Académique Documents
Professionnel Documents
Culture Documents
A teaching resource
Dr H. Fine
Faculty of Continuing Education
Birkbeck College
November 2006
CONTENTS
Introduction
Page
3
Introduction to Physiology
14
Introduction to Stress
20
26
30
35
Substance Abuse
40
46
54
Pain
60
Pain Management
66
69
77
82
87
88
90
Coursework
91
92
93
Updates
95
INTRODUCTION
Courses in Health Psychology are interdisciplinary in their content and their
audience. Although the students in these courses have a generic interest in
Psychology, substantial numbers of students come from allied disciplines, such as
nursing, sociology, physical education, and allied health fields.
The following teaching resource aims to offer sessional lecturers a variety of useful
tools to incorporate in their Health Psychology courses, in order to offer the students a
taste of the broad spectrum of Health Psychology to examine how biological,
psychological, and social factors interact with and affect:
1.
2.
3.
4.
The efforts people make in promoting good health and preventing illness.
The treatment people receive for medical problems.
How effectively people cope with and reduce stress and pain.
The recovery, rehabilitation, and psychosocial adjustment of patients with
serious health problems.
INTRODUCTION
HEALTH PSYCHOLOGY
Psychology
Module Title:
Health Psychology
ENTRY REQUIREMENTS
The course is open to all
AIM
To provide an overview of the way in which the study of psychology may be of
benefit in the promotion of health and the provision of health care.
OBJECTIVES
HEALTH PSYCHOLOGY
Support and develop students' study skills, including note taking and essay
writing.
Build students confidence in presenting their own ideas and in critical thinking.
Identify areas of interest for students that may be pursued in further study.
LEARNING OUTCOMES
By the end of the course you will be able to:
CONTENT
Psychology and Health:
Introduction
The biopsychosocial model of health: the example of stress.
Evidence based practice and the reflective practitioner .
Health behaviour
Attitudes, beliefs and behaviour.
Models of behaviour.
Modifying health behaviour: the public health model; the therapy model.
Nutrition (Obesity)
Constituents of a good diet and current trends in diet.
Problematic diets (atherosclerosis; hypertension; cancer).
HEALTH PSYCHOLOGY
HEALTH PSYCHOLOGY
Terminal illness
The relevance of the persons age
Psychosocial adjustment to terminal illness
Medical and psychological care of patients who are dying.
Pulling it all together
Using psychology in health and health care.
TEACHING AND LEARNING METHODS
A range of teaching methods may be used e.g. lectures on the area being studied students are encouraged to ask questions and discuss points throughout. There may
also be small group exercises with feedback to the large group to provide an
opportunity for clarification of ideas and discussion. Other methods may include:
videos, experiments, student presentations, discussion of published articles, etc.
Students will be given help with study skills.
It is expected that approximately 75% of the syllabus will be covered in class.
METHODS OF ASSESSMENT
The assessment process gives students important opportunities to learn, to check their
learning and to discuss their progress with the tutor. Consequently, students will be
expected to prepare four pieces of coursework for assessment. Two of which will be
written under timed conditions in the classroom. The other two may take a variety of
forms such as essays, case studies, reports and possibly class presentations. These two
pieces of work will each be 1,500 words in length (or the equivalent). You are
encouraged to discuss with your tutor the particular topics and the type of assignment
you would like to focus on in your assessments. It may be possible to accommodate
your personal interests within the syllabus.
The course is part of the Certificate and Diploma in (a) Applied Psychology or (b)
Applying Psychology in Health and Health Care. If the course is completed
successfully, 30 CATS points will be awarded, which may be transferred to some
degree courses.
READING
Barnyard, P. (2002). Psychology in Practice: Health. Hodder & Stoughton.
Bennett, P. and Murphy, S. (1997) Psychology and Health Promotion. Open
University Press.
Berry, D. (2004). Risk, Communication & Health Psychology. Open University.
Bowling, A. (1997). Measuring Health. Open University Press.
Brannon, L. and Feist, J. (2000). Health Psychology: An Introduction to Behavior and
Health (5th ed.). Wadsworth.
Curtis, A.J. (2000). Health Psychology. Routledge.
Edelmann, R. J. (2000). Psychosocial Aspects of the Health Care Process. Prentice
Hall.
Jarvis, M. (2002). Angles on Health Psychology. Nelson Thornes.
Kaptein, A. & Weinman, J. (2004). Health Psychology. Blackwell.
HEALTH PSYCHOLOGY
HEALTH PSYCHOLOGY
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Cultural Differences in Defining Health
David Matsumoto (2000) discusses the common belief of health as the absence of
illness, noting that these themes are embedded in a cultural context. For example,
Matsumoto notes that the medical model, the traditionally popular view of illness,
focuses on disease that results from some "specific, identifiable cause originating
inside the body" and treatment of disease then requires eliminating the pathogens that
"exist within a person's body." Health is therefore the lack of disease within the body.
Matsumoto goes on the describe definitions of health as they occur in other cultures.
In Asian cultures, he suggests, health is defined as the "balance between self and
nature and across the individual's various roles in life." The synergy between nature,
self, and others can result in a positive state called health. Matsumoto connects this
vision with current definitional debates occurring in the US and ties it to the
emergence of bio-behavioural medicine and health psychology.
As part of a discussion session, have students consider the theme of residing
within the body. How have we seen similar explanations in mental health? How is it
more generally linked to causal explanations that are common in our culture?
Source:
Matsumoto, D. (2000). Culture and psychology: People around the world. (2nd ed.).
(pg. 230). Stamford, CT: Wadsworth.
2. Sex and Gender Bias in Animal and Human Research.
Following an introduction of research methodologies to the student, discuss
the claims of sex and gender bias in clinical research using animal and human
participants. Reviews on the topic by Rodin and Ickovics (1990) and Sechzer and
colleagues (1994) might serve as the basis for the presentation. While they both
highlight the efforts to change requirements for participant inclusion in human
research, Sechzer and her colleagues note particular problems in animal research with
respect to the under-representation of female animal subjects in studies, lack of
information regarding the sex/gender of participants in studies, and overgeneralization
of findings drawn from male samples to females. Standards for reporting of findings
are presented.
Sources:
Sechzer, J.A., Rabinowitz, V.C., Denmark, F.L., McGinn, M.F., Weeks, B.M., and
Wilkens, C.L. (1994). Sex and gender bias in animal research and in clinical studies
of cancer, cardiovascular disease and depression. In J.A. Sechzer, A. Griffin, and S.
Pfafflin (Eds.), Forging a women's health research agenda: Policy issues for the
1990s. New York: New York Academy of Sciences.
Rodin, J., & Ickovics, J.R. (1990). Women's health: Review and research agenda as
we approach the 21st century. American Psychologist, 45(9), 1018-1034.
10
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Health Risk Appraisal. A generous number of health risk appraisals can now be
completed on-line. HRAs can be easily found by entering the key phrase "Health
Risk Appraisal" on most major search engines. Have students complete one and then
compare its format to the Assess Yourself exercise above. To extend this exercise,
have students pick one or two identified risk areas and develop a plan to address
improve their functioning on those areas.
2. Journal Comparison. Obtain copies of Psychosomatic Medicine, Journal of
Behavioural Medicine, and British Journal of Health Psychology. Compare and
contrast the types of problems studied and the approaches taken. Have the students
find at least one example of an experiment, a quasi-experimental study, a retrospective
study, a prospective study, and a case study. In particular, have students report on the
gender/sex bias argument presented in Discussion item 2.
11
HEALTH PSYCHOLOGY
RESOURCES
Suggested Readings:
Aboud, F.E. (1998). Health psychology in global perspective. Thousand Oaks: Sage.
Adler, N., & Matthews, K. (1994). Health psychology: Why do some people get sick
and some stay well? In L.W. Porter & M.R. Rosenzweig (Eds.). Annual Review of
Psychology. (Vol. 45, pp. 229-259). Palo Alto, CA: Annual Reviews.
Cook, A.R. (1999). Alternative medicine sourcebook: Basic consumer health
information. Detroit, MI: Omnigraphics.
de La Cancela, V., Chin, J., & Jenkins, Y. (1998). Community health psychology:
Empowerment for diverse communities. New York: Routledge.
Fontanarosa, P.B. (Ed.) (2000). Alternative medicine: An objective assessment.
Chicago, IL: American Medical Association.
Gesler, W.M. (1991). The cultural geography of health care. Pittsburgh,PA:
University of Pittsburgh Press.
Gordon, J.S. (1996). Manifesto for a new medicine: Your guide to healing
partnerships and the wise use of alternative therapies. Reading, MA: AddisonWesley.
Hafferty, F.W., & McKinlay, J.B. (1993). The changing medical profession: An
international perspective. New York: Oxford University Press.
Helman, C. (2000). Culture, health, and illness. Oxford: Butterworth-Heinemann.
Herman, C.E. (Ed.). (1997). Special issue: Psychological aspects of genetic testing.
Health Psychology, 16.
Jonas, W.B. & Levin, J.S. (Eds.) (1999). Essentials of complementary and alternative
medicine. Philadelphia: Williams & Wilkins.
Lederman, E. (1988). Health Career Planning. New York: Human Sciences Press.
Loustaunau, M.O., & Sobo, E.J. (1997). The cultural context of health, illness, and
medicine. Westport, CN: Bergin & Garvey.
Lyons, D. (1997). Planning Your Career in Alternative Medicine. Garden City Park,
NY: Avery.
Niven, C.A. & Carroll, D. (1993). The health psychology of women. Chur,
Switzerland: Harwood Academic.
Shorter, E. (1992). From paralysis to fatigue: A history of psychosomatic illness in
the modern era. New York: Free Press.
Taylor, S.E. (1990). Health psychology: The science and the field. American
Psychologist, 45, 40-50.
Suggested Films and Videos:
1. Bill Moyer's Healing and the Mind: A great 5 part series demonstrating the mindbody connection, social support, etc. Available from www.publicvideostore.org
2. Behavioural Health and Health Counselling. APA. Psychotherapy videotape series
III. Available from : www.apa.org/videos
3. Not so Sweet: Living with diabetes - Available from www.fanlight.com/
4. Supersize Me Junk food and obesity
Internet sites of interest:
1. American Psychosomatic Society - www.psychosomatic.org/
2. BPS Division of Health Psychology - www.health-psychology.org.uk/
12
HEALTH PSYCHOLOGY
3. British
Journal
of
Health
Psychology
www.bps.org.uk/publications/journals/bjhp/bjhp_home.cfm?&redirectCount=0
4. British Nutrition Foundation www.nutrition.org.uk
5. Cancer Research UK - www.cancerresearchuk.org/
6. Childrens Health www.heartforum.org.uk/Policy_Children'shealth.aspx
7. Connexions - www.connexions.gov.uk/
8. Department of Health www.doh.gov.uk
9. Diabetes UK Homepage - www.diabetes.org.uk/
10. European Health Psychology Society - www.ehps.net/1024/index.html
11. Food Standards Agency (nutrition) www.food.gov.uk/healthiereating/
12. International Stress Management Association - www.isma.org.uk/
13. Joseph Rowntree Foundation Social policy research - www.jrf.org.uk/
14. Kings Fund A health related site with useful links - www.kingsfund.org.uk/
15. MedLine Plus Trusted health information - www.medlineplus.gov/
16. National Childbirth Trust (NCT) - www.nctpregnancyandbabycare.com/
17. National Institute of Clinical Excellence (NICE) - www.publichealth.nice.org.uk/
18. National Institute of Mental Health - www.nimh.nih.gov/nimhhome/index.cfm
19. National Statistics Online - http://www.statistics.gov.uk/default.asp
20. NHS Direct - www.nhsdirect.nhs.uk
21. Pain Management and Research www.bath.ac.uk/pain-management/
22. Phillip Morris Tobacco - www.philipmorrisusa.com/en/home.asp
23. Race and Ethnicity in Medicine - http://cdh.med.wisc.edu/
24. Giving up Smoking - www.givingupsmoking.co.uk/
25. Some truths about tobacco www.thetruth.com
26. Stress www.hse.gov.uk/pubns/stresspk.htm
27. Tackling Drugs - www.drugs.gov.uk/
28. Talk to Frank www.talktofrank.com/
29. Terrance-Higgins Trust - www.tht.org.uk/
30. Tobacco Factfile www.tobaccofactfile.org
31. World Health Organisations www.who.int
32. Young Minds - www.youngminds.org.uk/
13
HEALTH PSYCHOLOGY
INTRODUCTION TO PHYSIOLOGY
I. The Nervous System
A. How the Nervous System Works
1. General function of nervous system
2. Structures of neurons
3. Neuronal transmission
4. Developmental changes in the nervous system
B. The Central Nervous System
1. The Forebrain
2. The Cerebellum
3. The Brainstem
4. The Spinal Cord
C. The Peripheral Nervous System
1. Somatic nervous system
2. Autonomic nervous system
3. Nerves of the peripheral nervous system
II. The Endocrine System
A. The Endocrine and Nervous Systems Working Together
1. Pituitary gland
2. Hormone specificity
3. Hypothalamus-pituitary-adrenal axis
B. Adrenal Glands
C. Other Glands
1. Thyroid gland
2. The thymus gland
3. Pancreas
III. The Digestive System
A. Food's Journey Through Digestive Organs
1. Disorders of the Digestive System
a. Peptic Ulcers
b. Hepatitis
c. Cirrhosis
d. Cancer
B. Using Nutrients in Metabolism
1. Metabolism
2. Outcomes of metabolism
3. Calories
4. Basal metabolic rate
5. Relationship between weight, activity level, and basal rate.
IV. The Respiratory System
A. Respiratory Function and Disorders
1. Disorders of the lungs
a. Pneumonia
b. Emphysema
c. Pneumoconiosis
14
INTRODUCTION TO PHYSIOLOGY
HEALTH PSYCHOLOGY
15
INTRODUCTION TO PHYSIOLOGY
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Stem Cell Research Debate.
The current public and scientific debate regarding the use of stem cell derived human
embryos highlights the ethical problems in the genetic chase to find solutions for
diseases such as diabetes and Parkinson's disease. A recent series of articles in Time
magazine (August 20, 2001) can be used for the discussion of genetic processes in
health where political, scientific, and social aspects are highlighted.
Source:
Time Magazine (August 20, 2001). pages 14 to 28.
2. Culture and Its Relationship to Disease.
Matsumoto raises some interesting issues regarding the relationship between culture
and mortality rates for various diseases. In his review of the topic, he notes that
Triandis and colleagues (1988) found a significant positive relationship between heart
attacks and individualism. It was suggested that social support networks, a variable
frequently linked to disease rates, vary along the individualism-collectivism
continuum with collectivistic cultures emphasizing stronger and deeper social ties.
Matsumoto reviews some of his own research that explores other cultural tendencies
found in 28 different countries around the world, including individualismcollectivism, power distance, uncertainty avoidance, and masculinity, as they relate to
various medical diseases. He found significant predictive relationships between these
cultural dimensions and mortality rates for these diseases. He concludes that these
cultural characteristics affect social support and/or the expression of negative affect
and thus contribute to cross-cultural differences in disease rates.
Source:
Matsumoto, D. (2000). Culture and psychology: People around the world. (2nd ed.).
(pp. 246-247). Stamford, CT: Wadsworth.
3. Cross-cultural Differences in Reporting Symptoms.
Richard Brislin, notes that cross-cultural researchers are well aware that research
instruments (i.e., questionnaires) are frequently difficult to use in research since the
connotative meaning of terminology can vary across cultures. As an example, health
or good health can mean different things depending on cultural understandings of the
nature of the body and disease aetiology. His basic suggestion is that people involved
in health care delivery need to be sensitive to cross-cultural variation in symptom
reporting since people are socialized to report symptoms in culturally-acceptable
ways. For example, somatisation may be more likely to occur in cultures where signs
of weakness, anxiety, or worry are less tolerated. Thus complaints of gastrointestinal
problems, nausea, or tightness in the head/chest may be indicative of homesickness or
other stressing life situations. Brislin contends that practitioner knowledge of the
bases for somatisation within various cultural groups can provide an important
context for understanding symptom reporting and positive health outcomes.
Source:
Brislin, R. (1993). Understanding culture's influence on behaviour. (pp. 329 - 334).
Fort Worth, TX: Harcourt Brace Jovanovich.
16
INTRODUCTION TO PHYSIOLOGY
HEALTH PSYCHOLOGY
ACTIVITIES
1. Medical Library Search for Treatments. Have students select one to two
diseases of interest and then, using the Medem medical library found at
http://www.medem.com/MedLB, explore the types of treatments typically used for
these diseases. This website includes information on the types of a disease class,
symptoms, general procedures in diagnosis, and treatment. Students can report to the
class the information they have gathered.
2. Blood Pressure. Obtain a sphygmomanometer and explain the procedure of
taking one's blood pressure. Chances are that one of the students may be in nursing
or some other occupation to assist. It is also possible to obtain a digital
sphygmomanometer, which reads the pressure for you.
If you need to take the pressure yourself, place the cuff on the arm of a
volunteer. The cuff should be inflated to roughly 150mm and then the air slowly
released as you listen to the brachial artery at the crook of the elbow (cubital fossa).
Note the pressure when sound is first heard. This is the pressure at which blood was
first able to pass the occluded artery and corresponds to the contractions of the heart,
the systolic pressure. The pressure at which the sounds lessen or dampen is noted and
corresponds to the pressure at rest or diastolic pressure. Diastolic pressures over 95
in resting individuals is considered hypertension.
3. Activation of the Sympathetic Nervous System. This demonstration of
sympathetic activation should be of interest to students. This activity is best
accomplished with a physiological recording instrument, e.g., a polygraph, but it can
be done easily and effectively with an inexpensive sphygmomanometer, a small ruler
with millimetre markings (to measure pupil dilation), and by having students measure
their own pulse rates.
First have students take baseline measures of their physiological systems, with
the students working in pairs or small groups. Any of the measures listed below can
be used. After baseline measures have been obtained, arrange to have a startling
disturbance take place (e.g., loud door slamming, balloon breaking), in order to
activate the sympathetic nervous system. Immediately have the students retake the
physiological measures.
Measures that can be used:
Heart rate: measured by obtaining a pulse rate, with or without a polygraph
Blood pressure: measured with a sphygmomanometer
Pupil dilation: measured with a millimetre ruler
Galvanic skin response (GSR, a measure of skin resistance), or
electrodermal activity (EDA, a measure of skin conductance): measured by
a polygraph
Muscle tension: measured with electromyography
17
INTRODUCTION TO PHYSIOLOGY
HEALTH PSYCHOLOGY
RESOURCES
Albrecht, G.L., Fitzpatrick, R., & Scrimshaw, S.C. (2000). Handbook of social
studies in health and medicine. Thousand Oaks, CA: Sage.
Boik, J. (1995). Cancer & natural medicine: A textbook of basic science and clinical
research. Princeton, MN: Oregon Medical Press.
Davey, B., & Seale, C. (1996). Experiencing and explaining disease. Buckingham,
PA: Open University Press.
Desnick, R.J. (1991). Treatment of genetic diseases. New York: Churchill
Livingston.
Hatty, S.E. & Hatty, J. (1999). The disordered body: Epidemic disease and cultural
transformation. Albany: SUNY Press.
Lorber, J. (1997). Gender and the social construction of illness. Thousand Oaks, CA:
Sage.
Memmler, R.L., Cohen, B.J., & Wood, D. (1996). Structure & function of the human
body. Philadelphia: Lippincott.
Moore, S. B. (1996). Everything you need to know about medical tests. Springhouse,
PA: Springhouse Corp.
Rayner, C. (Ed.) (1976). The Rand McNally atlas of the body and mind. New York:
Rand McNally.
Skelton, J.A., & Croyle, R.T. (1991). Mental representations in health and illness.
New York: Springer-Verlag.
Wasson, J.H. (1997). The common symptom guide: A guide to the evaluation of
common adult and pediatric symptoms. New York: McGraw-Hill.
Zaret, B.L. (1997). The patient's guide to medical tests. Boston: Houghton Mifflin.
Suggested Films and Videos:
1. Medicine at the Crossroads: Conceiving the future. (1993, BBC, 57 min).
Based on the premise that genetics provides a powerful way to predict health
and determine the future of every embryo; explores medical practice in
different societies is dealing with these capabilities.
2. Medicine at the Crossroads: Pandemic (1993, BBC, 57 min). Discusses
progress in the scientific understanding of AIDS and attempts to prevent the
disease.
3. Medicine at the Crossroads: Random Cuts (1993, BBC, 57 min). Discusses
the continued use of medical procedures even after they have been
demonstrated to be ineffective.
4. Medicine at the Crossroads: The Magic Bullet. (1993, BBC, 57 min). Looks at the
expectation that medicine can provide "a pill" to solve all health problems.
Internet sites of interest:
1. http://www.cpmcnet.columbia.edu/texts/guide/ - The Complete Home Medical
Guide
2. http://www.medic.med.uth.tmc.edu/index.html - MedIC (a medical instructional
multimedia tool).
3. http://www.ncbi.ulm.nih.gov/pubmed - PubMed (a publications index on
medicine).
4. http://www.ornl.gov/hgmis/medicine/medicine.html - information on the Human
18
INTRODUCTION TO PHYSIOLOGY
HEALTH PSYCHOLOGY
Genome Project
5. http://www.galaxy.tradewave.com/galaxy/Medicine?Health-Occupations?
Medicine/Psychological-Medicine.html - links for Psychological Medicine
Short Answer Questions
1. Compare and contrast the communication systems in the endocrine system versus
the nervous system.
2. Discuss the issue of individual variability in internal systems between people.
Provide evidence to support your answer.
Essay Questions
1. Derek has just been bitten by a dog. Explain what is happening within two of the
systems of his body as a result.
2. Leanne has high blood pressure. Discuss the mechanical, psychological,
environmental, and demographic factors that may be an influence on her condition.
19
INTRODUCTION TO PHYSIOLOGY
HEALTH PSYCHOLOGY
INTRODUCTION TO STRESS
I. Experiencing Stress in Our Lives
A. What is Stress?
1. Stress as a stimulus
2. Stress as a reaction or response
3. Stress as a process
B. Appraising Events as Stressful
1. Cognitive appraisal
2. Primary and Secondary Appraisal
3. What Factors Lead to Stressful Appraisals?
a. Personal factors
b. Situational factors
C. Dimensions of Stress
II. Biopsychosocial Reactions to Stress
A. Biological Aspects of Stress
1. Reactivity
2. Fight-or-flight response
2. General Adaptation Syndrome
3. Do All Stressors Produce the Same Physical Reactions?
B. Psychosocial Aspects of Stress
1. Cognition and Stress
2. Emotions and Stress
3. Social Behaviour and Stress
4. Gender and Sociocultural Differences in Stress
III. Sources of Stress Throughout Life
A. Sources Within the Person
B. Sources in the Family
2. Divorce
3. Family Illness, Disability and Death
C. Sources in the Community and Society
1. Jobs and stress.
2. Environmental stress
IV. Measuring Stress
A. Physiological Arousal
B. Life Events
1. The Social Readjustment Rating Scale (Holmes & Rahe, 1967)
2. Other Life Events Scales
C. Daily Hassles
20
INTRODUCTION TO STRESS
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Acculturative Stress.
Although a number of life changes that can contribute to the experience of stress are
noted in this chapter, moving to another culture is not noted as one of them. The term
acculturation has been defined as the changes that occur both to an immigrating groups
and to the culture into which they enter. John Berry has found that differences emerge in
how people attempt to deal with acculturative change and stress due to acculturation is
not always inevitable. Personal beliefs regarding acculturation including the importance
of maintaining one's cultural identity as well as relationships with others in the new
culture have an impact on the stress experienced. Any number of stressors may arise from
an acculturation situation. Persons who are marginalized (i.e., neither their original or
new cultural groups are any longer valued as important) experience the most stress
whereas those people who adopt an integration orientation (i.e., bringing his/her cultural
group into an integrated part of the larger, coordinated social group) experience the least
stress. The posture regarding acculturation adopted by acculturative society contributes to
the stress experienced. For example, societies that hold beliefs in pluralism are more
likely to create supportive networks for acculturating individuals and demonstrate more
tolerance of diversity. As a result, the experience of acculturative stress results from a
combination of belief systems found in the emigrating person and the acculturative
society to which he or she moves. Negative consequences of acculturative stress for the
individual include reduced health, lowered levels of motivation, a sense of alienation,
and increased social deviance. He argues, however, that acculturative stress can be
largely avoided or reduced if both participation in the larger society and maintenance of
ones heritage culture are welcomed by policy and practice of the larger society (pg.
215).
Source:
Berry, J. (1994). Acculturative stress. In W. Lonner & R. Malpass (Eds.), Psychology and
culture (pg. 211-215). Boston: Allyn and Bacon.
2. Cultural Discrepancies and Stress.
In 1997, Matsumoto and his colleagues conducted research on college students to
determine if the discrepancy between personal cultural values and the perceived
values of society are related to stress experiences. Participants reported their own
personal cultural values and their perceptions of the values of the society in which
they lived. Perceptions of ideal values were also gathered. Additional information
was gathered regarding coping strategies, mood, and physical well being. Results of
the study indicated that greater discrepancies between self values and perceived
values of one's culture were positively correlated with more distress and health
problems. Use of a greater number of coping strategies was related to these higher
levels of distress. Although the author suggests more research is required, he suggests
that cultural discrepancies may mediate health outcomes and be related to our stress
experiences.
Source:
Matsumoto, D. (2000). Culture and psychology: People around the world. (2nd ed.).
(pg. 238). Stamford, CT: Wadsworth.
21
INTRODUCTION TO STRESS
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Assess Yourself: Hassles in Your Life. The hassles survey developed by Sarafino
& Ewing (1999), has been reproduced in the handout. Have students complete the
scale and then look for trends across most frequent hassles for students at your
institution. An extension of this activity might be to have students add local hassles
that aren't addressed on this scale.
2. Disasters and Stress. Have the students find articles and each present a report on
a specific disaster and victims' reactions to the particular disaster. A good resource to
assign for required reading in conjunction with this project is Ursano (1997).
22
INTRODUCTION TO STRESS
HEALTH PSYCHOLOGY
23
INTRODUCTION TO STRESS
HEALTH PSYCHOLOGY
RESOURCES
Aneshensel, C.S. (1992). Social stress: Theory and research. Annual Review of
Sociology, 18, 15-38.
Brett, J.F., Brief, A.P., Burke, M.J., George, J.M., & Webster, J. (1990). Negative
affectivity and the reporting of stressful life events. Health Psychology, 9, 57-68.
Cohen, S., Kessler, R.C., & Gordon, L.U. (Eds.). (1995). Measuring stress: A guide
for health and social scientists. New York: Oxford University Press.
Dressler, W.W. (1994). Social status and the health of families: A model. Social
Science & Medicine, 39, 1605-1613.
Friedman, M.J., Charnery, D.S., & Deutch, A.Y. (Eds.). (1995). Neurobiological and
clinical consequences of stress: From normal adaptation to PTSD. Philadelphia:
Lippincott-Raven.
Goldberger, L., & Breznitz, S. (Eds.). (1993). Handbook of stress: Theoretical and
clinical aspects. New York: Free Press.
Kopin, I.J. (1995). Definitions of stress and sympathetic neuronal responses. Annals
of the New York Academy of Sciences, 771, 19-30.
Lazarus, R.S.(1998). The life and work of an eminent psychologist: Autobiography of
Richard S. Lazarus. New York: Springer.
Lazarus, R.S. (1999). Stress and emotion: A new synthesis. New York: Springer.
Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York:
Springer.
Selye, H. (1976). The stress of life. New York: McGraw-Hill.
Slavin, L.A., Rainer, K.L., McCreasry, M.L. & Gowda, K.K. (1991). Toward a
multicultural model of the stress process. Journal of Counseling & Development, 70,
156-163.
Smith, J.C. (1993). Understanding stress and coping. New York: Macmillan.
Ursano, R.J. (1997). Disaster: Stress, immunologic finction, and health behavior.
Psychosomatic Medicine, 59, 142-143.
Wykle, M., Kahana, E., & Kowal, J. (Eds.). (1992). Stress and health among the
elderly. New York: Springer.
Internet sites of interest:
1. http://www.w3.org/vl/Stress/ - a virtual library on stress.
2. http://www.fisk.edu/vl/Stress/ - another virtual library on stress.
3. http://healthfinder.gov - search engine with links to the topic of stress.
4. http://www.cmhc.com/psyhelp/chap5/ - comprehensive coverage of stress.
5. http://www.prcn.org/next/stress.html - Holmes & Rahe stress test.
6. http://www.ventura.com/jsearch/unique/12781/jshome2b.html - Job burnout
test.
7. http://wellness.uwsp.edu/Health_Service/services - website contains a stress
assessment.
8. http://www3.sympatico.cmha.toronto.sindex.htm - checklist assessment on
stress.
Short Answer Questions
1. Compare and contrast Cannon's fight-or-flight response with Selye's general
adaptation syndrome.
24
INTRODUCTION TO STRESS
HEALTH PSYCHOLOGY
25
INTRODUCTION TO STRESS
HEALTH PSYCHOLOGY
26
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Attributional style, culture, and depression.
Sarafino discusses the triad of internal-stable-global thinking as it relates to
pessimism. Cross cultural researchers have attempted to test the triad of internalstable-global thinking in its relation to pesimissim. In one study, Crittenden & Lamug
(1988) found that Filipino and American depressives did not differ in terms of their
explanations for negative events: they both endorsed the internal-stable-global triad.
Interestingly, however, while the triad pattern did not predict somatic complaints in
American participants it did predict them in Filipino participants. These authors argue
that Filipinos learn to express somatic complaints as part of their socialization as an
expression of depression whereas Americans learn to express depression through
indecisiveness, emptiness, and hopelessness. The key idea here is that cultural
influences contribute to symptom expression and reporting.
Source:
Crittenden, K., & Lamug, C. (1988). Causal attribution and depression: A friendly
refinement based on Philippine data. Journal of Cross-Cultural Psychology, 19, 216231.
2. Stress and Mental Health.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders (4th ed.) presents in its multiaxial diagnostic system the Severity of
Psychosocial Stressors Scales for both adults and children. In both cases the stressors
are rated as being either "predominantly acute, that is with a duration of less than 6
months, or predominantly enduring, those events enduring more than 6 months." The
stressors are then coded as being from I - None or 2 -Mild; through 3 - Moderate, and
4 - Severe; to 5 - Extreme and 6 - Catastrophic. The clinician is advised to rate the
stressor itself, not the person's reaction to it. In terms of the different ways stress may
be defined, which approach does the DSM-IV take? What are the advantages and
disadvantages of such an approach?
27
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Social Networks. Have the students examine their own social network (perhaps
the same people identified in the Assess Yourself exercise if you wish to extend that
activity). Identify how many people with whom they have regular contact. How
often are these people seen? What is the nature of their relationship to these people?
Now consider an adverse situation. Which of these people could be asked for a loan
of less than five dollars? Which could be asked for a hundred dollars? Who could be
asked to turn in a term paper if you were ill? Who could be asked to take you to the
emergency room? At 2:00 a.m.? Who would take care of you if you were seriously
ill?
Discuss their responses in terms of the buffering effect a good social network has on
limiting the effects of large stressors.
2. Learned Helplessness and Attributions. In order to students appreciate the
process of attribution, have the students examine their own cognitive processes. Ask
them to write down an example of a recent positive and a recent negative event in
their lives. For each event, have them answer the questions:
1. Was the cause of the event under your control or due to circumstances
beyond your control?
2. Was the event due to relatively temporary or long-lasting factors?
3. Was the event due to a narrow or wide-acting cause?
After these questions have been answered, have the students identify whether they
responded to question #1 in more of the internal vs. external direction #2 in the stable
or unstable direction, and #3 in the global or specific direction. Do the answers they
gave differ for the positive and negative events?
3. Locus of Control. Rotter's Locus of Control Scale is accessible on the Web at
http://duskin.com/connectext/psy/ch11/survey11.mhtml. Students can complete the
survey on-line, have their score calculated, and receive feedback about how their
score reveals the internal or external locus of control. Have students print their results
for an in-class discussion on the usefulness and connection of locus of control to
health issues.
28
HEALTH PSYCHOLOGY
RESOURCES
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioural change.
Psychological Review, 84, 191-215.
Bolger, N., & Zuckerman, A. (1995). A framework for studying personality in the
stress process. Journal of Personality and Social Psychology, 69, 890-902.
Costa, P.T. & McRae, R.R. (1985). Hypochondriasis, neuroticism and aging: When
are somatic complaints unfounded? American Psychologist, 49, 19-28.
Friedman, M.J., Charnery, D.S., & Deutch, A.U. (Eds.). (1995). Neurobiological and
clinical consequences of stress: From normal adaptation to PTSD. Philadelphia:
Lippincott-Raven.
Lynes, S.A. (1993). Predictors of differences between Type A and B individuals in
heart rate and blood pressure reactivity. Psychological Bulletin, 114, 266-295.
Rice, P.L. (1999). Stress and health (3rd ed.). Pacific Grove, CA: Brooks/Cole.
Schaufeli, W.B., Maslach, C., & Marek, T. (Eds.) (1993). Professional burnout:
Recent developments in theory and research. Washington, DC: Taylor & Francis.
Williams, R.B. (1995). Somatic consequences of stress. In M.J. Friedman, D.S.
Charnery, & A.Y. Deutch (Eds.), Neurobiological and clinical consequences of stress:
From normal adaptation to PTSD (pp. 403-412). Philadelphia: Lippincott-Raven.
Internet sites of interest:
1. http://unl.edu:80/stress/mgmt/ - discusses personality and stress.
2. http://msnbc.com/onair/nbc/nightlynews/stress/stresstypea.asp - a Type A quiz.
3. http://workhealth.org/risk/rfbtypea.htm - describes TABP.
4. http://www.teachhealth.com - explores the medical basis for stress
5. http://www.healthseek.com - database of materials on stress
6. http://www.psy.aau.dk/bobby/pni.htm - psychoneuroimmunology.
7. http://www.healthguide.com/Stress/helpless.htm - information on learned
helplessness
Short Answer Questions
1. Your Aunt Yvonne has to give a presentation to her boss and is very nervous about
doing so. In what ways might you give her social support that could help to reduce
her stress?
2. Discuss the sub-scales of the Multidimensional Health Locus of Control scale from
the standpoint of internal/external LOC.
Essay Questions
1. If you were a parent, which health characteristics would you seek to develop in
your children and why? In what ways would you foster this development?
2. If you were asked to arrive at a general conclusion regarding the relationship
between stress and illness, what would it be? Support your answer with evidence.
29
HEALTH PSYCHOLOGY
30
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. The Stress-reducing Power of Laughter:
Bond reviews the impact of laughter on endorphin release and immune functioning.
He also notes that children spend far more time laughing than do adults. He
highlights the professional career of Loretta LaRoche, therapist, adjunct faculty
member of The Behavioural Institute of Medicine (an affiliate of Harvard Medical
School), and stand-up comic as she travels around the US delivering humorous tips on
how to reduce the stress in our lives. Common themes in her presentation include the
contests of whining in which we engage with one another, our "wait" to finally be
happy (but in the mean time we must suffer), forgetting to be grateful for what we
have, and not letting ourselves "tah dah!" as we did as children. A very upbeat topic
for discussion of stress management.
Source:
Bond, J.F. (1999). Take Two Guffaws and Call Me in the Morning! In D. Corbin
(Ed.), Perspectives: Stress management. (pp. 127-128). St. Paul, MN: Coursewise
Publishing.
2. Music and Stress:
Kathleen Ganster reviews the use of music in therapeutic applications. As an
intervention, music therapy was first used following World War II by University of
Kansas professors E. Thayer Gaston and William Sears. Although initially rejected by
hospitals and the medical community, music therapy programs such as the ones
located at Duquesne University and Slippery Rock University have maintained a
steady number of graduating music therapists since the mid 1970s who work at major
hospitals and cancer centres. The forms of music and techniques used by music
therapists tend to vary depending on patient and diagnosis. Common areas of
application include stress management, relaxation during pain management, as a
coping adjunct during chemotherapy, as part of guided imagery therapy with oncology
patients, and as stimuli in drawing out the memories of patients with Alzheimer's. It
has also be used in programs with autistic and emotional disturbed children. Students
in class might be able to identify with the power of music to arouse and calm, and to
evoke positive and negative emotional states.
Source:
Ganster, K. (1999). The sound of healing. In D. Corbin (Ed.), Perspectives: Stress
management. (pp. 129-130). St. Paul, MN: Coursewise Publishing.
3. Ancient Approaches to Stress Management:
Very similar to Cannon's and Selye's theories of health and disease are the theories
from ancient and widely different cultures. Have the students read the review article
by Walton & Pugh (1995), or present the details in a lecture. This paper reviews the
fundamental elements of these theories and the current research supporting their
validity. Particular attention is given to Ayurvedic methods to control stress and
improve health.
Source:
31
HEALTH PSYCHOLOGY
Walton, K. G., & Pugh, N. D. (1995). Stress, steroids, and "ojas": neuroendocrine
mechanisms and current promise of ancient approaches to disease prevention. Indian
Journal of Physiology and Pharmacology, 39, 3-36.
ACTIVITY SUGGESTIONS
1. Assess Yourself: Your Focuses in Coping. This exercise (see following sheet)
helps students assess their use of emotion-focused and problem-focused coping
strategies. You might have them fill out the assessment on two different types of
stressors (one controllable, the other out of their control) to demonstrate the use of
different types of coping strategies.
2. In-class relaxation exercises. Students have a better feel for relaxation techniques
if given the chance to experience it themselves. Suggested techniques include
progressive muscle relaxation, autogenic relaxation, and imagery.
32
HEALTH PSYCHOLOGY
Why?
33
HEALTH PSYCHOLOGY
RESOURCES
Blonna, R. (1996). Coping with stress in a changing world. St. Louis: Mosby.
Girdano, D.A., Everly, G.S., & Dusek, D.E. (1990). Controlling stress and tension: A
holistic approach. Englewood Cliffs, NJ: Prentice Hall.
Greenberg, J.S. (1993). Comprehensive stress management. Madison: Brown &
Benchmark.
Humphrey, J.H. (1992). Stress among older adults: Understanding and coping.
Springfield, IL: C.C. Thomas.
Lehrer, P.M., & Woolfolk, R.L. (1993). Principles and practice of stress management.
New York: Guilford Press.
Maslach, C. (1997). The truth about burnout: How organizations cause personal
stress and what to do about it. San Francisco: Jossey-Bass.
Quick, J.C. (Ed.) (1997).
Preventive stress management in organizations.
Washington, DC: American Psychological Association.
Smith, H.W. (1994). The 10 natural laws of successful time and life management:
Proven strategies for increased productivity and inner peace. New York: Warner
Books.
Turkington, C. (1998). Stress management for busy people. New York: McGrawHill.
Internet sites of interest:
1. http://www.unl.edu/stress/mgmt/ - stress management - principles review.
2. http://www.gasou.edu/psychweb/mtsite/index.html - stress and time management
3. http://www.health-net.com/stress.htm - Health Net's Managing Stress home page
4. http://www.stressfree.com - Stress Free net
5. http://imt.net/~randolfi/StressLinks.html - stress management site with many links
to similar sites
6. http://www.mindtools.com/ - Coping skills such as time management and problem
solving are highlighted.
Short Answer Questions
1. Compare and contrast emotion-focused and problem-focused coping.
2. Compare and contrast systematic desensitization with biofeedback.
3. Compare and contrast Ellis' RET with Beck's cognitive therapy.
Essay Questions
1. Discuss the effectiveness of the various methods of stress management.
2. Consider the idea that the various methods of coping represent a multidimensional
approach to coping. Defend or refute this notion.
34
HEALTH PSYCHOLOGY
35
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. The Precaution Adoption Process:
The precaution adoption process model proposes that preventive behaviours occur in
stages ranging essential from uninformed bliss to actively taking precautions against a
health hazard. Particularly interesting is Weinsteins suggestion that people at
different stages will think and behave in qualitatively different ways and that
intervention strategists need to consider that different kinds of interventions and
information will be needed to move people through these stages.
Source:
Weinstein, N.D. (1988). The precaution adoption process. Health Psychology, 7(4),
355-386.
2. The Effect of the Environment on Women's Health:
Sarafino notes that mens occupational and recreational experiences have historically put
them at risk for illness and injury. VanDusens chapter explores a rich set of issues to be
considered when evaluating the environmental risks to which women have historically
been exposed. She explores environmental agents and situations within the home,
neighbourhood, and work settings where high numbers of women are found that put
women at risk. For example, over a million women working in the clothing and textile
industry may be exposed to formaldehyde, flame-retardants, solvents, benzidine-type
dyes, noise, vibration, and cotton dust as a result of their jobs. Nearly half a million
hairdressers and cosmetologists are exposed to bleaches, nail varnishes, and hair dye.
Household workers are at risk for exposure to chemicals such as solvents, pesticides, and
disinfectants and injury due to falls. This author discusses the impact of these
environmental hazards on the lives of women and the effects on children during gestation.
Source:
VanDusen, K. (1982). The effect of the environment on women's health. In
Hongladarom, G.C., McCorkle, R., & Woods, N.F. (Eds.), The complete book of
women's health. (pp.163-178).
3. Workplace Wellness Program.
According to Cohen (1985), the advantages to a health promotion program at the
workplace are:
a. Most employees go to the workplace on a regular schedule, facilitating
regular participation in the programs;
b. contact with co-workers can provide reinforcing social support, which is
believed by many to be a primary force in sustaining a life-style change;
c. the workplace offers many opportunities for environmental supports, such
as healthy food in the cafeteria and office policies regarding smoking;
d.
opportunities abound for positive reinforcement for individuals
participating in
the programs;
e. programs in the workplace are generally less expensive for the employee
than comparable programs in the community; and
f. programs in the workplace are convenient.
36
HEALTH PSYCHOLOGY
What are factors which encourage employers to institute such programs? What
factors discourage them? Are there factors about the workplace that serve to increase
health risks?
ACTIVITIES
1. Assess Yourself: Your Knowledge about AIDS. See handout.
2. Health Promotion. Have each student choose a problem addressed by public
health departments such as cancer, heart disease, drinking, smoking, drugs, or AIDS.
Monitor magazines, newspapers, television and radio programs as well as billboards
and promotional activities for prevention efforts. Classify the efforts so identified as
primary, secondary or tertiary in nature.
Are the efforts, fear-arousing,
information-providing, or skill-building?
37
HEALTH PSYCHOLOGY
1.
2.
3.
4.
5.
6.
People who have the AIDS virus can look and feel well.
7.
8.
9.
Kissing or touching someone who has AIDS can give you the
disease.
10.
38
HEALTH PSYCHOLOGY
RESOURCES
Brownson, R.C., Baker, E.A., & Novick, L.F. (1999). Community-based prevention:
Programs that work. Gaithersburg, MD: Aspen Publ.
Campbell, C.A. (1999). Women, families, and HIV/AIDS: A sociological perspective
on the epidemic in America. Cambridge: Cambridge University Press.
Miller, D.F. (1995). Dimensions of community health. Madison, WI: Brown &
Benchmark.
National Institutes on Drug Abuse. (2000). The NIDA community-based outreach
model: A manual to reduce the risk of HIV and other blood-borne infections in drug
users. Bethesda, MD: NIDA.
Schust, C.S. (1996). Community health: Education and promotion manual.
Gaithersburg, MD: Aspen Publ.
Tillman, P.S. & Pequegnat, W. (1996). Interventions to prevent HIV risk behaviours:
January 1991 through November 1996. Bethesda, MD: NIH.
Van Vugt, J.P. (Ed.) (1994). AIDS prevention and services: community based
research. Westport, CN: Bergin & Garvey.
Woolf, S.H., Jonas, S., & Lawrence, R.S. (1996). Health Promotion and Disease.
Prevention in Clinical Practice. Baltimore, MD: Williams & Wilkins.
Internet sites of interest:
1. http://www.wellnessjunction.com/ - A commercial website oriented to workplace
wellness.
Short Answer Questions
1. Discuss the similarities and differences between the health belief model and the
theory of planned behaviour.
2. How do gender and/or sociocultural background influence health-related
behaviours?
Essay Questions
1. Your co-worker, Jeff, has just had a heart attack. Using one of the cognitive
theories of change, describe how cognition will affect Jeff's efforts to make lifestyle
changes.
2. Trace the changes in beliefs about the relationship between health and behaviour in
children as they age.
39
HEALTH PSYCHOLOGY
SUBSTANCE ABUSE
I. Substance Abuse
A. Addiction
1. Definition
2. Physical dependence
3. Psychological dependence
B. Substance abuse
II. Smoking Tobacco
A. Who Smokes?
B. How Much Smokers Smoke
C. Why People Smoke
1. Starting to smoke
2. Becoming a regular smoker
3. The role of nicotine
E. Smoking and Health
1. Cancer
3. Cardiovascular Disease
4. Other illnesses
F. Preventing Smoking
1. Public health approach
2. Prevention programs
3. Psychosocial approach
4. Findings of studies of successful prevention programs
5. Programs using a psychosocial approach are most successful.
G. Quitting Smoking
1. Stopping on one's own
2. Treatment for stopping smoking
a. Drug approaches
b. Aversion strategies
c. Self-management strategies
d. Other techniques
e. Successful treatments are multidimensional
3. Succeeding at quitting and abstaining for good
III. Alcohol Use and Abuse
A. History
B. Who drinks, and how much?
C. Why People Use and Abuse Alcohol
D. Drinking and Health
E. Preventing Alcohol Abuse
F. Treatments for Alcohol Abuse
IV. Drug Use and Abuse
A. Who Uses Drugs and Why?
B. Drug Use and Health
C. Preventing and Stopping Drug Abuse
1. Public health approaches
2. Conclusions from research on treating drug abuse.
40
SUBSTANCE ABUSE
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Research on chemical dependency in women:
Sharon Hall discusses a number of issues related to womens experiences with
chemical dependency. After a basic review of the gender trends in substance use, she
notes the etiological factors contributing to substance use may vary to some extent
between women and men. For example, she cites literature suggesting alcoholism in
women may be influenced by dependency needs, power needs, sex role conflicts, low
self-esteem, and having a history of sexual abuse. Excessive alcohol use has been
linked to gynaecological and obstetric dysfunctions and a greater risk for liver
disease. Disease progression also tends to be gender linked. Concerns regarding
foetal alcohol syndrome are also unique to women. Treatment issues particular to
women are also reviewed including the need for intervention sensitivity towards
familial responsibilities, child care, and family opposition to treatment. For women
smokers, unique risk factor concerns include the relationship between oral
contraceptive use and risk for cardiovascular disease, effects of smoke on the foetus.
Nicotine is metabolized more slowly from the bodies of women. In treatment, weight
gain is likely to be addressed as a concern by women more so than for men. A section
of the chapter addresses the particular problems of prescription drug misuse in older
women.
Source:
Hall, S. M. (1994). Women and drugs. In Adesso, V.J., Reddy, D.M., & Fleming, R.
(Eds.), Psychological perspectives on womens health, (pp. 101-126). Washington:
Taylor & Francis.
2. Dissonance and alcohol use:
Claude Steele and colleagues have conducted several studies investigating alcohol use
under the theoretical umbrella of cognitive dissonance theory. This article, although a
bit on the long side, is a good example of a theory-based, experimental approach to the
study of alcohol use. Based on the assumption that cognitive dissonance is experienced
as a negative emotional state, these authors explored the relationship between the
amount of alcohol consumed by moderate and heavy drinkers and dissonance-reducing
effects of alcohol. A bit more specifically, they found that when heavy drinkers were
placed in a classic dissonance-arousing situation (a counter-attitudinal paradigm) their
later drinking increased if they first werent given an opportunity to change an earlier
attitude. General conclusions drawn from this research suggest self-regulated drinking
affects levels of cognitive dissonance and, importantly, that normal socialpsychological processes may play a role in the aetiology of alcohol abuse.
Source:
Steele, C.M., Southwick, L.L., & Critchlow, B. (1981). Dissonance and alcohol:
Drinking your troubles away. Journal of Personality and Social Psychology, 41(5).
5. How we get addicted:
This is an interesting article that seeks to educate its everyday readers about the links
between neurochemistry and addiction. Particular discussion is given to the role of
dopamine in addictions. The results of animal studies and PET scans of known addicts
are reviewed in great detail. This article could be the basis for some class discussion
41
SUBSTANCE ABUSE
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Assess Yourself: What's True About Drinking? Handout - self-assessment on
misconceptions about drinking is reproduced. After students complete the handout
they might also be asked to add any additional myths they can think of to the handout.
2. Assess Yourself: Do You Abuse Alcohol? Second self-assessment. You might
compare questions on the handout to the DSM-IV diagnostic criteria for alcohol abuse
and discuss any differences in these definitions.
3. Stimulus Control and Response Substitution. Smoking serves as an excellent
example of a behaviour frequently under stimulus control and amenable to
intervention through response substitutions. As smokers are relatively rare in Health
Psychology classes, have the students find a smoker and evaluate the situations under
which they smoke. The stimuli should include times of the day, locations (e.g., desk,
car), social situations, emotional state, and activity. Also, have the students identify as
specifically as possible the exact components of the smoking act. For example, What
brand of cigarettes are smoked? With what are they lit? Where are they kept? Have
the analysis of the behaviour suggest what ways and aspects of the stimulus and
response could be changed to interfere with the smoking.
4. Treatment Options. Local agencies are often eager to come to classes to discuss
their community prevention efforts or intervention programs to Health Psychology
classes and students are often interested in learning about local intervention efforts.
In particular, ask such speakers to describe in some detail their prevention or
intervention approaches. As students observe the presentation, ask them to keep notes
on intervention strategies that they identify.
5. Hidden Messages in Alcohol Ads. Ask students to bring in alcohol
advertisements. Discuss the messages of the ad. What is being sold? What is being
promised? Who is the intended audience? Are particular social influence tactics
being used?
6. On-line Intervention Programs. A number of on-line intervention programs are
currently available on the Internet. Have students locate one and then analyze it for
treatment components of the program. Take particular note of any outcome data the
site might have available.
42
SUBSTANCE ABUSE
HEALTH PSYCHOLOGY
43
SUBSTANCE ABUSE
HEALTH PSYCHOLOGY
44
SUBSTANCE ABUSE
HEALTH PSYCHOLOGY
RESOURCES
Centre for Substance Abuse Prevention. (1994). Tips for teens about smoking.
Rockville, MD: author.
Cinciripini, P.M., Cinciripini, L.G., Wallfisch, A., Haque, W., Van Vunakis, H.
Hartigan, F. (2000). Bill W.: A biography of Alcoholics Anonymous cofounder Bill
Wilson. New York: St. Martin's Press.
Kaufman, E. (1991). Help at last: A complete guide to coping with chemically
dependent men. New York: Gardner Press.
Landry, M.J. (1994). Understanding drugs of abuse: The processes of addiction,
treatment, and recovery. Washington: American Psychiatric Press.
McCrady, B.S., & Epstein. E.E. (1999). Addictions: A comprehensive guidebook.
New York: Oxford Press.
McDowell, D.M., & Spitz, H.I. (1999). Substance abuse: From principles to practice.
Philadelphia: Brunner/Mazel.
National Institute on Drug Abuse. (2000). Anabolic steriod abuse. Rockville: author.
Raphael, M.J. (2000). Bill W. and Mr. Wilson: The legend and life of AA's cofounder.
Amherst: UMass Press.
Stares, P.B. (1996). Global habit: The drug problem in a borderless world.
Washington: Brookings Institute.
Stern, L. (1999). The smoking book. Chicago: UChicago Press.
Wilcox, D.M. (1998). Alcoholic thinking: Language, culture, and belief in Alcoholics
Anonymous. Westport, CT: Praeger.
Internet sites of interest:
1. http://www.tobaccofree.org/ - Tobacco Free
2. http://www.na.org/ - Narcotics Anonymous
3. http://www.niaaa.nih.gov/ - National Institute on Alcohol Abuse and Alcoholism
Short Answer Questions
1. Discuss the relationships between the terms addiction, physical dependence,
tolerance, withdrawal, psychological dependence and substance abuse.
2. Distinguish between the various types and effects of the different categories of
drugs.
Essay Questions
1. Your neighbour, a 35 year-old two-pack-a-day smoker for the past 15 years, has
finally decided he wants to quit smoking and has asked for your advice on how to go
about doing so. What information could you give him regarding smoking cessation
techniques and their likelihood for success?
2. You may have noticed the similarity in treatment approaches for attempting to
prevent and/or get people to quit using tobacco, alcohol, and chemical substances.
Give an overview of the major approaches used in prevention or treatment.
45
SUBSTANCE ABUSE
HEALTH PSYCHOLOGY
46
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Men and muscles.
Barry Glassner, in his chapter "Men and Muscles", reviews cultural pressures on men to
be muscular which translates into powerful. Boyhood desires to be remembered as
"athletic stars" are transformed in muscular college men who report being happier with
themselves. Having muscular upper bodies correlated with higher self-esteem in a study
of 62,00 Psychology Today readers. Additionally, high school athletes are more likely to
hold higher-status, better-paying jobs in adulthood. When addressing why men "work
out", Glassner distinguishes between the obsessive, sporadic binge exerciser and the
moderate exerciser who has made exercise a integrated part of life. Some men, he
contends, exercise intensely as a way to bring discipline and order into their otherwise
stressful or rather chaotic lives. For them, exercise or body building acts as a form of
"therapeutic narcissism." For others, however, exercise is not a highly charged activity
but rather is no different than getting one's hair cut...it's a part of life that occupies a
significant part of free time but is set aside for other priorities. Probably active in sports
since childhood, this type of exerciser does not exercise to displace frustration but rather,
in keeping with continuity theory, is merely extending earlier behavioural practices. As a
result their exercise patterns are likely to be maintained.
Source:
Glassner, B. (1992). Men and muscles. In Kimmel, M.S., & Messner, M.A. (Eds.),
Men's lives. (pp 287-298). New York: MacMillan.
2. Schematic processes in eating disorders.
Vitousek & Hollon apply cognitive theory to the explanation of eating disorders.
Specifically, they argue that "eating disordered individuals develop organized
cognitive structures (schemata) around the issues of weight and its implications for
self that influence their perceptions, thoughts, affect, and behaviour." (pg. 192).
Moreover, they suggest that persistence of eating disorder behaviours represents the
automatic processing nature of schematic processing. Their article, albeit a bit
lengthily, is a rich example of schema (cognitive) theory to which many psychology
students will have been exposed, perhaps in a social psychology or memory &
cognition class. You may wish to have students read this article in its entirety before a
discussion in class regarding the aetiology and maintenance of eating disorders.
Source:
Vitousek, K.B., & Hollon, S.D. (1990). The investigation of schematic content and
processing in eating disorders. Cognitive Therapy and Research, 14(2), 191-214.
47
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Assess Yourself: Your Weight Control Patterns. Have students review
the first handout: Your Weight Control Patterns. Since some students may
feel uncomfortable responding to these questions, classroom discussion might
focus on whether such direct questions would be likely to produce genuine
responses instead. In particular, would some students find the classification
ratings alarming?
2. Exercise energy expenditure. On the second handout is a list of the
energy expenditure in various activities in kcal/min. Have the students
calculate how much energy they use in their weekly exercise. What variables
account for differences in the amount of energy used?
3. Kilocalorie activity. Handout three contains an exercise for calculating
average kilocalories expended during a day's activities. After students have
completed the handout compare to the following averages of kilocalories per
kilogram of body weight expended per day for individuals of different ages.
Have students consider different ways they could adjust their kilocalorie
expenditure.
Gender
Male
Female
30-39
38
33
40-49
37
31
50-59
36
30
60-69
34
29
48
HEALTH PSYCHOLOGY
1. Do you watch your calorie intake more carefully than anyone else you
know?
___
2. Do you weigh less than the "desirable weight' range for your height and
frame given in Table 8.1 on page 245?
___
___
4. Have you ever eaten so much so quickly that you felt like you lost control
of your eating?
___
5. If yes, has this happened more than about 10 times in the past year?
___
6. Have you ever eaten a lot and then tried to "purge" the food by using
laxatives, diuretics, or self-induced vomiting?
___
7. If yes, has this happened more than about 10 times in the past year?
___
___
___
10. Do you regularly exercise more than 10 hours a week to lose weight?
___
A high number suggests that you may have an eating disorder. If your number is:
from 3 to 5, you may want to consider getting professional help, especially if your
situation seems to be getting worse; 6 or more, you should seek help right away. You
can find help through your college's counselling office or by contacting the American
Psychological Association and the American Psychiatric Association, which are in
Washington, DC.
49
HEALTH PSYCHOLOGY
150
190
9.4
12.6
11.9
15.9
8.2
9.5
10.4
12.0
8.0
11.5
14.5
3.5
11.4
9.0
5.8
4.4
14.4
11.4
7.3
13.1
14.2
15.6
17.3
16.6
17.7
19.1
20.8
11.0
10.6
7.4
5.4
13.9
13.4
9.4
6.9
50
HEALTH PSYCHOLOGY
Energy Expenditure
1. Add up all the hours of sleep and naps you had yesterday.
_____
2. Multiply the total number hours of sleep and naps (line 1) by 1. (x1)
_____
_____
(x4)
_____
_____
(x6)
_____
_____
(x10) _____
(1 + 3 + 5 +7) =
_____
_____
(x15) _____
51
HEALTH PSYCHOLOGY
RESOURCES
Alexander-Mott, L., & Lumsden, D.B. (1994). Understanding eating disorders:
Anorexia nervosa, bulimia nervosa, and obesity. Washington, DC: Taylor & Francis.
Allen, M., & Moss, J. (2000). Workouts for working people: How you can get in great
shape while staying employed. New York: Villard.
Andersen, A.E. (Ed.) (1990).
Males with eating disorders.
New York:
Brunner/Mazel.
Anderson, E.S., Winett, R.A., & Wojcik, J.R. (2000). Social-cognitive determinants
of nutrition behaviour among supermarket food shoppers: A structural equation
analysis. Health Psychology, 19(5), 479-486.
Biddle, S.J.H., & Mutrie, N. (2001). Psychology of physical activity: Determinants,
well-being, and interventions. London: Routledge.
Christoffel, T., & Gallaher, S.S. (1999). Injury prevention and public health: Practical
knowledge, skills, and strategies. Gaithersburg, MD: Aspen.
Claude-Pierre, P. (1997). The secret language of eating disorders: The revoluntionary
new approach to understanding and curing anorexia and bulimia. New York: Times
Books.
Education Development Center. (1991). Preventing injuries. Newton, MA: author.
Hoeger, W.W.K., & Hoeger, S.A. (1996). Fitness & wellness. Englewood, CO:
Morton.
Immel, M.H. (Ed.) (1999). Eating disorders. San Diego: Greenhaven Press.
Jeffery, R.W., Drewnowski, A., Epstein, L.H., Stunkard, A.J., Wilson, G.T., Wing,
R.R., & Hill, D.R. (2000). Long-term maintanence of weight loss: Current status.
Health Psychology, 19(1),5-16.
Kumanyika, S.K., VanHorn, L., Bowen, D., Perri, M.G., Rolls, B.J., Czajkowski,
S.M., & Schron, E. (2000). Maintenance of dietary behaviour change. Health
Psychology, 19(1), 42-56.
Manton, C. (1999). Fed up: Women and food in America. Westport,CT: Bergin &
Garvey.
McAuley, E., Talbot, H., & Martinez, S. (1999). Manipulating self-efficacy in the
exercise environment in women: Influences on affective responses.
Health
Psychology, 18(3), 288-294.
McIntosh, E.N. (1999). American food habits in historical perspective. New York:
Praeger.
Messina, M., & Messina, V. (1996). The dietitian's guide to vegetarian diets: Issues
and applications. Gaithersburg, MD: Aspen.
Mintz, S. W. (1996). Tasting food, tasting freedom: Excursions into eating, culture,
and the past. Boston: Beacon Press.
Powers, S.K., & Dodd, S.L. (1999). Total fitness: Exercise, nutrition, and wellness.
Boston: Allyn and Bacon.
Prentice, W.E. (1996). Get fit stay fit. St. Louis: Mosby.
Sallis, J.F., Prochaska, J.J., Taylor, W.C., Hill, J.O., & Geraci, J.C. (1999). Correlates
of physical activity in a national sample of girls and boys in grades 4 through 12.
Health Psychology, 18(4), 410-415.
52
HEALTH PSYCHOLOGY
53
HEALTH PSYCHOLOGY
54
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Do clients get what they want?
Margaret Nelson has conducted a study exploring clients choices during childbirth
experiences. Birthing choices by expectant mothers are informed by hospital
sponsored classes, personal reading, discussions with friends/family, personal prior
experiences, and the ongoing socialization by medical personnel during prenatal
visits. Other factors, such as hospital standard operating procedures, medical
emergencies, staff shortages, or a rapid labour may influence the eventual procedures
that the patient receives however. As a result, a discrepancy may emerge between
what the patient wants and what occurs. Nelson notes that when a discrepancy occurs
three outcomes are possible: (1) the client may back away from her original choice
but maintain the belief in the right to choice, (2) the client may reconsider the right to
make choices in the future or (3) the client may maintain the commitment to the early
choice and right to make choices. Using a sample of 322 pregnant women, Nelson
measured their choices regarding 7 procedures surrounding hospital childbirth (e.g.,
episiotomy, medication during labour, etc.), outcomes during the birthing experience
as they pertaining to these procedures, and intent regarding these procedures in future
pregnancies. Findings indicate that not all patients made choices on the procedures; in
other words, they allowed medical personnel to decide what needed to be done.
Those who did make a choice often did not desire the procedure to be done.
Regardless of choice, there were few differences between those who choose a
procedure and those who didnt in whether the procedure was actually done. In fact,
anywhere from 17% to 82% of women did not get what they wanted, depending on
procedure. Nelson concluded that, in an era when we assume patients are given more
authority and choice, her data did not support this position.
Source:
Nelson, M.K. (1981). Client responses to a discrepancy between the care they want
and the care they receive. Women & Health, 6(3/4), 135-152.
2. Humour in the hospital:
Humour, described as an indirect mode of communication, finds its way into the
health care setting according to Vera Robinson. Although there are only a small
number of studies addressing the use of humour in the hospital, Robinson, a professor
emeritus in the Department of Nursing at California State University - Fullerton,
offers that humour serves three valuable functions within the world of health and
illness: a communication function, social function, and psychological function.
Humour can ease the communication of often difficult feelings surrounding health
situations and serves as a vehicle for broaching difficult topics. Socially, humour
provides an avenue for coping with the disrupted roles of daily life that occur when a
person enters the medical environment. Robinson also describes humour as an
equalizing force that decreases status and role distance between patient and physician.
It aides in soothing social conflict (i.e., violations of social norms about the privacy of
our bodies), promotes group solidarity by bringing people closer together, and restores
a sense of social control to the patient.
Psychological functions include
anxiety/tension relief, an outlet for anger or hostility, denial, and coping with tragedy.
The entire book provides a framework for understanding the research on humour and
offers ways to cultivate the use of humour.
55
HEALTH PSYCHOLOGY
Source:
Robinson, V.M. (1991). Humour and the health professions: The therapeutic use of
humour in health care. Thorofare, NJ: Slack Inc.
ACTIVITY SUGGESTIONS
1. Assess Yourself: Who's who in physician care. Have students complete the
handout. Discuss the impact of mysterious specialty titles and multiple specialties in
health care settings on the patient's experience with the health care system.
2. Assessments. Obtain copies of the MMPI, Millon Behavioural Health Inventory,
and Psychosocial Adjustment to Illness Scales. Compare the types of items on each.
Illustrate the different levels at which the questions are being asked. The MMPI is
interpreted indirectly through personality construct while the others are more
face-valid indicators of adjustment.
3. Hospital behaviours. Discuss the different expectations students have about
being hospitalized. How often would they expect to see their physician? Nurse?
How long would they expect it would take for a nurse to answer a request for
assistance? Do they feel it better to keep quiet about treatment they consider
inadequate, or should they complain? To whom would they complain? What result
might they expect?
4. Hospital preparation. Discuss which preparations would be useful for a hospital
stay. If staying in a hospital, what was, or would be, unfamiliar? What are students'
expectations regarding dress, meals, pain, procedures, consent, visits and so on. For
those who have been in a hospital, what would be their advice for others? What
preparations would they recommend?
56
HEALTH PSYCHOLOGY
Anaesthesiologist
______
Cardiologist
______
Neurologist
______
Orthopaedist
______
Oncologist
______
Gastroenterologist
______
Haematologist
______
Otolaryngologist
______
Proctologist
______
Radiologist
Specialty areas:
1. Cancer
2. Blood
3. Nervous system
4. Colon and rectum
5. Painkilling drugs
6. Ear, nose, and throat
7. Bones & joints
8. X-rays
9. Heart
10. Digestive system
57
HEALTH PSYCHOLOGY
RESOURCES
Carpenter, D. (2001). Our overburdened ERs. Hospitals & health networks, 75(3), 44-47.
Clark, E.J., Fritz, J.M., & Rieker, P.P. (1990). Clinical sociological perspectives on illness
and loss: The linkage of theory and practice. Philadelphia: Charles Press.
Costa, P.T., & VandenBos, G.R. (1990). Psychological aspects of serious illness: chronic
conditions, fatal diseases, and clinical care. Washington, DC: American Psychological
Association.
Cotauch, P.H. (1984). Health promotion in hospitals. In Matarazzo, J.D., Weiss, S.M.,
Herd, J.A., Miller, N.E., & Weiss, S.M. (Eds.) Behavioural Health. New York: John Wiley.
Frank, A.W. (1991). At the will of the body: Reflections on illness. Boston: Houghton
Mifflin.
Frank, A.W. (1995). The wounded storyteller: Body, illness, and ethics. Chicago:
University of Chicago Press.
House, A., Mayou, R., & Mallinson, C. (1995). Psychiatric aspects of physical disease.
London: Royal College of Physicians.
Leigh, H., & Reiser, M.F. (1992). The patient: Biological, psychological, and social
dimensions of medical practice. New York: Plenum Medical Book Co.
McCabe, J.B. (2001). Emergency department overcrowding: A national crisis. Academic
Medicine,76(7), 672-674.
Mishra, S.K. (2001). Hospital overcrowding. The Western Journal of Medicine, 174(3),
170.
Snook, I.D. (1992). Hospitals: What they are and how they work. Gaithersburg, MD:
Aspen.
Young-Mason, J. (1997). The patient's voice: Experiences of illness. Philadelphia: Davis.
Suggested Films and Videos:
1. Medicine at the crossroads: The magic bullet. (1993, BBC, 57 min). Looks at
the expectation that medicine can provide "a pill" to solve all health problems.
2. Medicine at the crossroads: Code of silence. (1993, BBC, 57 min). Takes the
viewer into the world of medical training, cross-cultural experiences with
disease, and the patient interface with medical systems.
3. Medicine at the crossroads: Temple of science. (1993, BBC, 57 min). The
world of the teaching hospital is highlighted using Johns Hopkins as an
example. Sophisticated technological successes and production of leading
doctors/scientists are placed in contrast with primary care provision.
4. Patch Adams. (1998, Universal, 115 min). A medical student in the 70's that
treated patients, illegally, using humor
58
HEALTH PSYCHOLOGY
2. Compare and contrast the "good" patient and "problem" patient roles.
Essay Questions
1. Distinguish between the psychological experiences and preparation techniques for
surgical versus non-surgical procedures.
2. Your 8-year-old nephew will be entering the hospital to have his tonsils removed.
Help him through the experience by developing a plan based on information from this
chapter.
59
HEALTH PSYCHOLOGY
PAIN
HEALTH PSYCHOLOGY
PAIN
I. What is Pain?
A. Definitions
B. The qualities and dimensions of pain
1. Organic versus psychogenic pain
2. Acute versus Chronic Pain
3. Acute pain in burn patients
C. Perceiving Pain
1. Pain sense properties
2. The physiology of pain perception
3. Pain without detectable body damage
4. The role of the "meaning" of pain
II. Theories of Pain
A. Early theories of pain
1. Specificity theory
2. Pattern theory
3. Criticisms of theories
B. Inducing pain in laboratory research
1. Common methods for studying pain
a. The cold-pressor procedure
b. The muscle-ischemia procedure
c. Pain research and ethical standards
C. The gate-control theory of pain
III. Biopsychosocial Aspects of Pain
A. Neurochemical transmission and inhibition of pain
1. Effects of stimulation-produced analgesia (SPA)
2. What stimulating the periaqueductal gray area does
3. How opiates and opioids work
4. Placebos and pain
B. Personal and social experiences and pain
1. Learning and pain
2. Social processes and pain
3. Gender, sociocultural factors, and pain.
C. Emotions, coping processes, and pain
1. Cognitive processes mediate the link between emotion and pain.
2. Does emotion affect pain?
3. Coping with pain
IV. Assessing People's Pain
A. Self-report methods
1. Interview methods in assessing pain
2. Pain rating scales and diaries
a. Visual analogue scale
b. Box scale
c. Verbal rating scale
d. Advantages to rating scales
d. Pain diaries
60
PAIN
HEALTH PSYCHOLOGY
3. Pain questionnaires
a. McGill Pain Questionnaire
b. The Multidimensional Pain Inventory
B. Behavioural assessment approaches
C. Psychophysiological measures
1. Electromyograph (EMG)
2. Autonomic (heart rate & skin conductance) activity
3. Electroencephalograph (EEG) recordings
V. Pain in Children
A. Pain and children's sensory and cognitive development
B. Assessing pain in children
1. Self-report provides limited information.
2. Pain questionnaires for children
3. Other methods of assessment
4. Factors that affect children's pain experiences
61
PAIN
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Myths about chronic pain.
Laura Hitchcock, Clinical Psychologist and Director of the National Chronic Pain
Outreach Association, recounts her experience in training and personal experiences with
chronic pain. As an intern, prevalent notions about the characteristics of chronic pain
patients were that they use their pain for secondary gain, play pain games, are addicted to
narcotics or at least prefer mood-altering drugs to reduce pain, are suffering from
personality disorders or are hypochondriacs and exaggerators, have unmet dependency need
or are from a dysfunctional family, are doctor shoppers, or are unwilling to learn to live
with pain. Following her own back injury, her viewpoint on chronic pain changed
substantially. She came to believe that more professional energy is needed in seeking to
reduce the experience of pain rather than the emphasis on reducing the frequency of pain
behaviours. Moreover, she highlighted the role that stigmatization and stereotyping plays
in the chronic pain experience.
Hitchcock proposes that four common
myths/misconceptions form barriers to effective intervention for chronic pain. They include
the belief that:
(1) chronic pain in the presence of no discernable tissue damage is psychogenic. Hitchcock points two observations: what was viewed as psychogenic 10 years ago, has now
been found to be organic with improved technology and some cases of psychogenic pain
have been wrongly diagnosed.
(2) chronic pain is usually an expression of depression. - although appearing less
frequently (and as Sarafino points out), the relationship between chronic pain and
depression appears to more that the former results in the latter. Moreover, she contends that
the stigmatised treatment of chronic pain patients contributes to their depression.
(3) patients receiving disability exaggerate pain for financial gain. - the loss of income
due to chronic pain exceeds the financial gains due disability money. Therefore, the
underlying logic falls apart.
(4) narcotic drugs aren't appropriate for treatment of chronic, non-malignant pain. also as noted by Sarafino, physician concern about addiction is contradicted by data that
shows narcotics taken for pain relief result in little addiction. Hitchcock points to Melzack's
animal research that suggests the biological mechanisms of acute pain differ from those of
chronic pain and that this difference may lay at the heart of the addiction issue.
Why are these myths prevalent? Hitchcock suggests several processes may be at work
here. First, professionals (and others) may be inappropriately applying their own
experiences with pain to those of the chronic pain sufferer. Second, when faced with
uncertainty, as is the case in understanding the causes of many chronic pain cases, a
tendency to blame the victim emerges. Third, because professionals tend to work with a
unique population patients, their general view of patients becomes skewed. Fourth, it is
difficult for physicians to give "authority" to the patients regarding the understanding of
their pain. And finally, the Western culture endorses the concept of maintaining a stiff
upper lip in the face of adversity.
Source:
Hitchcock, L.S. (1998). Myths and misconceptions about chronic pain (pp. 517-523). CRC
Press
62
PAIN
HEALTH PSYCHOLOGY
2. Assessing pain.
Paul Karoly has written a very extensive chapter on the central issues, difficulties,
and methodologies for assessing pain. Describing pain from a multidimensional
approach, he acknowledges the definitional difficulty in this area of health research
and practice. In his chapter, he provides a comprehensive survey of assessment
objectives, including ultimately the self-management of pain adaptation. A good deal
of the chapter is spent on an overview of 10 assessment strategies and procedures
used in a multifaceted treatment approach. One particularly interesting approach
involves the use of an articulated thoughts paradigm in which pain patients listen to
an audiotape of conversations and make comments on how pain influences their
social response. In the conclusion of his writing, Karoly notes that the complex
approach to assessment of pain reflects the inherent complexity of the human
experience of pain (p. 510). This chapter provides a comprehensive and in-depth
discussion of the issues in pain assessment.
Source:
Karoly, P. (1985). The assessment of pain: Concepts and procedures. In P. Karoly (Ed.),
Measurement strategies in health psychology (pp. 461-516). New York: Wiley.
ACTIVITY SUGGESTIONS
1. Pain dimensions. Have the students think about a pain they have experienced
recently. Write down the words used. Identify the words which correspond to the
affective, sensory, and evaluative dimensions measured by the McGill Pain
Questionnaire (Melzak, 1975).
2. A culture of analgesia. Assign the students to do the following exercise the next
time they are in the grocery store. Have them estimate the amount of shelf footage (or
number of products) devoted to pain relief. Compare that with a similar estimate of
other medications not devoted to pain relief. Discuss what this relationship reflects
about our culture (e.g., desire to be independent, mobile).
3. Advertising and pain. Have students keep track of the number of commercials
for pain products or obtain popular magazines and count the advertisements devoted
to pain relievers. Have them bring these advertisements to class to discuss any
culturally-relevant messages they may imply.
4. Placebos. It has been said that one should use new treatments while they are still
effective as a comment on the extra-therapeutic effects of most treatments. Discuss
the usefulness of placebos as a form of therapy and the ethical implications of their
use. Is it ethical to use them if an effective treatment exists? Is it ethical not to
consider placebos if an alternative treatment has side-effects? Does the deception
involved compromise the trust between the physician and patient? Consider the
nature of psychological treatments. How do psychological interventions differ from a
placebo treatment? What then comprises the effectiveness of psychological
treatment?
5. The Gate Control Theory of Pain. To help students conceptualise the Gate
Control Theory of Pain, use examples like acupuncture, natural childbirth techniques,
63
PAIN
HEALTH PSYCHOLOGY
narcotics, transcutaneous stimulation, and audio analgesia, to demonstrate the many
ways in which the gate to consciousness may be closed.
6. Physiotherapy. Invite a physiotherapist to speak to the class regarding physical
pain and its relief. The prevention of and treatment of back pain is an extremely
useful and popular topic.
RESOURCES
Edwards, R.R., Doleys, D.M., Fillingim, R.B., & Lowery, D. (2001). Ethnic
differences in pain tolerance: Clinical implications in a chronic pain population.
Psychosomatic Medicine, 63(2), 316-323.
Farrar, J.T., Portenoy, R.K., Berlin, J.A., Kinman, J.L., & Strom, B.L. (2000).
Defining the clinically important difference in pain outcome measures. Pain, 88(3),
287-294.
Hardcastle, V.G. (1999). The myth of pain [computer file]. Cambridge, MA: MIT
Press.
Horn, S. & Munafo, M. (1997). Pain: Theory, research, and intervention.
Buckingham: Open University Press.
Jensen, M.P., Romano, J.M., Turner, J.A., Good, A.B., & Wald, L.H. (1999). Patient
beliefs predict patient functioning: Further support for a cognitive-behavioural model
of chronic pain. Pain, 81(1-2), 95-104.
Keefe, F.J., Lumley, M., Anderson, T., Lynch, T., & Carson, K.L. (2001). Pain and
emotion: New research directions. Journal of Clinical Psychology, 57(4), 587-607.
Sandkuehler, J. (2000). Learning and memory in pain pathways. Pain, 88(2), 113118.
Sharp, T.J. (2001). Chronic pain: A reformulation of the cognitive-behavioural model.
Behaviour Research & Therapy, 39(7), 787-800.
Wall, P.D. (2000). Pain: The science of suffering. New York: Columbia University
Press.
Wall, P.D., & Jones, M. (1991). Defeating pain: The war against a silent epidemic.
New York: Plenum Press.
Woolf, C.J. (1999). Implications of recent advances in the understanding of pain
pathphysiology for the assessment of pain in patients. Pain, Sup. 6, 141-147.
Internet sites of interest:
9. http://www.halcyon.com/iasp/ - International Association for the Study of Pain
10. http://my.webmd.com/special_event_article/article/3199.144 - Chronic Pain
resource centre
11. http://www.pain-talk.co.uk/ - National pain discussion forum
12. http://www.bath.ac.uk/pain-management/ - Bath pain management service
Short Answer Questions
1. Provide support for the idea that organic and psychogenic pain should be
considered as a continuum.
2. Compare and contrast early theories of pain with the gate-control theory.
64
PAIN
HEALTH PSYCHOLOGY
Essay Questions
1. Using the gate-control theory, devise a plan to minimise pain during your next visit
to the dentist.
2. The text author suggests "all pain experiences involve an interplay of both
physiological and psychological factors." Provide a comprehensive statement that
supports this viewpoint.
65
PAIN MANAGEMENT
I. Clinical Pain
A. Acute clinical pain
B. Chronic clinical pain
II. Medical Treatments for Pain
A. Surgical methods for treating pain
B. Chemical methods for treating pain
III. Behavioural and Cognitive Methods for Treating Pain
A. The operant approach
B. Relaxation and biofeedback
D. Cognitive methods
1. Distraction
2. Imagery
3. Redefinition
5. The value of cognitive strategies in controlling pain
IV. Hypnosis and Insight-Oriented Psychotherapy
A. Hypnosis as a treatment for pain
B. Insight therapy for pain
V. Physical and Stimulation Therapies for Pain
A. Counterirritation
B. Stimulation therapies
1. Transcutaneous electrical nerve stimulation (TENS)
2. Acupuncture
C. Physical therapy
VI. Pain Clinics
A. Multidisciplinary programs
B. Evaluating the success of pain clinics
66
PAIN MANAGEMENT
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. The psychologist and multidisciplinary pain management teams.
For students who may be considering a career as a Clinical or Counselling
Psychologist who specialises in pain treatment, this article provides some much
needed professional perspective. Simon and Folen provide an extensive overview of
important issues for psychologists as part of a multidisciplinary pain team. Among
their tips on developing a working relationship with physicians on the team, they
suggest immersing oneself in the culture of the hospital setting. Write reports with
little psychological jargon and make them direct and to the point. Ones office should
be in the same building as other medical professionals and be decorated in a similar
fashion as theirs. Gain appropriate board certification (the norm in the medical
community) and hold memberships in respected pain societies. Publish in pain
journals as opposed to psychological journals.
Simon and Folen also note that a good deal of the activity of the psychologist in such
a setting is education of other medical professionals regarding issues such as placebos
and assessment of comorbid psychological conditions. These authors also suggest
that treatment for psychological intervention is critical before pain interventions begin
because of the exacerbation of pain symptoms due to depression and anxiety. In
many pain clinics, pain treatment teams are led either by an anaesthesiologist, a
physician, or a psychologist. Thus, the psychologist in this setting has taken on an
increasingly important role.
Source:
Simon, E.P., & Folen, R.A. (2001). The role of the psychologist on the
multidisciplinary pain management team. Professional Psychology: Research &
Practice, 32(2), 125-134.
2. From the perspective of a biofeedback therapist.
Dr. Aleene Friedman is a biofeedback therapist who, in this brief 1 st person article,
describes her treatment experiences with Joyce, a persistent headache sufferer. More
specifically, she describes her use of electromyography (EMG) to help Joyce learn the
source of her upper body tension that resulted in her frequent headaches. Temperature
training, imagery, and other lifestyle changes were incorporated to promote general
relaxation. This is a brief and interesting example of a biofeedback approach that
students would find very readable.
Source:
Friedman, A. (1997). Treating Chronic Pain. (pp. 272-276). In D. N. Sattler & V.
Shabatay (Eds.), Psychology in context: Voices and perspectives. Boston: Houghton
Mifflin.
ACTIVITY SUGGESTIONS
1. Pain control. Contact a local pain management clinic and invite a practitioner to
come to class to talk about various methods of pain control, including hypnosis,
biofeedback, therapeutic touch, cognitive-behavioural techniques.
67
PAIN MANAGEMENT
HEALTH PSYCHOLOGY
RESOURCES
Bates, M.A. (1996). Biocultural dimensions of chronic pain. Albany: SUNY Press.
Burns, J.W. (2000). Repression predicts outcome following multidisciplinary
treatment of chronic pain. Health Psychology, 19(1), 75 -84.
Fishman, S. (2000). The war on pain: How breakthroughs in the new field of pain
medicine are turning the tide against suffering. New York: HarperCollins.
Mercado, A.C., Carroll, L.J., Cassidy, J.D., & Cote, P. (2000). Coping with neck and
low back pain in the general population. Health Psychology, 19(4), 333-336.
Philips, H.C., & Rachman, S. (2001). The psychological management of chronic pain
(2nd ed.). New York: Springer.
Salerno, E., & Willens, J.S. (1996). Pain management handbook: An interdisciplinary
approach. St.Louis: Mosby.
Sinatra, R.S. (Ed.) (1992). Acute pain: Mechanisms and management. St.Louis:
Mosby-Year Book.
Thomas, V.N. (Ed.) (1997). Pain: Its nature and management. London: Balliere
Tindall.
Tumlin, T.R. (2001). Treating chronic pain patients in psychotherapy. Journal of
Clinical Psychology, 57(11), 1277-88.
Wall, P.D., & Jones, M. (1991). Defeating pain. New York: Plenum Press.
Internet sites of interest:
13. http://www.halcyon.com/iasp/ - International Association for the Study of Pain
14. http://my.webmd.com/special_event_article/article/3199.144 - Chronic Pain
resource centre
15. http://www.pain-talk.co.uk/ - National pain discussion forum
16. http://www.bath.ac.uk/pain-management/ - Bath pain management service
Short Answer Questions
1. Compare and contrast acute clinical pain with chronic clinical pain.
2. Compare and contrast behavioural versus cognitive methods for pain treatment.
Essay Questions
1. Discuss three issues pertaining to the use of chemicals for acute pain compared to
the use of chemicals for chronic pain.
2. Your close friend is debating whether to go to a psychologist who uses biofeedback
versus a psychologist who uses hypnosis to treat her chronic back pain. Provide a
convincing set of evidence to inform her choice.
68
PAIN MANAGEMENT
HEALTH PSYCHOLOGY
69
HEALTH PSYCHOLOGY
70
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Psychosocial aspects of chronic illness.
Taylor and Aspinwalls chapter on chronic illness is a comprehensive source for
discussion. These authors review the challenge of chronic illness to contemporary
health care delivery and highlight the psychosocial factors that contribute to the
development, experience, and treatment of chronic illness. Early in the chapter they
discuss the principle psychosocial factors that affect health and illness and then
discuss specific factors, including potential personality variables, that influence Type
A behaviour syndrome, cancer, hypertension, rheumatoid arthritis, and diabetes. They
provide an overview of the use attitude change efforts, cognitive-behavioural
interventions, and relapse intervention. The remainder of the chapter addresses issues
related to the role of anxiety and depression in chronic illness, coping approaches, and
enhancing quality of life.
Source:
Taylor, S.E., & Aspinwall, L.G. (1990). Psychosocial aspects of chronic illness. (pp
3-60). In G.M. Herek, S.M. Levy, S.R. Maddi, S.E. Taylor, & D.L. Wertlieb (Eds.),
Psychological aspects of serious illness: Chronic conditions, fatal diseases, and
clinical care. Washington, DC: American Psychological Association.
2. Psychological approaches to managing chronic illness: The example of
diabetes mellitus.
Shillitoe and Christie provide a very thorough overview of issues in treatment of
diabetes mellitus with a focus on the psychological aspects of the experience with this
disease. After reviewing the various forms of diabetes, these authors provide a
tongue-in-cheek snapshot of a regimen designed to encourage patient non-adherence.
They offer: It should be complicated, so that it cannot easily be comprehended;
flexible, so that its exact requirements cannot be stated clearly; intrusive and difficult
to fit in with the normal routines of family life, work, and social activity. It should be
life-long and require alterations of fundamental behaviours, such as eating.
Deleterious consequences arising from non-adherence should only become apparent
many years later (and then only in a proportion of patients), and should affect some
individuals whose self-care practices were good. Contact with health services should
be sporadic, impersonal, and inconvenient. Such a programme would be difficult to
distinguish from many diabetes regimens (p. 180).
Many aspects of diabetes regimen clearly are affected by psychological influences.
Dietary restrictions, for example, are subject to cultural, religious, and emotional
meanings associated with food and present difficulty when changing eating behaviour
is required. As a child, learning to competently self-inject insulin may be influenced
by stage of cognitive development. Lifestyle activities of exercise, smoking, and
drinking affect the balance of blood glucose levels in an of themselves but are also
influenced by psychological factors.
Source:
Shillitoe, R., & Christie, M. (1990). Psychological approaches to the management of
chronic illness: The example of diabetes mellitus (pp. 177-208). In P. Bennett, J.
Weinman, & P. Spurgeon (Eds.), Current developments in health psychology. New
York: Harwood Academic Publ.
71
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Assess Yourself: Do You Have Diabetes? Have students complete the handout,
which pertains to the symptoms of diabetes.
2. Alzheimer's disease. Students may be interested in attending a local Alzheimer's
support group.
3. Psychosocial aspects of chronic health problems. Adult diabetics and asthmatics
usually have good insights into the demands of their illnesses. Ask one or more of
these individuals to come to class to talk about their illness, their treatment, and the
way they cope with the illness and their treatment regimens.
4. Adjustment. Have the students describe someone they know with a chronic
illness or disability. How does the person cope with their physical limitations? How
would they describe the adjustment the person has made? Do the styles of adjustment
the class reports vary with the nature of the illness, such as its painfulness or physical
limitations? Does the adjustment vary as a function of the social support available?
Can the class give examples of positive and negative social support systems?
72
HEALTH PSYCHOLOGY
If you check three or more of these signs, see your doctorone or two signs alone
may not mean anything is wrong. But the more signs you checked, the greater the
chance that you have diabetes.
73
HEALTH PSYCHOLOGY
RESOURCES
Alberti, K., Zimmet, P., & DeFronzo, R.A. (Eds.). (1997). International textbook of
diabetes mellitus. Chichester, NY: Wiley.
Anderson, B.J., & Rubin, R.R. (1996). Practical psychology for diabetes clinicians.
Alexandria, VA: American Diabetes Association.
Cook, A.R. (1999). Arthritis sourcebook. Detroit, MI: Omnigraphics.
Haire-Joshu, D. (Ed.). (1996). Management of diabetes mellitus: Perspectives of care
across the life span. St. Louis: Mosby-Year Book.
Hoffman, S. B., & Platt, C.A. (2000). Comforting the confused: Strategies for
managing dementia. New York: Springer.
Indian Health Services. (1997). The intimate side of diabetes. Washington, DC:
author.
Kumar, V., & Eisdorfer, C. (1998). Advances in the diagnosis and treatment of
Alzheimers disease. New York: Springer.
Leahy, J.L., Clark, N.G., & Cefalu, W.T. (2000). Medical management of diabetes
mellitus. New York: Dekker.
Lubkin, I.M. (1998). Chronic illness: Impact and intervention. Boston: Jones and
Bartlett.
National Heart, Lung, and Blood Institute. (1997). Facts about controlling your
asthma. Bethesda: author.
National Institute of Neurological Disorders and Stroke. (2000). Seizures and
epilepsy: Hope through research. Bethesda, MD: author.
National Institute of Diabetes and Digestive and Kidney Diseases. (1999). 7
principles for controlling your diabetes for life. Bethesda, MD: author.
Nicassio, P.M., & Smith, T.W. (1995). Managing chronic illness: a biopsychosocial
perspective. Washington, DC: American Psychological Association.
Plaut, T.F. (1995). Children with asthma: A manual for parents. Amherst, MA:
Pedipress.
Schacter, S.C. (1995). The brainstorms companion: Epilepsy in our view. New York:
Raven Press.
Talbot, F., Nouwen, A., Gingras, J., Belanger, A., & Audet, J. (1999). Relations of
diabetes intrusiveness and personal control to symptoms of depression among adults
with diabetes. Health Psychology, 18(5), 537-542.
Taylor, M. P. (2000). Managing epilepsy: A clinical handbook. Oxford: Blackwell
Science.
VandenBos, G.R., & Costa, P.T. (Eds.). (1990). Psychological aspects of serious
illness. Washington, DC: American Psychological Association.
Whitehouse, P.J., Maurer, K., & Ballenger, J.F. (Eds.) (2000). Concepts of Alzheimers
disease: Biological, clinical, and cultural perspectives. Baltimore: Johns Hopkins
University Press.
Wilcock, G.K. (1993). The management of Alzheimers disease. Bristol, PA:
Wrightson.
Wyllie, E. (1997). The treatment of epilepsy: Principles and practice. Baltimore:
Williams & Wilkins.
Internet sites of interest:
1. http://www.diabetes.org.uk/ - The Diabetes charity UK
2. http://www.diabetic.org.uk/ - Diabetic insight for people living with the disease
74
HEALTH PSYCHOLOGY
75
HEALTH PSYCHOLOGY
76
HEALTH PSYCHOLOGY
a. Carcinomas
b. Lymphomas
c. Sarcomas
d. Leukemias
2. Prevalence
C. The sites, effects, and causes of cancer
1. Common cancer sites
2. Prognosis and causes of cancer
3. Age, gender, and sociocultural factors in cancer
D. Diagnosing and treating cancer
1. Knowing warning signs for cancer and having regular examinations
increases early detection.
a. Sites for early detection physician or self-examination
b. Warning signs for cancer
2. Diagnosis
a. Typical medical procedures
3. Treatment
a. Goal of treatment is cure
b. Types of treatment
c. Treatment side effects
d. Demands of treatment
E. The psychosocial impact on cancer
1. Cancer involves a series of threats and unique stresses.
a. Treatment decisions
b. Threat of recurrence
c. Adjusting to treatment
d. Incidents of emotional problems
2. Adjustment depends on patients' physical condition and age.
3. Site of cancer, age, and gender influence adjustment.
4. Psychosocial problems
F. Psychosocial interventions for cancer
G. Childhood cancer
1. Leukaemia is the most common cancer under children.
2. Treatment programs for leukaemia
3. Psychosocial adjustment
V. AIDS
A. Risk factors, effects, and treatment of AIDS
1. Risk factors
2. Age, gender, and sociocultural factors in AIDS
3. From HIV infection to AIDS
4. Medical treatment for people with HIV/AIDS
B. The psychosocial impact of AIDS
C. Psychosocial interventions for AIDS
VI. Adapting to a Terminal Illness
A. The patient's age
B. Psychosocial adjustments to terminal illness
1. How people cope with terminal illness
2. Does adapting to dying happen in "stages"?
77
HEALTH PSYCHOLOGY
78
HEALTH PSYCHOLOGY
DISCUSSION TOPICS
1. Humanizing death .
The topic of death can produce powerful discussion in a Health Psychology course.
Dr. Sandra Levy, a Clinical Psychologist, has written a powerful chapter on the role of
psychologists working with terminally ill patients. She observes that physicians often
rely on a curative orientation to care, even when the course of the disease can no
longer be affected. Experimental techniques may be tried, with possible iatrogenic
outcome and high costs to patient and family alike. At the same time, patients have
often not prepared for their end day. The rise in technological sophistication that
allows for life to be maintained is often in conflict with other needs of the patient, she
says. Cultural countertrends, such as hospice, living wills, and no-code orders, are a
growing acknowledgment of those needs.
Providing for the psychological needs of dying patients and their families requires
considering the relevant psychosocial stressors and needs of patient and family
members alike. Medical staff tend to under-report levels of depression in the
terminally ill. Undiagnosed depression can exacerbate the distress of those already
seriously physically ill. Moreover, disease states influence the neurophysiology and
contribute to depression. In many cancer patients, the hope that had manifested as a
hope for recovery is transformed into other hopes to live to see a certain event or
to die peacefully or transferring hopes to other family members lives. Feelings of
abandonment from friends, family, and even eventually ones physician, must be
confronted. Loss of control and physical loss are linked to acting out and mourning
or depression. Family members move through experiences of anticipatory grief . The
therapeutic approach then works with the dying person as well as the family with a
goal, not of attempting provide therapeutic growth as would be done for other mental
health concerns, but for helping patients and families build on strengths within their
fundamental values. Supportive interventions include enhancing levels of personal
control (environmental factors such as the place to die). Follow-up care with family
members remains a critical function of the psychologist.
Source:
Levy, S.M. (1990). Humanizing death: Psychotherapy with terminally ill patients.
(pp 185-213). In G.M. Herek, S.M. Levy, S.R. Maddi, S.E. Taylor, & D.L. Wertlieb
(Eds.), Psychological aspects of serious illness: Chronic conditions, fatal diseases, and
clinical care. Washington, DC: American Psychological Association.
ACTIVITY SUGGESTIONS
1. The nature of cancer. To help students gain an appreciation that cancer is not one
disease but many, assign each student one type of cancer to research. Have them
write a report about their assigned cancer and make a class presentation on it.
2. Hospice. Contact a hospice for a speaker on dealing with terminal illness and
bereavement.
3. Living with HIV/AIDS. Contact a local AIDS information office for names of
possible speakers who could come to class to talk about living with AIDS.
79
HEALTH PSYCHOLOGY
RESOURCES
Catz, S.L., Kelly, J.A., Bogart, L.M., Benotsch, E.G., & McAuliffe, T.L. (2000).
Patterns, correlates, and barriers to medication adherence among persons prescribed
new treatments for HIV disease. Health Psychology, 19(2), 124-133.
Cordova, M.J., Cunningham, L.L.C., Carlson, C.R., & Andrykowski, M.A. (2001).
Posttraumatic growth following breast cancer: A controlled comparison study. Health
Psychology, 20(3), 176-185.
Corr, C.A., & Balk, D.E. (Eds.) (1996). Handbook of adolescent death and
bereavement. Thousand Oaks, CA: Sage.
Corr, C.A., & Corr, D.M. (Eds.) (1996). Handbook of childhood death and
bereavement. Thousand Oaks, CA: Sage.
Crepaz, N., & Marks, G. (2001). Are negative affective states associated with HIV
sexual risk behaviors? A meta-analytic review. Health Psychology, 20(4), 291-299.
deVries, B. (Ed.) (1999). End of life issues: Interdisciplinary and multidimensional
perspectives. Thousand Oaks, CA: Sage.
Dusseldorp, E., van Elderen, T., Maes, S., Meulman, J., & Kraaij, V. (1999). A metaanalysis of psychoeducational programs for coronary heart disease patients. Health
Psychology, 18(5), 506-519.
Fagerlin, A., Ditto, P.H., Danks, J.H., Houts, R.M., & Smucker, W.D. (2001).
Projection in surrogate decisions about life-sustaining medical treatments. Health
Psychology, 20(3), 166-175.
Fang, C.Y., & Myers, H.F. (2001). The effects of racial stressors and hostility on
cardiovascular reactivity in African American and Caucasian men.
Health
Psychology, 20(1), 64-70.
Helgeson, V.S. (2001). Applicability of cognitive adaptation theory to predicting
adjustment to heart disease after coronary angioplasty. Health Psychology, 18(6),
561-569.
Huber, J.T. (1996). HIV/AIDS community information services: Experiences in
serving both at-risk and HIV-infected populations. New York: Haworth Press.
Kalichman, S.C., & Nachimson, D. (1999). Self-efficacy and disclosure of HIVpositive serostatus to sex partners. Health Psychology, 18(3), 281-287.
Kastenbaum, R. (2000). The psychology of death. Thousand Oaks, CA: Sage.
Mulder, C.L., deVroome, E. M., van Griensven, G.J., Antoni, M.H., & Sandfort, T.G.
(1999). Avoidance as a predictor of the biological course of HIV infection over a 7year period in gay men. Health Psychology, 19(2), 107-113.
National Institute of Neruological and Communicative Disorders and Stroke. (1999).
Stroke: Hope through research. Bethesda, MD: author.
National Institutes of Health. (1996). HIV/AIDS information resources. Bethesda,
MD: author.
Power, M., Bullinger, M., Harper, A., & The World Health Organization Quality of
Life Group. (1999). The World Health Organization WHOQOL-100: Tests of the
universality of quality of life in 15 different cultural groups worldwide. Health
Psychology, 18(5), 495-505.
Vanable, P.A., Ostrow, D.G., McKirnan, D.J., Taywaditep, K.J., & Hope, B.A. (2000).
Impact of combination therapies on HIV risk perceptions and sexual risk among HIVpositive and HIV-negative gay and bisexual men. Health Psychology, 19(2), 134-145.
Internet sites of interest
80
HEALTH PSYCHOLOGY
81
HEALTH PSYCHOLOGY
82
HEALTH PSYCHOLOGY
ACTIVITY SUGGESTIONS
1. Assess Yourself: Some Ethical Dilemmas: What Do You Think? Have students
complete the handout. Notice and discuss what factors led to students' beliefs that the
right or wrong decision had been made. For example, did behavioural choice
influence negative decisions?
2. A career in health psychology. Have students go to the BPS Division of Health
Psychology website and explore the educational and training programs for becoming
a health psychologist (http://www.health-psychology.org.uk/).
3. Attitude and behaviour change. Towards the conclusion of the course, have the
students reflect on their changed attitudes about their health. Have them describe
what attitudes of theirs have changed regarding their role in maintaining health. Have
the attitudes which changed instigate behavioural change? Have any changed health
risk behaviours discussed such as by losing weight, increasing exercise, eating better,
or reducing smoking? Have any behaviours changed? How long do they predict that
any effects might last?
4. Psychologists in medical settings. Arrange to have a psychologist who works in
a medical setting speak to the class. Be sure to have the guest describe their training
and preparation for their position. Was their background in clinical psychology health
psychology or some other field? What is their current role? What is their title? Are
they members of the medical staff? What privileges do they have? Do they provide
services such as testing, counselling to patients, staff education prevention, or
program evaluation?
5. Major approaches in clinical health psychology. Assign several students to each
approach listed below and ask them to research the approach and its applications in
health psychology. Have them prepare a class presentation and lead a class discussion
on their assigned approach to Health Psychology.
Behavioural Approach
Cognitive-Behavioural Approach
Psychophysiological Approach
Clinical Psychology Approach
Community Psychology Approach
Family Therapy Approach
Psychodynamic Approach
Insight-Oriented Approach
Holistic Approach
83
HEALTH PSYCHOLOGY
Assess Yourself
Some ethical dilemmas: What do you think?
Each of the following cases describes a decision involving an ethical dilemma that is
related to health. Circle the Y for "yes" and the N for "no" preceding each case to
indicate whether you agree with the decision.
Y
A 37-year-old executive was told by his boss that he would have to pay
half of the costs of his employer-provided health insurance if he did
not quit smoking and lower his cholesterol.
A year after a boy developed leukaemia, the company that provided his
family's health insurance quadrupled their premium.
84
HEALTH PSYCHOLOGY
RESOURCES
Aboud, F.E. (1998). Health psychology in global perspective. Thousand Oaks: Sage.
Belar, C.D., & Deardorff, W.W. (1995). Clinical health psychology in medical
settings: A practitioner's guidebook. Washington, DC: American Psychological
Association.
Goreczny, A.J. (1995). Handbook of health and rehabilitation psychology. New
York: Plenum Press.
Gordon, J.S. (1996). Manifesto for a new medicine: Your guide to healing
partnerships and the wise use of alternative therapies. Reading, MA: AddisonWesley.
Helman, C. (2000). Culture, health, and illness. Boston: Butterworth-Heinemann.
Kato, P.M., & Mann, T. (1996). Handbook of diversity issues in health psychology.
New York: Plenum Press.
Loustaunau, M.O., & Sobo, E.J. (1997). The cultural context of health, illness, and
medicine. Westport, CN: Bergin & Garvey.
Orlens, C.T. (2000). Promoting the maintenance of health behavior change:
Recommendations for the next generation of research and practice. Health
Psychology, 19(1), 76-83.
Quick, J.C. (1999). Occupation health psychology: Historical roots and future
directions. Health Psychology, 18(1), 82-88.
Resnick, R.J., & Rozensky, R.H. (1996). Health psychology through the lifespan:
Practice and research opportunities. Washington, DC: American Psychological
Association.
Sears, S.R., & Stanton, A.L. (2001). Physician-assisted dying: Review of issues and
roles for health psychologists. Health Psychology, 20(4), 302.
Wing, R.R. (2000). Cross-cutting themes in maintenance of behavior change. Health
Psychology, 19(1), 84-88.
Wolff, S.H., Jonas, S., & Lawrence, R.S. (1996). Health promotion and disease
prevention in clinical practice. Baltimore, MD: William & Wilkins.
Internet sites of interest:
4. http://www.health-psychology.org.uk/ - BPS Division of Health Psychology
5. http://www.bps.org.uk/publications/journals/bjhp/bjhp_home.cfm?&redirectCount=0
British Journal of Health Psychology
6. http://www.mdx.ac.uk/www/jhp/ - Journal of Health Psychology
7. http://www.apa.org/journals/hea.html - Information about Health Psychology
8. http://healthpsych.com - The Health Psychology Library
9. http://www.ehps.net/ - European Health Psychology Society
10. http://www.who.org - World Health Organization
Short Answer Questions
1. Summarise the ways that health psychologists contribute to prevention efforts.
2. Discuss issues that have been addressed and that still need to be addressed to
increase health psychologists' acceptance in medical settings?
85
HEALTH PSYCHOLOGY
Essay Questions
1. Suppose that you are an advisor in a psychology department and have an
advisee who wants to know more about health psychology. What can you tell
this student?
2. As a student in a health psychology course, you may have been contemplating
a career in this discipline. Using information you have gained from the
course, discuss the challenges of career in Health Psychology.
86
HEALTH PSYCHOLOGY
87
HEALTH PSYCHOLOGY
88
HEALTH PSYCHOLOGY
Health
&
www.hse.gov.uk/pubns/stresspk.htm
Safety
Executive
publications
89
HEALTH PSYCHOLOGY
90
HEALTH PSYCHOLOGY
COURSEWORK
The assessment process gives students important opportunities to learn, to check
their learning and to discuss their progress with the tutor. Consequently, students will
be expected to prepare four pieces of coursework for assessment. Two of which will
be written under timed conditions in the classroom. The other two may take a variety
of forms such as essays, case studies, reports and class presentations. These two
pieces of work will each be 1,500 words in length (or the equivalent).
91
COURSEWORK
HEALTH PSYCHOLOGY
Date:
Instructions:
Answer only one question.
Please write legibly and clearly. Answers which cannot be read will not be
marked.
Write your name on each piece of paper submitted. Include all notes and
essay plans you have produced during the allocated period.
Introduction
1. What is health psychology and how might it be applied?
2. Compare and contrast the medical (biomedical) and the biopsychosocial models of
health.
3. How have the causes of mortality changed in the past 100 years?
4. Discuss the factors that have contributed to the increased interest of Health
Psychology and the utilisation of Health Psychologists in the past few decades?
Individual differences / Health behaviour
1. Discuss the difficulties of studying cultural differences or gender differences in
health behaviour. Use specific cultural or gender based examples of health
behaviour.
Health Models
1. (a) Outline one model of health beliefs. (b) Discuss the problems of attempting
to measure a person's health beliefs.
2. What is the Health Belief Model, and what components contribute to the decision
to seek health care? Describe an example of a health decision using the model to
explain each component of health seeking behaviour.
3. What is the Transtheoretical (Stages of Change) Model, and what components
contribute to the decision to seek health care? Describe an example of a health
decision using the model to explain each stage of health seeking behaviour.
Sexual Health
1. Describe the main considerations in designing a HIV health prevention
programme for asylum seekers from sub-Saharan Africa?
Abnormal Psychology
1. Discuss the interaction of life-span development on the development or
either physical illness of mental health difficulties?
2. Normality is the absence of abnormality. Discuss.
3. Why is diagnosing someone as mentally ill a controversial act?
Childhood Development
1. Discuss the importance of pre-natal factors on later development.
2. Define an eating disorder and evaluate the interventions available.
Is ADHD a socially constructed disorder?
92
HEALTH PSYCHOLOGY
Date:
Instructions:
Answer only one question.
Please write legibly and clearly. Answers which cannot be read will not be
marked.
Write your name on each piece of paper submitted. Include all notes and
essay plans you have produced during the allocated period.
Stress and Coping
1.
Discuss and evaluate the impact of the main physiological and psychological
reactions to stress.
2.
Critically evaluate the extent to which individual differences modify the
effects of stressors.
3.
Discuss the main physiological and psychological reactions to stress. Are
there any interactions between them?
4.
Describe some psychological evidence that is relevant to our understanding of
the sources and causes of stress. Evaluate this evidence. Based on the above
evidence, suggest a psychological programme to reduce the stress of
examinations. Give reasons for your answer.
5.
(a) Outline one technique used to manage stress. (b) Evaluate the difficulties
in measuring the effectiveness of stress management programmes.
6.
How can stress causes illness? Discuss both behavioural and physiological
routes.
Health Psychology and Lifespan development
1. Old age promises nothing but decline. Discuss.
Individual differences / Health behaviour
1. Discuss personality as a causal factor in disease and how it might influence the
course and outcome of disease.
2. (a) Outline one cultural or one gender difference in health behaviour. (b) Discuss
the difficulties of studying cultural differences or gender differences in health
behaviour.
3. (a) Describe what psychologists have discovered about lifestyle and health. (b)
Evaluate what psychologists have discovered about lifestyle and health. (c)
Identify one cultural or gender difference affecting the health of a community and
suggest how a community health centre might deal with this. Using your
knowledge of psychology, give reasons for your answer.
Health Psychology Overview
1. How have causes of mortality changed in the past 100 years?
93
HEALTH PSYCHOLOGY
Pain Management
1. (a) Describe what Psychologists have discovered about measuring and managing
pain. (b) Evaluate what Psychologists have discovered about measuring and
managing pain. (c) Some people have a lower threshold for pain than others.
Suggest one way that Psychologists could measure whether individuals have a
higher than average pain threshold.
2. What is pain? Describe one piece of evidence indicating that psychological
processes moderate pain
3. How does the specificity theory or physiological view of pain characterize pain?
What are the problems with this type of view?
4. (a) Describe what Psychologists have discovered about pain. (b) Evaluate what
Psychologists have discovered about pain. (c) Based on Psychological evidence,
suggest one technique to control chronic (acute and chronic) pain in children.
Give reasons for your answer.
5. What do Health Psychologists understand about what affects pain? What
cognitive/attentional methods are used (consider for example, how effective is
biofeedback in controlling pain? How is pain measured?)?
Health Promotion
1. (a) Outline one example of promoting health in either schools or worksites. (b)
Evaluate the ethics of promoting health.
2. (a) Outline methods used by Psychologists in health promotion. (b) Evaluate the
difficulties of trying to promote good health using one specific health problem as
an example.
3. (a) Outline one example of promoting health in either communities or workplace.
(b) Evaluate the effectiveness of promoting health in communities or workplace.
Adherence
1.
(a) Outline psychological evidence on why people do not always adhere to
medical advice. (b) Evaluate the problems of investigating medical adherence.
Substance Abuse
1. (a) Outline psychological evidence that relates to the use and abuse of one
substance. (b) Evaluate evidence on the use and abuse of one substance. (c)
Suggest one technique to minimise the harm of using this substance. Give
reasons for your answer.
2. (a) Outline one technique that has been used to help people stop substance abuse.
(b) Discuss why the techniques use to help people stop substance abuse are not
very successful.
3. Why do people continue to smoke even when they know about the health risks?
Do smoking cessation programmes work?
4. Social views of addiction have changed over the years. Contrast the disease view
with the more recent Social Learning Theory view.
Chronic Disease
1. Does the Type A behaviour pattern predict coronary heart disease? Are there better
psycho-social predictors of coronary heart disease?
2. What evidence is there that psychosocial factors like social support and
personality are related to cancer incidence and mortality? What is the cancerprone personality?
94
HEALTH PSYCHOLOGY
UPDATES
We hope this resource continues to evolve with the shared input from users. Please
feel free to forward any resources, classroom demonstration, literature of video
suggestion, or any other information that you would like to share with other sessional
lecturers in Health Psychology.
Please email Howard Fine at
howard.fine@bartsandthelondon.nhs.uk
95
UPDATES
HEALTH PSYCHOLOGY