Chapter 1 Introduction to Health Psychology

Define health (C1)

World Health Organization (1948) defined health as “a complete state of physical, mental, and social well-being and
not merely the absence of disease or infirmity. the holistic concept of achieving balance among physical, mental, and
social well-being.
Many use the term wellness to refer to this optimum state of health.

Define health psychology (C1)

Matarazzo defined health psychology as ‘the aggregate of the specific educational, scientific and professional
contribution of the discipline of psychology to the promotion and maintenance of health, the promotion and
treatment of illness and related dysfunction, the identification of etiologic and diagnostic correlates of health, illness,
and related dysfunction, and to the analysis and improvement of the health care system and health policy formation.
Devoted to understanding psychological influences on how people stay healthy, why they become ill, and how they
respond when they do get ill. Study such issues and develop interventions to help people stay well or recover from
illness. Health psychology again challenges the mind–body split by suggesting a role for the mind in both the cause
and treatment of illness

The focus of health psychology

1. Health psychologists focus on health promotion and maintenance, which includes issues such as how to get
children to develop good health habits, how to promote regular exercise, and how to design a media campaign
to get people to improve their diets.
2. Health psychologists study the psychological aspects of the prevention and treatment of illness. A health
psychologist might teach people in a high-stress occupation how to manage stress effectively so that it will not
adversely affect their health. A health psychologist might work with people who are already ill to help them
follow their treatment regimen.
3. Health psychologists also focus on the etiology and correlates of health, illness, and dysfunction. Etiology refers
to the origins or causes of illness. Health psychologists especially address the behavioral and social factors that
contribute to health, illness, and dysfunction, such as alcohol consumption, smoking, exercise, the wearing of
seat belts, and ways of coping with stress.
4. Finally, health psychologists analyze and attempt to improve the health care system and the formulation of
health policy. They study the impact of health institutions and health professionals on people’s behavior to
develop recommendations for improving health care.

Components of health (C2)

1. Physical
Physical fitness is of utmost importance. The body that carries the weight has to be fit to endure all the other
challenges that a person faces in life. A healthy body not just helps stay away from diseases but also creates
mindfulness. There are many ways maintain good physic –
 Eating right: The selection of proper nutrition and in the right amount is crucial.
 Exercising well: Daily exercising in any form is beneficial for maintaining a healthy
weight and for muscles and bones as it brings flexibility and endurance.
 Detaching certain habits: Alcohol, drugs, and smoking gives nothing more than a kick for that moment. We are
all aware conditions that may lead to life-threatening diseases that excessive consumption may create hostile
health.
 Sleeping enough: Sleep is a necessary human activity that provides rest to the body and supports crucial
functions of the body. If someone has frouble sleeping, a coach will hyggest ways to get better sleep.

2. Emotional
 A holistic health will aim to achieve mindfulness. It is a state of self-awareness and acceptance of one's
conditions and feelings.
 Staying positive: People have to realise the importance of accomplishing life goals, feeling positive and
enthusiastic about their work and life because negative approaches and thoughts bring down confidence.
 Fighting stress: Stress suppresses the mental state because it takes away focus and makes a person emotionally
weak. Hence, stress is a major area where a professional can help sustain a healthy mindset.
 Having healthy relations: Having good relations with family, friends, colleagues, and society keeps a person
joyful. Happy mind sprouts positive and healthy thoughts.
 Expression of feelings: For an individual, it is vital to communicate help feelings. If they face problems in doing
so, they should take professional

3. Intellectual
 Intellectual wellness is achieved when a person is able to do problem-solving, think creatively, and shows an
urge to learn more and more and stay with current affairs.
 Just like physical fitness, even our minds need some exercise. This stimulates and keeps the brain sharp.
 People who possess a high level of intellectual wellness have an active mind and uses the resources available to
expand one's knowledge and improve skills.

4. Social
 Humans are social beings, and without society, we are bound to lose connection with humanity. A lot of people
suffer from social anxiety or have a lack of trust in others.
 A socially sound person will not just take from society but also contribute to the environment and people
around him. Such people follow the path of social responsibility. Ability to make and maintain meaningful
relationships with others.

5. Spiritual-
 Seeking meaningful connection with something bigger than self which can result in positive emotions like
peace, awe, contentment, gratitude, and acceptance.
 There is no doubt that the spiritual aspect of life is as real and important as the physical, emotional,
intellectual, and social parts. People often find this purpose from a belief or faith system, while others create
their own purpose. Undoubtedly just as important as physical, emotional, intellectual, and social components.

Explain the historical and conceptual basis of health psychology (C2)

When How did Health Psychology began-

 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 discase and
infirmity- WHO 1946. The holistic nature of health was thus emphasized.
 Field emerged in 1970s as response to number of factors like –
 changing pattern of illness and death in industrialised nations
 increasing medical care costs
 emerging new understanding of health and illness
 Health Psychology emerged in the 1970s as a response to a number of factors like –
 One of them the changing pattern of illness and death in industrialized nations.
 A second factor that facilitated the rise of the discipline was the increasing costs of medical care.
 A third factor was the emergence of a new understanding of health and illness.
 Four key health-related areas, namely –
1. promoting and maintaining health,
2. preventing and treating illness,
3. identifying causal and diagnostic correlates of health and illness, and
4. improving the health-care system and health policy formation.
 Health psychologists have historically focused their attention more on individuals attitudes and behaviours (and
changing these) than on changing health-care systems or developing policy.
 The field of health psychology was quickly dominated by the positivist approaches employed in mainstream
psychology, and the 'scientific' nature of the field was emphasised.
 Matarazzo, 1980 definition of health psychology that focused on underlying attitudes and behaviours and not
just healthcare systems and policies
 Health psychology was initially dominated by approaches of absolute scientific nature.
 George Engel’s 1977 biopsychosocial model was introduced which demonstrated a dynamic interplay between
psychology, biology, and sociology with outcomes of either health or disease that conceptualised a more holistic
and comprehensive nature of the themes falling under health psychology.
 This functioned to establish the credibility of health psychology within the broader array of biomedical and
health disciplines (Murray, 2014a).
 Since then, health psychology has taken off quite rapidly in growth and this is manifested in various forms of the
field such as critical, public, community, and clinical health psychology (Marks, 2002)
 Changing Patterns of Illness-
 The most important factor giving rise to health psychology has been the change in illness patterns that has
occurred in the United States and other technologically advanced societies.
 Now, however, chronic illnesses especially heart disease, cancer, and diabetes are the main contributors to
disability and death, particularly in industrialized countries. Chronic illnesses are slowly developing diseases
with which people live for a long time. Often, chronic illnesses cannot be cured but rather only managed by
patient and health care provider.
 Summary
 Psychology's involvement in health dates back to the beginning of the 20th century, but at that time, few
psychologists were involved in medicine.
 The psychosomatic medicine movement sought to bring psychological factors into the understanding of
discase, but that view gave way to the biopsychosocial approach to health and discase.
 By the 1970s, psychologists had begun to develop research and treatment aimed at chronic disease and
health promotion; this research and treatment led to the founding of two new fields, behavioural medicine
and health psychology.

Explain the assumptions of health psychology (C2)

The assumptions of health psychology include :
1. The mind-body split-
 The mind reflects the individuals’ psychological states (beliefs, cognitions, perceptions) which influence but
are separate to their bodies(the illness, body, the body systems).
 Health psychology sets out to provide an integrated model of the individual by establishing a holistic
approach to health. Therefore, it challenges the traditional medical model of the mind-body split and
provides theories and research to support the notion of a mind and body that are
one.
2. Dividing up the soul-
 Health psychology describes variables such as beliefs (risk perception, outcome expectancies, costs and
benefits, intentions, implementation intentions), emotions (fear, depression, anxiety) and behaviors
(smoking, drinking, eating, screening) as separate and discrete.
 It then develops models and theories to examine how these variables interrelate.
3. The problem of progression-
 It explains how theories, such as those relating to addictions, stress and screening have changed over time. In
addition, it presents new developments in the areas of social cognition model and psychoneuroimmunology.
4. The problem of methodology-
 In health psychology we carry out research to collect data about the world. We then analyze these data to
find out how the world is, and we assume that our methodologies are separate to the data we are collecting.
5. The problem of measurement-
 Throughout the different areas of health psychology, researchers develop research tools to assess quality of
life, pain, stress, beliefs and behaviors. These tools are then used by the researchers to examine how the
subjects in the research feel/behave.
 However, this process involves an enormous leap of faith that our measurement tool actually measures
something out there. Perhaps what the tool measures is simply what the tool measures. A depression scale
may not assess depression but only the score on the scale.
6. Integrating the individual with their social context-
 Health psychologists have made moves to integrate this individual with their social world.
 To do this they turn to social epidemiology (i.e. explore class, gender and ethnicity), social psychology (i.e.
turn to subjective norms) or social constructionism(i.e. turn to qualitative methods).
7. Data are collected in order to develop theories; these theories are not data-
 Health psychologists collect data and develop theories about the individual, for example theories about
smoking, eating, stress and pain.
 These theories are then used to tell us something about the world. However, these theories could also be
used as data, and in the same way that we study the world, we could study our theories about the world.
8. Theories concerning different areas of health psychology are distinct from each other-
 There are many theories relating to stress, pain and health behaviors, but has not examined parallels within
these theories.
 Perhaps there are patterns within these different theories that reflect ‘umbrella’ changes within health
psychology. Perhaps also these changes indicate consistent shifts in the way psychological theory describes
the individual.

Explain the goals of health psychology (C2)

 The field of health psychology has several different goals, each of which plays an important role in advancing our
understanding of the relationship between psychology and health.
 The goals of health psychology include:
1. Promote and maintain health
2. Prevent and treat illness
3. Identify the causes and diagnosis correlates of health, illness and related dysfunction.
4. Analyze and improve healthcare systems and health policy
 Some of the other major goals of health psychology include:
1. Understanding behavioral and contextual factors for health and illness,
2. Preventing illness
3. Investigating the effects of disease
4. Providing critical analyses of health policies
5. Conducting research on prevention and intervention in health problems
6. Improving doctor-patient communication
7. Improving adherence to medical advice
8. Finding treatments to manage pain.

Explain mind-body relationship (C2)

Introduction-
 Mind-body relationship has a significant impact on our health. Health does not refer only to physical health it is
not concerned only to what we eat. Rather health also includes what we think, say, feel and how we behave. Our
thoughts, emotions and actions are equally important in affecting our health as the food we take.
 Connection between totality of thoughts, emotions, and behaviour and how they affect physical health.
Important part of holistic medicine where the philosophy is to treat the whole person and not just their
symptoms and gives a comprehensive approach to healthcare that involves the mind, body and spirit.
 The brain and the body are deeply intertwined and any disturbance in our mind would cause an effect on our
bodily health.
 eg;-negative thinking patterns and any abnormality in our bodily processes would lead to imbalance in our
thoughts and mind.
 eg;- when there is an excess of stress hormones or they are released too frequently, it can lead to anxiety.

The Science Behind the Mind-Body Connection-

 Sometimes referred to as the "body's command center" or the "human supercomputer", the brain is a
remarkable and complex organ. But the brain is not a machine operating separately from the rest of the body
the two are deeply intertwined.
 Scientific studies are constantly revealing that the hormones and neurotransmitters (chemical messengers)
associated with emotion can also have physical effects. They can affect our blood pressure, heart rate, sleep
patterns, and even our appetite.

How Thoughts and Emotions Affect Health-

 When we're stressed, our body releases two hormones: adrenaline and cortisol. Known as the stress hormones,
they're supposed to give us a short-term energy boost (better known as an adrenaline rush) so we can get out of
dangerous situations quickly.
 However, you can still feel stressed even if there's no "danger" to escape. Releasing these hormones too
frequently can have negative long-term effects on the body, including: Weakened immune response, Digestive
problems, Healing more slowly

Models of mind-body relationship-

1. Psychological Approach-
 Psychological approach focuses on the psychological factors contributing to health problems and mental
disorders.
 Three major perspectives under this are: Psychodynamic perspective which states that repression of
unacceptable and threatening thoughts and desires in one's unconscious mind leads to mental disorders and
maladaptive behavior. Behavioural perspective views that maladaptive thoughts and behavior are learned
from the environment. Cognitive perspective focuses on the role of our thought patterns as responsible for
maladaptive behavior and disorders. It talks about illogical thinking patterns and irrational beliefs as causes.
2. Sociocultural Approach
 Individuals are not alone. They live and function in a group setting. Hence the role of family, community,
society, the socialization process and the cultural practices cannot be denied in the causation of
maladjustment and psychological disorders.
 Sociocultural factors influence our thoughts, attitudes and emotions, which in turn impact our adjustment,
functioning and well-being.
3. Biopsychosocial Model
 The biopsychosocial model of health is a holistic approach to health developed by George L. Engel in 1977,
which combines all the approaches of biological, psychological and sociocultural to explain abnormal thinking
and behavior.
 It takes a holistic view on the various factors (biological, psychological, and social) affecting the development,
adjustment and health of human beings.
 Biology - physical health, genetic vulnerabilities, drug effects.
 Social - peer, family relationships, family circumstances.
 Psychological- physical health, coping skills, social skills, family relationships,self-esteem and mental health)
 Advantages of the Biopsychosocial Model
 How does the biopsychosocial model of health and illness overcome the disadvantages of the biomedical
model? The biopsychosocial model maintains that biological, psychological, and social factors are all
important determinants of health and illness.
 Both macrolevel processes (such as the existence of social support or the presence of depression) and
microlevel processes (such as cellular disorders or chemical imbalances) continually interact to influence
health and illness and their course (Suls & Martin, 2011).
 The biopsychosocial model emphasizes both health and illness. From this viewpoint, health becomes
something that one achieves through attention to biological, psychological, and social needs.

Changing Patterns of Illness-

 The most important factor giving rise to health psychology has been the change in illness patterns that has
occurred in the United States and other technologically advanced societies.
 Now, however, chronic illnesses especially heart disease, cancer, and diabetes are the main contributors to
disability and death, particularly in industrialized countries. Chronic illnesses are slowly developing diseases
with which people live for a long time. Often, chronic illnesses cannot be cured but rather only managed by
patient and health care provider.

 Prehistoric times ⇒ most cultures regarded the mind and body as one, disease was thought to arise when evil
History-

 Ancient Greeks ⇒ were among the first civilization to identify the role of bodily factors in health and illness and
spirits entered the body, and treatment consisted primarily of attempts to exorcise these spirits (trephination)

developed a humoral theory of illness which claimed disease resulted when the four humors or circulating fluids
of the body (blood, black bile, yellow bile, phlegm) were out of balance, goal of treatment was to restore balance
among the humours; also described personality types associated with each of the four humors, with blood being
associated with a passionate temperament, black bile with sadness, yellow bile with an angry disposition, and

 Middle ages ⇒ cause for illness was attributed to supernatural explanations and disease was regarded as God’s
phlegm with a laid-back approach to life.

punishment for evildoing, where the cure often consisted of driving out the evil forces by torturing the body,
later, this form of “therapy” was replaced by penance through prayer and good works; the Church was the
guardian of medical knowledge at this time, and as a result, medical practice assumed religious overtones,
functions of the physician were typically absorbed by priests, and so healing and the practice of religion became
virtually indistinguishable.
 Renaissance to the present day → there have been a lot of developments in understanding the technical bases
of medicine, including the invention of the microscope in the 1600s and the development of the science of
autopsy, which allowed practitioners to see which organs were affected by different disease, as the science of
cellular pathology progressed, the humoral theory of illness was put to test, and in an effort to break with the
superstitions of the past, practitioners resisted acknowledging any role for the mind in disease processes and
instead focused primarily on organic and cellular pathology as a basis for their diagnoses and treatment

 Biomedical model ⇒ governed the thinking of most health practitioners for the past 300 years and says that all
recommendations which resulted in the biomedical model.

illnesses can be explained by somatic bodily processes, assumes psychological and social factors to be largely
irrelevant to the development of a disease, and its limits aided rise of biopsychosocial model

Outline the different fields within health psychology (C2)

1. Clinical health psychology (CIHP)-

 Clinical health psychology is a professionally recognized specialty that investigates and implements clinical
services across diverse populations and settings to promote health and well-being and to prevent, treat and
manage illness and disability.
 Clinical health psychology has remained the dominant approach. It is heavily research-based and draws on
positivist notions of science and knowledge production

2. Public health psychology (PHP)-

 Public health psychology works towards promoting health and preventing illness, rather than focusing on
treating illness.
 It is a social science focused on improving the health and wellbeing of whole populations.
 It does this by investigating the links between human psychology and public health to create better health
outcomes for populations, or sub-populations, of people.

3. Community health psychology (CoHP)-

 Community health psychology aims to promote positive well-being in communities through empowerment,
social action and practice.
 It works with communities to combat disease and to promote health.

4. Critical health psychology (CrHP)-

 Critical health psychology is somewhat less, demarcated.
 Critical health psychology was originally formulated as a challenge to mainstream health psychology.
 Critical health psychology articulates the need for a more reflexive approach - one that is able to analyse the
complex moral, emotional, ethical and political issues underpinning peoples' experiences of health and illness.

Explain the models of health psychology (C2)

1. Biological approach-
 A medical model where causative influences include genetic factors, brain damage or abnormalities,
hormonal and neurotransmitter imbalances, and chromosomal abnormalities.
 Biological basis of behaviour
 Twin, Emily and adoption studies
 Molecular genetics
 Psychoneuroimmunology
 Psychophysiology

2. Psychological approach-
 Psychodynamic (repression of unconscious unwanted impulses and early traumatic childhood experiences
cause disease)
 Behaviouristic (maladaptive or unwanted behaviour learned from environment or others cause illness)
 Cognitive (illogical thinking patterns, irrational beliefs and cognitive dysfunctions lead to maladaptive
behaviour which influences health and illness)

3. Sociocultural approach-
 Humans are social beings and live in group settings of family, community, society and are hence influenced by
socialisation processes, cultural traditions.
 Social cognitive theory
 Theory of planned behavior
 Health belief model- The health belief model was one of the first and remains one of the best-known social
cognition models. Developed in order to predict preventative health behavior including lifestyle behaviours.
Belief in a personal threat together with your belief in the effectiveness of the proposed preventative behavior
will predict the likelihood of that behavior.

 Protection motivation theory- The protection motivation theory is often presented as the successor to the fear
drive model. Postulates that sources of information (i.e. fear appeals) initiate two independent appraisal
processes: threat appraisal (risk) and coping appraisal (effectiveness of behavior)

 Implementation intentions
 Health action process approach
 Precaution adoption process model
 Transtheoretical model of behavior change or Stages of change model-
 Readiness to change.
 Diclemente and Prochaska (1982) developed a trans-theoretical model to examine the stages of change in
addictive behaviors.
 This model is now widely used in health psychology to both predict and understand behavior and it is
central to many interventions designed to change behavior.
 In particular, individuals are assessed at the beginning of any intervention to identify which stage they are
at. The content of the intervention can then be tailored to match the needs of eachperson.
 The stages of change model describes the following stages
1. Precontemplation (not seriously considering quitting in the next sixmonths)
2. Contemplation (considering quitting in the next six months)
3. Preparation (making cognitive changes)
4. Action (behavioral changes)
5. Maintenance (maintaining these changes)
6. Relapse (return to old behavior)
 Example-
1. Precontemplation: I am happy being a smoker and intend to consinue smoking.
2. Contemplation: I have been coughing a lot recently perhaps/ should think about stopping smoking.
3. Preparation: I will stop going to the pub and will busy lower tar cigarettes.
4. Action: I have stopped smoking.
5. Maintenance: Thave stopped smoking for four months now.

 George Engel, 1977 ⇒ Holistic model that integrates three domains of psychological, social, and biological
4. Biopsychosocial approach-

determinants.
 Advantages:
 Overcomes limits of biomedical model by maintaining that all three determinants are important.
 Demonstrate microlevel processes (cellular pathology or chemical imbalances) interact with macro level
(presence of social support or depression) to influence health and illness and their course.
 Emphasise both health and illness where health is achieved through meeting needs of all three domains.

5 A’s Behaviour Change Model adopted for self-management support improvement

Significance of health psychology (C2)

 To many people, health is simply a matter of staying well or getting over illnesses quickly. Psychological and
social factors might seem to have little to contribute. But consider some of the following puzzles that cannot be
understood without the input of health psychology:
 When people are exposed to a cold virus, some get colds whereas others do not.
 Men who are married live longer than men who are not married.
 Throughout the world, life expectancy is increasing. But in countries going through dramatic social
upheaval, life expectancy can plummet.
 Need for health psychology- Trends within medicine, psychology, and the health care system have combined to
make emergence of this field inevitable.
 Changing illness patterns- In US and other technologically advanced societies. However, chronic illnesses -
especially heart disease, cancer, diabetes - are main contributors to disability and death particularly in
industrialised countries. Chronic illnesses are slowly developing diseases with which people live for a long time,
and often cannot be cured but rather only managed by patient and health care provider.
 Advances in technology and research- Field changes regularly because new issues arise that require tech input.
eg;- new tech now makes it possible to identify the genes contributing to many disorders like breast cancer.
Answers questions like how to help individual with identified family gene history for a disorder, should they get
tested, what happens if it comes out positive, how can they cope with it, what lifestyle changes should they
make?
 Role of epidemiology- Epidemiology is the study of frequency, distribution, and causes of infectious and non-
infectious diseases in a population. Establishing the goals and concerns of health psychology and health care
endeavours require comprehensive data on statistics such as morbidity and mortality rates, major causes of
disease, especially those that lead to early death, in order to reduce their occurrence.
eg;- knowing cardiac disease is major cause of premature death has resulted in nationwide effort to reduce risk
factors among most vulnerable like smoking reduction and dietary changes.
 Expanded health care services- Containing health care costs is important and hence, the field emphasis on
prevention - specifically, modifying people’s risky health behaviours before they become ill - having the potential
to reduce the financial resources devoted to management of illness.
 Increased medical acceptance- Although health psychologists have been employed in health settings for many
years, their value is increasingly recognised by physicians and other health care professionals only recently.
 Demonstrated contributions to health- Health psychology has developed variety of short-term behavioural
interventions to address numerous health-related problems, including pain management, modifying bad health
habits such as smoking, and managing the side effects or treatment effects associated with range of chronic
diseases. Techniques that often take mere hours to teach often produces years of benefit and particularly those
that target risk factors like diet or smoking have contributed to actual decline in incidence of some diseases like
CHD.
 Methodological contributions to health- Health psychologists can be valuable members of research team by
providing methodological and stat expertise to issues of health and illness. Many issues that arise in medical
settings demand rigorous research investigation and although physicians and nurses receive some
methodological and statistical education, their training may be inadequate to conduct research on the issues
they wish to address.