Samenvatting inleiding in de
gezondheidspsychologie
Thema 1 Inleiding en achtergrond
An overview of psychology and health
Sarafino & Smith
Aaron Antonovsky: We are all terminal cases. And we all are, so long as there is a breath of life in us,
in some measure healthy.
He also proposed that we revise our focus, giving more attention to what enables people to stay well
than to what causes people to become ill.
We will use the term health to mean a positive state of physical, mental, and social well-being - not
simply the absence of injury or disease - that varies over time along a continuum.
Gezondheid wordt door veel mensen gezien als afwezigheid van symptomen van ziekte of schade
aan het lichaam. Gezondheid is echter meer dan dat.
Volgens de Wereldgezondheidsorganisatie is gezondheid ‘een toestand van volledig lichamelijk,
geestelijk en sociaal welbevinden en niet slechts de afwezigheid van ziekte of andere lichamelijk
gebreken’ (WHO, 1948). Deze definitie wordt ook in het tekstboek gehanteerd.
De gegeven definitie is eigenlijk een definitie van optimale gezondheid. Hieruit blijkt al dat
gezondheid een variabele is, een eigenschap die kan variëren. Iemand kan meer of minder gezond
zijn, mensen zijn in bepaalde mate ziek of gezond. Sarafino spreekt dan ook over illness-
wellnesscontinuüm (zie figuur).
Zie figuur 1.1 blz 3
During 17th, 18th and 19th centuries, people died from two types of illness: dietary and infectious.
Most of the diseases did not exist in North America before the European settlers arrived - the settlers
brought the infections with them - and the death toll among Native Americans. Two reasons:
1. The native population had never been exposed to these new microorganisms, and thus
lacked the natural immunity that our bodies develop after lengthy exposure to most diseases
2. Native Americans’ immune functions were probably limited by a low degree of genetic
variation among these people
In 19th century new diseases began to appear. Most significant was tuberculosis or ‘’consumption’’.
The 20th century witnessed great changes in the patterns of illness afflicting people. Death rate from
life-threatening infectious diseases declined, and people’s average life expectancy increased.
Important reason: the death among children was very high many years ago.
In de twintigste eeuw hebben grote veranderingen plaatsgevonden in de belangrijkste ziekten en
doodsoorzaken in de westerse wereld. In het begin van de twintigste eeuw waren vooral
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,infectieziekten zoals tyfus, tuberculose en difterie belangrijke doodsoorzaken, ook in Nederland.
Door sociale veranderingen zoals een betere voeding, betere hygiëne en door betere preventieve en
medische voorzieningen vond een sterke daling plaats van het aantal infecties (zie ook figuur 1a2).
Daardoor trad een enorme stijging op in de levensverwachting.
Zie figuur 1.2 blz 4
The main health problems and causes of death in developed countries today are chronic diseases
that develop or persist over a long period of time.
The leading cause of death in children and adolescents, by far, is not an illness but accidental injury.
Viewpoints from history: physiology, disease processes, and the mind
Early cultures: evil spirits
Ancient Greece and Rome:
- Hippocrates: four fluids called humors. When the mixture of these humors is harmonious, or
balanced, we are in a state of health. Disease occurs when the mixture is faulty
- Plato: mind and body are sperate entities
- Galen: illnesses can be localized, with pathology in specific parts of the body, and that
different diseases have different effects
The middle ages: people’s ideas about the cause of illness took on pronounced religious overtones,
and the belief in demons became strong again. Sickness was seen as God’s punishment for doing evil
things. As a result, Church came to control the practice of medicine, drive out. St. Thomas Aquinas
rejected the view that the mind and body are separate and saw them as interrelated.
The renaissance and after: Rene Descartes introduced three important innovations:
1. He conceived of the body as a machine and described the mechanics of how action and
sensation occurred
2. He proposed that the mind and body, although sperate, could communicate through the
pineal gland, an organ in the brain
3. He believed that animals have no soul and that the soul in humans leaves the body at death
Once scientists learned the basics of how the body functioned and discovered that microorganisms
cause certain diseases, they rejected the humoral theory of illness and proposed new theories.
Biomedical model: proposes that all diseases or physical disorders can be explained by disturbances
in physiological processes, which result from injury, biochemical imbalances, bacterial or viral
infection, and the like.
The biomedical model assumes that disease is an affliction of the body and is separate from the
psychological and social processes of the mind.
Countries worldwide have been facing escalating costs in health care. We need new approaches for
improving people’s health.
People have changed. Many individuals are more aware of signs and symptoms of illness, more
motivated to take care of their health, and better able to afford visits to physicians than they were in
the past.
The person as a unique individual is not included in the biomedical model.
Changes in people’s lifestyles can reduce chronic illnesses.
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,Characteristics or conditions that are associated with the development of a disease or injury are
called risk factors for that health problem. These are biological and behavioural. A risk factor is
associated with a health problem - it does not necessarily cause the problem.
Some behavioural risk factors associated with the five leading causes of death in US:
1. Heart disease - smoking, high dietary cholesterol, obesity, lack of exercise
2. Cancer - smoking, high alcohol use and diet
3. Stroke - smoking, high dietary cholesterol and lack of exercise
4. Copd - smoking
5. Accidents - alcohol/drug use and not using seat belts
Why don’t people do what’s good for them?
1. Less healthful behaviours often bring immediate pleasure
2. They may feel social pressures to engage in unhealthful behaviour
3. Some behaviours can become very strong habits
4. Sometimes people are simply not aware of the dangers involved or how to change their
behaviour
The term personality refers to a person’s cognitive, affective, or behavioural tendencies that are fairly
stable across time and situations. Researchers have found evidence linking personality traits and
health. For example, people whose personalities include:
- Low levels of conscientiousness measured in childhood or adulthood are more likely to die at
earlier ages
- High levels of positive emotions, tend to live longer
- High levels of anxiety, depression, hostility, or pessimism are at risk for dying early and
developing a variety of illnesses, particularly heart diseases
People with positive emotions and optimism are not only less likely to become ill than are people
with less positive personalities, but when they do, they tend to recover more quickly.
The link between personality and illness is not a one-way street: illness can affect one’s emotional
adjustment and outlook, too.
Sigmund Freud noticed that some patients showed physical symptoms with no detectable organic
disorder. Using his psychoanalytic theory, Freud proposed that these symptoms were ‘’converted’’
from unconscious emotional conflicts. He called this condition conversion hysteria; one form it can
take is called glove anesthesia because only the hand had no feeling.
The need to understand conditions such as conversion hysteria led to the development of
psychosomatic medicine, the first field dedicated to studying the interplay between emotional life
and bodily processes.
The field called psychosomatic medicine was formed in the 1930s.
The term psychosomatic does not mean a person’s symptoms are ‘’imaginary’’; it means that the
mind and body are both involved.
Two new fields emerged in the 1970s to study the role of psychology in illness: one is called
behavioural medicine and the other is called health psychology.
Behavioural medicine: had two defining characteristics. 1. Its membership is interdisciplinary, coming
from a wide variety of fields. 2. It grew out of the perspective in psychology called behaviourism,
which proposed that people’s behaviour results from two types of learning:
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, - Classical (or respondent) conditioning; in which a stimulus gains the ability to elicit a
response through association with a stimulus that already elicits that response
- Operant conditioning; in which behaviour is changed because of its consequences;
reinforcement (reward) strengthens the behaviour, punishment suppresses it.
Biofeedback: a person’s physiological processes, such as blood pressure, are monitored by the
person so that he or she can gain voluntary control over them. This process involves operant
conditioning; the feedback serves as reinforcement.
a. Wat is nu een goede definitie van gezondheidspsychologie?
b. Welke doelstellingen heeft de gezondheidspsychologie?
Ad a.
Er zijn verschillende definities van gezondheidspsychologie die gelukkig allemaal veel op elkaar lijken.
In Sarafino & Smith wordt een definitie gegeven die eerder door Matarazzo werd geformuleerd
(1982). Deze definitie richt zich vooral op de doelstellingen van gezondheidspsychologie:
‘het bevorderen en het handhaven van de gezondheid en de preventie, de behandeling en de
verwerking van ziekte, de identificatie van etiologische en diagnostische factoren bij gezondheid en
ziekte, en de analyse en verbetering van gezondheidszorg en gezondheidsbeleid’.
Ter aanvulling
In een ander bekend handboek over gezondheidspsychologie geeft Taylor (2003)* de volgende
definitie van gezondheidspsychologie:
‘Gezondheidspsychologie is het onderdeel van de psychologie dat is gericht op het verkrijgen van
inzicht in de psychologische factoren die een rol spelen bij hoe en waarom mensen gezond blijven of
ziek worden, en hoe zij omgaan met die ziekte. Gezondheidspsychologie speelt een rol in
gezondheidsbevordering en bewaking, preventie en behandeling van ziekte, de rol van
psychologische factoren in etiologie van ziekte en gezondheid, de verbetering van de
gezondheidszorg en het ontwikkelen van een gezondheidsbeleid.’
Ad b.
Uit de verschillende definities kunnen de volgende doelstellingen van de gezondheidspsychologie
worden afgeleid. Op educatief, wetenschappelijk en professioneel gebied een bijdrage leveren aan:
1. gezondheidsbevordering en handhaving van de gezondheid
2. preventie van ziekte, behandeling van ziekte en ‘goed’ omgaan met ziekte
3. identificatie van oorzaken van ziekte en gezondheid en van diagnostische factoren
4. het analyseren en verbeteren van gezondheidszorg en het gezondheidsbeleid.
Health psychology, goals:
- Promote and maintain health
- Prevent and treat illness
- Identify the causes and diagnostic correlates of health, illness, and related dysfunction
- Analyze and improve health care systems and health policy
Psychosomatic medicine, behavioural medicine and health psychology. Are separate mainly in an
organizational sense. The main distinctions among the fields are the degree of focus they give to
specific topics and viewpoints, and the specific disciplines and professions involved. All three fields
share the view that health and illness result from the interplay of biological, psychological, and social
forces.
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