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Health & Medical Psychology: ALLE Hoorcollege aantekeningen (HC1 t/m HC8)
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Hoorcollege aantekeningen Health and Medical Psychology 2023
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An Introduction to Health Psychology (Morrison V. & Bennet P.)
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!1Health & Medical
Week 1
Lecture
- What is health psychology?
• Alcohol in children/adolescents — primary prevention.
• Help general practitioners in consultations.
• Smoking. Help people effectively change their behaviour.
• Stress at work —> migraines.
• At risk of different diseases such as breast cancer — provide knowledge and information to people
to make decisions by discussing implications… — secondary prevention.
• Diabetes — tertiary prevention.
• Help adapt from wounds or accidents (burning…).
- Talking about things that can happen in your lifetime that affect your health.
- Body & mind, self-management & coping, positive psychology & empowerment, prevention & health
promotion, stress & disease
- Individual strengths; mind-body interaction; prevention & adaptation during all phases from health to
illness (severe ill, ‘healthy’, fatal diseases).
- Primary health care, private practice, specialised departments — primary prevention & training —
research — policy (local or federal government).
Prevention — little diagram
- Primary prevention (healthy people)
• Prevention of the problem, illness or casualty.
- Secondary prevention (screening early treatment — reversible —> healthy people with an increased
risk)
• Tracing illness in an early phase, for early treatment, or for prevention of more serious complaints.
- Tertiary prevention (revalidation — illness is already present)
• Prevention of complications & worsening of symptoms through optimal care (self-regulation
interventions).
Health as: not ill, reserve/resource, behaviour, physical fitness & vitality, psychological well-being,
function.
- Always ask and check, not everyone has the same definition of health.
WHO definition of health (1948): health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.
- Changed as it now included mental and social well-being — encompasses psychological and social
relationships.
Biomedical Model
- Exposure to contagious agents + insufficient immune response = illness.
• Influenced by behaviour, stress, emotions, social relations.
Biopsychosocial approach encompasses all these factors that determine health.
- Body & mind int interaction determine health & illness.
- Different systems influence each other continuously.
- Alameda 7 study in early 60s (epidemiological study):
• Sleep 7-8h
• No eating between meals
• Eat breakfast regularly
• Maintain proper weight
• Regular exercise
• Moderate or no use of alcohol
• No smoking
Types
- Behavioural pathogens: health compromising behaviours such as smoking or drug abuse…
- Behavioural immunogens: health enhancing behaviours such as exercises, health nutrition…
Why should we change behaviour?
, !2
- Help those that want to change but don’t know how or need guidance.
- Make people aware of the consequences of their behaviours.
- Impact on environment.
- Behaviour is already influenced anyways — ‘being health is not the norm so if you want to be healthy
you have to act extra’.
- Health behaviours are related to mortality and morbidity and quality of life
• When different agents or behaviours started to be adopted, incidence and prevalence of disease
started to decrease.
• 1900s: heart disease, flue & lung infections, tuberculoses, gastritis, accidents.
• 2000s: heart disease, cancer, cerebrovascular diseases, chronic obstructive pulmonary disease,
accidents.
- Socio-demographical differences in health behaviour increase social economic differences.
• Those in the lower SES have a higher prevalence of unhealthy behaviour which increases their
likelihood of suffering from diseases and higher mortality/morbidity.
- Prevalence of risk behaviours is high
• For example 28% of people in the NL smoke.
- Health behaviour is not always an informed choice
• Foods from big companies in supermarkets are made to be addictive addictive.
- Adverse effects may occur: increase of SES diff (as people with higher education get more of the
prevention), hardening (when people don’t want to change the behaviour), stigmatising.
What determines behaviour?
- First have an overview of the factors influencing your behaviour to then make a choice on what to
tackle.
- Motivation
- Social cognition models: advantages & disadvantages of behaviour change
• Health Belief Model
- Perceived vulnerability (susceptibility) — chance of getting the condition.
- Perceived severity.
- Fear + response efficacy determines the likelihood of occurrence of behaviour.
• Theory of reasoned action — more general
- About general outcomes in terms of positive outcomes.
- What do you think others expect you — normative norms.
• Descriptive
• Injuctive
• Group norms and social pressure
• Social support (positive and negative)
- Perceived behavioural control: own believes about whether you are able to do it or not (=self-
efficacy).
- Capability
- Social learning or cognitive theory
• Outcome + self-efficacy expectancies —> extent to which you believe you can do a behaviour and
that you will get an outcome.
Change happens when people believe that: they are susceptible, developing the disease will have
severe consequences, adopting the health (preventive) behaviour will make them less susceptible or will
reduce the severity, benefits will outweigh the anticipated costs, feel capable of doing so + attitude/
outcome expectancies are positive, social norms are favourable and supportive, the self-efficacy or
perceived behavioural control expectancies are high.
Chap 1. What is health?
- Root — wholeness.
- Early understandings can be seen in archaeological finds of human skulls from Stone Age who show
holes from trephination, done to release evil spirits.
- Ancient Hebrew texts reflect that illness is a punishment from God.
- Many variations can be found nowadays, and these are important to understand how diff individuals
respond to illness.
Mind-body relationships
- Ancient Greece — Hippocrates: balance of four circulation bodily fluids, or humours
, !3
• Balance = healthy; unbalance = ill.
• The humours are attached to seasonal variations, so to conditions like hot, cold, wet, dry.
• Phlegm is attached to winter (cold-wet) — excessive = calm.
• Blood to spring (wet-hot) — excessive = optimistic or sanguine.
• Black bile to autumn (cold-dry) — excessive = sadness.
• Yellow bile to summer (hot-dry) — excessive = choleric.
• He also considered mind and body as one unit, with the diff levels of humours defining the person.
- This humeral their of illness attributed disease states to bodily functions, but also acknowledge that
bodily factors impact the mind.
- Galen: physical or pathological basis for all ill health. The temperaments underpinned by the
humours contribute to the experience of specific illnesses.
• Mind and body were interrelated as they but have an underlying physical cause. The mind had no
role in illness aethiology (the cause).
- In Early Middle Ages, faith and spirituality became more important, with mind and body working
either together or in parallel, and illness was relieved with self-punishment, prayer…
- 14th-15th centuries —> ‘rebirth’: individual thinking predominated followed by the scientific
revolution in the early 1600s.
- Descartes came up with dualism saying that body and mind were separate entities connected in the
pineal gland in the midbrain — because of this thought that the soul left the body after death,
dissection and autopsy became acceptable, helping in the anatomical research of illness.
• The mechanistic viewpoint of body as a machine became prevalent.
• Treatment became more technical, diagnostic and focused on physical evidence obtainable with
individuals more passively involved —> biomedical model of illness.
Biomedical model of illness
- Health = absence of disease or any symptom thought to underly a pathology that can be cure through
medical intervention.
- Deals only with objective facts and assumes a causal relationship between illness/disability, its
symptoms/underlying pathology and adjustment outcomes.
- Assumes that removal of pathology through medical intervention restores health.
- Reductionist as mind and body are thought to be reduced and explained by only cells, neural activity
and biochemical activity — ignore evidence that diff ppl respond in diff ways to the same disease.
- Includes immunisation programs.
Challenging dualism: psychosocial models
- Matter can be perceived either objectively or subjectively, so the role of the mind in the manifestation
and response to illness is crucial for a broader understanding.
- Freud — consciousness (unconscious mind was at the basis of conversion hysteria).
• Unconscious conflicts have been repressed and can cause physical disturbances like paralysis.
• Unconscious conflict, personality and illness —> psychosomatic medicine.
Biopsychosocial model of illness
- Broad biomedical model of health to encompass and emphasise on the interaction between body and
mind, biological processes and psychological and social influences.
- Increases the recognition of the role of the individual’s behaviour.
Behaviour, death and disease
- Increased life expectancy (WHO — 71yo) lead to an increased trust in efficacy of traditional
medicine and its power to eradicate disease.
- Higher life expectancy in Japan, Australia, with country variations in the additional years of life
expected for those reaching age of 60 between 2010-2015.
- Diff in lifestyle and diet account for the variations in health behaviour, although the rise in child
obesity could reduce life expectancy.
- In the past death was the result of infectious disease, although now it has turned to heart, lung and
respiratory diseases, followed by dementias, which also indicates that leading causes of death have a
behavioural component.
- By 2020: heart disease, cerebrovascular disease, chronic lung disease, lower respiratory infections,
throat and lung cancers.
- Healthy life expectancy and subjective well-being are key.
, !4
Individual, cultural and lifespan perspectives
Lay theories of health
- Bauman — healthy means: general sense of well-being, absence of symptoms of disease, things that a
physically fit person can do: feeling, symptom orientation, performance (being & doing).
- Current health status influences subjective views of health and reports of what it is.
- Subjective health judgements are more tied to health behaviour in healthier individuals.
- Bennett distinguishes health as ‘being’, ‘having’ and ‘doing.
- Radley — health as not ill, as reserve, as behaviour, as physical fitness and vitality, as psychosocial
well-being (mental state), and as a function or the ability to perform one’s duties.
- Subjective well-being ratings correlated strongly with objective health indicators, but are reached
through comparison to others.
WHO definition
- 1974 — ‘state of complete physical, mental and social well-being’.
• Informed and helped shape global health targets like the Global Strategy for Health for All by the
Year 2000, which aim at securing health security for all, global health equity, increase life
expectancy and access to health care.
- Health policy acknowledges the relationship between behaviour, lifestyle and health, but fails to
include the socioeconomic and cultural influences.
- Bircher: ‘health is a dynamic state of well-being characterised by a physical and mental potential,
which satisfies the demands of life commensurate with age, culture and personal responsibility’.
Cross-cultural perspectives on health.
- Beliefs can influence the disclosure of symptoms and health-seeking behaviours…
- Westerns divide the body in part, other holistic cultures see the body as a whole.
- Spiritual well-being can be seen as an aspect of health in many cultures.
- Diff between collectivistic and individualistic cultures.
- In the West, value in alternative remedies for health maintenance or treatment seen in the growth of
these remedies as complementary.
- How people think about health and illness shapes expectations, behaviour and use of health
promotion.
Lifespan, ageing and beliefs about health and illness
- Decreased functioning and increased disability or dependence.
- Developmental theories
• Learning: change in knowledge through experience.
• Experience: what we do, see, hear…
• Maturation: genetically determined sequence of development and ageing.
• Erik Erikson — cognitive and intellectual functioning, language and communication skills,
understanding of illness, health care and maintenance behaviour.
- Deficits can impair the capacity to understand medical instructions…
• Piaget: maturational framework
- Sensorimotor stage — preoperational (awareness of how they can affect the external world) —
concrete operational (logical thinking)— formal operational.
• Illness concept develops gradually in first stages with questions about knowledge, experience,
attributions and recovery.
- Under-7s link illness on a magical level to — incomprehension, phenomenonism and
contagion.
- 8-11yo see illness as — contamination and internalisation.
- 12 up see illness as — physiological, psychophysiological. With an increase in control over
onset and course of illness. For them, health is about being functional, about being
mentally okay, and about lifestyle.
- Adulthood — increase in engagement in protective behaviours.
- Ageing — the incidence of many diseases increases with longevity (seen in epidemiology).
Self-concept is stable in this age frame.
• Successful ageing through Bowling and Iligge through:
- Biomedical model: physical and psychiatric functioning.
- Broader biomedical model: social engagement and activity.
- Social functioning model: nature and frequency of social functioning and networks.
- Psychological resources model: optimism and self-efficacy, sense of purpose, coping…
, !5
- Lay model: all + socioeconomic variables of income and perched social capita — strongest
predictor.
What is health psychology?
- Scientific study of mental and behavioural functioning.
- Empiricism is the base.
- Increase understanding about a particular phenomenon and provide knowledge useful to the
development of interventions.
- Integrated many cognitive, developmental and social theories and explanations and applies them to
health, illness and health care.
- Matarazzo — ‘aggregate of specific educational, scientific and professional contributions of
discipline of psychology to the promotion and maintenance of health, promotions and treatment of
illness and dysfunction’.
- Promotion/maintenance of health, improving health-care systems and health policy, prevention/
treatment of illness, causes of illness.
- Psychosomatic medicine: 1930, mind and body are both involved. Personality sometimes seen as the
trigger. Illness with no physical evidence = psychogenic.
- Behavioural medicine: interdisciplinary. Behavioural principles like conditioning. Matarazzo
distinguishes between ‘behavioural health’ —concerned with health enhancement and disease
prevention— and ‘behavioural medicine’.
- Medical medicine: holistic model, like a medical psychologist which is a professional working in a
medical setting who has a psychology degree and master in health psychology.
- Medical sociology: relationship between psychology and sociology with health and illness being
considered.
- Clinical psychology: concerned with mental health and diagnosis and treatment of these.
- Health psychology: biopsychosocial approach. Health psychologists working in the clinical setting or
clinical psychologist working with physical health populations (clinical health psychology). Public
health. Critical health psychology. Academic health psychology.
Chapter 3. Health-risk behaviour
- Kasl & Cobb: ‘any activity undertaken by a person believing themselves to be healthy for the
purposes of preventing disease or detecting it at an asymptomatic stage’.
• Health people engage in a particular behaviour to prevent chances of disease onset.
• Assumes that only motivation of health-related behaviours is to maintain health.
• Excludes the possibility that ppl may engage in healthy behaviours following onset of disease and
that people who consider themselves not healthy may engage in healthy behaviours.
- Harris & Guten: ‘behaviour performed by an individual, regardless of his/her perceived health status,
with the purpose of protecting, promoting or maintaining his/her health’.
- Matarazzo distinguishes between behavioural pathogen (health-risk behaviour) and behavioural
immunogen (health-protective behaviour).
- WHO: ‘health risk as a factor that raises the probability of adverse health outcomes’.
- There can be perceived benefits of some behaviours generally considered risky, such as sun or UVR
exposure.
• Beneficial effects of vitamin D levels can reduce the risk of osteoporosis, autoimmune disease,
cardiovascular disease…
- Alameda 7 states key behavioural factors: sleeping 7-8h, not smoking, consuming no more than 1-2
alcoholic drinks per day, getting regular exercise, not eating between meals, eating breakfast, being
no more than 10% overweight.
• Contributed to awareness of the associations between personal lifestyle behaviour and disease,
stating that the benefits of these activities were multiplicative and cumulative.
- Epidemiologists state that behaviour is predictive of mortality.
- It is important to understand psychological and social factors that contribute to the uptake and
maintenance of risk behaviour or the avoidance of health-enhancing or preventive behaviour.
Health-risk behaviour
- WHO identified 8 factors that account for 61% of cardiovascular deaths, 3/4 of ischaemic heart
disease (which account for 36% of deaths in Europe).
• Alcohol use, tobacco use, high blood pressure, high BMI, high cholesterol, high blood glucose, low
fruit and vegetable intake and physical inactivity.
• Heart disease: tobacco, high-cholesterol diet, lack of exercise.
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