History of Psychology: Chapter 1 What is Health Psychology? health psychology is devoted to understanding psychological influences on how people stay

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1 History of Psychology: Chapter 1 What is Health Psychology? health psychology is devoted to understanding psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill health psychologists promote interventions to help people get well or get over illness in 1948, the World Health organization defined health as a complete state of physical, mental, and social well being and not merely the absence of disease or infirmity rather than defining health as the absence of illness, health is recognized to be an achievment involving balance among physical, mental, and social well-being concerned with all aspects of health an illness across the lifespan health psychologists focus on health promotion and maintenance; activities that promote health( good exercise) they focus on prevention and treatment of illness (how to manage stress, or adjusting to illness) focus on etiology and correlates of health, illness, and dysfucntion etiology refers to origins or causes of illness, and health psychologists are especially interested in the behavioural and social factors that contribute to health and illness and dysfunction health psychologists analyze and attempt to improve the health care system and the formulation of health policy they study the impact of health institutions and health professional on peoples behaviour and develop recommendations for improving health care HOW HAS OUR VIEW OF THE MIND-RELATIONSHIP CHANGED OVER TIME? historically, philosophers have vacillated between the view that the mind and body are part of the same system and the idea that they are two separate ones in the earliest times, the mind and body were considered a unit early cultures believed that disease arose when evil spirits entered the body and that these spirits could be exorcised through the treatment process Archaeologists found Stone Age skulls with small holes that are believed to have been made with sharp stone tools intentionally (Trephination),which allowed evil spirits to leave body Greeks were among earliest civilizations to identify role of bodily functioning in health and illness developed a humoral theory of illness (first proposed by Hippocrates): disease arises when four circulating fluids of the body- blood, black bile, yellow bile, and phlegm- are out of balance, function of treatment is to restore the balance among the humours personality types we believed to be associated with bodily temperaments in which one of the four humours dominated therefore they ascribed disease to bodily factors but believed these factors had an impact on the mind Middle Ages, more supernatural explanation of illness mysticism and demonology dominated concepts of disease, which were seen as gods punishment for evildoing cure often consisted of driving out evil by torturing the body throughout this time the church was the gaurdian of medical knowledge and medical practices took an religious overtone as the functions of the physician were absorbed by the priest, healing and the practice of religion becoming indistinguishable early years of the Renaissance, the patients thoughts and beliefs were viewed as central to changes in physical states

2 imagination and emotion were seen as the means through which the individual could connect with God if an individual was always ill it was becuase of lack of faith and what was required was altering the imagination so as to restore the connection to God if physican was successful in curing a particular ailment, then the attack on illness involved changing physical pathologies and altering the imagination to induce bodily change consequently healing relied heavily on patients unwavering and pure belief in the words and practices of the physician Anton van Leeuwenhoek ( ) work in microscopy and Giovanni Morgagni's ( ) contributions to autopsy lead to rejection of humoural theory of illness As a result of Decartes mind and body dualism, medicine looked more to the medical laboratory and bodily factors, rather than the mind as a basis for medical progress dualistic conception of the mind and body was strongly reinforced so that physicians became the guardians of the body, while philosophers and theologians became caretakers of the mind Psychoanalytic Contributions Sigmund Freud ( );specific unconscious conflicts can produce particular physical disturbances that symbolize the repressed psychological conflicts in conversion hysteria the patient converts the conflict into a symptom via the voluntary nervous system; they become relatively free of the anxiety the conflict would otherwise produce Psychosomatic Medicine although true conversion hysteria responses are rarely seen, the idea that specific illnesses are produced by individuals internal conflicts was perpetuated in the work of Flanders Dunbar in the 1930s and Franz Alexander in the 1940s researchers linked patterns of personality rather than a single specific conflict to specific illnesses Freud believed that conversion reactions occur via the voluntary nervous system with no necessary physiological changes, Dunbar and Alexander argued that conflicts produce anxiety, which becomes unconscious and takes a physiological toll on the body via the automatic nervous system, which eventually produces an organic disturbance Dunbar and Alexander helped shape psychosomatic medicine by offering profiles of particular disorders believed to be psychosomatic in origin- bodily disorders caused by emotional conflict, ulcers,hyperthyroidism,rheumatoid,arthritis, essential hypertension, colitis and bronchial asthma idea that there may be disease prone personality was resurrected by researchers in the late 1980s researchers now believe that a particular personality type is not sufficient to produce illness rather, the onset of disease requires the interaction of a variety of factors: genetic weakness in the organism, the presence of environmental stressors, early learning experiences and conflicts, current ongoing learning and conflicts, and individual cognitions and coping efforts Behavioural Medicine psychosomatic medicine did much to bridge mind-body gap, but it relied on subjective, verbal interventions based on psychodynamic perspectives that didn't provide testable hypotheses behavioural medicine focused on objective and clinically relevant interventions that would demonstrate the connections between body and mind suggested by psychosomatic medicine behavioural medicine is an interdisciplinary behavioural science and for understanding physical health and illness and for developing and applying knowledge and techniques to prevent, diagnose, treat and rehabilitate Current Views of the Mind-Body Relationship now knwn that physical hlth is inextricably interwoven w/ all psychological/social environment the treatment of illness and prognosis for recovery are substantially affected by such factors as

3 the relationship between patient and practitioner, and expectations about pain and discomfort staying well is heavily determined by good health habits and socially determined factors as culture, socio economic status, place stress, availability of health resources and social support this perspective on mind-body relationship has also been influenced by growing interest in more holistic approaches to health and healing in Canada and other Western countries Eastern and other alternative medical philosophies emphasize the interrelation of all of the body's systems and view illness a disharmony between these systems, healing is accomplished through techniques and treatments that help restore both physical and psychological balance What is the Biopsychosocial Model of Health? the idea that the mind and the body together determine health and illness logically implies a model for studying these- biopsychosocial model it's fundamental assumption is that health and illness are consequences of the interplay of biological, psychological, and social factors The biopsychosocial model vs. The biomedical biomedical model maintains that all illnesses can be explained on the basis of aberrant somatic processes, such as biochemical imbalances or neurophysiological abnormalities assumes that psychological and social processes are largely independent of the disease process it is a reductionist model- that it reduces illnesses to low level processes, such as disordered cells and chemical imbalances rather than recognizing the role of more general social and psychological processes biomedical model is also essentially single factor model of illness- t it explains illness in terms of a biological malfunction rather than recognizing that a variety of factors are responsible assume a mind body dualism maintaining that mind and body are separate entities biomedical model clearly emphasizes illness over health- it focuses on aberrations that lead to illness rather than the conditions that might promote health has difficulty for accounting for why a particular set of somatic conditions need not inevitably lead to illness psychological and social factors are ignored in the biomedical model Advantages of the Biopsychosocial Model both macrolevel processes such as existence of social support and microlevel processes such as chemical imbalances, interact to produce a state of health or illness maintains that health and illness are caused by multiple factors and produce multiple effects maintains that the mind and body cannot by distinguished (inseparable)because both clearly influence an individuals state of health emphasizes both health and illness rather than regarding illness as deviation from steady state health becomes something that one achieves through attention to biological, psychological, and social need rather than something that is taken for granted systems theory: all levels of organization in any entity are linked to eachother hierarchically and that change in any one level will affect change in all other levels this means that microlevel processes are nested within macrolevel processes and that changes on the microlevel can have macrolevel effects health, illness, and medical care are all interrelated processes involving interacting changes both within the individual and on these various levels Clinical Implication of the Biopsychosical Model biopsychosocial model maintains that process of diagnosis should always consider interacting roles of biological, social, and psychological factors in assessing an individual's health or illness an interdisciplinary team approach may be the best way to make a diagnosis

4 maintains that recommendations for treatment must all examine all three sets of factors by doing this, it should be possible to target therapy uniquely to a particular individual, consider a persons health status in total, and make treatment recommendations that can deal with more than one problem simultaneously an effective patient-practitioner relationship can improve a patient's use of services as well as the efficacy of treatment and the rapidity with which illness is resolved clearly implies that the practitioner must understand the social and psychological factors that contribute to an illness in order to treat it appropriately Why is the field of Health Psychology Needed? adequate understanding of what keep people healthy or makes them get well impossible without knowledge of psychological and social context within which health and illness are experienced Changing Patterns of Illness until the 20 th century, acute disorders (tuberculosis, pneumonia) were among the major causes of illness and death in Canada acute disorders are short term medical illnesses, often the result of viral or bacterial invader and usually amenable to cure now chronic illnesses are the main contributors to disability and death, especially in industrialized countries chronic illnesses are slowly developing diseases with which people live for a long time, amny cannot be cured but maintained These are diseases in which psychological and social factors are implicated as causes health psychology has evolved in part to explore the causes and develop ways to modify them because people may live with chronic diseases for many years, psychological issues arise in connection with them health psychologists help people living with chronic illness adjust to psychologically and socially to their changing health state Advances in Technology and Research new technologies now make it possible to identify the genes that contribute to many disorders health psychologists conduct research that identifies the risk factors for disease advances in genetic research have made it possible to identify carriers of illness and to test a fetus for the presence of particular life threatening or severely debilitating illnesses certain treatments that may prolong life, severely compromise quality of life Role of Epidemiology epidemiology-the study of frequency, distribution, and causes of infectious and noninfectious disease in a population, based on investigation of the physical and social environment morbidity-the number of cases of a disease that exist at some given point of time- may be expresses as number of new cases (incidence) or as the total number existing cases(prevalence) mortality refers to numbers of deaths due to particular causes need to know major causes of diseases to reduce there occurrence knowing that cardiac disease is major cause of premature death has lead to countrywide strategy to reduce risk factors among those most vulnerable, including smoking reduction, dietary changes, cholesterol reduction techniques, increased exercise and weight loss this initiative has lead to Canada being recognized as world wide leader in cardiovascular disease prevention health psychology is concerned not only with biological outcomes but also with health related quality of life and symptomatic complaints health psychologists are becoming more involved in the effort to improve quality of life among

5 those diagnosed with chronic illnesses so that individuals may live out their remaining years as free from pain, disability, and lifestyle compromise as possible Changing Perspectives on Health and Health Care the definition of health has continued to evolve since World Health organization first introduced the idea that health is a positive state rather than merely the absence of disease 1974, Lalonde report challenged traditional views of health and suggested that changing lifestyles and physical and social environments would have greater chance of improving the health of Canadians than simply improving healthcare delivery system even before biopsychosocial model, Lalonde report proposed framework for health that rested on four main consequences:human biology,environment,lifestyle,healthcare organizations this proposal led to the initiation of several health promotion programs to increase awareness of importance of healthy behaviours and risks associated with other behaviours such as smoking since that time, a public health-health promotion perspective of health has continued to shape how we view the factors that contribute to making and keeping Canadians healthy The Epp Report released in 1986, proposed a health promotion approach to health in Canada that further echoed the need to view health in non-medical terms and give greater consideration to the social factors that contour health according to public health-health promotion perspective, health viewed not as a state, but more broadly as capacity or resource that is linked to ability to achieve ones goals,learn,and grow a variety of social, economic and physical environmental factors are recognized as making an important contribution to an individuals health status under these terms, health is conceptualized as the capacity of people to adapt to, respond to, or control life's challenges and changes public health promotion model is aimed at improving the health of both individuals and communities, primarily through highlighting the need for social policy changes and action Canada's publicly funded health care system provides access to most basic health care services at no cost to the individual this does not ensure that people will be satisfied with the healthcare they receive, or that they will make use of these services when they are needed the cost of healthcare in Canada has increased substantially since mid 1980s with rapid aging of Canadas population, the rates of chronic illness are likely to rise, as are the health care costs associated with managing illness Health Psychology represents an important perspective on these issues for several reasons: 1. health psychology's main emphasis on prevention has the potential to reduce the number of dollars devoted to the management of illness 2. health psychologists have done substantial research on what makes peoples satisfied and dissatisfied with thr healthcare, they can help in the design of user friendly health care systems 3. the health care industry employs thousands of individuals in a variety of jobs, therefore its impact is enormous Increased Medical Acceptance their value is increasingly recognized by physicians and other health professionals at one time, the value of health psychologists in healthcare was largely confined to the task of administering tests and interpreting the test results of individuals who were suspected of being psychologically disturbed psychologist usually only saw the problem patients who were difficult for medical staff to manage or whose physical complaints were believed to be entirely psychological in origin now, caregivers are recognizing that psychological and social factors are always important in

6 health and illness the role of the psychologist is in changing patients health habits and contributing to treatment is increasingly acknowledged Demonstrated Contributions to Health Health psychologists have developed a variety of short term behavioural interventions to address a wide variety of health related problems, including managing pain and modifying bad habits, and managing the side effects of treatments techniques that take only a few hours can provide years of benefit such interventions, particularly those that target rick factors have contributed to the actual decline in the incidence of some diseases, especially coronary heart disease Methodological Contributions the health psychologist can be a valuable member of the research team by providing the methodological and statistical expertise that is the hallmark of good training in psychology's Experiments in an experiment: a researchers created two or more conditions that differ from eachother in exact and predetermined ways, people are randomly assigned experiments conducted by health care practitioners to evaluate treatments or interventions and their effectiveness over times are also called randomized clinical trials experiments have been the mainstay of science, because when we manipulate a variable and see its effect, we can more definitely establish a cause-effect relationship Correlational Studies correlational research: the psychologist measures whether a change in one variable corresponds to change in another variable the disadvantage is that it is impossible to determine the direction of causality unambiguously more adaptable, enabling us to stdy issues when variables can't be manipulated experimentally Prospective Designs prospective research looks forward in time to see how a group of individuals change, or how a group of individuals change or how a relationship between two variable changes, over time longitudinal research, in which we observe the same people over a long period of time Retrospective Research retrospective research looks backward in time and attempts to reconstruct the conditions that led to the current situation were critical in identifying the initial outbreak and spread of SARS to 30 countries earliest cases emerged in mid November 2002 in China first recorded cases outside China appeared February 2003 after a medical doctor stayed at a hotel in Hong Kong he transmitted SARS to at least 16 people who then carried the virus with them as the travelled internationally to Singapore, Vietnam, and Toronto Because of retrospective studies, researchers were able to calm the fears regarding travel to infected countries such as Canada Qualitative Research qualitative research focuses on the quality of life issues, taking many forms such as, interviews, focus groups, case studies, and open ended questions on surveys includes the individuals voice and perspective What is the Purpose of Health Psychology Training students who are trained in health psychology at an undergraduate level go on to many occupation in applied setting or research

7 number of clinical health psychology programs in Canada students can also complete graduate training in a non-clinical psychology program that focuses on health Careers in Practice some health psychologists go into medicine, becoming physicians and nurses because of their experience in health psycholohy they are often able to understanf and manage the social and psychological aspects of the health problems they ttreat better than would be the case if their education had only training in traditional medicine others may work as health psychologists in a clinical research setting in which they apply their breadth of knowledge to deal with a variety of health issues Careers in Research many students go on to conduct research in public health, psychology, and medicine public health researchers are involved in research and interventions that have the broad goal of improving the health of the general population public health researchers typically work in academic settings, public agencies in these settings, public health researchers can be responsible for developing educational interventions for the general public to help people practice better health behaviours, or to inform policymakers about changes that would benefit communities many undergrads in health psychology go on to grad school in psychology, where they learn research, teaching, and applied skills necessary to research and/or practice health psychology