UNIT I
INTRODUCTION
Ms. Vishnu Priya, S. K.
Assistant Professor
Department of Psychology
Avinashilingam Institute for Home Science &
Higher Education for Women
Coimbatore
INTRODUCTION
Health is a complete state of physical, mental, and social well-being and not
merely the absence of disease or infirmity.
Health psychology is the study of psychological and behavioural processes in
health, illness, and healthcare. The discipline is concerned with
understanding how psychological, behavioural, and cultural factors contribute
to physical health and illness.
Health psychology is 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.
NEED & FUNCTIONS OF HEALTH PSYCHOLOGISTS
Health psychologists focus on health promotion and maintenance (develop
good health habits, promote regular exercise & design a media campaign to
get people to improve diets).
Health psychologists also study the psychological aspects of the prevention
and treatment of illness (manage stress effectively – so that it will not
adversely affect their health).
Health psychologists also focus on the etiology and correlates of health,
illness and dysfunction (origins or causes of illness). Especially interested in
the behavioural & social factors – health and illness (health habits – alcohol
consumption, smoking, exercise, wearing seat belts & ways to cope).
Health psychologists analyse and attempt to improve the health care system
and the formulation of health policy (people’s behaviour and develop
recommendation).
Health psychology – psychological & social factors – enhancement of health,
prevention & treatment of illness and evaluation & modification of health
policies – health care.
MIND-BODY RELATIONSHIP
Historically philosophers have vacillated – mind & body are part of the same
system – idea that they are two separate systems.
Human prehistory – mind & body as intertwined. Disease – arise when evil spirits
entered the body, treatment – primarily of attempts to exorcise these spirits.
Ancient greeks – identify the role of bodily factors in health & illness. Humoral
theory of illness: blood (passionate temperament), black bile (sadness), yellow bile
(angry disposition) and phlegm (laid back approach to life) – were out of balance.
Middle ages – disease: god’s punishment for evil doing & cure often consisted of
driving out the evil forces by torturing the body. Later, therapy – penance through
prayers & good works.
Beginning in the Renaissance & continuing into the present day – understanding
technical bases of medicine (invention of microscope & development of science of
autopsy – medical practitioners to see organs that implicated in different
diseases).
As a result of scientific advances – laboratory findings & looked to bodily factors
rather than mind as bases of health & illness (diagnoses & recommendations).
BIOPSYCHOSOCIAL MODEL
Idea that mind & body together determine health & illness logically implies a
model for studying these issues called – Biopsychosocial model.
Fundamental assumption is that health & illness are consequences of
interplay – biological, psychological & social factors. The BPS model figures
prominently in research & clinical issues.
BIOPSYCHOSOCIAL VERSUS BIOMEDICAL MODEL
Biomedical model – maintains that all illness can be explained on the basis of
aberrant somatic bodily processes – biochemical imbalances/
neurophysiological abnormalities.
Biomedical model – psychological & social processes are largely irrelevant to
the disease process.
Biomedical model – undeniable benefits for studying some diseases – several
potential liabilities.
1st – Reductionist model: reduces illness to low level processes - disorders cells &
chemical imbalances – rather than recognizing the role of social & psychological
processes.
2nd – Biomedical model is essentially single factor model: explains illness in terms
of a biological malfunction rather than recognizing variety of factors – only some
of which are biological may be responsible for the development of illness.
3rd – biomedical model implicitly assumes a mind-body dualism – maintaining
mind and body are separate entities.
Finally, Biomedical model emphasizes illness over health (aberrations that lead to
illness rather than on the conditions that might promote health). There are
psychological & social factors that influence the development of illness – ignored by
biomedical model.
ADVANTAGES OF BIOPSYCHOSOCIAL MODEL
Biological, psychological & social factors – determinants of health & illness. Macro-
level processes (existence of social support/ presence of depression) & Micro-level
processes (cellular disorders/ chemical imbalances) interact to produce a state of
health/ illness.
Health & illness are caused by multiple factors & produce multiple effects. Further
maintains that mind & body – cannot be distinguished in matters of health & illness –
both so clearly influence an individual’s state of health.
Emphasizes both health & illness rather than regarding illness as a deviation from
some steady state – one achieves through attention to biological, psychological &
social needs rather than something that is taken for granted.
Systems theory – maintains that all levels of organization in any entity are linked to
each other hierarchically & that change in any one level effect change in all the other
levels. (micro-level processes are nested within macro-level processes – vive versa).
CLINICAL IMPLICATIONS OF THE BIOPSYCHOSOCIAL MODEL
1st the model maintains that the process of diagnosis should always consider the
interacting role of biological, psychological & social factors in assessing an
individual’s health or illness. Interdisciplinary team approach – best way to make
a diagnosis.
2nd biopsychosocial model maintains that recommendations for treatment must
also involve all three sets of factor. Possible to target therapy uniquely –
consider a person’s health status in total & to deal with one or more problem
simultaneously.
3rd biopsychosocial model makes explicit the significance of the relationship
between patient & practitioner. P-P relationship can improve -patients use of
services, efficacy of treatment & rapidity with illness is resolved.
BPS Model clearly implies that practitioner must understand social & psychological
factors – contribute to an illness – to treat appropriately. Healthy individuals, BPSM –
understand health habits – psychological & social contexts. Ill individual, BPS factors
all contribute to recovery.
HEALTH PROMOTION
Health promotion is a philosophy that has at its core the idea that good health or
wellness, is a personal and collective achievement.
Individual – involves developing a program of good health habits.
Medical practitioner – involves teaching people how to achieve a healthy lifestyle
and helping people at risk.
Health psychologist – involves the development of interventions to help people
practice healthy behaviours.
Community & national policy makers – involves emphasizing good health &
providing information & resources to help people change poor health habits.
Mass media – contribute to health promotion by educating people about health
risks posed by certain behaviours (smoking/alcohol consumption).
Legislation – mandating certain activities that may reduce risks (use of child-
restraining seats & seat belts).
HEALTH BEHAVIOURS
Behaviours undertaken by people to enhance or maintain their health.
Poor health behaviours are important not only because they are implicated to
illness but also because they may easily become poor health habits.
Health habit – health related behaviour – firmly established & often
performed automatically, without awareness.
Usually develop – childhood & begin to stabilize around age 11 or 12 (wearing
seat belt, brushing one’s teeth, healthy diet).
Although – reinforced by specific positive outcomes – parental approval -
eventually becomes independent of the reinforcement & maintained by the
environmental factors.
Belloc & Breslow (1972) – good health habits: Sleeping 7 – 8 hours; Not
smoking; Eating breakfast each day; Having no more than one or two alcoholic
drinks/day; Getting regular exercise; Not eating between meals; Being no
more than 10% overweight.
BARRIERS TO MODIFY POOR HEALTH
BEHAVIOURS
Determinants of health habits is important – bad habits are ingrained, difficult
to change.
Researchers – how & when poor habits develop and exactly when & how to
intervene to change (Center for the Advancement of Health,2002).
Example: Young children usually get exercise, but they get older, a sedentary
lifestyle may set in.
The process is gradual & decline of exercise – changes in environment – no
longer having to take a compulsory physical education class than motivation to
get exercise.
People often have little immediate incentive for practicing good health
behaviours. Develop during childhood & adolescence (most people are healthy).
Smoking, drinking, poor health & lack of exercise – no apparent effect on
health & physical functioning. Cumulative damage these behaviours – may
not become apparent for years, few children & adolescence concerned about
their health will be like when they are 40 or 50 years old.
Once bad habits are ingrained, people may not motivated to change them.
Unhealthy behaviours – pleasurable, automatic, addictive & resistant to
change. Many people finds hard to change – bad habits are enjoyable.
Health habits are only modesty related to other. Person who exercise
faithfully – not necessarily wear seat belt; person who control weight – may
continue to smoke. Therefore, difficult to teach people a concerted program
of health behaviours.
Instability of health behaviours – another difficulty in modifying health habits – stable
over time. A person may stop smoking for year but take it up during high stress. A
dieter may lose weight only to regain later in years.
WHY HEALTH HABITS ARE INDEPENDENT TO EACH OTHER & UNSTABLE?
1st – Different health habits are controlled by different factors – smoking (stress) &
exercise (access of athletic facilities/gyms).
2nd – Different factors may control the same behaviour for different people – over
eating (social) & may eat primarily in the presence of others; overeating (level of
tension) & over eat when under stress.
3rd – Factors controlling health behaviour may change over the history of the
behaviour – peer pressure (initiate smoking), smoking may be maintained (reduces
cravings & feelings of stress).
4th – Factors controlling a health behaviour may change across a person’s lifetime –
childhood (regular exercise) built in school curriculum, adulthood (automatic habit)
practiced consciously.
5th – Health behaviour patterns, their developmental course & the factors that change
them across a lifetime – started smoking (social reasons) but continue smoking to
control stress; reverse pattern may characterize the smoking of another.
INTERVENING WITH CHILDREN &
ADOLESCENTS
Socialization: Health habits are strongly affected by early socialization – influence
of parents as role models
Parents instill certain habits in their children that become automatic – wearing seat
belt; brushing; eating breakfast regularly.
Nonetheless, in many families – even basic health habits may not be taught; even in
families that conscientiously attempt to teach good habits, there may be gaps.
Families – parents are separated/ familial distress, health habit guidance may slip
through the cracks.
Children move to adolescence – backslide or ignore the early training they receive
from their parents – little apparent effect on their health or physical functioning.
Adolescents are vulnerable to problematic health behaviours – excessive alcohol
consumption; smoking, drug use & sexual risk taking – parents aren’t monitoring
closely & peer practice these behaviours.
Using teachable moment: Health promotion – educational opportunities to prevent poor
health habits from developing. Teachable moment – fact that certain times are better
than others or teaching particular health practices.
Early childhood – Parents, opportunities to teach their children basic safety behaviours –
putting seat belt/ looking both ways before crossing & basic health habits – deinking milk
instead of soda with dinner.
Other teachable moments: arise because they build into health care delivery systems –
Pediatricians, early visits to motivate new parents, basic of accident prevention & safety
in the home. Dentists, importance of correct brushing.
Using the teachable moment - Teachable moments are not confined to childhood and
adolescence. Pregnancy is a teachable moment for stopping smoking and improving diet.
The time period immediately after giving birth is also a teachable moment for increasing
physical activity and regular exercises. New mothers may have many new responsibilities
leaving little time for behavior. Adults with newly diagnosed coronary artery disease are
especially motivated to change contributing health habits such as smoking and poor diet.
ADOLESCENT HEALTH BEHAVIOUR & ADULT HEALTH
Focusing on at- risk people helps to identify other factors that may increase
risk.
There are difficulties in working with people at risk.
People do not always perceive their risk correctly.
Most people are unrealistically optimistic and view their poor health
behaviors as widely shared but their healthy behaviors as more distinctive.
Sometimes testing positive for a risk factor leads people into needless worry
or hyper vigilant behavior.
People can become defensive, minimize the significance of their risk factor
and avoid using appropriate services or monitoring their condition.
HEALTH PROMOTION & OLDER ADULTS
Health promotion efforts with older adults focus on several behaviors:
maintaining a healthy, balanced diet, maintaining a regular exercise regimen,
taking steps to reduce accidents, controlling alcohol consumption, eliminating
smoking, reducing the inappropriate use of prescription drugs and remaining
socially engaged.
Exercise – important health behaviour – keeps mobile & able to care
Controlling alcohol consumption – important target for good health,
retirement or loneliness
Proper medication –middle aged & elderly people, poor can cut down to save
mony.
Flu vaccination – major cause of death – risk of heart & stroke
Depression and loneliness – by age of 70+
TRANSTHEORETICAL MODEL OF
BEHAVIOUR CHANGE
PRECONTEMPLATION
People in the precontemplation stage do not intend to take action in the foreseeable
future, usually defined as the next six months.
Being uninformed or under informed about the consequences of one’s behavior may
cause a person to be in the precontemplation stage.
Multiple unsuccessful attempts at change can lead to demoralization about the ability
to change.
Precontemplators are often characterized in other theories as resistant, unmotivated,
or nonadherent.
The fact is, traditional programs were not ready for such individuals and were not
designed to meet their needs.
CONTEMPLATION
Contemplation is the stage in which people intend to change in the next six
months.
They are more aware of the pros of changing, but are also acutely aware of
the cons.
The relative equal weighting between the costs and benefits of changing can
produce profound ambivalence that can cause people to remain in this stage
for long periods of time.
This phenomenon is often characterized as chronic contemplation.
Individuals in the Contemplation stage are not ready for traditional action-
oriented programs that expect participants to act immediately.
PREPARATION
Preparation is the stage in which people intend to take action in the
immediate future, usually measured as the next month.
Typically, they have already taken some steps toward action in the past year
(e.g., quitting smoking for 24 hours).
These individuals have a plan of action, such as joining a gym, consulting a
counsellor, talking to their physician, or relying on a self-change approach.
These are the people who should be recruited for action-oriented programs.
ACTION
Action is the stage in which people have made specific observable changes in
their lifestyles within the past six months.
Because action is observable, the overall process of behavior change often
has been equated with action.
But in the TTM, Action is only one of five stages. Typically, not all
modifications of behavior count as Action. In most applications, people have
to attain a criterion that scientists and professionals agree is sufficient to
reduce risk of disease. For example, while reducing the number of cigarettes
can be an important step in the cessation process, total abstinence from
smoking is the criteria for being in Action.
MAINTENANCE
Maintenance is the stage in which people have made and sustained a specific
behavior change for quite some time, typically defined as at least 6 months.
While they are still working to prevent relapse, they do not apply change
processes as frequently as do people in action.
Individuals in the maintenance stage are less tempted to relapse and are
increasingly more confident that they can continue their changes.
THANK
YOU
