CHAPTER 19

HEALTH
PSYCHOLOGY
 Chapter plan
 INTRODUCTION
 HEALTH BELIEFS AND BEHAVIOURS
 Behaviour and mortality
 The role of health beliefs
 Integrated models
 ILLNESS BELIEFS
 The dimensions of illness beliefs
 A model of illness behaviour
 Health professionals’ beliefs
 THE STRESS–ILLNESS LINK
 Stress models
 Does stress cause illness?
 CHRONIC ILLNESS
 Profile of an illness
 Psychology’s role
 SUMMARY
 Health psychology is a relatively recent yet fast
growing sub-discipline of psychology.

 It is best understood by answering the following

questions:
 What causes illness and who is responsible

for it?
 How should illness be treated and who is
responsible for treatment?
 What is the relationship between health and
illness, and between the mind and body?
 What is the role of psychology in health and
illness?
 Human beings are complex systems and illness can be
caused by a multitude of factors, not just a single
factor such as a virus or bacterium.

 Health psychology attempts to move away from a

simple linear model of health and looks at the
combination of factors involved in illness – biological
(e.g. a virus), psychological (e.g. behaviours, beliefs)
and social (e.g. employment).

 This approach reflects the biopsychosocial model of

health and illness that was developed by Engel (1977,
1980).
 Because, in this model, illness is regarded as the
result of a combination of factors, the individual is
no longer simply seen as a passive victim of some
external force, such as a virus.

 Acknowledging the role of behaviours such as

smoking, diet and alcohol, for example, means that
the individual may be held responsible for their
health and illness.
 According to health psychology, the whole
physical changes that occur due to ill health.

 This can include behaviour change, encouraging

changes in beliefs and coping strategies, and
compliance with medical recommendations.

 Because the whole person is treated, the patient

becomes partly responsible for their treatment.
 From the health psychology perspective, health and
illness exist on a continuum; rather than being
either healthy or ill, individuals are considered to
progress along a continuum from healthiness to
illness and back again.

 Health psychology also maintains that the mind and

body interact; it sees psychological factors as not
only possible consequences of illness (after all,
being ill can be depressing), but as contributing to
all the stages of health, from full healthiness to
illness.
 Health beliefs and behaviours
 Over the last century health behaviours have played
an increasingly important role in health and illness.

 McKeown’s book, The Role of Medicine (1979),

discusses the decline of infectious diseases in the
nineteenth century, which forms the focus for medical
sociology.

 It also highlights the increasing role of behaviour in

illness in the twentieth century; this represents the
focus for health psychology.
 McKeown also examined health and illness
throughout the twentieth century.

 He argued that contemporary illness is caused by

an individual’s own behaviours, such as whether
they smoke, what they eat and how much exercise
they take – and he suggested that good health was
dependent on tackling these habits.

 McKeown’s emphasis on behaviour is supported

by evidence of the relationship between behaviour
and mortality.
 Behaviour and mortality
 It has been suggested that 50 per cent of mortality
from the ten leading causes of death is due to
behaviour.

 If this is correct, then behaviour and lifestyle have a

potentially major effect on longevity.

 For example, Doll and Peto (1981) estimated that

tobacco consumption accounts for 30 per cent of all
cancer deaths, alcohol 3 per cent, diet 35 per cent,
and reproductive and sexual behaviour 7 per cent.
 As health behaviours seem to be important in
predicting mortality and longevity, health
psychologists have attempted to increase our
understanding of health-related behaviours.

 In particular, based on the premise that people

behave in line with the way they think, health
psychologists have turned to the study of health
beliefs as potential predictors of behaviour.
 Behaviour can have a major effect on longevity: for
example, around 90 per cent of deaths from lung cancer
are attributable to cigarette smoking. (Fig. 19.1)
 The role of health beliefs
Attribution theory
 The origins of attribution theory lie in the work of
Heider (1944, 1958), who argued that individuals are
motivated to understand the causes of events as a
means to make the world seem more predictable and
controllable.
 Attribution theory has been applied to the study of
health and health behaviour; for example, Bradley
(1985) examined diabetic patients’ daily injections –
the results indicated that the patients who chose an
insulin pump showed decreased control over their
diabetes and increased control attributed to doctors.
 A further study by King (1982) examined the
relationship between attributions for an illness
and attendance at a screening clinic for
hypertension.

 The results demonstrated that if the hypertension

was seen as external but controllable, the
individual was more likely to attend the
screening clinic (‘I am not responsible for my
hypertension but I can control it’).
 Health locus of control
 The issue of controllability emphasized in
attribution theory has been specifically applied to
health in terms of the health locus of control.

 Individuals differ in their tendency to regard

events as controllable by them (an internal locus
of control) or uncontrollable by them (an external
locus of control).
 It has been suggested that health locus of control
relates to whether we change our behaviour (by
giving up smoking or changing our diet, for
instance), and also to our adherence to
recommendations by a health professional.

 However, the literature regarding this question is

mixed.
 Unrealistic optimism
 Weinstein (1983, 1984) suggested that one of the
reasons we continue to practice unhealthy
behaviours is our inaccurate perceptions of risk
and susceptibility.

 He gave participants a list of health problems to

examine and then asked: ‘Compared to other
people of your age and sex, are your chances of
getting [the problem] greater than, about the same
as, or less than theirs?’
 Most participants believed that they were less
likely to experience the health problem.

 Clearly, this would not be true of everyone, so

Weinstein called this phenomenon unrealistic
optimism.
 Weinstein (1987) described four cognitive factors
that contribute to unrealistic optimism:
1. lack of personal experience with the problem;
2. the belief that the problem is preventable by
individual action;
3. the belief that if the problem has not yet
appeared, it will not appear in the future; and
4. the belief that the problem is infrequent.

 These factors suggest that our perception of our

own risk is not a rational process.
 In an attempt to explain why individuals’
assessment of their risk may go wrong, and why
people are unrealistically optimistic, Weinstein
(1983) argued that individuals show selective
focus.

 He claimed that we ignore our own risk-increasing

behaviour and focus primarily on our risk-
reducing behaviour.

 He also argued that this selectivity is compounded

by egocentrism.
 The stages of change model
 The stages of change model (also known as the
transtheoretical model of behaviour) was originally
developed by Prochaska and DiClemente (1982) as
a synthesis of 18 therapies describing the processes
involved in behavioural change.

 These researchers suggested a new model of change

which has been applied to several health-related
behaviours, such as smoking, alcohol use, exercise
and personal screening behaviour such as going for
a cervical smear or attending for a mammograph.
 If applied to giving up cigarettes, the model would
suggest the following stages:
1. Precontemplation: I am happy being a smoker
and intend to continue smoking.
2. Contemplation: I have been coughing a lot
recently; perhaps I should think about stopping
smoking.
3. Preparation: I will stop going to the pub and
will buy lower tar cigarettes.
4. Action: I have stopped smoking.
5. Maintenance: I have stopped smoking for four
months now.
 The model describes behaviour change as
dynamic, rather than being ‘all or nothing’, so the
five stages do not always occur in a linear fashion.

 The model also examines how we weigh up the

costs and benefits of a particular behaviour; in
particular, according to the model, individuals at
different stages of change will differentially focus
on either the costs of a behaviour or the benefits.
 Integrated models
 Attribution theory and the health locus of control
emphasize attributions for causality and control,
unrealistic optimism focuses on perceptions of
susceptibility and risk, and the stages of change
model stresses the dynamic nature of beliefs, time,
and costs and benefits.

 These different perspectives on health beliefs have

been integrated into structured models.
 The health belief model
 The health belief model was developed initially by
Rosenstock in 1966 and further by Becker and
colleagues throughout the 1970s and 1980s (e.g.
Becker et al., 1977).

 Their aim was to predict preventative health

behaviours and the behavioural response to treatment
in acutely and chronically ill patients.

 Over recent years, the model has been used to predict

many other health-related behaviours.
 According to the health belief model, behaviour is a
product of a set of core beliefs that have been
redefined over the years and which are used to
predict the likelihood that a behaviour will occur.
 The original core beliefs are the individual’s
perception of:
 susceptibility to illness – ‘My chances of getting
lung cancer are high’;
 the severity of the illness – ‘Lung cancer is a
serious illness’;
 the costs involved in carrying out the behaviour –
‘Stopping smoking will make me irritable’;
 the benefits involved in carrying out the behaviour
– ‘Stopping smoking will save me money’;
 cues to action, which may be internal (e.g. the
symptom of breathlessness) or external (e.g.
information in the form of health education
leaflets).
The health belief model. (Fig 19.2)
 In response to criticisms, the model was revised to
add the construct health motivation to reflect
readiness to be concerned about health matters (‘I
am concerned that smoking might damage my
health’).

 More recently, Becker and Rosenstock (1987)

suggested that perceived control (‘I am confident
that I can stop smoking’) should also be added to
the model.
The protection motivation theory
 Rogers (1975, 1983, 1985) developed the protection
motivation theory, which expanded the health belief
model to include additional factors.

 The protection motivation theory describes severity,

susceptibility and fear as relating to ‘threat appraisal’
(i.e. appraising an outside threat), and response
effectiveness and self efficacy as relating to ‘coping
appraisal’ (i.e. appraising the individual themselves).
The protection motivation theory. (Fig.19.3)
 According to the theory, there are two types of
information source: environmental (e.g. verbal
persuasion, observational learning) and
intrapersonal (e.g. prior experience).

 This information influences the five components

listed above, which then elicit either an adaptive
coping response (a behavioural intention) or a
maladaptive coping response (such as avoidance
or denial).
The theory of planned behaviour
 The theory of planned behaviour was developed by
Ajzen and colleagues (Ajzen, 1985; 1988; Ajzen &
Madden, 1986).

 It emphasizes behavioural intentions as the outcome

of a combination of several beliefs.

 The theory proposes that intentions should be

conceptualized as ‘plans of action in pursuit of
behavioural goals’ (Ajzen & Madden, 1986), and that
these are a result of a set of composite beliefs.
 Attitude towards a behaviour – composed of a
positive or negative evaluation of a particular
behaviour, and beliefs about the outcome of the
behaviour.
 Subjective norm – this represents the beliefs of
important others about the behaviour, and the
individual’s motivation to comply with such beliefs.
 Perceived behavioural control – comprising a
belief that the individual can carry out a particular
behaviour based on a consideration of internal
control factors (e.g. skills, abilities, information) and
external control factors (e.g. obstacles, opportunities)
– both of which are related to past behaviour.
 These three factors predict behavioural intentions,
which are then linked to behaviour.
 The theory of planned behaviour also states that
perceived behavioural control can have a direct effect
on behaviour without the mediating effect of
behavioural intentions.
 The model also predicts that perceived behavioural
control can predict behaviour without the influence of
intentions. For example, a belief that the individual
would not be able to exercise because they are
physically incapable of doing so might well be a
better predictor of their exercising behaviour than
their high intentions.
The theory of
planned behaviour
applied to the
intention to engage
in physical
exercise. (Fig.
19.4)
 Illness beliefs
 Leventhal and colleague defined illness beliefs as a
patient’s own implicit, commonsense beliefs about
his or her illness.

 They proposed that these beliefs provide a

framework, or schema, for coping with and
understanding an illness, and for telling us what to
look out for if we believe that we are becoming ill.
The dimensions of illness beliefs
 Using interviews with patients suffering from a
variety of illnesses, Leventhal et al. identified
five dimensions of illness beliefs:

1. Identity
2. Perceived cause of the illness
3. Time line
4. Consequences
5. Curability and controllability
 Evidence for the dimensions
 The extent to which beliefs about illness comprises
these different dimensions has been studied using
both qualitative and quantitative research.

 There is also some evidence for a similar structure of

illness representations in other non-Western cultures
(Lau, 1995; Wellar, 1984).
 Measuring illness beliefs
 In order to delve further into beliefs about illness,
researchers in New Zealand and the UK have developed
the ‘Illness Perception Questionnaire’ (IPQ).
 This asks people to rate a series of statements about
their illness.
 These statements reflect the dimensions of identity (e.g.
symptoms such as pain, tiredness) consequences (e.g.
‘My illness has had major consequences on my life’),
time line (e.g. ‘My illness will last a short time’), cause
(e.g. ‘Stress was a major factor in causing my illness’)
and cure/control (e.g. ‘There is a lot I can do to control
my symptoms’).
 A model of illness behaviour
 Leventhal incorporated illness beliefs into a self-
regulatory model of illness behaviour to examine the
relationship between someone’s cognitive
representation of his or her illness and their
subsequent coping behaviour.
The self-regulatory model. (Fig. 19.5)
 The model is based on problem solving and suggests
that we deal with illnesses and their symptoms in the
same way as we deal with other problems.

 The assumption is that, given a problem or a change in

the status quo, an individual will be motivated to solve
the problem and re-establish his state of ‘normality’.

 In terms of health and illness, if healthiness is your

normal state, then you will interpret any onset of
illness as a problem, and you will be motivated to re-
establish your state of health.
 Traditional models describe problem solving in
three stages:

1. interpretation – making sense of the

problem;
2. coping – dealing with the problem in order to
regain a state of equilibrium;
3. appraisal – assessing how successful the
coping stage has been.
 These three stages are said to continue until the
coping strategies are deemed to be successful and
a state of equilibrium has been attained.

 This process is regarded as self-regulatory because

the three components of the model interrelate, in
an ongoing and dynamic fashion, in order to
maintain the status quo – in other words, they
regulate the self.
 Stage 1 – Interpretation
 An individual may be confronted with the problem of
a potential illness through two channels – symptom
perception and social messages.

 Symptom perception: how an individual experiences

and makes sense of their symptom.

 Social messages: input from a range of sources such

a friends, family and media regarding the nature of
symptoms.
 Stage 2 – Coping
 Coping can take many forms, but two broad
categories have been defined – approach coping
(e.g. taking pills, going to the doctor, resting, talking
to friends about emotions) and avoidance coping
(e.g. denial, wishful thinking).

 When faced with the problem of illness, we develop

coping strategies in an attempt to return to a state of
healthy normality.
 Stage 3 – Appraisal
 Appraisal is the final stage in Levanthal’s model.

 At this point people evaluate their coping strategy as

either effective or ineffective.

 If it is appraised as effective, then they will continue

with it and the same set of coping strategies will be
pursued; if the coping strategies are appraised an
ineffective, then people are motivated to think of
alternatives which will then be put into place.
 Health professionals’ beliefs
 Early research regarded health professionals as
experts and assumed that doctors with similar levels
of knowledge and training would act in similar ways.

 But there is, in fact, considerable variability in

different aspects of medical practice.

 It is now generally accepted that health professionals

may behave not just according to their education and
training, but also according to their own ‘lay beliefs’.
 This means that any evaluation of the interaction
between health professionals and patients should
not only focus on the personal beliefs of the
patient and the knowledge base of the
professional, but also on the personal belief
system of the professional.
Interaction between patient and doctor can be influenced
by the health professionals beliefs about the patient and
the disease, as well as by their knowledge. (Fig. 19.6)
 Beliefs that influence practice
 Research indicates that the following beliefs
influence the development of a health professional’s
original diagnosis:

 The nature of clinical problems

 The probability of the disease
 The seriousness of the disease
 The patient
 Similar patients
Communicating beliefs to patients
 Health professionals’ own health-related beliefs may
be communicated to patients.

 A study by McNeil et al. (1982) examined the effects

of health professionals’ own language on patients’
choice of treatment.

 They found that patients are more likely to choose

surgery if they are told it will ‘increase the
probability of survival’ rather than ‘decrease the
probability of death’.
 The phrasing of a question like this tends very
much to reflect the beliefs of the individual
doctor.

 So the results indicate that the subjective views of

health professionals may be communicated to the
patient, and subsequently influence the patient’s
choice of treatment.
On the stock
exchange
floor, it is easy
to see how
stress arises
from a
transaction
between
people and
their
environment.
(Fig. 19.7)
 The stress–illness link
 The term ‘stress’ means many different things to
many people.

 Contemporary definitions of stress regard the external

environment as a potential stressor (e.g. problems at
work), the response to the stressor as stress or distress
(e.g. the feeling of tension), and the concept of stress
as something that involves biochemical,
physiological, behavioural and psychological changes.
 Researchers have also differentiated between
stress that is harmful and damaging (‘distress’)
and stress that is positive and beneficial
(‘eustress’).

 The most common definition of stress was

developed by Lazarus and Launier (1978), who
regarded it as a transaction between people and
the environment.
 So a stressful response might be the feeling of
stress that results from a mismatch between:

a) a situation that is appraised as stressful; and

b) the individual’s self-perceived ability to cope
and therefore reduce the stress.
 Stress models
 Throughout the twentieth century, stress models
have varied in terms of their definition of ‘stress’,
their emphasis on physiological and psychological
factors, and their description of the relationship
between the individual and their environment.
 Cannon’s ‘fight or flight’
model
 One of the earliest models of stress was developed by
Cannon (1932); the ‘fight or flight’ model suggested
that external threats elicit the ‘fight or flight’ response,
increasing activity rate and arousal.

 These physiological changes enable the individual

either to escape from the source of stress or fight.

 Cannon defined ‘stress’ as a response to external

stressors that is predominantly seen as physiological.
 Selye’s general adaptation
syndrome
 Developed in 1956, Selye’s general adaptation
syndrome describes three stages in the stress process:
1. ‘alarm’, which describes an increase in activity
and occurs immediately the individual is exposed
to a stressful situation;
2. ‘resistance’, which involves coping and attempts
to reverse the effects of the alarm stage; and
3. ‘exhaustion’, which is reached when the
individual has been repeatedly exposed to the
stressful situation and is incapable of showing
further resistance.
 Life events theory
 In an attempt to depart from models that
emphasize physiological changes, the life events
theory examines stress and stress-related changes
as a response to life change.

 Research has shown links between life events and

health status, in terms of both the onset of illness
and its progression.
 The model of appraisal and
transaction
 Both Cannon’s and Selye’s early models of stress
presented it as an automatic response to an
external stressor – a perspective that is also
reflected in life events theory, with its use of
expert rather than individual rating schemes.

 By contrast, more recent models allow for active

interaction between the individual and external
stressors, rather than passive response; this
approach provides a role for psychological state.
 It is epitomized by Lazarus’s transactional model of
stress and his theory of appraisal.

 In the 1970s, Lazarus introduced the psychological

dimension into our understanding of the stress
response; he argued that stress involves a
transaction between an individual and his or her
external world, and that a stress response is elicited
if the individual appraises an event as stressful.
 Richard Lazarus developed the role of
psychological factors and appraisal in the study
and treatment of stress. (Fig. 19.8)
 Lazarus defined two forms of appraisal:
1. Primary appraisal: the individual initially
appraises the event in three ways – as a)
irrelevant, b) benign and positive or c) harmful
and negative.
2. Secondary appraisal – the individual evaluates the
pros and cons of his or her different coping
strategies.

 So primary appraisal is essentially an appraisal of

the outside world, and secondary appraisal is an
appraisal by the individual of himself.
The role of appraisal in stress. (Fig.19.9)
 Does stress cause illness?
 The relationship between stress and illness is not
straightforward, and there is a lot of evidence to
suggest that several factors mediate the stress–illness
link, including exercise, coping styles, life events,
personality type, social support and actual or perceived
control.

 Stress can affect health through a behavioural pathway

(e.g. sleep, food intake and alcohol consumption)
and/or through a physiological pathway (e.g.
catecholamines, corticosteriods, and changes in
activity, such as heart rate).
 Stress and behaviour
 Recent research has examined the effect of stress on
specific health-related behaviours, such as exercise,
smoking, diet and alcohol consumption, in terms of
initiation, maintenance and relapse.
 It has also highlighted the impact of stress on general
behavioural change.
 For example, research suggests that individuals who
experience high levels of stress show a greater
tendency to perform behaviours that increase their
chances of becoming ill or injured and of having
accidents at home, work and in the car.
 Stress and physiology
 The physiological consequences of stress have been
studied extensively, mostly in the laboratory using the
acute stress paradigm.
 This involves bringing participants into a controlled
environment, putting them into a stressful situation
(such as counting backwards, completing an
intelligence task or giving an unprepared speech) and
then recording any changes.
 This research has highlighted two main groups of
physiological effects.
1. Sympathetic activation

 When an event is appraised as stressful, it triggers

responses in the sympathetic nervous system.

 This results in the production of catecholamines

(adrenaline and noradrenaline), which causes
changes in factors such as blood pressure, heart
rate, sweating and pupil dilation.

 These changes are experienced subjectively as a

feeling of increased arousal.
 This process is similar to the ‘fight or flight’
response described by Cannon.

 Sympathetic activation and prolonged production

of adrenalin may increase the chances of heart
disease and kidney disease, and leave the body
open to infection.
2. Hypothalamic-pituitary-adrenocortical
(HPA) activation

 Stress also triggers changes in the HPA system.

 This results in increased levels of corticosteroids

(cortisol), leading to more diffuse changes, such as
the increased use of carbohydrate stores and a
greater chance of inflammation.

 These changes constitute the background effect of

stress, and cannot be detected by the individual.
 They are similar to the alarm, resistance and
exhaustion stages of stress described by Selye,
as they show how chronic ongoing stress can
be damaging to the body in the longer term.

 These changes may increase the chances of

infection, psychiatric problems and losses in
memory and concentration.
 The role of hormones
 Kiecolt Glaser and Glaser (1986) argued that stress
causes a decrease in the hormones produced to fight
carcinogens (factors that cause cancer) and repair DNA.

 In particular, cortisol decreases the number of active T

cells, which can increase the rate of tumour development.

 This suggests that experiencing stress whilst ill could

exacerbate the illness through physiological changes; and
if the illness itself is appraised as being stressful, this
itself may be damaging to the chances of recovery.
 Psychoneuroimmunology (PNI)
 This relatively new area of research is based on the
prediction that psychological state can influence the
immune system via the nervous system.

 This perspective provides a scientific basis for the

‘mind over matter’, ‘think yourself well’ and ‘positive
thinking, positive health’ approaches to life.

 It suggests that not only can psychological state

influence health via behaviour, but beliefs may
influence health directly.
 Positive mood is associated with better immune
functioning, whereas negative mood is associated
with poorer immune functioning (Stone et al., 1987).

 Humour appears to be particularly beneficial (Dillon,

Minchoff & Baker, 1985).

 Certain coping styles (such as suppression and

denial) may relate to illness onset and progression
(e.g. Kune et al., 1991), while thought expression
through writing or disclosure groups may improve
immune functioning (Pennebaker et al., 1988; Petrie,
Booth & Pennebaker, 1998).
 Jamie Pennebaker found that writing and
talking can reduce time spent visiting the GP
and improve work performance. (Fig. 19.10)
 Chronic illness
 Chronic illnesses, such as asthma, AIDS, cancer,
coronary heart disease and multiple sclerosis are
another important focus for health psychologists.

 Coronary heart disease (one of the leading causes

of death in the present day) can be used to illustrate
the role of psychology at every stage, from
predicting risk factors through to rehabilitation.
 Profile of an illness
 Coronary heart disease (CHD) is caused by hardening
of the arteries (atherosclerosis), which are narrowed
by fatty deposits.
 This can result in angina (pain) or a heart attack
(myocardial infarction).
 CHD is responsible for 33 per cent of deaths in men
under 65 and 28 per cent of all deaths.
 It is the leading cause of death in the UK, killing
4300 men and 2721 women per million in 1992.
 Many risk factors for CHD have been identified,
some less modifiable (e.g. educational status,
social mobility, social class, age, gender, family
history and race) than others (e.g. smoking
behaviour, obesity, sedentary lifestyle, perceived
work stress and type A behaviour).
 Psychology’s role
 Psychology has a role to play at all stages of
CHD:

1. Psychological factors influence the onset of CHD;

our beliefs about both behaviour and illness can
influence whether we become ill or stay healthy.

For example, someone who believes that ‘lots of

people recover from heart attacks’ may lead an
inactive and sedentary lifestyle.
2. Once ill, people also hold beliefs about their
illness and will cope in different ways;
psychology therefore continues to play a role as
the disease progresses.

For example, if someone believes ‘my heart

attack was caused by my genetic make-up’, they
may cope by thinking ‘there is nothing I can do
about my health; I am the victim of my genes’.
3. Psychology also has a role to play in the outcome
of CHD.

For example, believing that a heart attack is due to

a genetic weakness rather than a product of
lifestyle may mean that a person is less likely to
attend a rehabilitation class, and be less likely to
try and change the way they behave.
The role of psychology in coronary heart
disease. (Fig. 19.11)
 Behavioural risk factors
 The risk factors for CHD can be understood and
predicted by examining an individual’s health
beliefs.

 Psychology’s role is to both understand and attempt

to change these behavioural risk factors, including
smoking lack of exercise and poor diet, high blood
pressure (hypertension), type A behaviour, stress.
The risk of heart disease can be reduced by cutting down
on saturated fats and increasing polyunsaturated fats and
fibre in our diet. (Fig 19.12)
 Rehabilitation programmes
 Modifying exercise – Most rehabilitation
programmes emphasize exercise as the best route to
physical recovery, on the assumption that this will
in turn promote psychological and social recovery,
too.

But whether, more generally, these programmes

influence risk factors other than exercise (such as
smoking, diet and Type A behaviour) is
questionable.
 Modifying type A behaviour – The recurrent
coronary prevention project was developed by
Friedman et al. (1986) in an attempt to modify type
A behaviour.

It is based on the following questions: ‘Can type A

behaviour be modified?’ and ‘Could such
modification reduce the chances of a recurrence?’

At five years, the type A modification group showed

a reduced recurrence of heart attacks, suggesting that
such intervention programmes may reduce the
probability of reinfarction in ‘at risk’ individuals.
 Modifying general lifestyle factors – Other
rehabilitation programmes have focused on
modifying risk factors such as smoking and diet.

Study results seem to provide some support for

including health education in CHD rehabilitation
programmes.
 Summary
 Health psychologists study the role of psychology
in health and wellbeing. They highlight the
importance of both a) developing and testing
psychological theory and b) relating theory to
health practice.

 Health psychology examines health beliefs as

possible predictors of health-related behaviours,
such as: a) the costs and benefits of a behaviour, b)
susceptibility and severity of an illness, c) self
efficacy in changing behaviour, d) a person’s past
behaviour and e) the beliefs of important others.
 Health psychology also examines beliefs about illness
and suggests that individuals conceptualize their
illness in terms of its time line, its symptoms, the
causes and consequences of the problem, and whether
it can be controlled or cured.

 The self-regulatory model of illness behaviour

highlights how symptoms are a perception, how
people are motivated to make sense of their illness,
how they cope with illness in different ways, and how
these factors can influence how they behave in
relation to their illness.
 The self-regulatory model of illness behaviour
highlights how symptoms are a perception, how
people are motivated to make sense of their
illness, how they cope with illness in different
ways, and how these factors can influence how
they behave in relation to their illness.

 A health professional’s beliefs about the

symptoms, the illness or the patient may influence
their diagnosis, how patients are treated and the
effectiveness of any communication between
patient and professional.
 Stress is seen as an interaction between the person
and their environment. It can influence illness,
either through changing health-related behaviours
such as smoking and exercise or via a
physiological pathway, and it is mediated by
coping and social support.

 Beliefs and behaviours can influence whether a

person becomes ill in the first place, whether they
seek help and how they adjust to their illness.