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. Matarazzo’s 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.

5. 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

6. 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.

7. 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.

8. 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

9. 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.

10. 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.

11. (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.

12. 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. • Today’s major killers are cardiovascular diseases-heart disease and strokes and cancers. • Cardiovascular diseases account for about 40% of all deaths in industrialised countries.

13. 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,

14. 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 people’s health beliefs, attitudes and behaviour. • The biomedical model has a reactive attitude towards illness. Traditional medicine is more focused on disease than on health.

15. 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.

16. 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 someone’s health status.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.