Health Psychology

• Health promoting behaviors

• Preventive rather than reactive

• How do people stay healthy? (emphasis on HOW)

• HEALTH:

  • Complete state of physical, mental, and social well-being; not merely the absence of illness or disease, infirmity (WHO, 1948)

  • WELL-BEING: optimum state of health

• Foci of Health Psychology

  • Health promotion and maintenance

  • Prevention and treatment of illness

    • Treatment: more cognitive behavioral therapy

  • Etiology and correlates of Health, Illness, and Dysfunction

    • Causes and factors

  • Improvement of the Healthcare System and formulation of Healthcare Policy

• Development of Health Psychology

  • Mind-Body Relationship

    • Human prehistory

      • superstitious

      • Evil Spirits = illness

      • Treatment = exorcism (trephination)

        • Exorcism: physical corporal punishment; rationalizing torture

        • Trephination: drilling into skull to remove evil spirit; treatment for head injuries

    • Ancient Greeks: Humoral Theory of Illness

      • 4 humors

        • blood (passionate personality)

        • black bile (sadness/melancholy personality)

        • yellow bile (angry disposition)

        • phlegm (laid-back personality)

          • Phlegmatic personality

      • Excess of a particular fluid = personality

    • Middle Ages

      • Divine punishment = illness

      • Treatment/Cure = physical/corporal punishment => penance (prayers and good works)

      • Continued exorcism but illness is divine punishment

      • Penance: undoing (defense mechanism)

      • Extended superstition

    • Renaissance

      • advancement of the technical basis of medicine

      • Invention of the microscope in the 1600s

      • Increased dependence on laboratory/physical findings as basis for health and illness

      • Clinical Eye: can use labs to confirm diagnosis but should not be too dependent on it

    • Modern Times

      • Psychodynamic Contributions

        • Sigmund Freud: Conversion Hysteria

        • Unconscious Conflict = physical disturbances that represent repressed psychological conflicts

        • Anna O. = diagnosed as having hysteria

          • Physical manifestation of a psychological conflict

          • Best treated with hypnosis

      • Psychosomatic Medicine

        • Flanders Dunbar (1930s) and Franz Alexander (1940s)

        • Conflicts led to anxiety and anxiety show up as physiological symptoms and sometime actual organic disease

• Current Perspectives

  • Traditional East Asian medical philosophies and practices

    • Acupuncture or acupressure

  • Advancement of Neuroscience

  • Development of Psychoneuroimmunology (PNI)

    • Link between brain, physical symptoms and immunity

• Biopsychosocial Model

  • Consider biological, psychological, and social factors

  • Help in planning treatment

  

• Biomedical Model

  • ALL illness can be explained on the basis of aberrant somatic/physical bodily processes.

  • Psychological and social processes are IRRELEVANT to the disease process.

  • Potential Liabilities of the Biomedical Model:

    • Reductionistic single-factor model: reduces illness to simplistic cause

    • Implicitly assumes a MIND-BODY DUALISM: mind is separate from body; psyche cannot influence physical body

    • Emphasizes illness over health

    • Fails to address certain puzzles related to health (e.g., Given 6 people exposed to measles, why do only 3 develop it?)

      • Are there psychological and social factors that influence their health?

• Advantages of the Biopsychosocial Model

  • Biological, psychological, and social processes are ALL important determinants of health and illness.

  • Mind and body cannot be distinguished in matters of health and illness.

  • Mind influences body, what we feel physically can influence our mind as well

• How do biological, psychological, and social processes interact if biological processes are micro-level processes and psychological and social processes are macro-level processes?

  • Systems Theory Approach

    • All levels of organization are linked to EACH OTHER hierarchically. A change in one level results in change in all the other levels.

    • One would affect another based on their level

• Clinical Implications of the Biopsychosocial Model

  • Diagnoses and recommendations for treatment should consider interactions between and among all 3 factors (Bio, Psych, and Social factors)

  • Makes explicit the Patient-Practitioner relationship as well as its significance

  • The achievement and practice of health habits involve the interaction of all 3 factors as well.

  • Ex social factor: support of family of them getting treatment

• Current trends in medicine, psychology, and the health care system

• Cases in Health Psychology: The Case of “Nightmare Deaths”

  • 1970s: influx of refugees to the United States from Laos, Cambodia, and Vietnam

  • Increase in sudden, unexpected, nocturnal deaths among males refugees from these countries.

  • INITIAL CLUES: Deaths occurred within the first few hours of sleep; victim was noted to gurgle (like drowning) and move restlessly in bed; most victims had a rare, genetically-based malfunction in the heart’s pacemaker (have irregular heartbeat); autopsies showed NO SPECIFIC CAUSE OF DEATH

• “Nightmare Deaths”: Bangungot?

  • Psychosocial Clues:

    • ONLY MEN from particular ethnic backgrounds were affected

    • Deaths were clustered in certain families

    • Survivors and victims’ relatives seemed to recall a dream that foretold the death

    • Survivors said they experienced a severe night terror

    • Many victims were noted to have either: watched a violent TV show prior to retiring to bed, or had a family argument, or were exhausted from working 2 jobs or from having full-time work AND learning English.

  • Bangungot:

    • acute pancreatitis (pancreas releases hormones and goes to shock and organ failure)

      • Pancreas release hormones to digest the food

      • Sudden flood of hormones = inflammation in the pancreas

      • Cardiac arrest: part of multiple organ failure; heart dilates; cannot handle pumping blood efficiently

    • “Asian Death Syndrome” : genetics may play in the occurrence

    • Sleep paralysis: paradoxical sleep (you know you’re awake but you cannot move)

      • Parasomnia, abnormal sleep features

    • Death certificates = acute pancreatitis, multiple organ failures, septic shocks

• The Need for Health Psychology

  • Changing patterns of illness: Acute vs. Chronic Illness

    • Examples of chronic illness: Lifestyle illness (hypertension, diabetes, high blood pressure), dementia

  • Advances in technology and research: Genetic research & PNI

  • Role of Epidemiology in Health Psychology: Morbidity and Mortality statistics

    • What health behaviors can help prevent COVID-19

  • Expanded Health Services: How can health psychologists help?

  • Increased medical acceptance of health psychologists

    • US, health psychologists work in clinics and hospitals; practice in tandem with psychiatrists, cardiologists

      • Teaching medical doctors how to encourage patients

• Career Paths in Health Psychology

  • Practical Application: Medicine, Applied Medical Field

    • Therapies (speech, physical)

  • Research: public health, industrial/occupational health settings

    • Types of Research: correlational studies, prospective and retrospective studies, longitudinal research, case studies

  • Issues: promote health behaviors, prevent illness and accidents, control health care costs