Lecture 7

Health psychology

Health psychology is the understanding of psychological influences on how people stay

healthy, why they become ill, and how they respond when they do get ill.

Community health psychology looks at the individual and broader social determinants of
health and health-related behaviours

Health is a ‘complete state of physical, mental and social well-being and not merely the
absence of disease or infirmity’ (WHO, 1948)

History of health psychology

Disease/illness theorized to be due to:

- Evil spirits; early ‘treatment’ used trephination, drilling holes in the skulls of diseased
individuals to let these out
- Hippocrates: imbalance in humours in the body; caused by an imbalance in the four
fluids – blood, phlegm, black bile and yellow bile
- Descartes: cartesian dualism mind and body separate – to treat illness focus on the
body alone, led eventually to cellular theory of illness and biomedical models;
- Freud: some illnesses can’t be traced to biological cause, psychosomatic medicine
- Eventual recognition that psychology and physiology mutually influence one another
led to biopsychosocial model of health

Theories of health behaviour

Health belief model. Suggest that health behaviors are predicted by four factors:
- Perceived susceptibility to a health threat; optimistic bias; a person’s perception that
he is likely to contract a particular illness e.g. George’s grandpa and father died from
lung cancer because of smoking but rate their own level of susceptibility lower which
they experience optimistic bias as his own chance of getting if he smokes is low
- Perceived seriousness/severity of a health threat; individual’s perception of the
impact a particular illness would have on their life e.g. having seen first-hand the
death of a close relative; George has no doubt as to the seriousness of lung cancer
- Benefits and barriers of undertaking particular health behaviors; benefits t be gained
from stopping the behaviour (e.g. offsetting a health threat such as lung cancer)
outweigh the costs or barriers associated with the termination of the behaviors (e.g.
side effects of withdrawal associated quitting smoking, weight gain)
- Cues to action of willingness to begin a healthy behavior e.g. includes advice from
friends and family, age, gender, socioeconomic status and exposure to media
campaigns related to health behaviors;
- Protection motivation theory of health includes the component of self-efficacy to
the health belief model; a person’s belief in her ability to successfully undertake a
particular action or behaviors e.g. if George went through the whole process of the
health belief model, he needs to believe that he can actually quit smoking
- Theory of reasoned action: a socio-cognitive view incorporating an individual’s
attitudes toward health behavior and subjective norms e.g. the belief that if George
stop smoking will reduce the possibility of his getting lung cancer and if his parents
are opposing to the idea of him smoking and then he wishes to comply with their
wishes to stop smoking then he will likely to stop
- Theory of planned behavior incorporates self-efficacy into the theory of reasoned
action e.g. if George went through the theory of reasoned action behind smoking, he
needs to have the belief that he can do it
Health compromising behaviours

Obesity
- Refers to an excessive accumulation of body fat (in excess of 30% in women and 20%
in men)
- Regarded as a global epidemic by the WHO
- Australia’s obesity rates are among the highest in the world (over 63% of Australians
are obese)
- Measured via Body Mass Index
- Overweight if they have a BMI between 25-30% depending on their gender and age

Consequences of obesity

- Health problems: e.g. diabetes, heart disease, sleep apnoea, some cancers,
gallstones
- Increased mortality rate: a BMI of 30 increases the risk of mortality by 30%
- Psychological problems: low self-esteem, stigmatization, depression, suicidal
ideation
- Discrimination e.g. social discrimination like less likely to get marry, get desired jobs,
be treated respectfully by doctors and other medical personnel and get into
prestigious university
- Economic costs e.g. treatment for obesity and related illnesses consumes between
2% and 7% of total health care costs and costs associated with lost work hours due
to illness and death associated with obesity
Treatment of obesity
- Dieting (caloric intake restrictions) but there is little evidence to support long term
success
- Appetite-suppressing drugs
- Surgical procedures e.g. gastroplasty (stomach stapling – stapling the stomach so
that only a small portion of it remains available for processing food) and gastric
bypass – a portion of the small intestine is attached directly to the pouch created
from stapling of the stomach where most of the stomach is bypassed and very little
food is actually absorbed into the body stimulating weight loss
- Therapeutic interventions – help them understand the origins of their obesity, their
patterns of disordered eating and the consequences of obesity for their health
- Systematic programs – for weight loss that are based on an individual’s BMI and
current health status

Cigarette Smoking
- Smoking rates in Australia are declining
- More men than women report smoking daily
- Males are more likely to be ex-smokers than women
- Indigenous Australians are more likely to be smokers than non-indigenous
Australians
- Australian teenagers are less likely to smoke than their elders, however teenage
smoking rates increase with age (18 is legal age to buy cigarettes)

Contributors to smoking
- Genetic, social and environmental contributors
- Genetic susceptibility to drug addiction (fast metabolizers of nicotine are less likely
to experience the negative effects of smoking or smoking as aversive)
- Peer pressure during adolescence (self-presentation (image))
- Rewarding properties of smoking e.g. relaxation, reduced anxiety, reduced pain
sensitivity, improved mental acuity
Treatment for smoking
- Prevention: education programs – inform young people of the hazards of smoking
are prevalent in school, high taxes – making prohibitively expensive for many
especially adolescences whose funds are limited
- ‘Quit’ campaign – educate young Australians about the harmful chemicals they
inhaled with every smoke and the long-term damages to their health
- Pharmacological treatments – nicotine patches, gum, inhaler
- Behavioral therapy
- Social support
- Success rate varies with method of quitting (only 25% of quitters remain smoke free)

Alcohol abuse
- Alcohol dependence (alcoholism is indicated when an individual is physiologically
dependent on alcohol)
- Problems drinkers are not addicted but have work, family and health related
complications associated with alcohol consumption
- In 2016, Australia ranked on the higher end of all OECD countries for per capita
alcohol consumption
- 1 in 5 Australians drink at a risky or high level on monthly basis

Contributors to alcoholism
- Genetic predisposition to drug addiction

Social-cognitive factors
- Mental ‘escape’ from stressors – they drink to mentally ‘escape’ from whatever
stressors they are currently facing as alcohol alters the thought processes of the
consumer, they think differently about the issues they are facing
- Self-handicapping – process by which people set themselves up to fail so they can
provide themselves with an excuse for failure in the event that it occurs e.g. jay gets
drunk the night before a big test and he can blame failure on the test on the alcohol
- Learning: from parents or significant others
- Personality: e.g. people with high levels of negative affect who are people chronically
in a bad mood are more likely to consume alcohol than people who are low in
negative effectivity or who are high in positive affectivity

Consequences of alcoholism
- Liver damage (e.g. cirrhosis)
- Increased risk of some cancers (e.g. cancer of the mouth, larynx, stomach, colon and
breast)
- Hypertension, stroke
- Fetal alcohol syndrome
- Poor judgement and decision making (increase in risk-taking and accidents)
- Loss of family and social relationships – interpersonal violence, domestic violence
and child abuse, homicide and suicide increases with the use of alcohol
- Elevated risk of affective and anxiety disorders
- High economic costs (recently estimated at 14 billion for Australia)
Treatments for alcoholism
- Spontaneous remission (~19%) – quit smoking or greatly reduce their alcohol intake
on their own without any formal method of intervention
- Detoxification – process of drying out, the inpatient setting allows the alcohol
dependent to go through the withdrawal symptoms associated with abstinence from
alcohol in a controlled setting and often with the use of medication to alleviate some
of the negative side effects of withdrawal where it will be several weeks period of
intensive inpatient individual and group therapy
- Aversion therapy – the introduction of something aversive as a means of
discouraging the negative health habit where they take a drug known as Antabuse
daily or acamprosate which helps people to control craving and naltrexone which
blocks the ‘high’ people get from drinking
- Cognitive-behavioral therapy (stress management techniques)
- Support groups (e.g. alcoholics anonymous)

Barriers to health promotion

Individual barriers
- Lack of knowledge is rarely an explanation
- Short-term rewards of health compromising behaviors
- Negative effects of health compromising behaviors are often not immediate
- Unrealistic optimism – less likely than the others person to contract a chronic
condition
- Gender: men less likely to engage in health promoting behaviors as women more
than men take a realistic view of their risk of illness and disease which may account
for men’s greater risk-taking behavior and they more likely to view themselves as
invincible and overly optimistic about their health outcomes

Family barriers
- Health habits acquired in childhood – models the health behaviors they see their
parents or siblings perform
Health system barriers
- Doctors trained to focus on illness and not health – treating the illness itself not the
negative health habits that might have contributed to the development of the illness
- Lack of health insurance
- Relationship between doctor and patient – patients who feel that their doctor is
unresponsive are unlikely to be completely forthcoming about symptoms they are
experiencing and those who are uncomfortable are also significantly less likely to
follow through with treatment regimens recommended by their doctor
- Communication between doctor and patient – when they do not speak the same
language and trying to understand a patient’s complaints in a short period of time is
not easy

Community, cultural and ethnic barriers

- Norms of the community – influenced by the norms of the community in which they
live, work and play as people who live and work in environments that encourages
the use of alcohol as a means of fitting in will likely initiate or continue alcohol use
- Disparities in health between indigenous and non-indigenous Australians
- Rural and remote living (access to health services)

There are at least four factors or barriers to health promotion: individual barriers (e.g.
people choose to continue to compromise their health either by engaging in health-
compromising behaviours and failing to engage in preventive health behaviours or health-
promoting behaviours, being unaware), family barriers (e.g. children frequently model the
health behaviours they see their parents or siblings perform, health habits), health system
barriers (e.g. doctors are trained to focus on treating the illness itself, not the negative
health habits that might have contributed to the development of the illness,
money/funding, availability of staffs), and community barriers (e.g. the norms of the
community in which people live, work, and play influence people’s willingness to engage in
preventive health behaviours, and avoid negative health habits). However, these barriers
can be overcome.

Self-presentation and health

People often engage in health-related behaviors (positive or negative) to convey positive

impressions to others, impression management
- Condom use
- Suntanning
- Smoking, alcohol and illegal drug-taking
- Exercise
- Risk-taking behavior

Stress
- Stress refers to a challenge to a person’s capacity to adapt to inner and outer
demands
- Stressful experiences typically produce physiological and emotional arousal
- Stressful experiences typically elicit cognitive and behaviors efforts to cope with the
stress
Stress as a psychobiological process

General adaptation syndrome

- Alarm: release of adrenaline and other hormones (fight or flight response, blood
pressure, heart rate, respiration and blood sugarrise as blood is diverted from the
gastrointestinal tract to muscles and other parts of the body that may be called upon
a emergency response)
- Resistance: respiration and heart rate return to normal, glucose levels and some
stress-related hormones remain high, organism remains on red alert with
heightened energy and arousal but adapting to a higher level of stress
- Exhaustion: after prolonged stress the body’s defenses break down, increased
vulnerability to infection/disease

Stress is a psychobiological process, with both physiological and psychological components

and consequences. Selye’s general adaptation syndrome consists of three stages: alarm (e.g.
release of adrenalin and other hormones and activation of the sympathetic nervous system
to allow the person to fight-or-flight), resistance (e.g. the parasympathetic nervous system
returns respiration and heart rates to normal, although the body remains of red alert, with
heightened energy and arousal), and exhaustion (e.g. the body eventually wears down,
resulting in greatly increased vulnerability to serious or even life-threatening disease).

Stress as a transactional process

Stress is a transaction between the individual and environment rather than a property of
either alone
- Primary appraisal: decide if the situation is benign, stressful or irrelevant – and is
stressful what to do about it e.g. lecturer who fails to make tenure
- Secondary appraisal: evaluate options and decide how to respond, emotional
forecasting e.g. deciding that she is better off leaving the university to work for an
internet firm and make a better living
- Emotional forecasting predicting what feelings the situation will produce (primary
appraisal) and predicting the likely emotional impact of each potential response
(secondary appraisal)

Stress is also a transactional process — a transaction between the individual and the
environment, in which the individual perceives the demands of the environment tax or
exceed her psychosocial resources. In a primary appraisal of the situation, the person
decides whether the situation is benign, stressful, or irrelevant. Part of this process involves
emotional forecasting in which a person evaluates what feelings particular situations will
produce. During secondary appraisal, the person evaluates the options and decides how to
respond.

3 types of stress:
- Harm or loss – when a person loses a loved one or something greatly valued such as
a job
- Threat – anticipation of harm or loss
 - Challenge – opportunities for growth that may nonetheless be fraught with
disruption and uncertainty e.g. getting married or entering university

Sources of stress

Stress and the immune system

- Psychoneuroimmunology looks at the influence of psychosocial factors on the

functioning of the immune system
Stress, health and personality

- Personality can influence stress and health through motives, cognitive appraisal of
situations and coping strategies employed
- Type A behavior pattern: a personality style characterized by impatience, ambition,
competitiveness, hostility and a ‘hard driving’ approach to life
- Type B behavior pattern: more relaxed, easy-going and less easily angered
- Optimism/pessimism – university students with a pessimistic explanatory style (a
tendency to explain bad events in negative, self-blaming ways) experienced more
days of illness and visited doctors more frequently than other students as they do
not take care as good care of themselves, do not cope as well and have poorer
immune functionating

Individuals with Type A behaviour pattern (a personality style characterised by impatience,

ambition, competitiveness, hostility, and a ‘hard-driving’ approach to live) react differently
to stress than those who exhibit Type B behaviour pattern (a personality style that is more
relaxed, easy-going, and less easily angered). Research indicates that people with Type A
behaviour pattern are more likely to suffer heart disease than people with Type B behaviour
pattern. Type B might lose the ability to think because if you don’t use it, it disappear.

Coping mechanisms

Coping is the way in which people deal with stressful situations

- Problem-focused: person attempts to change the situation
- Emotion-focused: person attempts to change thoughts or emotional consequences
of the stressor
Social support
- The presence of others in whom one can confide and from whom one can expect
help and concern

A high level of social support is protective against the effects of stress by

- Buffering people against the effects of stress – protective factor against the harmful
effects of stress during high-stress period e.g. provides a buffer in the elderly
between the experiences of stressful events such as the loss of a spouse and the
development of depression
- Making people less susceptible to the effects of stress in the first place, people with
supportive relationships are less likely to make a primary appraisal of situations as
stressful and they are more likely to perceive themselves as able to cope e.g. taking a
new job is much more threatening to a person who has no-one in whom to confide
and no one to tell her

- Loneliness is a major source of stress in humans with a physiological as well as

psychological impact