Health Psychology
Health psychology is a unique branch of psychology devoted to focusing on how biological, psychological, and social variables influence health and well-being. The significance of people seeking medical care cannot be overstated since they are often anxious or uneasy. When a person is diagnosed with a health problem or requires surgery, their mental state and emotions are still important. There is no question that certain psychological factors and behaviors positively affect physical well-being. Psychological factors and behaviors account for most deaths in the United States. Because the most prevalent reasons for non-adherence to medical advice are behavioral, it might be assumed that behaviors have a measurable impact on the prevalence of illness as well as the efficiency of therapies. For these reasons and many more, it is beneficial to have a good knowledge of the science of psychology and its psychological areas as well as counseling skills.
Proper self-care and a good mental attitude are crucial to health and well-being. A substantial body of research supports the notion that people’s mental attitudes are linked to being healthy or being unwell. Holding favorable views of oneself and being positive and upbeat has been shown to be conducive to people’s physical well-being. Despite the common-sense appeal and lucrativeness of the “mind-body” link, because of the risky “entanglements” of researching and practicing treatment from this perspective, members of the healthcare system and professional scientists have found it intimidating and even “repelling.” Dominant paradigms of psychiatry and psychology supported a body and consciousness dualism of humanity from the early twentieth century to the late twentieth century. Because of their organizational and economic costs, these attitudes in science sought to separate and elevate the human species from the remainder of the natural domain.
Definition and Scope
Health psychology offers a broader understanding of the mechanisms of health and healthcare, combining knowledge about mental and somatic processes. Health psychologists collaborate with other health professionals to diagnose and treat psychological conditions, as well as to aid in the design and implementation of mental health interventions. Health psychology includes several subdisciplines, including: 1) Coping – adaptation to physical and emotional challenges, including daily hassles and chronic life stressors; 2) Pain management – the study of chronic and acute pain and the modification of pain through psychological interventions; 3) Stress personality – personality factors that might contribute to or protect against illness; 4) Personality and health behaviors – whether personality differences contribute to health disparities; 5) Social relationships – how social relationships contribute to protecting or threatening health. The range of research and interventions in health psychology is enormous. It is quite likely you may even have experienced a health psychology intervention or visited somebody attended by a health psychologist at some stage in your life. For example, occupational health professionals are responsible for minimizing the impact of work-based stress and anxiety on mental health and are trained in psychological assessment and a range of practical interventions. Yet despite the importance of what they do, the study of health psychology within the broader discipline of psychology is small. For many, the stereotypes of negative mental health have a negative influence on some people. That’s why it’s often confused with clinical or abnormal psychology and seen as something that considers mental health odd. Even within the public health discipline, there is an absence of health psychologists as opposed to epidemiologists or healthcare professionals. In health psychology, mental health is a key priority. Its scope is the relationship between mental and physical health, studying the impact of the mind and psyche on health protection.
Historical Development
The contemporary discipline of health psychology is an amalgam of countless ideas, aspirations, and findings generated by psychologists in the broader field of psychology. Although the psychology of health and illness was considered a portion of psychology’s subject matter from the very beginning of the field, health psychology as an independent division in the American Psychological Association was established in 1978, attesting to its identity as a distinct area of practice and scholarship. The development of knowledge in health psychology has been characterized by specific foci on both the empirical and theoretical development of scientific endeavors. Important roles were also played by specific individuals dedicated to championing the scope of research and practice delineated by the field, learned societies, and specific publications to sustain the dissemination of information relevant to the field.
Given the central role of health psychology in furthering integration between psychosocial factors and health care, it is essential to be able to situate the field in its historical context. By beginning with a focus on the relationships between psychological theories and medical treatments, it is possible to trace the development of the discipline of health psychology through the transformation of how we think about health. Given the important role that practical insights about health and wellness continue to play in the current day, this historical approach is more than an intellectual exercise—the seemingly distant theory in medicine might prove to be surprisingly relevant to our own health problems.
The Biopsychosocial Model
The traditional or biomedical model of health and illness views the human body the way an intricate and complex machine is viewed. According to this model, illness and problems are primarily seen as something originating from the body. Today, scientists acknowledge that the experience of health and/or illness is incredibly intricate and cannot be fully understood by emphasizing the body exclusively. The biopsychosocial model integrates biological, psychological, and social factors when attempting to understand health and illness. This model goes beyond all past approaches and speaks to not merely our symptoms or even our behaviors but rather our complete experience of health and/or illness. First proposed 35 years ago, this approach has been embraced by health psychologists. You will notice throughout this work that many of the processes and experiences that will be discussed simultaneously involve biological, psychological, and social influences.
The biopsychosocial model can help provide new and enhanced ways of viewing and treating health problems and can assist in preventing a range of illnesses in many cases as well. This model acknowledges that health problems and causes are multifactorial. It advocates that changes at any one level are likely to affect the chances of a return to or maintenance of health in a positive direction. Additionally, the biopsychosocial model has implications for both research and practice in health psychology. From a research perspective, understanding the relative roles of biological, psychological, and social factors in health and illness necessitates interdisciplinary collaboration. From a practical perspective, understanding the thoughts, behaviors, and emotions that characterize illness requires understanding the psychological functioning of that person, including the medical treatment received and the healthcare settings in which that person moves from the viewpoint of the patient.
Components of the Model
Module 1: The Biopsychosocial Model of Health
Model Components
Several discussions of the Biopsychosocial Model outline the characteristics of the three model components. The basic premise of these characteristics is that in the Biopsychosocial Model, the dimensions comprising the components interact, rather than exist in isolation.
It is first important to point out that the major caveat of the synergy among the components is not symmetrical. In other words, biology and physiology affect psychology, which in turn affects social relationships. That is, the model is considered to run from biology and physiology, through psychological processes, to social and environmental factors. There are some loops of effects within each system, but for the most part, the basic logic of the model is that the systems lie in this order of importance. These are important points whenever using the Biopsychosocial Model or communicating about it. When discussing the model in research or clinical applications, one point of emphasis should be the idea that each of the components contributes to an integrated and operational system.
The biology and physiology components of the Biopsychosocial Model include a number of issues, such as genetics or the presence of certain diseases or conditions, that can contribute to overall well-being. The psychological component then includes the measurement of mental states and emotional factors such as anxiety, coping skills, and quality of life, as well as cognitive or thought processes. The social component includes aspects such as race, culture, ethnicity, and social support systems that can contribute to health disparities, or the prevalence, degree, and incidence of disease. An example of the biological or physical system could be found in the impact of heart rate or blood pressure on diabetes progression. For the psychological aspect of the model, an example may be found in the relationship between anxiety and the occurrence of panic attacks. The social system of the model can effectively summarize all three components in the connections that exist among them. For example, socioeconomic status can be linked to mechanisms such as depression, stress, and coping, and disorders such as hypertension and asthma. The framework of the Biopsychosocial Model is such that, together, the biological, psychological, and social components distinguish an all-inclusive schematic of overall health and behavior.
The ultimate purpose of the Biopsychosocial Model is not only to differentiate the diverse components associated with health but to uncover the areas in which the components blend or communicate with one another. While the model can be utilized as a gridded system or triage of health issues, it is also a reference for the connections among the biological, psychological, and sociological properties of human beings as they derive the essence of molecular entities coursing through the passage of individuality and developmental behavior. As a theoretical framework, the Biopsychosocial Model is beneficial in focusing on not the incidence of a disease, but the problem of the disease from all aspects of life. It is intended to be a model of the real world, from which inferences can be made regarding the research and design agenda for the pathogenesis of disease processes. The terms health psychology and behavioral medicine ultimately draw attention to a field of concern that incorporates a range of phenomena relevant to our behavior and overall experience.
Stress and Coping Mechanisms
Stress, those negative emotional and physiological responses to the demands placed on us, is an inescapable part of life. Emotions like anxiety, frustration, irritation, and anger can all lead to stress responses. Physiological responses that accompany those emotions include an increased heart rate, the release of stress hormones, and the boosting of metabolism in order to give us more energy. While the relationship between stress and harm to the body is complex, in general, stress is related to poor health. The triggers for this response are different for everyone, but may also include getting into a disagreement with someone, work pressure, and daily hassles.
One thing that has been pretty convincingly shown is that those who are in situations with much chronic stress, or with perceived uncontrollable stress, are at greater risk for adverse health outcomes. Increased risk for a variety of psychiatric illnesses like depression and post-traumatic stress disorder has also been shown in those who have been exposed to a great deal of chronic stress. A very important individual difference that seems to be protective for individuals who undergo life trauma is how they cope with the trauma. However, lower socioeconomic status showed a smaller reduction in PTSD with high levels of social support, suggesting that some of these variables are interrelated.
Reducing chronic stress is very difficult and requires changes in lifestyle, work, thinking, and sometimes medication. Hence, many studies in health psychology have also looked at different coping responses to try to decrease the problems that can come from exposure to stress. For example, instead of holding your emotions in, you might cope by telling a close friend about how you feel, or by seeking out a therapist to help you sort out your emotions. If you are on vacation but unable to do much to help your life stressors, distancing or ignoring might be adaptive. What people have found in general is that what are called “active” or “problem-focused” coping strategies, like talking and trying to deal with the problem directly, are adaptive and correlate with health. Those coping strategies like not changing or denying the stressor or venting anger do not in general correlate with health.
Understanding Stress
Stress is a part of life. We talk about feeling “stressed out,” or sometimes about being “under stress.” There are many different definitions of stress, and you will explore some of them here. At its most basic, stress is defined as the response to demands that are placed upon you. That response can involve psychological, physiological, and behavioral aspects.
There are different types of stress, and they are usually grouped according to the length of time that a person is under stress. Acute stress is the most common form and results from a traumatic event, such as an accident. Chronic stress often develops in jobs that are both demanding and distant, such as those of doctors or firefighters. Living in constant fear of violence can also be a source of chronic stress. In our working definition, you can see that we refer to the person who is stressed and to the demands that are placed upon him or her, rather than to any specific situation or event, and for good reason. One of the reasons behind this is that stress is really about people’s perception of the amount of pressure they are under. And everyone has a different perception of what is challenging, moderate, or “too much” pressure. A big project, for example, might be something that one person finds extremely stressful while another might really enjoy the opportunity. A long commute can be the ultimate in relaxation for one person, who uses the time to decompress, enjoy music, and “gear up” for home life. The same commute can be nausea-inducing for another who worries about evening obligations, household chores, or just getting home before bedtime. The framework can help professionals understand the ways a wide range of stressors can affect all aspects of health and open up possible areas for intervention. In the next three sections, the response to stress—evolving from psychological and physiological to behavioral responses—and the spread of effects are examined.
Types of Coping Mechanisms
Different people approach stressful situations in different ways. Coping, or the strategies people use to handle stress, can be categorized in a variety of ways. Problem-focused coping tackles the stressor itself. When the situation is changeable, confronting it directly can be useful. Emotion-focused coping aims to regulate emotional distress that occurs due to excessive stress. Coping strategies also serve different purposes. For some people, emotion-focused coping might be a helpful way to distance themselves from a problem to regain composure.
Some strategies are both emotion-focused and problem-focused. When a bad day approaches and I’m already overworked, an unusually challenging student might lead to generalizations about school changes, and unchangeable situations can activate high-stress emotional responses. For many people, the same challenging student might lead them to stoic acceptance, such as the ongoing problem of that one student, or limit the help the student gets. He’s an exception; I’ll deal with it without letting it affect me. The effectiveness of variations of coping varies from situation to situation. Problem-focused strategies are often more useful when problems are changeable, whereas emotion-focused strategies can be beneficial when solutions are not feasible.
Coping responses are also based upon the centrality of the stressor. An important, salient stressor is one I think about and focus on. An irrelevant, performance-limiting stressor is one I can ignore without much trouble, and a peripheral stressor is one I don’t need to attend to very much. Notably, a stressor can start at a lower level of centrality. Stressors that are more severe become more central, and irrelevant stressors are then ignored. This information can help provide you with more effective ways to cope with any problems that may arise. Some stressors can be intense and are expected, while others, such as minor social disruptions, can contribute to personal health and well-being. Adaptation in part depends on the meaning of the stressor and how it is coped with.
Psychological Factors in Health and Illness
The scientific study of health psychology is aimed at understanding how psychological factors affect health and illness. Substantial evidence shows that people’s mental states, beliefs, attitudes, and lifestyles can play highly significant roles in producing good health or in precipitating illness. The crucial point to grasp is that preventing illness and helping people get well involve much more than knowing about germs, viruses, and other biomedical factors. Until you understand the psychological aspects, health and the potential to become ill are not fully comprehended. People’s mental states are woven into their attitudes, behaviors, and the manner in which they live their lives. An individual’s attitudes and perceptions in turn help to determine preventive health practices. Psychological factors not only influence health practices, they can also work bidirectionally. Namely, attitudes and practices can influence an individual’s mental health status and his or her susceptibility to various physical conditions.
One of the most challenging aspects of this contemporary era is the increasingly rapid pace at which life and industry are transforming. Many scientific and healthcare disciplines, including nursing, are attempting to react to this change. Health psychologists and many researchers in other disciplines striving to understand health and wellness are increasingly focusing their attention on the individual being studied, the particular illness that is under investigation, or both. The contribution of individual differences, including the influence of many psychological factors, such as emotional states, to physical health and stress has also become very crucial. It is not just the presence or absence of certain diseases or the physical functioning of organs and systems that serve to determine health, but the way in which these attributes contribute to the quality of someone’s life is of paramount importance. Unfortunately, throughout most healthcare systems, the assessment of the psychological status of a patient is often exemplified by a quick question about depressive symptoms or a single action of referring a patient to the specialist team. If more health psychologists and other researchers can focus on the understanding of health-related practices and the relationship between physical and mental activity, they have a much better chance of transforming current health provision. Thus, having a good understanding of psychological components in health and illness is crucial.
Beliefs and Attitudes
The role of beliefs has been of central interest to health psychologists. We find particularly useful the conceptualization of health beliefs that consists of two parts. First, health beliefs are used to describe the meaning of health to people, including their judgments on issues such as the freedom from disease progression, the importance of the capacity for physical functioning or bodily structure, mental and emotional functioning, the use of healthcare services for symptoms, illness, and prevention, and so on. Second, these are used to describe decision-making regarding different health behaviors, including the importance of reporting symptoms, making healthy behavior changes, or taking prescribed therapy, hospitalizing, or seeking medical care when one is taught to be experienced with a particular condition or symptoms. In the patient, this is what the physicians endorse, but in reality, the process may include other behavior change plans of action. In simple terms, beliefs are often used as reasons offered to back decisions that are associated with health behaviors.
If people doubt their susceptibility to a condition, they are therefore less likely to engage in the basis of such behavior that is protective and preventive. Nevertheless, we avoid acting or learning toward our preferences if we don’t believe that getting through them is possible. Therefore, it can be pointed out that we don’t have to behave or practice certain kinds of behaviors if they are seen to have an unbothered risk. In general, theories disavow the intricacy behind behavior in its view, omitting a number of variables that play a major role in decision-making. We tend to reveal that such theories are based on different values from health behaviors, which are the beliefs that we uphold regarding our health. There are theories that associate positive attitudes toward a fact in compassion with a better welcome and health improvement, inducing a sense of perception in the individual about the world and how the healthcare systems are always present. They align these attitudes with the positive development of well-being, more effectively, and are majorly involved in the process of recovery. During a process of intervention, there can be other beliefs through which different perspectives lend this theory to make it better in health improvement. Their associations with treatment recommendations, completion, recovery expectations, lessened symptoms, and improvement of functional collaboration have formed the basis for principles of risk management of medication compliance and behavior change. The common-sense model of self-regulation is an example of a theory that uses these beliefs to improve health literacy.
Health Behaviors
Although we may think of physical health first and foremost when we consider the topic of health, related behaviors are also important for our mental health. In this section, we will address several different kinds of health behaviors and some psychological and social factors that can affect health behavior choices. A health behavior can be defined as any behavior that either adds positively to our well-being or detracts from it. As such, not all health behaviors are positive! Practically, health-related behaviors can be grouped into at least three types: preventive actions are things we do to avoid future illness and injury. Wearing a seatbelt is a good example of a preventive action. Curative actions refer to steps taken to treat a current problem, such as taking antibiotics for a bacterial infection. Finally, rehabilitative actions refer to behavior after an injury or in response to existing health issues. Depending on the injury or condition, this could refer to such behaviors as physical therapy or starting to take insulin medication if you have been diagnosed with diabetes. Obviously, we are often motivated to engage in health behavior by physical discomfort or suffering; this is no less true for psychological problems. People who suffer from conditions like anxiety or depression are often quick to say that they “just want to feel normal again” and that this is what informed their decision to seek out these problem-focused, curative approaches. Societal factors and the current culture are no small influences when it comes to our choices about health. Health behaviors such as diet and food intake, exercise, drug and medication choices, sexual safety, and managing stress all have to do with how healthy we are. Although the list of health behaviors is not comprehensive, it is a start. Maintaining a healthy diet helps protect us from developing health problems. Lifestyles that include smoking, unprotected sex, addiction, or inactivity are sometimes culprits of not being healthy. Lifestyle and health are associated with each other. Our options in life and the living conditions affect our health, while health also can affect what we can and cannot do in life.
Applications of Health Psychology
As a health psychologist, part of your job will be to take the theories and research findings that we described earlier in this chapter as part of basic science—knowledge for its own sake—and use them in a practical way to facilitate wellness and help people maintain good health. These activities span multiple levels of focus: entire populations, organizations, and even government entities with the main goal of enhancing the health of as many people as possible, to groups of people sharing some common status, such as having an elevated risk for a particular disease; members of the various health professions taking care of a distinct patient population, such as all people who are diagnosed with a particular condition, like diabetes, or in a certain venue such as a dialysis unit; and the person or persons diagnosed with the specific disease, disorder, or developmental problem. To further illustrate how psychologists put psychology to work, let us look at some practical examples of how health psychology is practiced.
Today, healthcare in the United States is provided by an expansive system of institutions and professionals that can be thought of collectively as the medical-industrial complex. We are the beneficiaries of an entire healthcare economy. Work in health psychology has meaningful applications across all levels of this system. Patients diagnosed with one or more long-term conditions can benefit from psychosocial approaches even at the biological level of being more adherent to medication regimens when the healthcare team understands the practical, social, and economic impact of the diagnosis. As populations age, chronic diseases, as well as the medications to treat them, will be ever more prevalent at all organizational levels. Such interdisciplinary cooperation in treating patients has a long tradition in health psychology. In health psychology, interdisciplinary cooperation is the rule rather than the exception. Last but not least are the applications of health psychology in treating individuals, as distinguished from populations or entire organizations. Having knowledge about the psychosocial impacts of health-related diagnoses and events may also lead to innovations in helping patients.
Behavioral Medicine
In recent years, substantial energy in health psychology has been invested in promoting the field of “behavioral medicine.” Behavioral medicine, and the interface between behavioral medicine and health psychology, constitutes one of the most exciting and innovative areas of psychological study. It is a problem-oriented, transdisciplinary field in which cooperation between psychology and medicine is essential if any progress is to be made. And it results when the content and methodology of psychological science, and research on behavior as well as the use of psychological principles and techniques of treatment, are made available and applicable to physical illness. In the following chapters, we will examine disease and the patient-centered approach to preventing and treating disease at the interface of health, behavioral medicine, and health psychology. Below, we define behavioral medicine and discuss its implications for professional practice.
Behavioral medicine is defined as the interdisciplinary field of inquiry that studies the relationship between behavior and physical health and disease. Its goal is to develop, evaluate, and integrate the theory, research, medical practice, and education of the various health-related disciplines and to aid in the prevention, diagnosis, etiology, and treatment of health-related problems. Behavioral medicine emphasizes the study and prevention of disease and illness from the standpoint of their relationship to physical and psychological dysfunctions and clinical concerns. This broader framework has evolved, in part, from the pioneering approach to medicine initiated by the World Health Organization. Such behavioral medicine is truly distinguished from the earlier approaches and represents a different scope and focus for health and healthcare thinking, teaching, and practice. At a behavioral medicine clinic, healthcare problems are analyzed from the patient’s point of view, a comprehensive approach to history-taking is used, the emotional component of illness is not avoided, and psychological counseling and therapy are integral to care. More resources are extended to total patient care than to seeking the best medical or surgical solution for the patient’s disease.
Health Promotion and Disease Prevention
The focus of health psychology is not only on making people feel better when they are unwell but also on understanding how people can maintain or improve their health. A key function in health psychology is that of health promotion. Health promotion also encompasses the area of disease prevention. Evidence-based strategies in this area emphasize the importance of the whole population in terms of normalizing lifestyles, encouraging the uptake of healthful behaviors, and discouraging risk behaviors. Any population-level health promotion initiative should be based on a health needs assessment. Health psychology encourages the design of such health facilitation strategies to be based on the best available evidence.
A health needs assessment evaluates health status in a given population. One important aspect in giving a positive definition of health promotion is that it focuses on a broad concept of health. Strategies for health promotion include diverse techniques, such as education and increased awareness, community development, sponsorship of events, and consultation with community groups. However, in 1986, an international conference organized by WHO published the Ottawa Charter for Health Promotion. This report increased the significance of health promotion as a necessary element of any long-term strategy for health. In this charter, the concepts of health education, health protection, and prevention, as well as health promotion, are highlighted. This is a balanced approach that has since been taken up by the UK Central Office of Information. It has been used in the promotion of health issues to the general public by government agencies, but it has also been used to promote certain health issues to leading decision-makers in different fields, such as transport, defense, and education. Health promotion campaigns can achieve their aims in very different ways. The aspects of worst-case and best-case scenarios are included in the case studies in the rest of the document.
