PB0522-242511 – Inleiding in de Gezondheidspsychologie
Book Health Psychologie
Chapter 1 An Overview of Psychology and Health
What is Health?
We commonly think about health in terms of an absence of
1. Objective signs that the body is not functioning properly, such as measured high blood pressure
2. Subjective symptoms of disease or injury, such as pain or nausea.
Health= 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. For example, the illness/wellness continuum, with death at one end
and optimal wellness at the other. Infectious diseases= are acute illnesses caused by harmful matter or
microorganisms, such as bacteria or viruses, in the body.
Illness patterns have changed over the years. F.E., most, if not all, of the infectious diseases (Malaria, smallpox,
influenza etc.) did not exist in North America before the European settlers arrived – they brought the infections
with them – and the death toll among Native Americans skyrocketed. This high deathrate occurred for 2 reasons:
1. The native population had never been exposed to these new microorganisms, and thus lacked the
natural immunity that our bodies develop after lenghty exposure to most diseases.
2. Native Americans immune functions were probably limited by a low degree of genetic variation among
these people.
But by the end of the 19th century, deaths from infectious diseases had decreased sharply. It appears that the
decline resulted chiefly from preventive measures such as improved personal hygiene, greater resistance to
diseases (owing to better nutrition), and public health innovations, such as building water purification and sewage
treatment facilities. Fewer deaths occurred from diseases because fewer people contracted them.
Death is still inevitable, of course, but people die at later ages now and from different causes.
Chronic diseases= degenerative illnesses, such as heart disease, cancer and stroke- that develop or persist
over a long period of time and is the main health problems and causes of death (more than 50%) in developed
countries. A major reason for the current prominence of chronic diseases is that more people are living to the age
when they are at high risk for contracting them. In addition, the growth of industrialization increased people's
stress and exposure to harmful chemicals.
The main causes of death in childhood and adolescence are different from those in adulthood.
Viewpoints from history: physiology, disease processes, and the mind
Is illness a purely physical condition? Does a person's mind play a role in becoming ill and getting well? People
have wondered about these questions for thousands of years, and the answers they have arrived at have
changed over time. For example, in early cultures where they appear to believe that illnesses were caused by
mystical forces, such as evil spirits (think about the procedure trephination) or in ancient Greece and Rome
where Hippocrates lived by his theory that the body contains four fluids called humors that has to be in the right,
balanced mixture to be in a state of health.
Today the body and mind are separate concepts (as Plato proposed before):
The body refers to our physical being, including our skin, muscles, bones, heart and brain.
The mind refers to an abstract process that includes our thoughts, perceptions, and feelings.
Although we can separate the mind and body conceptually, an important issue is whether they function
independently. Mind/body problem= the question of their relationship.
Galen (a famous physician) made important discoveries and became aware that illnesses can be localized, with
pathology in specific parts of the body, and that different diseases have different effects.
Rene Descartes also regarded the mind and body as separate entities, but he introduced three innovations:
1. He conceived the body as a machine & described the mechanics of how action and sensation occurred.
2. He proposed that the mind and body, although separate, 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. This
meant that dissection could be an acceptable method of study.
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 other
similar things. It assumes that disease is an affliction of the body and is separate from the psychological and
social processes of the mind. This model still represents the dominant view in medicine today.
William Osler says that stress and related aspects of everyday life also play a role on the heart.
Seeing a need: psychology's role in health
1
,Because medical costs continue to rise rapidly, we need to consider new approaches for improving people's
health. 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. These factors are clearly
important and relate to psychological and social aspects of the person. But the person as a unique individual is
not included in the biomedical model. Let's look at two factors:
1. Lifestyle and Illness:
Changes in people's lifestyles can reduce chronic illnesses. Risk factors= characteristics or conditions for that
health problem that are associated with the development of a disease or injury. Some risk factors are biological
(F.E. genetic), others are behavioral. For example, people who smoke and people who don't smoke.
Note: a risk factor is associated with a health problem – it does not necessarily cause the problem. Some
behavioral risk factors associated with the 5 leading causes of death in the US are:
1. Heart disease – smoking, high dietary cholesterol, obesity and 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 (incl. Motor vehicle) – alcohol/ drug use and not using seat belts.
2. Personality and Illness:
Personality= the term refers to a person's cognitive, affective, or behavioral 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, such as from cardiovascular diseases, than individuals high in conscientiousness.
High levels of positive emotions tend to live longer than individuals with low level of these emotions.
High level of anxiety, depression, hostility, or pessimism are at risk for dying early and developing a
variety of illnesses, particularly heart disease.
The link between personality and illness is not a one-way street: illness can affect one's emotional adjustment
and outlook, too. People who are ill and overcome their negative thoughts and feelings can speed their recovery.
Using his psychoanalytic theory, Freud proposed that certain symptoms were “converted” from unconscious
emotional conflicts. The need to understand such kind of conditions led to the development of psychosomatic
medicine= the first field dedicated to studying the interplay between emotional life and bodily processes. It was
formed in the 1930s. It is currently a broader field concerned with interrelationships among psychological and
social factors, biological and physiological functions, and the development and course of illness.
Two new fields emerged in the 1970s to study the role of psychology in illness:
1. Behavioral medicine
This field has two defining characteristics:
(1) Its membership is interdisciplinary (psychology, sociology and various areas of medicine).
(2) It grew out of the perspective in psychology called behaviorism, which proposed that people's behavior results
from two types of learning:
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 behavior is changed because of its consequences: reinforcement
(reward) strengthens the behavior; punishment suppresses it.
Biofeedback= whereby 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.
1. Health psychology
This field is principally within the discipline of psychology. Four goals of health psychology:
(1) To promote and maintain health. F.E. school health education programs and media campaigns.
(2) To prevent and treat illness. F.E. reducing high blood pressure, rehabilitation programs, adjustment.
(3) To identify the causes and diagnostic correlates of health, illness, and related dysfunction. Psychologists also
study physiological and perceptual processes, which affect people's experience of physical symptoms.
(4) To analyze and improve health care systems and health policy.
The main distinctions among the fields (psychosomatic medicine, behavioral medicine & health psychology) are
the degree of focus they give to specific topics and viewpoints & the specific disciplines/ professions involved.
Psychosomatic medicine= is an interdisciplinary field that includes physicians and behavioral scientists but
continues to be closely tied to medical disciplines, including the application of psychiatry to understanding and
2
,treating physical illness. Behavioral medicine= is also an interdisciplinary field and tends to focus on
interventions that promote healthy lifestyles without using drugs or surgery. Health psychology= is based in
psychology and draws heavily on other psychology subfields – clinical, social, developmental, experimental, and
physiological – to identify and alter lifestyle and emotional processes that lead to illness, and to improve
functioning and recovery for people who are sick.
All three fields share the view that health and illness result from interplay of biological, psychological,
and social forces. Health psychologists provide direct (therapy, teaching methods such as biofeedback
etc.) and indirect help (designing programs, such as quitting smoking, educating health professionals).
Current perspectives on health and illness
Biopsychosocial model= expands the biomedical view by adding to biological factors connections to
psychological and social factors. It proposes that all three factors affect and are affected by the person's health.
Biological factors= includes the genetic materials and processes by which we inherit characteristics from our
parents and the function and structure of the person's physiology. Psychological factors=
o Cognition= a mental activity that encompasses perceiving, learning, remembering, thinking, interpreting,
believing, and problem solving. F.E., if you believe that life is not worth living without the things you
enjoy. You probably won't give up smoking cigarettes to reduce the risk of cancer.
o Emotion= a subjective feeling that affects, and is affected by, our thoughts, behavior and physiology.
F.E. people whose emotions are relatively positive are more likely to take good care of their health and
people who are frightened of doctors may avoid getting the health they need.
o Motivation= the process within individuals that gets them to start some activity, choose its direction and
persist in it.
Social factors= individual people, groups, society, community, family. As we interact with people, we affect
them, and they affect us. But also, our society, and mass media.
System= a dynamic entity with components that are continuously interrelated. By this definition your body is a
system, as well as your family, your community and society. There are levels of systems:
If we look at levels within the person,
illness in one part of the body can have
far-reaching effects: if you fell and
seriously injured your leg, your internal
systems would be automatically mobilized
to help protect the body from further
damage. In addition, the discomfort and
disability you might experience for days or
weeks might affect your social relations
with your family and community.
Lifespan and Gender perspectives:
Life-span perspective= in this perspective characteristics of a person are considered with respect to their prior
development, current level, and likely development in the future. F.E. the kinds of illnesses people have tended to
change with age. Stressful adverse childhood experiences – such as emotional or physical abuse, poverty and
unstable family life – can increase the risk of developing several adult diseases many years later by altering the
person's response to stress. The more adversity the children experienced, the greater the likelihood of adult
diseases. Changes also occur in children's psychological systems, such as in cognitive processes. Children's
knowledge and ability to think are limited during the preschool years but grow rapidly during later childhood.
Changes in social relationships also relate to health and illness. F.E. Children's health relies on his adult
caregivers. But later, parents and teachers are still important, but age-mates in the community have a powerful
influence, and the need to be accepted by peers sometimes leads teens toward unhealthful or unsafe behavior.
Gender perspective= males and females differ in their biological functioning; health-related behaviors, such as
drinking alcohol; social relationships; experience of stress and rick of specific illnesses, such as breast cancer.
Related scientific fields: foundations and connections for health psychology
-> Medicine provides an essential foundation and connection for health psychology. To understand how medical
conditions can affect patients’ psychological and social functioning, it is essential to understand their experience
of the condition, its likely course, and the procedures they will undergo during typical medical care. It is not only
the patient's behavior that is the focus of change but the healthcare provider's behavior as well.
-> Health psychologists also need to know the context in which health and illness exist. Field of epidemiology –
the scientific study of the distribution and frequency of disease and injury – provides part of this context.
Epidemiologists use several terms in describing aspects of their findings. We will define five of these terms:
1. Mortality= means death, generally on a large scale.
3
, 2. Morbidity= means illness, injury or disability – basically any detectable departure from wellness.
3. Prevalence= refers to the number of cases, such as of a disease or of persons infected or at risk.
4. Incidence= refers to the number of new cases, such as of illness, infection or disability, reported during
a period of time. F.E. the number of new COVID-19 cases in the previous year.
5. Epidemic= usually refers to the situation in which the incidence has increased rapidly.
Rate= for example, the mortality rate gives the number of deaths per number of people in a given population
during a specified period of time.
Epidemiologists play a pivotal role in identifying risk factors for disease and health disparities, either within a
population, such as the entire US, or across nations, such as those that are or are not highly industrialized.
Another discipline of importance to health psychology is public health= the field concerned with protecting,
maintaining, and improving health through organized effort in the community. This field studies health and illness
in the context of the community as a social system. Two other related fields are sociology and anthropology:
Sociology= focuses on human social life; it examines groups or communities of people and evaluates the impact
of various social factors, such as the mass media, population growth, epidemics, and institutions.
Medical sociology= a subfield that studies a wide range of issues related to health.
Anthropology= includes the study of human cultures.
Medical anthropology= examines differences in health and health care across cultures.
Without the knowledge from sociology & anthropology, health psychologists would have a very narrow view.
Finally, health economics and health policy are fields that also relate health psychology.
Health economics= examines the supply and demand for health resources, the expenditures related to health
care and the costs and benefits of health care.
Health policy= examines the decisions, plans and actions taken by governments and other organizations, such
as insurance companies and employers, regarding health care and health-related behavior.
Chapter 2 The Body's Physical Systems
Module 1: The Nervous System
The nervous system= receives information about changes in the environment from sensory organs, including
the eyes, ears and nose, and it transmits directions that tell our muscles and other internal organs how to react.
The brain also stores information – being a repository for our memory of past events – and provides our
capability for thinking, reasoning and creating. Neurons= the nervous system provides “commands” through an
intricate network of billions of specialized nerve cells: neurons.
Projecting the cell body are clusters of branches called dendrites,
which generally function as receivers for messages from
adjacent neurons. These messages then travel through an axon,
which splits into branches at the far end. The tips of these
branches have small swellings called synaptic knobs that
connect to the dendrites of other neurons, usually through a fluid-
filled gap. This junction is called a synapse. The messages
consist of electrochemical activity. If the chemical activity at a
dendrite produces a sufficient concentration of electrically
charged particles, called ions, an impulse of electrical potential is
triggered. Normally this process occurs in a controlled pattern.
But in the disorder epilepsy, large clusters of neurons fire at abnormal rates, causing victims to have seizures
that can involve convulsions and loss of consciousness. Neurotransmitter= a chemical released by the synaptic
knobs which travels to the dendrites of an adjacent neuron.
Most of the growth in brain size after birth results from an increase in the number of glial cells and the presence
of a white fatty substance called myelin. Glial cells= are thought to service and maintain neurons.
Myelin= is responsible for increasing the speed of nerve impulses and preventing them from being interfered with
by adjacent nerve impulses. The importance of myelin can be seen in the disease called multiple sclerosis, which
results when the myelin sheath degenerates and nerves become damaged.
As the infant grows, the network of dendrites and synaptic knobs expands dramatically but at the beginning in
early adulthood, the brain slowly loses weight with age. Although the number of brain cells doesn't change very
much, the synapses decline in ability to send nerve impulses.
The nervous system is enormously complex and has two major divisions:
1. The central nervous system= consists of the brain and spinal cord.
2. Peripheral nervous system= is composed of the remaining network of neurons throughout the body.
4
