Introducing Health Psychology Lecture Outline I. The Changing Field of Health

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CHAPTER 1


Introducing Health Psychology
Lecture Outline
I. The Changing Field of Health

During the 20th century, changes in the field of health were accompanied by changing patterns of disease. In 1900, most diseases were short-duration, infectious diseases, but by the end of the century, behavior and lifestyle were the underlying causes of most diseases. These changes have influenced the cost of medical care and even the definition of health, which point to the possibility that a biopsychosocial approach may provide a better model than the biomedical model.



A. Patterns of Disease and Death

In recent years chronic diseases have become the leading causes of death in the United States and many other countries around the world, especially industrialized ones. In 1900, three of the leading causes of death were pneumonia, influenza, and tuberculosis, while in 2009 three of the leading causes of death were heart disease, cancer, and stroke. These three causes of death account for about 60% of deaths in the United States. These causes of death have declined in recent years. Unintentional injuries and other diseases that primarily affect young and middle-aged people have increased in recent years. Diseases that affect older people, such as Alzheimer's disease and Parkinson’s disease, are increasing as the U.S. population ages.



1. Age

Age is an important factor in mortality. Cardiovascular disease and cancer account for a large percentage of death in the US, but they are not the leading cause of death for younger adults. For younger adults, the leading cause of death is unintentional injuries, and violent deaths, such as suicide or homicide.


2. Ethnicity, Income, and Disease

The United States ranks 24th among industrialized nations in life expectancy, indicating that many countries are healthier. In addition, ethnicity is a factor in life expectancy, but economic status and educational level are both related to ethnic background. African Americans have higher rates of health problems than European Americans. Hispanic Americans also experience poverty, low educational levels, and negative effects to health.


3. Changes in Life Expectancy

Life expectancy has grown from 47.3 years in 1900 to over 77 years today. Behavior has also been a factor in the decline in deaths due to cardiovascular disease, but the major gains in life expectancy during the 20th century were due to decreases in infant mortality. Prevention of disease—such as vaccinations and safer drinking water--is also a contributor to the increase in life expectancy.



B. Escalating Cost of Medical Care

In the United States, costs of medical care have escalated far beyond the inflation rate. Between 1975 and 2005, medical costs rose over 600%, and during the early years of the 21st century, over 15% of the gross domestic product was spent for health care. This escalating cost has led some people to question the cost effectiveness of cures and to emphasize the role of prevention as a way to contain medical costs.


C. What is Health?

The traditional view of health is the absence of disease, a definition that follows the biomedical model of diseases produced by pathogens. The biopsychosocial model offers an alternative view, adding psychological and social factors to biological factors. Theorists who advocate this model study the interactions among biological, psychological, and social factors in health and disease. This definition allows a definition of health as the attainment of a positive state, and not merely the absence of disease.

The definition of health as attainment of a positive state of wellness is compatible with the World Health Organization’s definition and also with the view proposed by positive psychology. This movement within psychology includes health issues, such as the influence of optimism on health and health-related behaviors.

II. Psychology's Relevance for Health

Health psychologists concentrate on the behavioral and lifestyle components in the development of chronic diseases, but they also attempt to help people cope with stress, pain, and chronic disease.



A. The Contribution of Psychosomatic Medicine

Psychosomatic medicine is based on the premise that physical illness has its roots in psychological and emotional conflicts. This view emphasized the connection between emotion and disease, which is a positive contribution, but the negative aspect of psychosomatic medicine was the belief that disease has no real basis and is “all in the person’s head.”



B. The Emergence of Behavioral Medicine

The development of behavioral medicine altered psychology’s role in medicine by concentrating on behavioral rather than mental factors in health and illness. Behavioral medicine is an interdisciplinary field that attempts to integrate behavioral and biomedical knowledge and techniques and to apply this knowledge to prevention, diagnosis, treatment, and rehabilitation.



C. The Emergence of Health Psychology

Health psychology is a field of psychology dealing with the scientific study of behaviors that relate to health enhancement, disease prevention, and rehabilitation. This relatively new discipline developed as a result of an APA taskforce that found a scarcity of health-related research by psychologists. In 1976, psychologists interested in and working in health-related settings formed Division 38 (Health Psychology) of the American Psychological Association.

III. The Profession of Health Psychology

Psychologists in general and health psychologists in particular have the training to contribute to the nation's good health. It has founded its own national and international associations, established a number of its own journals, gained recognition in other fields of health care, established graduate training programs, and has received recognition from the American Board of Professional Psychology and other professional groups. In addition, its historical involvement in changing human behavior places it in a position to help people eliminate unhealthy practices as well as to incorporate healthy behaviors into an ongoing lifestyle.


A. The Training of Health Psychologists

Health psychologists receive a solid core of generic training at the doctoral level in the basic areas of psychology plus training in biological and medical specialty areas that prepares them to work as part of interdisciplinary teams and possibly to become primary health care providers.



B. The Work of Health Psychologists

Health psychologists have jobs that are similar to those of other psychologists—they teach, provide assessments, conduct research, and provide services. Those who are employed by a university typically teach and do research, and those who work in a clinical setting are usually involved in assessment, diagnosis, and therapy. Health psychologists may also be employed in medical schools where their duties include working with other health care professionals in providing services for people with physical disorders or in clinics, HMOS, or private practice providing services such as pain management, smoking cessation, stress management, or other such applications.


Exploring Health on the Web
The Internet is a source for health information on all levels, from press releases to technical research. Problems arise in selecting valid information from the many sources available. Exploring Health on the Web offers information on selected Internet sites that provide credible health information.

http://healthfinder.gov

One of the main websites for obtaining health-related information and for finding links to other sites is healthfinder®. The U.S. Department of Health and Human Services maintains this gateway website, and it is an excellent place to access information and to link to other sites devoted to health information. This website is oriented toward consumers and includes a homepage with a variety of choices that will help patients use the Internet to obtain information and to find links to other sites. The site also provides options that allow users to gain access to the technical health information collected by various government agencies.

http://www.nlm.nih.gov/medlineplus

MedlinePlus is a website that makes information available from the National Library of Medicine. It includes information from the National Institutes of Health and other government sources as well as information on hospitals and physicians, prescription and nonprescription drugs, and a great deal more. MedlinePlus can be a basic resource for obtaining health information because this website contains no advertising, is screened for quality of information, and is updated daily.

One feature on MedlinePlus is “A Guide to Healthy Web Surfing” (accessible at http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html ), which presents a series of warnings to those who seek health information on the Internet. The Internet offers a vast amount of information but little screening for quality or truth. The information in this website can help students think critically about material they get from the Net.
http://www.health-psych.org/

This website is home for APA’s Division 38 and contains a section entitled “What is a

Health Psychologist?” and “Frequently Asked Questions about Training in Health Psychology.” This site can be a good resource for students who are interested in training and career opportunities in the field of health psychology.
http://www.sbm.org/

This website is the home for The Society of Behavioral Medicine. The Society for Behavioral Medicine is an organization of researchers and practitioners concerned with the development, evaluation, and integration of behavioral, psychosocial, and biomedical science techniques relevant to prevention, diagnosis, treatment, and rehabilitation of a variety of health conditions.

http://www.cbsnews.com/health/

Many media outlets such as CBS News provide video clips and articles related to new developments in health research. The Health section of the CBS News website posts timely general-interest health news and may be a useful resource for current, popular health information and news. Many clips may provide useful introductions to the health issues discussed in the textbook.

Suggested Activities
Personal Health Profile I — Personal Definition of Health

As a course project, you may choose to have your student complete a Personal Health Profile in which they examine their personal health-related behaviors, review the literature concerning these different behaviors, and write an analysis of things they are doing right and things they could change to improve their health and lower their risks for disease. This activity is designed to begin in this chapter and continue for the duration of the course.

For Chapter 1, students should examine their personal definitions of health as a beginning for their Personal Health Profile. One way to examine personal definitions of health is through completion of the Multidimensional Health Locus of Control Scale (link below).

Link: http://www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm

Citation: Wallston, K. A., Strudler Wallston, B., & DeVellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales. Health Education & Behavior, 6(1), 160-170.

International Mortality Rates

Chapter 1 presents the causes of death in the United States for the years 1900 and 2012. During those years the causes of death in the U.S. have shifted from predominantly infectious diseases to mostly chronic diseases. However, this trend has not occurred in all countries.

Ask your class to research the leading causes of death in other countries. One source for life expectancy information is the CIA World Factbook, which is published yearly. They can access this information by going to https://www.cia.gov/library/publications/the-world-factbook . This website allows a download of the current Factbook or a search of the database. Examining the information will allow your students to build a picture of patterns of illness and death in countries around the world. After identifying these causes of death, discuss whether they are due to illness or violence and whether the illnesses are acute or chronic.

The leading causes of death for some countries more closely match the United States in 1900 than those for 2012. Some countries have a similar pattern of causes of death but a lower death rate than the United States. Discuss both types of differences and the economic and social factors that contribute to each country’s leading causes of death.


Personal Beliefs about the Nature of Illness

Explore people’s conceptualization of illness by allowing your students to interview people about their last illness. The interviewer should ask the person to explain the illness, why he or she got sick, and what helped the person to get well.

Class members can examine the explanations for biological, psychological, and social attributions for illness. These attributions may also appear in the explanations for getting well. Do these people’s explanations of their illness reflect a biopsychosocial model of illness?
Interview a Health Psychologist

To better understand the work of health psychologists, your students can interview a health psychologist. (To avoid burdening health psychologists, this activity might be best as a group assignment. Divide your class into groups, each preparing a set of questions for the psychologists.) Attempt to locate some health psychologists who work in academic settings and some who provide assessment, diagnosis, and therapy services.

The health psychologists may be interviewed by students, participate in a panel discussion, or even provide their answers over the Internet. After students have gathered the information, they should participate in a discussion to examine how the information matches and diverges from their conceptions of what health psychologists do.
Health Psychology in All Fields

Many students of health psychology are not psychology majors, but rather nursing or public health majors. The last two sections of Chapter 1 discuss psychology’s relevance in health fields and it may be useful for students to hear how the principles and theories they will learn this semester can be applicable in their chosen field.


Reading Current Research

http://psycnet.apa.org/journals/psp/83/2/261/ - This study finds that older individuals with more positive self-perceptions of aging lived 7.5 years longer than those with less positive self-perceptions of aging, even after controlling for age, gender, SES, loneliness, and functional health status. This article provides a nice introduction to the biopsychosocial model, as well as good fodder for a discussion of why these findings might appear. Why would a person’s beliefs about aging influence their longevity? Discussion may lead to factors such as health behaviors, the social environment, socioeconomic factors, as well as how people cope with stress.

Citation: Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2), 261-270.

Defining Health

In Chapter 1, students will learn that college is good for their health (“Would You Believe…?”) but students likely will come into this course will differing perceptions of what “health” means. Table 1.2 in the textbook lists definitions of health. Asking students to define health before they read the chapter may provide useful information for you (and your students) as you progress through the course. For example, asking students a wide range of questions about their health before you begin the course may provide you with some data and current health behavior of your students: What is health? What behaviors should one engage in to be healthy? Are you engaging in these behaviors? Why or why not?


Video Recommendations
From Films for the Humanities & Sciences:
Promoting Healthy Behavior (1998) introduces the complexities of the concepts of health and wellness and shows how people can become more actively involved in their health.
Achieving Psychosocial Health (1998) is a 29-minute program that highlights the role of psychological and social factors in achieving comprehensive health.

Videos from the Web:

Chapter 1 introduces the topic of socioeconomic disparities in health. Several excellent and short video clips are available that document these disparities. One of these clips is “Becoming American: Wealth Equals Health” (http://youtu.be/NqzsMW8B0u4), a short video (1:41) that briefly examines the impact of wealth on health in America and how often immigrant families struggle with discrimination and poverty which impacts their health. Another is “Poverty, Stress, and Diabetes Among Native Americans (http://youtu.be/_3CJKtC8aCc), a short video (3:21) that is part of a larger documentary called Unnatural Causes (http://www.unnaturalcauses.org/) that examines how inequalities can have physiological consequences.



Chapter 1 also introduces the biopsychosocial model. Two video clips examine this model. The first clip, entitled “Holistic Medicine and the Biopsychosocial Approach” (http://www.learner.org/series/discoveringpsychology/23/e23expand.html) is narrated by Dr. Phil Zimbardo of Stanford University and examines how psychological factors impact physical health. Another short clip (http://www.youtube.com/watch?v=OsBtjW61Vyw) showcases Sheldon Cohen’s work on stress and colds (see “Would you Believe..?” box in Chapter 1). The text also revisits these ideas again in Chapters 5 & 6, and students may enjoy reading a popular press article summarizing Cohen’s work: http://www.bbc.com/future/story/20120619-how-stress-could-cause-illness/1



Multiple Choice Questions



  1. People’s beliefs about health and illness may be incorrect. Which of these common beliefs is true?

    1. The United States ranks in the top five nations in the world in terms of life expectancy.

    2. The 30-year increase in life expectancy that occurred in the United States during the 20th century was due mostly to improved medical care.

    3. Good health is the absence of disease.

    4. None of these is true.

ANS: d REF: The Changing Field of Health


  1. A century ago, life expectancy in the US was ______ years and currently life expectancy in the US is ______ years.

    1. 20; 60
    2. 30; 70


    3. 50; 80

    4. 50; 70

ANS: d REF: The Changing Field of Health



  1. Chronic diseases

    1. develop and persist over a period of time.

    2. are due to infectious agents such as bacteria or viruses.

    3. are not as common today as during the 19th century.

    4. include influenza and pneumonia.

ANS: a REF: The Changing Field of Health


  1. _________ diseases are a class of diseases that consist of heart disease, cancer, and stroke.

    1. Infectious

    2. Chronic

    3. Unintentional

    4. Cardiovascular

ANS: b REF: The Changing Field of Health


  1. In 1900, most deaths in the United States were caused by ____, whereas today most are due to ____.

    1. pneumonia. . . cancer

    2. chronic diseases. . . cancer

    3. infectious diseases. . . chronic diseases

    4. cancer. . . alcohol-related causes

ANS: c REF: The Changing Field of Health


  1. During the last few years of the 20th century, chronic diseases in the United States

    1. began to rise more rapidly than during the previous 50 years.

    2. began to decrease while deaths not due to lifestyles began to increase.

    3. began to increase while deaths not due to lifestyles began to decrease.

    4. were replaced by acute diseases as the leading cause of death.

ANS: b REF: The Changing Field of Health



  1. The leading cause of death in the United States

    1. is due to acute, infectious disease.

    2. is due to risky sexual behaviors.

    3. has shifted from cardiovascular disease to cancer.

    4. has shifted from acute to chronic diseases.

ANS: d REF: The Changing Field of Health


  1. In the United States during the early years of the 21st century,

    1. deaths from Alzheimer’s and Parkinson’s diseases increased.

    2. deaths from accidents increased significantly.

    3. deaths from heart disease increased significantly.

    4. deaths only moderately related to lifestyle decreased significantly.

ANS: a REF: The Changing Field of Health


  1. In the United States, young people have a low mortality rate; those who die are most likely to die from

    1. cancer.

    2. unintentional injuries.

    3. homicide.

    4. HIV infection.

ANS: b REF: The Changing Field of Health


  1. Cardiovascular disease and cancer account for about _____ of all deaths in the US.

    1. 40%

    2. 50%

    3. 60%

    4. 70%

ANS: c REF: The Changing Field of Health


  1. All of the following are factors in life expectancy EXCEPT:

    1. age

    2. education

    3. ethnicity

    4. mother’s personality

ANS: d REF: The Changing Field of Health

  1. In the United States, young people ages 15 to 24 are most likely to die from _______ and _______.


    1. cancer. . . . heart disease

    2. unintentional injuries . . . . homicide

    3. homicide . . . . cancer

    4. suicide . . . . HIV infection

ANS: b REF: The Changing Field of Health


  1. In the United States, the three leading causes of death for adults ages 35 to 44 are

    1. unintentional injuries, cancer, and heart disease.

    2. suicide, homicide, and HIV infection.

    3. HIV infection, heart disease, and pneumonia.

    4. cancer, HIV infection, and pneumonia.

ANS: a REF: The Changing Field of Health; Fig. 1.2

  1. Cancer is the leading cause of death in which of the following ethnic groups?

    1. European Americans

    2. Hispanic Americans

    3. African Americans

    4. Asian Americans

ANS: d REF: The Changing Field of Health


  1. What two factors can help explain some of the ethnic differences in health and life expectancy?

    1. Poverty and age

    2. Poverty and low education level

    3. Low education level and age

    4. Low education level and drug use

ANS: b REF: The Changing Field of Health


  1. People who graduate from college show the following positive outcomes EXCEPT

    1. higher average incomes.

    2. more likely to exercise.

    3. better access to health care.

    4. more likely to eat a high-fat diet.

ANS: d REF: The Changing Field of Health

  1. The single most important contributor to an increase in life expectancy is


    1. the decrease in the infant mortality rate.

    2. the increase in individuals’ beliefs in the importance of exercise.

    3. advancement in medical technology.

    4. advancement in medical care.

ANS: a REF: The Changing Field of Health


  1. Rhona is a 32-year-old African American college professor. Gena is a 32-year-old Hispanic American engineer. Leah is a 32-year-old European American who has been unemployed for most of the past 10 years and living below the poverty level. Helen is a 32-year-old Asian American dentist. The woman most at risk for poor health is

    1. Rhona.

    2. Gena.

    3. Leah

    4. Helen.

ANS: c REF: The Changing Field of Health


  1. In the United States, people living below the poverty level generally

    1. have low educational levels.

    2. are more likely than other people to have health insurance.

    3. are members of ethnic minority groups.

    4. both a and c are correct.

ANS: d REF: The Changing Field of Health



  1. The increase in life expectancy since 1900 is due mostly to

    1. the decrease in cancer deaths.

    2. the conquest of influenza.

    3. major changes in lifestyle.

    4. none of these.

ANS: d REF: The Changing Field of Health


  1. Sheldon Cohen’s research on the common cold showcase that the ________ approach to understanding sickness and infection is inadequate.

    1. biopsychosocial

    2. biomedical

    3. the psychological

    4. biochemical

ANS: b REF: It Takes More Than A Virus to Give You A Cold



  1. In Sheldon Cohen’s research on the common cold, all participants received a cold virus injection and after a week,

    1. all participants showed signs of having a cold.

    2. only participants who were sick to begin with got a cold.

    3. only health participants got a cold.

    4. only participants who had dealt with a stressful experience got a cold.

ANS: b REF: It Takes More Than A Virus to Give You A Cold


  1. An inverse relationship exists between educational level and death rates, which means that

    1. people who graduate from high school have higher death rates than those who do not.

    2. people who attend college have higher death rates than those who drop out of high school.

    3. people who attend college live longer than those who have never attended college.

    4. both a and b

ANS: c REF: The Changing Field of Health


  1. College graduates generally live longer than people who drop out of high school. Which of these conditions is most likely to explain these differences?

    1. College graduates are more likely to smoke cigars.

    2. High school dropouts are more likely to seek health care.

    3. High school dropouts are less likely to use illicit drugs.

    4. College graduates are less likely to smoke cigarettes.

ANS: d REF: The Changing Field of Health


  1. Which of these has been a major health trend in the U.S. since 1900?

    1. Cost of medical care has risen faster than inflation.

    2. Health has been more frequently defined as the absence of illness.
    3. Acute illnesses have replaced chronic diseases as the leading causes of death.


    4. The biomedical model has been accepted by most psychologists.

ANS: a REF: The Changing Field of Health


  1. During the past 30 years, death rate from heart disease in the United States has declined. At the same time,

    1. medical costs have increased.

    2. smoking rates have increased.

    3. life expectancy has decreased.

    4. acceptance of the biomedical model has increased.

ANS: a REF: The Changing Field of Health


  1. Which of the following has been the LEAST significant contributor to escalating medical costs?

    1. increases in population

    2. the aging of the population

    3. more sophisticated medical technology

    4. increases in the number of complex surgical procedures

ANS: a REF: The Changing Field of Health


  1. The biomedical model of disease

    1. was common during the 1800s but was replaced by the biopsychosocial model during the early 1900s.

    2. views pathogens as the causes of disease.

    3. is more common among the public than among health care professionals.

    4. cannot explain infectious illness or the prevalence of viral illness.

ANS: b REF: The Changing Field of Health



  1. Many medical advances during the 19th century were prompted by the biomedical model that

    1. emphasized emotional rather than physical factors in diseases.

    2. replaced the Cartesian model.

    3. led to a search for microscopic organisms that cause disease.

    4. took a holistic view of health and disease.

ANS: c REF: The Changing Field of Health


  1. Cade attributes catching a "cold" to not getting enough sleep and feelings of distress. Thus, Cade has an implicit acceptance of the ____ model of health.

    1. biochemical

    2. biomedical

    3. Cartesian

    4. biopsychosocial

ANS: d REF: The Changing Field of Health


  1. Health psychologists are most likely to see health

    1. from a biomedical viewpoint.

    2. from a biopsychosocial viewpoint.

    3. as the absence of illness.

    4. as a single dimensional condition.

ANS: b REF: The Changing Field of Health



  1. Before 1950, psychologists were involved with physical health primarily in the area of

    1. changing lifestyles.

    2. changing attitudes.

    3. pain management.

    4. teaching in medical schools.

ANS: d REF: Psychology’s Relevance for Health


  1. Psychosomatic medicine sees physical illnesses as

    1. having emotional and psychological components.

    2. having biological causes.

    3. causing stress and subsequent organic illnesses.

    4. all of these.

ANS: a REF: Psychology’s Relevance for Health


  1. Presently, physicians and health psychologists are most likely to agree that psychosomatic illnesses are

    1. a primary means of coping with acute pain.

    2. all in the head of the person with the illness.

    3. diseases linked to a complex of biological, psychological, and social factors.

    4. flow from unconscious factors and are a means of reducing anxiety.

ANS: c REF: Psychology’s Relevance for Health


  1. Behavioral medicine assumes

    1. a link between individual behaviors and health.

    2. the existence of a specific pathogen in illness.

    3. that disease can be controlled, but that health cannot be enhanced.

    4. that the goals of medicine and psychology are incompatible.

ANS: a REF: Psychology’s Relevance for Health


  1. The discipline that emphasizes the prevention of illness and the enhancement of health in currently healthy people is called

    1. behavioral health.

    2. health psychology.

    3. behavioral medicine.

    4. medical psychology.

ANS: a REF: Psychology’s Relevance for Health

  1. Health psychology is best defined as the scientific study of those behaviors related to

    1. the adoption of the sick role for persons who believe themselves to be ill.

    2. health enhancement, disease prevention, and rehabilitation.

    3. the development of psychosomatic illness.

    4. the development of psychological and emotional illness.

ANS: b REF: Psychology’s Relevance for Health


  1. Health psychology is

    1. a branch of medicine related to psychological health.

    2. a discipline within psychology related to psychological health.

    3. a new name for psychosomatic medicine.

    4. a discipline within psychology related to health.

ANS: d REF: Psychology’s Relevance for Health

  1. In the biopsychosocial model proposed by the textbook's authors, health and disease outcomes flow DIRECTLY from


    1. psychological factors.

    2. biological factors.

    3. sociological factors.

    4. all of these.

ANS: b REF: Psychology’s Relevance for Health; Fig. 1.4


  1. In contrast to the biopsychosocial model, the biomedical model views health as

    1. a positive condition.

    2. an incorporation of psychological and social factors.

    3. a result of a combination of factors such as genetics, beliefs, and stress.

    4. the absence of disease.

ANS: d REF: Psychology’s Relevance for Health


  1. During the last quarter of the 20th century, psychology became involved in the changing field of health primarily by

    1. treating physical diseases.

    2. treating mental diseases.

    3. studying behaviors that enhance health and prevent disease.

    4. practicing psychosomatic medicine.

ANS: c REF: Psychology’s Relevance for Health


  1. Most experts in health psychology recommend that

    1. health psychologists should be physicians first.

    2. health psychologists should receive at least two years of postdoctoral training.

    3. health psychology should be a separate discipline from generic psychology.

    4. the training of health psychologists should be shortened to meet the demands for workers in the field.

ANS: b REF: The Profession of Health Psychology


  1. The work of health psychologists is similar to other psychologists because it includes

    1. counseling people with personal problems.

    2. conducting research on personality and health habits.
    3. assessment, research, and provision of services.


    4. working in health care settings.

ANS: c REF: The Profession of Health Psychology



  1. Janelle, a health psychologist, could do any of the following tasks EXCEPT

    1. offer alternatives to pharmacological treatments.

    2. provide behavioral interventions to treat physical disorders.

    3. design effective health communication to promote positive physical health.

    4. design drug trials to enable doctors to find a drug to treat breast cancer.

ANS: d REF: The Profession of Health Psychology


  1. Health psychologists are MOST likely to

    1. be part of an interdisciplinary team.

    2. work as a practitioner in a solo private practice.

    3. go to medical school after finishing a doctoral degree in psychology.

    4. do all of these.

ANS: a REF: The Profession of Health Psychology

True/False Questions


  1. Health is generally defined as an absence of disease.

ANS: F


  1. Currently, the leading cause of death in the United States is cancer.

ANS: F


  1. Most people in the United States die of chronic diseases.

ANS: T


  1. Death rates in the United States from both heart disease and cancer are declining.

ANS: T


  1. Stress is the leading cause of death in the United States.

ANS: F


  1. African Americans have a higher death rate than European Americans.

ANS: T

  1. Despite national media coverage to the contrary, poverty is not related to the mortality rate in the United States.


ANS: F



  1. College graduates generally have a higher death rate than high school dropouts.

ANS: F


  1. The training of health psychologists includes earning doctoral degrees.

ANS: T


  1. Health psychologists rarely work in hospitals.

ANS: F
Essay Questions
1. Trace the changes in patterns of disease during the 20th century. Are there signs that those trends are changing? If so, how?

A. Chronic diseases became more prevalent during the 20th century, overtaking acute diseases as leading causes of death.

1. In 1900, the leading causes of death were attributable to public or community health problems.

2. As the century progressed, diseases with behavioral components such as heart disease, cancer, and stroke, became leading causes of death.

B. Beginning in the mid-1990s, the death rate from diseases with behavioral components began to decrease (such as heart disease), whereas some causes of death with minor behavioral contributions increased (such as Alzheimer’s disease).

2. What roles do age and ethnicity play in mortality?

A. Age is strongly related to illness and death.

1. The likelihood of chronic illness increases with age.

2. Children and young adults are much less likely to die than middle-aged and older adults, but younger people are more likely to die of unintentional injuries and violence.

B. Ethnicity also plays a role in health and mortality.

1. European Americans (including Whites and Hispanics) have substantially longer life expectancies than African Americans.

2. The role of ethnicity is not entirely clear because poverty and low socioeconomic status also relate to ethnicity in the United States, and income relates to health.

a. Poverty is related to ethnicity and is a negative factor in life expectancy.

b. Educational level is related to ethnicity, and low educational level is an important factor in poor health.


3. Discuss the implications of the acceptance of the biopsychosocial model over the biomedical model.

A. Implications of the acceptance of one model over another are important because models guide research and practice in any area.

B. Acceptance of the biomedical model, the view that disease is a mechanistic response to pathogens, has promoted:

1. Acceptance of a mechanistic view of physiology as the source of both disease and the only route to cures.

2. Exclusion of psychological and social factors relating to illness and health because these factors do not fit into the model.

C. Acceptance of the biopsychosocial model promotes:

1. A more complex view of health and illness - multidimensional and contextual.

2. A definition of health that includes optimal functioning.

3. A focus on the behaviors that underlie the development of many chronic diseases.

4. A holistic approach to health and to treatment.


4. Before the development of health psychology, how was psychology involved in health?

A. Psychology's involvement in health traces back to the early years of the 20th century.

1. Psychologists were involved in medical education.

2. Despite long involvement, psychologists played a secondary role in medicine, restricted to mental health treatment and consultation.

B. The development of psychosomatic medicine promoted the role of mental factors in physical health.

1. The psychodynamic view holds that personality is a factor in the development of disease.

2. The psychosomatic view began to lose popularity, replaced by behavioral medicine and then by health psychology.

5. Trace the development of behavioral medicine and health psychology.

A. Behavioral medicine

1. Can be traced to the 1977 Yale conference but also has historical roots in psychosomatic medicine.

2. Was founded by people working in the health care field, some of whom were physicians but others who were in nursing, rehabilitation, and psychology.

3. Attempts to integrate biomedical and behavioral knowledge to enhance prevention, diagnosis, treatment, and rehabilitation.

4. Has its own association, the Society for Behavioral Medicine, and its own journal, the Journal of Behavioral Medicine.

B. Health psychology

1. Can be traced to the APA taskforce that studied the role of psychology in health

research.

2. Was founded by psychologists, some of whom were working in health care settings but others who were involved in research in various content areas of psychology.

3. Attempts to apply knowledge in psychology to the promotion of health, the prevention and treatment of disease, and the establishment of health policy.

4. Has its own division of the American Psychological Association, Division 38 and its own journal, Health Psychology.


6. Discuss how the preparation and work of health psychologists differ from and are similar to those of other psychologists.

A. The preparation of health psychologists is similar to other psychologists, following the scientist/practitioner model.

1. Health psychologists receive doctoral degrees in psychology, including a generic core of courses (experimental design, statistics, biopsychology, social psychology, cognitive psychology, and individual differences).

2. Many training programs include the clinical components necessary for psychologists who deliver psychological services.

3. Health psychologists often receive postdoctoral training and internships to enable them to become more familiar with health care services and to be health care providers.

B. Jobs of health psychologists may be similar to other psychologists or may vary considerably.

1. Like other research psychologists, health psychologists who conduct research usually are employed in educational settings where they combine teaching and research.

2. Unlike most research psychologists, health psychology researchers may be employed in medical centers, teaching medical students and participating in research as part of a biomedical research team

3. Like other clinical or counseling psychologists, health psychologists who provide services may work in private practice, in hospitals or clinics, or in health maintenance organizations (HMOs), where they provide diagnosis and treatment.

4. Unlike most clinical or counseling psychologists, health psychologists who provide services may work as part of a team that provides services to people who are physically sick, either as ancillary treatment or as treatment for the physical disorder.



5. Unlike most psychologists, health psychologists are more likely to be involved in providing preventive services.



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