Health Psychology

Introduction: What is Health Psychology?

Syllabus Point: Discuss to what extent biological, cognitive and sociocultural factors influence health-related behaviour.

Answered throughout.

Syllabus Point: Evaluate psychological research relevant to health psychology.

Answered throughout.

Stress

Syllabus Point: Describe stressors.

Stress: According to Selye (1956) a stress refers to a failure to respond appropriately to emotional or physical threats, whether real or imagined.

Stressor: A cause of stress – varies for different people.

Syllabus Point: Discuss physiological, psychological and social aspects of stress.

Physiological

·         Different genders have different physiological aspects of stress.

·         Women tend to juggle housework and career. Men tend to be more competitive and impulsive, feeling pressure to work harder and longer in their career.

·         Frankenhauser et al. (1976) reported boys = adrenaline rushes in exams that take longer to return to normal. Girls = gentler, lower increase + return to normal much quicker.

·         Stress has a negative impact on physical health

·         Powell et al. (1967) found that, children exposed to significant stress in their home life had impaired growth due to a lowering of production of growth hormone in the pituitary gland.

·         Stone et al. (1987): correlation between negative life experiences and respiratory illness. Also found changing mood = change in antibody concentration in bodily fluids.

·         Gross (1996): people often catch colds after periods of high stress as Goetsch and Fuller (1995) found decreases in activity of lymphocytes among medical students during their final exams.

Psychological

·         Lazarus (1966): for a situation to be stressful, it must be considered to be stressful by the individual = cognitive component to stress.

·         Selye (1956): stress is an automatic response to any threatening stimulus.

- Primary Appraisal: evaluate the potential threat and its significance.

- Secondary appraisal: assess the controllability of the situation.

·         Reed (1999): HIV-positive men stay healthier for longer if they remain optimistic about their future.

·         Expectations of physical health have an impact on health outcomes.

Social

·        Humans are social animals and sensitive to their environment.

·        Holmes and Rahe (1967): change causes stress. Compiled a Social Readjustment Rating Scale (SRRS): rates events out of 100 for their potential to lead to stress. <300 = high risk for stress-related health problems. However, reductionist approach and not always reliable.

·        Marmot et al (1997): lower job position = 4 times more likely to die of heart attack.

·        Workplace can lead to stress à de-individualization and job autonomy. Higher blood pressure in high demand – low control occupations (waiters and cooks).

Syllabus Point: Evaluate strategies for coping with stress.

STRESS INOCULATION TRAINING (SIT)

·         Developed by Meichenbaum (1996)

·         Cognitive approach to treatment with aim of changing thought processes to combat the effects of stress.

·         3 stages:

1-      Conceptualization stage: client and therapist try to identify the client’s triggers of stress. Clients are encouraged to perceive threats as solvable problems and to set short and long-term goals to solve them. Re-conceptualization then takes place, tailored for the individual; identify sources of anxiety and ways to combat them.

2-      Skills acquisition and rehearsal stage: skills for coping with stress are offered and rehearsed. Includes: emotional self-regulation, self-soothing and acceptance, relaxation, using social support systems, problem solving, cognitive reconstructing, etc.

3-      Application and follow through phase: client is told to imagine the stressful situation and apply the coping skills in the therapist’s office or a safe situation. Involves: role play, imagery and behavioural rehearsal.

Evaluation of SIT:

·         Advantages: accepts that stressful situations can’t be avoided and tailors appropriate solutions, empowering the client. Provides long-term success.

·         Disadvantages: not all individuals respond well to training, a lot of time and money, doesn’t suit some lifestyles, requires a high level of commitment. Works better with certain cultures than others.

YOGA

·         Cohen (2006): yoga can be said to improve quality of life. Provides exercise, relaxation and self-awareness, also provides regular social interaction with like-minded people. Consists of physical exercises, breathing routines and meditation.

·         Hartfiel et al. (2010): study, 48 employees, half did yoga for 6 weeks. Yoga group = improvement in clear mindedness, elation, energy and confidence in stressful situations.

·         Disadvantages: Doesn’t solve the stress causing problem and is only beneficial to those who internalize their learning’s and continually attend classes. (Time)

Substance Abuse and Addictive Behaviour

Syllabus Point: Explain factors related to the development of substance abuse or addictive behaviour.

Substance: anything an individual ingests to alter their cognition, behaviour or mood.

Substance abuse: over-indulgence or dependence on a drug leading to effects which are detrimental to the person’s physical and mental health or the welfare of others (Nutt et al. 2007)

Physiological factors contributing to alcoholism

·         More prevalent in males. US = 17% men and 8% = women become alcoholics at some point in their lives. (US centers for disease control)

·         Linked to risk-taking behaviour which is prevalent in men.

·         More likely to develop in those who are exposed to alcohol early.

·         Overstreet (2000): twin brothers with different life experiences have consistency in alcohol preference.

·         Lingford – Hughes (2004): found that alcoholics have fewer receptors on the frontal lobes for GABA which is involved in calming the body so people go to alcohol to get the calming effect they lack. Not clear whether the brain differences are the cause or consequences of alcoholism.

·         Genetic predisposition doesn’t determine behavioural destiny.

Cognitive and sociocultural factors

·         Bundura (1965) Social Learning Theory: alcohol engrained and passed on in culture. Normal to drink in Western cultures. Displayed in advertising.

·         Hill and Casswell (2001): underage drinking is more likely to lead to alcohol problems as they expect positive outcomes because of advertising.

·         Saffer and Dave (2003): advertising in US appeals to teens, studies show that removing the ads would reduce drinking in teens from 25% to 21% and binge drinking 12% to 7%

·         Sellers use SLT to promote alcohol in ads by making it look desirable.

·         Dring and Hope (2001): Ireland= teens voted alcohol ads as best ads, under impression that alcohol ads are aimed at them, social and sexual success. SLT: reward = do it.

·         UK advertising: not allowed to appeal to under 18s, no models younger than 25.

·         World Health Organisation (WHO): adolescents have the right to be protected from negative consequences of alcohol.

Syllabus Point: Examine the prevention strategies and treatments for substance abuse and addictive behaviour.

Prevention Strategies

·         Since 1990s, most European countries have either put a ban or restriction on smoking advertising.

·         Tobacco companies have always targeted the youth, but now are targeting adolescents in the developing world as it has become increasingly difficult to market their products in most Western countries.

·         On NO Tobacco Day, 31 May 2008, WHO targeted children + adolescents to prevent smoking.

·         Found that 2/3 countries have no info about tobacco use and dangers of smoking.

·         Consumer research has shown that tobacco advertising has a profound effect on smoking attitudes and behaviour of young people.

·         This is because of the use of imagery and positive association and because youth are more brand conscious.

·         Charlton et al (1997) found that boys who showed a preference for Formula One motor racing that was sponsored by cigarette manufacturers were more likely to begin smoking.

·         Who strategies are implemented in a number of countries.

·         Public health interventions to prevent smoking target all individuals. There has been an increase in health campaigns in recent years.

·         Government strategies encompass: restricting or banning tobacco ads, raising taxes on tobacco, and banning smoking in public places.

·         According to research from Italy, banning smoking in public places can motivate people to stop smoking and prevent relapse.

Treatment

·         Treatment offered to reduce individual’s dependence on smoking. (Hard part = dealing with withdrawal symptoms).

·         Nicotine Replacement Therapy (NRT) such as nicotine chewing gum, patches, and sprays can help to some extent.

·         It can prevent short-term relapse, useful addition to treatment programmes.

·         In late 1990s, drug called Zyban came out in the market to help people give up smoking.

·         Originally an anti-depressant, works by acting on sites in the brain affected by nicotine.

·         Can help people quit, also relieves withdrawal symptoms and blocks the effects of nicotine if people resume smoking.

·         Research = if treatment is tailored to the individual’s situation, greater chance of success.

·         Long-term cessation (termination) programmes are more successful in preventing relapse.

·         Pisinger (2008) studied research on the effect of interventions on the individual level.

·         Concluded: most efficient methods are those that include consultations and participation in smoking cessation interventions.

·         NRT and Zyban are efficient, especially in conjunction with other interventions.

·         Olsen et al (2006): studied effectiveness of standard smoking cessation interventions in real-life settings.

·         Used nurses and staff who had been trained for three days.

·         In Denmark, health staff were trained for 3 days for interviewing and advising smokers to quit using a manual with guidelines.

·         Participants were tailored a programme to suit their needs, were given consultations and offered NRT and Zyban.

·         Participants discussed their progress in groups, etc. 6 months later it was found that 18% of all enrolled participants continued to abstain from smoking.

·         After a year, 16% were still abstinent. Found that participants in group-based interventions and those in cessation interventions in pharmacies were more likely to stay abstinent.

·         Conclusion: was successful and could be implemented at a relatively low cost.

·         Strengths: large sample and population-based real-life setting.

·         Limitations: lack of control group and loss of data due to drop-out of participants during the programme.

Obesity

Syllabus Point: Discuss factors related to overeating and the development of obesity.

Obesity: a medical condition in which excess body fat has accumulated to the extent that it may have adverse effects on health.

·         Obesity in USA: 1967-80 = 47%        1999-2002 = 65% and still rising

·         Easy to access processed food and is also cheap.

·         Lack of exercise in lifestyle.

·         Kessler (2010): 1980 = 10%              2010 = 25%     expected in 2050 = norm.

Biological Factors

·         Hypothyroidism: 2-4 excess kilos possible.

·         Very rare genetic disorders (Laurence-Moon-Biedl syndrome): causes weight gain.

·         Body size runs in families, one obese parent = 40% increase offspring will be obese, both parents obese = 80% increase.

·         Skunkard et al. (1990): 93 pairs of twins, genetic factors = 66-70% of weight variance = metabolism and fat cells play a role.

·         Lifestyle not inherited.

Sociocultural Factors

·         Jeffry (2001): obesity is caused by lack of physical activity and eating behaviour. Sedentary lifestyle.

·         Peterson (2006): High socio-economic status = healthy foods + education. Low socio-economic status = cheap, processed foods.

·         Secondhand obesity = kids learn to be obese. Advertising, people eat for pleasure, indulge, media à SLT Bundura (1965).

·         Lawdig et al. (2001): Children’s hospital, 548 12 year olds, study over 19 months. Results: chances of becoming obese increased significantly with each additional daily serving of sugar-sweetened drink.

Cognitive Factors

·         Byrne (2002): healthy life-style hea\\ard to maintain due to ads, peer pressure, etc.

·         Exercise + healthy eating takes effort which deters people.

·         People with high self-acceptance won’t easily change their eating habits.

·         Binge Eating Disorder (BED): people take comfort in eating. Affects 2% individuals in US. Usually in people who have psychiatric disorders. Emotional lows usually trigger it. People with BED become obese at a younger age.

Syllabus Point: Discuss prevention strategies and treatments for overeating and obesity.

PREVENTION STRATEGIES

Education:

·         Only works if people want to lose weight. Movements such as the fat-acceptance movement are seen as an obstacle to convincing people that weight loss is in their best interest (health wise).

·         Exercise and healthy eating are best prevention strategies. Campaign to End Obesity in US found: only 12% adults and 2% children eat healthy diet according to federal nutrition recommendations.

Political Intervention:

·         Food labels found to be confusing by 75% of consumers. Removal of misleading language on labels.

·         Active programs for youngsters in UK and Australia.

·         Fast food zoning à poor people = less access to private transport = less likely to eat healthy as they would need to travel greater distances.

TREATMENT

Dieting:

·         Wadden (2009): diets successful at losing weight but not keeping it off. Weight gain after treatment is the norm.

·         Geissler and Powers (2005): key to weight loss is new habits associated with food and exercise, a healthy diet is not the same as dieting. High degrees of compliance and motivation, and a willingness to accept new diets and lifestyles are needed for dieting to be successful.

·         Many types of different diets.

Surgery:

·         Gastric bypass/lapband: cut off part of the stomach = feel fuller sooner. Accompanied by an altered physiological and psychological response to food.

·         Maggard et al. (2005): 147 studies, found surgery = 20-30 kilos lost and kept off for up to 10 years and better overall health.

·         Elkins et al. (2005): many who have undergone surgery suffer from depression in following months as a result of a change in the role food plays in their emotional outlook. Severe limitations placed on individuals which causes great emotional strain for some.

·         Adams et al. (2007): long-term mortality rate of gastric bypass patients reduced by up to 40%, suggests that some may be depressed after operation, but otherwise may not be alive at all.

Health Promotion

Syllabus Point: Examine models and theories of health promotion.

HEALTH BELIEF MODEL (HBM)

·         First developed by Rosenstock (1966).

·         Key assumption = people will engage in healthy behaviour if they understand that a health problem will arise if they don’t.

1-      Evaluation of Threat: people act if health problem relates to them.

2-      Cost-benefit analysis: will evaluate if the cons outweigh the pros in the long run.

·         Self-efficacy: what people think they’re capable of, determines stuff Bandura (1977).

·         Problems with model: no emotional, social or economic factors, only cognitive.

·         Awareness doesn’t inhibit risky behaviour.

·         Assumes that people are rational and make rational decisions, which is not always true.

·         Assumes people care about their health or the health of those they care for.

·         Model ignores physiological determinism.

·         Assumes people are active thinkers able to make choices within the realm of freewill. Ignores level of aggressive marketing that food corporations engage in.

·         Doesn’t address effects of conditioning on behaviour.

THEORY OF REASONED ACTION (TRA)/PLANNED BEHAVIOUR (TPB)

·         Developed by Fishbein and Ajzen (1975).

·         Key assumption = people don’t always indulge in behaviour that is in-line with their stated beliefs and intentions.

·         Concept of perceived behavioural control was added by Ajzen (1985).

·         Strengthens theory as it includes the individual’s own perception of the likelihood that a planned behaviour will be followed.

·         Self-efficacy also plays an important role in the theory. Self efficacy = belief one can successfully engage in behaviour to produce desired outcomes.

·          achieve success = more motivation.

·         People with high self-efficacy = carry out their intentions, overcome challenges better and recover from setbacks faster.

·         People with low self-efficacy = difficulty meeting challenges to change behaviour, quick loss of confidence, focus on negative and failings, avoid challenges.

·         Cons of theory: doesn’t address conditioning; the social learning theory (ads).

·         HBM is also more descriptive than TPB in field of explaining forces in the environment which influence a person when they make a decision.

·         TPB focuses on explaining why individuals make choices they do on an individual level.

Syllabus Point: Discuss the effectiveness of health promotion strategies.

·         Goal of health promotion strategies is to enhance good health and prevent illness.

·         WHO (1986) defined health promotion as “the process of enabling people to increase control over, and to improve their health.”

·         Not always easy to get people to behave in healthy ways.

·         One-to-one contact is an effective way to change behaviour in individuals or small groups, but not possible when whole populations have serious health problems.

·         Modern health-promotion activities:

-Health education programmes to raise awareness in the public about health risks and encourage behaviour change.

-Public health campaigns that aim to change beliefs, attitudes and motivations.

-Changing physical environment (eg. Elevators to stairs)

-Public or private health services that can help people change their behaviour.

-Political activities

Health Campaigns

·         Often criticized for being ineffective.

·         Holm (2002): conducted a survey on the efficiency of health campaigns in relation to food habits in Denmark.

·         Found that health campaigns are useful, but not as effective on their own.

·         Must be seen as an integral part of the entire health promotion project.

·         Holm claims that a campaign needs to be based on people’s daily life in order to be effective.

·         Successful health campaign in Denmark in 1990s: aimed to reduce use of butter on bread.

·         From 1985 to 2001, amount of people who said they didn’t use butter on sandwiches increased from 7% to 40%, similar case with low-fat milk.

·         Demonstrates that campaigns can promote change.

·         Long-term effects, but hard to give precise evaluations.

·         According to Sepstrup (1999), media campaigns can only be used to convey simple messages. Needs to be combined with other measures to change attitudes and promote behavioural change.

·         Media campaign = great to attract attention and communicating knowledge, but people need the necessary means to actually do something.

·         VERB – It’s what you do was a national campaign that ran from 2002-2006 in the US.

·         Used commercial marketing strategies to persuade the audience (9-13 yrs) to be physically active every day.

·         Huhman et al. (2005) conducted a large-scale survey of children and parents to investigate the effectiveness of the campaign to create awareness and promote physical activity.

·         Found: after 1 year, 74% of children were aware of VERB campaign.

·         Was also an increase in free-time physical activity for children who were aware of the campaign compared with those who were unaware of it.

·         Researchers concluded: commercial advertising in health promotion is promising.

·         
TRUTH anti-tobacco campaign in US 1998-99.

·         Aim: to prevent teen smoking by changing attitude of teens and encouraging them to form groups and spread the message in the community.

·         Campaign included 33 tv ads, billboards, posters, internet, programme sponsorship, merchandise and local youth advocacy groups.

·         Core component was youth groups confronting tobacco industry and accusing them of manipulation.

·         Campaign carried out a number of telephone surveys to measure effect and awareness of the campaign.

·         One finding = teenagers’ negative attitude to smoking had risen.

·         Middle- and high-school current smokers went down by 19.4% and 8% respectively.

·         Sly et al. (2002) carried out a survey 22 months after the campaign to investigate if the campaign had an effect on attitude change; if non-smokers would remain non-smokers.

·         Found that non-smokers remained as such due to the exposure to ads.

·         Study shows: possible to change people’s attitudes and behaviour if the campaign is clear and focused on a target group.