237 10 health848.ch10 16/4/07 2:57 pm Page 238 11 health848.ch11 16/4/07 2:57 pm Page 239 Chapter 11 Stress and illness Chapter overview This chapter first assesses whether stress causes illness and then explores a chronic and acute model of the mechanisms behind this association. 1987). Likewise, problems could be considered hot and dry (e.g. Applied to smoking, this perspective suggests that nicotine causes addiction through its constant use. 1995). Skevington 1998; Skevington et al. (1992) Psychosocial correlates of immune status and disease progression in HIV-1 infected homosexual men: review of preliminary findings and commentary, Psychology and Health, 6: 17592. Quantitative research Other studies have used more artificial and controlled methodologies, and these too have provided support for the dimensions of illness cognitions. These two approaches will now be considered. However, even within these models the mind and the body are still regarded as separate. 08 health848.ch08 16/4/07 2:55 pm Page 177 DEVELOPING THE CONTEMPORARY RESEARCH PERSPECTIVES ON SEX Percentage using no contraception 100 Men Women 80 60 40 20 0 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Age at first intercourse Figure 8.1 Percentage using no contraception at rst intercourse, by age at rst intercourse (after Wellings et al. It is possible that many important cognitions are missed which are central to understanding eating behaviour. These were all assessed using 7point Likert scales. Several studies have examined breast self-examination behaviour and report that barriers (Lashley 1987; Wyper 1990) and perceived susceptibility (Wyper 1990) are the best predictors of healthy behaviour. avoidance), cognitive control (e.g. Perhaps, rather than developing models that can be applied to a whole range of behaviours, individual models should be adapted for each specific behaviour. Whenever I dont feel well I should consult my doctor) and external control/chance (e.g. Aspects of the task Writing versus talking Some research has compared the effectiveness of writing versus talking either into a tape recorder or to a therapist (e.g. However, the development of the original hypothesis involves the health professionals own health beliefs, which may vary as much as those of the patient. Actual or perceived control. Sutton (2002a) argues that both these designs are problematic and do not allow inferences about causality to be made. This chapter examines problems with defining placebos and then assesses the different theories concerning how they work, highlighting the central role for patient expectations. Within this context, social support is defined as either emotional support, involving trust between colleagues and social cohesion, or instrumental social support, involving the provision of extra resources and assistance. The results showed that those who had self-affirmed were more accepting of the health message. is my cancer serious? It set the scene for much subsequent research and shifted the emphasis from doctor as expert to seeing the consultation as an interaction. The potential role of psychological factors in understanding HIV and AIDS is shown in Figure 14.1. The concept of separate biological and psychological boundaries suggests that the physical and psychological are separate entities which interact. The health checks involved the nurse recording information about personal and family history of heart disease, stroke, hypertension, diabetes and cancer. It has been argued that the degree of hardiness influences an individuals appraisal of potential stressors and the resulting stress response. So how might a relative increase in fat consumption relate to obesity? They therefore did not address the issue of individual variability and psychological factors were given only a minimal role. These models address the problem of how beliefs are turned into action 185 08 health848.ch08 186 16/4/07 2:55 pm Page 186 CHAPTER 8 SEX using the behavioural intentions component. Since then, health education programmes have changed in their approach to preventing the spread of the virus. ? or Do you want to . This involves letting the miscarriage take its natural course and enables the woman to be at home as the miscarriage occurs. These processes are illustrated in Figure 3.2. Including psychology in theories of pain The early simple models of pain had no role for psychology. However, Wadden also concludes that most obese patients treated in research trials still regain their lost weight. Chapter 13 specifically examines the interrelationships between beliefs, behaviour and health using the example of placebo effects. they only felt isolation; second, the study illustrates how simply having a gay identity is not enough to prepare them for their new community and that they have to learn a gay specific knowledge and a gay language; and third, the study describes how this new culture influences their sexual behaviour. This presents the problem of a floor effect with little individual variability. Mahawah, NJ: Lawrence Erlbaum Associates. The sample was followed up over five-and-a-half and ten years in a prospective study and the authors reported that these seven behaviours were related to mortality. 1979) and others indicating no relationship (e.g. The research examining condom use has not produced consistent results. Salient events. I wanted to supplement US work with that from my colleagues from the UK, the rest of Europe, New Zealand and Australia. The prescriptive literature has recommended patient centredness as the preferred style of doctorpatient communication as a means to improve patient outcomes (Pendleton et al. Ley and Morris (1984) examined the effect of written information about medication and found that it increased knowledge in 90 per cent of the studies, increased compliance in 60 per cent of the studies, and improved outcome in 57 per cent of the studies. Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them. Therefore by tapping into variables such as implementation intentions it is argued that the models may become better predictors of actual behaviour. It then outlines the implications of placebos for the different areas of health psychology discussed in the rest of this book, such as health beliefs and illness cognitions, health behaviours, stress, pain and illness and places this within a discussion of the relationship between the mind and body and the interrelationship between beliefs, behaviour and health and illness. In Asia about 8.3 million people were living with HIV at the end of 2005 and most of these were in India. From this analysis the overeating shown by dieters is actually caused by attempts at dieting. The authors suggest that the intervention changed unbalanced coping profiles. health and fitness versus enjoyment). Second and relatedly, the results may reflect the conceptualization of impairment. This shift challenged the concepts of addictions, addict, illness and disease; however, the theories still emphasized treatment. However, placebos have been shown to have an effect on pain relief. The ethos of screening received impetus from multiphasic screening, which became popular in the USA in the late 1940s, and in 1951 the Kaiser Permanente organization incorporated screening methods into its health examinations. (2002, 2003a) searched a range of databases and located 18 trials that included some form of psychological therapy and sufficient information to be entered into the analysis. The authors concluded that acute exposure to stress resulted in negative changes in those behaviours that had only a minimal influence on the students ability to perform satisfactorily. Within the always jobless group, those who reported higher levels of social support reported far fewer physical symptoms than those who reported lower social support. . Further, those whose marriages were troubled at follow-up also showed higher levels of stress hormones at baseline than those whose marriages were untroubled. 1 Human beings as rational information assume that behaviour is a consequence measured. The link between hostility and heart disease illustrates a role for a physiological pathway with the associated heightened stress reactivity leading to cardiac damage. For example, hostile individuals may avoid social support and refuse to draw upon any help when under stress. . (2004) Chapter 2 Health beliefs Aiken, L.S., West, S.G., Woodward, C.K., Reno, R.R. (What is normal?) This model is based on approaches to problem solving and suggests that illness/symptoms are dealt with by individuals in the same way as other problems (see Chapter 4 for details of other models of problem solving). Fife-Schaw and Breakwell (1992) undertook an overview of the literature on condom use among young people and found that between 24 per cent and 58 per cent of 16- to 24-year-olds had used a condom during their most recent sexual encounter. This can take the form of behaviour change, encouraging changes in beliefs and coping strategies and compliance with medical recommendations. An early study explored the impact of social suggestion on childrens eating behaviours and arranged to have children observe a series of role models making eating behaviours different to their own (Duncker 1938). Women with breast cancer often report changes in their sense of femininity, attractiveness and body image. 1948). You are more mobile) measures of pain. Research may therefore be biased in terms of the areas of research selected, the data collected and funded and ways in which the research is interpreted and presented. Control has also been discussed by Bandura (1977) in his selfefficacy theory. Ways of coping Researchers have described different types of coping. The results showed that the monkeys illustrated not only behavioural signs of stress but also a marked increase in the disease of their coronary arteries. Ive been giving up trying to deal with it) denial (e.g. The first two are called specific immune processes and are cell mediated immunity and humoral mediated immunity. Consistency over modality: the same attribution would be made in a different situation. Psychological problems Research has examined the relationship between psychological problems and obesity. 1998). Kinsey argued that the sexual drive was a biological force and the expression of this drive to attain pleasure was not only acceptable but desirable. The results showed that those who were told that they had a genetic mutation reported a lower belief that their cholesterol could be managed by diet. In summary, social factors such as the behaviour and beliefs of parents, peers and schools influence the beliefs and behaviours of children. Here we are on cloud nine: how can we suddenly interrupt everything just to get a bit of rubber out and roll it on, Other guys fuck without a condom much more often than I do. However, some people recover more quickly than others and some research indicates that this rate of recovery may relate to a susceptibility to stress-related illness. 5 During sex. (2002b) explored peoples beliefs about HAART. Stress and changes in behaviour Stress has been mostly studied in the context of coronary heart disease (CHD). Further, they need to perceive the consequences of their behaviour change as valuable. A high-risk situation is any situation that may motivate the individual to carry out the behaviour. Because of this it is often seen by the health profession as a positive development. Dieters, however, also show episodes of overeating, particularly in response to triggers such as high calorie preloads, anxiety or smoking abstinence. There was a small subgroup in Rosss study who were both overweight and depressed who tended to be the most educated. Cognitive dissonance theory has mainly been tested using acute pain, which has been elicited in a laboratory setting. Perhaps the diagnosis following screening is the factor that creates distress and the subsequent treatment is regarded as a constructive and useful intervention. It is likely, however, that the very identication of a stressor in the rst place which may or may not then lead to illness is determined by the degree of coping, social support or control. (1992) examined the relationship between the pros and cons of exercise and stage of change in 778 men and women. 1976). East Sussex: Psychology Press. Crombez et al. Coping behaviour. As expected, the receipt of a positive result can be associated with a variety of negative emotions ranging from worry to anxiety and shock. These changes constitute the background effect of stress and cannot be detected by the individual. (1998) explored which factors were important for the transition between the earlier stages of adoption and the later stages of continued behaviour and concluded that continued exercise was predicted by intrinsic motives, specifically enjoyment. Likewise, Smith et al. Problems with life events theory The use of the SRE and similar measures of life experiences have been criticized for the following reasons: 1 The individuals own rating of the event is important. This study integrates the PMT with other cognitions in order to predict sexual behaviour in the context of HIV. This study examines addition examines the effect of expa social norms and previous behaviou Focus on research Boxes that include both recent and classic research studies in health psychology, explaining the background, methodology, results and conclusion of the work. (1990) Mokdad, A.H., Marks, J.S., Stroup, D.F. The role of social learning is also shown by the impact of television and food advertising. However, the number of calories that exercise burns up is relatively few compared with those in an average meal. Lazarus defined two forms of appraisal: primary and secondary. Lader and Matheson (1991) reviewed the data from national surveys between 1982 and 1990 and indicated that smoking behaviour in 11- to 15-year-old school boys including those boys who have just tried a cigarette had fallen from 55 to 44 per cent and that smoking in school girls of a comparable age had fallen from 51 to 42 per cent. Such characteristics have been described as emotional dependency, extroversion, neurosis and being highly suggestible. From this perspective comes the belief one drink a drunk, once a drunk, always a drunk and stories of abstaining alcoholics relapsing after drinking sherry in a sherry trifle. it is likely that I will start swimming next week). HIV, however, is a worldwide problem which affects people from all religions and cultural backgrounds. Research in this area has shown that these lay theories are at least as elaborate and sophisticated as medicines own explanatory models, even though they may be different. They also suggest that greater attention to the immediate effects of exercise may improve adherence to exercise programmes. This was shown to increase food preference. (1993) examined changes in mood, mental vigour and exhilaration in sportsmen and inactive men following maximal, moderate and minimal exercise. Therefore, in reality, stress is linked to illness via a complex interaction between behavioural and physiological factors. Some research has therefore attempted to increase stair use. (1991) showed that children selected different foods when they were being watched by their parents compared to when they were not. Stunkard, Stinnett et al. Rogers (1985) has also suggested a role for a fifth component, fear (e.g. (1997) Communication pattern of primary care physicians, Journal of the American Medical Association, 277: 3506. This is reflected in the use of the term arousal which has been criticized by more recent researchers. There is some exciting new research under way in health psychology and it is important that students are exposed to new studies and understand that health psychology is a dynamic discipline. (2002) communication and the role Marteau, T.M. The results again showed that stress management was effective and that this effect was related to reduction in cortisol and depressed mood. With reference to eating and smoking, the desire to smoke may be labelled as hunger and therefore satiated by food intake. For example, according to the gate control theory, anxiety reduction may close the gate and reduce pain, whereas increased anxiety may open the gate and increase pain (see Chapter 12). However, Self-monitoring Behaviour assessment Relaxation training Stress management Imagery High-risk situation No coping response Relapse fantasies Skills training Relapse rehearsal Contract Reminder card (what to do if you slip) Decreased self-efficacy Positive outcome expectancies Lapse Initial use of substance Abstinence violation effect Cognitive dissonance Internal attributions Education about effects of substance Decision matrix Programmed relapse Cognitive restructuring Figure 5.9 Relapse prevention intervention strategies (after Marlatt and Gordon 1985) 05 health848.ch05 16/4/07 3:18 pm Page 123 A CROSS-ADDICTIVE BEHAVIOUR PERSPECTIVE from a social learning perspective, it is possible to examine similarities between behaviours and to apply similar processes to the initiation, maintenance, cessation and relapse of behaviours such as exercise, sex, gambling and eating (e.g. An example of Totmans theory The following example illustrates the relationship between justification and the need to see oneself as rational and in control, and the problem of dissonance between these two factors. Current recommendations state that drugs should be used only when other approaches have failed, that they should not be prescribed for longer than three months in the first instance and should be stopped if a 10 per cent reduction in weight has not been achieved (Kopelman 1999). If so, consider the reasons that you did or did not become a smoker. This is in line with much research on adherence and illness representations and is discussed in detail in Chapter 3. 1998). Initially, it was defined according to the number of friends that were available to the individual. In 1989, it was reported that cancers are the second leading cause of death in the UK and accounted for 24 per cent of all deaths in England and Wales in 1984 (Smith and Jacobson 1989). They suggested that patients who expect treatment to be effective engage in other health practices that lead to improved clinical outcomes (Horwitz and Horwitz 1993). If the immune system overreacts then this can lead to allergies. 4 Control. I can feel a pain in my chest. Developing new coping strategies (e.g. Agreement between health professional and patient If health professionalpatient communication is seen as an interaction between two individuals then it is important to understand the extent to which these two individuals speak the same language, share the same beliefs and agree as to the desired content and outcome of any consultation. How should illness be treated? It is also a good introduction to psychoneuroimmunology. 1982). The study also looked at how many children both the working and the non-working women had and related this to CHD. Totmans model is illustrated in Figure 13.2. Karasek and Theorell (1990) report a study in which subjects were divided into low social support and high social support groups, and their decisional control and the demands of their job were measured. Furthermore, the models predict that high levels of susceptibility will relate to less risk-taking behaviour (e.g. Health Psychology (4th ed.) In terms of acute pain, pain increases anxiety; the successful treatment for the pain then decreases the pain which subsequently decreases the anxiety. 1 The mindbody split. Control over the stressor may decrease the effects of stress on the individuals health status. An emphasis on the interaction between health professionals and patients represents an attempt to examine the cognitions of both these groups in the context of each other (the relationship context). These stages, however, do not always occur in a linear fashion (simply moving from 1 to 5) but the theory describes behaviour change as dynamic and not all or nothing. Governments could opt to ban cigarettes and alcohol completely (although they would forego the large revenues they currently receive from advertising and sales). To support this theory, one study of 11,500 people in Scotland showed that men consuming the lowest proportion of carbohydrate in their diets were four times more likely to be obese than those consuming the highest proportion of carbohydrate. Mediterranean countries such as Italy, Portugal and Spain ate the most fruit and England and Scotland ate the least. (1992) aimed to examine the relationship between psychosocial factors and NKCC in HIV-positive men. access for your students, Customer Service & Tech Support contact information, FAQs, articles, chat, email or phone support, Instructor tools, training and resources for, Get step by step instructions for requesting an evaluation, exam, or desk copy, https://www.mheducation.com/cover-images/Jpeg_400-high/1260253902.jpeg. After eating/drinking the preload, subjects are asked to take part in a taste test. It functions to generate change either in the form of seeking help or avoiding activity. 2 Start of the evening. cue exposure) and body (e.g. Mapes (1980) suggested that they vary in terms of their prescribing behaviour, with a variation of 1590 per cent of patients receiving drugs. It then discusses the relationship between illness cognitions, symptom perception and coping behaviour. (eds) (2001) Behavioural Factors and Interventions in Pain and Musculoskeletal Disorders: A Special Issue of the International Journal of Behavioural Medicine. (1997) Writing about emotional experiences as a therapeutic process, Psychological Science, 8(3): 1626. What opens the gate? Chronic benign low back pain is most often a midlife condition and is the single largest cause of disability and time lost at work in the western world. Balancing the different ethical positions and perspectives of medicine can prove difcult. their habits and preferences. The results also showed some changes over time, with patients being less likely to blame their behaviour and/or personality as time went on. Conclusion The results from this study support the use of the PMT to predict sexual behaviour in the context of HIV. Discuss. These data indicate an overall increase in condom use as the usual form of contraception, which is particularly apparent in the younger age groups. This involves improving muscle tone, improving self-esteem, improving self-efficacy, improving distraction and decreasing boredom, pain behaviour and secondary gains. Furthermore, if risk factors can be modified then the likelihood of a further MI is greatly reduced. 1992). to have sex without intercourse, to have intercourse without a condom, to have exciting sex, to have a drink or get mildly stoned); and (ii) to rate their mood at this time (e.g. .btn-primary{white-space: normal !important;}. Therefore increased exercise decreases blood pressure. My symptoms appear to have been reduced by doing relaxation exercises may be a form of denial). Background It is generally believed that early detection of both breast and cervical cancer may reduce mortality from these illnesses. At the end of 2005 there were 5.5 million people in Sub-Saharan Africa who were living with HIV. These factors are dealt with in detail later on. Chronic low back pain is often described as chronic benign pain whereas illnesses such as rheumatoid arthritis result in chronic progressive pain. Impact of mode of treatment Miscarriages can occur throughout a pregnancy but most occur during the first trimester (Steer et al. In addition, measures of smoking behaviour were taken. Several studies indicate that blacks are less active than whites, that black women are especially less active and that these differences persist even when income and education are controlled (e.g. This suggests that social support enables individuals to change their role or identity according to the demands of the stressor. (1959) listed a whole series of areas where placebos have been shown to have some effect, such as allergies, asthma, cancer, diabetes, enuresis, epilepsy, multiple sclerosis, insomnia, ulcers, obesity, acne, smoking and dementia. Recently, however, some researchers have been calling for a shift in focus towards pain acceptance. This can then cause a further decrease in the pain. They argued that the degree of mastery may be related to the stress response. This conceptualizes these two processes as separate and discrete. It has been suggested that fat does not switch off the desire to eat, making it easier to eat more and more fat without feeling full. Therefore, in order to understand the processes involved in health professionalpatient communication, the resulting management decisions and any variability in the outcome of the consultation, both the patient and health professional should be considered as a dyad. If the doctor believes that an illness is the result of lifestyle, and can be cured by changes in that lifestyle, then a placebo in the form of a medical intervention may not work, as the doctors expectation of failure may be communicated to the patient. Self-reports Self-report scales of pain rely on the individuals own subjective view of their pain level. The term stress means many things to many different people. Over recent years, due to government documents such as Health for All and The Health of the Nation, primary care team members are spending more time on health promotion practices, which often involve making recommendations about changing behaviours such as smoking, drinking and diet. These debates are best understood within the context of the four major ethical principles relating to decision-making principles in medicine: beneficence, non-maleficence, autonomy and justice. Acute pain is defined as pain that lasts for six months or less. 3 Expert stage: at this stage, the individual has incorporated sexuality into their self-concept and will seek professional advice and plan contraceptive use. In the final session, this action plan was reviewed, concerns about medication were explored and symptoms that were part of the recovery process such as breathlessness upon exercise were distinguished from those that were indicative of further pathology such as severe chest pain. They suggested that most patients experience spontaneous recovery following illness as most illnesses go through periods of spontaneous change and that patients attribute these changes to the treatment. Research is needed to explore how women experience expectant management as it becomes the more normal approach used. Therefore, regardless of what the drug was (whether a beta-blocker or a placebo), taking it as recommended halved the subjects chances of dying. Factors such as the availability of facilities and cultural attitudes towards exercise may be related to individual participation. The role of psychology in the study of HIV HIV is transmitted mostly because of peoples behaviour (e.g. Early data from San Francisco, which had one of the highest homosexual incidences of HIV, showed that by the late 1980s the incidence of new HIV infections had fallen dramatically and that by the late 1990s had become essentially stable (Katz 1997; Schwarcz et al. As psychological factors appeared to have a role to play in eliciting pain perception, multidisciplinary pain clinics have been set up to use psychological factors in its treatment. Traditional treatment programmes aimed to correct the obese individuals abnormal behaviour, and recent packages suggest that the obese need to readjust their energy balance by eating less than they usually do. et al. Longshoremen have occupations that involve a range of energy expenditure. However, all subjects reported increased exhilaration and increased mental vigour two minutes after both the maximal and moderate exercise compared with the minimal condition, and in addition, the increase in exhilaration was maintained after the 30 minutes of recovery. For those few who do succeed in their attempts at weight loss, Wooley and Wooley (1984: 187) suggest that they are in fact condemned to a life of weight obsession, semi-starvation and all the symptoms produced by chronic hunger . Immunocompromise is when the immune system is failing in some way. 103 05 health848.ch05 104 16/4/07 3:18 pm Page 104 CHAPTER 5 SMOKING AND ALCOHOL USE The description of controlled drinking, which suggested that alcoholics can return to normal drinking patterns (Davies 1962; Sobel and Sobel 1976, 1978), challenged the central ideas of the disease model.
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