Health Psychology

Health Psychology
Week 1 – Class 2
Muhammad Behroz Khan
Lecturer Psychology
Ministry of Higher Education
Government of Khyber Pakhtunkhwa
The Rise of The Biopsychosocial Model
• The biomedical viewpoint began to change with the rise of modern
psychology, particularly with Sigmund Freud’s (1856–1939) early work on
conversion hysteria.
• According to Freud, specific unconscious conflicts can produce physical

disturbances that symbolize repressed psychological conflicts.
• Although this viewpoint is no longer central to health psychology, it gave

rise to the field of psychosomatic medicine.
Psychosomatic Medicine
• The idea that specific illnesses are produced by people’s internal conflicts
was perpetuated in the work of Flanders Dunbar in the 1930s (Dunbar,
1943) and Franz Alexander in the 1940s (Alexander, 1950).
• For example, Alexander developed a profile of the ulcer-prone personality

as someone with excessive needs for dependency and love.
• Dunbar and Alexander maintained that conflicts produce anxiety, which
becomes unconscious and takes a physiological toll on the body via the
autonomic nervous system.
• The continuous physiological changes eventually produce an organic

disturbance. In the case of the ulcer patient, for example, repressed
emotions resulting from frustrated dependency and love-seeking needs
were thought to increase the secretion of acid in the stomach, eventually
eroding the stomach lining and producing ulcers (Alexander, 1950).
• Dunbar’s and Alexander’s work helped shape the emerging field of

psychosomatic medicine by offering profiles of particular disorders
believed to be psychosomatic in origin, that is, caused by emotional
conflicts.
• These disorders include ulcers, hyperthyroidism, rheumatoid arthritis,

essential hypertension, neurodermatitis (a skin disorder), colitis, and
bronchial asthma.
• We now know that all illnesses raise psychological issues. Moreover,
researchers now believe that a particular conflict or personality type is not
sufficient to produce illness.
• Rather, the onset of disease is usually due to several factors working

together, which may include a biological pathogen (such as a viral or
bacterial infection) coupled with social and psychological factors, such as
high stress, low social support, and low socioeconomic status.
• The idea that the mind and the body together determine health and
illness logically implies a model for studying these issues. This model is
called the biopsychosocial model.
• Its fundamental assumption is that health and illness are consequences

of the interplay of biological, psychological, and social factors.
Advantages of the Biopsychosocial Model

• How does the biopsychosocial model of health and illness overcome the
disadvantages of the biomedical model?
• The biopsychosocial model maintains that biological, psychological, and
social factors are all important determinants of health and illness.
• Both macro-level processes (such as the existence of social support or the

presence of depression) and micro-level processes (such as cellular
disorders or chemical imbalances) continually interact to influence health
and illness and their course.
• The biopsychosocial model emphasizes both health and illness. From this
viewpoint, health becomes something that one achieves through
attention to biological, psychological, and social needs, rather than
something that is taken for granted.
Clinical Implications of the Biopsychosocial Model

• The biopsychosocial model is useful for people treating patients as well.
First, the process of diagnosis can benefit from understanding the
interacting role of biological, psychological, and social factors in assessing
a person’s health or illness. Recommendations for treatment can focus on
all three sets of factors.
• The biopsychosocial model makes explicit the significance of the relationship
between patient and practitioner.
• An effective patient-practitioner relationship can improve a patient’s use of

services, the efficacy of treatment, and the rapidity with which illness is
resolved.
The Need For Health Psychology

• What factors led to the development of health psychology? Since the inception
of the field of psychology in the early 20th century, psychologists have made
important contributions to health, exploring how and why some people get ill
and others do not, how people adjust to their health conditions, and what
factors lead people to practice health behaviors.
• In response to these trends, the American Psychological Association (APA)

created a task force in 1973 to focus on psychology’s potential role in health
research.
• Participants included counseling, clinical, and rehabilitation psychologists, many

of whom were already employed in health settings.
• Independently, social psychologists, developmental psychologists, and
community/ environmental psychologists were developing conceptual approaches
for exploring health issues.
• These two groups joined forces, and in 1978, the Division of Health Psychology
was formed within the APA.
• It is safe to say that health psychology is one of the most important developments
within the field of psychology in the past 50 years. What other factors have fueled
the growing field of health psychology?
Changing Patterns of Illness

• An important factor influencing the rise of health psychology has been the change
in illness patterns in the United States and other technologically advanced
societies in recent decades.
• As Table 1.2 shows, until the 20th century, the major causes of illness and death in
the United States were acute disorders.
• Acute disorders are short-term illnesses, often result of a viral or bacterial invader
and usually amenable to cure.
• The prevalence of acute infectious disorders, such as tuberculosis, influenza,
measles, and poliomyelitis, has declined because of treatment innovations
and changes in public health standards, such as improvements in waste
control and sewage.
• Now, chronic illnesses—especially heart disease, cancer, and respiratory

diseases—are the main contributors to disability and death, particularly in
industrialized countries.
• Chronic illnesses are slowly developing diseases with which people live for
many years and that typically cannot be cured but rather are managed by
patient and health care providers.
• Why have chronic illnesses helped spawn the field of health psychology? First,
these are diseases in which psychological and social factors are implicated as
causes.
• For example, personal health habits, such as diet and smoking, contribute to
the development of heart disease and cancer, and sexual activity is critical to
the likelihood of developing AIDS (acquired immune deficiency syndrome).
• Second, because people may live with chronic diseases for many years,
psychological issues arise in their management. Health psychologists help
chronically ill people adjust psychologically and socially to their changing
health state and treatment regimens, many of which involve self-care.
• Chronic illnesses affect family functioning, including relationships with a

partner or children, and health psychologists help ease the problems in
family functioning that may result.
• Chronic illnesses may require medication use and self-monitoring of

symptoms, as well as changes in behavior, such as altering diet and getting
exercise. Health psychologists develop interventions to help people learn
these regimens and promote adherence to them.
Advances in Technology and Research

• New medical technologies and scientific advances create issues that can
be addressed by health psychologists. Just in the past few years, genes
have been uncovered that contribute to many diseases including breast
cancer.
• How do we help a college student whose mother has just been diagnosed
with breast cancer come to terms with her risk? If she tests positive for a
breast cancer gene, how will this change her life? Health psychologists help
answer such questions.
• Certain treatments that prolong life may severely compromise quality of life.
Increasingly, patients are asked their preferences regarding life-sustaining
measures, and they may require counseling in these matters. These are just a
few examples of how health psychologists respond to scientific developments.
Expanded Health Care Services

• Other factors contributing to the rise of health psychology involve the
expansion of health care services. Health care is the largest service industry in
the United States, and it is still growing rapidly. Americans spend more than $3
trillion annually on health care (National Health Expenditures, 2014).
• In recent years, the health care industry has come under increasing scrutiny,
as substantial increases in health care costs have not brought improvement in
basic indicators of health.
• Moreover, huge disparities exist in the United States such that some
individuals enjoy the very best health care available in the world while
others receive little health care except in emergencies.
• Prior to the Affordable Care Act (known as Obamacare), 49.9 million

Americans had no health insurance at all (U.S. Census Bureau, 2011). Efforts
to reform the health care system to provide all Americans with a basic
health care package, similar to what already exists in most European
countries, have resulted.
• Health psychology represents an important perspective on these issues for

several reasons:
 Because containing health care costs is so important, health psychology’s main

emphasis on prevention—namely, modifying people’s risky health behaviors
before they become ill—can reduce the dollars devoted to the management of
illness.
 Health psychologists know what makes people satisfied or dissatisfied with their
health care and can help in the design of a user-friendly health care system.
• For all these reasons, then, health care delivery has a substantial social
and psychological impact on people, an impact that is addressed by health
psychologists.
Increased Medical Acceptance

• Another reason for the development of health psychology is the
increasing acceptance of health psychologists within the medical
community.
• Health psychologists have developed a variety of short-term behavioral

interventions to address health-related problems, including managing
pain, modifying bad health habits such as smoking, and controlling the
side effects of treatments.
• Techniques that may take a few hours to teach can produce years of
benefit. Such interventions target risk factors such as diet or smoking,
have contributed to the decline in the incidence of some diseases,
especially coronary heart disease.
• To take another example, psychologists learned many years ago that
informing patients fully about the procedures and sensations involved in
unpleasant medical procedures such as surgery improves their
adjustment.
• As a consequence of these studies, many hospitals and other treatment

centers now routinely prepare patients for such procedures.
• Ultimately, if a health-related discipline is to flourish, it must demonstrate

a strong track record, not only as a research field but as a basis for
interventions as well. Health psychology is well on its way to fulfilling both
tasks.

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• According to Freud, specific unconscious conflicts can produce physical

• Although this viewpoint is no longer central to health psychology, it gave

• For example, Alexander developed a profile of the ulcer-prone personality

• The continuous physiological changes eventually produce an organic

• Dunbar’s and Alexander’s work helped shape the emerging field of

• These disorders include ulcers, hyperthyroidism, rheumatoid arthritis,

• Rather, the onset of disease is usually due to several factors working

• Its fundamental assumption is that health and illness are consequences

Advantages of the Biopsychosocial Model

• Both macro-level processes (such as the existence of social support or the

Clinical Implications of the Biopsychosocial Model

• An effective patient-practitioner relationship can improve a patient’s use of

The Need For Health Psychology

• In response to these trends, the American Psychological Association (APA)

• Participants included counseling, clinical, and rehabilitation psychologists, many

Changing Patterns of Illness

• Now, chronic illnesses—especially heart disease, cancer, and respiratory

• Chronic illnesses affect family functioning, including relationships with a

• Chronic illnesses may require medication use and self-monitoring of

Advances in Technology and Research

Expanded Health Care Services

• Prior to the Affordable Care Act (known as Obamacare), 49.9 million

• Health psychology represents an important perspective on these issues for

 Because containing health care costs is so important, health psychology’s main

Increased Medical Acceptance

• Health psychologists have developed a variety of short-term behavioral

• As a consequence of these studies, many hospitals and other treatment

• Ultimately, if a health-related discipline is to flourish, it must demonstrate

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