BTEC Pearson Extended

Certificate

Unit 3: Health Psychology

Revision guide
 Topic – unit 3 Notes? Revised? Rag
rate
Learning aim A: Definitions of health
Biomedical vs biopsychosocial

Griffiths six components of addiction

Physiological vs behavioural addiction

Definition of stress vs stressor

Learning aim A: Psychological approaches to health

Biological influences e.g., genetics or neurotransmitters

Behaviourist influences e.g., positive reinforcement,

cues etc

Social learning approach e.g., role models

Cognitive approach e.g., cognitive bias or dissonance

Learning aim A: Theories of stress and addiction

Health belief model

Locus of control

Theory of planned behaviour

Self-efficacy theory

Transtheoretical model

Learning aim B: Causes of stress

Life events and daily hassles

Role of workplace stress

Personality

Learning aim B: Responses to stress

General adaptation syndrome (GAS)

Sympathomedullary (SAM) system

Hypothalamic-pituitary-adrenal (HPA)
The role of adrenaline
Limitations of viewing stress as a physiological
response
Learning aim B: Physiological (substance) addiction
Smoking – biological approach

Smoking – learning approach

Alcohol – learning approach

Alcohol – cognitive approach

Learning aim B: Behavioural (Non-substance) addiction

Gambling – cognitive approach

Gambling – learning approach

Shopping – learning approach

Shopping – cognitive approach

Learning aim C: Theories of persuasion

Hovland-Yale theory

Fear arousal theory

Elaboration-likelihood model

Learning aim C: Treatment of addiction and stress

Mindfulness

Relaxation

Talking therapies e.g., CBT

Social support (instrumental, emotional and esteem)

Biofeedback

Skills training

Learning aim C: Reasons for non-adherence

Stress

Rational non-adherence
Learned helplessness.

Irrational thoughts

Lack of social proof

Lack of support

Learning aim C: Methods used to improve adherence

Health education

Reduction of perceived threats

Lifestyle changes

Increased availability of activities

Definitions of stress and addiction
Biomedical model a definition of health that focuses on
physical, medical, and biological
explanations e.g., genetics.

Biopsychosocial a definition of health that focuses on

biological, psychological, and social
explanations.

Physiological addiction addicted to a substance such as smoking and

alcohol

Behavioural addiction addicted to a non-substance such as

shopping and addiction

Stress a psychological or physiological response to

a stressor. This can be positive or negative.

Stressor anything physiological or psychological that

produces a stress response e.g., divorce,
examinations, marriage, moving house etc.

Models of health: Health belief model

This model suggests the likelihood of whether an individual will take part in a heath
behaviour e.g., quitting smoking.
Perceived susceptibility – individuals' assessment of their risk of getting the condition.
Perceived severity – individuals' assessment of the seriousness of the condition and the
consequences
Perceived benefit – individuals' assessment of the positive outcomes of adapting the
behaviour.
Perceived barriers – individuals' assessment of the influence that support the behaviour being
carried out.
Cues of action - they are triggers to remind the individual that they need to do something.
They can be either internal: feeling out of breath or external: health promotion advert.
Demographic variables – can be applied with psychosocial factors to predict the likelihood
that a behaviour will occur and are a starting point in finding out where the individuals'
beliefs about their health started from.
Evaluation –
Strengths Weaknesses
 This model helps to understand The HBM structure indicates that
people’s perception of health and humans process information in an
the factors that will influence them unrealistic manner and sometimes
to seek health advice e.g., if people humans act rationally.
believe they are susceptible to
cancer through a family history, Other models of health may better
they are likely to opt in for cancer explain behavioural change e.g.,
screening. viewing self-efficacy as a motivator to
change.
Models of health: Theory of planned behaviour
Perceived behavioural control
Definition: how much control we believe we have over our behaviour.

· (PBC) can indirectly influence our intentions to behave- e.g., the more control I believe I have, the
stronger my intention is.
· PBC can also influence behaviour directly- e.g., the more control I believe I have, the longer and
harder I will try to do something.
Subjective norms
Definition: the individuals' belief about whether the people who matter most to them approve or disapprove
of their behaviour.

 For example, an alcohol addict considers what their friends and family think about their addiction;
the alcoholic might conclude; “most people who matter to me are very unhappy with me drinking
like this”.
 This would make them less likely to drink.

Personal attitudes

 an individual's favourable and unfavourable beliefs about their behaviour. e.g., “I overeat because I
enjoy food” vs “overeating makes me anxious”.
 The persons overall attitude is formed from the balance of positive and negative judgements of their
own behaviour.
Research section

 Ajzen (1985, 1991) formulated the theory of planned behaviour (TPB) to explain how people can
exercise control over their behaviour. Central to the theory is the concept of initiation- the TPB
asserts that behaviour can be predicted from our intentions to behave. Applied to health the TPB
links intentions to change behaviour (e.g., give up drugs).

Strengths
One strength of the TPB is that there is support for
some of its predictions.
Hagger et al (2011) found that personal attitudes,
subjective norms, and PBC all predicted an
intention to limit drinking to a guideline number of
drinks.
Intentions then influenced the number of units
actually consumed after one month and three
months.
This supports the TPB because these outcomes
were all exactly as the theory predicted (in relation
to alcohol addiction).
Weaknesses
One weakness of the TPB is that it cannot account
for the intention behaviour gap.
Miller and Howell (2005) studied the gambling
behaviour of underage teenagers.
They found they could not predict the reduction of
actual gambling behaviour from intentions to give
up (there was no relationship between intentions
and what the teenagers eventually did).
This means that the TPB cannot predict behaviour
change, which suggests it can't be used for
interventions.
Models of health: Locus of control theory
Locus of control refers to the sense we have about what directs events in our lives.
“internals”- believe they are responsible for what happens to them.
“Externals”- believe luck or other people influence what happens to them.
These are known as internal and external locus of control.
Internal and external locus of control
Rotter (1966)
Some people believe they are responsible for what happens to them- they have an internal locus of control.
 E.g., `I did well in my exams because I tried hard`
Others believe things are out of their control or happen due to luck- they have external locus of control.
 E.g., `I did well in my exams because my teacher was great`
Attributions and health behaviour
Attribution- the process of explaining our own/other people's behaviour.
We explain our own/others behaviour based on internal and external causes internals and externals
“attribute” their own health- related behaviours to different causes.
Attributions and health behaviour: addiction
 Internals views their behaviour as under their control.
In terms of addiction, they may avoid risk factors (resisting influence from peers, avoiding situations of
stress)
 Externals view their behaviour as a result of luck or their genetics.
This means they’re less likely to take control/ engage in health- changing habits. This means they won’t
actively avoid risk factors as they think it will happen either way. So, in the case of addiction, we would
assume the externals are more likely to suffer with addiction.
Strengths Weaknesses
Gale et al, (2008) measured the locus of control of Some people may fluctuate between an internal and
7551 children, aged 10. external locus of control and therefore their LOC is
Their research found that by the time these children not a good predictor of health, because it will
were 30, those who had categorised as an internal
change based on the situation.
when they were younger were less likely to
experience psychological stress, compared to those
who were categorised as external. Other models of health may better explain
This supports the theories idea that internal behavioural change e.g., viewing self-efficacy as a
individuals are able to respond to stress more motivator to change.
effectively.

Models of health: Self-efficacy

Key terms:
 Self-efficacy – a person’s confidence in being able to do something. Such confidence generates
expectations and these act as self-fulfilling prophecies.
Key points:
 Mastery experiences:
- the more positive experiences we have, the higher the self-efficacy.
- the more failures we have, the lower self-efficacy.
 Vicarious influences:
- self efficacy is affected by observing another person.
- observing a person being successful increases self-efficacy.
- observing a person failing decreases self-efficacy.
 Social persuasion influences:
- encouragement and discouragement from others can have a profound impact on our self-efficacy. -
social persuasion – using words is a form of social persuasion.
- Bandura focused on verbal persuasion.
- the effects of social persuasion depend on the perceived credibility of the persuader.
- social persuasion is less influential than mastery and vicarious experiences, but it is easier to
provide.
 Emotional influences:
- self-efficacy is influenced by the person’s emotional state.
- stress, anxiety and fear can all reduce self-efficacy.
Strengths Weaknesses
Strength: the theory offers several strategies that Weakness: it assumes that high self-efficacy is
interventions can use to produce behaviour change. universally a positive thing, but there is evidence
For example, the theory suggests that opportunities that it can backfire.
to perform a task successfully have to be structured In one study, Vancouver et al (2002) increased
very carefully. The target behaviour should be students’ self-efficacy by giving them social
broken down into achievable elements, with the persuasion as they played a puzzle-based game.
earlier ones easier than later ones. This increased the performance of many students
Therefore, the theory provides many useful on the current game but lowered it on the next. The
practical suggestions. researchers then withheld feedback, which lowered
the student’s self-efficacy but increased their
performance.
The researchers argued that high self-efficacy may
lead to overconfidence, which means the individual
makes less effort the next time they perform a task.
This suggests the model is flawed because it does
not predict some of the negative effects of high
self-efficacy.
Models of health: Transtheoretical model
Strengths
A strength of the Transtheoretical Model of Health
is that it views relapse realistically.
For example, the model acknowledges that
overcoming addiction happens in stages, and that it
doesn’t happen overnight.
This is a strength because it is not considered a
biased way of thinking, in the sense that it does not
assume one thing, and it comes from a realistic
point of view.
Weaknesses
A weakness of the Transtheoretical Model of
Health is that it is reductionist. It doesn’t consider
other models of health.
For example, it doesn’t consider self-efficacy
theory, which looks at various influences for
boosting self-esteem.
This is a weakness because other models of health
may be more effective, therefore they need to be
considered.
Causes of stress: Daily hassles
Daily hassles are defined as small but frequent events that cause stress.

 Most 43 life changes in the SRRS aren’t everyday events. Kanner et al (1981) has designed a hassles
scale which consists of 117 items, including concerns about losing things, traffic jams, disappointments,
weight, and physical appearance.
 Daily Hassles are “irritating, frustrating, distressing demands that to some degree characterise everyday
transactions with the environment.”
 Kanner (1981) states that everyday events can have a positive effect on stress, and these are called ‘daily
uplifts.
 Kanner aimed to compare the hassles and uplift scale with the Social Readjustment Rating Scale (SRRS)
as predictors of psychological symptoms of stress such as ill health.
Kanner’s Study:
100 participants (52 women and 48 men) aged 45-64 participated in a 12-month study. The tests were sent to
them one month before the study began and a month later, they had an assessment via interview. They were
due to complete the hassles and uplift scale, the SRRS and self-reporting symptom checklist. They found
that men’s life events were positively correlated with hassles and negatively correlated for uplifts. For
women, life events positively correlated with both hassles and uplifts. They found the hassles scale tended to
be a more accurate predictor of stress related problems, such as anxiety and depression, than the SRRS.
Uplifts had a positive effect on the stress levels of women, but not men.

Strengths
Further research has provided evidence to support
Kanner (1981) findings that daily hassles
significantly increase the chances of psychological
and physical dysfunction.
For example, Ruffin (1993), carried out a study in
Australia and found that daily hassles were linked
to greater psychological and physical dysfunction
compared to negative life events.
Weaknesses
A weakness of daily hassles as a cause of stress is
that it ignores other causes of stress.
For example, it ignores workplace stress which
looks at environmental and organisational factors.
This is a weakness because daily hassles are not the
only cause of stress. Others need to be considered.

This is a strength because such findings.

support Kanner’s research highlighting that it is the
presence of daily hassles as opposed to negative life
events make an individual more vulnerable to
illness.
Causes of stress: Major life events
Life events are defined as large but infrequent events that cause stress.
Holmes and Rahe (1967) created the Social Readjustment Rating Scale (SRRS) which measures life events
and stress. They asked a sample of people to adapt to 43 stressful life events. The items more stressful were
given Life Change Units (LCU), these are the number of points awarded on an item on the SRRS. The level
of stress was measured by asking people to self-report how many stressful life events they had in the past 1-
2 years. Examples of events were Death, marriage, moving house etc.
Rahe et al (1970) investigated whether scores of the SRRS correlated with the onset of illness. 2664 males
from the US Navy Cruisers were given the SRRS prior to a tour lasting 6-8 months and were asked how
many life events they had experienced in the previous six months. They found a small but positive
correlation between life change scores and illness scores across all ships. As life change scores increase, so
does the illness.

Strengths Weaknesses
A strength of major life events as a cause of stress A weakness of major life events as a cause of stress
is that it is supported by Rahe. is that it ignores other causes of stress.

For example, Rahe found that there was a small but
positive correlation between life change scores and
illness scores.
This is a strength because this cause of stress has
research to back it up.
For example, it ignores workplace stress which
looks at environmental and organisational factors.
This is a weakness because major life events are not
the only cause of stress. Others need to be
considered.
Causes of stress: Role of workplace stress
Workplace stress refers to factors within the working environment (e.g., the effects of overload or control)
that are experienced as being stressful, and which cause a stress reaction. In recent years, the workplace has
been seen as the major source of stress with millions of adults attributing their highly stressed state to the
demands of their job.
Workplace stressors are aspects of the workplace environment which elicit a stress response therefore which
we experience as stressful.
Control – in many organisations, other people determine workload, work patterns, and limit the number and
type of decisions employees can make.
Workload – how much work and the type of work a person does. Too much and too little can lead to stress.
People with a hardy personality are more likely to cope with stress. A hard personality explains someone
that is resilient and can cope with change.
Johansson et al’s study: He aimed to investigate the stress response in the workplace, he did this with a high-
risk group and a control group. All workers were on money and linked pay and worked in shifts. The high-
risk group had better lighting and exposed to more noise, dust, and accident rates. All participants performed
urine tests and self-report methods to test mood.
Results: Adrenaline levels of the high-risk group were doubled than their normal levels and continued to rise
through their shifts. The high-risk group were irritable and reported feeling rushed.

Strengths Weaknesses
+ Scientific - Low sample group
For example, measures adrenaline levels For example, 24 in total, 14 in high risk, and 10 in
As a result, makes findings more reliable. control
+ Measures physiological and psychological factors As a result, is hard to generalise.
For example, adrenaline and mood through self-
report methods
As a result, is low in reductionism.
Causes of stress: Personality
 Freidman & Rosenman developed 4 personality types involved with stress (Type A, B, C, D)

 Type A- competitive, hostile, impatient- most likely to become stressed. People with a type A
personality have a higher risk of suffering from heart disease

 Impatient - Type A personalities experience a constant sense of urgency: Type A people seem to be
in a constant struggle against the clock.
 Often, they quickly become impatient with delays and unproductive time, schedule commitments too
tightly, and try to do more than one thing at a time, such as reading while eating or watching
television.
 Hostility - Type A individuals tend to be easily aroused to anger or hostility, which they may or may
not express overtly. Such individuals tend to see the worse in others, displaying anger, envy, and a
lack of compassion.
 When this behaviour is expressed overtly (i.e., physical behaviour) it generally involves aggression
and possible bullying (Forshaw, 2012). Hostility appears to be the main factor linked to heart disease
and is a better predictor than the TAPB as a whole.
 Competitiveness - Type A individuals tend to be very competitive and self-critical. They strive
toward goals without feeling a sense of joy in their efforts or accomplishments.
 Interrelated with this is the presence of a significant life imbalance. This is characterized by a high
work involvement. Type A individuals are easily ‘wound up’ and tend to overreact. They also tend
to have high blood pressure (hypertension).

 Type B- easy going, patient, relaxed-less likely to become stressed.

Strengths
A strength of using personalities as explanation of
stress is that there is research for Type A
personalities and its role in illness.
For example, José
Weaknesses
A weakness of personality explanation of stress is
that it ignores other explanation of stress.
For example, it ignores major life events.

This is a weakness because someone could think

they have a type a personality which could increase
their stress when there could be another explanation
for that certain individual
Physiological responses to stress: General adaptation syndrome
1. Alarm- The body's mechanism to deal with stress are activated. Brain sends signals to
hypothalamus. Stress-related hormones increase. Heart rate and blood pressure
increase.
2. Resistance- The body holds this level of response. After a while, the response systems
begin to show signs of strain. Stress-related illness then occur as the immune system
becomes compromised and is unable to cope. Situation becomes long term (chronic)
3. Exhaustion- The long-term stress level can make the body very tired. The body uses
all its energy.
Physiological responses to stress: SAM system
Key definitions:
Key term Definition
Hypothalamus The control centre of the brain

Sympathetic nervous system The nervous system responsible for dealing with threats

Fight/flight Automatic physiological reaction to a perceived threat

Adrenal gland Produces hormones to help regulate response to stress and other essential
functions
Adrenaline A hormone produced by the adrenal glands which is part of the body’s acute
stress response neurotransmitter-prepares for fight/flight
Parasympathetic nervous system The nervous System responsible for slowing down the stress response

· Body is threatened by a stressor.

· Hypothalamus activates the sympathetic nervous system.
· Sympathetic nervous system activates adrenal gland which releases adrenaline.
· Body goes to fight/flight.
· Parasympathetic nervous system restores body to homeostasis.
Physiological responses to stress: HPA system
Key term Definition
Hypothalamus The control centre of the brain
CRF Corticotropin releasing factors
Pituitary gland Controls all hormones
ACTH Controls the production/release of cortisol
Adrenal gland Produces hormones to help regulate response to stress and other essential functions
Cortisol Stress hormone

· Hypothalamus releases CRF which stimulates the pituitary gland.

· Pituitary gland releases adrenaline which causes bodily changes.
· Pituitary gland releases ACTH.
· ACTH notifies the adrenal gland to release cortisol.
· Hypothalamus and pituitary gland work together to monitor levels of cortisol.
Physiological responses to stress: the role of adrenaline
Adrenaline activates the “fight/flight” system which prepares the body for stressful
situations. This allows a person to either run in a stressful situation from danger or fight the
threat to reduce the danger. This system tends to be more active in men because women have
the “tend and befriend” response which means they are nice to the threat to reduce the danger
they are in. A “freeze response” is when adrenaline is active, but the person stops and mind
goes blank, so they do not know what to do.
The link between stress and ill health
Short term effects
Some short-term effects of stress are headaches, muscle tensions, upset stomach and
temporary alterations to heart rate and blood pressure.
Long term effects
Long term effects of stress include a variety of mental health issues such as depression,
anxiety, and personality disorders.
The link to cardiovascular disorders
The fight or flight response activates an increase in blood pressure which can cause long-
term damage resulting in a heart attack. Coronary heart disease has contributing risk factors
(gender, age, genetics etc.) which coupled with stress there is an increased risk of coronary
heart disease.
Issues with self-reporting
Strengths
It is the most accurate way of measuring a person’s
thoughts and opinions as the responses are coming
directly from them.
This means that it’s more accurate and more valid
in comparison to someone else judging their
behaviour e.g., a doctor or a clinician.
Weaknesses
The person may not be telling the truth as they feel
pressure to think a certain way due to social
influence or environmental norms, they live in. This
is due to the social desirability bias which states
that people will become biased when reporting on
themselves because they wish to look good in front
of others.
Questions may be too confusing for people,
therefore responses from the person will not be
accurate as they will not be answering the questions
properly.
This means that their data will not be accurate and
therefore not valid.
Limitations of seeing stress as a physiological response
Limitation Explanation
More than two responses The freeze response and the mental action or process of acquiring
knowledge and understanding through thought, experience, and the
senses. This shows that other factors such as cognition also plays a role
in the way we deal with stress. *

Gender differences Most research into the fight/flight response was conducted on males
therefore, we cannot apply the same to females. Researcher has
suggested that females adopt a ‘tend and befriend’ response due to the
care-giving attachment which influences arousal levels. Females are
more likely to befriend an enemy and seek social support which releases
endorphins, making them feel good and motivates them to act in a
friendly manner
Dependent on personality The Type A personality types of behaviour makes them more prone to
stress-related illnesses such as CHD, raised blood pressure, etc. Such
people are more likely to have their “flight or fight” response set off
by things in their environment.

Fight/flight system is not While the fight or flight response may have been a useful survival
helpful in modern society. mechanism for our ancestors, who faced genuinely life-threatening
situations (e.g., from predators), modern day life rarely requires such an
intense biological response. Furthermore, the stressors of modern-day
life can repeatedly activate the fight or flight response, which can have a
negative consequence on our health. For example, humans who face a lot
of stress and continually activate the sympathetic nervous system,
continually increase their blood pressure which can cause damage to
their blood vessels and heart disease. This suggests that the fight or flight
response is a maladaptive response in modern-day life.
Physiological addiction: Smoking
Smoking addiction Biological Approach
Initiation Nicotine (this is the drug/substance
found in tobacco) binds with
dopamine which creates pleasure and
will give smokers a rush.
Maintenance Nicotine binds with ACTH and
replaces dopamine. For a smoker to
get a ‘rush’, they must have nicotine
in their system to gain pleasure.
Whereas previously, dopamine was
the substance to gain pleasure.
Receptors become DEPENDENT on
nicotine.
Relapse A1 allele – gives people a genetic
predisposition to being a smoker (if
you have this allele, you are more
prone to smoking and to relapse)
Evaluation Strength- helped develop treatments
such as nicotine replacement therapy
e.g., nicotine replacement patches.
This helps patients to self-treat their
addiction, makes them feel more
empowered and would save the NHS
more money.
Weakness- doesn't consider other
factors such as the influence of role
models
Physiological addiction: Alcohol
Learning Approach
Social learning theory - Role models who
smoke. · People will observe someone
smoking and then imitate that behaviour
by smoking themselves
Negative reinforcement – people will
continue to smoke (reinforcement)
because it reduces their stress (negative)
Classical conditioning – associate
smoking with good experiences (e.g.,
social events) and this is a rewarding
experience.
Positive reinforcement – you smoke to get
the ‘buzz’.
Cue reactivity – adverts may contain
smokers, and this means that people
return to smoking because the cues bring
back positive feelings.
Strength- helped develop Stress
Inoculation Therapy, for example people
can be counter-conditioned to relax in
response to stress. This has helped to
reduce addiction which in turn has helped
to reduce the cost to the NHS due to
preventing future addictions.
Weakness- Doesn't consider biological
factors such as the influence and power of
nicotine on dopamine.
Alcohol addiction Learning Approach
Initiation Social learning theory - Role models
who drink alcohol.
People will observe someone
drinking alcohol and then imitate that
behaviour by drinking alcohol
themselves
Maintenance Positive reinforcement- people drink
alcohol to have a good time.
Negative reinforcement- people will
continue to drink (reinforcement)
because it reduces their stress
(negative)
Classical conditioning – associate
smoking with good experiences (e.g.,
social events) and this is a rewarding
experience.
Relapse Cue reactivity- adverts may contain
people drinking alcohol and this
means that people return to drinking
because the cues bring back the
positive feeling
Evaluation Strength- helped develop Stress
Inoculation Therapy, for example
people can be counter-conditioned to
relax in response to stress.
Weakness- Doesn't consider
biological factors
Cognitive Approach
Self-medication model – drink to treat
underlying trauma e.g., loss of a parent
etc, and this lifts people’s mood or fills a
void or creates euphoria.
Cognitive bias – errors in thinking e.g.,
recall bias – they remember the good
times with alcohol.
Irrational beliefs – beliefs that have no
basis in reality e.g., drinking will save my
marriage, drinking will make me happy
or forget.
Rebound effect – the less they have the
more they want.
Break down in coping strategies – when
you feel alone, you turn to alcohol as
your ‘friend’.
Withdrawal symptoms
Strength- helped develop CBT as a
treatment, this eases pressure on health
industries like the NHS.
Weakness – Doesn't consider socially
influenced factors such as the influence
of role models on the development of
addiction.
Behavioural addiction: Shopping
Cognitive approach
Initiation The self-medication model says that
people select this addictive behavior of
shopping as it helps them in situations,
they are in.
E.g., Feeling unhappy about looks
Engage in shopping behavior as it’s a
distraction from psychological issues.
E.g., depression
Believing shopping is essential,
disregarding the normal rational thought
process.
Maintenance Individuals believe that shopping is
helping their problems and gives a sense
of self-confidence. Cognitive bias will
take over. People will feel excited once
the purchase is made which results in
guilt and the cycle continues.
Relapse Withdrawal symptoms such as boredom
and sadness will make them want to shop
again.
Evaluation Cognitive explanations have led to
successful therapies which can be used to
treat the basis of shopping addiction
through cognitive behavioural therapy.
This happens between the therapist and
patient identifying the irrational thoughts
and cognitive biases and challenging
them. The fact that CBT is successful
suggests that shopping addiction could
have a cognitive bias.
Learning approach
Shopping addiction can result from direct
reinforcement, such as being complimented.
Or vicarious reinforcement I.e., seeing others
being complimented for their purchases.
Social media places emphasis on appearance
and the desire to be considered trends and
fashionable.
Rewards are seen as positive reinforcement,
for example receiving compliments. The
compulsive belief that people can buy items
combined with poor credit can make people
think that they're happier, which is a negative
reinforcement.
Cue reactivity from social media or media in
general can mean people find it difficult to
not make a purchase. Shopping can substitute
low self-esteem, guilt, or frustration.
Spending too much money can cause
unpleasant feelings which makes them want
to shop.
Learning explanations for shopping addiction
is simplistic and doesn’t consider other
explanations such as biological reasons and
the involvement of dopamine and reward
pathways. Excessive shopping can change the
number of neurotransmitters in the body.
Behavioural addiction: Gambling
Cognitive Approach for Gambling
Initiation Expectancy theory – People are likely to
participate in a behaviour if they know they will
have a positive reward.
Cost benefit analysis – The individual will
weigh up the pros and cons of participating in
the behaviour. The pro is winning, and the con is
losing.
Maintenance Irrational thoughts – These are thoughts that
have no basis in reality. Gambling addicts are
likely to have irrational thoughts about their
chances of winning or losing. E.g., “I won’t win
because the machines hate me”.
Cognitive Biases – These are errors in thinking
that occur in order to argue for your own
thoughts. For example, recall bias is when a
gambler will think back to their wins rather than
looking back at their losses.
Relapse Cognitive Biases – Again, recall bias makes a
gambler think about the times where they won
and not how they lost which makes them want to
gamble again.
Overestimation of success – The gambler will
believe they have more chance of winning than
they actually do. This is a type of irrational
thought.
Evaluation It has helped to develop therapies to treat
gambling I.e., cognitive behavioural therapy.
CBT helps to identify irrational thoughts and
cognitive biases (e.g., recall bias). This helps to
treat gambling which could help the patient and
NHS long term as it reduces co-morbidity
(developing other illnesses or addictions).
Doesn’t consider other factors such as the
influence of role models on gambling. This
means it’s reductionist and other factors should
be considered when explaining gambling.
Learning Approach for Gambling
Role Models – An individual may see a role
model (e.g., a parent) gambling and therefore
take up the behaviour themselves. This is done
through the process of observation and
imitation (social learning theory)
Positive Reinforcement – This refers to when
the individual makes a gain from participating
in a certain behaviour. For gambling, the
individual gains a good feeling and money each
time they win. This motivates them to continue
gambling.
Negative Reinforcement – This refers to when
something is lost from participating in an
activity. In the case of a gambler, this is likely
to be stress or boredom.
Cues to action – This is a certain stimulus that
causes an individual to want to gamble again.
This could be an advert for a gambling or
coming across a betting shop.
It has helped to develop therapies to treat
gambling through concepts such as classical
conditioning. Gamblers can counter-condition
their response so that they no longer associate
gambling with positive experiences. This helps
the patient and the NHS long term as it reduces
co-morbidity (developing other illnesses or
addictions).
Doesn’t consider other factors such as the
influence of cognitive biases (e.g., recall bias)
on gambling. This means it’s reductionist and
other factors should be considered when
explaining gambling.
Theories of persuasion: Hovland Yale Theory
Hovland yale theory states that there are several factors that will affect how likely change of attitude
through persuasion is. There are 3 factors within the theory that influence persuasion: source, message, and
audience.
Source- credibility of the source. The theory states that people are more likely to be persuaded when a
source is presented as credible. This may be a subject expert or someone who has a lot of experience in the
area.
Message- Content of the message is important. Messages need to be repeated. Fear-induced messages are
more effective if they have low to moderate fear rather than high fear.
Audience- Effects how likely somebody is to be persuaded. More intelligent audiences are more likely to be
persuaded by valid arguments. Culture can also affect the likelihood of persuasion because if the message is
not suited to the culture, the message will be misinterpreted.

Strengths
A strength of the Hovland yale theory is that it has
real life application because it can be used to design
behavioural change programmes.
For example, when designing a behaviour change
programme, people can ensure they are using a
credible source to promote the message (e.g., an ex-
smoker to discuss the issues with smoking). This
will make people more likely to be persuaded to
change their own behaviour.
Weaknesses
A weakness is that it ignores other persuasive
factors such as the different routes of persuasion
within the elaboration likelihood morel (central and
peripheral routes).
This may be a better theory of persuasion because it
looks at two different routes into the message.

This model is the best theory of persuasion in

comparison to fear arousal theory and the
elaboration likelihood model.
This is because it incorporates all other elements of
the other theories of persuasion in one e.g., fear, the
message etc.
Theories of persuasion: Fear arousal theory
Fear arousal theory includes messages that are trying to persuade people about the potential Harm that may
happen to them if they do not accept the message that they are being informed of.
If fear arousal is too high, then an individual may be less persuaded because they go into denial. People may
not listen or pay attention to low levels of fear either because it’s not motivating enough. As the level of fear
increases, so does the audience's attention. The best level of fear is moderate fear as this has enough fear to
motivate individuals. However, high fear levels can be motivating as long as the individual has a way of
dealing with the fear.

Strengths
A strength is that it is supported by research. Janis
and Feshback (1953) found that when fear is
strongly aroused but not reassured the audience
tend to ignore the message or ignore the importance
of the threat.
This shows that the right level of fear is important
in persuading people to change their behaviour.
Weaknesses
A weakness is that it doesn’t consider other
theories of persuasion such as the likelihood model
as it only focuses on the fear aspects.
Also, evidence doesn’t full support the fear arousal
model, for example Janis and Feshback (1953) did
confirm that high-fear messages are
counterproductive as it proved that moderate fear
arousal did not produce more behaviour change
than minimal and high fear arousal.
This finding contradicts a key prediction of the fear
arousal theory, partly undermining its validity.
Theories of persuasion: Elaboration likelihood model
Elaboration-likelihood model - The elaboration likelihood model seeks to explore how humans process
stimuli differently and how the outcomes of these processes result in changing attitudes and, consequently,
behaviour.
 Petty & Cacioppo (1986) suggested that persuasive messages are processed through central and
peripheral routes with a change in attitude as they process information and persuasion being
dependent on the level of elaboration of the messages.
 The model identified the central and peripheral route to persuasion.
 TV and media influence the persuasive messages to get their political, health and advertising
messages across to the audience.

Strengths
A strength is that it is supported by research. Janis
and Feshback (1953) found that when fear is
strongly aroused but not reassured the audience
tend to ignore the message or ignore the importance
of the threat.
Weaknesses
This theory of persuasion ignores other theories
such as the fear arousal theory.
This theory states that people are more persuaded
by the level of fear rather than the message itself.

This shows that the right level of fear is important

in persuading people to change their behaviour.
Treatments: Mindfulness
Mindfulness
 The process of helping people become ‘present’ with your mood, thoughts and feelings and
promoting healthy behaviour.
 Helps people become less overwhelmed with their stress in life because they feel they are living in
the ‘now’ rather than the past or future.
 Methods of mindfulness include:
 Yoga.
 Meditation.
 Relaxation.
 Breathing exercises.

Strengths Weaknesses
Very practical- This treatment can be completed at Not useful for everyone- Some people may not be
home which means that it is accessible for everyone engaged in mindfulness or may not see the point in
and is also usually free to do. this treatment.

This is useful because people may not usually have This means that they are less likely to even try it in
time or motivation to attend other forms of the first place, allowing their stress to worsen.
treatments like biofeedback.
Treatments: Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy- CBT
 CBT is a talking therapy that helps to identify and challenge irrational thoughts about behaviour.
 Patients are asked to identify their stressful thoughts and challenge them with evidence that opposes
their views.
 Additional features of the treatment include encouragement in keeping a journal or to have
homework in order to gather evidence opposing their irrational thoughts.
 This treatment can be linked with mindfulness.

Strengths
Organised- CBT sessions are organised at set
appointments with professionals which means they
have structure and could even motivate the patient
to attend.
The sessions are done by professionals in CBT, so
the patient will be very likely to receive methods
and advice that is highly effective.
Weaknesses
Practicality- People may be unable to attend these
sessions for personal reasons including school or
work and just having a busy schedule as you would
have to go somewhere and spend 30-60 mins there.
This could allow opportunity for the stress to
become worse and even harder to combat.
Waiting lists- CBT sessions can have waiting lists
from 6-12 months when done within the NHS.
This can cause people to initially lose hope and
their condition could worsen which means that they
are more at risk of developing more illnesses from
stress or more addictions, in turn costing the NHS
more money.
Treatments: Stress inoculation therapy
Stress inoculation therapy is a form of ABT and a method which reduces stress through conceptual
skills training methods.
Stress inoculation therapy is a cognitive behavioural approach to stress management developed by
Donald Meichenbaum (1977). He argued that just as people can be inoculated against a flu virus,
they could also be inoculated against stress and become stress resistant.

Stress inoculation therapy involves three phases:

1) conceptualisation - using the cognitive interview to identify and clarify the nature of the person’s
stress and to educate them about the nature and effects of stress, and how stress inoculation works;
2) skills acquisition - where the person learns a series of skills for dealing with stressful situations;
and
3) rehearsal and follow through or application - where the person puts into practice what they
have learned.

Strengths
Allows clients to have some control over their
treatment so they may feel ethically less stressed
about having it imposed on them.
This means that they are more likely to engage with
the behaviour and be motivated, unlike other
treatments such as medication.
Weaknesses
Can be expensive and time consuming, this is a
weakness as stress inoculation therapy may not be
accessible to all patients.
Patients must be motivated to take part, and this
may not always be the case.
Physiological treatments
Drug therapies work by replacing addiction with a drug that has similar effects.
 Nicotine replacement therapy is used to treat smoking addiction.
 This gives the body nicotine so that you cannot be affected by withdrawal symptoms.
 They are still given doses, so they still get a hit, but they get smaller doses each time until it gets to 0.
 They can come in the form of nicotine patches, gums, and inhalers.

Strengths
The patient can access nicotine replacement in their
local chemist and therefore do not have to rely on
their doctor to support them with this.
This means that they can take control of their
addiction and build their own levels of self-
efficacy.
Weaknesses
Some drugs have big side effects e.g., irritability,
sweating, night terrors etc. and this can cause
nonadherence. Some people may not be able to
constantly afford NRT, especially if the smoke a
lot.
Treatments: Over the counter remedies
Herbal supplements - Valerian, chamomile, and lavender
Exercise increases your overall health and your sense of well-being. When you exercise
regularly you may find the resulting energy and optimism, can help you stay calm, clear, and
focused in everything you do.

Valerian root contains a number of compounds that may help promote calmness by reducing
GABA breakdown, improving stress response and maintaining adequate levels of mood-stabilizing brain
chemicals.

Chamomile. One 2016 study found that long-term use of chamomile extracts significantly reduced
moderate to severe symptoms of generalized anxiety disorder (GAD).

Lavender is most commonly used in aromatherapy. The fragrance from the oils of the lavender plant
is believed to help promote calmness and wellness. It's also said to help reduce stress, anxiety, and possibly
even mild pain.

Strengths
Some limited research evidence to support
their use e.g., Chamomile. Limited data
shows that short-term use of chamomile is
considered safe and can be effective in
reducing symptoms of anxiety
Weaknesses
Side effects for some people and can
interfere with other medication e.g.,
chamomile can increase the risk of bleeding
when used with blood-thinning drugs or
cause allergic reactions in some people who
are sensitive to the family of plants that
includes chamomile.
Treatments – Social support
Social support involves a network of people known to an individual e.g., family. 4 types of
support: instrumental support, emotional support, esteem support and informational support.
Instrumental support – this refers to more practical support. This is mainly given by doctors,
professionals and sometimes parents. An example of instrumental support could be
medication given by doctors.
Emotional support – this refers to the emotional support given by friends, family. An
example of emotional support could be family/friends offering to help out during your daily
routine, e.g., picking children up from school.
Esteem support - this refers to the support given to boost the person’s self-esteem. This could
be provided by friends or family. An example of esteem support could be that friends of the
individual remind them what they’re good at in order to boost their self-esteem.
Uchino (1996) completed a meta-analysis of social support studies and suggested that social
support is effective in reducing physiological responses like increased heart rate and blood
pressure. However, it is unsure which type of social support is more effective at reducing
stress symptoms. Support aims to be instrumental (practical), emotional (emotions) and
esteem (self-esteem)
Strengths Weaknesses
The individuals have a support system Individual differences cannot be accounted
which is likely to reduce the likelihood of for e.g., women tend to rely on more social
relapse. Patients build self-efficacy which is support than men and some personality
essential for recovery. types may need more support than others.

Social support keeps people in track through
distractions or encouragements which may
mean that their condition will improve over
time. The patient will also fell like they are
not alone in combating their stress/
addiction.
Some people may not have a social support
system and therefore, their condition is
automatically likely to worsen.
Therefore, other treatment may be needed
e.g., CBT where there is a consistent
support system through a therapist
(instrumental/ esteem support).
Treatments: Biofeedback
 Biofeedback helps the patient to recognise the physical consequences of their stress e.g.,
increased heart rate.
 They learn skills to combat this and to visibly see less impact on their stress levels e.g.,
lowered heart rate.
 Awareness – client is connected to a heart rate monitor to measure their response to
stress.
 Relaxation – they are taught relaxation techniques.
 Transfer – they then transfer the skills to real situations.
Strengths Weaknesses
Biofeedback helps the patients to recognise Biofeedback could potentially frighten
the physical responses to stress which helps people e.g., they become concerned over
them to identify when they are stressed e.g., their heart rate increasing. This could then
headaches, sweating, trouble sleeping etc.
make them more stressed, which means it is
This then helps them to implement
relaxation techniques to self-manage this. counterproductive. It is also appointment
This then reduces the strain on the NHS in based which means that patients don’t have
the long term because patients are managing permanent access to health monitors – they
their stress levels. will have to visit the doctor to obtain this.
Treatments: Skills training
Can be used with any treatments such as cognitive behavioural therapy (CBT) as it increases
self-efficacy.
 Assertiveness training- conflict may lead to high stress levels and therefore this can
help to deal with conflict in a controlled manner.
 Anger management- reduces anger levels through relaxation.
 Social skills- addicts can find it difficult to control their emotions and training can
help.

Strengths
The individuals have a support system
which is likely to reduce the likelihood of
relapse. Patients build self-efficacy which is
essential for recovery.
Weaknesses
Individual differences cannot be accounted
for e.g., women tend to rely on more social
support than men and some personality
types may need more support than others.
Reasons for non-adherence:
Stress:
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you
feel frustrated, angry, or nervous. Stress is your body's reaction to a challenge or demand. In short bursts,
stress can be positive, such as when it helps you avoid danger or meet a deadline.
There are two main types of stress:
· Acute stress. This is short-term stress that goes away quickly. You feel it when you slam on the
brakes, have a fight with your partner, or ski down a steep slope. It helps you manage dangerous
situations. It also occurs when you do something new or exciting. All people have acute stress at one
time or another.
· Chronic stress. This is stress that lasts for a longer period of time. You may have chronic stress if
you have money problems, an unhappy marriage, or trouble at work. Any type of stress that goes on
for weeks or months is chronic stress. You can become so used to chronic stress that you don't
realize it is a problem. If you don't find ways to manage stress, it may lead to health problems.
Irrational beliefs:
Beliefs that have no basis in reality e.g., CBT does not make sense to me, so it does not work. Irrational
beliefs can lead to an individual not partaking in a health behaviour as they have become convinced that it
has no value. According to Ellis, irrational thoughts are patterns of thinking that are illogical, distort reality
and prevent you from reaching your goals. They also lead to unhealthy emotions and self-defeating
behaviour.

Rational non-adherence:
Most nonadherence is intentional with patients making a rational decision not to take their medicine based
on their knowledge, experience, and beliefs. Rational non-adherence is done with a person being completely
aware of their actions and planning out how and why they are not going to participate in the health
behaviour.
Side effects – people will not take their medication due to a cost/benefit analysis. The costs may include
serious side effects, and this will make people not want to comply with their medical treatment.
Financial Barriers – For example, people with private medical insurance that covers treatment are more
likely to adhere to medication because they are less sensitive to the costs. When people have to pay for an
element of their treatment costs when they previously did not pay, they are then more likely to opt for non-
adherence instead.
Practitioner relationship – if the patient does not trust their doctor (practitioner) then they are less likely to
adhere to the medical treatment. If the practitioner is more hostile and shows they have all the power, people
are less likely to comply with their treatment.
Lack of understanding – if patients do not understand the advice, it’s because it’s too complex. They may
not remember what the practitioner has said and therefore will take the treatment wrong OR not at all. If
people have learning disabilities, they may need to be shown how to take their medication of if you have
elderly patients, they will need instructions written down.

Learned helplessness.
Learned helplessness is a state that occurs after a person has experienced a stressful situation repeatedly.
They then believe that they are unable to control or change the situation, so they do not try — even when
opportunities for change become available.
People may try different treatments which are not working for them and as such they learn to not adhere to
their new treatment.

Lack of Support
Individuals are less likely to adhere to medical advice/ treatment when they do not have support/help from
friends/family or health professionals.
Significant Others-
 Lack of Practical support- A person may not have someone to remind them to take medication/
take them to appointments etc.
 Lack of emotional Support- adherence is less likely when an individual lacks people who can
provide encouragement.
Health Professionals-
 Lack of Practical support- lack of information can lead to non-adherence.
 Lack of emotional Support- may be a ‘gap’ between the amount of support a client expects and
what the professional provides.
Methods to improve adherence:
Health education
 People who need to follow medical advice differ from each other in several ways. For
instance, elderly clients may have issues with memory, so health education should
include opportunities to confirm that the client has understood and remembered the
advice.
 Health education should use simple language in discussions to make it easier to
understand.
 In making lifestyle changes, some clients (e.g., people with learning difficulties) benefit
from a health professional modelling the behaviour, e.g., showing them specific exercises
or how to plan meals.
Improving access to information:
 Access to information is improved when it is given a form that suits the client (e.g., a
printed booklet) or a website e.g., NHS.
 Discussions with health professionals are still a key source of information and
appointments can be made via apps.
 Pharmacists have become more accessible sources because they are present on many high
streets and appointments are not usually necessary.
 Telephone follow-ups to discussions are common and give clients the chance to ask
questions that they may not have considered during a face-to-face consultation.

Reduction of perceived threats

Reduction of perceived threats are when doctors or health care professionals teach patients the
side effects of taking medication, however they also teach how to reduce these side effects. For
example, they might say one side effect of taking a specific medication is headaches; therefore,
the doctor will not want the patient to adhere so they will also give them tips on what to do to
reduce these side effects like taking extra paracetamol. Health professionals can also reduce the
patients fear of taking medication such as telling them it will not harm them if they take it
properly.
Lifestyle changes
 Reducing stress can boost motivation which can help to access treatments. Which also
helps to boost self-esteem so that people have got the self-efficacy to cope. Optimistic
people are more likely to adhere to treatment plans because of the positive effects that
they can have.
 Improved self-esteem and self-confidence can have an effect because some people
lack the confidence when carrying out healthy behaviours. Interventions should be
used to boost these factors.
 Instead of targeting adherence, interventions should be used to try and reduce and
manage a person's levels of stress.
  If a person's resilience is improved there are more likely to adhere and develop
positive relationships with health behaviour and consequently improving their outlook
on life.
Increased awareness of activities
 Exercise- Being physically active can improve your brain health, help manage weight,
reduce the risk of disease, strengthen bones and muscles, and improve your ability to
do everyday activities. Adults who sit less and do any amount of moderate-to-vigorous
physical activity gain some health benefits. For example, joining a sport club will help
you create new bonds or friendships which can increase your awareness.
 Financial Incentives- To encourage behaviour or actions which otherwise would not
take place. A financial incentive motivates actions which otherwise might not occur
without the monetary benefit. These can be used, and these can help adherence. Volpp
(2009) aimed to find out if financial incentives for smoking cessation in work settings
had an effect on stopping smoking.
 Use of reinforcement- Reinforcements in the form of rewards are an encouraging form
of feedback which reinforces behaviour e.g., approval of family or friends. The
reinforcement should be immediate and consistent, which will help the patient feel
motivated however this could be counterproductive.