness may have psychological consequences, but
  not psychological causes.

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The Biopsychosocial Model

• In opposition to these ideas, Health Psychology
  argues that human beings should be seen as
  complex systems. Illness is often caused by a
  combination of biological ( e.g. viruses) and
  psychological (e.g. behaviour and beliefs) and
  social (e.g. poor housing, unemployment) factors.
• These assumptions reflect the biopsychosocial
  model of health and illness, reflecting the
  changes in the nature of illness, causes of death
  and life expectancy of the (20th.
• Health Psychologists are interested in normal
  everyday behaviour and normal psychological
  processes in relation to health and illness,
  rather than in psychopathology or abnormal
  behaviour.

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(20th Changes in the nature of Illness

• The biopsychosocial model reflects fundamental
  changes in the nature of illness, causes of death
  and overall life expectancy during the (20th.
• Average life expectancy in the the USA has
  increased from 48 in 1900 to 76 today. There is
  the same rate of increase for most Western,
  industrialised nations. This is due mainly to the
  virtual elimination of infectious diseases such
  as pneumonia, flu, TB, diptheria, scarlet
  fever, measles, typhoid and polio as causes of
  death.

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Major Killers of the (20th and (21st

• HIV/AIDS increased the number of
  infection-related deaths in the West in the 1980s
  and 1990s. It is a major killer in Africa,
  reducing life expectancy to the 30s in some
  nations.
• Poverty and poor nutrition has reduced life
  expectancy in Burma, for example, to 48.
• Todays major killers are cardiovascular
  diseases-heart disease and strokes and cancers.
• Cardiovascular diseases account for about 40 of
  all deaths in industrialised countries.

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Why the Biomedical Model is no longer adequate

• There has been a small, but steady decline in
  deaths due to cardiovascular diseases since the
  1960s. This is due to
• Improvement in medical treatment.
• Changes in lifestyle reduction in cholesterol
  levels and cigarette smoking.
• Rise in cancers in industrialised nations due
  almost entirely to rises in lung cancer,

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Why the Biomedical Model no longer applies

• The influence of lifestyle factors is
  incompatible with the biomedical model. (Stroebe
  2000).
• Conceptualisation of disease in purely biological
  terms means that the model has little to offer
  the prevention of chronic diseases through
  efforts to change peoples health beliefs,
  attitudes and behaviour.
• The biomedical model has a reactive attitude
  towards illness. Traditional medicine is more
  focused on disease than on health.

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The Biopsychosocial Model

• It would be more appropriate to call our
  healthcare systems disease care systems, as the
  primary aim is to treat or cure people, rather
  than promote health or prevent diseases. Maes
  Van Elderen 1998.
• The biopsychosocial model underlying health
  psychology adopts a more proactive attitude
  towards health.
• Bio genetic, viruses, bacterial, lesions,
  structural defects, gender
• Psycho cognitions (e.g. expectations of health),
  emotions (e.g. fear of treatment), behaviour (e.g
  smoking, exercise, diet, alcohol consumption,
  stress, pain.

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The Social aspect of the Biopsychosocial Model

• Social Norms of behaviour e.g. smoking/not
  smoking.
• Pressures to change e.g. peer pressure,
  expectations, parental pressures.
• Social values placed on health.Social class
• Ethnicity
• Employment
• Gender expectations
• The Biopsychosocial model offers a holistic
  approach. The person as a whole has to be looked
  after. Both at micro-level e.g.causes, such as
  chemical imbalance and at macro-level, such as
  the extent of social support need to be taken
  into account. These processes interact to
  determine someones health status.

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Key Beliefs that inform the Biopsychosocial Model

• Individuals are not just passive victims, but are
  responsible for taking their medication and
  changing their beliefs and behaviour.
• Health and illness exist on a continuum-people
  are not either healthy or ill, but progress along
  a continuum in both directions.
• Psychological factors contribute to the aetiology
  (causes) of illness. They are not just
  consequences of illness.
• According to Ogden (2002) health psychology aims
  to
• Evaluate the role of behaviour in the aetiology
  of illness, such as the links between smoking,
  coronary heart disease, cholesterol level, high
  blood pressure.
• Predict unhealthy behaviours- for example,
  smoking, alcohol consumption and high fat diets
  are related to beliefs and belief about health
  and illness can be used can be used to predict
  behaviour.

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Role of Health Psychology cont.

• Understand the role of psychological factors in
  the experience of illness. For example,
  understanding the psychological consequences of
  illness could help alleviate pain, nausea,
  vomiting ,anxiety and depression.
• Evaluate the role of psychological factors in the
  treatment of illness.
• These aims are put into practice by
• Promoting health behaviour, such as changing
  beliefs and behaviour
• Preventing illness, for example by training
  health professionals to improve communication
  skills and to carry out interventions that may
  prevent illness.
• Why do people adopt, or fail to adopt
  health-related behaviour?
• Models of health behaviour try to answer this
  question.

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Culture Health

• One of the macro-level processes.
• 1) How cultural factors influence various aspects
  of health. Stemming from an earlier, more
  established study.
• 2) The more recent and active study of the health
  of individuals and groups as they settle into and
  adapt to new cultural circumstances through
  migration and their persistence over generations
  as ethnic groups.
• Health Disease as Cultural Concepts
• Concepts of health and disease are are defined
  differently across cultures.
• Disease is rooted in pathological, biological
  processes common to all.
• Illness now widely recognised as a culturally
  influenced, subjective experience of suffering
  and discomfort.

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Culture Health

• Recognising certain conditions as either healthy
  or a disease is also linked to culture e.g.
  trances are health-seeking mechanisms in some
  cultures. In others it is seen as a psychiatric
  disorder.
• How a condition is expressed is also linked to
  cultural norms. In some cultures, psychological
  problems are expressed somatically- in the form
  of bodily symptoms e.g. in Chinese culture.
• Disease and disability are highly variable.
  Cultural factors such as diet, substance abuse
  and social relationships within the family also
  contribute to the prevalence of disease,
  including heart disease, cancer and schizophrenia.

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Acculturation

• The process of adaptation to a new host culture
  is called acculturation.
• Cross-cultural psychologists believe that there
  is complex pattern of continuity and change in
  how people who have developed in one cultural
  context adapt when they move to and live in a new
  cultural context.
• The longer immigrants live in the host country
  (increasing acculturation) their health status
  migrates to the national norm of that country.
• For immigrants to Canada from 26 out of 29
  countries, their coronary heart disease rates
  shifted to the Canadian norm. Similar patterns
  have been found for stomach and intestinal cancer
  among immigrants to the USA.
• One possible explanation is exposure to widely
  shared risk factors in the physical environment,
  such as climate, pollution, pathogens.

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Pursuit of Assimilation or Integration

• Pursuing assimilation or integration as a way to
  acculturation may expose immigrants to cultural
  risk factors, such as diet, lifestyle and
  substance abuse..
• This behavioural shift interpretation would be
  supported if health status both improved and
  declined relative to national norms.
• Main evidence points to a decline. This supports
  the acculturation stress interpretation that
  the very stress of acculturation may involve risk
  factors that can reduce health status.
• This is supported by evidence that stress can
  reduce resistance to diseases such as
  hypertension and diabetes. Berry 1998.