Health Psychology: Introduction

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

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