DSE-B-03-HEALTH PSYCHOLOGY

UNIT-3: HEALTH ENHANCING

BEHAVIOURS
(EXERCISE, NUTRITION, SAFETY, PAIN)

Prepared By-
Dr. Antara Ghosh, Ms. Bidisha Mitra,
State Aided College Teacher- I, State Aided College Teacher- I,
Department of Psychology, Department of Psychology,
Bangabasi College. Seth Anandram Jaipuria College.
❖Concept of Health:
Health is a state of complete physical, mental and social well-being and not merely
the absence of disease of infirmity. [WHO; 1948]

❖Health Enhancing Behaviour:

Health behaviours are the behaviours undertaken by people to enhance or
maintain their health. According to Cockerham (2012), health behaviours is defined as the activity
undertaken by people for the purpose of maintaining or enhancing their health, preventing health
problems, or achieving a positive body image.
It is not limited to healthy people trying to stay healthy, but also includes the differently able
persons and person with chronic diseases who seek to control, minimize, or contain their affliction
through positive forms of health behaviour, such as diet, exercise, and avoiding smoking.

➢ Examples of health enhancing behaviours ->

✓Exercise
✓Nutrition
✓Safety
✓ Manage pain etc.
EXERCISE
• Concept:
Exercise helps to maintain mental and
physical health. It is physical activity that is
planned, structured and repetitive for the purpose
of conditioning the body. It enhances or maintain
physical fitness and overall health and wellness.
It consists of cardiovascular conditioning, strength
and resistance training, and flexibility.
Types of Exercise-
Physical exercises Mental exercises
• Flexibility exercises/ Stretching • Solve puzzles
• Play cards
• Builds vocabulary
• Aerobic exercises/ Cardiovascular • Listen to music
Exercises
• Learn new skills
• Meditation
• Anaerobic exercises/ Weight • Learn new languages
Training • Use senses
• Take a new route
Physical exercises cont..
• Flexibility exercises /Stretching: Improve the ability to bend joints and stretch muscles
through a full range of motion.
Examples:- Yoga, Suryanamaskara, Warm-up & Cool-down Stretches

• Aerobic exercises/ Cardiovascular Exercises: Improve the body’s ability to take in and
use oxygen to produce energy. Aerobic activities make us breathe hard & they increase our heart rate.
Examples: - Jogging , Walking, Swimming , Bicycling

• Anaerobic exercises/ Weight Training: Improve the strength and endurance of our
muscles. Improve performance & body composition, injury prevention, improves self image.
Examples: - Weight Lifting, Push-Ups, Pull Ups
Benefits [Why exercises?]
Physical benefits
• Increase flexibility, energy levels
• Improves quality of sleep
• Protection against osteoporosis
and thinning bones
• Reduction in
✓ Blood pressure
✓ Weight and obesity
✓ Diabetes
✓ Coronary heart diseases
Psychosocial benefits
1. Engaging in regular vigorous exercise is
associated with lower feelings of stress
& anxiety.
2. People who engage in a fitness program
with aerobic exercise show improved
cognitive processes, such as, in making
fewer errors & having better memory.
3. Regular exercises enhance self concepts
of individuals, especially children.
FITT Principles-
The FITT Principles are an exercise prescription to help participants
understand how long and how hard they should exercise.
FITT is acronym that stands for-
• F- Frequency: Daily moderate exercise is ideal, but try to exercise a
minimum of 3-5 days per week.
• I- Intensity: Moderate to vigorous intensity exercise is recommended
for adults.
• T-Time: 30 to 60 minutes per day.
• T- Type: To maintain a well balanced fitness level, perform a variety
of exercises includes cardiovascular, strength and flexibility training.
 Are there health liabilities to exercise?
❖Uncontrolled disease state (unstable angina, poorly controlled diabetes,
uncontrolled hypertension)
❖Hazards of exercise (for example, cycle and swimming accidents)
❖Musculoskeletal injuries, triggering of other health issues (for example, heart attack,
respiratory tract infections).
❖Too old, too fat, injury
❖Shyness, embarrassment, fear, lack of energy, lack of confidence, don’t enjoy
exercise
❖Lack of equipment, safe place to exercise
❖Lack of contract with trainer, prompt, rewards, social support, counseling, goal
setting
❖Can’t be addicted – withdrawal, fear of not exercising, see it displacing other
activities, interfering with relationships, taking physical toll, causing OCD
 Strategies to promote exercise behaviours
#1 Health Education: It is important that one seek information from experts on the
benefits of exercise, proper exercise techniques and the results that should be expected
during exercise. This will ensure that one truly understand why and what he/she doing
and it will give the confidence and motivation required to participate in long-term
physical activity as well as to prevent injury or discouragement.
#2 Health Risk Appraisals: Health risk appraisals provide individual with relevant
information about their current health, risk factors and level of fitness. This helps to
enhance motivation and can be used to monitor changes over time. It can also help with
regards to the goal setting process as one identify areas the need to improve.
#3 Goal Setting: This strategy has been widely used to identify, document and monitor
goals related to physiological changes and physical activity behavior. Person goals
should be realistic, specific, measurable and over the short term. Studies even say that
person should document the necessary steps required to achieve their specific goal.
CONT….
# 4Self-Monitoring: This involves documenting persons activity behavior, the data collected
often includes; date, time of exercise, duration, type of exercise, type of activity, heart rate
and/or rate of perceived exertion. Sharing this document with a group leader or another
participant will help to build some accountability and facilitate exercise adherence.
#5 Reinforcement and Incentives: These strategies are often associated with self-monitoring
and/or goal setting and involve the rewarding oneself and/or being rewarded by a group leader
once one reach an activity-related goal. The best types of rewards are those that are not
detrimental towards their overall goal. It could be a physical reward of practical use or simply
the acknowledgement amongst peers.
#6 Problem Solving: This intervention is based around identifying the obstacles and barriers
that stand between individual and his/her physical activity goals. Then it’s important to
generate and implement solutions, evaluate the outcomes and choose different solutions if
needed.
#7 Social Support: Taking part in physical activity as part of a group program, with a friend or
family member or interactions with health professional can increase exercise adherence as
person will have a network of people working towards a common goal. Also, as relationships
develop the need to maintain the relationship is often associated with the continuance of that
physical activity or group program.
Nutrition
• Concept:
Nutrition can be considered to be the foundation of good health and
freedom from disease. The term ‘Nutrition’ is derived from a Latin
word nutritic, meaning nourishment.
It is the processes of the intake, digestion and assimilation of
nutrients resulting in maintenance health and combat diseases.
Nutrients are components of foods needed for body in adequate
amounts for proper growth, reproduction and leading normal life.
Adequate, optimum and good nutrition – indicates the right amount
and proportion of nutrients for proper utilization for achieving
highest levels of physical and mental health.
NUTRITION= Eating Digestion Absorption Transformation Utilization
Components of food
The term ‘food’ refers to anything that we eat and which nourishes the body.
It includes solids, semi-solids and liquids. The nourishment is brought
about by small units called nutrients present in food.
Nutrients are the chemical substances present in food and are responsible for
nourishing the body.
Nutrients are of two types:
1.Macronutrients
2. Micronutrients
Both macronutrients and the micronutrients are equally essential for good
health. Each nutrient plays a significant role in the body.
1.Macronutrients
These are present in large quantities in foods and are also required in large
amounts by the body.
Carbohydrates, proteins, fats and oils are macronutrients.
➢ Carbohydrates: Present in a large quantity as starch in cereals, pulses and
potatoes. They are present as simple carbohydrates in sugar, jaggery, fruits,
honey and milk.
Sources- Cereals - wheat, rice, bajra, maize, etc.
Pulses - Rajma, channa, all dals
Roots and tubers - potatoes, sweet potatoes, beetroot
Sugar, jaggery
Functions - Provide energy, body building function
➢Proteins: It’s needed in the body for body building. 1 gm of protein gives
4kcal of energy Proteins are made up of smaller units known as amino acids.

Sources - Meat, poultry, fish, eggs

Milk, cheese, paneer, curd
Soybeans, peas, pulses,
Nuts and oilseeds like til, groundnuts, etc.

Functions- (i) Needed for growth, maintenance and repair of tissues.

(ii) Necessary for production of enzymes, hormones,
antibodies, haemoglobin, etc.
(iii) Help in the clotting of blood
(iv) Provide energy
➢Fats and oils:- These are the concentrated source of energy in our diet. 1 gm of fat gives 9
kcal of energy. Fats are made up of small units called fatty acids. The nature of fats is dependent
on the type of fatty acids present.

Types: Fatty acids may be saturated or unsaturated.

▪Saturated fatty acids are found in solid fats
▪oils contain more of unsaturated fatty acids. Vegetable oils are rich in unsaturated fatty acids.

Sources: Cooking oils, ghee, butter - Oilseeds, nuts - Meat, poultry, fish, eggs - Whole milk,
cheese
Functions: (i) Provide concentrated source of energy
(ii) Reduce the use of proteins for energy
(iii) Carry fat soluble vitamins (A, D, E, K) into the body and help in the
absorption of these vitamins
(iv) Help to maintain body temperature. The layer of fat under the skin helps
to conserve body heat
(v) Act as a cushion to certain vital organs
(vi) Help in growth of tissues
2.Micronutrients
Another important nutrients which are present in small
quantities in foods but are essential for our body are called
micronutrients. These are minerals and vitamins and are
required in very small quantities. If these micronutrients are
not eaten in required amounts, it results in deficiency
diseases.
Minerals and vitamins are called micronutrients .
Micronutrients Cont..

Vitamins Minerals
• Organic chemicals that regulates • Inorganic substances, such as
metabolism & function the body. calcium, phosphorus, potassium,
• Used in converting nutrients to sodium, iron, zinc, iodine. Each of
energy, producing hormones & which is important in body
breaking down waste products and development and functioning.
toxins.
• Calcium and phosphorus are
• Types: components for bones and teeth.
1.Fat soluble: (Vitamins A, D, E & K) • Potassium and sodium are involved
Dissolve fats and are stored in in nerve transmission
body’s fatty tissues.
2.Water soluble: ( B, C) Excretes excess • Iron helps transport oxygen in the
quantities as waste. blood.
Water
Water is the major constituent of our body. It forms about
two-thirds of the body weight. We can do without food
more readily than water. It is present in all the cells, being
a vital part of all living tissues. It surrounds tissues and
organs, and gives protection from shock. Water helps in
digestion, absorption and transportation of nutrients in the
body. It helps to excrete unwanted materials in the form of
urine and maintains body temperature through
perspiration.
Normally, we need to drink 6-8 glasses of water everyday.
Other forms in which we can receive water are milk, juice,
kanji, etc. Water is vital for survival. .
Function of food
There are basically three important functions of food:

1.Social Function: Food and eating have significant social meaning. Sharing food
with any other person implies social acceptance. Food is also an integral part of
festivity every where in the world Food also has a specific significance and
meaning in the religious context.
2.Psychological Function: We all have emotional needs, such as need for security,
love and affection. Food is one way through which these needs are satisfied.
For example, how do we feel when our mother prepares our favorites food or
dish? Similarly, certain foods become associated with sickness, such as khichri
and bland foods. Sickness is an unpleasant experience, hence, even the food
items served during this state may be associated with unpleasant feelings.
Function of food Cont…
3.Physiological Function: There are three physiological functions performed by
food.
(i) Food provides energy: Everybody needs energy to do work. Energy is
required for walking, studying, eating, working in the house or outside.
(ii) Food helps in body building: Our body is already made up of thousands of
small cells. New cells are added to these to help the body to grow. Food is
needed for the formation of new cells. Cells also die or are damaged due to
injury. New cells need to be formed and this repair work is done with the help
of food.
(iii) Food regulates body processes and provides protection against diseases:
Regulatory functions refer to the role of food in controlling body processes, for
example, our body temperature is maintained at 98.60 F or 370 C. Similarly, the
heart beats are also maintained at 72 beats/minute.
Types of nutrition
• Optimal nutrition:
✓ Obtained from a varied diet
✓ Desired amounts should be
balanced
• Under nutrition:
✓ Less than desired amounts of
nutrients
✓ Limits work capacity, immune
system, mental activity
• Over nutrition:
✓ Excess nutrients and energy
intake over time
✓ Produce harmful gross body
weight
✓ Excessive amounts of nutrients
supplements over time
• Malnutrition:
✓ Reserves depleted
✓ Nutrients and energy intake
insufficient
Benefits of good nutrition

• Well developed body

• Ideal weight for body composition
• Good muscle development
• Smooth skin, glossy hair, clear and bright eyes
• Mental and physical alertness
• Ability to resist disease
• Increased life span
Diet & Nutritional care
Diet: It refers to whatever is eaten or drunk each day. It includes
normal diet that is consumed either individually or in group. Diets
may be modified for making it suitable for sick individuals as a part
treatment – therapeutic diets.
Nutritional care: It using the knowledge of nutrition for meal
planning and preparation to make it in an attractive and acceptable
form. In this the existing meals can be modified to improve in terms
of nutrition and acceptability. Diet can be planned for individuals or
a group to suit their requirements like health status, nutritional
status, place of living, climate etc.
Nutrition and Health
The health of a person depends on the type and quantity of food stuff
consumed. Good nutrition is essential for a person to grow and develop
normally and to remain healthy throughout life. When a person does not
eat proper food, there are chances of the body not developing normally.
These are chances of that some organs of the body may start
malfunctioning or there may be some diseases. Poor nutrition may also
influence the mental and social well being adversely.
Food Nutrition

Health
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SAFETY-
• A health behaviour is any activity people perform to maintain or improve their health,
regardless of their perceived health status or whether the behaviour actually achieves
that goal.

Safety can be understood as preventive or precautionary

measures to avoid or to reduce injuries, illness and
accidents. So, it might be considered as one kind of health
behaviour. Safety is one of the important component in
accident and injury preventions.
 CHANCES OF
ILLNESS,
INJURIES, RISKS
AND
ACCIDENTS

SAFETY
BEHAVIOUR
Safety Measures can be adhered in different settings -

• Home Safety
• Road, Traffic and Automobile safety
• Workplace and Organization safety
• Safety from Environmental Hazards
• Safety in Health practices
• Safety practices in Internet
People acquire health‐related behaviours-
COGNITIVE FACTORS –
• Learning - people also learn health‐related behaviour, particularly by way of classical
conditioning, operant conditioning, modelling.
• The role of beliefs and intentions-
The Health Belief Model
The Theory of Planned Behaviour
PERSONALITY, AND EMOTIONAL FACTORS-
Temperament - Novelty Seeking
Health Locus of Control
Optimism
AGE. GENDER AND SOCIO-CULTURAL FACTORS
Possible Approaches to develop Safety Behaviour-
• Methods for promoting health
Providing information and education
Features of information to enhance motivation
Behavioural and cognitive methods
Motivational interviewing
Maintaining healthy behaviours

• Promoting Safety Programs in Schools, Religious Organizations, Worksite

and Community-Based Programs
• Electronic interventions
SO WHAT IS PAIN…
“An unpleasant sensory & emotional experience associated with actual or
potential tissue damage, or described in terms of such damage” ( The
International Association for the Study of Pain, 1989)

“Pain is whatever the experiencing person says it is, existing whenever

the experiencing person says it does” (McCaffery, 1989)
PAIN – A FRIEND OR FOE…
MALADAPTIVE ASPECTS-
Experience of pain is unpleasant,
overwhelming. At times, it can be insistent
which can be annoying and distressing.
Chronic pain can affects one quality of life,
interpersonal life and marked emotional
distress.
Thus, Burden associated with pain could
not and should not be overlooked.
ADAPTIVE ASPECTS-
Provides constant feedback about our body and
enabling us to make required adjustments.
Pain is often a warning sign that something is
wrong and results in protective behaviour.
Pain also triggers help-seeking behaviour and is
a common reason for patients visiting their
doctor.
No pain condition -Congenital Insensitivity to
Pain (CIPA and problems associated with it)
PAIN CAN BE CLASSIFIED ON THE BASIS OF-

On the basis of
Region of the Anatomic system which On the basis of On the basis
Duration body involved location is causing the cause of intensity
pain

Generalized For example Neuropathic High

Acute pain Somatic nervous system,
pain
cardiovascular
system
Chronic Localized Nociceptive Moderate
Visceral
pain pain

Referred Pain
Psychogenic Low
Phantom Limb
Pain
 PHYSIOLOGY OF PAIN
• Nociceptors (Pain Sensors/Receptors) which only responds to noxious stimuli.
• Located in Skin, Joints, Muscles and Viscera.
• Closely linked to Peripheral sensory and Sympathetic neurons ( “ Free nerve endings”)
Nociception is a complex sequence of actions between tissue damage
and the perception of pain.
Ascending and Descending Pathway
of pain-
Neurochemicals Associated with Pain-
Pain Inhibitors –
Endorphins,
Serotonin,
Enkephalins

Pain Initiator -
Glutamate and
Substance P
 Early Pain Theories: Pain as a Sensation-
• Early models of pain described it within a biomedical framework as an automatic response to an external
factor.

• Descartes, perhaps the earliest writer on pain, regarded it as a response to a painful

stimulus. He described a direct pathway from the source of pain (e.g. a burnt finger) to
an area of the brain that detected the painful sensation.
• Specificity theory of pain- Von Frey (1895) developed the specificity theory of pain. He
suggested that there were specific sensory receptors which transmit touch, warmth and
pain, and that each receptor was sensitive to specific stimulation.
• Pattern theory of pain - He suggested that nerve impulse patterns determined the
degree of pain and that messages from the damaged area were sent directly to the brain
via these nerve impulses.
Therefore as per the early models of pain-

• Tissue damage causes the sensation of pain.

• Psychology has no causal influence.
• Pain is an automatic response to an external stimulus. There is no place
for interpretation or moderation.
• Emphasis was on organic pain.
Including Psychological Aspect in Theories of Pain
The Gate Control Theory of Pain-

• Melzack and Wall (1965), developed the gate control theory of pain (GCT).
• It suggested that, although pain could still be understood in terms of a stimulus–
response pathway, this pathway was complex and mediated by a network of
interacting processes. Therefore the GCT integrated psychology into the
traditional biomedical model of pain and not only described a role for
physiological causes and interventions, but also allowed for psychological causes
and interventions.

• Gating Mechanism

• Factors influencing opening and closing of the ‘ Gates’

The schematic diagram of The Gate Control Theory (GTC) of Pain
• Melzack later proposed the idea of a ‘Neuromatrix’ a neural network in
the brain that integrates information from the senses, cognitive and
emotional areas of the brain, and stress-regulation systems (Melzack &
Katz, 2004). In phantom limb pain, the neuromatrix creates the perception
of pain from the pattern of impulses in the network, without the presence
of a noxious stimulus.
BIOPSYCHOSOCIAL ASPECTS OF PAIN
Biological factors- genetic
vulnerability, tissue damage,
neurophysiology of pain

Psychological factor –
Learning, Attention Social Factors –
(Hypervigilance), Meaning
association, Perceived control, Social Support, Cultural
Self efficacy, Emotions ( Fear, traditions, Socioeconomic
Anxiety), Catastrophic strata, Education.
thinking, Coping strategies.
 PAIN ASSESSMENT

• Assessment is an essential, but challenging, component of any pain management plan.

• Pain is subjective, so no satisfactory objective measures of pain exist.

• Pain is also multidimensional, so the clinician must consider multiple aspects

(sensory, affective, and cognitive) of the pain experience.
Initial assessment of pain must start with Pain history taking –
ASSESSMENT TOOLS -
• Unidimensional Scales-
Rating scales provide a simple means for patients to rate pain intensity.
Examples –
Multidimensional Tools-

Although not used as often as they should be, multidimensional tools provide
important information about the pain’s characteristics and effects on the patient’s
daily life. These tools are designed for patient self-report, but a clinician may assist
the patient. Examples of multidimensional tools include-

• MPQ (McGill Pain Questionnaire) (Melzack, 1975)

• Brief Pain Inventory (Cleeland, 1991)

• Initial Pain Assessment Tool (Pasero & McCaffery, 2008)
 •
Nonverbal indicators of pain-

When a person is non-verbal and cannot self-report pain, observation becomes

critical, and specific behaviours can be monitored as pain indicators.

Behaviour indicators of pain might be facial grimacing , Rubbing (Massaging

affected area), Bracing (Clutching or holding onto furniture, equipment, or
affected area during movement)increase or decrease in vocalizations, changes in
routine behaviour patterns, Social withdrawal, irritation and agitation associated
with pain.
 Pain Management
IT IS bOTH uNREAlISTIc AND uNDESIRAblE TO cAST “NO PAIN” AS A TREATmENT gOAl

GOALS OF PAIN MANAGEMENT should focus on -

• Reduction of pain to an acceptable level
• Restoration of Psychological, Emotional and Social functioning
• To Correct secondary consequences of pain ( Postural deficits, weakness, overuse ,
Maladaptive behaviour, poor coping )
• Improving quality of life
• Staying within therapeutic window ( by avoiding undertreatment and toxicity associated
with pharmacological treatment)
 PAIN
MANAGEMENT

Stimulation
Medical and Physical Psychological
Treatment Management
Therapies

Pharmacological
Surgical
Management Intervention
 Pharmacological Management-
• Traditionally and primarily, pain management relies on Pharmacological
interventions.
• The interventions play a crucial role in alleviating pain
• However, they have their limitations including unpleasant side effects,
tolerance and physical dependence
• Apart from that, some chronic pain problems are difficult to diagnose and
medicine may only provide temporary relief.
• Analgesics, Anticonvulsants, Antidepressants, Muscle Relaxants,
Antiarrhythmic are some medications primarily used in treating pain.
Surgical Methods-
• Relativelyradical approach and is likely to be more effective when pain is
localized and acute than Generalized and Chronic Pain.

• Methods – Neuroablation, Spinal fusion and Laminectomy.

Stimulation and Physical Therapies-
Stimulation Therapies-
The principle of counterirritation is the basis for present-day stimulation
therapies for reducing pain.
Transcutaneous Electrical Nerve Stimulation (TENS), Spinal Cord Stimulation
and Acupuncture are some techniques used this therapy.
Physical therapy-
• Physical therapy
is an important rehabilitation component for many medical
conditions—for instance, after injury or surgery, patients perform exercises to
enhance muscular strength and tissue flexibility to restore their range of
motion.
• Physical therapy
includes – Massage, Manipulation of joints and bones, Manual
therapy using hands or tools on soft tissue, Cold laser therapy to alleviate
inflammatio, Movement therapy and exercise.
Psychological Management-
• Gate-control theory changed the way many health care workers conceptualize
pain by proposing that pain can be controlled not only by biochemical methods
that alter sensory input directly, but by modifying motivational and cognitive
processes, too.
• The goal of psychological Management is not directly eliminating the locus of
pain rather the goals are
• Reduction of pain and pain-related disability,
• Increasing self-management
• Increasing perceptions of control and self-efficacy
• Increasing health behaviors, such as appropriate medication use,
exercise/activation, sleep habit
• Addressing pain-related psychosocial factors, such as the impact of pain on
family functioning and work life.
 Common Psychological Approaches used in Pain
Intervention -

Cognitive
Behavioural Psychodynamic Mindfulness
Motivational Behavioural Approaches- Approaches- Based
Interviewing Approaches
Approaches-
•Psychoeducation
Linking the pain with
Is a client centred •Operant intervention • Skills acquired in
•Fear Reduction CBT- self-regulatory emotional trauma and
approach that pathologic internal
strategies skills and stress- Acceptance And
motivates clients to object relations, patient
•Relaxation management skills. Commitment therapy
engage in the necessary to discover multiple
interventions, •Cognitive
changes to reduce Clinical hypnosis restructuring meanings for the
disability and sick role strategies and symptom.
•Stress Inoculation
behaviour resulting Biofeedback Training
from pain
BIO-PSYCHO-SOCIAL APPROACH
TO PAIN MANAGEMENT

MULTIDISCIPLINARY
TREATMENT
Books Referred-
• Ogden, J. (2012). Health psychology: A textbook: A textbook. McGraw-Hill
Education (UK).

• Sarafino, E. P., & Smith, T. W. (2014). Health psychology: Biopsychosocial

interactions. John Wiley & Sons.

• Taylor, S. E. (2006). Health psychology. Tata McGraw-Hill Education.

 THANK YOU.
Looking Forward for your kind Guidance/Suggestions .