Test: Psychology and Life- 2

As health behaviours seem to be important in predicting mortality and longevity, health psychologists have attempted to increase our understanding of health-related behaviours. In particular, based on the premise that people behave in line with the way they think, health psychologists have turned to the study of health beliefs as potential predictors of behaviour

The stages of change model (also known as the trans-theoretical model of behaviour) was originally developed by Prochaska and DiClemente (1982) as a synthesis of 18 therapies describing the processes involved in behavioural change. These researchers suggested a new model of change which has been applied to several health-related behaviours, such as smoking, alcohol use, exercise, and personal screening behaviour such as going for a cervical smear or attending for a mammograph (e.g. DiClemente et al., 1991; Marcus, Rakowski & Rossi, 1992).
The model describes behaviour change as dynamic, rather than being ‘all or nothing’, so the five stages do not always occur in a linear fashion. For example, an individual may move to the preparation stage and then back to the contemplation stage several times before progressing to the action stage. Even when an individual has reached the maintenance stage, they may slip back to the contemplation stage over time. The model also examines how we weigh up the costs and benefits of a particular behaviour. In particular, individuals at different stages of change will differentially focus on either the costs of a behaviour (‘Giving up smoking will make me anxious in company’) or the benefits (‘Giving up smoking will improve my health’).

The original core beliefs are the individual’s perception of:

• susceptibility to illness – ‘My chances of getting lung cancer are high’;
• the severity of the illness – ‘Lung cancer is a serious illness’;
• the costs involved in carrying out the behaviour – ‘Stopping smoking will make me irritable’;
• the benefits involved in carrying out the behaviour – ‘Stopping smoking will save me money’; and
• cues to action, which may be internal (e.g. the symptom of breathlessness) or external (e.g. information in the form of health education leaflets).

The beliefs of the important people in your life represent the subjective norms related to the behaviour, therefore personal attitude toward the behaviour and perceived control over the behaviour are the two additional factors necessary to evoke behavioural change.

All of these risk factors are associated with coronary heart disease except for hormones.

Contemporary definitions of stress regard the external environment as a potential stressor (e.g. problems at work), the response to the stressor as stress or distress (e.g. the feeling of tension), and the concept of stress as something that involves biochemical, physiological, behavioural and psychological changes.
Researchers have also differentiated between stress that is harmful and damaging (‘distress’) and stress that is positive and beneficial (‘eustress’). The most common definition of stress was developed by Lazarus and Launier (1978), who regarded it as a transaction between people and the environment. Within this definition, stress involves an interaction between the stressor (‘My job is difficult’) and distress (‘I feel stressed by it’). So a stressful response might be the feeling of stress that results from a mismatch between (i) a situation that is appraised as stressful and (ii) the individual’s self-perceived ability to cope and therefore reduce the stress.

More recent models of stress allow for active interaction between the individual and external stressors, rather than passive response. This approach provides a role for psychological state. It is epitomized by Lazarus’s transactional model of stress and his theory of appraisal: In the 1970s, Lazarus introduced the psychological dimension into our understanding of the stress response (1975; Lazarus & Cohen, 1973, 1977). He argued that stress involves a transaction between an individual and his or her external world, and that a stress response is elicited if the individual appraises an event as stressful. Lazarus defined two forms of appraisal:

1. Primary appraisal: the individual initially appraises the event in three ways – as (a) irrelevant, (b) benign and positive or (c) harmful and negative.
2. Secondary appraisal – the individual evaluates the pros and cons of his or her different coping strategies.So primary appraisal is essentially an appraisal of the outside world and secondary appraisal is an appraisal by the individual of himself.

Alarm, resistance and exhaustion refer to the three stages of Selye’s model that describes the stress process from onset of the stressor to the effects of chronic stress. Life events theory is another stress model that examines stress and stress-related changes as a response to life change.
The self-regulatory model describes the relationship between people’s illness beliefs and their subsequent coping mechanisms. Protection motivation theory is an extension of the health belief model, and both attempt to explain changes in health-related behaviours.

All of the above have been identified as beliefs of health professionals that can bias and/or affect the information used by professionals to make their initial diagnoses.

Psychology has a role to play at all stages of illnesses like CHD:

1. Psychological factors influence the onset of CHD. Our beliefs about both behaviour and illness can influence whether we become ill or stay healthy. For example, someone who believes that ‘lots of people recover from heart attacks’ may lead an inactive and sedentary lifestyle; and a belief that ‘smoking helps me deal with stress’ is hardly likely to help someone give up smoking. Beliefs such as these therefore result in unhealthy behaviours that can lead to CHD.
2. Once ill, people also hold beliefs about their illness and will cope in different ways. Psychology therefore continues to play a role as the disease progresses. For example, if someone believes ‘my heart attack was caused by my genetic make-up’, they may cope by thinking ‘there is nothing I can do about my health; I am the victim of my genes’. Beliefs like this are likely to influence the progression of the illness either by affecting behaviour or by having an impact on the immune system.
3. Psychology also has a role to play in the outcome of CHD. For example, believing that a heart attack is due to a genetic weakness rather than a product of lifestyle may mean that a person is less likely to attend a rehabilitation class and be less likely to try and change the way they behave. People also differ in other ways regarding their experiences of illness and their ability to adjust to such a crisis in their lives. For example, while some people cope by taking definite action and making plans about how to prevent the illness getting worse, others go into a state of denial or cope by indulging in unhealthy behaviours, making the situation worse. Such factors can impact upon their quality of life, possibly even influencing how long they live.