Introduction to Health
Psychology
Health Psychology

Study of social, behavioural, cognitive,
and emotional factors that influence
the:

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
Maintenance of health
Development of illness and disease
Course of illness or disease
Patient’s and family’s response to illness
and disease
What is health, illness, and
disease?
World Health Definition of
Health (1948)
“A complete state of physical, mental, and
social well-being and not merely the
absence of disease and infirmity.”
Health Concept
Physical
Emotional
Vitality
Role - Physical
Role- Emot.
General Health
Social
Pain
SF-36 (John Ware et al., 1993)
– Social Functioning
1.
2.
…in past 4 weeks, to what extent have
…physical/emotional problems interfered
with normal social activities with family,
friends, neighbors, or groups.
…in past 4 weeks, how much time has
your physical/emotional problems
interfered with your social activities (like
visiting with friends and relatives)?
SF-36 (John Ware et al., 1993)

Role limitations due to physical health – Do you
have any of the following problems with work
or other regular daily activity as a result of your
physical health?



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Cut down on …time spent on work…
Accomplished less than you would like
Limited in the kind of work you could do
Had difficulty performing work…(took more effort)
SF-36 (John Ware et al., 1993)

Role limitation due to emotional problem –
Do you have any of the following problems
with work or other regular daily activity as
a result of any emotional problems?



Cut down on time spent at work…
Accomplished les than you would like
Didn’t do work or other activities as carefully
as usual.
What are your health risks?
For each item, answer YES or No.
1.
I believe if I feel well I must be healthy.
2.
My weight is not within the range that the
charts say it should be.
I smoke cigarettes
3.
4.
5.
My drinking would not qualify as moderate
– I either do not drink or I drink too much
to be considered a moderate drinker.
I rarely get 7 or 8 hours of sleep.
What are your health risks?
For each item, answer YES or No.
6.
7.
I do not follow a regular exercise program.
I believe that most disease have a genetic
base.
8. I believe that modern medicine will find
cures for most diseases before I am old
enough to be affected by these diseases.
9. As long as I am not overweight, I believe
that my diet will not affect my health.
10. I can wait until I am older to develop a
healthier lifestyle.
Estimated contributions of different
factors to health status.
10%
30%
40%
20%
Other Factors
Genetic
Behaviour
Medical Care
Health Psychologist



Scientists who research the area
Health promotion – intervene at the social
(e.g., government policy, community) or
individual level to promote health and prevent
illness and disease.
Clinical health psychologist – intervene at the
individual level to treat illness, slow or
prevent disease progression, and reduce
disability.
Health Psychology

Development or progression of illness
and disease


Etiology
Individual’s and family’s response to
illness and disease

Outcomes
Relation of health psychology to
other health-related fields
Health
Education
Nutrition
Medicine
Psychosomatic
Cardiology
Oncology, etc.
Behavioural Behavioural
Sociology
health
Nutrition
medicine
Exercise Phys.
Health
Psychology
Psychology
Physiology
History of Medicine
History of Medicine
1. Stone-age
Body____Mind
2. Ancient Greeks
Body
Mind
Spirit
3. Middle-Ages
Body____Mind
Spirit
4. Contemporary View
Body
Mind
Socio-behavioural
Supernatural or Magical Belief;
Disease resulted from:





Sorcery
Breach of social taboo
Object intrusion
Supernatural possession
Losing one’s sole
Treatments


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Confession and appeasing of the gods.
Magical sucking to remove the intrusive
object.
Drive out evil spirits by using vile
concoctions such as animal excrement
or even torture.
Trephination
Greeks – Hippocrates
(460-377 B.C.)


Origin of the view that disease is a
natural process.
Humoral theory



View that disease occurs when the four
fluids of the body are out of balance
Four fluids are blood, black bile, yellow
bile, and phlegm.
Personality types
Hippocrates - Treatments
Temperament
Humor
Phlegmatic
Phlegm
Sanguine
Melancholic
Choleric
Disease
Cold,
headaches
Blood
Angina,
epilepsy
Black bile Hepatitis,
ulcers
Yellow
Stomach,
bile
jaundice
Treatment
Hot baths,
warm food
Blood letting
Hot baths
Blood letting,
liquid diet
Evolving view of diseases

Anatomical pathology


Tissue pathology

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Belief that disease was localized in anatomy
(16th to 18th Centuries)
Specific tissues could become diseased while
others remain healthy (Late 1800s)
Cellular pathology

Belief that life resided in cells and so cells must
be the place to look for disease (19th century)
Evolving view of diseases

Germ theory


Magic bullet


Discovery that particles in the air that could not
seen (e.g., bacteria) could cause disease.
A specific cure could be found for every ailment
that restore the person to perfect health.
Biopsychosocial model

Mind, body, and environment interact in
causing disease.
History of Medicine
Stone-age
Body____Mind
Ancient Greeks
Body
Mind
Spirit
Middle-Ages
Body____Mind
Spirit
Contemporary View
Body
Mind
Socio-behavioural
Psychosomatic Medicine

Freud (1856-1939)

Cannon (1932)

Dunbar (1930)

Alexander (1940s – 1950s)
Biopsychosocial Model of
Disease
Biology
•Genetic variability
•Anatomy
•Physiology
Pathogens
•Germs
•Toxins
Behavioural risk factors
•Diet
•Exercise
•Smoking
•Safe sex
•Wearing seat belts in the car, etc.
Social
•Family
•Society
•Friends, etc.
Biopsychosocial Model

Psychological component

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Behaviour (adoption and maintenance)
Emotional (feelings)
Cognition (thoughts, beliefs, and attitudes)
Personality – characteristic ways of
thinking and feeling
Important Contributions of
Psychology to Health


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Has provided techniques useful in changing
behaviours that affect health and illness.
Is committed to keeping people healthy
rather than waiting to only treat them when
they become ill.
Long history of developing reliable and valid
measures for assessing health-related factors.
Has contributed a solid foundation of
scientific methods for studying such
behaviours.
Please respond to each of
these items with YES or NO.
1. Personal testimonials are a good way to decide
about treatment effectiveness.
2. Newspaper reports of scientific research give an
accurate picture of the importance of the research.
3. The personal information from case studies usually
provides more valid data than information from
longitudinal studies.
4. Placebo effects apply only to suggestible people
and are not an important factor in the treatment of
most people.
Please respond to each of
these items with YES or NO.
5.
Placebo effects can influence psychological but not
physical disorders.
6.
Different research methods are not important in
determining the validity of research because all
scientific methods yield equally valuable results.
The number of participants in a research study is not
important to the validity of the study.
7.
8.
Studies with nonhuman subjects can be just as
important as those with human participants in
determining important health information.
Please respond to each of these
items with YES or NO.
9.
Experimental rather than observational research is
required to learn about patterns of disease.
10.
Valuable research is done by people outside the
scientific community, but scientists try to discount
the importance of such research.
11.
Scientific breakthroughs happen everyday.
12.
Each new report of health research seems to
contradict previous findings, so there is no way to
use this information to make good personal
decisions about health.
Research Methods
Case Studies

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In depth analysis of one individual
Type of single-subject research design


Advantage is a more complete analysis of
the individual
Disadvantage is that it can magnify
sampling errors
Correlational Studies


Yield degree of relationship between
two variables
Type of descriptive research design


Advantage is that it can examine variables
that cannot be experimentally manipulated
(e.g., IQ and occupational status).
Disadvantage is that it cannot determine
causality.
Cross-Sectional Study Designs

Compares groups at one point in time
(e.g., age groups, ethnic groups,
disease groups)


Advantage is that it is an efficient way to
identify possible group differences because
you can study them at one point in time.
Disadvantage is that you cannot rule out
cohort effects.
Personality and Hypertension,
The effect of Hypertension
Awareness (Irvine et al. 1989)
Hypertension Study
Matched
Normotensive
1st BP Screen
2nd BP
Screen
DBP >= 90 but
< 115 mmHg
Personality
Study
2nd BP Screen
2-3 weeks later
Personality
Study
3rd BP Screen
3 months
DBP < 105
4th BP Screen
4 months
5th BP Screen
5 months
Mean DBP>= 90 mmHg
Hypertensive
Personality and Hypertension:
Effect of Hypertension Awareness
Variable
Group 1
Aware
Hypertensive
Group 2
Normotensive
Group 3
Unaware
Hypertensive
Group 4
Normotensive
% Male
75
75
89
89
Age
Mean*
(SD)
46.2
(9.2)
46.2
(8.2)
46.4
(8.3)
45.8
(8.0)
135.8/
93.8
(8.2/3.4)
118.5/
75.7
(10.3/4.8)
SBP/DBP 135.1/
118.7/
Mean*
93.9
76.3
(SD)
(9.2/5.1) (11.5/5.5)
Personality and Hypertension:
Effect of Hypertension Awareness
Variable
Neuroticism
Mean*
(SD)
Type A
Mean*
(SD)
Group 1 Group 2
Aware
HyperNormotensive
tensive
Group 3
Unaware
Hypertensive
Group 4
Normotensive
12.0
(5.3)
9.3
(5.3)
9.7
(4.8)
9.5
(4.6)
0.79
(8.5)
-3.0
(9.4)
-2.0
(9.4)
-2.6
(8.2)
* Group 1 > Group 2 & Group 3 (p < 0.01)
Personality and Hypertension:
Effect of Hypertension Awareness
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
Aware Hyper
Normot
Unaware Hyper
Normot
Neuroticism
Aware hypertensive > normotensive & unaware hypertensive,
P < 0.001
Personality and Hypertension:
Conclusion

Do hypertensives have a different
personality than those with normal blood
pressure?


No, because the unaware hypertensives did
not differ from the normotensives.
Why did the aware and unaware
hypertensives differ?

Possible explanations?
Personality and Hypertension:
Conclusion

Awareness of hypertension status
confounds assessment of the
association between personality
characteristics and hypertension.


Due to hypertension labeling effect; or
Due to self-selection bias
Longitudinal Design

To gather data on the course of health
or disease over time (e.g., progression
of multiple sclerosis).


Advantage is that you can see the time
course of the disease or behaviour (e.g.,
smoking cessation over time).
Disadvantage is it is costly and still subject
to bias
Experimental Designs

Examines differences between
experimentally manipulated groups
(e.g., one group gets a certain drug and
the other gets a placebo).


Advantage is that you can determine
causality.
Disadvantage is cost and many variables
cannot be experimentally manipulated
(e.g., smoke exposure over time).
Please answer anonymously
these questions
1.
2.
3.
4.
What is the main thing you learned from this
lecture?
What is the main question you have that wasn’t
answered?
The things the instructor did best …OR the best
things about the lecture that were?
The things the instructor did worst …OR the
worst things about the lecture that were?