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Lecture 1: Introduction to Health Psychology

Lecture 1: Introduction to Health Psychology. Dr. Antoinette M. Lee The University of Hong Kong. What is Health Psychology?.

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Lecture 1: Introduction to Health Psychology

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  1. Lecture 1: Introduction to Health Psychology Dr. Antoinette M. Lee The University of Hong Kong

  2. What is Health Psychology? • “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, and the identification of etiologic and diagnostic correlates of health, illness and related dysfunction” Matarazzo (1980) p.815 Master of Behavioral Health Health Psychology Module Spring 2005

  3. What is Health Psychology? • The scientific study of how psychological factors relate to the promotion and maintenance of health, and causation, prevention, and treatment of physical illnesses, as well as how people respond when they do get ill (Taylor, 1999) • Psychological factors: behaviors, emotions, beliefs, attitudes, personality, and stress etc Master of Behavioral Health Health Psychology Module Spring 2005

  4. What Do Health Psychologists Do? • Research • Practice • Individual and community levels • Prevention of physical illnesses and health promotion; treatment of and adjustment to physical illnesses Master of Behavioral Health Health Psychology Module Spring 2005

  5. Examples of Health Psychologists at Work • 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 techniques to reduce stress that affect the risk of further heart problems • Health psychologists help patients modify Type A behaviors and hostility • Health psychologists also help these patients deal with depression and anxiety that are common among CHD patients Master of Behavioral Health Health Psychology Module Spring 2005

  6. Examples of Health Psychologists 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) Master of Behavioral Health Health Psychology Module Spring 2005

  7. Examples of Health Psychologists at Work • 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 Master of Behavioral Health Health Psychology Module Spring 2005

  8. Examples of Health Psychologists at Work • Cancer • Prevention: • Changing health-compromising behaviors (e.g. smoking) among high-risk individuals • Designing public campaigns: • Cancer awareness • Encouraging participation in screening programs • Reducing cancer-related behaviours Master of Behavioral Health Health Psychology Module Spring 2005

  9. Historical Development • Early cultures • Mind and body as a unit • Illness believed to be caused by evil spirits • Trephination Master of Behavioral Health Health Psychology Module Spring 2005

  10. Historical Development • 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 Master of Behavioral Health Health Psychology Module Spring 2005

  11. Historical Development • 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: • Mind and body as separate entities to severe the ties between mysticism and disease – mind-body 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 Master of Behavioral Health Health Psychology Module Spring 2005

  12. Historical Development: Emergence of Health Psychology • Challenges to the biomedical model led to the development of: • Psychosomatic Medicine • Behavioral Health • Behavioral Medicine • Health Psychology Master of Behavioral Health Health Psychology Module Spring 2005

  13. Psychosomatic Medicine • 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 • Psychological intervention needed in treatment of physical problems Master of Behavioral Health Health Psychology Module Spring 2005

  14. Psychosomatic 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 Master of Behavioral Health Health Psychology Module Spring 2005

  15. Psychosomatic Medicine • 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 • Criticism: • Too simplistic: disease caused by 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 Master of Behavioral Health Health Psychology Module Spring 2005

  16. Behavioral Health • Maintenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviors and lifestyle • Role of behavior in determining one’s health status • Integration of the mind and body Master of Behavioral Health Health Psychology Module Spring 2005

  17. Behavioural Medicine • Integration of the behavioral sciences with the practice and science of medicine (Gatchel, Baum, & Krantz, 1989) • Interdisciplinary • Challenges the biomedical separation of the body and the mind Master of Behavioral Health Health Psychology Module Spring 2005

  18. Behavioral Medicine • Role of behaviors • Evaluation, prevention and treatment of physical disease or physiological dysfunction • Heavily related to behaviorism • Focus not only on treatment as in the biomedical model, but also in the prevention of illness Master of Behavioral Health Health Psychology Module Spring 2005

  19. 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 Master of Behavioral Health Health Psychology Module Spring 2005

  20. Health Psychology • Psychology influences on health: • Direct pathway • E.g. physiological effect of stress on CHD and cancer • Indirect pathway • Health related behaviors e.g. smoking, diet, exercise • Impact on vulnerability to illness • Reactions to illness • E.g. delayed help-seeking Master of Behavioral Health Health Psychology Module Spring 2005

  21. Factors Contributing to the Growth of Health Psychology? • 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 family) of acute and chronic disease • Re-emergence of the significance of infectious diseases: AIDS, SARS, bird flu…….. • Decrease in age of onset of certain diseases • Advances in medical technology and research Master of Behavioral Health Health Psychology Module Spring 2005

  22. Factors Contributing to the Growth of Health Psychology? • Increasing health care costs & disease burden • The importance of prevention • Increased acceptance and acknowledgement by medical personnel • Demonstrated contribution to health • Changing health-compromising behaviors, pain management, treatment adherence, dealing with treatment side effects…. • The limits of medicine Master of Behavioral Health Health Psychology Module Spring 2005

  23. Health Psychology I. Mind-Body Interface & Biopsychosocial Approach II.Prevention of Disease and Promotion of Health in addition to Intervention and Treatment III. The Role of Behaviors and Lifestyle Factors IV. Application of Psychological Theories and Methodologies V Working on Both the Individual and Community Levels Master of Behavioral Health Health Psychology Module Spring 2005

  24. I. Mind-Body Interface What is Health? Hippocrates: • Health as a natural balance of both physical and emotional aspects, mediated by a harmonious mixture of the humors Master of Behavioral Health Health Psychology Module Spring 2005

  25. Mind-Body Interface • “The reason why a sound body becomes ill, 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) Master of Behavioral Health Health Psychology Module Spring 2005

  26. Psychological Problems and Physical Illness Five forms of relationship: • Psychological factors as causes of physical illness • Psychiatric disorders presenting with physical symptoms • Psychiatric consequences of physical illness • Psychiatric and physical disorder occurring together by chance • Psychiatric problems with physical complications (e.g. deliberate self-harm, alcohol and substance abuse, eating disorders) From Oxford Textbook of Psychiatry Master of Behavioral Health Health Psychology Module Spring 2005

  27. Role of Psychology in Health and Illness • Stress • Behaviours • Help-seeking • Adjustment to physical illnesses • Adherence to treatment Master of Behavioral Health Health Psychology Module Spring 2005

  28. Biopsychosocial Approach • World Health Organization (1948), “a complete state of physical, mental, and social well-being and not merely the absence of disease of infirmity” • Therefore, health is achieved with a balance of physical, mental, and social well-being Master of Behavioral Health Health Psychology Module Spring 2005

  29. 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 Master of Behavioral Health Health Psychology Module Spring 2005

  30. Disease versus Illness • Disease: deviation from health ~ What the doctor identifies as an abnormality in health • Illness: the discomfort the patient experiences ~ What the patient identifies as symptoms and feels (fear, distress, etc.) Master of Behavioral Health Health Psychology Module Spring 2005

  31. Reflection • Why do we want good health? • What is health for? • A means to what? • What contributes to health? Master of Behavioral Health Health Psychology Module Spring 2005

  32. Biomedical vs Biopsychosocial Model Master of Behavioral Health Health Psychology Module Spring 2005

  33. Biomedical vs Biopsychosocial Models Master of Behavioral Health Health Psychology Module Spring 2005

  34. Biomedical vs Biopsychosocial Models Master of Behavioral Health Health Psychology Module Spring 2005

  35. Biomedical vs Biopsychosocial Models Master of Behavioral Health Health Psychology Module Spring 2005

  36. Biomedical vs Biopsychosocial Models Master of Behavioral Health Health Psychology Module Spring 2005

  37. II. Prevention • Primary prevention • Modification of risk factors (e.g. smoking, drinking) before illness onset • Health promotion efforts are a form of primary prevention • Secondary prevention • Interventions aimed at detecting illness at an asymptomatic stage so that its progression can be haltered or retarded • E.g. screening • Tertiary prevention • Treatment interventions once an illness has manifested itself to prevent it from worsening • Rehabilitation of patients Master of Behavioral Health Health Psychology Module Spring 2005

  38. 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 Master of Behavioral Health Health Psychology Module Spring 2005

  39. III. Role of Behaviours in Health and Illness • Behavior and mortality • 50% of mortality from the 10 leading causes of death is due to behavior • Tobacco consumption accounts for 30% of all cancer deaths (90% of lung cancer deaths) • Alcohol: 3% • Diet: 35% • Reproductive and sexual behavior: 7% • 75% of all deaths due to cancer related to behaviors Master of Behavioral Health Health Psychology Module Spring 2005

  40. Role of Behaviors • Behavioral risk factors associated with the 5 leading causes of death: • Heart disease: • smoking, high dietary cholesterol, lack of exercise • Cancer: • smoking, high alcohol use, diet • Stroke: • smoking, high dietary cholesterol, lack of exercise • COPD (Chronic lung diseases): • smoking • Accidents: • alcohol/drug use, speeding, not using seat belts Master of Behavioral Health Health Psychology Module Spring 2005

  41. Role of Behaviors • Behavioral risk factors associated with the 5 leading causes of death: • Heart disease: smoking, high dietary cholesterol, lack of exercise • Cancer: smoking, high alcohol use, diet • Stroke: smoking, high dietary cholesterol, lack of exercise • COPD (Chronic lung diseases): smoking • Accidents: alcohol/drug use, speeding, not using seat belts Master of Behavioral Health Health Psychology Module Spring 2005

  42. 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 Master of Behavioral Health Health Psychology Module Spring 2005

  43. 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 Master of Behavioral Health Health Psychology Module Spring 2005

  44. 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) Master of Behavioral Health Health Psychology Module Spring 2005

  45. Longevity Factors • 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 Master of Behavioral Health Health Psychology Module Spring 2005

  46. Daily diet, risk of CVD, and Longevity The Polymeal: Ingredients % reduction (95%CI) in risk of CVD Wine (150ml/day) 32 (23 to 41) Fish (114g four times/week) 14 (8 to 19) Dark chocolate (100g/day) 21 (14 to 27) Fruit & vegetables (400g/day) 21 (14 to 27) Garlic (2.7g/day) 254 (21 to 27) Almonds (68g/day) 12.5 (10.5 to 13.5) Combined effect 76 (63 to 84) Master of Behavioral Health Health Psychology Module Spring 2005

  47. Daily diet, risk of CVD, and Longevity • For men: total life expectancy increases by 6.6 years; life expectancy free from CVD increases by 9 years; life expectancy with CVD decreases by 2.4 years • For women: total life expectancy increases by 4.8 years; life expectancy free from CVD increases by 8.1 years; life expectancy with CVD decreases by 3.3 years Franco et al. (2004). BMJ, 329: 18-25. Master of Behavioral Health Health Psychology Module Spring 2005

  48. Types of Health-Related Behaviors Kasl & Cobb (1966): 1.) Health Behavior: behavior aimed at preventing disease (e.g healthy diet) 2) Illness Behavior: behavior aimed at seeking remedy (e.g. seeing the doctor) 3) Sick Role Behavior: any behavior aiming to get well (e.g. rest, medication) Master of Behavioral Health Health Psychology Module Spring 2005

  49. Health Behaviors Matarazzo (1984) further defined health behaviors in terms of either: • Health impairing habits: • “behavioral pathogens” • habits that will deteriorate health (e.g. high fat diet, smoking, substance abuse) • Health protective behaviors: • “behavioral immunogens” • behaviors that will maintain health (e.g. enough sleep everyday, regular exercise, attending health checks, seeking health information, using headsets while driving/not talking on mobile phones at all while driving) Master of Behavioral Health Health Psychology Module Spring 2005

  50. How Can Behaviors be Changed? • Behaviors play an important role in health and illness, so how can we change people’s behaviors for the better? Master of Behavioral Health Health Psychology Module Spring 2005

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