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Chapter 12 - Health Psychology

Chapter Summary

CONCEPT I: Life-Style and Health

The biopsychosocial approach holds that social, psychological, and biological factors interact to affect our health. According to the biomedical model, sickness is the result of biological malfunction, and is best treated by medical professionals. The biomedical model focuses on containing illness; the biopsychosocial model seeks to promote health and it forms the basis of health psychology, a growing subfield of psychology.

Before this century, the major causes of death in the U.S. were acute infectious diseases. Now, our major health problems are disorders of lifestyle like cardiovascular disease, cancer, and automobile accidents. These problems can often be linked to patterns of behavior, like smoking and overeating.

Although Americans appear to be health conscious, many do not take simple steps to reduce risks of developing serious diseases, such as self-examination for breast cancer, and taking necessary precautions in dealing with AIDS. Research shows that four beliefs influence health behaviors: (1) how severe the threat is perceived to be, (2) how vulnerable a person feels, (3) beliefs about whether one can act to reduce the threat of disease, and (4) belief about whether one’s actions can overcome the threat.

Sexual drives are powerful motivators and can lead to risky behaviors, which may endanger a person’s health. Sexually transmitted diseases (STDs) have affected virtually every society. Acquired Immune Deficiency Syndrome (AIDS) is an STD for which there is no cure. It affects the immune system and leaves the victim vulnerable to other illnesses. Perhaps because of the low number of reported cases of AIDS in the adolescent and young adult populations, large portions of these groups continue to engage in risky sexual behaviors.

Weight is a major concern in America today. The mechanisms affecting food intake and body weight are complex and not completely understood. Many health problems involve food, diet, and eating. Obesity is an excess of body weight. It is difficult to easily define when a person’s body weight is excessive. Many factors can lead to obesity. Some psychologists attribute obesity to a strong response to external cues. Others attribute obesity to a setpoint for fat, a fat level that the brain considers normal. Setpoints seem to vary from one individual to another. There is evidence for a genetic influence on weight. It is possible, for example, that the metabolic rate (the rate at which food energy is burned away) is passed on through genes.

People who are obsessed with the subject of their weight and starve themselves suffer from a condition known as anorexia nervosa. About half of all anorexics suffer from another eating disorder known as bulimia. Bulimics go through periods of bingeing and purging. Purging is a behavior used to avoid weight gain and can take the form of vigorous exercise, the use of laxatives, or vomiting. While bulimia is often found in anorexics, unlike anorexics most bulimics are of average or above-average weight.

Over-eating, like all human behavior, is controlled by both internal and external forces. The cognitive-behavioral approach is based on the idea that both attitudes and behaviors must change in order for lifestyle adjustment to be successful. It also requires that the client accept responsibility for change, rather than leaving that responsibility entirely with the therapist. The most successful programs use a multimodal approach which involves several kinds of learning techniques such as self-observation and self-monitoring (paying attention and keeping track of one’s own behavior), stimulus control (removing cues that initiate the unwanted behavior), and self-reinforcement (rewarding oneself for appropriate behavior) which might include shaping, or gradual reduction in the pattern of rewards. In contingency contracting, a person makes a contract with another which details the rewards or punishments that will result from the behavior being controlled. Cognitive restructuring is used to help clients change the way they think about their behaviors. Finally, skills training, in which the therapist helps the client develop better social skills, can help the client become better able to control his or her behavior.

Relapse rates after treatment for most addictive disorders run from 50% to 90%. Furthermore, neither "booster sessions," contingency management, nor life-long treatment seems to help. The most promising results seem to come from building relapse protection into the initial therapy sessions so clients can work out strategies in advance for how to respond when temptation occurs.


Stress has both physiological and psychological components. An early model of stress reactions, the fight-or-flight response, holds that, when threatened, the sympathetic nervous system and endocrine system are aroused and enable the organism to fight or flee. According to Selye’s general adaptation syndrome theory, all types of stress evoke a similar pattern of physiological responses. The general adaptation syndrome postulates three stages in a stress reaction: alarm, in which the sympathetic nervous system supplies additional energy; resistance, in which the body appears normal but is being gradually weakened; and exhaustion, in which the body’s ability to combat stress begins to break down. Other researchers suggest that cognitive and emotional factors also play a role in stress, and that stress responses vary with the individual and with the type of stress.

The psychological view defines stress as that which we appraise as harmful, threatening, or challenging. It emphasizes that differences exist among people in how, when, and to what they react, and focuses its attention on how we appraise, or evaluate, a situation. Appraisal is an important step in the interpretation of stressful events. For example, one research study showed that participants who focused on the pain and trauma experienced by people in a film were much more stressed than those who focused on the religious significance of the film’s subjects. Appraisal involves two steps: whether we judge a situation as a threat (primary appraisal ), and whether we believe we can cope with it (secondary appraisal ).

Psychoneuroimmunology is a new field which examines how psychological factors alter the immune system and alter the risk of immune system-related diseases like AIDS, cancer, arthritis, infections, and allergies. The immune system guards the body against foreign invaders (called antigens). B-lymphocytes, which are made in the lymph organs and bone marrow, coat or neutralize the antigens. Then macrophages ingest and destroy them. T-lymphocytes attack invader cells directly, breaking down their cell membranes. Natural killer (NK ) cells attack cells already infected and secrete interferon, which inhibits virus reproduction. Immunocompetence refers to how well the immune system is operating. Even academic stress during exams can lower students’ immunocompetence, as can problems with interpersonal relationships. Both acute and long-term stress can lower one’s resistance.

Thomas Holmes and Richard Rahe developed the Social Readjustment Rating Scale (SRRS) to measure the amount of stress in a person’s life. It consists of a scale of points associated with stressful life events. People who have experienced more stressful life events tend to have higher scores, and be at greater risk for illness and injury. Critics of this approach argue that the scale items are too ambiguous, that people experience the items in different ways, that the scale does not consider the context of the events, and that the scale focuses on past, rather than present events and situations.

Researchers are also looking at the effects of chronic stress on mental and physical health. For spouses of soldiers fighting in the Persian Gulf, the chronic stress of waiting and worrying was worse than the acute stress of knowing that their spouses were in combat. It is very difficult, however, to separate the effects of chronic stress and acute stress. Other researchers have focused their attention on daily hassles such as getting stuck in traffic and waiting in line. Some studies have tied the presence of such stresses directly to declines in physical health.

Many studies suggest that uncontrollable situations are more stressful than controllable ones. For example, in a study of nursing home residents, the group who were encouraged to take control of their lives were happier, more active, more assertive, healthier, and lived longer than members of the group who were encouraged to let others care for them.

Posttraumatic stress disorder (PTSD) is a delayed reaction to stress seen among combat veterans and other victims of traumatic experiences. Symptoms may last for months or years, and can include hyperalertness, sleep disturbances, guilt, memory loss, and emotional distance. As many as 50% of combat veterans experience PTSD. Thus, both major traumas and minor irritations can affect health.

Personality traits also can affect health. Optimism seems to be linked to better health than pessimism, perhaps because pessimists tend to blame themselves for bad events and to see negative events as stable and global. Too much optimism may, however, lead to a maladaptive denial of real problems, just as excessive pessimism may lead to the engagement of maladaptive behavior. Other things being equal, an optimistic but reality-based view may be related to a healthier state.

Stress may be linked to illness in a variety of ways. The direct route suggests that stress may produce physiological and psychological changes that contribute to the development of illness. However, preexisting variables, such as personality, may influence the link between stress and illness. Stress may also act by altering health behaviors, and stress may actually promote "illness behaviors" for which people seek treatment. Finally, all these factors may interact, with no one factor being enough to cause illness, but with a combination of them being powerful enough to have an effect on health.

CONCEPT III: Coping with Stress

Coping is the process of managing the internal and external demands that one appraises as taxing or overwhelming. Coping takes two main forms: problem-directed coping (trying to do something about the stressful situation) and emotion-focused coping (trying to regulate the emotional consequences of a stressful situation). Oftentimes these two forms work together.

The Ways of Coping Questionnaire asks participants to list and then rate the major events of their lives, and then indicate how they have dealt with them. Eight coping strategies have been identified: confrontational coping (fighting for what you want), social support (turning to others for comfort and advice), planful problem solving (devising a plan of action), self-control (not letting your feelings show), distancing (keeping your mind off the problem), positive reappraisal (looking for the best in a situation), accept responsibility (accept the situation as yours and try to learn from it), and escape/avoidance (denying the situation or escaping through drugs). Generally, research shows that confrontation is a better coping strategy than avoidance, although both have their appropriate uses. In many cases, a combination of strategies is most successful.

Catharsis is the process of venting emotions, often by talking about stressful events. Generally, catharsis increases short-term stress but provides long-term benefits in coping. One exception is that sometimes talking about stressful events intensifies the negative emotions associated with them. Talking about stressful situations can be helpful if we can rely on a social support system composed of others who will listen and care about our well-being. Social support can include tangible assistance (e.g., money or food), information (e.g., what actions are appropriate), and emotional support (e.g., reassurance that others care). Effective social support can reduce stress, lower the likelihood of illness, speed recovery from illness, reduce the risk of death from disease, and lead to better health habits. Sometimes, however, social support can be unhelpful. These unhelpful tactics most often include giving advice, encouraging too quick a recovery, minimizing the loss, and tryi ng to identify with the bereaved’s loss ("I know just how you feel"). Helpful tactics include "just being there," being available to discuss feelings, and expressing concern. Participants in a smoking study found it easier to quit when the proportion of positive to negative behaviors in their social support network was high.

Stress management techniques can also help people reduce stress. One cognitive-behavioral technique involves three stages. The first involves education about stress, its relationship to health performance, its symptoms, and some coping strategies. Next, participants receive some training about how they can develop better work habits and social skills. The third stage is practice, in which participants try out their strategies in real-life situations and report back to the group on their experiences.

Biofeedback is a specialized procedure for monitoring and controlling the physiological aspects of stress and pain. In early trials, biofeedback was shown to be very effective in reducing stress-related physical problems such as migraine headaches.

Relaxation techniques, however, are easier to use and seem to be equally effective. Since relaxation is the counterpoint to stress, if we can teach ourselves to relax, we can reduce our stress levels. Progressive relaxation requires that the participant progressively tense and relax muscle groups in the body. Controlled breathing also reduces stress. Participants who undertake relaxation programs have been shown to experience less stress and have better immune functioning than those who do not.

Exercise, especially if it is aerobic (demands oxygen intake), helps increase tolerance for stress, improves cardiovascular fitness, and improves general health, mood, and well-being. Exercise should consist of brisk workouts for at least 15 minutes, at least three times a week. Even though exercise is touted in society as desirable, there is a greater percentage of physically unfit children in the U.S. than 10 years ago. Health is an active achievement toward which we need to work.

CONCEPT IV: Anorexia Nervosa

Anorexia is one of the most striking health-related disorders with psychological origins. Even though most anorexics are on the verge of starvation, they view themselves as overweight. The vast majority of anorexics (between 90% and 95%) are women and display many of the symptoms of starvation. This disorder is highly resistant to treatment.

Hilde Bruch proposed that anorexia was triggered by the anxiety associated with sexual maturation. Consistent with this view, anorexia is highest among women in the years immediately following puberty and adolescence. The weight loss gives anorexics a much younger appearance and ceases their ovulation and menstruation. These may or may not be the desired outcome of starving oneself.

Minuchin proposed a revision of Bruch’s model. Minuchin’s views are shaped by the interpersonal or family-systems perspective. He found that families of anorexics had similar characteristics. They tended to display overprotectiveness, inflexibility, and lack of genuine warmth and concern for one another. Anorexia draws attention away from these family problems. Minuchin’s treatment works with an entire family and has a much higher success rate than other forms of therapy.

Other theorists point to social and cultural factors as contributors to anorexia. A relationship has been shown between the increasing thinness of American magazine models and the rate of anorexia. Other cultures that do not emphasize thinness do not have high rates of anorexia nervosa. Other researchers believe that there are biological factors involved in anorexia.

Research has shown that anorexia has no single cause, but is brought about by a number of factors such as family environment, sexual fears and anxieties, and cultural expectations. Consequently, no single treatment approach appears to be effective in stopping anorexia.

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