Health and Medical Psychology

What are lay perceptions of health (Blaxter, 1990)?

• Health as not ill: no visits to doctor

• Health as reserve/resources: strong family, recover quickly

• Health as behaviour: look after myself

• Health as physical fitness and vitality: energetic

• Health as psychological well-being: in harmony, balance, proud, enjoyment

• Health as function: to do what I want/have to do

What is the definition of health according to WHO (1948) and what is the criticism?

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Criticism: black and white: two people with same symptoms can have a different health

How does the biomedical model understand health and illness and what is the criticism?

As underlying pathology, neural and/or biochemical activity (exposure to contagious agents, insufficient immune response)

Criticism: you can only become ill if a bodily process is affected, not always the case (also health behaviour, stress and emotions, social relations)

What are other predictors of health and illness?

• Health behaviour

• Stress/emotions

• Social relations

How does the biopsychosocial model understand health and illness?

• Body and mind interaction

• Consequences of interplay biological, psychological and social

• Systems influence each other

What kind of prevention are there?

• Primary: prevention of problem, illness or casualty

  • Target group: healthy people

• Secondary: tracing illness in an early phase, for early treatment or for prevention of more serious complaints

  • Target group: (healthy) people with increased risk for disease

• Tertiary: revalidation/ living life to decrease symptoms or learning to live with it

  • Target group: ill people

What is the Alameda 7 for longevity?

1. Exercising

2. Drinking less than five drinks in one sitting

3. Sleeping 7-8 hours a night

4. Not smoking

5. Maintaining desirable weight for height

6. Avoid snacks

7. Eating breakfast

What kind of health behaviours are there (Matarazzo, 1984)

• Behavioral pathogens (health risk behavior): smoking, alcohol etc.

• Behavioral immunogens (health protective behaviour): exercising, sun protection etc.

Why would you influence health behaviour?

1. Health behavior is related to morbidity and mortality

2. The prevalence of risk behaviors is high

3. Socio-economic differences in health and health behavior

4. Health behavior is not always an informed choice

What diseases and their medications reduced mortality?

• Measles: vaccine

• Scarlet fever: penicillin

• Tuberculosis: izoniazid

• Typhoid: chloramphenicol

What are the top 3 main causes of death worldwide?

1. High blood pressure

2. Smoking

3. High blood sugar

What are the main causes of death in the USA in 1900 compared to 2010? (Jones, Podolsky & Greene, 2012)

1900

1. Pneumonia or influenza

2. Tubercolosis

3. Gastrointestinal infections

2010

1. Heart disease

2. Cancer

3. Noninfectious airways disease

What adverse effects may occur in health interventions?

• The interventions only reach the higher part in SES and generate inequalities

• Hardening: people lose trust in the government

• Stigmatizing: people who have conditions and blaming them for this

What are determinants of health according to Lalonde’s Health Field Concept?

• Health risk behavior

• Health promoting behavior

What are behavioural determinants of health behaviour?

Things that have been proven to influence behavior change. Effective interventions work by addressing a set of determinants (determinants —> behaviours, (CDC, 2024))

OR

The underluing factors why someone does (not) engage in health behavior

What health theories are about getting motivated?

• Health Belief Model

• Social Cognitive Theory

• Theory of Planned Behavior/Reasoned Action Approach

What is the Health Belief Model (Becker, 1974)?

• Perceived susceptibility: how likely am I to get the disease?

• Perceived severity: how bad would it be if I got the disease?

• Perceived benefits: if I get the vaccine I can see my friends and family

• Perceived barriers: what side-effects do you expect?

• Health motivation: how motivated are you to live a healthy life in general?

• Cues to action: how often are you prompted to engage in the behaviour?

What is the basic concept of the Social Cognitive Theory (Bandura, 1977, 1989)?

Three observable elements: person, behavior, outcome

• Self-efficacy: your expectation that you can engage in health behaviour and that it will help you

• Outcome expectation: if I engage in this health behaviour, will it lead to the desired outcome?

What is the Social Cognitive Theory, and then specifically self-efficacy? (Bandura, 1977, 1989)

• Own experiences: if you have tried it and it did not work

• Vicarious: someone else’s experiences

• Verbal persuasion: someone can tell you

• Emotional arousal: how you feel after doing something

What is the Theory of Planned Behaviour (Ajzen, 1991)

• Intention is the most important for engaging in health behaviour (determined by: relevance, valence, evaluation)

• Attitude: your evaluations of what it will lead to (similar to outcome expectations)

• Subjective norm: what others do (descriptive: what they do, injunctive: what people think is right)

• Perceived: related to self-efficacy, trust in own ability

• Normative beliefs: what do you think others think?

• Motivation to comply: how much you care about someone’s opinion

What is the Reasoned Action Approach? (Fishbein & Ajzen, 2010)

• + Actual control (skills, ability, environment)

• This makes intentions turn into behaviour

What health theories are about preparing for action and starting to change?

• Self-Determination Theory

• Health Action Process Approach

What is the Self-Determination Theory? (Deci & Ryan, 1985, 2000)

• Quality of motivation: what kind of motivation drives behaviour

• Amotivation: you do not know why you should engage in health behaviour

• Autonomous: values that you have

Understands content of motivation

What is the Health Action Approach (Schwarzer, 1992)?

• What is between intention and action

• Volitional phase: how you translate intention into action

• Action planning: what are you going to do about your intention?

• Coping planning: how are you going to cope if things are not going according to plan?

Moves beyond motivation and highlights importance of volition

Stage model

What are dual process theories?

• Theories that assume we to not always make reasoned decisions

• Two systems: reflective/intuitive

• We can also have reasoning (type 2) to engage in unhealthy behaviours (‘I worked hard so I deserve this chocolate)

What is the COM-B model?

• A model that collects all theories and simplifies it

• Actual control (RAA)

• Automatic & reflective processes (dual process theories), self-efficacy & outcome expectations (SCT)

• Cues to action (HBM), perceived norms and behavioral control, actual control (RAA)

What is the Theoretical Domains Framework?

• Green: COM-B

• Motivation has automatic and reflective components (sources of behaviour)

Integrative model for understanding health behaviour

What is the Behaviour Change Wheel?

• Method to guide intervention development

• Red wheel: COM-B model first to characterize factors that underlie

Integrative model for understanding health behaviour

What fields do health and medical psychologists work in?

• Health care: primary (huisarts), secondary (mental health organizations, rehab) en medical psychology department in hospital (multidisciplinary)

• Primary prevention, policy and training

• Research and policy

Self-efficacy (Bandura)

het geloof in je eigen vermogen om een specifieke taak of gedrag succesvol uit te voeren en de gewenste uitkomst te bereiken

Habit

A mental association between a cue and a goal-directed response

Behavior —> habit when frequently performed in a stable situation until context automatically triggers the behavior

• Efficient

• Problematic

• Difficult to change despite strong intentions

• Different interventions: competing with excising habits

What is the Reflective Impulse Model (Strack & Deutsch, 2004)?

• Reflective system

• Impulsive system

• Parallel but asymmetry

What are the information provision NICE guidelines (2014)

• Outcome expectancies

• Personal relevance

• Positive attitude

• Self-efficacy

• Descriptive norms

• Subjective norms

• Personal and moral norms

How can you motivate change?

1. Boosting self-efficacy (SCT)

2. Social norms (TPB, RAA): majority norms instead of minority norms, identification with norm referent group

• Injunctive norms: what we think should be done

• Descriptive norms: what people actually do (more effective than injunctive)

3. Fear appeals (HBM) (if too extreme, cognitive dissonance and defensive responses, so important to recommend healthy alternatives)

4. Self-monitoring (HAPA)

5. Implementation intentions/Action planning

   • Motivational phase= setting goals

   • Volitional phase= translating intentions into behavior (assumption: sufficient motivation, but it actually has to do with volitional phase)

6. Changing habits

   • By removing/avoiding cue (changing environment)

   • Implementation intentions (alternatives)

   • Promoting health-protective behaviour and decreasing habits

7. Nudging= strategic use of mental shortcuts (dual process models)

• We do what most people do (social norms), we favour the status quo (loss aversion, inertia)

8. Motivational interviewing: individual approach

Fear appeal

A persuasive communication that tries to scare people into changing their attitudes by conjuring up negative consequences that will occur if they do not comply with the message recommendations (motivational technique)

• Consider information inaccurate

• Sensitivity to counter-information

• Estimate low personal risk

• Spending less time on the information

• Suppressing threat-related thoughts

• Making up excuses for the behaviour

• Increased commitment to/intensity of the risk behaviour

What is the Extended Parallel Process Model?

You need perceived threat and perceived efficacy to have an effective fear appeal

Protection motivation= accepting the message and using a danger control process

Defensive communication= rejecting the message and using a fear control process

What is self-monitoring?

• Evaluating ongoing performance relative to the standard

• Periodically noting qualities of target behaviour

• Identify discrepancies between current state and desired state

• Effective, especially when public/recorded

What is the behaviour-intention gap?

Intentional control of behaviour is limited, thus people can have intentions but not act upon them (there are many other influences on our behaviour)

'A medium-to-large change in intention —> small-to-medium change in behaviour’

Implementation intentions can help translating intentions into behaviour (If X, then Y), effective because:

• Increased activation of specified cue

• Automatic activation of specified response

Libertarian Paternalism (nudging)

The idea that it is both possible and legitimate for private and public institutions to affect behavior while also respecting freedom of choice

What are examples of nudges?

• Salience (opvallendheid): fruit bij de kassa neerleggen

• Social proof: 85% of guests in this room reuse their towels

• Defaults

What are the pros and cons of nudges?

+no need for cognitive resources/strong motivation/highly acceptable

-one shot localized intervention: very specific and target one choice

What is the Model of Stage of Change (Prochanska, DiClemente, Norcross)

Lapses= little slipups

Relapses= completely falling back into old behaviour

What is the Rubicon Model of Action Phases? (Heckhausen & Gollwitser)

What development was there in Work Health Psychology?

1. Safety and quality of products

2. Top management

3. Medical risk factors

4. Health Behaviour

5. Health wellness programmes

Why Health Promotion at the worksite?

• Lifestyles connected with mortality, morbidity, absenteeism, health care corsts, productivity

• Worksite specific advantages

Why do organisations introduce Work Health Psychology?

•keep employees healthy

•part of the business culture

•reduces indirect costs of health failure

•moral responsibility towards employees

•in response to employee requests

•desire to project a favorable corporate image

•belief that WHP is an important benefit that improves employee recruitment and retention

•as a means for improving employee morale and job satisfaction

What kind of preventions are there in the workplace?

Prevention	Response type	Orientation	Focus
Primary	Proactive	Prevention or promotion	All employees and/or the organisation
Secondary	Pro-active, potentially reactive	Primarily prevention	Employees at risk and/or organizational risk factors
Tertiary	Reactive	Reduction consequences	Employees with ill health / in need of assistance

What are advantages as the worksite as a setting for Health Psychology?

•large population adults (also the ‘’difficult to reach’’)

•convenience for target population

•stability of population

•social context

•availability organisational structure

•possibility to intervene at different levels (individual,   organisational, environmental)

What are health-wellness programmes?

• Focus on employee wellness next to physical health/absence of disease (and positive outcomes)

• Work is important determinant of employee health, stress management (individual)

What is the criticism toward individual-focues intervention?

-Often low participation

-Often not attracting the target (stressed) population

-Focus on employees not coping adequately (‘blaming the victim’)

-Avoids employers having to modify any work-related causes of stress

What is the model of Tetrick & Winslow, based on the Job Demands-Resources model?

How do job stressors influence physical and mental health? (LaMontagne)

What is the Participative Action Research Program?

involves employees in a cyclic process participating in:

(a)defining issues or problems,

(b)developing methodology and collecting data to inform the   problem,

(c)making sense of the data,

(d)defining the interventions,

(e)helping to implement these interventions,

(f)evaluating the results

What is the effectiveness of stress-management programmes (LaMontagne)?

Combining individual + organisational is more effective

What are two important aspects of WHP programs?

• Reach/participation rate (important to the employee, match interest, supported by top management, culture integrated within culture, incentives)

• Effectiveness in creating behavior change (individual goal setting, social support, low costs/barriers for healthy behaviour, sufficient intensity and duration, environmental cues)

What were the results of the Assessment of Health Risks with Feedback (Goetzel & Pronk)?

Tobaccy use, dietary fat, seat belt use, high blood pressure, cholesterol, high-risk drinkers, absenteeism, physical activity, overall health, health care use —> useful gateway activity for WHP interventions

Insufficient evidence: fruit, BMI, overall phyisical

Stressor

Event with possible threat to the attainment of psychobiological goals

Stress response

Adaptive psychobiological reaction to a stressor

What are the differences between stress and anxiety?

Stress (short-term)

• Typically caused by a demanding situation/external trigger

Anxiety (lingering)

• Caused by persistent, excessive worries

What is the Yekes-Dodson law?

Performance increases with mental arousal (stress) but only up to a point: when an individuals' level of stress is too low or too high, their performance deteriorates

What are positive aspects of stress?

• Helps adjusting

• Concentration

• Avoiding danger

• Flexibility

• Boosts immunity

• Protects DNA

What are the key factors in stress?

• Duration

• Impact/intensity (adversity)

• Predictability/controllability

Why is stress a secondary prevention?

Aims to reduce its harmful effects

What is homeostasis?

Your body’s tendency to maintain a stable internal environment

What is the difference between allostasis and allostatic (over)load?

• Allostasis: process of achieving  homogeneity (stability) through  physiological and behavioral  adaptation in response to a challenge

• Allostatic (over)load: demands  exceed energy supplies: kind of  balance may be achieved but system  needs to work too hard and slowly  breaks down

What two important stress systems are there?

• Sympatho-adrenomedulary (SAM) axis: acts via sympathethic (activation) nervous system & adrenal glands

  • Neurotransmitters: catecholamines (nor)adrenaline —> short-lived arousal

  • increased heart rate and blood pressure, local constriction of  peripheral blood vessels: more blood to muscles, less to viscera  (guts): preparation for action!

    more glucose in blood: ‘fuel’… preparation for action!

    more sweating: ‘cooling’

    

• Hypothalamic Pituitary Adrenal (HPA)

  • Hormones: glucocorticoids (cortisol) —> longer term arousal

  • suppressing immune activity and other ‘non-essential’ activity  (digestion, growth etc.): save energy (fuel: glucose & simple  proteins/fats) to support  fight/flight action

    buffering against SAM induced tissue damage

    suppressing pain (via endorphins): no interference of pain-  experience with action

    returning to steady state

    

What are the differences between the sympathetic and the parasympathetic system?

Stress reactivity/recovery

The tendency/capacity to respond to a stressor

Cortisol pros and cons

+regulating immune response

+increased energy and inhibition of inflammation

-decreased energy
-brain damage and cognitive declines (memory and attention)
-reduced ability to adapt

What is psychoneuroimmunology?

Bi-directional relationship  between psychological  stress and physiological immune responses

What types of stressors are there (related to specific events)?

• Transient

  • Acute time-limiting

  • Traumatic events

  • Life events

• Repeated

  • Daily hassles

  • work-related

What is the cognitive transactional model of stress (Lazarus)?

Stress is a subjective experience

Cognitive appraisal + thoughts/interpretations

• Primary appraisal: perceived demands

  • Harm-loss: damage that already occured

  • Threat: future harm/loss

  • challenge

• Secondary appraisal: resources (coping potential)

Stress= mismatch between perceived demands and resources

Coping

• Anything a person does to reduce the impact of a perceived or actual stressor

• Dynamic process involving constellation of cognitions and behaviour that arise

• Can operate/alter/reduce negative emotions or target stressor

• Concerned by adaptation

Coping style

Trait

Approach/avoid

Coping strategy

Varies according to event/context

• Situation-specific coping

• Problem-focused coping

• Passive coping

Coping taxonomies

• Problem-focused/emotion-focused: reduce demands (emotion when control is low)

• Approach-oriented/avoidance: attending to the source or distracting yourself

What is the Coping Process (Lazarus)?

What is the Stress-Coping Model (Maes, Leventhal & De Ridder)

What kind of personalities are there?

What is the difference between worry and rumination?

Worry: anticipation of future events

Rumination: dwelling on past events

—> these are perseverative cognitions (passive, repetitive and self-focused thinking about negative emotional states and implications/consequences of these states)

What is the perceived locus of control?

Appraisal of control over the outcome;  distinguish between internal versus external locus of control  

What kind of perceived control types are there?

•Behavioral (e.g., breathing techniques)

•Cognitive (e.g., distraction)

•Decisional (e.g., opportunity to choose between options)

•Informational (e.g., opportunity to find out more about  stressor)

•Retrospective (e.g., searching for meaning)

What kind of social support is there (Lazarus)?

• Instrumental (practical aid)

• Emotional

• Informational

What are negative moderators of stress?

•Neuroticism

•Negative affectivity

•Social inhibition

•Hostility and anger

•Perseverative cognitions

What are positive moderators of stress?

Social support

Optimism

Hardiness – belief of control, feeling involved and challenged:  buffering effect

Self-efficacy - one's belief in one's own ability to complete

tasks and reach goals

Perceived locus of control

Fighting spirit, hope

What is the stress model according to Selye and which phases does it have?

• Alarm stage: initial response, increased arousal

• Resistance stage: adaptation to the stressor

• Exhaustion stage: depletion

Criticism: physiological response can differ depending on type of stressor (specific response)

He defines general adaption syndrome (stress response is innate drive to maintain homeostasis)

What factors contribute to an increased likelihood of perception of symptoms?

• Painful or disruptive

• Novel (or rare)

• Persistent

• Pre-existing chronic disease

What is the Symptom Perception Model? (Kolk et al.)

What are factors in Symptom Perception?

• Current emotions

• Personality traits: neuroticism, negative affectivity

• Attention (increased knowledge, distractions)

• Social situations

• Perceptions of vulnerability

• Gender

• Coping style

• Cognitions

Placebo/nocebo

Favorable / unfavorable treatment effects that cannot be ascribed to mechanisms  of treatment itself but due to positive/negative expectation

How are expectations formed?

• Instructions

• Conditioning

• Observation

What are pros and cons of placebos?

+Reduced pain perception

-Reduced trust

-Disappointment

What influences Symptom Interpretation?

• Culture

• Individual differences

• Self identity

• Illness experiences

• Causal attributions

What is the Common-Sense Model of Illness (Leventhal &Diefenbach)

What are the 5 themes in illness representations?

1. Identity

2. Consequences

3. Cause

4. Timeline

5. Curability/controllability

Direct effects on seeking treatment, engaging self-care, attitudes towards use brand-specific, return to work, caregiver anxiety, quality of lide

What are reasons for delay in seeking health advice?

• Appraisal delay

• Illness delay

• Utilization/Behavioural delay

• Scheduling delay

• Treatment delay

What are factors that determine a good medical consultation?

• Qualifiers

• Shared decision making

• Language

• Relationship

What 4 steps are involved in Shared Decision-Making?

• Choice

• Options

• Preferences

• Decision

Poor adherence predictors

• Social factors

• Psychological factors

• Treatment factors

How to improve adherence during the consultation?

• Achieving concordance

• Maximising understanding

• Maximising memory