Health Psychology

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Biomedical Model of Illness

  • Health defined as absence of disease
  • Illness arising from biological changes beyond the individual's control
  • Responsibility for treatment by medical profession.
  • Mind and body are independent.
  • Allows little room for subjectivity
  • Reductionist: idea that mind, body and behaviour can be explained at the level of cells, neural activity or biochemical activity.
  • Underpins successful treatments including immunisation programmes.
  • Engel, 1977.
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Biopsychosocial Model of Illness

  • Holistic model, monists see mind and body as a unit
  • Biological: Viruses, bacteria
  • Psychological: Behaviour, beliefs, coping, stress, pain
  • Social: Class, employment, ethnicity
  • Freud postulated existence of 'unconscious mind' - led to field of Psychosomatic Medicine.
  • Health is more than the absence of disease.
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Psychosomatic Medicine

  • 1930s
  • Challenged Biomedicine
  • Mind and body both involved in illness
  • Psychoanalytic interpretations of illness being triggered by repressed emotions.
  • Illness with no identifiable organic cause often considered nervous disorders or psychosomatic conditions for which medical treatment was not forthcoming.
  • Today is more concerned with mixed psychological, social and biological explanations.
  • Led to emergence of behavioural medicine.
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Behavioural Medicine

  • 1970s
  • Developed from psychosomatic tradition that had followed Descartes & the mind/body debate.
  • Behavioural principles are employed - results from classical/operant conditioning.
  • Principle applied to techniques of prevention and rehablitation.
  • Prevention receives less attention than rehab and treatment, which makes this different to health psychology
  • Furthered view of direct mind-body link
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Social Cognition Theory

  • Assumes that behaviour is motivated by outcome experiences and goals.
  • Ingledew and McDonagh - 5 coping functions attached to health behaviour; problem solving, feeling better, avoidance, time out and prevention.
  • Interventions designed to reduce unhealthy behaviour need to take into account the coping functions or goals that individual behaviour serves for each individual - these goals will motivate the behaviour.
  • Process of Self-Regulation enables individual to achieve desired outcomes or reduce undesired outcomes.
  • Cognitive regulation is required as well as emotional regulation to successfully execute goal-directed activity.
  • Attentional control is required to achieve goals - aspect of dispositional self-regulation.
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Self-Efficacy

  • Bandura: Individuals' beliefs about their capabilities to produce designated levels of performance.
  • E.g. Believing a future action such as weight loss is within your capabilities is likely to generate other cognitive and emotional activity, such as the setting of high personal goals, positive outcome expectancies and reduced anxiety.
  • Success in attaining a goal feeds back in a self-regulatory manner to further a person's sense of self-efficacy and their efforts to attain goals.
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Health Belief Model of Behaviour Change (HBM)

  • Rosenstock
  • Likelihood of a person engaging in health behaviour depends on demographic factors. E.g. Class, gender, age, and 4 beliefs.
  • The beliefs encompass perceptions of threat and evaluation of the behaviour in question.
  • Perception of threat: I believe CHD is a serious illness contributed to by being overweight (perceived severity). I believe that I am overweight (perceived susceptibility).
  • Behavioural evaluation: If I lose weight my health will improve (perceived benefits of change). Changing cooking and dietry habits when I also have family to feed will be difficult and expensive (perceived barriers).
  • Cues to action, added 1975 Becker and Maiman: Recent TV programme on health risks of obesity worried me (external). I regularly feel breathless, maybe I should lose weight (internal).
  • Health motivation, added 1977 Becker et al: It is important to me to maintain my health.
  • Perceived benefits associated with preventive behaviours.
  • Perceived barriers associated with low levels of preventive behaviour.
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HBM Evaluation

  • HBM studies on reducing-risk behaviour provide mixed findings.
  • Rosenstock did not specify the manner in which different variables interact with one another or combine to influence behaviour.
  • Strecher & Rosenstock suggested adding susceptibility scores with severity scores to get an overall perceived threat score may enable greater prediction than independent scores. Cues to action, perceived benefits and barriers may better predict behaviour in situations where perceived threat is high. Not tested empirically.
  • Becker et al - Did not specify how combined score was to be calculated.
  • HBM may overestimate role of 'threat'. Perceived susceptibility is not consistently predictive of HB change. Promotion messages should not overuse fear arousal, this can be counter-productive among those who lack the resouce to change.
  • HBM takes limited account of social influences on behaviour.
  • A further barrier to behaviour is mood, found to be inversely associated with exercise behaviour in women with breast cancer.
  • Static model - suggesting beliefs occur simultaneously in a one off assessment. Does not allow for staged or dynamic processes such as changing or oscillating beliefs over time.
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Protection Motivation Theory of Behaviour Change

  • Change occurs due to appealing to fear
  • Similar to HBM in terms of how it considers threat appraisals.
  • Threat: Perceived severity and perceived probability of occurence
  • Coping: Self-efficacy and response effectiveness - knowing what to change
  • Behaviour intention and actual behaviour.
  • Rogers, 1975
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Theory of Planned Behaviour (TPB)

  • Fishbein and Ajzen
  • Social Cognition models (and TRA)
  • Social behaviour determined by beliefs about behaviour in given social contexts and by their social perceptions and expectations and not simply by their cognitions and attitudes.
  • Behaviour proximally determined by intention, which in turn is influenced by a person's attitude towards the object behaviour (outcome expectancy beliefs and outcome value) and their perception of social pressure regarding the behaviour (subjective norm).
  • Motivation to comply (I would like to please my parents and friends)
  • Importance of person's attitudes towards behaviour is weighted against the subjective norm beliefs, whereby a person holding a negative attitude towards changing may still develop a positive intention to because their subjective norm promotes it and they wish to comply with their significant others.
  • Perceived behavioural control - person's belief they have control over own behaviour in situations, even when facing barriers. PBC will directly influence intention and therefore, indirectly, behaviour.
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TPB Evaluation

  • Does not acknowledge likely transactions between predictor variables & outcome variables.
  • Research supporting a link between intention and subsequent behaviour is limited by an over reliance on cross-sectional studies.
  • Assumes that same factors predict inititation of behaviour and maintenance or change of it. Most studies focus on behaviour initiation. This may be why interventions based on such findings fail to have long-term effects.
  • Povey et al, 2000: Intentions of people to eat 5 portions of fruit/veg a day were best predicted by perceived behaviour control.
  • Rutter, 2000: Intention and first-time attendance successfully predicted by TPB.
  • Schwarzer, 1992: No description of order of factors or causality.
  • Intention does not always mean action.
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Transtheoretical Model (TTM)

  • Prochaska and di Clemente, 1984
  • Makes 2 broad assumptions: people move through stages of change & processes involved at each stage differ and are independent.
  • Pre-contemplation: No current intention to change in next 6 months.
  • Contemplation: Awareness of need to change, generally considering doing so in next 6 months.
  • Preparation: Ready to change. Setting goal such as start date. Includes thought and action.
  • Action: Overt behaviour change.
  • Maintenance: Keeping up with change, resisting temptation.
  • Termination: Change maintained for adequate time, feels no temptation to lapse. Belief in self-efficacy to maintain change.
  • Relapse: Common and can occur at any stage. Lapsing into earlier behaviour patterns.
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TTM Evaluation

  • Research shows matching intervention to stages improves behaviour changes.
  • Does not explain delayed medical seeking when in serious condition
  • Little empirical evidence of distinct difference in terms of attitudes and intentions of contemplaters and preparers.
  • Past behaviour has been found an important factor of future behaviour change, so are stages useful?
  • Validity of stages questioned on basis of data that did not succeed in allocating all pps to one specific stage. Suggests continuous variable of readiness may be a better description.
  • Insufficiently addresses social aspects of health behaviour.
  • Does not allow for people not knowing about the behaviour or issue in question. Likely when a rare or new illness isbeing considered.
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Life Events Theory of Stress

  • Stress as a stimulus
  • Holmes and Rahe, 1967
  • The more life events experienced, the greater likelihood of physical health problems.
  • 5000 pps generated list of most stressful events. List of 43 commonly mentioned events. Asked new sample of 400 pps to rank events in order of degree of disruption caused by event.
  • Created social readjustment rating scale (SSRS) with values from 11 to 100. Values called life changing units (LCU).
  • Both positive and negative events would require adjustment from individual.
  • Greater LCU score associated with higher risk of ill health.
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Evaluation of Life Events Model

  • An individual's own rating of a life event is important, they may not be the same for everyone.
  • Studies rely on retrospective assessment.
  • Some events are not applicable depending on age.
  • Experiences may intertwine and cancel each other out - such as marriage requiring positive adjustments but coinciding with negatively perceived house move.
  • Some events listed are too vague - change in social activities could mean many things
  • Still shows life events can and do impact people's lives in a variety of ways.
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Transactional Model of Stress

  • Lazarus, 1997
  • Appraisal responses mediate stress responses
  • Interaction between characteristics and appraisals, external or internal event (stressor) environment and internal or external resources available.
  • Primary appraisal: Considers quality and nature of stimulus event. 3 kinds of possible stressor: those that pose harm, those that threaten and those that set a challenge.
  • Secondary appraisal: assessing resources and abilities to cope with stressor. Either internal (strength, determination) or external (social support, money).
  • Stress would be experienced when perceived harm or threat was high but perceived coping ability was low.
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Evaluation of Transactional Model

  • Compatible with both biological and social models
  • Criticised for circularity. Limited research attempted to examine nature of interaction between primary and secondary appraisals.
  • Demand and coping capacity are not defined separately, leading to claims of the model being tautological.
  • Unclear whether both appraisal types are necessary. Zohar and Dayan (1999) found positive mood outcomes in sample to be affected mainly by coping potential variables, not primary appraisal variables.
  • Found stress arose as stakes or motivational relevance of event increased, even when coping potential was not restricted.
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Fight or Flight Response

  • Cannon, 1932
  • Catecholamines (adrenaline and noradrenaline), when released from adrenal glands of sympathetic NS as hormones, heighten arousal to facilitate Fight or Flight response.
  • Occurs when faced with imminent danger or high threat level.
  • Physical arousal - dry mouth, increased heart rate, rapid breathing.
  • Enables quick response to threat but is also harmful as it disrupts emotional and physiological functioning.
  • Thought to contribute to medical problems if prolonged. (Heart disease, high BP, digestive problems, memory impairment, decreased immunity).
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General Adaptation Syndrome (GAS)

  • Selye, 1956
  • Universal, non-specific responses to stress. Same physiological responses followed a range of stimuli, whether pleasant or not, and fight or flight was only the first stage of response to stress.
  • Stage 1: Alarm reaction - Awareness of stressor. Arousal attributed to activation or anterior-pituitary-adrenal cortex system.
  • Stage 2: Stage of resistance - Body tries to adapt to stressor that has not subsided in spite of resistance efforts in stage 1. Arousal decreases but still higher than normal.
  • Stage 3: Stage of exhaustion - occurs if resistance stage lasts too long. Depletion of bodily resources and energy. Ability to resist stress declines. Increased likelihood of 'diseases of adaptation' such as cardiovascular disease, arthritis and asthma.

- Cannot say all stressors produce same response

- Different stressors lead to release of different hormones

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Psychoneuroimmunology

  • Role of immune system
  • Relationships between psychosocial processes and activities of neurons, endocrine and immune systems.
  • Neurons and endocrine systems send chemical messages in the form of neurotransmitters and hormones. These increase or decrease immune function.
  • Stressful situations start with crisis and the emotional reaction continues, suppressing the immune system over extended periods.
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