Lecture 1: Introduction to
Health Psychology
Dr. Antoinette M. Lee
The University of Hong Kong
What is Health Psychology?

“Health psychology is the aggregate of the specific
educational, scientific, and professional
contributions of the discipline of psychology to the
promotion and maintenance of health, the
prevention and treatment of illness, and the
identification of etiologic and diagnostic correlates of
health, illness and related dysfunction”
Matarazzo (1980) p.815
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
What is Health Psychology?

The scientific study of how psychological factors
relate to the promotion and maintenance of health,
and causation, prevention, and treatment of physical
illnesses, as well as how people respond when they
do get ill (Taylor, 1999)

Psychological factors: behaviors, emotions, beliefs,
attitudes, personality, and stress etc
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
What Do Health Psychologists
Do?

Research

Practice


Individual and community levels
Prevention of physical illnesses and health
promotion; treatment of and adjustment to
physical illnesses
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Examples of Health
Psychologists at Work

Patients with coronary heart diseases (CHD):
 Health psychologists can help these patients change
behaviors (reduce health-compromising behaviors and
increase health-enhancing behaviors) to reduce the
likelihood of future attacks
 Health psychologists also teach these patients relaxation
techniques to reduce stress that affect the risk of further
heart problems
 Health psychologists help patients modify Type A
behaviors and hostility
 Health psychologists also help these patients deal with
depression and anxiety that are common among CHD
patients
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Examples of Health
Psychologists at Work

Prevention of CHD:


Efforts to reduce health-compromising behaviors
and increase health-enhancing behaviors among
those with risk factors for CHD e.g. hypertension,
high serum cholesterol
Help in designing heath promotion campaigns in
community that target at changing risk factors for
CHD (e.g. anti-smoking and anti-obesity
campaigns)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Examples of Health
Psychologists at Work

Cancer

Working with cancer patients:
 Health psychologists help patients dealing with
emotional adjustment problems, including
depression and anxiety
 Pain management
 Group psychosocial interventions for reducing
stress, improving social support, dealing with
treatment side effects, and reducing rate of
recurrence
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Examples of Health
Psychologists at Work

Cancer

Prevention:


Changing health-compromising behaviors (e.g.
smoking) among high-risk individuals
Designing public campaigns:



Cancer awareness
Encouraging participation in screening programs
Reducing cancer-related behaviours
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Historical Development

Early cultures



Mind and body as a unit
Illness believed to be caused by evil spirits
Trephination
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Historical Development

Ancient Greeks:




Hippocrates developed the humoral theory of illness; later
elaborated by Galen
Disease caused by an imbalance of the four humors:
blood, black bile, yellow bile, and phlegm; humoral
imbalance also have an impact on the mind
Treatment involved restoring balance among the humors
Mind and body as separate entities
 But Hippocrates did believe that health includes both
physical and emotional aspects
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Historical Development

Middle Ages:
 Disease seen as God’s punishment for wrongdoing
 Cure consisted of torturing the body to drive out the evil

The Renaissance and After:
 Mind and body as separate entities to severe the ties
between mysticism and disease – mind-body dualism
 Development of microscopy, autopsy, antiseptic techniques
and anesthesia
 Rejection of the humoral theory
 Biomedical Model, for the next 300 years
 All disease or physical disorders can be explained by
disturbances in physiological processes resulting from
injury, biochemical imbalances, bacterial or viral infection
and the like
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Historical Development:
Emergence of Health Psychology

Challenges to the biomedical model led
to the development of:

Psychosomatic Medicine

Behavioral Health

Behavioral Medicine
Health Psychology

Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Psychosomatic Medicine

Freud: unconscious psychological conflicts as the cause
of certain physical disturbances
 Conversion hysteria
 Established that repressed feelings, experiences and
conflicts becomes converted into physical problems
such as paralysis and blindness
 Psychological intervention needed in treatment of
physical problems
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Psychosomatic Medicine

Dunbar and Alexander:
 Personality: ulcer-prone personality:
excessive need for dependency and love
 Alexandra: 7 psychosomatic illnesses
 Peptic ulcer, asthma, essential hypertension,
hyperthyroidism, rheumatoid arthritis,
neurodermatitis, and colitis
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Psychosomatic Medicine

The study of physical problems in which the cause is
psychological rather than physical

1930: the National Research Council began publishing
the journal Psychosomatic Medicine

Criticism:
 Too simplistic: disease caused by interaction of a variety
of factors rather than a particular repressed conflict or
personality type alone
 Psychosomatic approach to illness much more useful
than the concept of Psychosomatic illnesses
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Behavioral Health

Maintenance of health and prevention of
illness in currently healthy individuals through
the use of educational inputs to change
behaviors and lifestyle

Role of behavior in determining one’s health
status

Integration of the mind and body
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Behavioural Medicine

Integration of the behavioral sciences with the
practice and science of medicine (Gatchel,
Baum, & Krantz, 1989)

Interdisciplinary

Challenges the biomedical separation of the
body and the mind
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Behavioral Medicine

Role of behaviors

Evaluation, prevention and treatment of physical
disease or physiological dysfunction

Heavily related to behaviorism

Focus not only on treatment as in the
biomedical model, but also in the prevention
of illness
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Psychology




Based within psychology
Division of Health Psychology formed within
the American Psychological Association in
1978
Draws upon knowledge from other subfields in
psychology including clinical, experimental,
and social psychology
A role for the mind in both the cause and
treatment of illness
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Psychology

Psychology influences on health:

Direct pathway


Indirect pathway



E.g. physiological effect of stress on CHD and cancer
Health related behaviors e.g. smoking, diet, exercise
Impact on vulnerability to illness
Reactions to illness

E.g. delayed help-seeking
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Factors Contributing to the
Growth of Health Psychology?

Changing patterns of disease and increase in life
expectancy




From Acute Infectious Diseases to Chronic Diseases
 Differences in cause, course, treatment and impact
(individual and the family) of acute and chronic disease
Re-emergence of the significance of infectious diseases:
AIDS, SARS, bird flu……..
Decrease in age of onset of certain diseases
Advances in medical technology and research
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Factors Contributing to the
Growth of Health Psychology?

Increasing health care costs & disease burden

The importance of prevention

Increased acceptance and acknowledgement by
medical personnel

Demonstrated contribution to health


Changing health-compromising behaviors, pain
management, treatment adherence, dealing with treatment
side effects….
The limits of medicine
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Psychology
I.
Mind-Body Interface & Biopsychosocial Approach
II.
Prevention of Disease and Promotion of Health in
addition to Intervention and Treatment
III. The Role of Behaviors and Lifestyle Factors
IV. Application of Psychological Theories and
Methodologies
V
Working on Both the Individual and Community
Levels
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
I. Mind-Body Interface
What is Health?
Hippocrates:
 Health as a natural balance of both physical
and emotional aspects, mediated by a
harmonious mixture of the humors
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Mind-Body Interface

“The reason why a sound body becomes ill,
or an ailing body recovers, very often lies in
the mind”
Gaub (1747), professor in medicine

“There is much ‘physical’ in ‘mental’ disorders
and much ‘mental’ in ‘physical’ disorders”
DSM-IV-TR (2000)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Psychological Problems and
Physical Illness
Five forms of relationship:
 Psychological factors as causes of physical illness
 Psychiatric disorders presenting with physical symptoms
 Psychiatric consequences of physical illness
 Psychiatric and physical disorder occurring together by
chance
 Psychiatric problems with physical complications (e.g.
deliberate self-harm, alcohol and substance abuse,
eating disorders)
From Oxford Textbook of Psychiatry
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Role of Psychology in Health and
Illness





Stress
Behaviours
Help-seeking
Adjustment to physical illnesses
Adherence to treatment
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Biopsychosocial Approach

World Health Organization (1948),
“a complete state of physical, mental, and
social well-being and not merely the
absence of disease of infirmity”

Therefore, health is achieved with a balance
of physical, mental, and social well-being
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
What is Psychological
Health?

Criteria of psychological health suggested by
Capuzzi and Gross (1997):









Self-acceptance and self-esteem
Self-knowledge
Self-confidence and control
Clear (though slightly optimistic) perception of reality
Courage and resilience
Balance and moderation
Love of others
Love of life
Purpose in life
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Disease versus Illness

Disease: deviation from health
~ What the doctor identifies as an
abnormality in health

Illness: the discomfort the patient experiences
~ What the patient identifies as symptoms
and feels (fear, distress, etc.)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Reflection

Why do we want good health?

What is health for?


A means to what?
What contributes to health?
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Biomedical vs Biopsychosocial
Model
Factor
Causes of
Illness
Antoinette M. Lee, HKU
Biomedical
foreign
bodies (viruses or
bacteria) entering the body
internal, involuntary,
somatic changes such as
the imbalance of chemicals
Master of Behavioral Health
Health Psychology Module Spring 2005
Biopsychosocial
Combination
of
biological, social, and
psychological factors
Biomedical vs Biopsychosocial
Models
Factor
Responsibility
for illness
Treatment of
Illness
Antoinette M. Lee, HKU
Biomedical
Biopsychosocial
External
factors
Patient
Patient is victim to Certain behaviors and
illness (helpless)
cognition affect the
formation and cessation
of illness
Alters
physical
changes in body via
vaccinations,
chemotherapy,
surgery, etc.
Treats
the person as a
whole, including
modifying behaviors that
cause harmful effects to
health
Master of Behavioral Health
Health Psychology Module Spring 2005
Biomedical vs Biopsychosocial
Models
Factor
Biomedical
Responsibility  Medical
for treatment profession
Biopsychosocial
Patient
is in part
responsible:
to adhere to treatment
change beliefs and
behaviors

Relationship
between
health and
illness
Antoinette M. Lee, HKU
Health
and illness
seen as
qualitatively
different
No continuum in
between
Health
and illness
exist on a continuum
Individuals
progresses from
healthiness to illness
and back again
Master of Behavioral Health
Health Psychology Module Spring 2005
Biomedical vs
Biopsychosocial Models
Factor
Mind-Body
Relationship
Antoinette M. Lee, HKU
Biomedical
Separate
entities
One has no influence on
the another and vice versa
Master of Behavioral Health
Health Psychology Module Spring 2005
Biopsychosocial
Mind
and body still
seen as separate but
reciprocal influence on
each other
Interaction between
the mind and body is
evident
Holistic approach to
health
Biomedical vs
Biopsychosocial Models
Factor
Role
of
psychology in
health and illness
Antoinette M. Lee, HKU
Biomedical
Illness
Biopsychosocial
have psychological Psychological factors
consequences but not
as both possible
psychological causes
causes and
consequences of
illness; also impacts on
progression of illness
Both a direct and
indirect association
between psychology
and health
Master of Behavioral Health
Health Psychology Module Spring 2005
II. Prevention

Primary prevention



Secondary prevention



Modification of risk factors (e.g. smoking, drinking) before
illness onset
Health promotion efforts are a form of primary prevention
Interventions aimed at detecting illness at an asymptomatic
stage so that its progression can be haltered or retarded
E.g. screening
Tertiary prevention


Treatment interventions once an illness has manifested
itself to prevent it from worsening
Rehabilitation of patients
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Promotion



Good health is a personal and collective
responsibility
The importance of good health habits and
healthy lifestyles
Concerted effort of individual, medical
personnel, health psychologists, government,
and the mass media
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
III. Role of Behaviours in Health
and Illness

Behavior and mortality






50% of mortality from the 10 leading causes of
death is due to behavior
Tobacco consumption accounts for 30% of all
cancer deaths (90% of lung cancer deaths)
Alcohol: 3%
Diet: 35%
Reproductive and sexual behavior: 7%
75% of all deaths due to cancer related to
behaviors
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Role of Behaviors

Behavioral risk factors associated with the 5 leading
causes of death:





Heart disease:
 smoking, high dietary cholesterol, lack of exercise
Cancer:
 smoking, high alcohol use, diet
Stroke:
 smoking, high dietary cholesterol, lack of exercise
COPD (Chronic lung diseases):
 smoking
Accidents:
 alcohol/drug use, speeding, not using seat belts
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Role of Behaviors

Behavioral risk factors associated with the 5
leading causes of death:





Heart disease: smoking, high dietary cholesterol,
lack of exercise
Cancer: smoking, high alcohol use, diet
Stroke: smoking, high dietary cholesterol, lack of
exercise
COPD (Chronic lung diseases): smoking
Accidents: alcohol/drug use, speeding, not using
seat belts
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Role of Behaviors

Role of Obesity:

10% reduction in weight among men between 35
to 55 would lead





20% decrease in coronary heart disease
 Degenerative arthritis
 GI cancer
 Diabetes
 Stroke
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Role of behaviors

And consider the role of behaviors in these
health conditions as well:

Infectious diseases






AIDS, STDs
SARS
Hepatitis B
Diabetes
Hypertension
Obesity
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Longevity Factor







Sleeping 7-8 hours a day
Having breakfast every day
Not smoking
Rarely eating between meals
Being near or at prescribed weight
Having moderate or no use of alcohol
Taking regular exercise
Belloc & Breslow (1972), Belloc (1973), Breslow & Enstrom (1980)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Longevity Factors

Prospective longitudinal study of 7000 people

Health status of those over 75 who practiced all 7
health habits were comparable to those aged 35 to
44 who practiced less than 3

At 9.5 years follow-up: Men practicing all 7 health
habits had mortality rate of only 28% that of men
practicing 0 to 3 of the health habits, women
practicing all 7 health habits had mortality rate of
only 43% that of men practicing 0 to 3 of the health
habits
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Daily diet, risk of CVD, and
Longevity
The Polymeal:
Ingredients
Wine (150ml/day)
Fish (114g four times/week)
Dark chocolate (100g/day)
Fruit & vegetables (400g/day)
Garlic (2.7g/day)
Almonds (68g/day)
Combined effect
Antoinette M. Lee, HKU
% reduction (95%CI) in risk
of CVD
32 (23 to 41)
14 (8 to 19)
21 (14 to 27)
21 (14 to 27)
254 (21 to 27)
12.5 (10.5 to 13.5)
76 (63 to 84)
Master of Behavioral Health
Health Psychology Module Spring 2005
Daily diet, risk of CVD, and
Longevity

For men: total life expectancy increases by 6.6
years; life expectancy free from CVD increases by 9
years; life expectancy with CVD decreases by 2.4
years

For women: total life expectancy increases by 4.8
years; life expectancy free from CVD increases by
8.1 years; life expectancy with CVD decreases by
3.3 years
Franco et al. (2004). BMJ, 329: 18-25.
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Types of Health-Related
Behaviors
Kasl & Cobb (1966):
1.) Health Behavior: behavior aimed at
preventing disease (e.g healthy diet)
2) Illness Behavior: behavior aimed at seeking
remedy (e.g. seeing the doctor)
3) Sick Role Behavior: any behavior aiming to
get well (e.g. rest, medication)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Behaviors


Matarazzo (1984) further defined health behaviors in terms of
either:
Health impairing habits:
 “behavioral pathogens”
 habits that will deteriorate health (e.g. high fat diet,
smoking, substance abuse)
Health protective behaviors:
 “behavioral immunogens”
 behaviors that will maintain health (e.g. enough sleep
everyday, regular exercise, attending health checks,
seeking health information, using headsets while driving/not
talking on mobile phones at all while driving)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
How Can Behaviors be
Changed?

Behaviors play an important role in health
and illness, so how can we change people’s
behaviors for the better?
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
III. Models and Theories in Health
Psychology

Attributional Theories

Cognition and Social Cognition Models

Learning Theories:
 Classical Conditioning
 Operant Conditioning
 Social Learning

Cogintive-Behavioural Approaches
 For predicting and changing behaviors as well as for
understanding and developing interventions for other areas in
health psychology
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Applications of These Methods
For:

Changing behaviours


Increase
Decrease
Coping with medical procedures
 Coping with pain
 Stress management
 Improving treatment adherence
…………………….

Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Models of Health Behavior
Change
How can we predicting and changing
health behaviors?

Attributional Theories

Cognition Models:
 Health Belief Model (HBM)
 Protection Motivation Theory (PMT)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Models of Health Behavior
Change

Social Cognition Models:
 Theory of Planned Behaviour (TPB)
 Health Action Process Approach
(HAPA)

Transtheoretical Model of Behavior
Change: The Stages of Change Model
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
In-Class Exercise

How do you apply these models in
understanding and changing the following
health behaviors?



(1) screening (e.g. pap smear, mammogram)
(2) using serving spoon and chopsticks
(3) condom use
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Attribution Theories

Health Locus of Control (Wallston & Wallston, 1982)
 Whether an individual regards his health as controlled
by themselves or external events
 Internal locus of control
 External locus of control
 Controlled by powerful others
 Controlled by chance / fate
 Affects whether an individual changes his behavior
 Is health locus of control a state or a trait? Can we be
both external and internal?
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Attribution Theories

Why Do People Continue Unhealthy Behaviors,
Even With Knowledge of the Hazards?
Unrealistic Optimism (Weinstein, 1983 &1984):

Inaccurate perceptions of actual risk of and
susceptibility to illness

Majority of subjects thought that they were
less likely than other to contract an illness
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Unrealistic Optimism

Four cognitive factors contributing to
unrealistic optimism:
1)
Little or no experience with illness
2)
Illness can be avoided with individual action
3)
Believe that if illness has not developed yet,
it will not develop in the future
4)
Believe that the illness is rare
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Unrealistic Optimism

Weinstein believed this phenomenon occurs
because of the individual’s focus on riskreducing behaviors rather than riskincreasing behaviors

Egocentrism also reinforces the riskincreasing behaviors of others rather than
their risk-reducing behaviors

Therefore, the individual perceives the risk of
illness upon themselves is less likely than the
risk of others
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Belief Model (HBM)

Rosenstock (1966)
Perceived
Susceptibility
Perceived
Vulnerability
Perceived
Severity
Likelihood of
Engaging in
Health
Behaviour
Perceived
Benefits
Perceived
Barriers / Costs
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Cue to
Action
(internal,external)
Health Belief Model

Health behavior predicted by the following set of
beliefs:
 High susceptibility to illness
 High severity of illness
 Low costs and high benefits for behavior
 Prompts for behavior to occur

Becker & Rosenstock (1987): +


High level of concern for health (health
motivation, general health values)
Perceived control
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Strategies for Behavior
Change (HBM)







Assess individual’s perceived susceptibility
and severity of health threat
Design health message accordingly
Assess and discuss perceived benefits of
behavior change
Elicit perceived costs / barriers
Design ways of overcoming these barriers
Elicit perceived benefits
Elicit potential cues
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Belief Model


In using the HBM, an action can be
predicted with the evaluation of the different
beliefs
For example, let’s consider the action of
quitting smoking; the person will think:
 “I have high susceptibility of lung cancer.”
 “Lung cancer is a severe illness.”
 “The cost of quitting cigarettes is without
them, I will be tense and nervous.”
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Belief Model




“However, quitting smoking will help me
save a lot of money .”
“I have been shown a pamphlet that
outlined the hazards of smoking.”
“I have high concern for my health
because my family depends on me.”
“I believe I can control my health by
quitting smoking.”
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Belief Model

According to all of the above comments, this
individual’s incentive to quit smoking is high
and will likely carry out the behavior
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Belief Model

However, there are several drawbacks to this
model:
 Studies have found that low perceived
severity, rather than high, influence
behavior
 Other studies have shown a low perceived
susceptibility rather than high can also
influence behavior
 Focuses on the person and his
consciousness rather than any social or
emotional influences
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Protection Motivation Theory
(PMT)

Rogers (1975, 1983, 1985) introduced the
PMT, which elaborates the HBM
Severity
Perceived
Susceptibility
& Vulnerability
Threat
Appraisal
Fear Arousal
Behavioural
Intentions
Response
Efficacy
SelfEfficacy
Response
Cues
Antoinette M. Lee, HKU
Coping
Appraisal
Master of Behavioral Health
Health Psychology Module Spring 2005
Behaviour
Protection Motivation Theory

According to this theory, five factors influence
health-related behaviours:

Severity of illness

High susceptibility to illness

Emotional Response (such as fear)

Response Effectiveness

Self-efficacy
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Threat
Appraisal
Coping
Appraisal
Protection Motivation Theory

Threat Appraisal: individuals examining
external threat

Coping Appraisal: individuals examining
their own capabilities
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Protection Motivation Theory

Individuals examine these protection
motivation factors to conclude if a
certain behaviour is warranted based
on:
 Environmental information (e.g.
Information leaflets, observational
learning)
 Intrapersonal information (e.g.
experiences from the past)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Protection Motivation Theory

Two resulted health-related behavioural
change:
 Adaptive Coping Response: intention
present for a change in behaviour
 Maladaptive Coping Response:
avoidance or denial
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Protection Motivation Theory

How the model works (in the case of the
smoking habit change):
 Fear increases when the person witness the
pain suffered by his father going through lung
cancer
 Person’s perception of the imminent threat of
lung cancer due to smoking therefore
increases
 Person has confidence that he will start
smoking less and eventually quit such that it
will decrease the chance of lung cancer
=> Intentions are high for person to change
behaviour
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Strategies

What strategies can you use to facilitate
behavior change based on the ProtectionMotivation Theory?
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Theory of Planned Behavior
Theory of Planned Behavior (Ajzen, 1985&1988)

health behavior is the result of behavioral
intentions which are affected by:



attitudes towards the behavior
subjective norms
perceived behavioral control
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Theory of Planned Behaviour
(TPB)

Ajzen (1985,1988)
Behavior
Beliefs
Outcome
Evaluation
Attitude
towards
the
Behavior
Behavioral
Intentions
Normative
Beliefs
Subjective
Norms
Motivation to
Comply
Antoinette M. Lee, HKU
Perceived
Behavior
Master of Behavioral Health
Control
Health Psychology Module Spring 2005
Behavior
Theory of Planned Behaviour

TPB consist of the following three factors in
deciding a behavioural change:



Attitude towards the behaviour: view the pros and
cons of the behaviour and evaluate the result of the
behavioural change
Subjective Norm: perception of social norms and
pressures in a behavioural change and the
willingness to comply with the pressures
Perceived Behavioural Control: Internal and
external control factors are considered
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Theory of Planned Behaviour

Back to the smoking habit example:


Person weights the pros and cons of
quitting smoking and concludes that
not smoking can maintain a better
state of health
Person feels that his second-hand
smoke affects his the health of his
family and that if he choose to quit, his
family will support his decision
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Attitude
towards
the
Behavior
Subjective
Norms
Theory of Planned Behaviour
- Person feels that they could control the
amount of cigarettes he has in a day and
will slowly wean off them
Perceived
Behavior
Control
=> Evaluating these three factors, intentions are high for
person to reduce the amount of cigarette intake
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Strategies

What strategies can you use to facilitate
behavior change based on the Theory of
Planned Behavior?
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach (HAPA)

Developed by Schwarzer (1992)
Outcome
Expectancies
Self-Efficacy
expectancies
Vocational Process
Action
Plans
Severity
Behavioral
Intention
Behavior
Threat
Vulnerability
Antoinette M. Lee, HKU
Action
control
Situational Barriers
and Resources
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach

HAPA splits the process into:
1) Decision-making/ Motivation stage
2) Action/Maintenance stage

In doing so, it adds a temporal and
mental processing factor into the
process of a behavioural change
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach
1)
Decision-making/ Motivation stage
components:

Self-efficacy- how confident a
behaviour will be carried out

Outcome Expectations- anticipated
outcomes of behaviour towards self
and others

Threat Appraisal- illness severity and
the probability of having illness
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach
2) Action/Maintenance stage :
 Integration of three factors (cognitive,
situational, & behavioural) determines the
nature of initiation and maintenance of the
behaviour
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach

The Three Factors:
 Cognitive factor: consist of action plans
& action control  Determines
individual’s will
 Situational factor: consist of social
support & situational barriers
 Behavioural factor: maintenance of a
behavior is heavily determined by selfefficacy
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach

How it works
 Individual decides on quitting smoking
(motivation stage):

Self-efficacy: “I have confidence in
quitting.”

Outcome expectancies: “If I quit, I would
not cough as often and my chances of
lung cancer will decrease.”

Threat Appraisal: “Respiratory diseases
are very serious and will shorten my life.”
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach

Individual plans for quitting smoking (action stage):

Cognitive: “I will try to avoid situations in which I
will be offered a cigarette to smoke.”

Situational: “My family does not enjoy my second
hand smoke and will support me to stop
smoking.”

Behavioral: “Because I have the confidence to
stop smoking, I will prolong this behavior as long
as I can so that my family and I will enjoy
healthier lives.”
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Health Action Process
Approach

Crucial points:
 Self-efficacy is emphasized in HAPA for
successful behavioural change, since it
plays a role in both the intentions and
cognitive plans for maintenance in
behavioural change

HAPA also emphasizes a link between
intentions and behavior
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Transtheoretical Theory of
Behavior Change





The Stages of Change Model (Prochaska & DiClemente,
1982)
Dynamic Model
Behavioral changes occurs in stages
Stages may not always occur in as linear manner
 Revolving door
Needs vary in different stages, so do intervention
strategies
The need to tailor treatment goals and interventions to
specific stage the individual is in
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
The Stages of Change Model
5 Stages:

Precontemplation: not intending to make any changes

Contemplation: considering a change: awareness of the
problem but have not made a commitment to change

Preparation: intends to change but has not yet begun to
change, sometimes making small changes

Action: actively engaging in behavior change

Maintenance: sustaining the change over time
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Transtheoretical Theory of Behavior
Change: The Stages of Change Model
Contemplation
Pre-Contemplation
Relapse
Maintenance
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Action
Strategies

What strategies can you use to facilitate
behavior change based on the Stages of
Change Model?
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Learning Theories

Problem behaviors are learned behaviors

Many principles derived from experimental
psychology

Functional Analysis: ABC of behavioral therapy



A: antecedent
B: behavior
C: consequence
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Learning Theories
(1) Classical conditioning
(2) Operant conditioning
(3) Social (Observational )learning
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Classical Conditioning

Pavlovian or respondent conditioning

A stimulus elicits a certain response




Unconditioned Stimulus (UCS)
Unconditioned Response
Conditioned Stimulus (CS)
Conditioned Response (CR)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Classical Conditioning: The
Process

1.) US (food) elicits UR (salivation)
naturally
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005

2.) The neutral stimulus was paired with the US for
a number of times
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005

3.) CS (food dish) alone produces CR
(salivation)
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Classical Conditioning:
Applications in Health Psychology

Chemotherapy and anticipatory nausea

Substance abuse


Dependence
Relapse

Placebo effect

Aversive conditioning and aversive therapy


Pairing an aversive (unpleasant) stimulus with the
undesirable behavior
E.g. Antabuse for alcoholism
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Operant Conditioning


Instrumental conditioning
A response is emitted to obtain an outcome




Behaviors operate on the environment to produce
consequences
Controlled by its consequences
Reinforcement (positive or negative) and
punishment
Behavior change occurs when the
consequences of the behavior are changed
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Operant Conditioning:
Applications in Health Psychology

Secondary gains

Withdrawal symptoms

Biofeedback

Self-Management programs
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Self Management Programs

self observation and self-monitoring

self-reinforcement

contingency contracting

covert sensitization

stimulus control
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Social / Observational
Learning




Learning through observing the
consequences of behaviors performed by
others
Vicarious learning
Learning maladaptive behaviors
Learning adaptive behaviors and responses
through modelling
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Cognitive-Behavioral
Approaches
Focus on
 (i) the conditions that elicit and maintain unhealthy
behaviors and factors that reinforce these behaviors
 (ii) cognitions and beliefs that interfere with behavior
change e.g. self-doubts, self-defeating thoughts
 Incorporates both cognitive and behavioral (classical
and operant conditioning, social learning)
techniques
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
V. Community-Based Interventions
for Behavior Change: What Works
and What Doesn’t

1.) The message
 Colorful and vivid
 Avoid jargons
 Case histories
 Very extreme messages should be avoided
 For illness detection behaviors: emphasizing the problems
 For health promotion behaviors: emphasizing the benefits
 Use of fear? - useful but need to be coupled with effective ways
to change the behavior that the audience is capable of following

2.) The communicator
 Credibility – expert, trustworthy, prestigious
 Likeability
 Similarity to audience
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005
Community-Based Interventions for
Behavior Change: What Works and
What Doesn’t

3.) How the message is communicated




Strong arguments should be presented at the beginning
and end of the message, not in the middle
Short, clear and direct
State conclusions explicitly
4.) The audience


If audience is already receptive of change: include
supporting only
If audience is not receptive: discuss both sides of the issue
Antoinette M. Lee, HKU
Master of Behavioral Health
Health Psychology Module Spring 2005