Health psychology

Health psychology studies the biological, psychological, and social interactions of health, illness, recovery from illness, and the impact of health care systems and treatments. It encompasses the maintenance and promotion of health, the treatment and prevention of illness, and the development of health policy.

DATE: Late 1970’s forward

TYPE OF PSYCHOLOGY: Stress

Introduction

Health psychology is concerned with the psychological components of promoting and maintaining health, treating and preventing illnesses, improving health care services, and developing health care policy. Health psychology seeks to generate new knowledge about people’s health beliefs and practices and to apply existing knowledge to improve health and well-being. Psychologists interested in health psychology generally adhere to the belief that health cannot be understood exclusively by focusing on the physical condition of the body. The psychological side—the state of the mind—must be considered as well.

The Biopsychosocial Model

The relationship between mind and body and its impact on health are best understood by using what has been labeled the biopsychosocial model. This model assumes that one’s health state is based on the often-complicated interactions of three sets of factors: biological factors, psychological factors, and social factors. Biological factors include genetic or inherited influences that may predispose some individuals to be more susceptible than average to certain maladies such as heart disease. Examples of psychological factors could include the amount of stress an individual experiences, a personality trait such as optimism, or the degree of belief in control over one’s own health. Support and empathy one receives from family, friends, or colleagues constitute social factors. Such social support can come in the form of emotional, informational, or even tangible resources such as financial assistance. Other social factors that play roles in health and illness are cultural, ethnic, and gender differences.

Thus, the biopsychosocial model assumes that health is based on more than the absence of illness; it is also based on attaining physical, social, and mental well-being. Indeed, this model highlights the role of psychosocial variables. Psychosocial variables can be internal mental states, such as depression, or external situational factors, such as the quality of social support one receives. The important point is that psychosocial factors should be examined in combination with, not independent of, biological influences.

Although this model’s biological aspects are readily accepted as important to understanding health, the psychosocial components are controversial in some areas in which the biomedical model is heavily relied on. This more traditional model assumes that disease or illness is exclusively biological in nature, so that diagnosis and subsequent treatment are focused on the state of the body as distinct from the mind. The controversy concerning the biopsychosocial model is relatively minor, however, because there is a recognition among many researchers and health professionals that psychosocial variables often add more to knowledge concerning health, illness, and disease than do biological factors alone.

The Rise of Lifestyle Diseases

The rise in interest concerning psychosocial variables specifically, and health psychology generally, can be attributed in part to the changing conditions of health problems. Because of advances in disease prevention, vaccination, and other biomedical treatments, many of the primary health problems are no longer major infectious diseases, such as polio, smallpox, or rubella. (Acquired immunodeficiency syndrome, AIDS, is one important exception.) The threat of these acute diseases has been successfully eliminated through vaccination programs, which resulted in a doubled life expectancy within the twentieth century. This increased life span, however, has a price. A collection of more chronic and age-related diseases, including cancer, heart disease, and stroke, are increasingly prevalent health problems worldwide. Unlike infectious diseases, these threats cannot be treated through vaccination because they are largely caused by people’s lifestyles or aging.

The intriguing aspect of these modern lifestyle diseases is that they have a significant behavioral component and may be preventable. Ironically, most people are probably aware of ways they could reduce their susceptibility to these diseases, yet they choose not to change their lifestyles. To decrease the risk of lung cancer, for example, people who smoke should pursue smoking cessation treatments. Heart disease can be controlled through improved diet and a moderate amount of exercise. Alcohol consumption should be moderate, and recreational drugs should be avoided altogether. Making people aware of the origins of these lifestyle diseases is no longer the key problem. It has been replaced by the problem of how to alter negative behaviors affecting health. Many of these negative behaviors, such as binge drinking, have rewarding short-term consequences that increase these negative behaviors more effectively than delayed punishment, such as a hangover, can decrease them. Health psychologists are interested in researching motivation, coping strategies, and other behavioral modification techniques and therapies that promote health and well-being.

Some advances in dealing with the problems of lifestyle and behavior have been made. There has been a downward trend in smoking; more people are aware that exercise and eating healthier food improves the quality and quantity of life. However, people in industrialized countries are showing alarming increases in obesity and decreases in physical activity. Finding ways to alter health behaviors is one of the major contributions health psychologists can provide, one that relies on an understanding of biological as well as psychosocial factors in health.

The changing nature of illness, related in complex ways to biology and behavior, must be understood in relation to broader issues in health psychology, such as the expansion and development of adequate health care services. Preventable illness account for the bulk of health care costs in the United States. By 2012, Forbes magazine reported that obesity accounted for a staggering $190 billion in annual national health care costs, exceeding only smoking in terms of health care costs. A 2012 study published in the Journal of Health Economics estimated that obese men account for an additional $1,152 annual in medical spending, predominantly due to hospitalizations and prescription drugs, and obese women account for an additional $3,613 per year. This money supported escalating health expenses such as health care, health care workers’ jobs, and health-related research. Health psychology seeks to address these issues as well as make recommendations concerning future directions for health care.

Optimism and Heart Surgery

Because health psychology encompasses both theoretical and applied elements, researchers work in both laboratory and field settings. Given the variety of research efforts that potentially fall within the bounds of health psychology, only a brief review of representative pieces of research is possible. This review will be highly selective, focusing on two studies that explicitly link psychosocial variables to health-related issues: recovery following coronary artery bypass surgery and adjustment to a nursing care facility.

Heart disease is an important topic within health psychology because it accounts for more deaths annually in the United States than all other diseases combined. Each year, many persons require life-saving cardiac surgery to increase blood flow to the heart, thereby decreasing the risk of subsequent heart attack. The surgery itself, however, can be a stressful and physically and emotionally draining experience. It is useful for medical professionals to be able to predict which patients will cope better with the coronary artery bypass operation and show more rapid rates of recovery.

Michael F. Scheier and Charles S. Carver have argued that a personality trait they call “dispositional optimism” can lead to more effective coping with a threatening event such as heart surgery. Dispositional optimism refers to a person’s general belief that positive outcomes will occur in the future. If individuals can envision good things happening in the future, then these expectations might allow them both to cope effectively with and to recover more quickly from the surgery. Pessimists, those who anticipate relatively negative outcomes, might show a slower rate of recovery and poorer adjustment to the surgery.

In an article published in the Journal of Personality and Social Psychology in 1989, Scheier, Carver, and their colleagues assessed the optimism of a group of middle-aged men one day before their coronary artery bypass surgeries. As expected, following surgery the optimists showed earlier signs of physical recovery, such as walking around their hospital rooms, than did the pessimists. They were also judged by the medical staff to have demonstrated faster recovery rates. After six months, optimists were more likely to have resumed their normal routines of work, exercise, and social activity and to have done so more quickly than the pessimists. Furthermore, there is accumulating evidence that even mild depression, which is related to pessimism, increases the chances of death from a future heart attack.

Clearly, a more optimistic orientation can lead some people to deal effectively with adverse health problems. It may be that dispositional optimism promotes a reliance on useful coping strategies, such as making future plans or setting goals. In turn, these strategies affect one’s adjustment to the physical illness. Further research has shown that optimism leads people to seek social support and to focus on the positive aspects of stressful events. As a psychosocial variable, then, dispositional optimism has important implications for adjusting to physical problems related to disease. Health psychologists are interested in studying and reinforcing positive coping strategies for individuals with chronic illnesses or terminal diseases.

Control in the Nursing Home

Other psychosocial variables are relevant to adequate adjustment to health problems posed by particular environments. Many older adults may need to live in nursing care facilities because of health or economic difficulties. Such facilities provide adequate shelter and health care, but they frequently operate under fixed financial resources which limit the individualized activities and freedoms enjoyed by their residents.

Writing in the Journal of Personality and Social Psychology in 1976, Ellen J. Langer and Judith Rodin argued that such institutional environments unwittingly reduce morale and health by gradually taking away the patients’ perceptions of control over daily events. As a psychosocial variable, the perception of control is the belief that one can influence outcomes. Nursing home residents may lack such perceptions of control in nursing homes where almost no aspect of their environment is their responsibility. Practically all decisions, from hygiene to entertainment, are made for them by staff members.

Langer and Rodin reasoned that by creating opportunities for patients living in nursing homes to perceive even relatively small amounts of control and autonomy, their health and well-being might improve. To test this idea, these researchers gave one floor of patients in a nursing home plants to care for and then asked them to make some decisions regarding participation in recreational activities in the facility. Patients on a comparison floor also received plants but were told that the nursing staff would be responsible for their care. This group also participated in the same recreational activities but made no decisions about them. Several weeks later, staff observations and comments made by the patients showed that those individuals who perceived control were more physically active and had a stronger sense of well-being. One year later, those patients who were made to feel responsible for events in their environment were still physically and psychologically healthier, even exhibiting a lower mortality rate than those who did not perceive control.

Perceived control is only one psychosocial variable that can be linked to environmental effects on health and well-being, just as nursing home residents represent only one group who may benefit from interventions of this sort. Based on these results, however, a few conclusions can be drawn. Perceived control can be engendered in fairly simple ways with profound effects on people’s physical and mental health. The adverse effects of some environments, such as institutions that care for patients with chronic health problems, can also be reduced. Finally, some health interventions can be implemented in a cost-effective manner. Many applications of the biopsychosocial model are clearly possible.

Evolution of the Field

The belief that a sound mind leads to a sound body is by no means novel. The medical and psychological communities have long operated under the assumption that mental and physical states affect one another, though active cooperation between professionals in these two fields was limited. Psychiatry, for example, served as one of the bridges for communication between these groups. Within psychology itself, there have always been scholars whose research focused on health and medical issues, although they tended to identify themselves with areas such as clinical, social, or physiological psychology.

In the late 1970s, there was growing recognition that a distinct subdiscipline of psychology relating to health matters was coalescing. Various names for this subdiscipline, such as behavioral medicine, medical psychology, and behavioral health, became more common, as did specialized journals, texts, symposia, and organizations. A division of health psychology became an official part of the American Psychological Association in 1978. Health psychology has since become more formalized, articulating its goals, defining its scientific and professional orientations, and evaluating the training needs of students drawn to it. One prominent health psychologist, Shelley E. Taylor, has described the field as a “maturing discipline.”

Because philosophers have always speculated about the association between mind and body, the philosophical roots of health psychology can be located in antiquity and traced forward to modern times. Psychology’s interest and experimental approaches are more recent developments. From the 1930s to the 1950s, researchers such as Flanders Dunbar and Harold Wolff attempted to link personality variables and psychosocial stressors to specific diseases. In the early 1960s, Stanley Schachter and Jerome E. Singer examined the role of cognitive and physiological processes in the perception of emotional states. In related work during the same period, Richard S. Lazarus pioneered the study of stress and coping.

In the twenty-first century, diseases with strong behavioral components such as type 2 diabetes, heart disease, and various types of cancer will continue to be major concerns. The human genome will provide new insights into interplay of genes and behavior in the development of health and illness. The developing field of psychoneuroimmunology, which is the study of the complex interplay of behavior, the nervous system, the endocrine system, and the immune system, will take on more significance. For example, psychoneuroimmunological research is progressing rapidly on the effects of social stress on upper respiratory infections and speed of wound healing. Finally, the new discipline of positive psychology will become infused into health psychology. Martin E. P. Seligman and Mihaly Csikszentmihalyi wrote in American Psychologist in 2000 that scientific study of the development and fostering of positive traits in humans and their institutions will eliminate many of the mental and physical maladies that affect the human condition. Scientific research in the twenty-first century will help to develop and foster traits such as hope, wisdom, creativity, courage, and perseverance and will determine how these traits can positively influence health and allow individuals and social groups to thrive.

Because of this growing interest in health threats, health psychology may increasingly adopt a salutogenic rather than a pathogenic focus. A salutogenic focus seeks to understand the origins of health by attending to those factors that promote people’s health and psychological well-being. Healthy people behave in ways that keep them healthy, and researchers attempt to uncover the aspects of healthy and happy lifestyles that may aid individuals suffering from illness or disease. In contrast, a pathogenic focus highlights the causes of illness and disease and is less prevention-oriented. This is not to say that the cause of illness is a secondary concern. Rather, the onset of illness should be understood in relation to behaviors and psychological factors that maintain good health.

Health psychology promises to continue as an important arena for interdisciplinary research on health. Basic and applied approaches to understanding health will develop by examining the interplay of biological, psychological, and social factors. As a growing subdiscipline of the field of psychology, health psychology will yield intriguing insights regarding the relationship between mind and body.

Bibliography

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