Health Psychology

Module 1: Introduction to Psychology and Health

1.1 Introduction to Physiology, The Relationship between Mind and Body

1.2 Various components of health; social, emotional, cognitive, and physical

aspects

1.3 Models of health psychology; traditional and Contemporary

1.4 Scope of Health Psychology

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1.1 Introduction to Physiology, The Relationship between Mind and Body

Definition:

Matarazzo (1982): ‘the promotion and maintenance of health, the prevention and
treatment of illness, 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”’.

Taylor: Health psychology is an exciting and relatively new field devoted to understanding
psychological influences on how people stay healthy, why they become ill, and how they
respond when they do get ill.

According to the American Psychological Association (APA), Health Psychology (Division

38) is a subfield of psychology that focuses on
(a) the examination of the relationships between behavioural, cognitive, psychophysiological,
and social and environmental factors and the establishment, maintenance, and detriment of
health;
(b) the integration of psychological and biological research findings in the design of empirically
based interventions for the prevention and treatment of illness; and
(c) the evaluation of physical and psychological status before, during, and after medical and
psychological treatment.

Health psychology can be understood in terms of a few questions:

What Causes Illness?

Health psychology believes that illness is caused by a complex mix of factors, not just one single
thing. It's like a puzzle with many pieces, including biology (like viruses), psychology (like
beliefs and behaviors), and social factors (like work).

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Who is Responsible for Illness?

Since illness is caused by many factors, individuals can't be seen as helpless victims. For
example, if unhealthy behaviours contribute to illness, individuals might be partly responsible for
their health.

How Should Illness Be Treated?

Health psychology emphasizes treating the whole person, not just the physical symptoms. This
means focusing on behavior changes, beliefs, coping strategies, and following medical advice.

Who is Responsible for Treatment?

Because the whole person is treated, patients play a role in their recovery. This can involve
taking medication or making changes to beliefs and behaviours. They're not just passive
recipients of treatment.

What is the Relationship Between Health and Illness?

Health and illness aren't completely separate. They're on a spectrum, like a sliding scale. People
can move back and forth between feeling healthy and feeling ill.

What is the Relationship Between the Mind and the Body?

In the past, people thought the mind and body were separate. Now, we understand that they're
connected and influence each other. This is why health psychology takes a holistic approach,
considering both the mind and body.

What is the Role of Psychology in Health and Illness?

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Health psychology believes that psychological factors can contribute to illness at every stage,
from being healthy to being ill. It's not just about the consequences of illness but also the factors
that lead to it.

FOCUS
Health Promotion and Maintenance

Health psychologists promote healthy behaviours and practices. They help children develop goo

MODELS

Models in Health Psychology

These models help us understand how our thoughts, feelings, and actions affect our health. They
can be used to predict what people will do, plan ways to help people stay healthy, and improve
health outcomes.

Traditional Models

These models focus on the body and how it works. They often don't consider how our minds or
our lives affect our health.

Contemporary Models

These models look at the whole picture. They consider how our bodies, minds, and lives all work
together to influence our health.

The Biopsychosocial Model

The biopsychosocial model, developed by George Engel in 1977, integrates biological,

psychological, and social factors in understanding health and illness. It represents a holistic

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approach, contrasting the traditional biomedical model which focuses solely on biological
aspects.

d habits, encourage physical activity, and design campaigns for better eating. This work is

essential for long-term health and preventing diseases.

Prevention and Treatment of Illness

Health psychologists address the psychological factors that affect health outcomes. They teach

stress management to people in stressful jobs to reduce its negative effects. They also help

patients follow their treatment plans to improve treatment effectiveness and overall health.

Etiology and Correlates of Health, Illness, and Dysfunction

Health psychologists study the causes and factors that contribute to health problems. They

examine how behaviours and social factors, like alcohol use, smoking, physical activity, seat belt

use, and coping strategies, affect health and illness. This knowledge helps create interventions to

promote healthier lifestyles and reduce risks.

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Improvement of Health Care Systems and Policy Formulation

Health psychologists analyze and improve healthcare systems and policies. They assess how

health institutions and professionals influence patient behaviour and develop recommendations

to enhance healthcare delivery. This includes evaluating and proposing changes to health policies

to better support public health needs.

In conclusion, health psychology examines the psychological and social factors that influence

health, illness prevention, treatment, and health policy evaluation.

WHAT IS HEALTH?

We often define health as the absence of observable signs of illness or subjective symptoms.
However, this definition is limited, as people can appear healthy on the outside but still have
underlying health problems.

Health and Illness: A Continuum

A more nuanced view suggests that health and illness exist on a spectrum, rather than being
distinct categories. This continuum acknowledges that even those without overt symptoms might
have underlying health issues, indicating that health is a complex concept that goes beyond the
mere absence of disease.

The Illness-Wellness Continuum, created by Dr. John Travis, is a model that redefines wellness
beyond the mere absence of disease, framing it as a spectrum where individuals can continually
aspire to higher levels of wellness. It places death at one end and optimal wellness at the other. It
helps to visualize the varying degrees of health and illness that individuals experience over time.

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Key Concepts of the Illness-Wellness Continuum

1. Wellness as a Process:

1. Ongoing Journey: Wellness is not a static state but a dynamic, continuous process.

2. Neutral Level: Achieving a state free from disability, illness, and disease symptoms
places an individual at a neutral level of wellness.

3. Growth: Progressing beyond the neutral point involves awareness, education, and
personal growth, moving an individual higher on the wellness spectrum.

2.The Iceberg Model:

Illness and health are just the visible tips of the iceberg. True understanding of one's health status
requires looking below the surface at lifestyle choices, behavior, psychological motivations, and
spiritual well-being.

3.Interconnectedness:

Every individual is interconnected with the rest of humanity and the universe. Health and illness
involve managing one's attitude and energy. Negative emotions and stress can weaken the
immune system, whereas positive emotional management can enhance wellness.

COMPONENTS OF HEALTH

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Health encompasses various aspects: social, emotional, cognitive, and physical. Each
component is crucial for overall well-being. A balanced life requires attention to all these
areas.

Social Health:

● Key Elements:

• Relationships: Building and maintaining supportive and meaningful connections

with family, friends, and the community.

• Social Support: Access to a network that provides emotional and practical

support.

• Social Skills: Effective communication, empathy, and the ability to resolve

conflicts.

Impact on Health:

Strong social ties boost mental health, and immunity, and reduce disease risk. In “Social
Relationships and Mortality Risk: A Meta-analytic Review," Holt-Lunstad, Smith, and
Layton (2010) found social connections linked to better mental health and lower
mortality. They also improved immune function and reduced chronic disease risk.

Interventions:

Promote community events, teach social skills in schools, and create support groups.

Emotional Health

Emotional health is the ability to understand, manage, and express emotions in a

constructive way.

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 ● Key Elements:

•Emotional Regulation: Managing emotions such as stress, anger, and sadness in a

healthy manner.

•Mental Well-being: Having a positive self-image, high self-esteem, and a sense of

purpose.

•Resilience: The ability to recover from setbacks and adapt to change.

Impact on Health:

Good emotions boost physical health. Anger control aids healing. In "The Influence of
Anger Expression on Wound Healing," Gouin et al. (2008) showed that managing anger
helps recovery.

Actions:

Teach emotional health in schools, offer mental health services, and encourage
mindfulness.

Cognitive Health

Cognitive health refers to the ability to think, learn, and remember effectively.Key
Elements:

•Mental Processes: Engaging in activities that stimulate thinking, learning, and

problem-solving.

•Brain Function: Maintaining cognitive abilities through mental exercises and

continuous learning.

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 •Mental Disorders: Awareness and management of conditions like depression,
anxiety, and cognitive decline.

Cognitive Health and Overall Well-being

Mental sharpness affects daily life and relationships. Engaging the mind helps prevent
dementia.

Dr. Snowdon's Nun Study shows that nuns who kept learning stayed mentally sharp and
had less Alzheimer's.

Recommendations:

Encourage lifelong learning, offer brain training, and promote a healthy lifestyle.

Physical Health Physical health is about the proper functioning of the body and its
systems.

● Key Elements:
○ Body Functioning: Ensuring that bodily systems, such as cardiovascular,
respiratory, and muscular systems, operate efficiently.
○ Lifestyle Choices: Making healthy choices such as eating a balanced diet,
exercising regularly, getting adequate sleep, and avoiding harmful
behaviors like smoking and excessive drinking.
○ Medical Care: Regular check-ups, preventive measures, and appropriate
medical treatment when necessary.

Impact on Overall Health

Good health is a mix of physical and mental well-being. Exercise helps your heart,

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Physical health is about the proper functioning of the body and its systems.muscles, and
bones, and it also boosts your mood.

The Diabetes Prevention Program (DPP) study, published by the Diabetes Prevention
Program Research Group (2002) found that people who exercised more and ate better
were less likely to get type 2 diabetes. This shows how lifestyle changes can make a big
difference.

Recommendations

We should encourage people to be more active, eat healthy, and get regular check-ups.

SCOPE:

Health psychology studies how our minds and behaviours affect our health. Here's a
breakdown:

1. Behavior and Health

● Heart disease: Smoking, poor diet, lack of exercise

● Cancer: Smoking, alcohol, skipping check-ups
● Stroke: Smoking, high cholesterol, high blood pressure
● Accidents: Alcohol, drugs, careless driving

2. Mind and Body

● Stress, social support, coping skills impact health

● Social, cultural, and economic factors affect health
● 3. Mind and Body
● Stress and emotions can affect physical health
● Psychological factors can trigger or worsen illnesses

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4. Living with Illness

● Pain, anxiety, depression, nausea, vomiting

● Reducing these symptoms and improving quality of life

5. Treatment

● Using psychology to treat illnesses

● Addressing both physical and mental health
● Behavioral interventions to prevent illness and improve outcomes

6. Prevention

● Promoting healthy behaviors

● Preventing illness by changing behaviors and managing stress
● Training healthcare professionals to communicate better and provide effective
interventions

Mind and Body: A Long History

Ancient Greece and Rome

● Hippocrates: Father of medicine. Thought health was about balance.

● Greek philosophers: Believed mind and body were separate.
● Galen: Respected doctor. Supported balance theory, found new things about the
body.

The Middle Ages

● Church's influence: Saw illness as punishment.

● St. Thomas Aquinas: Thought mind and body were linked.

The Renaissance and Later

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 ● Renaissance: New ideas, people focused on humans.
● Descartes: Believed mind and body were separate, but could talk.
● Medical advances: Microscopes and autopsies helped us understand illness better.

Strength

● Evidence-based: Uses facts and research.

● Encourages research: Looks for new treatments.
● Successful treatments: Has helped many people.
● Reassuring: Explains mental health issues.

Criticism

● Reduces illness to cells: Doesn't consider the whole person.

● Ignores social factors: Doesn't see how life affects health.
● Focuses on illness: Should focus on staying healthy.
● Can't explain everything: Doesn't answer all questions.
● Too much on treatment: Should focus more on preventing illness.

Psychosomatic Medicine in a Nutshell

Mind and Body Connection

Psychosomatic medicine studies the link between mental and physical health. Early on,
doctors like Dunbar and Alexander believed some illnesses stemmed from emotional
conflicts. For example, they linked a certain personality type to ulcers.

How It Works

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They thought conflicts triggered anxiety that affected the body. Repressed emotions, they
believed, could cause physical changes like increased stomach acid, leading to ulcers.

Psychosomatic Disorders

Their work helped identify potential psychosomatic conditions like ulcers,

hyperthyroidism, and asthma, thought to be caused by emotional problems.

Modern Understanding

Today, we know illness involves a complex mix of factors. While mental health is
important, it's just one piece of the puzzle. Other factors include:

● Biological Pathogens: Viruses, bacteria, etc.

● Social Factors: Low social support, socioeconomic status, etc.
● Psychological Factors: Stress levels, mental well-being, etc.

Growth of Health Psychology

The mind-body connection led to the field of health psychology. The American
Psychological Association (APA) formally recognized it in 1978. The field gained further
recognition in the 1980s with the British Psychological Society's involvement.

Shift Towards Practice In the 1990s, health psychology moved towards professional
practice. This trend continued in the 2000s and 2010s with global expansion and a focus
on preventing chronic diseases and promoting health.

Key Takeaways

● Mind and body are connected.

● Mental factors can influence health.
● Health results from a combination of biological, social, and psychological factors.

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The Biopsychosocial Model of Health

Biological Factors:

● Genes: Family history can make you more likely to get certain diseases.
● Germs: Viruses and bacteria cause illnesses.
● Body Problems: Defects or imbalances in your body can affect your health.

Psychological Factors:

● Thoughts: What you think about your health matters.

● Feelings: How you feel can impact your health.
● Actions: What you do (like eating or exercising) affects your health.

Social Factors:

● Rules: What's expected of you in your community can influence your health.
● Pressure: Friends, family, or society can push you to change your behavior.
● Values: How your society sees health affects your own health.
● Money and Job: Your social status and work can impact your health.
● Culture: Your background can influence your health habits.

Why the Biopsychosocial Model is Better:

The biopsychosocial model looks at the whole picture of health. It considers your body,
mind, and social life, giving a better understanding of illness and a more helpful
treatment plan.

The Lifespan and Gender Perspective in Health Psychology

Understanding How Health Changes Over Time and Varies by Gender

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This model explores how age and gender affect our health. It helps us understand the
complex interplay of biology, psychology, and social factors throughout life.

● Key Concepts

Developmental Changes

Health isn't the same at every age. Kids often get colds, but adults face heart disease, cancer, and
diabetes. This is because our bodies change as we grow.

Early Life Influences

Tough childhood experiences, like abuse or poverty, can lead to health problems later in life.
This is because they can change how our bodies react to stress.

Cognitive Development

As we get older, we understand health better and can make better choices. Kids might rely on
parents, but teens take more responsibility.

Social Relationships

Our relationships change as we age. Teens might feel peer pressure, while older adults might
face loneliness.

Gender Perspective

Biological Differences

Men and women have different bodies, which can affect their health. Hormones, genes, and how
our bodies work can vary.

Health-Related Behaviors

What we do, like smoking or exercising, affects our health. These behaviors can be influenced by
gender roles and societal expectations.

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Social and Psychological Factors

Gender can affect how we handle stress and find support. Women might seek social support,
while men might withdraw.

Disease Risk and Manifestation

Some diseases are more common in one gender than the other. Even the same disease can affect
men and women differently.

Conclusion

By understanding how age and gender affect health, we can create better ways to help people
stay healthy. This approach can improve the well-being of everyone.

Social Ecological Model (4 level model)

The Social Ecological Model (SEM) offers a comprehensive framework for understanding the
complex interplay of factors that influence health. While the core principles provide a solid
foundation, it's essential to delve deeper into each level of the model to gain a more nuanced
understanding.

Levels of the SEM

1. Individual Level: This level focuses on personal factors that influence health behaviors,
such as:
○ Knowledge, attitudes, and beliefs: An individual's understanding of health, their
perceptions of risks and benefits, and their beliefs about their ability to change.
○ Skills and abilities: Personal competencies that enable healthy behaviors, such as
cooking healthy meals or managing stress.
○ Genetics and biology: Biological factors that can predispose individuals to
certain health conditions.
2. Interpersonal Level: This level examines the influence of social relationships on health,
including:

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 ○ Social networks: The people an individual interacts with, such as family, friends,
and colleagues.
○ Social support: The emotional, informational, and instrumental assistance
provided by others.
○ Social norms: The unwritten rules and expectations that guide behavior within a
social group.
3. Organizational Level: This level considers the impact of organizations and institutions
on health, such as:
○ Schools: The policies, programs, and environments within schools that can
influence students' health behaviors.
○ Workplaces: The physical and social conditions in workplaces that can affect
employees' health and well-being.
○ Healthcare systems: The accessibility, quality, and affordability of healthcare
services.
4. Community Level: This level explores the role of communities in shaping health,
including:
○ Physical environment: The built environment, such as access to green spaces,
recreational facilities, and safe transportation options.
○ Social environment: The social norms, values, and cultural practices within a
community.
○ Economic environment: Factors such as income inequality, poverty, and
unemployment that can affect health outcomes.
5. Policy Level: This level examines the influence of laws, regulations, and policies on
health, such as:
○ Health policies: Government policies that promote health, such as tobacco
control, alcohol restrictions, and food safety regulations.
○ Economic policies: Policies that affect income distribution, access to healthcare,
and other social determinants of health.
○ Environmental policies: Policies that protect the environment and promote
sustainability.

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By understanding the interconnectedness of these levels, policymakers, health professionals, and
community leaders can develop more effective interventions to promote health and address
health disparities. The SEM provides a valuable framework for identifying and addressing the
root causes of health problems and creating healthier communities.

CDC’s(Centers for Disease Control and Prevention), Four-Level

Model (2007)

This model recognizes that health outcomes are shaped by interactions between individualsand
their environments, and it addresses multiple levels of influence.

Individual Level: This level focuses on the biological and personal characteristics ofindividuals,
such as age, education, income, health history, and personal behaviors.

Interpersonal Relationships: This level includes the influence of close social networks such as
family, friends, and peers. These relationships can affect individual behaviors and health
experiences.

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Community Level:

This level examines the settings where individuals interact, such as schools, workplaces, and
neighbourhoods. It focuses on how these environments can affect health.

Societal Level:

This level addresses broader societal factors that influence health, including cultural norms,
social policies, and economic conditions. These factors shape the overall environment in which
individuals and communities operate.

The Health Belief Model (HBM)

Overview:

The HBM predicts health behaviors based on individual beliefs.

Core Components:

● Susceptibility: Perceived risk of illness.

● Severity: Perceived seriousness of illness.
● Benefits: Perceived benefits of action.
● Costs: Perceived barriers to action.
● Cues to Action: Triggers for action.
● Health Motivation: Readiness to be concerned about health.
● Perceived Control: Confidence in one's ability to act.

Predicting Behavior:

The HBM suggests that these beliefs predict health behaviors. For example, a woman is more
likely to get a cervical cancer screening if she believes she's at risk, the cancer is serious,
screening benefits outweigh costs, and she's motivated and confident.

Evidence:

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Studies have shown that the HBM can predict behaviors like dietary compliance, safe sex,
vaccinations, dental visits, and exercise.

Limitations:

Some studies have found mixed results, and not all studies use the full HBM.

Application:

To apply the HBM to cervical cancer screening, focus on the woman's beliefs about risk,
seriousness, benefits, costs, motivation, and confidence.

The Stages of Change Model (SOC)

Overview:

The SOC model explains how people change their behaviors. It outlines five stages:

● Pre-contemplation: Not considering change.

● Contemplation: Thinking about change.

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 ● Preparation: Making small changes.
● Action: Actively changing.
● Maintenance: Keeping the change.

Decisional Balance:

The SOC focuses on how people weigh the pros and cons of change at each stage.

● Pre-contemplation: Focus on costs.

● Contemplation: Weigh pros and cons.
● Preparation: Focus on benefits.
● Action: Focus on positive outcomes.
● Maintenance: Focus on sustained benefits.

Pre-Contemplation Stage: Focus: Costs of Change, "Stopping smoking will make meanxious in
social situations.

At this stage, individuals are not considering change and often emphasize the negative aspects of
changing their behaviour. They might believe that quitting will lead to uncomfortable feelings or
inconvenience.

Contemplation Stage: Focus: Weighing Pros and Cons, "I’ve been coughing a lot lately. Maybe
I should think about stopping smoking.”

Individuals start to recognize the problem and consider the possibility of change. They evaluate
both the positive and negative aspects of making the change, trying to balance the potential
benefits with the perceived costs.

Preparation Stage: Focus: Benefits of Change, "I will stop going to the pub and will buy
nicotine patches.“ At this stage, individuals are preparing to make a change. They begin to focus
more on the benefits and positives of changing their behavior, planning and making small
adjustments to support their goal.

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Action Stage: Focus: Positive Outcomes of Change, "I have stopped smoking.“Individuals are
actively engaged in the new behaviour. They emphasize the positive results and benefits of their
change, such as feeling healthier and experiencing improved well-being.

Maintenance Stage: Focus: Sustained Benefits and Long-Term Positive Outcomes, "I’ve been
smoke-free for four months now.“

In this stage, individuals work to maintain their new behaviour over time. They concentrate on
the long-term benefits and reinforce the positive changes to prevent relapse.

The COM-B Model

Overview:

The COM-B model explains why people do or don't do things. It suggests that to engage in a
behaviour (B), a person needs to have the capability (C), opportunity (O) and motivation (M) to
perform that behaviour, so any behaviour change will require modifying at least one of those
components.

Core Components:

● Capability: Physical and mental ability.

● Opportunity: External factors like time, money, and social support.
● Motivation: Internal factors like beliefs, emotions, and habits.

Policy Categories:

● Communication: Spreading information.

● Guidelines: Setting standards.
● Regulations: Implementing rules.
● Legislation: Making laws.
● Environmental/Social Planning: Designing Environments.
● Service Provision: Offering support.
● Fiscal Measures: Using money to influence behaviour.

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Evaluation:

The COM-B model is a good framework for understanding behavior change. It's comprehensive,
evidence-based, and can help identify barriers and engage stakeholders. However, it can be too
simple and might not work well outside of health contexts.

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