Module: Health Psychology
Lecture: Introduction to Health Psychology
Date:
19 January 2009
Chris Bridle, PhD, CPsychol
Associate Professor (Reader)
Warwick Medical School
University of Warwick
Tel: +44(24) 761 50222
Email: C.Bridle@warwick.ac.uk
www.warwick.ac.uk/go/hpsych
Aims and Objectives


Aim: To provide an introduction to the discipline of health
psychology and the health psychology module
Objectives: The student should be able to provide a basic
description of the …

nature of health psychology, e.g. who and what are studied

levels of clinical application of/for psychology

pathways through which psychological processes influence
physical health

structure and content of the module

module requirements, e.g. tutorial tasks
What is Health Psychology?
 Psychology is both an academic and applied discipline
involving the scientific study of mental processes and
behaviour.
 Classic definition: ‘… the aggregate of the specific
educational, scientific and professional contribution of the
discipline of psychology to the promotion and maintenance of
health, the prevention and treatment of illness, the
identification of etiologic and diagnostic correlates of health,
illness and related dysfunction’ (Matarazzo, 1980)
 Pragmatic definition: Health psychology is the study of
psychological processes that influence health, illness and
health care
Implications of Our Working Definition
Health psychology is the study of psychological processes
that influence health, illness and health care

Four questions:
1. In who do psychological processes exert influence, i.e.
who gets studied?
2. What types of psychological process are studied?
3. How do processes influence health, illness and health
care?
4. In what ways can psychology be applied in clinical
practice?
1: Psychological Processes in Who?

People who receive health care

Patients: anyone interacting with a health care professional or
service



People who provide health care



Users: perceived presence of symptoms driving health care use
Consumers: active, and proactive, care seeking by the
asymptomatic
Providers: professional responsibility to provide care directly to
patient
Carers: as above, but without professional responsibility
People who organise health care


Purchasers / managers: who fund and evaluate local service
against benchmark quality indicator, e.g. treatment targets
Policy- / Decision-makers: set national-level quality indicators,
provide clinical guidance and allocate financial resources
2. Processes Studied in Health Psychology
 Multiple developmental influences, in particular
 Behaviourism
 Social Psychology
 Cognitive Psychology
Behaviourism


The scientific study of how reward and
punishment (stimuli) affect emotion and
behaviour (response)
Empirical approach: Vary contingencies
of reward and punishment and measure
effect on behaviour

Try to explain all behavior without going
inside the ‘black box’, i.e. the mind

Behaviour is a conditioned response
occurring in the presence of a stimuli

Operant conditioning (Skinner)
Classical conditioning (Pavlov)
If behaviour is learned, it can also be
unlearned / modified through
conditioned learning
Classical conditioning (Watson)
Behavioural Conditioning
A Clockwork Orange
Alex given drug to induce extreme nausea
(response) whilst also being forced to watch
graphically violent films (stimuli) for two weeks
At treatment end, Alex is unable to even think
about violence without crippling nausea, e.g.
conditioned response in presence of the paired
stimuli
Fiction or reality? This is an example of classical
conditioning, and describes the use of aversion
therapy.
Addiction believed to have its roots in
conditioning, e.g. positive stimuli associated with
consumption of food, alcohol, drugs, etc.
Social Psychology




The scientific study of the way in which people’s thoughts,
feelings, and actions are influenced by the social
environment
Empirical approach: Vary aspects of social environment
and see how this affects thoughts, feelings, and/or
behaviour
Posit psychological processes as explanations for observed
effects
Classic examples: Obedience
Milgram’s Obedience Study

Pain-induced learning (Milgram, 1963)

Procedure: A study about ‘learning’



Ask questions to another ‘subject’ in the
next room
Authority figure instructs subject to
administer increasing ‘shock levels’ in
response to wrong answers
Question: How obedient will people be?

Obedience measure: Shock level
administered

Levels: ‘moderate’, ‘strong’, .very strong’,
‘intense’, ‘danger–severe’, ‘XXX’
Obedience
 Result: 65% administered highest shock level
 Interpretation: Perceived legitimate authority
facilitates obedience
‘The ordinary person who shocked the victim did so
out of a sense of obligation - an impression of his
duties as a subject - and not from any peculiarly
aggressive tendencies.’ (Milgram)
Obedience in Health Care?

Drug administration


Result:

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Nurses asked, by Dr on phone, to give patient a nonprescribed and incorrectly dosed drug
21 / 22 administered the drug
Interpretation:

Perceived legitimate authority facilitates obedience
(Hoffling et al)
Cognitive Psychology
 The scientific study of basic mental abilities
 perception, learning, memory, language, problemsolving, etc. – ‘information-processing approach’
 Empirical approach: Vary information input,
measure performance output
 Posits psychological processes that account for
observed effects
 Classic examples: Stroop Effect
Stroop Effect


Name the colour of each block: Start
top left, work down and then across
Two measures: (1) response/reaction
time, and (2) errors
Easy?

Quick time?

No errors?
(Stroop, 1935)
This time – coloured words instead of coloured blocks
 Name the colour in which the word is written

e.g. ‘table’ the answer / response would be ‘yellow’
yellow
white
pink
grey
black
orange
yellow
purple
orange
green
tan
red
green
purple
grey
orange
pink
black
orange
white
yellow
Not so easy?
 Took longer?
 Didn’t finish?
 More errors?
Answered ‘yes’
to 1 or more
above?
That makes
you ..
… NORMAL
(Stroop, 1935)

Stroop Effect



Result: Fewer errors and faster time to name color
alone than in presence of word written in
conflicting colour
Explanation: Presence of conflicting colour word
interferes with processing ability / task
performance
Conclusion: The meaning of a word is processed
automatically, without intention
Social
Psychology
+
Cognitive
Psychology
= Social Cognition
Social Cognition

The scientific study of how people make sense of
their social world:



How they perceive, represent, interpret, and
remember information about themselves, others and
social groups
Information processing in its social context
Key question: Is the combined total more than the
sum of its parts?
What does social cognition offer over and above the
contributions of social and cognitive psychology?
New methodologies:
Stroop & Person-perception
Race of Person
Caucasian (White)
African-american (Black)
W
Colour
Of Ink
B
(Karylowski, et al., 2002)
New methodologies:
Stroop & Person-perception
Race of Person
Caucasian (White)
African-american (Black)
W
Match 
Mismatch 
B
Mismatch 
Match 
Colour
Of Ink
(Karylowski, et al., 2002)
New methodologies:
Stroop & Person-perception
Race of Person
Caucasian (White)
African-american (Black)
W
Jerry Seinfeld
Oprah Winfrey
B
Rosie O’Donnell
Bill Cosby
Colour
Of Ink
(Karylowski, et al., 2002)


Result: Slower to read
ink colour when colour
and racial category
mismatch than when
they match
What do these data
actually mean?
Racial categories come to
mind automatically
(Karylowski, et al., 2002)
Reaction Time (ms)
Stroop and Person-Perception
Ink Color
In the Health Context
 Social categories are activated automatically during
interactions with other people
 Interactions and decision-making potentially influenced
by stereotypic beliefs and biased knowledge
 Helps us understand evidence showing that, for certain
social groups, clinicians …
 offer less information, less support and are less clinically
proficient
 provide different treatments, preventive interventions
and referral to specialist services
3. Psychology and Health

Dual Pathway Model: Two broad ways in which
psychological processes may influence physical health
Psychological
Processes
Direct Path
Behaviour
Physical
Health
A Primer

Psychoneuroimmunology (PNI)


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Lutgendorf & Costanzo (2003). PNI and health
psychology: An integrative model. Brain, Behavior and
Immunity, 17, 225-232
Glaser & Kiecolt-Glaser (2005). Stress damages
immune system and health. Discovery Medicine, 5,
165-169
Antoni et al. (2006). The influence of bio-behavioral
factors on tumour biology: pathways and mechanisms.
Nature Reviews (Cancer), 6, 240-248
Nerves
Nervous System:
Physiological
Reactivity
Hormones
Psych Processes
GI: IBS,
ulcers
Psychological
Appraisal
Psych: cognitive
decline, morbidity
RS: impotence,
amenorrhea
Endocrine System
ReS: asthma,
hyperventilation
Cardiovascular
System
Essential
Hypertension
Physical and
Psychological
Health Status
Immune System
Sensitivity more severe
Salient
Event
4. Clinical Application
 Three basic levels at which psychological principles
(knowledge and techniques) can be applied:
 Awareness of patient’s psychological state
 Knowledge of basic psychological issues relevant to
context (e.g. condition), patient-centred communication
 Intervention in the form of brief counselling
 Emotional care, motivational support, behavioural advice,
informational and educational care
 Therapy from relevant psychological therapist
 Knowing when and where to refer, screening for
‘caseness’, engaging in/with a care team, follow-up, case
management, etc.
Module Aims / Objectives

Block 1: Before
 to conceptualise the interplay between biological, psychological
and social factors in health by considering core psychological
constructs underlying health-related behaviours and beliefs.

Block 2: During
 to appreciate and consider the use of core psychological
constructs to facilitate positive consultation outcomes.

Block 3: After
 to recognise the importance of considering post-consultation
consequences in the context of ongoing patient care

Block 4: Consolidation
 to provide opportunity for structured supported revision and
consolidated learning.
Module Content
Lecture
Assumption
Health psychology
Tells us what we already know but in a language we can’t understand
Health behaviour and beliefs
People will protect, not damage, their health if they know the facts
Illness behaviour and beliefs
Patients consult when they think they are ill, and adhere to advice
Consultation
They get ill, we consult, I treat, and they get better – simple
Preventive medicine
Patients willingly engage with & benefit from preventive protocols
Psychological medicine
Weak medicine for weak people – a waste of time and resources
Addiction, change & relapse
A social problem with an individual solution – just say no, or stop
Stressful medicine
Patients are content when referred to an expert for specialised care
Chronic illness & somatisation
Challenging patients – no, more like challenging patience
Revision session
Students welcome the opportunity to consolidate their learning
Question and answer
Students will consider course material & formulate sensible questions
Bank holiday
Self-directed learning
Structure
Time
Mins
1345 – 1500
60 – 75
-
15 – 30
Self-study
1515 – 1645
75 – 90
Tutorial*
1515 - 1645
75 – 90
Lecture
Break
* Weeks 3, 6 and 9
Requirements

The module is a core module that must be
completed satisfactorily in terms of:



Attendance at both lectures and tutorials is
compulsory
Assessment, which may include both written ESAs
and OSCEs
Participation, including the completion of required
reading and tutorial tasks
Tutorial Tasks

Student-led tutorials involving 4 small-group (4-5 students)
presentations, each with two components:



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Integration template: students will select a clinical condition
and identify (from the lectures in that block) the psychological
factors relevant to the condition
Formative questions: students will develop ESA questions (1
per group per tutorial
The template and ESA questions will be presented to other
students for critique and evaluation
Example ESA questions will be


made available to all students for formative assessment /
revision purposes at the end of each block
submitted to the WMS ESA question bank
Integration Template Example: Back Pain
Learning Domain
Knowledge, Skills and Abilities
1. Science:
Basic / Clinical
Anatomy of the spine / Effect of spinal cord injury at different
levels; Radicular syndromes
Psychological
Biopsychosocial models of disease, pain, self-management; Gate
theories of pain; PNI link between pain and depression
Aetiologic/Pathologic
Accidental injury / Pathology of spine disease – disc disease,
spine infection, ankylosing spondylitis
Social / Ethical
Loss of work; Disproportionate use of scarce resources; Social
isolation; Learned helplessness; Treatment of pain
2. Diagnosis
Symptoms / Signs
Back pain/stiffness; Radicular syndromes; Back deformity
Skills / Investigation
Screening MS examination; Detailed regional MS and neurologic
examination / Basic haematological tests; X-rays; MRI
3. Management:
Therapeutic skills
Treatment of chronic diseases; Psychological pain management;
Medication / Operation
Simple analgesics; NSAIDS / Indications for operation
Rehab / Follow-up
Musculoskeletal/occupational therapy / Stepped care; Timelimited treatment with follow-up from referral
Prevention/Pub Health
Health and Safety; Workplace educational programmes; Injury
prevention
Additional Information
Module Leader:
Office:
Telephone:
Chris Bridle
A0.22 Medical School Building
(024) 761 50222
Email:
Webpage:
C.Bridle@warwick.ac.uk
www.warwick.ac.uk/go/hpsych

Module staff:
 Each tutor available to meet at the end of each tutorial


I will be available to meet at the end of each lecture
Office hours:
 I have an open door policy – please don’t abuse it.
Conclusions

This session would have helped you to
understand the …



nature of health psychology, e.g. who and what are
studied
different levels of clinical application for
psychological principles
dual pathways through which psychological
processes influence physical health

structure and content of the module

module requirements, e.g. tutorial tasks

What now?




Familiarise yourself with the module webpage
Obtain / download one of the recommended
readings
Organise yourselves into small groups (re: tutorial
tasks)
Consider / select a condition on which to develop
your integrated template
Any questions?