Part One:Part One:Introduction to Health Introduction to Health PsychologyPsychology

Chapter 1:Chapter 1:What is Health Psychology?What is Health Psychology?

What is Health Psychology?What is Health Psychology?

Definition:Definition:Health psychologyHealth psychology is the field devoted to understanding is the field devoted to understanding psychological influences on how people stay healthy, why the psychological influences on how people stay healthy, why the become ill and how they respond to this. become ill and how they respond to this.

Health psychologists focus on Health psychologists focus on health promotionhealth promotion, , maintenancemaintenance, , preventionprevention and and treatmenttreatment of the illness. of the illness.-Example: reasons why people smoke.-Example: reasons why people smoke.

They also focus on They also focus on etiologyetiology (origins or causes of the illness) and (origins or causes of the illness) and correlates of healthcorrelates of health, , illnessillness and and dysfunctiondysfunction, especially , especially interested in interested in behavioralbehavioral and social factors and social factors such as exercise, such as exercise, alcohol consumption, smoking and ways of copying with stress.alcohol consumption, smoking and ways of copying with stress.

• Finally, they Finally, they analyzeanalyze and attempt to and attempt to improve health care systemimprove health care system..

The Mind-Body Relationship: A Brief HistoryThe Mind-Body Relationship: A Brief History There’s evidence of ancient cultures that suggests that mind and There’s evidence of ancient cultures that suggests that mind and

body were considered body were considered a unita unit..

Early cultures believed that disease arose when Early cultures believed that disease arose when evil spiritsevil spirits entered entered the body and that these spirits could be the body and that these spirits could be exorcisedexorcised through through treatment processtreatment process..

The The GreeksGreeks : They were among the first to identify the role of bodily : They were among the first to identify the role of bodily functioning in health and illness. They developed a functioning in health and illness. They developed a humoral theory humoral theory of illnessof illness, in which specific personalities were associated to four , in which specific personalities were associated to four humors.humors.

Middle Ages: Middle Ages: Mysticism and demonology dominated the concepts Mysticism and demonology dominated the concepts of disease, which was “God’s punishment of evildoing”. Throughout of disease, which was “God’s punishment of evildoing”. Throughout this time, the Church was the guardian of medical knowledge.this time, the Church was the guardian of medical knowledge.

RenaissanceRenaissance: : Great strides were made in the technological basis Great strides were made in the technological basis of medical practice, such as Leeuwenhoek’s microscopy and of medical practice, such as Leeuwenhoek’s microscopy and Morgagni’s contributions to autopsy.Morgagni’s contributions to autopsy.

For the next 300 years, physical For the next 300 years, physical evidenceevidence became the sole basis became the sole basis for diagnosis and treatment of the illness.for diagnosis and treatment of the illness.

This view began with the rise of modern psychology, with This view began with the rise of modern psychology, with Sigmund Freud’sSigmund Freud’s early work on conversion early work on conversion hysteriahysteria. According . According to him, unconscious conflicts can produce physical disturbances to him, unconscious conflicts can produce physical disturbances that symbolize the repressed psychological conflicts.that symbolize the repressed psychological conflicts.

In 1930, unlike Freud, In 1930, unlike Freud, Flanders DunbarFlanders Dunbar and and Franz AlexanderFranz Alexander linked patterns of personality to a specific illness.linked patterns of personality to a specific illness.

Their works helped the emerging field of Their works helped the emerging field of psychosomatic psychosomatic medicinemedicine

The Mind-Body Relationship: A Brief HistoryThe Mind-Body Relationship: A Brief History

Now, it is known that all conditions of health and illness are Now, it is known that all conditions of health and illness are influenced bye influenced bye psychological and social factorspsychological and social factors..

This current conception is one of the many factors that have This current conception is one of the many factors that have spawned the rapidly spawned the rapidly growing field of health psychologygrowing field of health psychology..

The Mind-Body Relationship: A Brief HistoryThe Mind-Body Relationship: A Brief History

Why is the field of health Why is the field of health psychology needed?psychology needed?Health psychology is one of the most important developments

wthin the field of psychology in the last 50 years.Some of the factors that have contributed to its emergenceare the following.

Chaging Patterns of Illness

The major causes of illness and death in the United States were acute disorders.Acue disorders are short-term medical ilness often result of a viral or bacterial invader and usually amenable to cure.Now, however, chronic ilness are the main contributors to disability and death.

Health psychology has evolved, in part, to help researchers and practitionersunderstand develop research for improving our understanding of the relation ofbehavioral and social factors to illness and how we may affect these factors.chronic ilness affect family functioning, including relationships with a partner and/or children, and health psychologists both elucidate these effects and help ease the

Problems in family functioning that may result.Helping people make informed appropriate decsions is fundamentally a Psychological task.

Patients play in fundamental decision regarding their health and illnessand its management, and of the help health psychologists can provide inthis process.

Changing patterns of illness have been charted and followed by the fieldof epidemiology, this is a study of the frequency, distribution, and causesof infectious and non-infectious diseasein a population, based on aninvestigation of the physical and socil enviroment.In the context of epidemiologic statistics, we will see frequent use of twoimportant terms:Morbidity: Number of cases of a disease that exist at some given point in

time.Morality: Refers to numbers of deaths due to particular causes.

Health psychologists are becoming more involved in the effort to improvequality of life among those diagnosed with chronic illnesses so thatindividuals may live out their remaining years as free from pain, disabilityand lifestyle compromise as possible.

Another set of factors tha has contributed to the rise of health psychology

relates to the expansion of health care services.Health care is the largest service industry in the United States.Americans spend over $1000 billion annually on health.Health psychology represents an important perspective on these

issuesfor several reasons: Health psychology´s emphasis on prevention. Research on what makes people satisfied or dissatisfied with their

health care. Design of health care systems. Health care industry employs many millions of individuals in a

variety of jobs.

Expanded Health Care Services

Psychologists have been involved in the development of behavior-change programsto teach people to practice better health habits, including not smoking, gettingexercise, eating a balanced diet, practicing safe sex, reducing alcohol consumptionavoiding accidents and managing stress.

Psychologists learned many years ago that preparing patients to undergo unpleasantMedical procedures, such as surgery, improves their adjustment to those procedures.

Increased Medical Acceptance

Although health psychologists have been employed in health seetings for many years, their value is increasingly recognized by physicians and other health care professionals.Caregivers are increasingly recognizing that psychological and social factors are always important in health and illness.

Demonstrated Contributions to Health

The health psychologist can be a valuable member of the research team by providing the methodological and statistical expertise that is the hallmark of good training in psychology.

Health psychology is important because the major health problems of the day, especialy the origin and treatment of chronic illness, can increasingly be understood substantially in of psychological and social factors; the field of health psychology terms addressesan issue of paramount economic and social importance, namely, Health Care.

Methodological Contributions

The Biopsychosocial Model The Biopsychosocial Model in Health Psychologyin Health Psychology

Its fundamental assumption is that any Its fundamental assumption is that any heath or illness outcome is a heath or illness outcome is a consequence of the interplay of consequence of the interplay of biological, psychological and social biological, psychological and social factors.factors.

The Biopsychosocial Model The Biopsychosocial Model vs The Biomedical Modelvs The Biomedical Model

Maintains that all illness can be explained Maintains that all illness can be explained on the basis of aberrant somatic on the basis of aberrant somatic processes ( biochemical imbalances or processes ( biochemical imbalances or neuropsychological abnormalities)neuropsychological abnormalities)

Assumes that psychological and social Assumes that psychological and social processes are largely independent of the processes are largely independent of the disease process.disease process.

The biomedical model clearly The biomedical model clearly incorporates the assumption of a mind-incorporates the assumption of a mind-body dualism, maintaining that mind and body dualism, maintaining that mind and body are separate entries.body are separate entries.

The biomedical model clearly The biomedical model clearly emphasizes illness over health.emphasizes illness over health.

This model has proven to be scientifically This model has proven to be scientifically and clinically inadequate in explaining the and clinically inadequate in explaining the disease process.disease process.

Advantages of the Advantages of the Biopsychosocial ModelBiopsychosocial Model

Both, Both, macrolevel processesmacrolevel processes (such as the (such as the existence of social support, the present of existence of social support, the present of depression) and depression) and microlevel processes microlevel processes (such as (such as cellular disorders or chemical imbalances) cellular disorders or chemical imbalances) interact to produce a state of health or illness.interact to produce a state of health or illness.

Maintains that the mind and body cannot be Maintains that the mind and body cannot be distinguished in matters of health and illness distinguished in matters of health and illness because both clearly influence an individual’s because both clearly influence an individual’s state of healthstate of health

Emphasizes both health and illness Emphasizes both health and illness rather than regarding illness as a rather than regarding illness as a deviation from some steady statedeviation from some steady state

The Biopsychosocial The Biopsychosocial Model as a Research ToolModel as a Research Tool

Research investigators must try to Research investigators must try to measure ALL three classes of variables.measure ALL three classes of variables.

Must also be conducted on the context of Must also be conducted on the context of the state of art methodology on the the state of art methodology on the relevant fields (psychology, biology, relevant fields (psychology, biology, social)social)

Clinical Implication of the Clinical Implication of the Biopsychosocial ModelBiopsychosocial Model

The diagnosis should always consider the The diagnosis should always consider the interacting role of biological, psychological, and interacting role of biological, psychological, and social factors in assessing an individuals health social factors in assessing an individuals health or illnessor illness

Recommendation for treatment must also Recommendation for treatment must also examine all three sets of factorsexamine all three sets of factors

Makes explicit the significance of the Makes explicit the significance of the relationship between patient and practitionerrelationship between patient and practitioner

What do health What do health psychologist do?psychologist do?

Because of their experience in health Because of their experience in health psychology, they are often able to psychology, they are often able to understand and manage the social an understand and manage the social an psychological aspects of the health psychological aspects of the health problems they treat better that would be problems they treat better that would be the case if their if their education had the case if their if their education had included only training in traditional included only training in traditional medicine.medicine.

Other health psychology Other health psychology students go into the allied students go into the allied health professional fields:health professional fields:

Social workSocial work Occupational therapyOccupational therapy DieteticsDietetics Physical therapyPhysical therapy Public healthPublic health

Many undergraduates go on to graduate Many undergraduates go on to graduate school in psychology, where they learn school in psychology, where they learn the research, teaching, and intervention the research, teaching, and intervention skills necessary to practice health skills necessary to practice health psychology in psychology in academic positionsacademic positions..

Many health psychologists become Many health psychologists become clinical and work with medical patients in clinical and work with medical patients in a hospital or other treatment settinga hospital or other treatment setting

HEALTH PSYCHOLOGY: AN OVERWIEW

We will now see how health psychologists address different problems In part 1: we provide an overview of the field of health psychology, covering its

history and the reasons for its development.

°Chapter 2: provides a brief look at human physiology

°Part 2: ackownledges the role that psychological and social factors play, in the health habits and in the environmetal context.

-The two major causes of death in the U:S: heart disease and cancer, are now known to be affected by behavioral factors.

-25% of all cancer deaths could be avoided simply by getting people to stop smoking.

-Dietary factors and stress are implicated in both the onset and management of diabetes.

-Breast cancer, the main cause of death amongst American women, can be successfully trated if it is detected early. Breast self-examination is one of the best methods currently available for doing this.

°Chapter 3: focuses on the general issue of health promotion and determinants of the practice of health habits.

°Chapter 4: examines attitudinal and cognitive-behavioral approaches to the modification of poor health habits.

°Chapter 5: considers Health-Enhacing Behaviors such as: exercise, accident prevention, breast and testicular self-examination.

°Chapter 6: considers Health Compromising Behaviors such as: alcoholism and smoking.

-In Part 3: we examine the role that stress plays in good health

°Chapter 7: points out that stress is an important contributing factor in illnesses

-An example: President Lyndon Johnson. During each of his of his major election battles, he developed a serious illness. The most dramatic event came when President Richard Nixon disbaned the Great Society, which Johnson thought to be his greatest success. Johnson died that same day.

°Chapter 8: considers factors that moderate the stress-illness relationship

-Example: the most intriguing discovery would be the finding that people with strong personal relationships are less likely to become ill and tend to recover more quickly.

-Part 4: examines the psychological and social factors that prompt people to seek tratment.

°Chapter 9: looks at how people detect and appraise their symptons and what leads them to seek or neglect treatment.

-The processes of interpreting disorders and seeking treatment are substantially guided by cultural and social factors.

°Chapter 10: discusses communication problems. As many as two-thirds of all patients are unable to repeat simple facts about their illness and its treatment. The consequence can be severe.

-Including nonadherence to treatment or malpractice suits.

°Chapter 11: examines the elusive nature of pain. -in this context we examine developments in the physiology of

pain, especially the existence of natural pain combating substances, called endorphins.

-We also consider the control of pain and examine the many technologies that have been used to cambat it, including biofeedback, relaxation, acupuncture, and hypnosis.

-In particular this chapter will consider the problems of the patient with chronic pain.

-Part 5: discusses the management of chronic and terminal illnesses.

-Chronic illnesses raise more issues of phychological interest. -Some os these issues areise because chronic illnesses are

often caused at least partly by behavioral factors that can be modified.

°Chapter 12: examines that chronic ilnesses are a condition with which people may live for years.

-Example: a male adolescent who learns at age 13 that he has a chronic illness: diabetes.

°Chapter 13: presents a strong challenge to health psychologists. -Here we deal with terminal illnesses. -One of the most promising developments in this area is

the creation of hospices. *Institutions designed especially to care for the

terminally ill.

°Chapter 14: considers factors that predict the development of coronary heart disease, hypertension, diabetes and strokes.

°Chapter 15: addresses psychoimmunology, AIDS, cancer, and arthritis

°Chapter 16: examines anticipated trends in the field of health psychology.

-Example: new techniques for the control of pain and discomfort will be developed and psychologists will have a role in their implementation.