Health Psychology

Health Psychology Definition

Health psychology is devoted to understanding psychological influences on health and disease. According to Shelley E. Taylor, a leading health psychologist, this field addresses the psychological factors that determine how people stay healthy, why they become sick, and how they respond when they do get sick. Health psychology encompasses a broad array of topics and addresses a variety of questions, including health promotion and health maintenance; for example, why do some people engage in positive or negative health behaviors, such as exercise or smoking? Other areas of health psychology focus on the behavioral and social factors that could cause illness and how psychological interventions can help prevent and treat disease. For example, is low socioeconomic status associated with the onset of cardiovascular disease (in other words, are poor people more likely to have heart attacks)? What are effective behavioral techniques to manage and alleviate stress; for example, do relaxation exercises reduce stress levels? Health psychologists also analyze health care systems; research in this area can inform policies for improving hospitals, nursing homes, and health care accessibility. For example, health psychologists can offer solutions for reducing barriers to adequate health care (e.g., not trusting/being comfortable with doctors or fear of medical procedures).

Health PsychologyHealth psychology is an interdisciplinary field, which integrates other areas of psychology (e.g., social psychology, developmental psychology, clinical psychology) as well as other disciplines (e.g., immunology, public health, medicine). Health psychologists can conduct basic research and work in applied and clinical settings. With its emphasis on holistic health—or treating the body, spirit, and mind of the patient—training in health psychology can provide an important perspective for those working in medical or allied health professions (e.g., occupational therapy, dietetics, social work). Health psychology is a relatively new, emerging field with important implications for how we conceptualize health and disease; understanding how psychological processes contribute to health and illness provides a foundation for improving physical and mental health outcomes.

Biopsychosocial Model of Health and Illness

In the biomedical model of health and illness, physicians look for an underlying biological cause for a physical disorder and treat it with biological interventions, such as performing surgery or prescribing medicine. This perspective, in which diseases or physical disorders are caused by biological processes, has been the dominant viewpoint in medicine over the past several centuries. In contrast, health psychologists view health and illness through the biopsychosocial model, which recognizes that biological, psychological, and social factors can all contribute to health outcomes. Health psychology research has demonstrated that the inclusion of psychological and social factors in this equation is important, as these elements can have an influence on health. For example, psychological states, such as thoughts, emotions, or perceptions of stressors, can be associated with the development and progression of certain diseases. Social factors, such as family environment or social status in society, are also important determinants of health outcomes. To treat illness, proponents of the biopsychosocial model would not solely treat the problem at the biological level but would design and implement interventions that target psychological and social factors as well.

Physicians were initially reluctant to acknowledge the role that psychosocial factors could play in health and disease. However, some very persuasive research findings have helped the medical community better understand the importance of the biopsychosocial model. For example, large prospective studies (which follow the same individuals over long periods of time) have found that psychological stressors can lead to the development of disease; those that experienced more negative life events were more likely to develop cardiovascular disease compared to people without as many major stressors in their lives. Other studies have shown that having large social networks—or belonging to different social groups—is associated with increased longevity, or how long people live. Impressive findings such as these have helped the biopsychosocial model gain more acceptance within the medical community.

Physiological Responses to Stressful Situations

Characterizing how individuals respond and adapt to stressful situations has been a cornerstone of health psychology research. Stressors are situations in which the demands of the situation exceed one’s resources to cope. Stressors can be major life events, such as experiencing the death of a loved one or going through a divorce, but they can also be minor, everyday occurrences, such as getting stuck in traffic or taking an exam. Stressors can be categorized as acute or short-term (e.g., delivering a speech), or chronic and ongoing (e.g., caring for a spouse with dementia). Both acute and chronic stressors can lead to stress responses, the psychological and physiological changes that can follow a stressful event (e.g., feeling anxious, pounding heart).

Research has demonstrated that stressful situations can have profound effects on the body, including changes in the how the heart beats (cardiovascular system), in specific chemicals that are released (hormonal system), and how the body fights infection (immune system). In the first half of the 20th century, Walter Cannon and Hans Selye provided the groundwork for this area of research. Cannon first described the fight-or-flight response, the body’s reaction to threat and danger in the environment, which includes physiological changes that can lead to increases in arousal, heart rate, and blood pressure. He theorized that this increased physiological activation helps the organism quickly respond to the danger, that is, to attack or flee from the threat. Selye focused more on the endocrine responses to stressors and their potential effects on health. He proposed that stressors elicit a constellation of physiological changes, including secretion of an important hormone, cortisol. He argued that continued activation of certain physiological systems could lead to adverse effects on health. Current research in health psychology has extended and modified the seminal contributions of these two scientists. For example, it is now known that certain types of stressors are more likely to trigger these physiological responses; uncontrollable contexts elicit greater changes in certain hormones in humans and nonhuman animals compared to situations that are more controllable.

Research in psychoneuroimmunology, the study of the relationship between psychological states and the body’s natural processes for fighting off diseases (called the immune system), has demonstrated that stressful situations can influence aspects of immunity. Acute stressors can lead to changes in the number of immune cells present in the bloodstream as well as how effectively these cells function. Exposure to long-term, chronic stressors is associated with a number of negative effects on the immune system, including decrements in the function of certain types of immune cells, impaired responses to vaccination, and delays in the body’s ability to heal a wound.

Research that documents the effects of stressors on physiology is important because it provides a pathway through which stressful life events could translate into effects on health; in other words, stressors could influence the body’s processes (like the cardiovascular system), which in turn could affect health. For example, if a person experiences a number of stressors that cause his or her heart to beat much faster than normal, this accelerated heart rate over time could lead to the development of disease. Therefore, prolonged activation of certain body processes (caused by repeatedly experiencing stressful situations or having greater physiological responses to stressors) could put individuals at risk for illness.

Moderators

Not everyone responds in the same way to stressful situations; individual differences in coping and our social environment can influence health outcomes. Coping refers to how we manage the demands of a stressful situation; effective coping strategies can dampen or reduce stress responses. Problem-focused coping involves doing something constructive about the situation, such as taking direct action or getting help from others. This can be particularly effective when something can be done to change the situation (e.g., preparing for a difficult midterm exam). Emotion-focused coping involves regulating one’s emotional response to the situation. This type of coping can be especially beneficial when acceptance is necessary, such as when coming to terms with the death of a loved one. However, there is not a universally effective coping strategy; both types of coping can be beneficial, depending on the characteristics of the situation, the individual, the timing, and the outcome examined.

Social relationships and social support can also be important for understanding how psychological processes can influence health. Social support can be stress-buffering; that is, it can protect an individual from the effects of a stressor. For example, having a supportive partner present during a stressful situation can lead to decreased emotional and physiological reactivity in some circumstances. Social support can also have direct effects on health or be beneficial regardless of the amount of stressors experienced. For example, social integration, or having a large social network, has been associated with increased longevity (regardless of the number of stressors in an individual’s life). In other words, people who have many friends and relatives live longer than other people.

Research has found that individuals with certain personality traits are more likely to interpret situations as stressful and react with larger changes than others. For example, individuals high on hostility interpret ambiguous situations as threatening and are more likely to respond to interpersonal stressors with greater physiological reactivity. Other personality factors, such as optimism and hardiness, appear to buffer the impact of stressful events.

Hostile individuals are more likely to develop cardiovascular disease. In addition, researchers have linked hostility and rates of coronary artery disease survival. Many have posited that hostile individuals’ increased health risk could be due to their known exaggerated reactivity to stressors.

How do psychosocial factors influence the progression and outcome of disease? Health psychologists have studied how diseases such as HIV/AIDS progress as a function of psychological and interpersonal influences. For example, HIV-positive gay men with high levels of stressful events in their lives show faster progression of the disease. However, the presence of a supportive network can keep people healthier longer. In addition, cognitive beliefs, such as negative expectations about the future or negative beliefs about the self, have been associated with more rapid declines in the immune system and in physical health for those with HIV.

How do individuals adjust to terminal illness and dying? Cancer patients have received a good deal of attention. Cancer has many negative physical and emotional consequences, including nausea, weakness, and hair loss from chemotherapy; disfigurement; and disability from cancer itself, from surgery to remove cancer, or both. In addition to these physical ailments, cognitive responses to the diagnosis and disruptions in interpersonal relationships can lead to great psychological distress, such as depression and anxiety. Health psychology has a lot to offer in the alleviation of this suffering; some have focused on improving pain management, increasing social support, and cognitive therapy (e.g., to improve body image and self-esteem). Research has generally supported the use of these techniques with cancer patients for improvements in quality of life.

Disease Course

Health psychology has made important contributions in helping to better understand who gets sick, which factors influence disease course and outcome, and how individuals adjust to illness and dying.

Who gets sick? Health psychologists have explored the connections between personality traits and disease incidence. One example of this line of inquiry has been in the area of heart disease. Of the many risk factors studied, hostility has been one of the more widely investigated; research has consistently found that

Health Behaviors

Many of the leading causes of death are chronic illnesses, or diseases that develop over a long period of time (e.g., heart disease, cancer, diabetes). These chronic illnesses are more prevalent today because the population is living longer and people are exposed more to toxic substances. Chronic illnesses are influenced by psychosocial factors, such as behavior, lifestyle, and stress. Changes in behavior may help to prevent many deaths from these leading causes. For example, quitting smoking can contribute to reduced risk of lung cancer. Rising health care costs have also inspired individuals to better understand behaviors that contribute to poor health.

Researchers have focused on health-related behaviors and what predicts health-impairing and health-protective behaviors. Health-impairing behaviors are those that harm one’s health (e.g., alcoholism, drug abuse, and smoking). Health-protective behaviors protect or support one’s good health; these behaviors include obtaining regular physical exams (screening), exercising, wearing seat belts, and controlling one’s weight. Many factors play a role in determining whether someone will engage in particular health behaviors, including social values, genetics, the environment, individual emotions, beliefs, and experiences.

Health psychology has focused on understanding why health-related behaviors occur, how they progress, and how to modify them by identifying points for intervention. Major models have included the health locus of control, the health belief model, and the theory of planned behavior. For example, according to the health belief model, which was developed in the 1950s, behavior can be predicted by knowing an individual’s perception of how severe a health threat is and how successful taking action would be. In other words, the individual’s view is important in weighing the pros and cons in deciding a course of action in response to a health threat. Additional factors have been determined to influence the perception of threat, such as the likelihood of developing the health problem, how serious the problem is, and the individual’s general beliefs about health. This model has been used to successfully predict behaviors such as dental checkups, condom use, breast self-exams, breastfeeding, and vaccination.

Health Psychology Intervention

Another area of health psychology examines how health psychologists can get involved in improving the health of individuals. For example, how can health psychologists best design and apply programs to teach behaviors that can have a positive effect on health? Interventions can take a variety of different forms (e.g., teaching coping skills or stress management techniques, providing health-relevant information or social support), and can occur at different points in the disease process.

Primary prevention is the process of intervening before an illness or injury develops. The goal is to keep people from developing bad health habits.

Commonly, this type of prevention is aimed at promoting health among young or at-risk populations. Educating people to wear seat belts, brush and floss regularly, and get immunized against disease are all examples of community health promotion. Behavior change, or altering problem behaviors, is the most common intervention in health psychology. This can be challenging when dealing with addictive health-impairing behavior, but it is also difficult when individuals are healthy because there is less incentive to engage in health-protective behavior, especially behaviors that are not favorable, such as dieting or exercise.

Psychological principles have shown to be useful in understanding how to change problem behavior and encourage health-protective behavior. One popular approach is cognitive behavioral; here one focuses on what circumstances elicit, maintain, and reinforce a certain behavior. Then one addresses the thoughts and beliefs about one’s behavior. Cognitive behavior restructuring has been applied to behaviors such as smoking, wearing seat belts, diet, and exercise.

Secondary prevention is the process of screening and diagnosing illness or injury early on. The goal is to treat the individual immediately and stop the progression of disease. The most common example is physical exams, such as vision, hearing, dental, blood pressure, blood tests, and cancer screening. Health psychologists conduct research to better understand why some people do or do not screen for illness. For example, researchers are studying why individuals at high risk for certain types of cancer may or may not choose to screen for the disease.

Tertiary prevention occurs after illness or injury has progressed, and the focus is on containing illness or injury to avoid future complications. Goals include disease management, rehabilitation, and relapse prevention. To do this, researchers and clinicians have helped to develop and evaluate the effectiveness of support groups and therapy for individuals with diseases such as cancer, alcoholism, and cardiovascular disease.

Primary, secondary, and tertiary prevention programs can help individuals live longer and healthier, improve the quality of their lives, or both.

Future of Health Psychology

There are a number of exciting areas of research that health psychologists are now pursuing. Many are now examining questions of health and disease from a life-span perspective, from the time of conception (How do prenatal stressors influence birth outcomes?) to the end of life (How can clinicians help people die with dignity?). Others are now discovering how cultural and gender differences in lifestyles, stress reactivity, and coping can influence health outcomes. As the population ages and many develop chronic diseases, it will be increasingly important to focus on health promotion and how to help individuals cope with their diagnoses and improve their quality of life. As the biopsychosocial model gains acceptance in the medical community, health psychologists have increasingly important roles to play on interdisciplinary teams of health care providers. Health psychologists have the potential to have a dramatic impact on the health of individuals by conducting research that contributes knowledge of how psychosocial factors can influence behavioral and disease processes and by intervening to promote health and prevent illness.

References:

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