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HEALTH PSYCHOLOGY:

A teaching resource

Dr H. Fine
Faculty of Continuing Education
Birkbeck College
November 2006

CONTENTS

Introduction

Page
3

Health Psychology Syllabus

Introduction to Health Psychology

Introduction to Physiology

14

Introduction to Stress

20

Stress, Biopsychosocial Factors and Illness

26

Coping with and Reducing Stress

30

Health Related Behaviours and Health Promotion

35

Substance Abuse

40

Nutrition, Diet and Exercise

46

Hospital Based Health Psychology

54

Pain

60

Pain Management

66

Chronic and Disabling Conditions

69

Heart Disease, Stroke, Cancer and AIDS

77

The Future of Health Psychology

82

Additional Course Resources

87

General Web Resources and Podcasts

88

General Exercises and Demonstrations

90

Coursework

91

Term 1 Times Essay Sample

92

Term 2 Times Essay Sample

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.

The skeleton syllabus provided at Birkbeck, focus on three broad topics:


Factors underlying health habits and lifestyles
Methods to enhance health behaviour and prevent illness
Stress and stress management
Other main topics include body systems and psychophysiology, pain and pain
management, people's use of and experience with health services and hospitals, and
the psychosocial impact that living with disabling or life-threatening illnesses has on
patients and their families. Within these relatively broad content areas, the most
common subtopics are expected to be covered either in class or through background
reading and investigation, including:
Theories of and methods for controlling pain
Stress and illness
Compliance/adherence with medical regimens
Cardiovascular disease and cancer
Tobacco use
Nutrition and weight control
Illness behaviour
Biofeedback and relaxation training
Type A behaviour patter
Psychoneuroimmunology
Exercise
Medical settings and the relationships between patients and practitioners.
In order to provide a point of reference and structure, the teaching resources are
based largely on Edward Sarafinos popular student textbook Health Psychology:
Biopsychosocial interaction (4th Ed.). Each section offers an overview of the subdiscipline, class discussion topics, activity suggestions, related resources (references /
internet links / video) and sample essay questions. These resources are suggestions of
bolt-on tools for the skeleton syllabus provided. Please feel free to add to these
resources and forward further suggestions to the Psychology Department.
3

INTRODUCTION

HEALTH PSYCHOLOGY

BIRKBECK, University of London,


FACULTY OF CONTINUING EDUCATION
Module/
Occurrence Code:
Subject Area:

Psychology

Module Title:

Health Psychology

Award Designation: Certificate or Diploma in Applied Psychology


Certificate or Diploma in Applying Psychology
in Health and Healthcare
Institution:
Class Venue:
First Meeting:
No of Meetings:
Class Dates:
Class Taught by:

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

Introduce the biopsychosocial model of health psychology.


Explore the possible uses of psychology in promoting beliefs and behaviours
which support health.
Give an overview of the possible uses of psychology in service provision.
Highlight and discuss the research methods that have been used to study the topics
under discussion.
Highlight the ethical issues involved when conducting research and the issues that
arise when trying to generalise results (for example across cultures).
Point to the links between health psychology and psychobiology, social
psychology, developmental psychology, cognitive psychology, abnormal and
personality psychology.
Support students to take part in the assessment process.

HEALTH PSYCHOLOGY SYLLABUS

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:

Describe the biopsychosocial model of health psychology, using the example of


stress.
Highlight links between health psychology and other branches of psychology.
Explain how health behaviours might be modified using the examples of obesity,
addiction and sexual health behaviour.
Explain the ways in which the study of psychology may impact on the practice of
health professionals both in terms of service provision (e.g. the quality of
communication) and in terms of treating specific problems (e.g. pain) and
conditions (e.g. cancer).
Recognise a range of research methods that might be appropriate to the study of
this area of psychology (identifying strengths and weaknesses of core
methodologies).
Highlight the ethical issues involved when conducting research and the issues that
arise when trying to generalise results (for example across cultures).
Think critically about the subjects covered.
Present your own ideas about issues addressed on the course.
Discuss and implement a range of strategies to support your learning.
Successfully plan and write essays or other assignments which have been set to
support your learning on this course.

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 SYLLABUS

HEALTH PSYCHOLOGY

Biological factors in weight control.


Psychosocial factors in weight control.
Treatments to loose weight
Commercial diets; behavioural techniques; self-help; medical procedures.
Exercise
Health effects of exercise; factors effecting exercise; promoting exercise behaviour;
changing
behaviour.
Addiction (Alcohol)
Social / environmental factors in drinking.
Problem drinking:
Psychosocial reasons (NB stress)
Heredity
Health problems related to alcohol
Prevention
Treatment:
Stages of change model
Detoxification
Behavioural and cognitive interventions
Chemical therapies
Insight therapy
Relapse.
Sexual health and risky behaviour

Psychology and Illness:


The use and provision of health services
Perceiving and interpreting symptoms
The patient-practitioner relationship
Helping patients cope with hospitalisation and hospital procedures
Hospitalisation of children
Using psychology in the treatment of physical conditions
(the example of pain
Chronic illness
Adjusting to chronic illness
Psychosocial interventions for chronic illness
Specific examples (e.g. CDH; diabetes; arthritis; cancer)
Using psychology to inform health care of the elderly
Psychology of the 3rd and 4th ages
Self esteem and older people (well-being, control etc)
Reminiscence / life story
Dementia

HEALTH PSYCHOLOGY SYLLABUS

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 SYLLABUS

HEALTH PSYCHOLOGY

Maclachlan, M. (2004). Embodiment: Clinical, Critical & Cultural Perspectives.


Open University.
Niven, C. & Carroll D. (1993). The Health Psychology of Women. Harwood
Academic Publishers.
Ogden, J. (2004). Health Psychology: A Textbook (3rd ed.). Open University Press.
Sarafino, E. (1998). Health Psychology (3rd ed.). Wiley.
Library and study skills resources
You may find the following web links helpful for your studies.
For information on the resources available for psychology students through
Birkbeck College Library, including on-line books, reference works,
journals, catalogues, and search tools go to:
http://www.bbk.ac.uk/lib/pssubject.html
For guidance on study skills, including essay and report writing, research and
referencing, go to http://www.bbk.ac.uk/ce/psychology where you will be
directed to relevant links.
For specific guidance for psychologists and psychology students on getting
the best out the internet go to http://www.vts.rdn.ac.uk/tutorial/psychologist
Course Evaluation:
During the course students will be asked to complete an evaluation form which gives
the opportunity to provide feedback on all aspects of their learning.
Lecturers Background:
A maximum of 50 words to describe your academic and professional background that
would be of interest to students in relation to this module.

HEALTH PSYCHOLOGY SYLLABUS

HEALTH PSYCHOLOGY

INTRODUCTION TO HEALTH AND PSYCHOLOGY


I. What is health?
A. Introduction
B. The Illness/Wellness continuum
C. Illness Today and in the Past
II. Viewpoints from History: Physiology, Disease Processes, and the Mind
A. Early Cultures
B. Ancient Greece and Rome
C. The Middle Ages
D. The Renaissance and After
E. The biomedical model
III. Seeing a Need: Psychologys Role in Health
A. Problems in the Health Care System
B. The Person in Health and Illness
1. Lifestyle and Illness
2. Personality and Illness
C. How the Role of Psychology Emerged
1. Sigmund Freud
2. Psychosomatic medicine
3. Behavioural medicine
4. Health psychology
5. Integrating the fields
D. Health Psychology: The Profession
1. Work locations
2. Nature of work with patients
3. Research and teaching
4. Educational/training requirements
IV. Current Perspectives on Health and Illness
A. The Biopsychosocial Perspective
B. The Life-Span Perspective
V. Relating Health Psychology to Other Science Fields
A. Related Fields
Epidemiology, Public health, Sociology, Anthropology, Impact on
Health Psychology, Health and Psychology Across Cultures
VII. Research Methods
A. Introduction
B. Experiments
C. Correlational Studies
D. Quasi-Experimental Studies
E. Genetics Research
F. Deciding which method is best

INTRODUCTION TO 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.

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3. Cultural Differences in Health Care and Medical Delivery Systems.


The "social" in the biopsychosocial perspective also includes institutionalized forms
of health care delivery. Matsumoto contends that health care delivery systems are
products many factors including the country's level of social and economic
development, the nature of technological advances and their availability to people, the
level of urbanization and industrialization within the country, governmental structure,
international trade laws and practices, and demands for privatization and public
expenditures. He describes the US as "an example of a country with a relatively high
economic level that uses an entrepreneurial system of health care, characterized by a
substantial private industry covering individuals as well as groups." He goes on to
attest that "it makes sense that an entrepreneurial system is used in the United States,
for example, because of the highly individualistic nature of the American culture."
This observation makes for an interesting starting point in a discussion with students
regarding the influence that culture has with their health and illness experiences.
Source:
Matsumoto, D. (2000). Culture and psychology: People around the world. (2nd ed.).
(pp. 246-247). Stamford, CT: Wadsworth.

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.

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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/

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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/

Short Answer Questions


1. Provide a brief summary of Antonovsky's illness-wellness continuum. How does it
differ from traditional definitions of health?
2. Review the two primary perspectives of the mind-body problem. How is the
debate relevant to a discussion of health and illness?
Essay Questions
1. Compare and contrast the disciplines of psychosomatic medicine, behavioural
medicine, and health psychology.
2. You are interested in testing the effectiveness of a newly developed treatment for
back pain. Outline your approach to your research project.

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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

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d. Disorders affecting the bronchial tubes


e. Lung cancer
f. Most lung disorders are worsened by smoking.
V. The Cardiovascular System
A. Introduction
B. The Heart and Blood Vessels
C. Blood Pressure
D. Blood Composition
E. Cardiovascular Disorders
1. Atherosclerosis
2. Arteriosclerosis
3. Myocardial infarction, or heart attack
4. Angina pectoris
5. Aneurism
6. Stroke
VI. The Immune System
A. Introduction
B. Antigens
C. The Organs of the Immune System
D. Soldiers of the Immune System
E. Defending the Body with an Immune Response
F. Less than Optimal Defences
1. Immune system across the life span
2. Childhood vaccinations stimulate the production of memory
lymphocytes.
3. In old age, T-cells, B-cells, and antibodies respond weakly.
4. Lifestyle behaviours impair immune system response
5. Auto-immune diseases
VII. The Reproductive System and Heredity
A. Conception and Prenatal Development
1. Events involved in development of a human being
2. Changes in mother's anatomy during pregnancy
B. Genetic Processes in Development and Health
1. Genetic Materials and Transmission
2. The Impact of Genetics on Development and Health
3. Gene therapy

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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.

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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

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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

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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.

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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

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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.

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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).

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Assess Yourself: Hassles in Your Life.


Instructions: Rate the frequencies of each of the following events using the following
scale
0 = never
3 = often
1 = rarely
4 = very often
2 = occasionally
5 = extremely often
___ annoying social behaviour of others
___ annoying behaviour of self
___ appearance of self
___ accidents/clumsiness/mistakes
___ getting up early for class/work
___ relationship issues
___ bills/overspending
___ boredom (few or uninteresting activities)
___ car problems
___ crowds/large social groups
___ dating (lack of or uninteresting partners)
___ environment
___ extracurricular groups
___ exams (preparing for, taking)
___ exercising
___ facilities/resources unavailable
___ family obligations or activities
___ family relationships
___ fears for physical safety
___ fitness (inadequate physical condition)
___ professors/coaches
___ registering for/selecting classes
___ roommates/housemates: relationships
___ sexually transmitted diseases
___ sports team/celebrity performance
___ tedious everyday chores
___ waiting
___ weight/dietary management
Total score: _____

23

___ food (unhealthy meals)


___ forgetting to do things
___ friends/peers: relationship issues
___ future plans (career/martial decisions)
___ athletic activities of self
___ goals: not completing enough
___ grades (getting low grades)
___ health/physical symptoms of self
___ schoolwork (working on/hard)
___ housing (finding or moving)
___ Injustice
___ job seeking/ interviews
___ job/work issues
___ lateness of self
___ losing or misplacing things
___ medical/dental treatment
___ money (lack of)
___ new experiences or challenges
___ noise of other people/animals
___ public speaking/presentations
___ parking problems
___ lack of privacy
___ time demands/deadlines
___ traffic problems (other drivers)
___ traffic tickets
___ weather

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.

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2. What stress factors might be affecting your performance on an exam?


Essay Questions
1. Michael has started a new job and is experiencing a great deal of stress. What are
some of the situational and personal factors that might be affecting him physically,
psychologically, and emotionally?
2. Consider that you are a consultant to a stress researcher. She is beginning a new
study and wants to incorporate some measures of stress. What advice would you give
her?
\

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INTRODUCTION TO STRESS

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STRESS, BIOPSYCHOSOCIAL FACTORS AND ILLNESS


I. Psychosocial Modifiers of Stress
A. Social Support
1. Types of Social Support
2. Who Gets Social Support?
3. Gender and Sociocultural Differences in Receiving Support
4. Social Support, Stress and Health
5. How May Social Support Affect Health?
B. A Sense of Personal Control
1. Types of Control
2. Beliefs About Oneself and Control
3. Determinants and Development of Personal Control
4. Gender and Sociocultural Differences in Personal Control
5. When People Lack Personal Control
6. Personal Control and Health
7. Health and Personal Control in Old Age
C. A Hardy Personality
1. Hardiness, Coherence, and Resilience
2. Hardiness and health
3. Hardiness in Old Age
D. Type A and Type B Behaviour Patterns
1. Type A behaviour pattern characteristics
2. Type B behaviour pattern is characterized by low levels of above
3. Measuring Type A and Type B Behaviour Patterns
4. Behaviour Patterns and Stress
5. Gender and Sociocultural Differences in Reactivity
6. Type A Behaviour and Health
7. Behaviour Patterns and Development
II. How Stress Affects Health
A. Stress, Behaviour, and Illness
B. Stress, Physiology, and Illness
C. Psychoneuroimmunology
III. Psychophysiological Disorders
A. Psychophysiological disorders
B. Digestive System Diseases
C. Asthma
D. Recurrent Headache
E. Other Disorders
IV. Stress and Cardiovascular Disorders
A. Hypertension
B. Coronary Heart Disease
V. Stress and Cancer
A. Common characteristic of cancers
B. Cancer and stress

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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?

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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.

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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.

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COPING WITH AND REDUCING STRESS


I. Coping With Stress
A. Functions and Methods of Coping
1. Functions of Coping
2. Methods of Coping: Skills and Strategies
3. Developing Methods of Coping
4. Gender and Sociocultural Differences in Coping
II. Reducing the Potential for Stress
A. Enhancing Social Support
B. Improving One's Personal Control
C. Organizing One's World Better
D. Exercising: Links to Stress and Health
E. Preparing for Stressful Events
III. Reducing Stress Reactions: Stress Management
A. Medication
B. Behavioural and Cognitive Methods
1. Relaxation
2. Systematic desensitization
3. Biofeedback
4. Modelling
4. Approaches focusing on cognitive processes
5. Multidimensional approaches
C. Massage, Mediation, and Hypnosis
IV. Using Stress Management to Reduce Coronary Risk
A. Modifying Type A Behaviour
B. Treating Hypertension

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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:

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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.

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Assess Yourself: Your Focuses in Coping.


Instructions: Think about a very stressful personal crisis or life event you experienced
in the last year - the more recent and stressful the event, the better for this exercise.
How did you handle this situation and your stress? Some of the ways people handle
stressful experiences are listed below. Mark an "X" in the space preceding each one
you used.
_____ Tried to see a positive side to it.
_____ Tried to step back from the situation and be more objective.
_____ Prayed for guidance or strength.
_____ Sometimes took it out on other people when I felt angry or depressed.
_____ Got busy with other things to keep my mind off the problem.
_____ Decided not to worry about it because I figured everything would work out.
_____ Took things one step at a time.
_____ Read relevant material for solutions and considered several alternatives.
_____ Drew on my knowledge because I had a similar experience before.
_____ Talked to a friend or relative to get advice on handling the problem.
_____ Talked with a professional person (e.g., doctor, clergy, lawyer, teacher,
counsellor) about ways to improve the situation.
_____ Took some action to improve the situation.
_____ Total of Xs in first six coping strategies.
_____ Total of Xs in second six coping strategies.
Which type of strategies did you use the most?

Why?

What functions did your strategies serve?

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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.

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HEALTH PSYCHOLOGY

HEALTH RELATED BEHAVIOURS AND HEALTH PROMOTION


I. Health and Behaviour
A. Lifestyles, Risk Factors, and Health
1. Health behaviour
2. Practicing health behaviour
B. Interdisciplinary Perspectives on Preventing Illness
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
C. Problems in Promoting Wellness
1. Factors within the Individual
2. Interpersonal Factors
3. Factors in the Community
II. What Determines People's Health-Related Behaviour?
A. General Factors in Health-Related Behaviour
1. Heredity or genetics appears to influence some health behaviours
such as in alcoholism
2. Learning
3. Social, Personality, and Emotional Factors
4. Perception and Cognition
B. The Role of Beliefs and Intentions
1. The Health Belief Model
2. The Theory of Planned Behaviour
3. Beliefs in Personal Control
4. The Stages of Change Model
C. The Role of Non-rational Processes
1. Motivational factors in beliefs
2. Emotional Factors in Beliefs
III. Development, Gender, and Sociocultural Factors
A. Development and Health-Related Behaviour
1. During gestation and infancy
2. Childhood and adolescence
3. Adulthood and Aging
B. Gender and Health-Related Behaviour
C. Sociocultural Factors and Health-Related Behaviour
IV. Programs for Health Promotion
A. Methods for Promoting Health
1. Motivating people to change is an important step in interventions.
2. Providing information
3. Features of information to enhance motivation
4. Behavioural methods
5. Maintaining healthy behaviours
B. Promoting Health in the Schools
C. Worksite Wellness Programs
D. Community-Wide Wellness Programs
E. Prevention With Specific Targets: Focusing on AIDS

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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

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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 RELATED BEHAVIOURS AND HEALTH PROMOTION

HEALTH PSYCHOLOGY

Assess Yourself: Your Knowledge about AIDS.


Instructions: Answer the following true-false items by circling the T or F for each
one.
T

1.

People who develop AIDS usually die within a couple of years.

2.

Blood tests can usually tell within a week after infection


whether someone has the AIDS virus.

3.

People do not get AIDS from using swimming pools or rest


Room after someone with AIDS does.

4.

Some people have contracted AIDS from insects, such as


mosquitoes, that have previously bitten someone with AIDS.

5.

AIDS can now be prevented with a vaccine and cured if treated


early.

6.

People who have the AIDS virus can look and feel well.

7.

Gay women (lesbians) get AIDS much more often than


heterosexual women, but not as often as gay men.

8.

Health workers have a high risk of getting AIDS from or


spreading the virus to their patients.

9.

Kissing or touching someone who has AIDS can give you the
disease.

10.

AIDS is less contagious than measles.

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HEALTH RELATED BEHAVIOURS AND HEALTH PROMOTION

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 RELATED BEHAVIOURS AND HEALTH PROMOTION

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

on biological factors that influence reactions to chemical substances. While the


textbook addresses the role of genetics and heredity, this article focuses almost
exclusively on the neurochemical effects of substance use.
Source:
Nash, J. M. (May 5, 1997). How we get addicted...and how we might get cured. Time
Magazine, pg. 69-76.

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

Assess Yourself: What's True About Drinking.


Instructions: Put a check mark in the space preceding each of the following
statements you think is true.
_____ Alcohol is a stimulant that energizes the body.
_____ Having a few drinks enhances people's performance during sex.
_____ After drinking heavily, people usually sober up a lot when they need to, such
as to drive home.
_____ Most people drive better after having a few beers to relax them.
_____ Drinking coffee, taking a cold shower, and getting fresh air help someone who
is drunk to sober up.
_____ People are more likely to get drunk if they switch drinks, such as from wine to
beer, during an evening rather than sticking with the same kind of drink.
_____ Five pints of beer won't make someone as tipsy as four mixed drinks,
such as highballs.
_____ People seldom get drunk if they have a full meal before drinking heavily.
_____ People can cure a hangover by any of several methods.
_____ Most people with drinking problems are either "skid row bums" or over 50
years of age.

43

SUBSTANCE ABUSE

HEALTH PSYCHOLOGY

Assess Yourself: Do You Abuse Alcohol?


Instructions: Ask yourself the following questions about your drinking.
1. Do you usually have more than 14 drinks a week (assume a drink is one mixed
drink, 12 ounces of beer, or the equivalent)?
2. Do you often think about how or when you are going to drink again?
3. If your job or academic performance suffering by your drinking?
4. Has your health declined since you started drinking a lot?
5. Do family or friends mention your drinking to you?
6. Do you sometimes stop and start drinking to "test" yourself?
7. Have you been stopped for drunk driving in the past year?

44

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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

NUTRITION, DIET AND EXERCISE


I. Nutrition
A. Components of Food
B. What People Eat
C. Nutrition and Health
II. Weight Control and Diet
A. Desirable and Undesirable Weights
1. Overweight and obesity
2. Sociocultural, gender, and age differences in weight control
B. Becoming Overly Fat
1. Biological factors in weight control
2. Psychosocial factors in weight control
3. Overweight and health
4. Preventing overweight
C. Dieting and Treatments to Lose Weight
1. Commercial and ''fad diet'' plans
2. Exercise
3. Behavioural and cognitive methods
4. Self-help groups and worksite weight-loss programs
5. Medically supervised approaches
a. Drugs that suppress appetite
b. Very low calorie diets
c. Surgery may include gastric restriction or liposuction.
6. Relapse after weight loss
D. Anorexia and Bulimia
a. Anorexia nervosa
b. Bulimia nervosa
1. Why people become anorexics and bulimics
a. Genetic and physiological factors
b. Cultural factors
c. Cognitive factors
2. Treatments for anorexia and bulimia
III. Exercise
A. The Health Effects of Exercise
1. Types and amounts of healthful exercise
2. Psychosocial benefits of exercise
3. Physiological effects of exercise
B. Who Gets Enough Exercise, Who Does Not--And Why?
1. Gender, age, and sociocultural differences in exercise
2. Reasons for not exercising
C. Promoting Exercise Behaviour
1. Strategies to promote exercise
2. Other factors in promoting exercise behaviour

46

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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

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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

Age (in years)


17-19
20-29
44
40
35
35

30-39
38
33

40-49
37
31

50-59
36
30

60-69
34
29

4. Eating Disorders. There are usually a number of professionals in the local


community (or a nearby community) who specialize in the treatment of eating
disorders. Ask one of these clinicians to come to class to talk about his or her
clinical practice.

48

NUTRITION, DIET AND EXCERCISE

HEALTH PSYCHOLOGY

Assess Yourself: Your Weight Control Patterns


For each of the following questions, put a check mark in the preceding space if your
answer is yes.
___

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?

___

3. Do you think gaining a few pounds during a holiday season would be a


terrible thing?

___

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?

___

8. Have you felt a lot of emotional distress in recent months?

___

9. Do you often eat fewer than two meals a day?

___

10. Do you regularly exercise more than 10 hours a week to lose weight?

___

Total "yes" responses.

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.

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Exercise energy expenditure


(kcal/min)
Weight (lbs)
110
Activity
Basketball
6.9
Circuit training
9.3
Climbing hills
With no load 6.1
With 22 lb. pack 7.0
Cycling
Leisure
5.9
10.1
Racing
8.5
Dancing
Ballroom
2.6
Choreographed 8.4
Football
6.6
Golf
4.3
Running
9 min/mile
9.7
8 min/mile
10.8
7 min/mile
12.2
6 min/mile
13.9
Swimming
Crawl, fast
7.8
Crawl, slow
6.4
Tennis
5.5
Walking
4.0

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

Weekly energy expenditure: ________


Source:
Matarazzo, J.D., Weiss, S.M., Hord, J.A., Miller, N.E., & Weiss, S.M. (1984).
Behavioural Health . New York: J. Wiley & Sons. Reprinted by permission of J.
Wiley & Sons, Inc.

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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)

_____

3. Add up the total number of hours spent in moderate activity.

_____

4. Multiply the hours spent in moderate activity (line 3) by 4.

(x4)

5. Add up the total number of hours spent in hard activity.


6. Multiply the hours spent in hard activity (line 5) by 6.

_____
_____

(x6)

_____

7. Add up the total number of hours spent in very hard activity.

_____

8. Multiply the hours spent in very hard activity (line 7) by 10.

(x10) _____

9. Add up the figures in lines 1, 3, 5, and 7.

(1 + 3 + 5 +7) =

_____

10. Hours spent in light activity is equal to 24 hours


minus the hours in lines 1,3,5,& 7.
24 - (1 + 3 + 5 + 7) =

_____

11. Multiply the figure in line 10 by 1.5.

(x15) _____

12. Add up the figures in lines 2, 4, 6, 8 & 11. (2 + 4 + 6 + 8 + 11) =


_____
This figure is the total kilocalories per kilogram of body weight expended per
day.
13. To calculate the total number of calories you expended in one day, multiply your
total body weight in kilograms (weight in pounds divided by 2.2046 = weight in
kilograms) by the figure in line 12.
__________ x __________ =
__________________
Body wt. (kg)
line 12 total calories expended
Source:
Matarazzo, J.D., Weiss, S.M., Hord, J.A., Miller, N.E., & Weiss, S.M. (1984).
Behavioural Health. New York: J. Wiley & Sons. Reprinted by permission of J. Wiley
& Sons, Inc.

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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.

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Suggested Films and Videos:


2. Dying to be thin. (1995, Films for the Humanities & Sciences, 28 min). Follows
a young woman through hospitalizations and outpatient therapy as she lives with
anorexia.
3. Supersize me. (2004, Independent, 97 min). Satirical look at mass produced
processed food and the fastfood nation.
Internet sites of interest:
4. http://www.dietetics.com/link/dietitians.htm - Dieticians websites and online
dietetics.
5. http://store.yahoo.com/1magazines/healthmagazine.html - Health Magazine online
6. http://syndistar.com/health/index.htm - Syndistar's health & safety website
7. http://www.theonlinedietitian.com/ - online dietician website
8. http://www.fitnesslink.com/ - fitness, nutrition, and exercise website.
Short Answer Questions
1. Your couch potato friend tells you that the healthfulness of exercise is grossly
overrated. Refute his armchair logic.
Essay Questions
1. Present an argument that supports the statement that weight is a biopsychosocial
phenomenon.
2. You have just been hired to develop a successful weight reduction and exercise
program for your company. Outline the basics of your plan.

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HEALTH PSYCHOLOGY

HOSPITAL BASED HEALTH PSYHOLOGY


I. The Hospital -- Its History, Setting and Procedures
A. How the hospital evolved
B. The organization and functioning of hospitals
1. Organization
2. Medical staff
a. Physicians
b. Teaching hospitals
c. Nurses
d. Allied health workers
e. Other workers.
C. Roles, goals, and communication
1. Coordinating patient care
2. Health hazards in hospitals
II. Being Hospitalized
A. Relations with the hospital staff
1. Social role of patient entering hospital
2. Depersonalization or non-person treatment
3. Psychosocial components of burnout among health care
professionals:
B. Sick-role behaviour in the hospital
III. Emotional Adjustment in the Hospital
A. Coping trends
B. Adjustment is a function of age, gender, and characteristics of illness
C. Coping processes in hospital patients
1. Cognitive processes in coping
a. Attributions of blame
b. Beliefs of personal control
2. Helping patients cope
D. Preparing patients for stressful medical procedures
E. When the Hospitalized Patient is a Child
IV. How Health Psychologists Assist Hospitalized Patients
A. Activities of health psychologists
a. Consulting with patient's specialists.
b. Assess client's needs for and providing preparation to cope.
c. Help with adherence.
d. Develop behavioural programs.
e. Assist with rehabilitation processes.
B. Initial steps in helping
C. Tests for psychological assessment of medical patients
1. Minnesota Multiphasic Personality Inventory
2. Specialized tests for medical patients
D. Promoting patient's health and adjustment

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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.

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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?

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HEALTH PSYCHOLOGY

Assess Yourself: Who's Who in Physician Care


The medical staffs in hospitals contain a great variety of specialized personnel. If you
were hospitalized, chances are you'd receive care from at least two of the ten types of
medical specialists listed below. Do you know what their specialty areas of illness or
treatment are? For this matching task, write the number for each specialty are in the
space preceding the corresponding type of specialist.
______

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

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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

Internet sites of interest:


1. http://medhlp.netusa.net/home.htm - Med Help International
2. http://www.galaxy.tradewave.com/galaxy/Medicine?Health-Occupations?
Medicine/Psychological-Medicine.html - links for Psychological Medicine
3. www.nhsdirect.com NHS Patient health advice
Short Answer Questions
1. Describe the roles and responsibilities of three occupations in a hospital system.

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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.

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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

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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

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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

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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,

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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.

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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.

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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

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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.

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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.

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CHRONIC AND DISABLING CONDITIONS


I. Adjusting to a Chronic Illness
A. Initial reactions to having a chronic condition
I. Sequence of reactions to diagnosis of serious illness
a. Shock
b. Encounter
c. Retreat
2. Use of avoidance strategies
B. Influences on coping with a health crisis
1. Initial reactions to acute versus chronic conditions
2. Crisis theory
3. Illness-related factors
4. Background and personal factors
5. Physical and social environmental factors
C. The coping process
1. Section introduction
2. The tasks and skills of coping
3. Long-term adaptation to chronic health problems
II. Impacts of Different Chronic Conditions
A. Asthma
1. What Is asthma?
2. The physiology, causes, and effects of asthma
3. Medical regimen for asthma
4. Psychosocial factors in asthma
B. Epilepsy
1. Clinical characteristics
b. Types of epilepsy
c. Demographics for epilepsy
d. What to do for a seizure
2. Medical regimen for epilepsy
a. Main medical treatment is anticonvulsant medication.
b. Surgical options
3. Psychosocial factors in epilepsy
C. Nervous system injuries
1. The prevalence, causes and physical effects of spinal cord injuries
2. Physical rehabilitation
3. Psychosocial aspects of spinal cord injury
D. Diabetes
1. Clinical characteristics of diabetes
2. The types and causes of diabetes
3. Health implications of diabetes
4. Medical regimens for diabetes
5. Do diabetics adhere to their regimens?
6. Self-managing diabetes
7. Psychosocial factors in diabetes care
8. When the diabetic is a child or adolescent
E. Arthritis
1. Clinical characteristics

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2. The types and causes of rheumatic diseases


3. The effects and treatment of arthritis
4. Psychosocial factors in arthritis
F. Alzheimers disease
1. Characteristics of dementia and Alzheimers disease
2. The causes and treatment of Alzheimers disease
3. Psychosocial effects of Alzheimers disease
III. Psychosocial Interventions for People with Chronic Conditions
A. Study on perceptions of chronic illnesses
B. Educational, social support, and behavioural methods
C. Relaxation and biofeedback
D. Cognitive methods
E. Insight and family therapy

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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.

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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?

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Assess Yourself: Do You Have Diabetes?


About half of the people who have diabetes dont know it. To tell if you might have
this disorder, put a check mark in the space preceding each of the following warning
signs that are true for you.
_____ Very frequent urination.
_____ Frequent excessive thirst.
_____ Often hungry, even after eating.
_____ Unexplained large weight loss.
_____ Chronically tired.
_____ Occasional blurry vision.
_____ Wound heal very slowly.
_____ Tingling or numbness in your feet.
_____ Waist measurement greater than half your height.

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.

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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

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3. http://www.library.nhs.uk/diabetes/Default.aspx - NHS Diabetes specialist library


4. http://www.idf.org/ - International Diabetes Foundation
5. http://web.idirect.com/~cprprog/diabetes/services.htm - Diabetes International
Services
6. http://www.niddk.nih.gov/health/diabetes/pubs/dmdict/dmdict.htm - The Diabetes
Dictionary
7. http://www.diabetes-self-mgmt.com/ - Diabetes Self-Management
8. http://www.nlm.nih.gov/medlineplus/diabetes.html - MEDLINEplus Health
information on diabetes
9. http://www.arthritiscare.org.uk/Home - UK Arthritis organisation
10. http://webmd.lycos.com/content/article/3172.10408 - WebMD information on
arthritis
11. http://www.mednews.net/arthritis/ - Arthritis News on the Net
12. http://www.rheumatoid.org.uk/ - National rheumatoid arthritis society
13. http://www.asthma.org.uk/ - UK Asthma organisation
14. http://www.ginasthma.com - Global Initiative for Asthma
15. http://www.pslgroup.com/ASTHMA.HTM - guide to asthma information
16. http://www.epilepsy.org.uk/ - Epilepsy Action UK based charity
17. http://www.ncype.org.uk/ - National Centre for Young People with Epilepsy
18. http://www.nice.org.uk/page.aspx?o=CG020 NICE guidelines for Epilepsy
19. http://www.efa.org/ - Epilepsy Foundation
20. http://www.alzheimers.org.uk/ - Alzheimers Society website
21. http://www.alz.co.uk/ - Alzheimers Disease International
22. http://www.spinal.co.uk/ - Spinal Injuries Association UK
23. http://www.spinalcord.uab.edu/ - Spinal Cord Injury Information Network
24. http://www.sonic.net/~spinal/ - Spinal Cord Injury Network International (SCINI)
25. http://www.spinalinjury.net - Spinal Cord Injury Resource Centre
26. http://www.traumaburn.com/spinal_cord_injury.htm - Management of Spinal Cord
Injury
Short Answer Questions
1. Your cousin is just about to enter rehabilitation for a spinal cord injury due to a
motorcycle accident. Outline for him what he should expect during treatment.
2. Compare and contrast the various forms of rheumatic diseases.
Essay Questions
1. Your 8-year-old nephew has just been diagnosed with Type I diabetes. Based on
what you've learned from the text, help him understand the disease and what he needs
to do in his treatment regimen.
2. Develop and discuss a comprehensive treatment program for patients with one of
the following chronic illnesses: asthma, arthritis, epilepsy, or diabetes.

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HEART DISEASE, STROKE, CANCER AND AIDS


I. Coping With and Adapting to High-Mortality Illness
A. Adapting while the prospects seem good
1. Early concerns following diagnosis
2. Developing regular routines
3. Family dynamics
4. Cognitive adjustments to high-mortality illness
B. Adapting in a recurrence or relapse
II. Heart Disease
A. Coronary heart disease
B. Who is at risk of heart disease, and why?
1. Age, gender, and sociocultural risk factors
2. Lifestyle and biological risk factors
3. Negative emotions and heart disease
C. Medical treatment and rehabilitation of cardiac patients
1. Initial treatment for heart attack
2. Rehabilitation for cardiac patients
D. The psychosocial impact of heart disease
1. Importance of work
2. Family relationships
E. Psychosocial interventions for heart disease
1. Approaches using technological devices
2. Other approaches
a. Programs with education and psychological counselling.
b. Stress-management programs
c. Ornish's multi-component program
III. Stroke
A. Section introduction
1. Section introduction
a. Common symptoms of stroke
b. Definition and prevalence
B. Causes, effects, and rehabilitation of stroke
1. Section introduction
a. Causes of blood disruption
2. Age, gender, and sociocultural risk factors for stroke
3. Lifestyle and biological risk factors for stroke
a. Risk factors
b. Role of negative emotions
4. Stroke effects and rehabilitation
B. Psychosocial aspects of stroke
1. Common coping strategies
2. Emotional adjustments
3. Occupational effects
4. Social effects
IV. Cancer
A. The prevalence and types of cancer
1. Four types of cancer

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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"?

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a. Kubler-Ross' five stages in adjustment to dying


b. Empirical support for stage approach
VII. The Quality of Life in Death
A. Medical and psychological care of dying patients
1. Terminal care phase
2. Impact on medical staff
3. Informing a patient that the illness is terminal is controversial.
B. A place to die -- hospital, home or hospice?
VIII. The Survivors: And Life Goes On
A. Adapting to bereavement
1. Bereavement is the state of having lost someone through death.
2. Adapting to bereavement
3. Adjusting to bereavement in AIDS cases for gay men.
4. Adjusting when a child or parent dies
5. Long-term adjustment

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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.

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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

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1. http://azaz.essortment.com/medicalsymptom_mal.htm - Coping with a terminal


illness
2. http://griefnet.org/library/biblio/terminal.html - Books on terminal illness and
dying process.
3. http://www.ove-and-light.net.index.asp - site for book entitled Why Me? Why
Not? Living Beyond Terminal Illness.
4. http://www.skdesigns.com/internet/spirit/death.html - Spirituality & Alternative
Healing: Death, Dying, & Terminal Illness
5. http://stroke.org.uk/ - The Stroke Association home page
6. http://www.medivillage.com/guides/index....d=stroke&GuideName=StrokeRehabilitation - Medifocus Preview Stroke Rehabilitation
7. http://www.strokejournal.org - Journal of Stroke & Cerebrovascular Diseases
8. http://www.cancerresearchuk.org/ - Cancer Research UK
9. http://www.acor.org/index.html - Association of Cancer Online Resources
10. http://www.avert.org/ - Averting HIV and AIDS
11. http://www.tht.org.uk/ - Terrence Higgins Trust
12. http://www.nat.org.uk/ - National Aids Trust
13. http://www.hivatis.org - HIV/AIDS Treatment Information Service
14. http://www.healingwell.com/AIDS/ - AIDS/HIV Resource Centre
15. http://www.ama-assn.org/special/hiv/hivhome.htm - JAMA HIV/AIDS Resource
Centre
16. http://topchoice.com/~psyche/aids95us.html - The first 500,000 AIDS cases
17. http://www.hospiceinformation.info/ - Hospice information in the UK
18. http://ww.hospicecare.com/ - International Association for Hospice & Palliative
Care
19. http://www.lastacts.org/ - Last Acts campaign to improve end-of-life care
20. http://www.isoqol.org/main.html - International Society for Quality of Life
Research
21. http://www.uib.no/isf/people/doc/qol/httoc.htm - Quality of life compendium
22. http://hal.fmhi.usf.edu/institute/pubs/pdf/abstracts/qol.html - Quality of Life
Assessment Manual
23. http://griefnet.org/ - GriefNet.org website
24. http://www.wellnessbooks.com/dying/ - Grief & Dying Book Store
Short Answer Questions
1. How is the rehabilitation of cardiac patients influenced by the psychosocial impact
of the disease?
2. Discuss the importance of knowing the warning signs of a disease in the treatment
of it.
Essay Questions
1. Describe the ways in which adapting to high-mortality illness is different before
and after a relapse.
2. Compare and contrast the experiences of patients with AIDS versus those with the
other high-mortality illnesses.

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HEALTH PSYCHOLOGY

THE FUTURE OF HEALTH PSYCHOLOGY


I. Goals for Health Psychology
A. Enhancing efforts to prevent illness
B. Improving efforts for helping patients cope
C. Documenting the efficacy and cost-benefit ratio of care
D. Enhancing psychologists' acceptance in medical settings
II. Careers and Training in Health Psychology
A. Career opportunities
B. Training programs
III. Issues and Controversies for the Future
A. Environment, health, and psychology
1. Psychologists may help assess the effects of exposure to toxic
substance, pollutants, or to stress.
B. Quality of life
1. Why the focus on quality of life?
2. Psychologists will need to make better quality of life assessments.
C. Ethical decisions in medical care
1. Technology and medical decisions
a. Use of technology and data has raised ethical questions.
b. Ethical dilemmas in organ transplants.
c. Ethical dilemmas in genetics technology.
2. Assisted suicide and euthanasia
a. b. Assisted suicide
b. Euthanasia
c. Legal issues
d. Role of the psychologist
IV. Future Focuses in Health Psychology
A. Life-span health and illness
1. From conception to adolescence
2. Adulthood and old age
B. Sociocultural factors in health
C. Gender differences and women's health issues
V. Factors Affecting Health Psychology's Future
A. Factors influencing amount of research, clinical intervention and clinical
intervention.
1. Economic and financial pressures.
2. Education and training
3. Developments in medicine

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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

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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 47-year-old woman developed cirrhosis of the liver as a result of


long-term alcoholism. She promised to stop drinking if she could
receive a liver transplant. Her request was denied because of likely
future drinking.

An overweight, chain-smoking, sedentary 51-year-old man with high


blood pressure had his first heart attack 7 years ago. His request for a
heart transplant was denied because of continuing risk factors.

A 28-year-old married woman with a hereditary crippling disease that


is eventually fatal decided to become pregnant, knowing that there was
a 50% chance that she would pass on her disease to her baby and she
would not consider having an abortion.

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.

An obese 20-year-old woman who refused to try to lose weight was


expelled from nursing school, despite having good grades and clinical
evaluations, because it was said she would "set a poor example for
patients."

A 24-year-old man was denied employment as a bank clerk because


was overweight and smoked cigarettes.

A 30-year-old woman was denied a promotion to a job that involved


working in an area with gases that could harm an embryo if she were to
become pregnant.

A year after a boy developed leukaemia, the company that provided his
family's health insurance quadrupled their premium.

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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?

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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.

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ADDITIONAL COURSE RESOURCES


General Resources
1. Pamphlets - The NHS and organisations concerned with specific health
problems, such as the Cancer Research UK and Terrence Higgins Trust,
publish and distribute health-related pamphlets.
2. Journals specialising in psychology and health, e.g. The British Journal of
Health Psychology; Annals of Behavioural Medicine and Journal of
Behavioural Medicine, Health Psychology, Journal of Health and Social
Behaviour, Psychology and Health, and Psychosomatic Medicine.
3. Other major reference books can be readily selected by reviewing the
catalogues of publishers with extensive lists in Health Psychology. These
publishers include Erlbaum, Guilford, Jossey-Bass, Pergamon, Plenum, and
Wiley.
Guest Speakers
Enrichment possibilities through the use of guest speakers are quite wide ranging in
the field of Health Psychology. Speakers might include:
1. Practitioners or researchers who are experts on specific illnesses, such as
diabetes, cancer, or kidney disease
2. Health care or rehabilitation specialists, such as nurses, physical and
occupational therapists, and medical social workers
3. Clinical Health Psychologists who help patients cope with chronic or terminal
illnesses
4. Hospice workers
5. Public health workers involved in community health-promotion programs
6. Individuals who work in AIDS prevention and treatment programs
7. Representatives of a local voluntary self-help agencies.

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GENERAL WEB RESOURCES AND PODCASTS


Web Resources
The following is a list of trusted websites with validated information. The sites
referenced offer a broad range of resources encompassing the discipline of Health
Psychology from a multi-disciplinary and life-span perspective. Further specific
resources are cited for later topics.
American Psychosomatic Society - www.psychosomatic.org/
BBCs introduction to different types of psychology: Health psychology www.bbc.co.uk/science/humanbody/mind/articles/psychology/psychology_7.shtml
BPS Division of Health Psychology - www.health-psychology.org.uk/
British
Journal
of
Health
Psychology
www.bps.org.uk/publications/journals/bjhp/bjhp_home.cfm?&redirectCount=0

British Nutrition Foundation www.nutrition.org.uk


Cancer Research UK - Funding world-class research and training to improve cancer
treatment and prevention, and providing authoritative cancer information and
advocacy - www.cancerresearchuk.org/
Childrens Health www.heartforum.org.uk/Policy_Children'shealth.aspx
Connexions - Offers a range of guidance and support for 13 to 19 year olds, to help
make the transition to adult life a smooth one - www.connexions.gov.uk/
Department of Health, legislation and guidance from the UK Government and the
National Health Service www.doh.gov.uk
Diabetes UK Homepage - www.diabetes.org.uk/
European Health Psychology Society - www.ehps.net/1024/index.html
Food Standards Agency (nutrition) www.food.gov.uk/healthiereating/
International Stress Management Association - www.isma.org.uk/
Joseph Rowntree Foundation Social policy research - www.jrf.org.uk/
Kings Fund A health related site with useful links - www.kingsfund.org.uk/
MedLine Plus Trusted health information - www.medlineplus.gov/
National Childbirth Trust (NCT) - Information on pregnancy, childbirth,
breastfeeding, and parenthood - www.nctpregnancyandbabycare.com/
National Institute of Clinical Excellence (NICE) - an independent organisation
responsible for providing national guidance on promoting good health and preventing
and treating ill health - www.publichealth.nice.org.uk/

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National Institute of Mental Health - www.nimh.nih.gov/nimhhome/index.cfm


National Statistics Online - http://www.statistics.gov.uk/default.asp
NHS Direct, The 24 hour nurse-led telephone advice service run by the NHS.
Provides information on the diagnosis and treatment of common conditions.
www.nhsdirect.nhs.uk
Pain Management and Research Bath Pain management unit - www.bath.ac.uk/painmanagement/
Phillip Morris Tobacco - www.philipmorrisusa.com/en/home.asp
Race and Ethnicity in Medicine - http://cdh.med.wisc.edu/
Smoking - Giving up Smoking - advice and information on smoking and giving up
from the NHS - www.givingupsmoking.co.uk/
Some truths about tobacco www.thetruth.com
Stress

Health
&
www.hse.gov.uk/pubns/stresspk.htm

Safety

Executive

publications

Tackling Drugs - The cross-government website providing information and resources


for drugs professionals - www.drugs.gov.uk/
Talk to Frank The more you know about drugs the better - www.talktofrank.com/
Terrance-Higgins Trust - HIV/AIDS information, safer sex, online booklets and help
line - www.tht.org.uk/
Tobacco Factfile www.tobaccofactfile.org
World Health Organisations www.who.int
Young Minds - Charity committed to improving the mental health of all children and
young people - www.youngminds.org.uk/
Podcasts
ABC Radio All in the Mind Weekly foray into all thinks mental www.abc.net.au/rn/allinthemind/default.htm
DANA Centre Webcasts of exciting and innovative debates about contemporary
science - www.danacentre.org.uk/
New Scientist Weekly podcast - www.newscientist.com/podcast.ns
Radio 4 - All In the Mind explores the limits and potential of the mind http://www.bbc.co.uk/radio4/science/allinthemind.shtml
Shrink Rap Radio Psychological slant on social issues of the day www.shrinkrapradio.com/shows.htm

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GENERAL EXERCISES AND DEMONSTRATIONS


Conduct a demonstration of relaxation training for stress management, having the
students do muscle relaxation and slow breathing exercises.
Administer, score, and critique any of a variety of psychological tests, such as the
Multidimensional Health Locus of Control Scales, Hospital Anxiety and
Depression Scale, McGill Pain Questionnaire etc.
Have students bring in newspaper articles that describe the findings of research
related to health psychology. Discuss how the research was conducted, or how it
was probably conducted if the methodology is unclear.
Construct a list of medical jargon (e.g., incubation period, sutures, secretions,
sucrose, umbilicus, membrane, purgative, antitoxin, aseptic, myocardium,
paresis, pleura, thrombus, vasoconstriction, hepatic, fallopian tubes, ectoderm,
endometrium, congenital, etc.) and have the students define the terms. Discuss
what the terms mean and how using jargon can impair the patient/practitioner
relationship and the patient's likelihood of adhering to a medical regimen.
Construct a list of mental health diagnosis (e.g., schizophrenia, autism, bi-polar,
personality disorder etc.), and have the students define the terms. Discuss what
the terms mean and the impact of social constructionist on our use if such terms.

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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).

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Date:

Time allowed: 60 minutes

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?

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HEALTH PSYCHOLOGY

Date:

Time allowed: 60 minutes

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?

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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?

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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

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