BPCG 173 Full Textbook

BPCG-173
PSYCHOLOGY FOR HEALTH

AND
WELL BEING
School of Social Sciences

Indira Gandhi National Open University
EXPERT COMMITTEE
Prof. Swaraj Basu Prof. Suhas Shetgovekar Prof. Swati Patra (Convenor)
Former Director, School of Social Sciences Faculty, Discipline of Psychology Faculty, Discipline of Psychology
IGNOU, New Delhi School of Social Sciences School of Social Sciences
IGNOU, New Delhi IGNOU, New Delhi
Prof. Vimala Veeraraghavan
Former Emeritus Professor Dr. Monika Misra Course Coordinator
Discipline of Psychology Faculty, Discipline of Psychology Prof. Suhas Shetgovekar
IGNOU, New Delhi School of Social Sciences Faculty, Discipline of Psychology
Dr. Kamlesh Singh IGNOU, New Delhi School of Social Sciences
Associate Professor Dr. Smita GuptaFaculty IGNOU, New Delhi
School of Humanities and Social Sciences Discipline of Psychology General Editor
IIT, New Delhi School of Social Sciences Prof. Suhas Shetgovekar
IGNOU, New Delhi Discipline of Psychology
SOSS, IGNOU
COURSE PREPARATAION TEAM
Block 1 Introduction
Unit 1 Introduction to Health and Well being Dr. Arti Singh
Unit 2 Models of Health and Illness Dr. Arti Singh
Block 2 Introduction to Stress

Unit 3 Stress: An Introduction Prof. Suhas Shetgovekar
Unit 4 Factors Contributing to Stress Proneness Prof. Suhas Shetgovekar
Unit 5 Effect of Stress Prof. Suhas Shetgovekar
Block 3 Stress Management
Unit 6 Coping with Stress Prof. Suhas Shetgovekar
Unit 7 Stress Management Techniques I Prof. Suhas Shetgovekar
Unit 8 Stress Management Techniques II Prof. Suhas Shetgovekar
Block 4 Promotion of Physical and Mental Health
Unit 9 Physical Illness Experiences I Prof. Suhas Shetgovekar
Unit 10 Physical Illness Experiences II Prof. Suhas Shetgovekar
Unit 11 Mental Illness Experiences Prof. Suhas Shetgovekar
Unit 12 Prevention, Management and Intervention Prof. Swati Patra
Course Coordinator : Prof. Suhas Shetgovekar

General Editors : Prof. Suhas Shetgovekar
Block 1, Block 4 : (Unit 12) : Prof. Suhas Shetgovekar
Block 2, Block 3 and Block 4 (Units 9 and 10) : Dr. Tima D’Cunha
Block 4 : (Unit 11) : Dr. Monika Misra
PRINT PRODUCTION
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Assistant Registrar (P) Section Officer (P)
MPDD, IGNOU, New Delhi MPDD, IGNOU, New Delhi
December, 2020
© Indira Gandhi National Open University, 2020
ISBN-81
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BPCG 173 PSYCHOLOGY FOR HEALTH
AND WELL BEING
The course on Psychology for Health and Wellbeing (BPCG 173) is a 6 credits
course offered under Bachelors Degree Programme of IGNOU. The objectives
of this course are to acquaint learners with the spectrum of health and illness,
to identify and manage stress, to learn approaches to enhance well being and
to acquaint learners with strategies to prevent illnesses, promote and manage
health and well being
The course is divided into four blocks. Each of these blocks represents a specific
theme which is discussed in terms of units. The units are arranged in a logical
sequence so as to cover the main aspects of each theme.
Before proceeding to read the units, you are advised to go through instructions
about how to read the course material. Given below is the explanation of the
organization and sequencing of the unit.
Organization and Sequencing of a Unit
The following is the structure of each unit:
1.0 Objectives
1.1 Introduction
1.2 Section (Theme of the section)
1.2.1 Subsection of 1
……………….
Check Your Progress I
1.3 Section (Theme of the section)
1.3.1 Subsection of 2
……………….
Check Your Progress II
Let Us Sum Up
References
Key Words
Answers to Check Your Progress
Unit End Questions
As the scheme suggests, each unit is divided into sections for easy reading and
better comprehension. The numbering and length of each section and subsection
may vary from one unit to the other, depending upon the depth of information
in each unit. Each section is indicated by BOLD CAPITALS and each sub-
section by a relatively smaller but bold typeface. Divisions within the sub-
sections are in relatively smaller bold typeface so as to make it easy for
you to understand. 3
Let us now discuss each section of a unit.
Objectives
We begin each unit with the section Objectives. It tells you briefly about the
objectives of the unit, what you will learn after you study the unit.
Introduction
The section Introduction will mainly focus on introducing the theme of the present
Unit.
Illustration
There are several illustrations in each unit in the form of figures and diagrams.
The main purpose of these illustrations is to make the study comprehensive and
interesting.
Check Your Progress
We have given self-check exercises under the caption Check Your Progress
at the end of main sections. You can provide your answers in the space given
below each question/ exercise. You will be tempted to have a glance of the
main text as soon as you come across an exercise. But we do hope that you
will resist this temptation and turn to the main text only after completing the
answers.
You should read each unit and note the important points in the margin provided
in the course material. This will help in your study. It will also help you to
answer the self-check exercises and the assignment questions, as well as help
in revising your course before appearing for your Term End Examination (TEE).
Let Us Sum Up
This section of each unit under the heading Let Us Sum Up summarises the
whole unit for the purpose of ready reference and recapitulation.
References
We have given a list of references at the end of each unit. This is a list of
books and articles used by the course writers to prepare the units. This reflects
that your course material is based on a wide spectrum of literature available
on a particular theme, related to your course. This also informs you of the wide
literature available in the particular area of study. If interested in widening your
knowledge, you may look for the mentioned references. Each reference mentions
the name of the author, year of publication, title of the book/article, name of
publisher and place of publication.
Suggested readings help you to increase your level of understanding of a
particular theme in each unit.
Key words
The key words explain the basic ideas, technical terms and difficult words.
Answers to Check Your Progress
The answers to check your progress are given here.
4
Unit End Questions
Besides Check Your Progress, we have given Unit End Questions in each Unit.
Practicing these questions will help you in answering assignments and Term End
Examination Question Paper, though the pattern and style of questions asked
may not be similar.
Audio and Video Aids
Some Units have been selected for the audio and video programmes to
supplement the printed material. This will help you to understand the units with
greater clarity.
Apart from this, you may also access IGNOU’s FM radio channel, Gyanvani
(105.6 FM), which is available across many cities in India, for regular
programmes, related to themes on Psychology. You can listen to the live
discussions by faculty and experts on the topic of the day and interact with
them through telephone, email, and through chat mode.
You may also watch Gyandarshan TV channel (free to air educational channel),
for programmes related to topics on Psychology. The schedule of Gyanvani and
Gyandarshan is displayed on www.ignou.ac.in. The radio and TV channels may
also be accessed on Gyandhara, webcast facility for Gyanvani and Gyandarshan,
provided by the University.
Assignment
You will receive a set of assignments for the whole programme. These are Tutor
Marked Assignments, which are to be submitted to the respective Study Centre
after completion. These assignments will be evaluated by academic counsellor
from your Study Centre. Ensure that you complete all your assignments because
the grades that you get in each of these assignments are included in the final
evaluation of your degree. Before answering the assignments, read all the units
and additional material (if available).
Guidelines for assignments
While working on assignment, kindly ensure the following points,
1) Clearly write your Enrollment number
2) Answer them in your handwriting and in your own words (do not copy
the sentences from the course material or any other source).
3) Write clearly and neatly so that it is easy to read your answers
4) Leave margins on one side of your answer-sheets so that evaluator may
write his/ her comments on your performance.
5) Organise your answers well based on the question asked.
6) You will submit the assignments at your Study Centre on or before the
date mentioned as per the admission cycle. Kindly check the dates from
www.ignou.ac.in or your Regional Centre website.
5
Term End Examination (TEE)
Consider the following points while answering TEE.
1) Questions need to be answered in one’s own words and they need to
be focused based on the question asked.
2) Answer the questions keeping in mind the word limit.
3) Organise answers well based on the question asked and also keep in mind
any bifurcation given in the marks.
4) Ensure that you mention correct question numbers for respective answers.
Preparation of Course Material
The syllabus of course material BPCG-173 is designed by an Expert Committee
(see page 2 of this course) and prepared by Course Preparation Team which
comprises the author(s) of units, content editor(s), language editor, and the course
coordinator. The expert committee selected the themes and sub-themes of the
blocks and units, keeping in view the prescribed syllabi of UGC (CBCS
model).The authors of units have provided their expertise in elaborating them
in the form of the main text of each unit. The content editor has carefully examined
the course contents and has made an attempt to make the material clear and
comprehendible.
For any query or feedback related to the course, you may kindly contact
the course coordinator at,
Prof. Suhas Shetgovekar
Room No. 121, Block-F,
School of Social Sciences
IGNOU, New Delhi
Email: sshetgovekar@ignou.ac.in
6
Course Contents
BLOCK 1 : INTRODUCTION ............................................................ 11
Unit 1 : Introduction to Health and Wellbeing .......................... 13
Concept and Definition of Health ...................................... 14
Cross-cultural Perspectives of Health ................................. 17
Health-Illness Continuum ..................................................... 19
Unit 2 : Models of Health and Illness ....................................... 24
Medical Model of Health and Illness ................................ 25
Holistic Model of Health .................................................... 27
Biopsychosocial Model ....................................................... 29
Social Model of Health ...................................................... 30
Concept of Wellbeing ......................................................... 31
BLOCK 2 : INTRODUCTION TO STRESS .................................... 37
Unit 3 : Stress: An Introduction ................................................... 39
Concept of Stress .............................................................. 40
Nature of Stress ................................................................. 42
Sources of Stress ............................................................... 45
Measurement of Stress ....................................................... 49
Unit 4 : Factors Contributing to Stress Proneness .................... 53
Factors Contributing to Stress Proneness .......................... 54
Moderators of Stress ......................................................... 52
Unit 5 : Effect of Stress ................................................................ 62
Effect of Stress on Health ................................................. 63
Effect of Stress on Performance and Productivity ............ 66
Effect of Stress on Relationship ......................................... 69
BLOCK 3 : STRESS MANAGEMENT ............................................. 75
Unit 6 : Coping with Stress ........................................................... 77
Definition and Nature of Coping ....................................... 78
Coping Styles ...................................................................... 81
Unit 7 : Stress Management Techniques I ................................. 88
Relaxation Techniques ......................................................... 89
Meditation ........................................................................... 91
Yoga .................................................................................... 93
Mindfulness .......................................................................... 96
7
Biofeedback ........................................................................ 98
Unit 8 : Stress Management Techniques II ............................. 103
Cognitive Restructuring ...................................................... 104
Time Management ............................................................. 107
BLOCK 4 : PROMOTION OF PHYSICAL AND MENTAL

HEALTH .......................................................................... 115
Unit 9 : Physical Illness Experiences I ..................................... 117
Illnesses Related to Food, Diet, Obesity ........................ 118
Problems Related to Sexual Health ................................. 123
Unit 10 : Physical Illness Experiences II ................................... 132

Acute and Chronic Pain ...................................................133
Chronic Illnesses ............................................................... 135
Unit 11 : Mental Illness Experiences .......................................... 144

Depression ......................................................................... 145
Anxiety .............................................................................. 147
Psychosomatic Illnesses ..................................................... 150
Substance Use ..................................................................152
Unit 12 : Prevention, Management and Intervention ................ 162

Cultivating Human Strengths
and Virtues ........................................................................ 163
Hope and Optimism ......................................................... 165
Gainful Employment .......................................................... 168
Work Life Balance ........................................................... 170
Exercise, Nutrition, ............................................................ 171
Yoga and Meditation ........................................................ 172
8
BPCG 173 PSYCHOLOGY FOR HEALTH
AND WELL BEING
Dear Learner,
Psychology for Health and Well Being is a six credits course and the main
objectives of this course are to acquaint learners with the spectrum of health
and illness, to identify and manage stress, to learn approaches to enhance well
being and to acquaint learners with strategies to prevent illnesses, promote and
manage health and well being.
Block 1 is titled Introduction and covers mainly two units, Unit 1 and
2. The first unit is titled Introduction to Health and Wellbeing and this unit will
extensively discuss about the concept and definition of health and cross cultural
perspectives on health. Further, Health-Illness will also be covered in this unit.
The second unit is titled ‘Models of Health and Illness’ and covers the medical
model of health and illness, the holistic model of health and the biopsychosocial
model and social model of health. It also introduces the concept of wellbeing.
Block 2 of this course is divided into three Units; Units 3, 4 and 5. Unit
three is titled ‘Stress: An introduction’ and this unit will serve as a basis to
rest of the units that will be covered in this block. It will cover the concept,
nature, sources and measurement of stress. Discussion on the concept and nature
of stress will provide a fair idea about the term and will set a framework for
comprehension of other topics and subtopics discussed in this block. Sources
of stress mainly focus on frustration, conflict of motives and pressure, that can
be termed as general sources of stress. Measurement of stress is relevant and
necessary for effective diagnosis of stress. There are various ways in which
stress can be measured. Varied methods of measurement like physiological
measures, psychological tests, checklist and interview will be discussed under
this unit.
Unit four mainly focuses on the factors contributing to stress proneness including
Type A personality, hostility, perfectionism, procrastination and learned helplessness/
learned pessimism. Various moderators of stress will also be discussed in this
unit. The moderators play an important role in relationship between the stress
and corresponding reactions. These moderators may lead to individuals experiencing
high or low stress. Various moderators of stress including personality, locus of
control, social support, optimism and pessimism and gender and culture will
be covered in the unit.
Unit five will highlight the effect of stress. Mainly the effect of stress on health,
performance and productivity and on relationships will be covered in this unit.
Block 3 constitutes Units 6, 7 and 8 six. Unit six is related to coping with
stress and covers coping and coping styles. In this unit not only the concept
of coping will be discussed but various coping styles will also be highlighted.
Units seven and eight will cover various stress management techniques. In the
previous block we studied about stress as a concept and in the present block
we will cover how to manage and deal effectively with stress. Unit seven will
cover relaxation techniques, meditation, Yoga, mindfulness and biofeedback and
Unit eight will mainly cover cognitive restructuring and time management.
9
Block 4 focuses on promotion of physical and mental health. This block
is again divided in to four units. Units 9, 10, 11 and 12. Unit nine and
10 deal with physical illness experiences. Unit nine will highlight the illnesses
related to food, diet, obesity. It will also focus on the problems related to sexual
health. And Unit 10 will discuss acute and chronic pain besides chronic illnesses.
Unit 11 discusses mental illness experiences including, depression, anxiety,
psychosomatic illnesses and substance use. The last unit (Unit 12) is related
to the prevention, management and intervention and the topics that are covered
in this unit include cultivating human strengths (intra and inter personal) and
virtues, hope and optimism, gainful employment and work life balance. Further,
the unit will also discuss exercise, nutrition, Yoga and meditation.
Some suggestions and tips to enhance your study of this course are as follows:
1) Ensure that your basic concepts, given in this course, are clear. If you
don’t understand the terms, read again. The first unit is a foundation to
rest of the units, so ensure that you read and learn this unit first.
2) After you read each section, try to attempt the Check Your Progress for
that section and cross check your answers from Answers to Check Your
Progress given in the later section of the unit. This will provide you with
a feedback on what you have learned and what you need to further focus
on and understand.
10
BLOCK 1
INTRODUCTION TO HEALTH AND WELLBEING
11
UNIT 1
Introduction to Health and Wellbeing 13
UNIT 2
Models of Health and Illness 25
12
UNIT 1 INTRODUCTION TO HEALTH
AND WELLBEING*
Structure
1.0 Objectives
1.1 Introduction
1.2 Concept and Definition of Health
1.3 Cross-cultural Perspectives on Health
1.3.1 Western Perspective
1.3.2 Eastern Perspective on Health
1.3.3 Indian Perspective on Health
1.4 Health-Illness Continuum

1.5 Let Us Sum Up
1.6 References
1.7 Key Words
1.8 Answers to Check Your Progress
1.9 Unit End Questions
1.0 OBJECTIVES
After reading this unit, you will be able to:
 discuss the concept and definition of health;
 explain the perspectives of health; and
 describe the Health-Illness continuum.
1.1 INTRODUCTION
Rahul and Samina are a happily married couple in their early 30s. They
both work in a multi national company and are doing very well in their
jobs. But despite of high income and a comfortable lifestyle, Rahul was
recently diagnosed with hypertension and Type II diabetes and Samina is
stressed all the time and has developed sleep problem for which she is
consulting a physician.
Nirav is a ten year old boy and though he has always been on a healthier
side, he has been recently diagnosed as being obese. Doctor has attributed
his obesity to lack of healthy diet, (including fruits and vegetables that
are rich in fibre) and to regular consumption of junk food, soft drink and
sweets.
Arun was a topper throughout his school years and managed to get
admission to one of the best colleges in his cities to pursue a programme
* Dr. Arti Singh, Academic Associate, Discipline of Psychology, SOSS, IGNOU, New Delhi 13
Introduction in management. During this time, he started consuming alcohol and also
started smoking, that soon developed in to a habit and addiction. As a
result not only his studies suffered but his relationship with his family and
friends has also been negatively affected. His parents have now admitted
him to a de-addiction centre to help him recover.
After loosing her mother to a terminal illness, Savita who was once a bubbly
eight year old has now become secluded and lonely. She has stopped
interacting with her friends and refuses to attend school. She is also not
able to eat and sleep adequately. Her family doctor recommended her to
a clinical psychologist who has diagnosed her with having depression.
The above examples, highlight some of the aspects of health. It can be said
that health is one of the most important but most deprived aspect of our life.
Nowadays, our lifestyle has become more leisure oriented, indoor, technology-
centered and dependent on food such as pizza, burger, chips, cold drink, etc.
In all probability, this lifestyle is damaging our health and increasing the burden
of non-communicable diseases on our healthcare system. Moreover, conventional
hospital treatment has been found to be inefficient in treating lifestyle-related
diseases. It is thus important to focus on health and deal with it at multiple
levels not only by making adequate health services available but also by
encouraging healthy lifestyle amongst the individuals.
In the very first unit of this course, we will discuss about the concept and
definition of health. The difference between illness, disease, and sickness will
also be focused on. Further, the conceptualisation of health according to western
and eastern perspectives will also be explained. The Health-Illness continuum
will also be described.
1.2 CONCEPT AND DEFINITION OF HEALTH

What do you mean by health? The answer to this question is a complex one,
as it holds many different meanings across time, culture, society, social class
and even age groups. In this section, we will discuss the meaning of health
and how it has been conceptualised among lay people, by the World Health
Organisation, and among different cultures.
Many studies have been conducted to understand what common people think
and understand by health. In a study done by Bauman (1961), she asked people
to explain ‘what does being healthy mean for them?’ Majority of the participants
reported either of the following three types of responses:
1) health means a ‘general sense of wellbeing.’
2) health is identified with ‘the absence of symptoms of disease’ and,
3) health can be seen in ‘the things that a person who is physically fit is able
to do’.
Thus, according to layperson health has three components; feeling, symptom
orientation and performance. In another study, Benyamini, Leventhal, and
Leventhal (2003) found that according to 500 elderly participants, health is an
ability to perform physical functions and vitality. Krause and Jay (1994) also
conducted a study to understand the frame of reference for judging one’s health.
14 They found that for older participants the frame of reference was the absence
or presence of health problems. Whereas, for the younger participants, health Introduction to Health
and Well-being
promoting behaviour was the frame of reference. These studies suggest that the
meaning of health is very subjective and it changes with social factors and factors
like age group can also play a role.
The term health has been derived from ‘Hoelth’, that is, an old English word
that denotes ‘the state or condition of being whole or sound’ (Melquiades, 2015,
pg. 3).
Pindar, in 5th Century BC defined health as “harmonious functioning of the
organs”. (Svalastog et al, 2017, pg. 431) This definition mainly focused on the
physical aspect of health including the functioning of the physical organs as well
as the absence of pain and experience of comfort. Hippocrates described health
in relation to lifestyle of the individual and the environmental factors including
climatic conditions, air quality, lifestyle habits, quality of water and food as well.
The term ‘positive health’ was introduced by him, that focuses on diet as well
as exercise (Svalastog et al, 2017).
Health has also been described in terms of a person’s ability to adjust to the
environmental influences. Thus, if he/ she is not able to adapt then he/ she may
experience some illness or develop a disease (Svalastog et al, 2017). Most
of the modern definitions define health as not mere absence of disease but an
increased capacity for realisation and fulfilment of self. It has been explained
as a state in which the individual is able to adequately function at physical,
mental, social as well as spiritual level and is able to express his/ her potentials
in the context of the environment within which he/ she exists (Svalastog et al,
2017).
In 1946, The Constitution of World Health Organisation (WHO) came up with
a definition of health as “a state of complete physical, mental and social wellbeing
and not merely the absence of disease or infirmity”. Later in its 1998 constitution,
WHO again modified its definition and defined health as “a dynamic state of
complete physical, mental, spiritual and social wellbeing and not merely the
absence of disease or infirmity”. Few points should be noted down from these
definitions of health by World Health Organisation; (i) health is not equivalent
to absence of disease or symptoms, (ii) health is dynamic in nature, (iii) not
just your physical wellbeing but your mental, social and spiritual wellbeing are
equally important and, (iv) our health is a combination of four dimensions;
physical, mental, social and spiritual.
As you can see in the definition of health given by WHO, the term wellbeing
has been used. Wellbeing is also known as ‘Subjective Well-being’ (SWB).
The concept of wellbeing is closer to the concept of mental health, life satisfaction,
and happiness. Wellbeing is a subjective feeling, which involves evaluation of
those affective and cognitive aspects of life which are getting affected by disease
and illness directly or indirectly. Often it involves evaluation of happiness, sense
of contentment, sense of belongingness, achievement and being without any
distress and discomfort. We will discuss about it in detail in the next unit of
this course.
Other important terms related to health are ‘illness’, ‘disease’ and ‘sickness’.
Often used interchangeably, these three terms are used to describe the ill health
of the person. However, in the scientific community, these terms are used to
explain different connotations of ill health. Let us have a look at the basic
definition of these terms. 15
Introduction Disease: This term is used by the doctors or physicians to describe the
pathological (symptoms, causes etc.) and biological aspects of the health
condition of his/her patients.
Illness: It refers to the general term that people use to describe their perceived
deteriorated health conditions that may or may not have been yet diagnosed
by a doctor. Thus, this term represents subjective experiences of the person’s
ill health.
Sickness: It is the societal role and perception related to illness such as taking
rest, days off from work, stigma, etc.
Being healthy can be denoted not only by absence of illness but also presence
of physical, mental and social wellbeing, ability of an individual to adapt well
to his/ her environment. Health is also denoted by a movement towards wellbeing
or wellness. Illness on the other hand can be characterised by decreased
functioning in terms of physical, emotional, mental, social and spiritual aspects.
Illness can be determined by presence of symptoms as well as by the diminished
ability to function effectively in day to day life. It can also be determined by
how the individual is feeling.
Health can be described in terms of its three domains as proposed by Dalal
and Mishra (2012). They suggested the field of health broadly comprised of
three domains, namely, restoration, maintenance, and growth. The objective
of the first domain (restoration) is to help an individual in recovering his health
from the state of illness. Thus, this domain involves all kinds of interventions
that will help a patient in recovering from his illness symptoms, bodily pain,
and sufferings. The second domain of health is maintenance, and its objective
is to help people in maintaining good health and protecting them from diseases.
All kinds of health-promoting behaviour such as yoga, exercise, eating good
food, etc, are part of this domain. The last domain; growth, sees health not
just in the physical terms but it considers social factors and spirituality as its
parts as well. Therefore, this domain helps patients to achieve and grow in all
spheres of their life.
1) Define Health.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2) List the three domains of health.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
16 ................................................................................................................
Introduction to Health
1.3 CROSS-CULTURAL PERSPECTIVES ON and Well-being
HEALTH
The way in which health is defined or perceived may vary based on culture.
In this sub section of the unit, we will try to understand varied cross cultural
perspectives on health.
Since cultural beliefs are intricately woven into the health beliefs of patients,
therefore to understand any health-related behaviour it is essential to acknowledge
and understand the role of culture and society first. In this section, we will discuss
how western and eastern societies conceptualise health and illness. Before starting
this section, first let’s discuss the concept-Karma. Karma refers to the
metaphysical principle of cause and effect. It is a belief that the accumulated
effects of your deeds of last birth have an effect on the events of present life.
Studies have suggested that in India patients with life-threatening chronic diseases
such as AIDS, heart disease, and cancer tend to attribute the cause to karmic
factors more. Whereas, in western countries very few patients attribute illness
to karmic factors. What do you think, why there is a difference in their causal
attribution? The reason could be ‘cultural differences’ in the conception of the
role of Karma in life-events. This example suggests that cultural notions
significantly affect our conception of health.
1.3.1 Western Perspective

Culture never remains constant. It changes with time. Therefore, cultural
conception about health also changes with time. For instance, ancient Greek
culture (a western civilisation) believed in the role of four humors (blood, yellow
bile, black bile, and phlegm) in our health and investigated health as a whole.
Hippocrates, one of the renowned scholars of ancient Greek civilisation had
described in his writings about how mind, body, and spirit are interrelated and
work together to maintain our health. However, with the passage of time and
especially after the Renaissance, the scientific revolution led to considerable
development in the physical medicine. The explanation of the illness became
more scientific and physiological based. Further, during the seventeenth century,
French philosopher René Descartes’s philosophies about the dualism of mind
and body influenced contemporary and later philosophers and scholars alike.
As a result of this, western medicine started considering the mind and body
as entirely separate entities, and this philosophy still dominates their medical
theories. This theory of dualism is responsible for the idea of viewing the human
body as a machine and is known as the reductionist or mechanistic viewpoint.
According to this viewpoint, we can understand our body through its constituent
parts (cells, DNA, different body parts) and there is no role of concepts like
mind and spirit or spirituality in one’s health. The underlying assumption of
Western view on health is that the cause of the illness lies outside one’s body
in the form of germs and bacteria. Further, its (germs and bacteria) removal
will lead to the achievement of optimal health. Thus, it can be concluded that
the Western system of medicine treats patients only at the physical level and
thus ignoring his or her feelings, beliefs as well as cultural background. This
viewpoint underpins the medical or bio-medical model of health and illness.
We will discuss this model in detail in unit two. 17
Introduction 1.3.2 Eastern Perspective on Health
Eastern perspective refers to the viewpoint of eastern civilisation such as India
and China on health and its related issues. The basic premise of all eastern
civilisations is that health is more than just an absence of disease or its symptoms.
If you are healthy, then you will experience happiness, wellbeing, satisfaction
with life, be able to function optimally as a member of your social community
and, will be able to set goals and achieve them. Thus, you will be able to
function as a whole. So, it can be suggested that the WHO definition of health
supports eastern view more. In contrast to the western view, all eastern
civilizations primarily view health as a whole and, not in parts. Seeing health
as a whole means health is made up of many interrelated components such
as physical, social, mental and spiritual, and any imbalance among them will
manifest itself in the form of disease or illness. The eastern viewpoint underpins
the holistic model of health and illness. According to the holistic model, the
cause of illness does not lie outside but it is inside our body and harmony between
physical, mental, social and spiritual components will lead to the state of optimal
health.
1.3.3 Indian Perspective on Health
As culture plays a significant role in Indian life, it is important to understand
the traditional Indian view on health. The Sanskrit word for health is Swastha,
‘swa’ means ‘inner self’ and ‘-sth’ means ‘conscious’. Thus, in Indian tradition,
being healthy has been considered equivalent to being conscious of your inner-
self (Gupta et al., 2011). Dalal and Mishra (2011) have also pointed out the
inner- directedness of Indian view about health. It means the cause of all illnesses
lie within ourselves and if we became conscious of our inner selves, only then,
we can achieve optimal health. All traditional Indian systems like Ayurveda and
Siddha consider “physical, psychological, philosophical, ethical and spiritual
wellbeing of mankind” and harmony with the cosmos, nature, and science is
a necessary condition for wellbeing (Ravishankar & Shukla, 2007, p. 321).
Conceptualisation of health in traditional Indian system is in contrast to the
contemporary bio-medical health model. Instead of only treating symptoms of
the disease, all traditional Indian treatments aim to heal and improve the wellbeing
of the person.
1) Complete the sentences.
a) Ancient Greek culture believed in the role of four humors, namely
.........................................................................................................
.........................................................................................................
.........................................................................................................
b) The basic premise of all eastern civilisation is that
.........................................................................................................
.........................................................................................................
.........................................................................................................
c) The Sanskrit word for health is ....................................................
18
1.4 HEALTH-ILLNESS CONTINUUM and Well-being
As we have now developed an understanding of the concept of health, let us

discuss about the Health-Illness continuum. Health-illness continuum was introduced
by John Travis in the year 1972 and it can be explained as a graphical
representation of wellness. Wellness here is not mere absence of illness but
denotes healthy mental and emotional state. As can be seen in the Fig. 2.1,
there are two arrows in the figure that move in opposite direction with ‘neutral
point’ indicating the midpoint. Neutral point denotes absence of illness as well
as wellness. As we move towards the left of the figure, that is, towards premature
death, we can see that there are three steps, namely, signs, symptoms and
disability that result in premature death, thus indicating deterioration of health
ultimately leading to premature death. On the other hand, as we move towards
the right of the figure, the steps are awareness, education, growth present that
result in wellness. Thus, indicating increasing wellbeing or health of an individual.
The figure also shows treatment paradigm that denotes that if adequate treatment
is given the person can be brought back to neutral point.
Fig. 2.1: Health-Illness continuum
According to the Health-Illness continuum, health is dynamic. Our health moves

back and forth within a continuum, with optimum health or highest health at
one end and death or complete disability at the other end of this continuum.
One day you may feel energetic, another might have a headache for all day
long, while on the third day you may feel fine again. These situations suggest
that our health never remains constant and it changes or fluctuates throughout
one’s life. According to this model, since our health continuously changes;
therefore, our adaption or response to that change matters most as it affects
our health directly. For the same stressful situation, one person might respond
positively while another person might get anxious. The person who responded
positively will have better health than the second one.
19
Introduction Check Your Progress III
1) Who introduced Health-Illness Continuum?
.................................................................................................................
.................................................................................................................
2) Complete the figure of Health-Illness continuum.
1.5 LET US SUM UP

In the present unit we mainly discussed about the concept and defition of health.
The term health has been derived from ‘Hoelth’, that is, an old English word
that denotes ‘the state or condition of being whole or sound’. WHO defines
health as “a dynamic state of complete physical, mental, spiritual and social
wellbeing and not merely the absence of disease or infirmity”. The concept of
wellbeing was also briefly discuss in this Unit. Wellbeing is a subjective feeling,
which involves evaluation of those affective and cognitive aspects of life which
are getting affected by disease and illness directly or indirectly. Other important
terms related to health, namely, ’illness’, ‘disease’ and ‘sickness’, were also
explained. Further, the three domains of health, namely, restoration, maintenance
and growth were also highlighted. The unit also covered the cross- cultural
perspectives of health including the western perspective, the eastern perspectives
and the Indian perspective. The Health-Illness continuum was then discussed
with the help of a figure. Health-illness continuum was introduced by John Travis
in the year 1972 and it can be explained as a graphical representation of wellness.
In the next unit, that is, unit two, we will discuss about the various models
of health and illness.
1.6 REFERENCES
Bauman, B. (1961). Dversities in the Conception of health and Physical Fitness.
Journal of Health and Human Behaviour, 2, 39-46
20
Benyamini, Y., Leventhal, E. A., & Leventhal, H. (2003). Elderly People’s Introduction to Health
and Well-being
Ratings of the Importance of Health-Related Factors to their Self-assessments
of Health. Social Science & Medicine, 56(8), 1661-1667.
Boyd, K. M. (2000). Disease, Illness, Sickness, Health, Healing and Wholeness:

Exploring Some Elusive Concepts. Medical Humanities, 26(1), 9-17.
Brannon, L., Feist, J., & Updegraff, J. A. (2013). Health Psychology: An

Introduction to Behaviour and Health. Cengage Learning.
Dalal, A. K., & Misra, G. (Eds.). (2012). New Directions in Health

Psychology. SAGE Publications India.
Ghosh, M. (2015). Health Psychology: Concepts in Health and Wellbeing.

New Delhi: Dorling Kindersley (India) Pvt. Ltd.
Marks, D. F; Murray, M; Evans, Brian; Willig, C; Woodall, C and Sykes, C.

M. (2008). Health Psychology: Theory, Research and Practice. New Delhi:
Sage.
Melquiades, 2015. Concept of Health, Illness and Wellness. Retrieved from

https://www.researchgate.net/publication/275365494_ Concept_of_
Health_Illness_and_Wellness on 13/06/2019 at 2:55 pm.
Morrison, V., & Bennett, P. (2009). An Introduction to Health Psychology.

Pearson Education.
Rao, K., Paranjpe, A. C., & Dalal, A. K. (2008). Handbook of Indian

Psychology. Cambridge University Press India/Foundation Books.
Sanderson, C. (2013). Health Psychology. USA: John Wiley and Sons Inc.
Svatastog, A. L; Doney, D; Kristoffersen, N. J and Gajovic, S. (2017), Concepts

and Definitions of Health and Health-Related Values in the Knowledge
Landscapes of the Digital Society. Croatian Medical Journal, 58(6): 431–435,
doi: 10.3325/cmj.2017.58.431.
Undén, A. L., & Elofsson, S. (2001). Health from the Patient’s Point of View.
How does it Relate to the Physician’s Judgement? Family Practice, 18(2), 174-
180.
Wikman, A., Marklund, S., & Alexanderson, K. (2005). Illness, Disease, and
Sickness Absence: an Empirical Test of Differences between Concepts of Ill
Health. Journal of Epidemiology & Community Health, 59(6), 450-454.
1.7 KEYWORDS
Disease: Used by doctors or physicians to describe the pathological and
biological aspects of health conditions of his/her patients.
Dualism: Perspective prevalent in western societies, which states that mind and 21
Introduction body are two separate entities and have no connection between them.
Health: As defined by WHO, “it is a dynamic state of complete physical, mental,

spiritual and social wellbeing and not merely the absence of disease or infirmity”.
Holistic model: This is the model of health and illness majorly followed by
all eastern civilisations.
Illness: An individual’s experiences and descriptions of his/her ill health.
Sickness: It refers to social role and expectations associated with the patients
and its caregivers.
Wellbeing: Wellbeing is a subjective feeling, which involves evaluation of those

affective and cognitive aspects of life which are getting affected by disease and
illness directly or indirectly.
1.8 ANSWERS TO CHECK YOUR PROGRESS

1) Define Health
Health is a dynamic state of complete physical, mental, spiritual and social

wellbeing and not merely the absence of disease or infirmity (WHO).
2) List the three domains of health
The three domains of health are restoration, maintenance, and growth.
1) Complete the sentences.
a) Ancient Greek culture believed in the role of four humors, namely

blood, yellow bile, black bile, and phlegm.
b) The basic premise of all eastern civilisation is that health is more than
just an absence of disease or its symptoms.
c) The Sanskrit word for health is Swastha.
Check Your Progress III
1) Who introduced Health-Illness Continuum?
John Travis
2) Complete the figure of Health-Illness Continuum.
22
and Well-being
1.9 UNIT END QUESTIONS

1) How is the conceptualisation of health by lay people different from
conceptualisation of WHO. Explain.
2) Discuss the cross-cultural perspectives of health.
3) Write a note on Indian perspective on health.
4) Explain Health-Illness continuum.
23
UNIT 2 MODELS OF HEALTH AND
ILLNESS*
Structure
2.0 Objectives
2.1 Introduction
2.2 Medical Model of Health and Illness
2.3 Holistic Model of Health
2.4 Biopsychosocial model
2.5 Social Model of Health
2.6 Concept of wellbeing
2.7 Let Us Sum Up
2.8 References
2.9 Key Words
2.0 OBJECTIVES
 discuss the medical model of health and illness;
 describe the holistic model of health;
 explain the biopsychosocial model;
 discuss the social model of health; and
 elucidate the concept of wellbeing.
2.1 INTRODUCTION
In recent times many public celebrities like Deepika Padukone (a Bollywood
actress) have become more vocal about their mental illness (Depression in the
case of Deepika Padukone), that was quite positively received. Do you think,
reactions would have been received around 50 years ago if some one had talked
about his or her state of depression? May be not because the probability of
social rejection and taboo were much higher at that time and also, because
of the prevalent health models that labeled and defined an illness. Models provide
a theoretical framework so as to enhance our understanding of the concept,
in this case, health.
So why do we need to study health models? Because the model of the health
and illness adopted by society can have many important implications. It not
only influences the line of treatment but also influences people’s perception,
attitude and cultural beliefs. Another benefit we can gain from studying these
24 * Dr. Arti Singh, Academic Associate, Discipline of Psychology, SOSS, IGNOU, New Delhi
health models is that they can help us in appreciating their role in establishing Models of Health and
Illness
health psychology as a separate branch. Health psychology has been briefly
described in Box 2.1.
Box 2.1: Health Psychology

Health psychology is a subfield of psychology that mainly covers the
application of principles of psychology to the field of health. According
to Sanderson, (2013), health psychology aims to study the influence of
an individual’s behaviour on his/ her health, wellness and illness. It also
deals with the influence of various psychological factors on the experience
and reaction to stress, maintenance and promotion of health, coping with
pain and the effect of varied illnesses on the psychological wellbeing and
functioning of an individual. Ghosh (2015, pg. 4), defines health psychology
as “a scientific field that applies psychological theory and methods to the
study of health and tries to explain the entire range of behaviour from illness
to wellness’’.
As stated by Josepth Matarazzon, the major goals of health psychology
include, promotion and maintenance of health, prevention and treatment of
illness, identification of causes and the diagnostic correlated of illness and
other related dysfunctions and carrying out analysis and bringing about
improvements in health policies (Ghosh, 2015).
Health psychology as a separate field emerged with the realisation and
research evidence that (i) contemporary health model is efficient in dealing
with many illnesses, (ii) biological factors alone are not sufficient in
maintaining our health and, (iii) psychological mechanisms can help in
understanding wide-range of health issues.
In the previous unit we discussed about the concept of health and also focused
on the cross-cultural perspectives of health besides the Health-Illness continuum.
This unit tries to offer an overview of important health models that have played
a vital role in the development of health psychology. Further, the concept of
wellbeing will also be described at the end of the present Unit.
2.2 MEDICAL MODEL OF HEALTH AND

ILLNESS
What images come to your mind with the word: hospital? White coats, patients
resting on beds, X-ray machines, MRI scan machines, patients standing in the
queue for their turn to see the doctor, the smell of drugs, injection and many
more. Even though this description of contemporary treatment setup looks like
a part of our common sense but it would not have been for our great-great-
grandfathers and other ancestors. Why? Because this conception of medical
treatment is fairly recent. Since the 19th century, the medical model is the most
prevalent model of health and illness among contemporary healthcare
practitioners. The medical model is also known as “Biomedical model”. The
term ‘biomedical’ comes from the Greek word bios (meaning ‘life’) and the
Latin word medicus (meaning ‘healing’). But ironically, healing is not a part
of the practicing medical professionals as it focuses only on the physical aspect
of the disease. To understand the medical model, we will discuss some of its
major characteristics: 25
Introduction Cause of Disease: This model considers health as equivalent to a state
of absence of disease and symptoms. The root cause of a disease according
to this model is always some external pathogenic agents like virus, bacteria
or some other physiological problem or cellular abnormalities. (Guttmacher,
1979). Further, it denies any role of emotional and psychological factors in
disease.
Responsibility for disease: This model considers that the cause of illness is
not dependent on the individual. Due to this reason, individuals are not seen
as responsible for their illness. Patients are considered as only victims of some
external factor or internal abnormalities.
Treatment: Since the focus of the medical model is always on biological or

physical aspect. Therefore, treatment also focuses only on the human body’s
physical aspect. It involves removal of pathogenic agents either through drugs
or through interventional strategies like surgery. The objective of treatment is
the removal of symptom and relief from any type of pain.
Techno-oriented Model: This is the only model of health which relies heavily
on machines and technologies. From making a generic drug to performing a
surgery, everything here requires technology.
Practitioner-Physician relationship: This model considers that

physicians possess all the required knowledge, expertise, and skill to treat
patients. The medical model further considers patients as only passive
recipiens of their physician’s expertise and expects patients to only corporate
with their treatment regime. Thus, the model considers practitioners superior to
patients.
There is no doubt that the medical model is very effective in critical medical
conditions. Therefore, it is often referred to as “quick fix” approach. It can
provide immediate relief and quickly minimise the symptoms of the disease.
However, many researchers have pointed out a number of limitations of medical
treatment. According to George Engel (1997) and Guttmacher (1979), the
medical model have many drawbacks. Some of the major limitations are as
follows:
 It has a reductionist approach to human body and views it in the mechanistic

framework. It does not give importance to the concept of ‘mind’ and
considers mind-body dualism.
 It ignores any role of social, emotional, spiritual and psychological factors

in health and illness. Thus, it does not talk about the wellbeing or healing
aspect of the disease.
 It is not always effective in treating many diseases. Specifically, any

psychosomatic diseases, chronic and lifestyle-related diseases.
 The issue of affordability is also associated with this model. Hospital

treatment offers impersonal professional care, leading to a burden on one’s
pocket because of high fees. Its accessibility also depends on one’s socio-
economic status.
26
Check Your Progress I Models of Health and
Illness
1) Why is medical model characterised as techno-oriented model?
................................................................................................................
................................................................................................................
................................................................................................................
2) State any one limitation of the medical model of health and illness.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2.3 HOLISTIC MODEL OF HEALTH

In response to the various limitations of the medical model, many scholars came
up with new models for health and illness. One such model is known as the
holistic model. The term Holistic medicine was first used by F. H. Hoffman
in 1960 (Derick, 2009). It refers to conceptualising health as a ‘whole’.
Guttmacher (1979) has suggested that holistic model considers health as
equivalent to “a sense of wellbeing” and disease is not considered as a presence
or absence of a pathogenic agent only. Instead, according to the holistic model,
a disharmony between social, psychological and spiritual dimensions of one’s
life causes disease. In this way, the holistic model puts responsibility for ill health
on the individual also. This model also gives equal importance to the role of
practitioners and patients. Unlike biomedical model, it considers a practitioner
as a mentor and role model, whose role is to motivate patients to be self-
responsible for their health instead of having blind faith in practitioners’ efficacy.
In recent times the concept of holism has become quite popular among scholars
and health care. As a result of this, there are many associations that are promoting
the concept of holistic health. Some of these prominent associations include the
American Holistic Medical Association, British Holistic Medical Association,
American Holistic Health Association and, American Holistic Nurses Association.
According to one such association; American Holistic Medical Association (n.d.)
Holistic medicine is “the art and science of healing that addresses care of the
whole person-body, mind, and spirit. The practice of holistic medicine integrates
conventional and complementary therapies to promote optimal health, and
prevent and treat disease by addressing contributing factors”. Based on this
definition and earlier discussion we can conclude following points about the
holistic model:
 Holism refers to a complete and comprehensive analysis of health and
illness.
 We need to understand health from multiple perspectives as there is no
single cause of illness.
 A holistic practitioner may treat patients from a wide range of healthcare
options, that is, he/she may use medication along with alternative therapies. 27
Introduction As a result, many researchers called for an alternative model which can
incorporate all dimensions of health and treats health as a whole. First holistic
model “Biopsychosocial” was proposed by Engel in 1977, since then many other
holistic models have been proposed by researchers such as Biopsychosocial-
Spiritual Model (Sulmasy, 2002), Expanded WHO ICF Model of Illness (Wade,
2004), BMSEST model (Body, Mind, Spirit, Environment, Social, Transcendent)
(Anandarajah, 2008), Eastern Body-Mind-Spirit Model (Chan, 2008). Studies
have reported that treatment based on the holistic models can lead to an
improvement in perceived wellbeing, depression and quality of life and decrease
in depression and anxiety among its patients (Chan et. al, 2005; Targ & Levine,
2002; Sulmasy, 2002).
1) Describe the holistic model of health.
................................................................................................................
................................................................................................................
................................................................................................................
Box 2.1: A Summary of Major Differences between the Medical

Model and Holistic Models
Medical Model Holistic Models
1. Health: Absence of disease. Health: A sense of wellbeing.
2. Disease: Pathogenic agents, Disease: Disharmony between the

such as a chemical irritant or individual and his/her environment
bacteria or cellular abnormalities, or a disintegration social,
and can be identified by psychological, and spiritual
distinctive symptoms. dimension.
3. Healing: Is the treatment of Healing: Healing must entail a

physical symptoms. reintegration of basic dimensions.
4. Role of Practitioner: Possesses Role of the Practitioner: Guide,

the necessary specialized mentor and role model.
technical knowledge and skill to
cure the disease.
5. Role of the Patient: The patient Role of the Patient: Individual

must cooperate with the physician patient is essentially responsible
and comply with instructions. for the outcome of an illness episode.
6. Treatment Outcomes: Treatment Outcomes: Long-term

Immediate relief, long-term relief, fewer complications, higher
complications, lowering of Health- HR-QoL, fewer psychological
Related–Quality of Life (HR-QoL), problems, lesser dependency on
psychological problems such as drugs and, higher self-
depression and anxiety, dependency responsibility.
on drugs and, lower self-
responsibility.
28
Models of Health and
2.4 BIOPSYCHOSOCIAL MODEL Illness
In this section, we will discuss the most famous holistic model, Biopsychosocial
model. Between the 1960s and 1980s, George Engel published a series of papers
criticising medical model and advocating the need for a new model of health
and illness. He proposed that,
‘‘........the existing biomedical model does not suffice. To provide a basis for
understanding the determinants of disease and arriving at rational treatments and
patterns of health care, a medical model must also take into account the patient,
the social context in which he [sic] lives, and the complementary system devised
by society to deal with the disruptive effects of illness, that is, the physician
role and the health care system. This requires a biopsychosocial model’’ (Engel
1977, pg. 132)
Biopsychosocial model, as the name suggests, conceptualises health as consisting
of multiple dimensions. The medical or biomedical model focuses only on the
physical aspect of health, but Engel’s new model includes psychological and
social aspects as well. It is based on the idea that “humans are inherently
biopsychosocial organisms in which the biological, psychological, and social
dimensions are inextricably intertwined” (Melchert, 2007, pg. 37). Engel did
not completely reject the benefits of the medical model but emphasised on giving
equal importance to psychological and social factors in the process of treatment.
This model suggests that other than physiological abnormalities, germs and
viruses, our behaviours, thoughts, and feelings may also influence our physical
state. Further, Engel also argued that physicians should also give importance
to subjective experiences of their patients.
Broadly, there are three areas in which the biopsychosocial model has offered
new insights: (1) patient’s subjective experience is as important as objective
biomedical data, (2) a comprehensive causation can give fuller and deeper
understanding of our health and illness, and (3) patients should not be treated
as passive recipients of the treatment. They should be given more power in
the clinical process.
The main advantage of this model is that it leads to numerous development
in technology and research. It also contributes to the diagnoses and effective
treatment of varied illnesses. It also leads to increase in life expectancy and
enhancement of life expectancy. Though the model tends to rely on technology
and thus could be cost ineffective and may not be affordable. The focus of
this mode is also more on treatment than on actual promotion of good health.
1) What are the three areas in which the biopsychosocial model has offered
new insights?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
............................................................................................................... 29
Introduction
2.5 SOCIAL MODEL OF HEALTH
Social model of health finds its roots in the social model of disability and as
such is a reaction to the medical model. In this model various factors that play
an important role in health, like, social, political, economical, cultural and even
environmental are taken in to consideration. For instance, environmental pollution
can lead to detrimental effects on health. This model can be termed as a
community based approach where the focus is on prevention of the illnesses/
diseases. Thus, relevance is given to the awareness programmes and policies
related to health so as to modify the lifestyle and health related behaviour of
the individuals so as to promote their health and wellbeing. Thus, according
to this model health can be promoted by keeping in mind the social, political,
economical, cultural and environmental factors.
The main characteristics of this model are as follows (Yuill, Crinson and
Duncan, 2010):
1) Social context in which the individual exists has a significant influence on

the health related experiences, choices and behaviour of the individual. The
social context includes class, ethnicity, gender and so on.
2) The human body is social, psychological and biological simultaneously.
3) Cultural variations exist in the way health and illness are perceived.
4) Though, biomedicine and medicine are relevant in the context of health,

there are other aspects as well that play a role.
5) Health and social determinants of health are influences by political decisions.
6) The opinions of persons from non-medical background are relevant as they

may provide a different perspective on health.
Social model thus focuses on the social responsibility in order to ensure that
people have a healthy lifestyle and environment. And strategies at varied
levels, like, economical, political and so on, need to be developed in order
to promote health amongst individuals. Thus, the social model of health focuses
on varied determinants of health and also strives towards decreasing social
inequalities. It focuses on empowerment of not only individuals but communities
as well.
Some of the major advantages of this model are that this model promotes
education amongst the individuals and is also cost effective. It also puts the
onus on the individual so that he/ she develops healthy lifestyle. The model is
based on community approach and seeks involvement of both governmental and
non-governmental agencies. Despite of the advantages, the social model may
also display some issues or disadvantages. Individuals may not be motivated
or may lack awareness regarding health behaviour and lifestyle. Further, brining
about change in an individual’s health related behaviour is not easy. This is a
long term measure and thus quick results may not be achieved.
30
Check Your Progress IV Models of Health and
Illness
1) State any one characteristic of social model of health.
................................................................................................................
................................................................................................................
................................................................................................................
2.6 CONCEPT OF WELLBEING

The concept of wellbeing can be termed as broad and finds application in varied
situations like economic, social, psychological and so on (King, 2007). According
to Veenhoven (2004), the term ‘wellbeing’ broadly “denotes that something is
in a good state”. Though the term does not specify what is in the good state
and what constitutes that good state.
There were mainly two approaches to defining wellbeing. The hedonic tradition
and the eudaimonic tradition. The hedonic tradition focuses on constructs such
as happiness, positive emotions and life satisfaction. The eudaimonic tradition
on the other hand described wellbeing in terms of effective and positive
psychological functioning and development. Despite of these two different views,
as such wellbeing as a construct is seen as multi-dimensional (Dodge et al, 2012).
Lets us now look at various definitions of wellbeing.
Shin and Johnson (1978, pg. 478) stated that “wellbeing is a global assessment
of a person’s quality of life according to his own chosen criteria”.
Shah and Marks (2004, pg. 2) explained that “wellbeing is more than just
happiness. It is feeling satisfied and happy. Wellbeing means developing as a
person, being fulfilled, and making a contribution to the community’’.
According to Dalal and Misra (2006), the concept of wellbeing is closer to
the concept of mental health, life satisfaction, and happiness. The concept of
wellbeing refers to a subjective feeling, which involves an evaluation of those
affective and cognitive aspects of life which are getting affected by disease and
illness directly or indirectly. Often it involves evaluation of happiness, sense of
contentment, sense of belongingness, achievement and being without any distress
and discomfort.
Wellbeing can be of two types: subjective wellbeing and objective wellbeing.
Subjective wellbeing: It is that part of one’s wellbeing which can be measured
only by asking people directly about three aspects of wellbeing; evaluative
wellbeing (life satisfaction), hedonic wellbeing (positive emotions such as feelings
of happiness, sadness, etc), and eudemonic wellbeing (sense of purpose and
meaning in life). “Subjective wellbeing consists of three interrelated components:
life satisfaction, pleasant affect, and unpleasant affect. Affect refers to pleasant
and unpleasant moods and emotions, whereas life satisfaction refers to a cognitive
sense of satisfaction with life” (Diener & Suh, 1997, pg. 200).
Objective wellbeing: This type of wellbeing has its roots in the discipline of
economics. It can be measured through self-reports as well as by studying
objective measures such as mortality rate, life expectancy etc. This form of 31
Introduction wellbeing measures whether people have basic human needs and rights such
as education, food, water and health facilities.
Wellbeing can also be categories as emotional wellbeing, physical wellbeing,
social wellbeing, workplace wellbeing and societal wellbeing (Davis, 2019).
 Emotional wellbeing denotes an individuals ability to adequately manage
stress, display resilience and display positive emotions.
 Physical wellbeing is explained in terms of improving one’s bodily functioning
by exercising and eating healthy.
 Social wellbeing is described in terms of effective communication and ability
to develop relationships and having adequate social support.
 Workplace wellbeing is an individuals ability to develop in his/her profession
and pursue one’s interest, values and gain meaning and happiness.
 Societal wellbeing is about active participation in activities related to
community and environment.
Check Your Progress V
1) What is subjective wellbeing?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
2.7 LET US SUM UP

To summarise, since the last 200 years medical model has dominated the
healthcare system. This model has a reductionist approach with regard to human
body and equates the absence of symptoms as equivalent to good health.
Dissatisfaction with the medical model motivated many scholars to switch to
the holistic model. This model proposes to treat illness not just at the physical
level but also at psychological, social and spiritual level. Biopsychosocial model
(given by George Engel in 1977) is one such holistic model which attempts
to treat patients as whole. Social model of health finds its roots in the social
model of disability and as such is a reaction to the medical model. In this model
various factors that play an important role in health, like, social, political,
economical, cultural and even environmental are taken in to consideration.
The topic of health is not complete without understanding the concept of
wellbeing. Wellbeing involves evaluation of happiness, a sense of contentment,
sense of belongingness, achievement and being without any distress and
discomfort. The concept of wellness can be broadly categorised as subjective
wellbeing and objective wellbeing.
In the next block, that is block 2, we will discuss about stress and stress
32 management.
Models of Health and
2.8 REFERENCES Illness
Baum, A.,& Posluszny, D. M.(1999). Health Psychology: Mapping

Biobehavioral Contributions to Health and Illness. Annual Review of Psychology,
50, 137-163.
Callahan, D. (1973). The WHO Definition of ‘Health’. The Hastings Center
Studies, 1(3), The Concept of Health, 77-87.
Davis, T. (2019). What Is Well-Being? Definition, Types, and Well-Being Skills.
Retrieved from https://www.psychologytoday.com/us/blog/click-here-happiness/
201901/what-is-well-being-definition-types-and-well-being-skills on 17/06/2019
at 11:20 am.
Dalal, A. K., & Misra, G. (2006). Psychology of Health and Wellbeing: Some
Emerging Perspectives. Psychological Studies.
Dalal, A. K. & Misra, G. (2011). New Directions in Health Psychology (1 st
ed.). New Delhi: Sage Publication.
Diener, E., & Suh, E. (1997). Measuring Quality of Life: Economic, Social, and
Subjective Indicators. Social Indicators Research, 40 (1-2), 189-216. http://
dx.doi.org/10.1023/A:1006859511756
Dodge, R., Daly, A., Huyton, J., & Sanders, L. (2012). The Challenge of
Defining Wellbeing. International Journal of Wellbeing, 2(3), 222-235. doi:10.5502/
ijw.v2i3.4
Engel, G. L. (1977). The Need for a New Medical Model. Science,196, 129-136.
Farre, A., & Rapley, T. (2017, November). The New Old (and Old New)
Medical Model: Four Decades Navigating the Biomedical and Psychosocial
Understandings of Health and Illness. In Healthcare (Vol. 5, No. 4, p. 88).
Multidisciplinary Digital Publishing Institute.
Ghosh, M. (2015). Health Psychology: Concepts in Health and Wellbeing. New
Delhi: Dorling Kindersley (India) Pvt. Ltd.
Guttmacher, S. (1979). Whole in Body, Mind, and Spirit: Holistic Health and
the Limits of Medicine. The Hasting Center Report, 9(2), 15-21.
Marks, D. F; Murray, M; Evans, Brian; Willig, C; Woodall, C and Sykes, C.
M. (2008). Health Psychology: Theory, Research and Practice. New Delhi: Sage.
Shah, H., & Marks, N. (2004). A Wellbeing Manifesto for a Flourishing Society.
London: The New Economics Foundation
Shah, P., & Mountain, D. (2007). The Medical Model is Dead–Long live the
Medical Model. The British Journal of Psychiatry, 191(5), 375-377.
Shin, D., & Johnson, D. (1978). Avowed Happiness as an Overall Assessment
of the Quality of Life. Social Indicators Research, 5(1), 475–492. http://
dx.doi.org/10.1007/BF00352944
Veenhoven, R. (2004) “Subjective Measures of Wellbeing.” Discussion Paper
No. 2004/07. United Nations University: WIDER. 33
Introduction Wade, D. T., & Halligan, P. W. (2004). Do Biomedical Models of Illness Make
for Good Healthcare Systems?. BMJ: British Medical Journal, 329(7479),
1398.
Wade, D. (2006). Why Physical Medicine, Physical Disability, and Physical
Rehabilitation? We should Abandon Cartesian Dualism.
Wade, D. T. (2009). Holistic Health Care. What is it, and how can we Achieve
it? Oxford Centre for Enablement,1-35.
Yuill, C., I. Crinson, and E. Duncan, Key Concepts in Health Studies. Sage
Key Concepts. 2010, Los Angeles; London: Sage.

1) Why is medical model characterised as techno- oriented model?
Medical model is characterised as techno-oriented model because, this is the
only model of health which relies heavily on machines and technologies.
From making a generic drug to performing a surgery, everything here
requires technology.
2) State any one limitation of the medical model of health and illness.
The medical model ignores any role of social, emotional, spiritual and
psychological factors in health and illness. Thus, it does not talk about the
wellbeing or healing aspect of the disease.
1) Describe the holistic model of health.
Holistic model considers health as equivalent to “a sense of wellbeing” and
disease is not considered as a presence or absence of a pathogenic agents
only. Instead, according to the holistic model, a disharmony between social,
psychological and spiritual dimensions of one’s life causes disease.
1) What are the three areas in which the biopsychosocial model has offered
new insights?
The three areas in which the biopsychosocial model has offered new insights
are:
 patient’s subjective experience is also as important as objective
biomedical data,
 a comprehensive causation can give fuller and deeper understanding
of our health and illness,
 patients should not be treated as passive recipients of the treatment.
They should be given more power in the clinical process.
Check Your Progress IV
1) State any one characteristic of social model of health.
Social context in which the individual exists has a significant influence on
the health related experiences, choices and behaviour of the individual. The
34 social context includes class, ethnicity, gender and so on.
Check Your Progress V Models of Health and
Illness
1) What is subjective wellbeing?
It is that part of one’s wellbeing which can be measured only by asking
people directly about three aspects of wellbeing; evaluative wellbeing (life
satisfaction), hedonic wellbeing (positive emotions such as feelings of
happiness, sadness, etc), and eudemonic wellbeing (sense of purpose and
meaning in life).
2.10 KEY WORDS

Medical model : The dominant model of health in the
contemporary healthcare sector. It focuses
only on the physical aspect of the disease and
follows mind-body dualism.
Holistic model : Treats patients as a whole. The aim of this
model is not just to cure but heal patients.
Biopsychosocial model : Propounded by Engel in 1977. It views illness
not only from the physical dimension but gives
equal importance to psychological and social
dimensions.
Wellbeing : The concept of wellbeing refers to a subjective
feeling, which involves an evaluation of those
affective and cognitive aspects of life which
are getting affected by disease and illness
directly or indirectly.

1) What is medical model? Explain its major characteristics.
2) What is the holistic model of health? Write a note on factors that lead
to dissatisfaction with the medical model.
3) Differentiate between the medical model and holistic model.
4) Write a note on wellbeing.
35
36
BLOCK 2
INTRODUCTION TO STRESS
37
UNIT 3
Stress: An Introduction 39
UNIT 4
Factors Contributing to Stress Proneness 53
UNIT 5
Effect of Stress 62
38
UNIT 3 STRESS: AN INTRODUCTION*
Structure
3.0 Objectives
3.1 Introduction
3.2 Concept of Stress
3.3 Nature of Stress
1.3.1 Types of Stress
1.3.2 Symptoms of Stress
3.4 Sources of Stress

3.5 Measurement of Stress
3.6 Let Us Sum Up
3.7 References
3.8 Key Words
3.0 OBJECTIVES
After reading this Unit, you will be able to:
 explain the concept of stress;
 describe the nature of stress;
 discuss the sources of stress; and
 describe measurement of stress.
3.1 INTRODUCTION
Nirav was a very studious boy. He pursued MBA and was a topper in
his institute. He was also able to secure a good job as a manager in one
of the leading multinational companies. Nirav was very excited about his
new job. Though, as he started working, his parents and friends started
noticing change in Nirav’s behaviour. He was always irritated, angry, barely
interacted with any one, was not eating and sleeping adequately. His
colleagues also noticed the change in his behaviour as they felt that
otherwise effective and jovial Nirav was becoming secluded and that was
affecting his performance at work.
Samina was eldest child in her family and was a bright student. She wanted
to become a doctor when she grew up. However, her mother fell very sick
and Samina had to leave her studies and take care of her ailing mother
and her three younger siblings. Subsequent to death of her mother, Samina
was not same as before. She started falling sick often and doctors could
find no physiological reasons for her sickness. She also lost interest in her
studies and in fact did not even bother to appear for her examination.
* Prof. Suhas Shetgovekar, Faculty, Discipline of Psychology, SOSS, IGNOU, New Delhi 39
Introduction to Stress Ravi was sure that he will be promoted to senior manager’s post after
this year’s performance appraisal. He had worked very hard and felt that
he deserved the promotion. However, as the news with regard to promotions
in his department was announced, he was shocked to see that he was not
promoted. Ravi felt very frustrated after this news as he felt that his work
and sincerity were not appreciated by his superiors. He lost interest in his
job and his productivity started declining. The frustration experienced by
him also affected his family relationship and he started having fights with
his spouse. This led to further frustration and anger and Ravi ended up
having a psychological breakdown.
Above are three different examples of individuals who experienced stress in
one way or other in their lives. Nirav was stressed due to the job pressure
that he experienced, with which he was not able to cope, and that had an
impact on his wellbeing. A very negative and tragic life experience of losing
a parent led Samina to experiencing stress that affected her physiological
wellbeing. Stress as a result of frustration experienced by Ravi him to become
psychologically distressed and experiencing a psychological breakdown. The
three examples also imply that there are various reasons why a person may
experience stress and the symptoms of stress as displayed by the individuals
also vary. Though, one thing can be stated clearly, that is, if stress is not identified
and managed in time or on regular basis it can have detrimental effects on the
individual, His/her functioning and productivity will decrease and it can also have
a negative impact on the significant people in his/her life like parents, spouse,
children, friends and even colleagues. Stress has a negative impact on both
psychological and physiological wellbeing of a person and thus needs to be
dealt with adequately using suitable intervention strategies. Though, before the
techniques of stress management are discussed, it is important to understand
what is stress, its nature, its symptoms and sources.
In the present unit we will make an attempt to understand the concept of stress
and will also focus on the symptoms and sources of stress. Further, measurement
of stress will also be discussed.
3.2 CONCEPT OF STRESS

After reading the above examples you may have developed some idea about
what is stress. In the present section of this Unit we will discuss about the
concept and nature of stress so as to develop a better understanding about
this term.
The term stress has been derived from ‘stringere’ that is a Latin word and
means ‘to draw tight’ (Cox, 1978). It has today become a very commonly
used term in every context whether school, workplace, day to day life and
so on. We often come across people who say that they are stressed or
experiencing stress in their lives. We ourselves experience stress often.
The origins of stress can mainly be traced to physical sciences (Schafer, 1998).
During the 17th century it was exceedingly used to denote affiliations and
hardships experienced by individuals and during the 18th century it came to
be described mainly in terms of pressure, strain or force (Cartwright and Cooper,
1997). The initial conceptualisation of stress mainly focused on stress as an
external stimulus. Though later it came to be described as a response of an
40 individual to certain disturbances. The study carried out by Cannon can be
mentioned in this context, where he mainly studied the fight and flight reaction. Stress: An Introduction
The focus of the study by Cannon was on the effect that stress has on animals
as well as humans. Cannon also observed physiological changes in the
participants of his study and he attributed these changes, as displayed by
individuals, to stress.
Hans Selye (1974) described stress as a response of the body to certain demand
that is made on it and he further stated that this response was non-specific.
Baum et al. (1981) have defined stress as a “process in which environmental
events or forces, called, stressors, threatens an organism’s existence and
wellbeing”.
Schafer (1998, pg 6) defined stress as “arousal of mind and body in response
to demands made on them”.
Both the above definitions focus on the demand and an individual’s response
to the same. Thus, the onus here is on the response of the individual. Though
the first definition focuses only on body the second definition brings in the
important aspect of mind, implying that stress is a response of both body as
well as mind.
Yet another definition of stress was given by Lazarus and Folkman (1984, pg.19).
They define stress as “a particular relationship between the person and the
environment that is appraised by the person as taxing or exceeding his/ her
resources and endangering his/ her wellbeing”. This definition emphasises the
relationship between person and the environment, though here the stress is
presented in a negative light and stress is not always negative and may have
its own advantages. Lazarus and Folkman put forth the transactional model of
stress and coping that focuses on how an event is interpreted or appraised
by an individual, which in turn will determine the stress experienced by the
individual. This model highlights that stress and coping with stress as being
interrelated processes.
Truxillo et al. (2016, pg. 440) defined stress as “the body’s reaction to a change
that requires a physical, mental or emotional adjustment or response”. This
definition has further elaborated the response as being physical, mental or
emotional in nature.
The above definitions mainly looked at stress from a western perspective. If
we describe stress from an eastern perspective, it denotes absence or lack on
inner peace (Seaward, 2014). And thus, the stress managing techniques would
also focus on achieving the inner peace.
While discussing the concept of stress it is also important to understand the
term stressor, that can be described as situation, event, person or anything that
leads to the stress response. Gerrig and Zimbardo (2005, pg. 430) defined
stressor as a stimulus event that places a demand on an organism for some
‘‘kind of adaptive response”. At a given point of time an individual may have
various stressors in his/ her life. It could be an upcoming official event, an
impending report, examination and so on. Stressors can also be described as
varied external and internal stimuli that may lead to stress. Stressors can be
categorised into physical, psychological, environmental, social and as life events.
Stressors could range from adjusting to change, financial issues and problems,
life events like separation, divorce, illnesses or death of a loved one, managing
varied roles and responsibilities, facing frequent challenging situations and even 41
Introduction to Stress technological changes and development. Some of the stressors that an individual
may have in one’s life are shown in figure 3.1.
Fig. 3.1: Showing various Stressors

1) Define Stress
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
3.3 NATURE OF STRESS

Stress as such is like salt and pepper and a life without stress would be without
motivation, as stress often motivates us to work in certain direction. Thus, without
any stress in life, any individual will not be motivated to perform or carry our
varied activities. As more salt than required can make food taste bad. In a
similar manner, stress beyond optimal level can have a negative effect on the
individual and will interfere with his/ her day today functioning. When stress
experienced exceeds the optimal level of an individual, the individual may find
it exceedingly difficult to cope with it and it can have detrimental effects on
the wellbeing (both psychological and physiological) and performance and
productivity of the individual. Stress is not altogether negative and does have
numerous advantages.
It is therefore important that stress is managed and is kept below the optimal
level.
In the present section of the Unit, we will discuss about the types and symptoms
of stress.
42
1.3.1 Types of Stress Stress: An Introduction
Stress can be categorised into different types as follows:
1) Eustress: Stress can be good stress that is explained as ‘Eustress’.

Eustress can be defined as “good stress, caused by a positive response
to a desired stressor, such as a wedding or a new job” (Truxillo et al
(2016, Pg. 441).
2) Neustress: When stress is not helpful nor harmful, it can be described

as ‘Neustress’ (Schafer (1998, pg 7).
3) Distress: This is the third category of stress that most people commonly
relate stress with. ‘Distress’ occurs when the arousal experienced by the
individual is very high or very low (Schafer (1998, pg 8). Distress can
also be categorised into acute and chronic stress. Acute stress can be termed
as stress that is intense but does not last for a prolonged period of time.
Whereas, chronic stress may not be as intense but may exist for a prolonged
period of time.
4) Hyperstress: Excessive stress is termed as ‘Hyperstress’.
5) Hypostress: Insufficient stress is termed as ‘Hypostress’.
1.3.2 Symptoms of Stress

Stress can have an impact on various aspects of life that include behaviour,
cognition, emotions as well as physical health. Though stress will have a different
effect on different individuals and each individual will react to stress in a different
way, there are certain symptoms that can be related with stress. These are
discussed as follows:
Physical symptoms: The physical symptoms of stress include low levels of

energy, stomach upset, headaches and migraines, pain and aches, chest pain,
rapid heartbeats, lack of sleep, dryness in mouth, experiencing tension in muscles,
frequent infections and so on.
Emotional symptoms: The emotional symptoms include, displaying frustration,

getting irritated or agitated easily, feelings of worthlessness, feeling lonely and
even depressed.
Psychological symptoms: The cognitive symptoms related to stress include

worrying constantly, experiencing racing thoughts, lack of organisation in thinking,
forgetting, not able to focus, lack of judgement or poor judgement and also
pessimism.
Behavioural symptoms: The behavioural symptoms of stress include deterioration

in performance effectiveness, indulgence in substance use, prone to accidents,
nervous mannerism, poor time management, displaying checking rituals, changes
in appetite, procrastination, eating faster, even talking or walking faster, impaired
speech and so on.
Thus, the symptoms of stress can be categorised into the above main four
categories, but it is to be remembered that individual differences do exist in
the symptoms displayed by different individuals. 43
Introduction to Stress Table 3.1: Symptoms of Stress
PHYSICAL PSYCHOLOGICAL EMOTIONAL BEHAVIOURAL

- Rapid Pulse - Feeling upset - Anxiety - Deterioration in performance
effectiveness
- Pounding - Inability to - Depression
concentrate - Smoking or use of alcohol or
Heart - Anger other recreational drugs
- Irritability
- Increased - Guilt - Accident proneness
Perspiration - Loss of self
confidence - Jealousy - Nervous mannerism (foot
- Tensing of arm tapping, nail biting)
and leg - Worry - Shame
- Increased or decreased eating/
muscles - Difficulty in making
- Impatient Anorexia
decisions
- Shortness of - Increased or decreased
breath - Racing thoughts - Suicidal
feelings sleeping/ sleep disruption
- Gritting of - Absent mindedness
- Phobias
teeth
- Eating/ walking/ talking faster
- Headaches - Poor time management
- Indigestion - Impaired speech
- Numbness - Checking rituals
- Dry mouth
- Pain
- Cold sweat
- Abdominal
cramps

1) What is neustress?
................................................................................................................
................................................................................................................
................................................................................................................
2) What are the cognitive symptoms of stress?
................................................................................................................
................................................................................................................
................................................................................................................
3) Explain the physical symptoms of stress?
................................................................................................................
................................................................................................................
................................................................................................................
44
Stress: An Introduction
3.4 SOURCES OF STRESS
As we have developed a clear idea about the concept and nature of stress,
we will now move on to the sources of stress.
As such, the sources of stress can be categories in to three main sources, namely,
Frustration, Conflict of motives and Pressure (Coleman, 1970).
Frustration: Frustration can be described as occurring when a goal oriented
behaviour of an individual is thwarted. As stated by Mangal (1984, pg 46)
“a wide range of environmental obstacles, both physical and social and the
internal factors in the form of personal limitations, biological conditions and
psychological barriers may lead to frustration of our needs, motives and efforts”.
For example, Ravi expected his promotion, however, when he did not receive
the same, he experienced frustration.
Conflict of Motives: The next source is conflict of motives that can cause
stress as an individual has to choose between alternatives and decision making
in this regard can lead to stress. Conflict of motives can be of four different
types, approach - approach conflict, avoidance - avoidance conflict, approach -
avoidance conflict and double approach - avoidance conflict.
1) Approach-approach conflict: In this type of conflict the individual has
to choose between two goals that are positive and are similar. For example,
an individual may have to choose between two similar job opportunities.
2) Avoidance- avoidance conflict: The next type of conflict of motives is
avoidance- avoidance conflict. Here again there are two goals that are
similar but as opposed to approach- approach conflict, the goals here are
negative. For example, an individual may have to take decision whether
he/ she wants to remain unemployed or take up a mediocre job that he/
she is not interested in.
3) Approach- avoidance conflict: Here there is a single goal which is both
positive and negative. For example, an individual taking up a job abroad
may be excited about the opportunity but also has to face the fact that
he/ she will have to stay away from the family. Thus, this goal has both
negative and positive consequences and thus the individual may experience
stress.
4) Multiple approach-avoidance conflict: It may so happen that the
conflicts faced by us are quite complex and they are combinations of
approach and avoidance conflicts. In this conflict the individual has to choose
between the options that have both positive and negative consequences.
For example, a student may have to choose between two educational
opportunities, one of pursuing music that he/ she is interested in which
will make his/her parents unhappy and the other of pursuing engineering,
which will make his/ her parents happy but he/ she is really not
interested in it.
Pressure: Pressure is yet another source of stress that can be external or internal.
External pressure are pressures that could be as a result of demands from the
environment, responsibilities and obligations that are mainly social in nature as
well as demands and expectations of the significant persons in our lives. With 45
Introduction to Stress regard to internal pressures, Mangal (1984, pg 46) states that “Internal pressures
are caused by our own self for maintaining the picture of ourselves - as we
think we could and should be”. An example of external pressure is when a
child is pressurised by parents to do well in examination and an example of
internal pressure is when a child himself/ herself feels that he/ she needs to
study and do well in examination.
Thus, any stress can be categorised into the above three sources, though a
person may experience stress due to more than one or all the three sources
as well.
Besides the above sources, stress can also be as a result of personality factors
that may make an individual prone to stress. Past experiences, basic temperamental
factors, perception of control over the situation causing stress play an important
role in determining the reaction of individual to stress (Parmeswaran and Beena,
2004). In the context of personality, the type A and type B personalities can
be discussed. Individuals with Type A personality display hurriedness, restlessness
and are often involved in carrying out various activities at the same time. They
are also competitive, anxious and are often achievement oriented. The individuals
with type B personality, on the other hand, display behaviour that is relaxed.
It can be said that individuals with type A personality are comparatively more
prone to stress when compared with individuals with type B personality
(Parmeswaran and Beena, 2004).
Further, certain life events, like death of a near or dear one, divorce, pregnancy,
child leaving home, change in conditions of living, retirement, marriage, losing
one’s job and so on can also lead to stress (Nolen- Hoeksema, 2009).
Frustration, conflict of motives and pressure can be termed as broad sources
of stress. Though stress can also result due to ineffective interpersonal
relationships or interpersonal conflicts, family related issues, lack of work life
balance, work pressures and work overload and even environmental pressures
that could be due to noise pollution, crowding and so on.
Let us now discuss some of the specific sources of stress.
Life events: Stress can be caused due to varied life events. These could be
death of a loved one, divorce or separation, losing one’s job, marriage and
so on. These could be termed as significant life events in one’s life that may
put pressure on the adjustment and coping resources of the person as they
expose the individual to certain new and unique challenges. Thus, life events
can lead to stress which in turn can have detrimental effects on the day to
day functioning as well as physical and psychological health of the individual.
Daily hassles: Similar to life events, daily hassles can also create stress. Daily
hassles like lack of time, work overload, daily roles, responsibilities and duties
and so on can lead to stress.
Interpersonal relationships: Stress can also be caused due to issues related
to interpersonal relationships. Interpersonal relationships could be in the context
of family, work or it could be with peer groups. Conflicts could occur between
individuals that can have an impact on the interpersonal relationship, which in
turn may lead to stress. Issues in interpersonal relationship could range from
misunderstandings to violence and abuse and can have negative impact on the
physical and psychological wellbeing of the person.
46
Stress as a result of social conditions: Social conditions in which the individual Stress: An Introduction
exists can also lead to development of stress. These social conditions can be
related to crowding, discrimination, technological developments and changes,
pollution and so on. The individual today exists in a world that is much more
complex. There is globalisation, increased competition, and high amount of social
pressure. These have a negative impact on the individual and makes him/ her
prone to stress.
1) What is frustration?
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2) Explain stress as a result of social conditions.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
3.5 MEASUREMENT OF STRESS

Measurement of stress is a prerogative for effective diagnosis of stress. There
are various ways in which stress can be measured. These are discussed as
follows:
1) Physiological measures: Physiological measures could serve great purpose
in identifying and understanding stress experienced by an individual. The
physiological responses in terms of increase in blood pressure, rapid pulse
rate, breathing rate and so on can be measured to understand the stress
experienced by the individual. This can be done by using various instruments
and machines, for instance a Polygraph. Further, stress can also be
measured with the help of biochemical measures as hormones, like
epinephrine, norepinephrine, cortisol and so on, are released as stress is
experienced. Though, physiological measures seem to be effective in
detecting stress, there are a number of limitations. Firstly, the physiological
changes may occur due to some other reasons and not stress. Secondly,
the whole process of taking the physiological measure could create stress
in the individual, as either blood test is taken or the individual is plugged
to a machine. Further, the tests could also be costly and time consuming.
2) Psychological tests: A psychological test can be explained as a measure
of sample of behaviour that is objective and systematic in nature. Various
psychological tests that are standardised, reliable and valid can be used
to measure stress. Such psychological tests could be self-report inventories.
In self report inventories, the individual is expected to provide responses
to certain statements and based on the responses interpretations can be 47
Introduction to Stress made. One main advantage of self-report inventory is that the individual
will answer them on his/ her own and as he/ she is in a better position
to understand the stress experienced, he/she will be able to report
adequately. They are simple, less costly and easy to administer. Though,
there could be issues related to social desirability and language. Individual
may not understand the language in which the test is available or he/ she
may not comprehend certain statements or words.
3) Checklist: A checklist can also be used to measure stress. For instance,

a checklist can be used for major life events. The individual is asked to
check the major life events from a list that the individual has undergone
in a given period of time. The list of major events is carefully prepared
and includes representation of major life events that may occur in any
individual’s life. The major life events could include, death of a near or
dear one, divorce, transfer and so on. Any major event in one’s life can
put pressure on the individual’s coping resources as he/she is trying to
adapt to the situation. Also, if an individual is undergoing number of major
life events at the same time, the stress that he/ she will experience is much
more.
4) Interview: Yet another method for measurement of stress is interview,

where in-depth information is collected from the individual face to face.
Interview can be structured, unstructured or semi-structured. Though with
the help of interview method a lot of relevant information can be collected,
it is a very time-consuming method as well as costly. Further, interviewer
needs to be adequately trained in interview methods.
It is also possible that the above methods are used together to get an adequate
picture of stress experienced by the individual.
1) List the limitations of physiological measures.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2) What is a psychological test?
................................................................................................................
................................................................................................................
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................................................................................................................
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48
3.6 LET US SUM UP
To summarize, the term stress has been derived from ‘stringere’ that is a Latin
word and means ‘to draw tight’ (Cox, 1978). It has today become a very
commonly used term in every context whether school, workplace, day to day
life and so on. We often come across people who say that they are stressed
or experiencing stress in their lives. We ourselves experience stress often. Stress
is like salt and pepper and a life without stress would be without motivation.
Stress often motivates us to work in a certain direction and therefore stress
is not altogether negative and does have numerous advantages. Hans Selye
(1974) described stress as a response of the body to certain demand that is
made on it and he further stated that this response was non-specific. Various
definitions of stress were also discussed in this Unit that mainly described stress
in terms of demand and an individual’s response to the same. The concept of
stressor was also described that can be explained as a situation, event, person
or anything that leads to the stress response. Stressors can be categorised into
physical, psychological, environmental, social and as life events. Various types
of stress including eustress, neustress and distress were also discussed in the
Unit. The Unit then moved on to explain the various symptoms of stress that
were categorised into behavioural symptoms, cognitive symptoms, emotional
symptoms and physical symptoms. Further, the sources of stress mainly,
frustration, conflict of motives and pressure were also explained. Lastly, the Unit
focused on the measurement of stress, that is a prerogative for effective diagnosis
of stress. There are various ways in which stress can be measured. Varied
methods of measurement like physiological measures, psychological tests,
checklist and interview were discussed.
3.7 REFERENCES
Cartwright, S., & Cooper, C. L. (1997). Managing Workplace Stress. New
Delhi: Sage Publications.
Coleman, J. C. (1970). Abnormal Psychology and Modern Life. Bombay:

D. B. Taraporewala and Sons.
Cox, T. (1978). Stress. London: Macmillan.

Nolen-Hoeksema, S., Fredrickson, B., Loftus, G., & Lutz, C. (2009). Atkinson
& Hilgard’s Psychology An Introduction. United Kingdom: Cengage Learning.
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal and Coping. New
York: Van Nostrand.
Marks, D. F., Murray, M., Evans, Brian., Willig, C., Woodall, C., & Sykes,
C. M. (2008). Health Psychology: Theory, Research and Practice. New Delhi:
Sage Publications.
49
Introduction to Stress Mangal, S. (1984). Abnormal Psychology. New Delhi, India: Sterling Publishers.
Miner, J. B. (1992). Industrial- Organizational Psychology. New Delhi:

McGraw-Hill Inc.
Parmeswaran, E. G., & Beena, C. (2004). An Invitation to Psychology. Delhi:

Neelkamal Publications Pvt. Ltd.
Pestonjee, D. (1999). Stress and Coping. New Delhi: Sage.
Schafer, W. (1998). Stress Management for Wellness. United States: Thomson

Wadsworth.
Selye, H. (1974). The Stress of Life. New York: McGraw-Hill.
3.8 KEY WORDS

Conflict of motives : Conflict of motives is a source of stress that occurs
when an individual has to choose between
alternatives and decision making in this regard can
lead to stress in the individual.
Frustration : Frustration can be described as occurring when a

goal oriented behaviour of an individual is thwarted.
Interview : In interview, in-depth information is collected from

the individual face to face.
Pressure : Pressure is a source of stress that can be external

or internal. External pressure are pressures that
could be as a result of demands from the environment,
responsibilities and obligations that are mainly social
in nature as well as demands and expectations of
the significant persons in our lives. Internal pressures
are caused by our own self for maintaining the
picture of ourselves- as we think we could and
should be.
Psychological test : Psychological test can be explained as a measure

of sample of behaviour that is objective and
systematic in nature.
Stress : Stress is a particular relationship between the

person and the environment that is appraised by
the person as taxing or exceeding his/ her resources
and endangering his/ her wellbeing.
Stressor : Stressor can be described as situation, event,

person or anything that leads to the stress response.
50
1) Define Stress
Hans Selye (1974) described stress as a response of the body to certain

demand that is made on it and he further stated that this response was
non-specific.
Schafer (1998, pg. 6) defined stress as “arousal of mind and body in

response to demands made on them”.
1) What is neustress?
When stress is not helpful nor harmful, it can be described as neustress
2) What are the cognitive symptoms of stress?
The cognitive symptoms related to stress include worrying constantly,

experiencing racing thoughts, lack of organisation in thinking, forgetting, not
able to focus, lack of judgement or poor judgement and also pessimism.
3) Explain the physical symptoms of stress?
The physical symptoms of stress include, low levels of energy, stomach

upset, headaches and migraines, pain and aches, chest pain, rapid
heartbeats, lack of sleep, dryness in mouth, experiencing tension in muscles,
frequent infections and so on.
1) What is frustration?
Frustration can be described as occurring when a goal oriented behaviour

of an individual is thwarted.
2) Explain stress as a result of social conditions.
Social conditions in which the individual exists can also lead to development
of stress. These social conditions can be related to crowding, discrimination,
technological developments and changes, pollution and so on. The individual
today exists in a world that is much more complex. There is globalisation,
increased competition, and high amount of social pressure.
1) List the limitations of physiological measures.
The limitations of physiological measures are as follows:
51
Introduction to Stress a) The physiological changes may occur due to some other reasons and
not stress.
b) The whole process of taking the physiological measure could create

stress in the individual, as either blood test is taken or the individual
is plugged to a machine.
c) The tests could also be costly and time consuming.
2) What is a psychological test?
Psychological test can be explained as a measure of sample of behaviour

that is objective and systematic in nature.

1) Explain the concept of stress.
2) Discuss the various types of stress.
3) Explain various symptoms of stress.
4) Describe the sources of stress.
5) Explain various ways in which stress can be measured.
52
UNIT 4 FACTORS CONTRIBUTING TO
STRESS PRONENESS*
Structure
4.0 Objectives
4.1 Introduction
4.2 Factors Contributing to Stress Proneness
4.2.1 Type A Personality
4.2.2 Hostility
4.2.3 Perfectionism
4.2.4 Procrastination
4.2.5 Learned Helplessness/Learned Pessimism
4.3 Moderators of Stress

4.4 Let Us Sum Up
4.5 References
4.6 Key Words
4.0 OBJECTIVES
 explain the factors contributing to stress proneness; and
 discuss the moderators of stress.
4.1 INTRODUCTION
Shalini would fall sick every time she had her school examinations. She
would prepare very hard and try to learn all the relevant topics, but one
day before the examinations, she would fall sick with either fever or
stomach upset or some other illness, as a result of which she would not
be able to answer her examinations. When a medical doctor was consulted,
the Doctor could not find any medical reason. Shalini’s cousin who was
a clinical psychologist suspected that the reason could be psychological
rather than physiological and that Shalini could be falling sick because
of stress that she was experincing before the examination.
You as well may have come across certain individuals who are more prone
to stress and those who are not so prone to stress. Thus, it can be said that
individual differences exist in the way people deal with stress and some could
be more prone to stress than others due to varied factors.
In the previous Unit, we discussed about the concept, nature, sources and
measurement of stress (Unit 1). In the present unit we will discuss about stress
Introduction to Stress proneness and will also focus on the factors contributing to stress proneness
as well as the moderators of stress.
4.2 FACTORS CONTRIBUTING TO STRESS

PRONENESS
Let us try to first understand what is stress proneness. Stress proneness in simple
words can be described as a tendency of a person to take more stress. Such
individuals are more likely than others to experience stress. The opposite of
stress proneness is stress resistant and such individuals are less likely to
experience stress.
Let us now look at some of the factors that can contribute to stress proneness:
4.2.1 Type A Personality
Schafer (2004, pg 178) describes personality as “person’s enduring set of habits
of thinking, feeling and acting”. Personality traits can be said to determine not
only the way an individual reacts to stress but also how he/ she will cope with
the stressful situation. Type A personality is often linked to high levels of stress
as individuals with type A personality perceive stress as threatening and their
reactions to stressful situations are intense and faster. On the other hand,
individuals with type B personality display lower stress reactivity. Thus,
individuals with type A personality are more prone to varied physical and
psychological problems that may occur as a result of stress experienced by
them.
Let us discuss further about type A personality, that can be termed as one of
the factors that can make an individual more prone to stress. Individuals with
this type of personality are in a hurry to achieve certain objectives. They often
like competition, they are highly alert and display perfectionism. They want to
achieve much more than it may be possible within a certain time frame. Such
individuals are also likely to be irritable, they lack patience and may also get
angry faster. Some of the components of type A behaviour as stated by Schafer
(2004) are as follows:
 Status insecurity: Individuals with type A behaviour may display status
insecurity, which is likely to stem from low self-esteem. Such individuals
will constantly compare themselves with others and will find themselves to
be inferior in their own eyes. They are also constantly striving to enhance
their self-esteem. These individuals often have a very high expectation from
themselves and are also highly critical about self. This will often drive them
to achieve and accomplish as much as possible.
 Urgency of time: The insecurities and low self-esteem experienced by
a person with type A personality often leads him/her to gasp with time.
Such individuals want to do many things within a certain period of time.
Thus, they are in constant hurry to get things done and as a result they
think faster, plan faster and carryout activities at a faster pace and this
can be reflected in their day to day functioning as well. They also engage
in polyphasic thinking and behaviour, that can be described as engaging
in thinking and carrying out multiple activities/ things at a time (Schafer,
54 2004).
 Hyper-aggressiveness: Individuals with type A personality may also display Factors Contributing to
Stress Proneness
hyper-aggressiveness that is denoted by dominating behaviour without any
regard to how others feel or any regard for their rights. This aggressiveness
may also stem from low self-esteem that such individuals experience and
due to the frustration experienced by them.
 Free-floating hostility: An individual with type A personality is more likely
to perceive others negatively and thus will not trust others and will be
suspicious of them. This free-floating hostility is displayed by such an
individual whenever he/ she feels something (coworkers laughing, slow sales
person at a shop counter, directives by government and so on) is wrong.
 Drive towards self-destruction: The lifestyle led by a type A individual
can take a toll on them and they often seek escapism and thus in a way
they may drive themselves on the path of self-destruction.
Individuals with type A are not only more prone to stress, as was mentioned
earlier, but they may display lower satisfaction with regard to job, health, home
and life. They may also experience lack of energy and may experience more
affective tension and symptoms of distress.
4.2.2 Hostility
Schafer (2004, pg. 194) described hostility as ‘‘cynicism towards others’’
motives and values, easily and frequently aroused anger, and a tendency to
express that anger towards others’’. Hostility in this context does not relate
to anger that leads to violent behaviour. But this is the irritability and anger
experienced by individuals who otherwise seem perfectly normal (Schafer, 2004).
Such a hostility may be experienced in simple events in life, like someone spills
tea on the office table, a family member does not fold clothes and they are
left in the sitting chair and so on, for which individuals who are not hostile
may barely react. Such individuals often engage in blaming others, which in turn
can make them express anger towards that individual, which could lead to
aggressive behaviours directed towards that person. Hostility is, thus, characterised
by an attitude that is skeptical or cynical, recurring arousal of anger and
manifestation of anger in terms of aggressive behaviour. The long-term effect
of such hostility is negative as it not only affects one’s health but can also affect
one’s social relationships. Links have been found between hostility and stress
(Felsten,1996; Hackett et al, 2015). Thus, hostility can also be termed as a
factor that can make individuals more prone to stress.
4.2.3 Perfectionism
Yet another factor that can lead to stress proneness is perfectionism. Perfectionism
can be described as expectations that an individual may have from self and
others or both and these expectations are demanding in nature which seldom
leaves chance for compromise. Perfectionism can be categorised into internal
perfectionism (expectations from self) and external perfectionism (expectations
from others). Individuals with internal perfectionism will have high expectations
from themselves and this can not only affect their health but also their productivity.
It can also negatively affect their relationship and self-esteem. Individuals who
have external perfectionism will often find fault with others and are never satisfied
with how others work and this can lead them to experiencing frustration as
well as hostility. 55
Introduction to Stress Following are some of the beliefs that are characteristic of an individual with
perfectionism (Schafer, 2004):
 Anything that I do should be carried out perfectly.
 No mistakes should be made by me or others.
 There is always a correct way in which things should be done.
 I am failure if I don’t do things perfectly.
 If I make a mistake, I am a total failure.
Such beliefs (all or nothing) can be termed as irrational as they are loaded
with injunctions and they can push an individual on the path of distress. An
individual having such beliefs is more likely to experience stress than a person
with more rational beliefs. For instance, an individual who believes, that if he/
she makes a single mistake then he/ she is a failure will experience prolonged
sadness and anger with self and may not make any attempts in future. However,
an individual who sees a mistake as a learning experience is more likely to
make attempts in future and less likely to experience stress or anger. Besides
experiencing stress, individuals with perfectionism are also more likely to
procrastinate. They are also more defensive and choosy about stuff and things.
Further, they may find it difficult to let go and discard things, thus leading to
hoarding and they may also indulge in overdoing things.
4.2.4 Procrastination
We discussed earlier that perfectionism may lead to procrastination, but
procrastination in itself is also a factor that could lead to stress proneness.
Procrastination can simply be described as not doing things/ activities on time
and keeping them for later. This can be because the things or those activities
are viewed as not appealing/ pleasant or difficult. Procrastination can lead to
stress because individuals who procrastinate will not only feel guilty and indulge
in condemnation of self, but there could also be external repercussions (for
example, examination fee not paid in time, delay in submitting an important report
and so on). Procrastination either results from fear (for instance fear of failure
or doing well or at fear of pain or intimacy and so on), or from laziness, where
the individual develops habit of not putting effort or seeking comfort (Schafer,
2004).
4.2.5 Learned Helplessness/Learned Pessimism

The term learned helpless was put forth by Seligman and it can be described
as tendency to become helpless when frequently faced with events that cannot
be controlled. Schafer (2004, pg 215) defines learned pessimism as “the
tendency to interpret bad events as personally caused, part of a permanent
pattern, and pervasive into all parts of one’s life and the tendency to interpret
positive events as caused by luck or external forces, temporary, and limited
to this one aspect”. The key points in this definition are:
Personalisation: Personalisation can be internal or external. Thus, when a

negative event or situation is experienced, the individual will attribute it internally
or externally. For instance, getting less marks in examination may be attributed
56 internally (not studying hard enough) or externally (unfair evaluation).
Permanence: Permanence can be in terms of either permanent or temporary. Factors Contributing to
Stress Proneness
The individual will either perceive the event as being permanent or temporary.
For instance, if he/ she scored less marks in an examination, this can either
be seen as something that will always happen or as just one event or setback
in path of success.
Pervasiveness: This can be described as whether an interpretation is related
to one or multiple dimension(s) of life. Thus, it can be either universal or specific.
For instance, ‘I scored less marks in one subject but scored well in others’
or ‘Getting less marks is yet another negative event in my life’.
A person with learned helplessness/ learned pessimism is more prone to
experiencing stress and needs help to move towards learned optimism.
1) List the components of type A behaviour.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2) What is procrastination?
................................................................................................................
................................................................................................................
................................................................................................................
4.3 MODERATORS OF STRESS

Besides the above factors, there are also certain moderators of stress that need
to be mentioned. The moderators play an important role in the relationship
between the stress and corresponding reactions. These moderators may lead
to individuals experiencing higher or lower stress.
Locus of control (LOC): Locus of control is a concept that was proposed
by Rotter in 1954 and can be explained as the belief system possessed by
an individual with regard to whether the outcome of his/ her actions can be
attributed to his/ her own actions or to events, objects, people outside his/ her
control. Thus, individuals could either have an internal control orientation or an
external control orientation. Relationship has been seen between LOC and stress
and it was found that individuals with internal locus of control displayed better
physical and psychological wellbeing (Ghosh, 2015). Individuals with internal
locus of control perceive stressful situations as a challenge and not as a threat
and thus are in a position to deal with stress in a better way.
Hardiness: Hardiness can be described as denoting a likeness for challenges,
having a strong sense of commitment and control (Schafer, 2004, pg 236).
Individuals having high hardiness are optimistic and they see a stressful situation
as an opportunity to grow. They also put in hard work because they enjoy
doing so. Thus, individuals with high hardiness are in better position to deal
with stress than individuals that have low hardiness. 57
Introduction to Stress Social support: This is one of the significant moderators of stress. A person
experiencing stress will be able to deal with it in a better way if he/ she has
adequate social support. Social support can be in form of material gifts, finance,
food and so on, or in terms of information to comprehend the stress and coping
strategies. Social support could also be emotional in nature. Social support not
only lowers stress reactivity but individuals receiving social support are also less
likely to suffer the negative effects of stress.
Optimism and pessimism: Optimistic individuals are found to be able to deal
with stress adequately and thus may not get adversely affected by stress that
they experience. Optimism can also be related to resilience that helps individuals
to bounce back from stressful situations. On the other hand, individuals who
are pessimistic can get affected by stress and are likely to develop the psycho-
physiological disorders.
Gender and culture: Besides the above gender and culture may also play
an important role as moderators of stress. Socialisation to a great extent may
depend on gender as well as culture that can have an impact on not only the
personality but also beliefs and attitudes of the individual. And personality, beliefs
and attitudes can have an impact on how individual perceives, deals and copes
with stress.
1) What is locus on control?
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
4.4 LET US SUM UP

Individual differences exist in the way people deal with stress and some could
be more prone to stress than others due to varied factors. Stress proneness
in simple words can be described as a tendency of a person to experience
more stress. Such individuals are more likely than others to experience stress.
The opposite of stress proneness is stress resistant and such individuals are
less likely to experience stress. Various factors that contribute to stress proneness
like type A personality, hostility, perfectionism, procrastination and learned
helplessness/ learned pessimism were discussed. Type A personality is often
linked to high levels of stress as individuals with type A personality perceive
stress as threatening and their reactions to stressful situations are intense and
faster. Some of the components of type A behaviour include status insecurity,
urgency of time, hyper-aggressiveness, free-floating hostility and drive towards
self-destruction. Hostility (another factor contributing to stress proneness) can
be described as cynicism towards others’ motives and values, easily and
frequently aroused anger, and a tendency to express that anger towards others.
The long-term effect of such hostility is negative as it not only affects one’s
health but can also affect one’s social relationships and links have also been
58
found between hostility and stress. Yet another factor that can lead to stress Factors Contributing to
Stress Proneness
proneness is perfectionism. Perfectionism can be described as expectations that
an individual may have from self and others or both and these expectations
are demanding in nature which seldom leaves chance for compromise. Perfectionism
can be categorised into internal perfectionism (expectations from self) and
external perfectionism (expectations from others). Procrastination is also a factor
that could lead to stress proneness. Procrastination can simply be described
as not doing things/activities on time and keeping them for later. The last factor
discussed was learned helplessness/learned pessimism. Learned pessimism can
be described as the tendency to interpret bad events as personally caused,
part of a permanent pattern, and pervasive into all parts of one’s life, and the
tendency to interpret positive events as caused by luck or external forces,
temporary, and limited to this one aspect. The key points of this definition
include personalisation, permanence and pervasiveness. While discussing
factors contributing to stress proneness the moderators of stress were also
discussed. The moderators play an important role in the relationship between
the stress and corresponding reactions. These moderators may lead to individuals
experiencing higher or lower stress. Various moderators of stress including, locus
of control, social support, optimism and pessimism and gender and culture were
explained.
4.5 REFERENCES
Felsten, G. (1996). Hostility, Stress and Symptoms of Depression. Personality
and Individual Difference, 21 (4), 461 - 467. https://doi.org/10.1016/0191-
8869(96)00097-9

Hackett, R. A., Lazzarino, A. I., Carvalho, L. A., Hamer, M., & Steptoe, A.
(2015). Hostility and Physiological Responses to Acute Stress in People with
Type 2 Diabetes. Psychosomatic Medicine, 77(4): 458 – 466. Published Online
2015 May 14. Doi: 10.1097/PSY.0000000000000172
York: Van Nostrand.
Sage.
Mangal, S. (1984). Abnormal psychology. New Delhi, India: Sterling Publishers.


Wadsworth. 59
Introduction to Stress
4.6 KEY WORDS
Hardiness : Hardiness can be described as denoting a
likeness for challenges, having a strong sense
of commitment and control.
Hostility : Hostility can be described as cynicism towards

others’ motives and values, easily and frequently
aroused anger, and a tendency to express that
anger towards others.
Learned pessimism : Learned pessimism can be described as the

tendency to interpret bad events as personally
caused, part of a permanent pattern, and
pervasive into all parts of one’s life and the
tendency to interpret positive events as caused
by luck or external forces, temporary, and
limited to this one aspect.
Locus of control (LOC) : Locus of control can be explained as the belief

system possessed by an individual with regard
to whether the outcome of his/ her actions can
be attributed to his/ her own actions or to
events, objects, people outside his/ her control.
Perfectionism : Perfectionism can be described as expectations

that an individual may have from self and others
or both and these expectations are demanding
in nature which seldom leave chance for
compromise.
Procrastination : Procrastination can simply be described as not

doing things/ activities on time and keeping
them for later.
Type A personality : Individuals with this type of personality are in

a hurry to achieve certain objectives. Individuals
with this personality often like competition, they
are highly alert and display perfectionism. They
want to achieve much more than it may be
possible within a certain time frame. Such
individuals are also likely to be irritable, they
lack patience and may also get angry faster.

1) List the components of type A behaviour.
The components of type A behaviour include status insecurity, urgency of

time, hyper-aggressiveness, free-floating hostility and drive towards self-
60 destruction.
2) What is procrastination? Factors Contributing to
Stress Proneness
Procrastination can simply be described as not doing things/ activities on
time and keeping them for later.
1) What is locus on control?
Locus of control is a concept that was proposed by Rotter in 1954 and

can be explained as the belief system possessed by an individual with regard
to whether the outcome of his/her actions can be attributed to his/her own
actions or to events, objects, people outside his/her control.

1) Discuss Type A personality as a factor contributing to stress proneness.
2) Explain hostility as a factor contributing to stress proneness.
3) Describe perfectionism and procrastination as factors contributing to stress

proneness.
4) Discuss learned helplessness/ learned pessimism.
5) Discuss the various moderators of stress.
61
UNIT 5 EFFECT OF STRESS*
Structure
5.0 Objectives
5.1 Introduction
5.2 Effect of Stress on Health
5.3 Effect of Stress on Performance and Productivity
5.4 Effect of Stress on Relationships
5.5 Let Us Sum Up
5.6 References
5.7 Key Words
5.0 OBJECTIVES
 discuss the effect of stress on health;
 describe the effect of stress on performance and productivity; and
 explain the effect of stress on relationships.
5.1 INTRODUCTION
Sameer’s parents always had very high expectations from him. They wanted
him to become an IAS officer. Though Sameer was more interested in
pursuing his interest in music. He was an excellent guitar player. But giving
in to the pressures of his parents he started preparing for the civil services
examination. He tried to put in his best but over the period of time, he
experienced fatigue, sleeplessness and also lost his appetite. He also started
falling sick more often. Medical doctors could not find any physical cause
for the symptoms displayed by Sameer. The stress (caused due to external
pressure as well as conflict that he had in his mind with regard to pursuing
his interest in music or becoming an IAS officer as per his parents wish)
experiened by him had taken a toll on his health.
Tiska had recently been promoted to the post of deputy director of her
institute. She was very excited about her new position. Though, the new
position meant more responsibilities and workload. Despite of trying to put
in her best, she felt that her immediate superior never seemed to be happy
with her and would always find faults in her work. Tiska became
increasingly irritable, would easily get angry with her subordinates and
colleagues and her interpersonal relationship with her family and friends
was getting affected due to her behaviour. She also started experiencing
breathing problems and was diagnosed with high blood pressure. The work
62 * Prof. Suhas Shetgovekar, Faculty, Discipline of Psychology, SOSS, IGNOU, New Delhi
pressure coupled with continuous criticisms and lack of appreciation from Effect of Stress
her immediate superior had affected the physical and psychological
wellbeing of Tiska.
In the above examples, we can see that stress and stressful situations had an
impact on the physical and psychological health of these individuals. The examples
discussed earlier also reflect that there are individual differences in the way each
individual will react to stress. You may have come across children who get so
stressed before exams that they fall sick and children who do not experience
much stress. Further, difference may also exist in the effect that stress has on
the individuals. For instance, some may get affected psychologically, whereas,
others may display more of physiological symptoms related to stress.
In the previous Units, that is Units three and four, we discussed about the
concept, nature, sources, symptoms and measurement of stress. We also
discussed about various factors that contribute to stress proneness. Thus, by
now you must have developed a fair idea about what stress is. In the present
Unit, we will mainly focus on the effect of stress. Stress can affect individuals
in different ways. In some individuals it may have an impact on their physical
health and in others it may affect their psychological wellbeing. Thus, understanding
the effect of stress is relevant. In the present Unit, we will mainly discuss about
the effects of stress on health, performance and productivity and relationships.
Needless to say, all these three are interrelated and the effect of stress on one
of these can affect the other(s) as shown in figure 5.1. For instance, if a person
falls sick often due to stress then his/ her productivity will decrease. Any issue
that the person faces in relationship can lead to development of stress and that
can have an impact on his/ her performance and productivity.
Fig. 5.1: Effects of stress are interrelated
5.2 EFFECT OF STRESS ON HEALTH

Stress has an impact on the physical health of an individual. A number of illnesses
like cardiovascular disorders, aches and pain, ulcers, hypertension, diabetes,
asthma, hyperthyroidism, and even cancer can be attributed to stress. 63
Introduction to Stress Stress can have an impact on the immune system of the individual and thus
the individual may become easily prone to varied infections and illnesses stress
can also accelerate ageing. When an individual is experiencing Stress, the
resources and energy is diverted from immune system to systems in the body
that play more important role in stress reactivity and thus, individuals who
experience stress for long period of time are prone to develop infections as
their immune system is compromised.
Stress can lead to development of cardiovascular disorders in individuals. When
there is perception of stress, one of the physiological changes that occurs is
that pulse rate increases as well as there is an increase in the blood pressure.
As such the heart tends to be on a rapid mode and works harder when stress
is experienced. A stress for a long period of time will have the heart working
overtime for a longer period of time and that can lead to development of
cardiovascular disorders. Further, lifestyle of the individual, including diet and
nutrition, physical exercise, consumption of alcohol and drugs and so on can
also contribute to the development of such disorders.
Prolonged stress can also cause hypertension as sympathetic nervous system
gets activated and blood pressure increases and remains increased for a longer
period of time. And prolonged hypertension can again lead to development of
cardiovascular disorders and could also lead to stroke and kidney related
disorders. Glucose and fatty acids may also accumulate if an individual has
hypertension for a long period of time and that in turn could lead to plaques
in the artery. Further, the release of Catecholamine and Corticosteroid that take
place when an individual is undergoing stress can also have a negative impact
on the arteries and heart.
We sometimes come across children who develop stomach upset before
examination. This could also be attributed to stress experienced by them. As
a result of prolonged stress, an individual could also develop ulcers, irritable
bowel syndrome and inflammatory bowel diseases. Activation of sympathetic
nervous system that takes place when stress is experienced could lead to excess
production of the hydrochloric acid and pepsin which in turn could lead to peptic
ulcers.
Stress is one of the factors that can also lead to individuals developing asthma.
Asthma is denoted by breathing problem that occurs when the bronchial airways
are blocked. This blockage could be due to mucus, inflation or spasms (Ghosh,
2015).
Prolonged stress could also lead to occurrence of cancer amongst the individuals.
Migraine are headaches that an individual may experience for a prolonged period
of time that occurs on one side of the head. Stress is one of the factors that
can cause migraines in individuals. Stress also has a negative effect on the immune
system.
Stress can also cause hyperthyroidism, as experiencing stress for a prolonged
period of time can negatively affect thyroid, the gland that is responsible for
metabolism as well as regulation of various physiological functions. Stress can
not only affect the release of hormone from pituitary gland, that stimulates thyroid,
but also reduces the conversion to T3 hormone, that is, Triiodothyronine (Lutz,
2019). Thus, the functioning of the thyroid can get affected. Various hormones
are also released as stress is experienced and this can lead to increased levels
of glucose in blood.
64
Further, stress can also cause anxiety and depression. When stress is experienced Effect of Stress
by an individual, there is a release of neurotransmitters (the chemicals that transmit
signal between the neurons) Serotonin and Adrenalin. After the release of these
neurotransmitters, the stress related hormones are released and these can have
an impact on area of brain relevant to memory and regulation of affect. When
stress is experienced by an individual for a prolonged period of time, then there
is a negative effect on the way these systems function and as a result the individual
is prone to developing anxiety and depression. Further, depression can also be
linked to extended activation of immune system, that is a result of stress
experienced by an individual over a period of time (Crannage, 2018).
Extreme stress can also lead to development of Post Traumatic Stress Disorder
(PTSD). PTSD may develop in an individual after he/ she experiences a traumatic
situation. You must have heard about soldiers developing PTSD after a war
or individuals developing PTSD after experiencing a natural calamity like
earthquake or Tsunami. The symptoms of PTSD include flashbacks and
uncontrollable thoughts about the traumatic event. This again has been linked
to the disruption of functioning of stress related hormones and neurotransmitters
that are normally released after stress is experienced (Crannage, 2018).
Stress can also lead to indulgence of the individual in unhealthy coping behaviour
which can also involve substance use (alcohol, drug and so on). This in turn
can not only lead to addiction but can have detrimental effect on health. Besides
a person under stress may also engage in unhealthy lifestyle, like they may not
exercise, maintain healthy diet and may even indulge in unhealthy eating
behaviours.
Thus, it can be said that stress can have a negative effect on one’s physical
health as well as mental health. Further, it can also impact one’s lifestyle and
behaviour which in turn have adverse effects on one’s overall health.
1) List any five illnesses that can be attributed to stress.
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2) How can stress lead to development of cardiovascular disorders in
individuals?
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Introduction to Stress
5.3 EFFECT OF STRESS ON PERFORMANCE
AND PRODUCTIVITY
When we talk about performance and productivity, it could be overall
performance and productivity of the individual and it could also be performance
and productivity in the context of work. Before we go on to discuss performance
and productivity in the context of work, let us discuss about how stress can
impact cognitive functioning, that is a key to performance and productivity.
Stress can have a negative impact on cognitive functioning or performance of
the individual, which can be for a short term or for long period of time. In
fact, stress experienced over a long period of time may even lead to decline
in cognitive functioning and is also linked to occurrence of dementia (Scott et
al, 2015).
Prolonged stress can affect memory, attention and concentration of the individual.
Individuals experiencing stress may also display ineffective decision making.
Stress can also lead to worrying constantly, forgetting, lack of organisation, lack
of judgement, racing thoughts and being pessimistic and all these in turn can
have an impact on the overall performance and productivity of the individual.
Stress has a negative effect on the executive functioning of an individual that
includes tasks like making plans, reasoning, management of one’s life, problem
solving and so on. And this can be attributed to the overload that is created
by stress, where the resources of the individual are diverted towards coping
with stress. Thus, an individual under stress may not be able to remember well,
indulge in effective problem solving and may not be able to pay his/ her complete
attention.
When an individual is experiencing stress, his/ her cognitive performance as well
as ability to make decisions can get negatively affected. When experiencing stress,
the peripheral stimuli may be screened out by the individual and he/she may
indulge in decision making that is based on heuristics. Individuals under stress
may also experience rigidity in their performance and display thinking pattern
that is narrow. Under stress, individuals may also not be able to indulge in
analysing complex situations or carry out manipulation of information (Kavanagh,
2005).
Stress that is experienced in day to day life can also result in negative mood
that is experienced by the individual, which in turn may lead to the individual
experiencing fatigue, which can further affect his/ her ability to pay attention
(Scott et al, 2015).
While discussing about relationship between stress and performance, the
hypothesis related to the inverted- U can be discussed. Inverted- U is also
called as Yerkes-Dodson Law that denotes relationship between arousal and
performance. It was put forth by Robert Yerkes and John Dillingham Dodson
in 1908. The diagrammatic representation of Inverted - U is given in
figure 5.2. As can be seen in the figure as the stress increases, the performance
also increases, however at certain point where stress continues to increase, the
performance is affected and goes down. Thus, it can be said that stress plays
an important role in performance, but as it goes beyond certain optimal level,
the performance will get negatively affected.
66
Effect of Stress
Fig. 5.2: Inverted - U
Thus, stress can affect one’s performance and productivity in varied spheres
of life including academics, workplace and so on.
As discussed earlier, stress can have an impact on cognitive functioning, even
leading to its decline. Students experiencing stress as well can experience such
a decline in cognitive functioning and may not be able to pay attention to the
subject matter and may also forget what they have learned. You must have
seen this especially as a result of examination stress. The students may not be
able to answer the examination well because they could not recall the information.
And such students will not only experience stress from academics but they may
face various stressors from different sources, for instance, pressure from parents,
teachers and significant others, internal pressure to do well, stress due to
competition and uncertainty about future and so on. All this can not only impact
their health but also their cognitive functioning leading to detrimental impact on
their performance and productivity.
Let us discuss about how stress can have an impact on performance and
productivity at workplace. When employees experience stress for a longer period
of time, the outcome could be affective exhaustion, decreased organisational
commitment and higher turnover amongst the employees (Kavanagh, 2005).
Decreased performance, job dissatisfaction and even absenteeism can be related
with stress (Miner, 1992). Most often individuals under stress take more time
to complete a task than an individual not experiencing stress. Individuals
experiencing stress may also display poor time management. This is especially
true when stress experienced is above the optimal level of the individual, thus
he/she is not able to cope well and this can interfere with the way he/ she
manages time. Inability to manage time and complete work as per deadlines
can further cause stress. Such individuals may also display lack of punctuality
which can cost the organization man-hours. Individuals experiencing stress may
also remain absent from jobs for extended period of time (absenteeism). This
could mainly be because of the negative impact that the stress can have on
their physical and mental health. 67
Introduction to Stress Individuals under stress may also not be able to focus on their work activities
and this again can affect the productivity and even cause accidents, especially,
if the individuals’ work activity involves working with machinery/ chemicals and
so on.
Stress can also have a negative impact on teamwork and ability of individuals
to function in groups (Kavanagh, 2005). Communication can also get hampered
when individuals are under stress and the likelihood of individuals being prone
to groupthink is also high. As a result of groupthink, the members of a group
may reach a consensus decision which may not be correct or rational. Thus,
stress can have a negative effect on interactions and relationships at workplace,
which in turn can affect team work.
Employees may also experience technostress, stress that is experienced due to
lack of ability to cope with advances in technology. Technostress can also
negatively affect performance and productivity, not only because the individual
is not able to understand the technology but also because his work goals and
activities can get affected causing frustration.
In this context, we also need to discuss about yet another term that is ‘Burnout’.
Pestonjee (1999, pg 23) defined burnout as “the end of stress experienced
but not properly coped with, resulting in symptoms of exhaustion, irritation,
ineffectiveness, discounting of self and others and problems of health (hypertension,
ulcers and heart problem)”. The employees thus can experiences BOSS, that
is Burnout Stress Syndrome. Development of BOSS in an individual could lead
to decrease in energy level of the individual, decreased illness resistance,
experiencing heightened dissatisfaction and pessimism as well besides lack of
efficiency in carrying out one’s work and also absenteeism (Pestonjee, 1992).
Thus, it can be said that stress can have a negative impact on the work life
of the individual. Not only the quality of work of the individual experiencing
stress will suffer but stress can also have an impact on the work life balance
of the individual.
1) What is inverted U?
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.................................................................................................................
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Draw the Figure of Inverted-U below
68
2. What is Burnout? Effect of Stress
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5.4 EFFECT OF STRESS ON RELATIONSHIPS

Individuals are not islands but are interdependent on each other. They cannot
function in isolation and rely on each other to carry out various activities as
well as for support. Thus, one of the important dimensions of an individual’s
life is his/her relationship with others. Stress can also have an impact on the
individual’s relationships.
As we have discussed in earlier Units, as stress is experienced by an individual,

he/ she will become irritable and may also express anger. These can have an
impact on his/her relationship with others. Further, individuals undergoing stress
may withdraw themselves or may seem distracted or may display less affection
towards significant individuals in their lives. Experiencing stress for a considerable
period of time may also lead to depletion in coping resources, thus the person
experiencing stress is also less patient with others.
Inadequate coping strategies employed by the individuals may also lead to

behaviours that may negatively affect the individual’s relationship with others.
For instance, as a result of stress, the person may indulge in substance use
(consumption of alcohol and drug use) and such behaviours over a period of
time can negatively affect his/ her relationship with others.
Stress may also lead to interpersonal conflicts that again may result in negative
effects on relationships. Individuals who are under stress may say certain things
or make certain mistakes that they would otherwise refrain from doing. Even
decision making and problem-solving abilities of the person get affected and
certain decisions he/she takes or problem solving strategies that he/she may
employ can affect his/her relationship with others and develop interpersonal
conflicts.
A person under stress may also become more sensitive and may be offended
by certain things said by others, intentionally or unintentionally. All these could
interfere with one’s relationship with others and relationship problems may further
lead to stress in the individual.
As was discussed in the earlier section of this unit, stress can also affect
communication and thus the individual experiencing stress may not filter what
he/ she wants to say and may indulge in using harsh and unpleasant language,
which otherwise he/ she would have refrained from using. The outcome could
be that the other person may feel bad or hurt. This can have an impact on
relationships. Jobs and work-related activities have become more and more
complex and the stress experienced at work is also high and this can have
a spill over in the personal life of the individual.
Often, individuals bottle up their stress and do not deal with it or express it,
in such a case, it is not possible for significant others in the person’s life, especially
69
Introduction to Stress the spouse, to understand what he/ she is going through and provide the required
support. Further, stress can be termed as contagious, where when a partner
is undergoing stress, the other partner will also experience stress (Shrout, 2018).
Besides the direct effects of stress, there are indirect effects of stress as well.
For instance, individuals experiencing stress may not maintain a healthy lifestyle,
are less likely to exercise, may not sleep or eat adequately and may also consume
alcohol and indulge in smoking. These in turn will lead to development of various
disorders and illnesses and also have negative impact on relationships.
The day to day experiences that we go through from traffic jams, pollution,
fast pace of life, overuse of technology can lead to building up of stress within
us and if these are not dealt with effectively, they can have an impact on not
only one’s health and wellbeing but also one’s relationships. A vicious circle
is created where stress has a negative effect on relationships and the relationship
problems and issues in turn could lead to further stress in the individual.
1) Highlight the indirect effects of stress.
.................................................................................................................
.................................................................................................................
.................................................................................................................
5.5 LET US SUM UP

To summarise, stress has negative impact on health of an individual. A number
of illnesses like cardiovascular disorders, aches and pain, ulcers, hypertension,
diabetes and even cancer can be attributed to stress. Stress can have an impact
on the immune system of the individual and thus the individual may become
easily prone to varied infections and illnesses stress can also accelerate ageing.
Further, stress can also cause anxiety and depression. Extreme stress can also
lead to development of Post Traumatic Stress Disorder (PTSD) and other
psychological disorders. Stress can also have an impact on cognitive functioning
of the individual, that can be termed as a key component of performance and
productivity. Prolonged stress can affect memory, attention and concentration
of the individual. Stress can also lead to worrying constantly, forgetting, lack
of organisation, lack of judgement, racing thoughts and being pessimistic and
all these in turn can have an impact on the overall performance and productivity
of the individual. While discussing about relationship between stress and
performance, the hypothesis related to the inverted - U was discussed. The
diagrammatic representation of Inverted - U was also given. The inverted –
U denotes that as the stress increases, the performance also increases, however
at certain point where stress continues to increase, the performance is affected
and goes down. Thus, it can be said that stress plays an important role in
performance, but as it goes beyond certain optimal level, the performance will
get negatively affected. The effect of stress on academic performance was briefly
discussed besides effect of stress on performance and productivity at workplace.
When employees experience stress for a longer period of time, the outcome
could be affective exhaustion, decreased organisational commitment and higher
turnover amongst the employees. Decreased performance, job dissatisfaction and
70
even absenteeism can be related with stress. Stress can affect not only focus Effect of Stress
of the individual but also his/her communication pattern and interpersonal
relationship at work. The term burnout was also discussed in this context. Lastly,
we discussed about the effect of stress on relationships. Individuals are not islands
but are interdependent on each other. They cannot function in isolation and rely
on each other to carry out various activities as well as for support. Thus, one
of the important dimensions of an individual’s life is his/her relationship with
others. Irritability, communication issues, inadequate coping and so on can take
a toll on individuals’ interpersonal relation. There are indirect effects of stress
as well. For instance, individuals experiencing stress may not maintain a healthy
lifestyle, are less likely to exercise, may not sleep or eat adequately and may
also consume alcohol and even smoking. These in turn will lead to development
of various disorders and illnesses and have negative impact on relationships.
The day to day experiences that we go through from traffic jams, pollution,
fast pace of life, overuse of technology can lead to building up of stress within
us and if these are not dealt with effectively, they can have an impact on not
only one’s health and wellbeing but also one’s relationships. A vicious circle
is created where stress has a negative effect on relationships and the relationship
problems and issues that may thus emerge in turn would lead to further stress
in the individual.
5.6 REFERENCES
Crannage, A. (2018). Stress and Our Mental health - What is the Impact
& How can we Tackle it? Retrieved from https://www.mqmentalhealth.org/
posts/stress-and-mental-health on 22nd November at 10:00 pm.
Kavanagh, J. ( 2005). Stress and Performance: A Review of the Literature
and Its Applicability to the Military retrieved from https://www.rand.org/
content/dam/rand/pubs/technical_reports/2005/RAND_TR192.pdf on 22nd
November, 2019 at 8:00 pm.
Lazarus, R. S. & Folkman, S. (1984). Stress, Appraisal and Coping. New
York: Van Nostrand.
Lutz, J. (2019). How to Manage Stress If you have Autoimmune Thyroid
Disease Retrieved from https://www.endocrineweb.com/conditions/thyroid/how-
manage-stress-if-you-have-autoimmune-thyroid-disease at 10:00 pm.
Sage.
Mangal, S. (1984). Abnormal Psychology. New Delhi, India: Sterling Publishers.
71
Introduction to Stress Schafer, W. (1998). Stress Management for Wellness. United States: Thomson
Wadsworth.
Scott, S. B., Graham-Engeland, J. E., Engeland, C. G. et al. (2015). The Effects
of Stress on Cognitive Aging, Physiology and Emotion (ESCAPE) Project. BMC
Psychiatry 15, 146 doi:10.1186/s12888-015-0497-7.
Shrout, R. (2018). What are the Effects of Stress on a Relationship? Retrieved
from https://www.unr.edu/nevada-today/news/2018/atp-relationship-stress on 24th
November, 2019 at 1:00 am.
Stress Management Retrieved from https://www.mayoclinic.org/healthy-lifestyle/
stress-management/in-depth/stress-symptoms/art-20050987 on 23rd November,
2019 at 10:00 pm.
Surwit, R. S; Schneider, M. S. & Feinglos, M. N. (1992). Stress and Diabetes
Mellitus. Diabetes Care, 15(10): 1413-1422. https://doi.org/10.2337/
diacare.15.10.1413.
5.7 KEYWORDS
Burnout : Burnout can be described as the end of stress
experienced, by not properly coped with, resulting in
symptoms of exhaustion, irritation, ineffectiveness,
discounting of self and others and problems of health
(hypertension, ulcers and heart problem).
Inverted- U/ : Inverted - U describes the relationship between stress
Yerkes-Dodson Law and performance, where as the stress increases, the
performance also increases, however at certain point
where stress continues to increase, the performance is
affected and goes down.
Technostress : Technostress is stress that is experienced due to lack
of ability to cope with advances in technology.

1) List any five illnesses that can be attributed to stress
Cardiovascular disorders
Asthma
Migrane
Irritable bowel syndrome
Cancer
2) Highlight how stress affects cognitive functioning.
Prolonged stress can affect memory, attention and concentration of the
individual.
72
Check Your Progress II Effect of Stress
1) What is inverted U?
In Inverted - U, as the stress increases, the performance also increases,
however at certain point where stress continues to increase, the performance
is affected and goes down.
2) What is Burnout?
Burnout is the end of stress experienced but not properly coped with,
resulting in symptoms of exhaustion, irritation, ineffectiveness, discounting
of self and others and problems of health (hypertension, ulcers and heart
problem).
1) Highlight the indirect effect of stress.
Individuals experiencing stress may not maintain a healthy lifestyle, are less
likely to exercise, may not sleep or eat adequately and may also consume
alcohol and even smoking. These in turn will lead to development of various
disorders and illnesses and also have negative impact relationship. Thus,
stress can have an indirect effect on the individual.

1) Describe the effect of stress on health.
2) Discuss the effect stress can have on performance and productivity.
3) Explain how stress can have an impact on relationships.
73
74
BLOCK 3
STRESS MANAGEMENT
75
Unit 6
Coping with Stress 77
Unit 7
Stress Management Techniques I 88
Unit 8
Stress Management Techniques II 103
76
UNIT 6 COPING WITH STRESS*
Structure
6.0 Objectives
6.1 Introduction
6.2 Definition and Nature of Coping
6.2.1 Goals of Copying
6.3 Coping Styles

6.3.1 Proactive Coping and Avoidant Coping
6.3.2 Emotion Focused Coping and Problem Focused Coping
6.4 Let Us Sum Up

6.5 References
6.6 Key Words
6.0 OBJECTIVES
 discuss the nature of coping and explain its goals; and
 explain coping styles.
6.1 INTRODUCTION
Sania was interested in pursuing a career in dance, but her parents insisted
that she gets into a professional course. She joined MBA programme to
make her parents happy but was not able to keep pace with demands of
the programme. She tried her best to study hard but could not get adequate
marks in the examination. With the frustration that she experienced as
a result of not able to pursue her interest, pressure from her parents and
stress she experienced while pursuing the programme took a toll on her.
She started feeling irritable and angry all the time. Her relationship with
friends was also getting affected. Ultimately, she decided to talk to her
parents and convinced them to let her pursue her interest and took
admission at a performing arts institute, where she excelled and was well
appreciated by her teachers.
Sharan got the promotion that he long waited for and was on top of the
world. But with the promotion came immense responsibilities and work
overload. As a result of the stress and burnout that he experienced, he
started making errors and found himself at the end of blames and criticisms.
Soon, Sharan started experiencing symptoms of depression and also had
suicidal ideation. A day came when he had to be taken to a clinical
psychologist for help in coping with his situation.
Above we discussed two examples. On one hand where Sania was effectively
able to cope with stress, Sharan found it difficult to cope and had to seek
Stress Management professional help. As a person experiences stress, he/she will try to cope and
will utilise varied coping strategies. These strategies could be effective or
ineffective.
In the present unit, we will explain the concept of coping as well as various
coping styles.
6.2 DEFINITION AND NATURE OF COPING

Coping in simple terms can be described as ways in which an individual tries
to deal with stress experienced by him/ her. And in this context, the individual
may be able to deal effectively with stress if he/ she adopts effective coping
skills and he/ she may not be able to deal effectively with stress if the coping
skills adopted by him/ her are ineffective.
Coping refers to “the individual’s response to a psychological stressor which

is often related to a negative event” (Roncaglia, 2014, pg. 137). Coping can
also be described as deliberate efforts that are directed towards decreasing the
negative effects, that could be psychological, physical or even social, of the
stressful situation.
Coping has been defined by Lazarus and Folkman in 1980 as efforts, both
cognitive and behavioural, that are directed towards overcoming, decreasing or
enduring the internal and external demands. Thus, there is an effort to deal with
the demands that are created on the resources of an individual as a result of
stress. Coping in this context could be instrumental or palliative. Instrumental
coping is denoted by results of cognitive appraisal or conflicts related to emotions.
Palliative coping, on the other hand, is denoted by regulation of emotions as
a result of cognitive reappraisal of the stressful event or situation. Thus, either
the problem is altered or the emotional regulation is carried out during the coping
process (Ghosh, 2015).
Matheny et al. (1986) defined coping as conscious or unconscious, healthy or

unhealthy effort that is directed towards either prevention or elimination of
stressor or to weaken it or be able to endure its effects in a manner that is
least harmful.
Haan (1993) explained coping as an effort directed towards using the resources
to overcome the difficulties as the obstacles are encountered.
As described by Bartram and Gardner (2008, pg. 228) “Coping is the process
of thoughts and behaviours that people use to manage the internal and external
demands of situations they appraise as being stressful or exceeding their own
resources. Coping efforts seek to manage, master, tolerate, reduce or minimise
the demands of a stressful environment”.
From the above definitions it is clear that coping is an effort to deal with a
stressor. The coping may aim at dealing with the problem that is the cause
of any distress in the individual or to deal with the negative emotions experienced
by him/ her. Though coping could either be adaptive or maladaptive.
An adaptive coping not only reduces stress but has long term positive effects.
Whereas, maladaptive coping may provide respite from stress for a short period
78 of time but it could have negative impacts on physical and psychological health
of the individual. Some of the maladaptive coping strategies are consumption Coping with Stress
of alcohol or drugs, smoking, risky behaviours, isolating oneself, being overcritical
of oneself and so on.
Individual differences exist in the way individuals cope with stressful situations.
Variations could exist based on personality of an individual, his/ her tolerance
level for stimulation, psychological hardiness, the style of attribution, learned
helplessness and his/ her sense of coherence. Difference may also exist due
to gender (Ghosh, 2015).
Personality not only determines how stress is perceived by an individual but
also how he/ she reacts and copes with stress. Individuals having varied
personalities will display different coping styles and strategies. Similarly people
with high or low need for stimulation will also vary in their coping strategies.
Persons with low need for stimulation are not able to cope with stress as do
people with high need for stimulation (Ghosh, 2015).
Hardiness and resilience also play a role in determining the coping ability of
the individuals. Psychological hardiness can be described as an individual’s ability
to deal with stressful situations with resilience. (Bartone, 1999; Kobasa, 1979).
Hardiness can be related with three main aspects, namely, commitment, control
and challenge and these can determine the response to stress or coping strategy
employed by the individual (Ghosh, 2015).
With reference to the style of attribution, individuals could be optimistic or
pessimistic and this can also determine the coping strategy employed by the
individuals. Optimistic individuals are likely to cope better with stressful situations
when compared with individuals who are pessimistic.
The term learned helplessness was introduced by Seligman. The term is used
to “describe the interference with adaptive responding produced by inescapable
shock and also as a shorthand to describe the process which we believe underlies
the behavior” (Seligman, 1972, pg. 408). The coping process that an individual
goes through may differ based on learned helplessness.
Anttonovosky, 1987 (as cited in Ghosh, 2015, pg. 169) described sense of
coherence as “enduring through dynamic, feeling of confidence that:
1) the stimuli deriving from one’s internal and external environments in the
course of living are structured, predictable and explicable,
2) the resources are available to one to meet the demands posed by these
stimuli, and
3) these demands are challenges worthy of investment and engagement”.
Men and women also differ in the way they cope with stress. Women are more
likely to employ coping strategies like positive self-talk, seeking support from
others, continuously worrying about the stressful event and so on, though they
are also more prone to develop learned helplessness. Men on the other hand
could engage in maladaptive coping strategies like consumption of alcohol and
drugs (Ghosh, 2015). Further, women are more prone to using the coping
strategies that target at bringing about change in their emotional reactions to
a situation that is stressful and men are more likely to focus on the problem
(Endler and Parker, 1990; Matud, 2004; Ptacek et al., 1994). Further, women
also experience more psychological distress as well as display symptoms of 79
Stress Management depression and anxiety when compared with men and this can also be attributed
to the coping strategies that are emotion focused that are more frequently used
by women when compared with men (Kelly et al, 2008). Coping can also differ
or may depend on various external aspects including social support received
by the individual.
6.2.1 Goals of Coping
As we now have a clear idea about the meaning and definition of coping, let
us now discuss the goals of coping. As was explained earlier, the main goal
of coping is dealing with the stressor so that its impact on the individual is
minimal. Further, individual differences exist in the coping styles adopted by the
persons. Also, different coping strategies may be effective in different situations.
Thus, during the coping process either internal resources or external resources
are utilized by the individuals (Ghosh, 2015). Some of the major goals of coping
are as follows (Ghosh, 2015):
 To enhance the possibility of recovery by decreasing the negative
environmental conditions.
 To be able to adjust to the negative situation.
 To maintain a self-image that is positive and maintain emotional balance.
 To ensure positive interpersonal relationship.
Coping is termed as effective when it leads to recovery and when the individual
is able to adapt to the stressful situation by means of maintaining a positive
image about one’s self, emotional balance and has effective interpersonal
relationships. Whether a coping has been effective or not can be assessed based
on the results of the coping. For instance, physiological and biochemical changes
and functioning can be assessed in order ascertain whether the coping has been
adaptive or not. An adaptive coping will lead to regulation of various physiological
indicators. Besides the physiological measures, if there is decrease in psychological
distress displayed by the individual, then the coping strategy can be termed as
adaptive. The duration of time taken by individuals to achieve the same state
of functioning before they experienced a negative event (for instance, divorce,
job loss and so on) or display of an improved state of functioning than before
the negative event was experienced can also be an indicator of successful coping.
1) Define Coping.
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
2) State any one goal of coping
...............................................................................................................
...............................................................................................................
...............................................................................................................
80
Coping with Stress
6.3 COPING STYLES
As the nature of coping is now clear let us focus on the coping styles and
strategies. Coping styles can be categorised as proactive coping, avoidant coping,
emotion focused coping and problem focused coping. Proactive coping and
avoidant coping are based on the method of coping and the emotion focused
coping and problem focused coping are based on the focus of the coping. Let
us discuss each of these styles in detail.
6.3.1 Proactive Coping and Avoidant Coping

In proactive coping the individual will directly confront the stressful situation or
event. An individual adopting this type of coping will take direct action by
developing a better idea about the stress creating situation.
There are various stages of proactive coping (Ghosh, 2015):
Stage 1 Accumulation of resources: In order to be able to deal with the

stressful situation, the individual will make attempts to accumulate resources,
this could also be in terms of gathering information so as to understand the
stressful situation in better manner.
Stage 2 Identifying or anticipating the potential stressor: A potential

stressor is anticipated or identified by the individual. For instance, if it is expected
that one’s superior may ask for a certain report, the employee will anticipate
the stressor and start working on the report before hand.
Stage 3 Initial appraisal: Initial appraisal of the stress creating situation is

carried out.
Stage 4 Preliminary efforts to cope with the stressful situation: Based

on the initial appraisal, preliminary efforts to cope with the stressful situation
are carried out. In case these efforts do not show any positive results then,
some other action is taken in order to deal with the situation.
Stage 5 Seeking feedback and using the same: Based on the stages three
and four, feedback is sought and used so that any modifications and changes
can be carried out.
In avoidant coping, as the name suggests, the individual will try to avoid the
stress creating situation or may give less importance to the stressful event. Thus,
the behaviour that is displayed by the individual is directed towards avoiding
certain thoughts or feelings that could arise due to the stressful situation.
Avoidance coping can result in individuals experiencing not only stress and anxiety
but it can have an impact on self-confidence of the individual as well (Boyes,
2013). As stated by Holahan et al. (2005) “Avoidance coping involves cognitive
and behavioral efforts oriented toward denying, minimising, or otherwise avoiding,
dealing directly with stressful demands and is closely linked to distress and
depression. In avoidant coping certain behaviours that may stir up negative
memories are avoided”. Situations that may stir up negative feelings are also
avoided. Individuals who use avoidant coping may not continue pursuing their
goal if they experience thoughts that create anxiety (Boyes, 2013).
81
Stress Management 6.3.2 Emotion Focused Coping and Problem Focused Coping
Let us look at the example given below:
Since Sunny was assigned to a new superior, Sunny felt that he has been
given more work compared to his colleagues and is also criticised frequently.
He is not aware why his superior is doing so, but the work overload and
frequent criticisms are taking a toll on him and he feels stressed. He even
lost sleep and appetite. Sunny’s friends noticed change in Sunny as he would
keep to himself and was not his usual self. Some of his friends decided
to speak to him. After understanding the issue, one of them, Kabir,
suggested that Sunny should directly speak to his superior or the human
resource department. Another friend, Kedar, suggested that he needs to
accept and adjust with the situation and try to put in his best.
As you can see in the above example, two of the Sunny’s friends gave two
different suggestions. The suggestion given by Kabir is mainly problem focused
where the problem is dealt with in a direct manner. Whereas, the suggestion
given by Kedar mainly focuses on managing one’s emotions and can be termed
emotional coping or emotion focused coping.
Emotion focused coping can be differentiated from problem focused coping as
its purpose is to manage emotions that are related with the stressful situation
rather than modifying the situation.
Emotion focused coping involves management of the emotional reactions towards
the events causing stress. “Emotion-focused coping strategies aim to reduce and
manage the intensity of the negative and distressing emotions that a stressful
situation has caused rather than solving the problematic situation itself” (Galor,
2012). Thus, this coping is directed towards decreasing any unpleasantness that
the person experiences as a result of facing the stressful situation. The avoidant
coping style that we discussed earlier could be related with this coping style
as it involves avoidance of a situation. Though, this coping style also involves
positive reappraisal, where, positive aspects of the situation are focused on
keeping in mind one’s own benefits and growth. Emotion focused coping are
often used when change in the stressful situation is not possible and it is also
more likely to be used by women than men (Ghosh, 2015). Using emotion
focused coping can help in decreasing the negative effects of the stressor on
the individual and will help the individual accept the situation and will thus lead
to decrease in the experience of chronic stress. It also helps individuals to think
with a clear mind and seek a solution to the problem. It may also lead to
contentment in life and bring about positivity. This in turn can lead to enhancement
of one’s ability to focus on aspects that can be modified or changed. Some
of the strategies of emotion focused coping include, listening to music, maintaining
a diary, meditation, exercise and so on.
Some of the drawbacks of this coping are that it may not be as effective, as
the source of the stress is not dealt with, and, as such no long term solution
is sought.
Problem focused coping involves identifying the source of the problem so as
to either deal with it or modify it. The proactive coping that we discussed earlier
can be closely related with this type of coping. Further, problem focused coping
also involves taking control of the stressful situation, seeking information about
it and evaluation of positive and negative aspects in a situation (Roncaglia, 2014).
In problem focused coping the first step involved is identification of the problem
82
so that the source of stress is clear. And this is important as this coping style Coping with Stress
can be effective only when there is clarity with regard to the problem. For
instance, problem focused coping works well while coping with examinations,
interviews, making presentations and so on where one knows what the source
of stress is and also stress caused due to such situations can be controlled
by the individual. Though, if the source of stress is based on emotions then
it is better to use emotion focused coping rather than problem focused coping.
For instance, while dealing with loss of a loved one, divorce or breakup and
so on. Further, in this style, the obstacles that may arise in the process of dealing
with the stressful situation need to be avoided and the focus should be on
problem. For instance, if a person has an interview, but could not prepare for
it due to paucity of time, he/ she has no other choice but face the interview
and do his/ her best. In this case the paucity of time could be termed as a
roadblock that need not be focused on as time has already passed and nothing
can be done about it. The main limitations of this coping style are that it may
not be effective in every stressful situation and as such may not be suitable
for all the individuals. Though it is often effective in dealing with stressors and
useful in long run.
Various strategies involved in problem solving coping include, management of
time, seeking support, seeking help from others, planning and so on.
Yet another coping style was proposed by Carver and Connor-Smith in 2010.
It is called appraisal- focussed coping. In this coping style, the assumptions
of an individual with regard to his/ her perceptions of the stressor are challenged
by the means of a cognitive reappraisal (Roncaglia, 2014).
Coping can also be categorised as combative coping and preventive coping
as stated by Folkman et al. (Ghosh, 2015). In combative coping, in order to
deal with the stressor, the individual makes an attempt to remove the stressor
by overcoming it. Combative coping involves monitoring of stress, resource
accumulation, dealing with the stressor by attacking it directly, tolerance of stress,
and decreasing arousal (Ghosh, 2015).
In preventive coping, cognitive restructuring takes place so that the stressor is
not threatening any more. Further, one’s own potential for resistance is also
strengthened so that the stressor can be prevented from occurring. Preventive
coping includes adjustments so that the stressors can be avoided. Also demand
levels are adjusted, behaviour patterns that lead to stress are modified and coping
resources (physiological, psychological, financial and so on) are developed
(Ghosh, 2015).
1) List the stages of proactive coping.
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Stress Management 2) What is problem focused coping?
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6.4 LET US SUM UP

In the present Unit, we discussed the definition and nature of coping with stress
and the coping styles. Coping in simple terms can be described as ways in
which an individual tries to deal with stress experienced by him/ her. Coping
can also be described as deliberate efforts that are directed towards decreasing
the negative effects, that could be psychological, physical or even social, of
the stressful situation. Coping could either be adaptive or maladaptive. An
adaptive coping style not only reduces stress but has long term effects. Whereas,
maladaptive coping may provide respite from stress for a short period of time
but it could have negative impacts on physical and psychological health of the
individual. Individual differences exist in the way individuals cope with stressful
situations. Variations could exist based on personality of individuals, his/ her
tolerance level for stimulation, psychological hardiness, the style of attribution,
learned helplessness and his/ her sense of coherence. Difference may also exist
due to gender. The goals of coping were also discussed in this Unit and some
of the major goals of coping include enhancing the possibility of recovery by
decreasing the negative environmental conditions, being able to adjust to the
negative situation, maintaining a self-image that is positive and emotional balance
and ensuring positive interpersonal relationships. Coping is termed as effective
when it leads to recovery and when the individual is able to adapt to the stressful
situation by means of maintaining a positive image about one’s self, emotional
balance and has effective interpersonal relationship.
Coping styles can be categories as proactive coping, avoidant coping, emotion
focused coping and problem focused coping. Proactive coping and avoidant
coping are based on the method of coping and the emotion focused coping
and problem focused coping are based on the focus of the coping. In proactive
coping the individual will directly confront the stressful situation or event. An
individual adopting this type of coping will take direct action by developing a
better idea about the stress creating situation. In avoidant coping style, the
individual will try to avoid the stress creating situation or may give less importance
to the stressful event. Emotion focused coping involves management of the
emotional reactions towards the events causing stress and problem focused
coping style involves identifying the source of the problem so as to either deal
with it or modify it. Emotion focused coping can be differentiated from the
problem focused coping as its purpose is to manage emotions that are related
with the stressful situation rather than modifying the situation.
In the next Unit we will discuss about various stress management techniques
6.5 REFERENCES
Bartone, P. T. (1999). Hardiness Protects against War-related Stress in Army
Reserve Forces. Consulting Psychology Journal, Vol. 51, pp. 72-82.
84
Bartram, D., & Gardner, D. (2008). Coping with Stress. In Practice 30, 228- Coping with Stress
231.
Boyes, A. (2013). Avoidance Coping. Retrieved from https://
www.psychologytoday.com/intl/blog/in-practice/201305/avoidance-coping on 21/
06/2019 at 7:00 pm.
Endler, N. S., Parker, J. D. A. (1990). Multidimensional Assessment of Coping:
A Theoretical Analysis. Journal of Personality and Social Psychology, 58, 844–
854.
Galor, S. (2012). Emotion-Focused Coping Strategies. Retrieved from https:/
/drsharongalor.wordpress.com/2012/03/31/emotion-focused-coping-strategies/ on
22/06/2019 at 3:00 pm.
Haan, N. (1993). The Assessment of Coping, Defence, and Stress. In L.
Goldberger & S. Breznitz (Eds.), Handbook of Stress: Theoretical and Clinical
Aspects (pp. 258-273). New York, NY, US: Free Press.
Holahan, C., Moos, R., Holahan, C., Brennan, P., & Schutte, K. (2005). Stress
Generation, Avoidance Coping, and Depressive Symptoms: A 10-Year Model.
Journal of Consulting and Clinical Psychology, 73(4), 658-666. doi:
10.1037/0022-006x.73.4.658.
Kelly, M. M., Tyrka, A. R., Price, L. H & Carpenter, L. L. (2008). Sex
Differenced in the use of Coping Strategies: Predictors of Anxiety and Depression
Symptoms. Depression Anxiety 25 (10): 839-846 doi: 10.1002/da.20341
Kobasa, S. C. (1979). Stressful Life Events, Personality, and Health: An Inquiry
into Hardiness. Journal of Personality and Social Psychology, 37, 1–11.
Kobasa, S. C., Maddi, S. R., Puccetti, M., & Zola, M. A. (1986). Relative
Effectiveness of Hardiness, Exercise, and Social Support as Resources against
Illness. Journal of Psychosomatic Research, 29, 525–533.
York: Van Nostrand.
Marks, D. F., Murray, M., Evans, Brian., Willig, C., Woodall, C & Sykes,
Sage Publications.
Mangal, S. (1984). Abnormal Psychology. New Delhi, India: Sterling Publishers.
Matheny, K. B., Aycock, D. W., Pugh, J. L., Curlette, W. L., & Silva Cannella,
K. A., (1986). Stress Coping: A Qualitative and Quantitative Synthesis with
Implications for Treatment. The Counseling Psychologist, 14, 499-549.
Matud, M. P. (2004). Gender Differences in Stress and Coping Styles.
Personality and Individual Differences, 37,1401–1415.

85
Stress Management Pestonjee, D. (1999). Stress and Coping. New Delhi: Sage Publications.
Ptacek, J. T., Smith, R. E., Dodge, K. L. (1994). Gender Differences in Coping
with Stress: When Stressors and Appraisal do not Differ. Personality and Social
Psychology Bulletin, 20, 421–430.
Roncaglia, I. (2014). Coping Styles: A Better Understanding of Stress and
Anxiety in Individuals with Autism Spectrum Conditions through Sport and
Exercise Models. Psychological Thought, 7(2), 134–143, doi:10.5964/
psyct.v7i2.115
Wadsworth.
Seligman, M. (1972). Learned Helplessness. Annual Review Of Medicine,
23(1), 407-412. doi: 10.1146/annurev.me.23.020172.002203.
6.6 KEY WORDS

Coping : Coping in simple terms can be described as ways
in which an individual tries to deal with stress
experienced by him/ her.
Avoidant coping : In avoidant coping, as the name suggests, the
individual will try to avoid the stress creating
situation or may give less importance to the
stressful event.
Emotion focused coping : Emotion focused coping involves management of
the emotional reactions towards the events causing
stress.
Proactive coping : In proactive coping the individual will directly
confront the stressful situation or event. An
individual adopting this type of coping will take
direct action by developing a better idea about
the stress creating situation.
Problem focused coping : Problem focused coping involves identifying the
source of the problem so as to either deal with
it or modify it.

1) Define Coping.
Lazarus and Folkman in 1980 defined coping as efforts, both cognitive
and behavioural, that are directed towards overcoming, decreasing or
enduring the internal and external demands.
2) State any one goal of coping
One of the goals of coping is to enhance the possibility of recovery by
86 decreasing the negative environmental conditions.
Check Your Progress II Coping with Stress
1) List the stages of proactive coping.

The stages of proactive coping are as follows:
Stage 1 Accumulation of resources
Stage 2 Identifying or anticipating the potential stressor
Stage 3 Initial appraisal
Stage 4 Preliminary efforts to cope with the stressful situation
Stage 5 Seeking feedback and using the same
2) What is problem focused coping?
Problem focused coping style involves identifying the source of the problem
so as to either deal with it or modify it.

1) Define coping and discuss its goals.
2) Explain the nature of coping.
3) Describe the steps involved in proactive coping.
4) Discuss proactive and avoidant coping styles.
5) Describe emotion focused and problem focused coping.
87
UNIT 7 STRESS MANAGEMENT
TECHNIQUES I*
Structure
7.0 Objectives
7.1 Introduction
7.2 Relaxation Techniques
7.3 Meditation
7.4 Yoga
7.5 Mindfulness
7.6 Biofeedback
7.7 Let Us Sum Up
7.8 References
7.9 Key Words
7.0 OBJECTIVES
After reading this Unit, you will able to:
 discuss the techniques of stress management like relaxation technique,
meditation, Yoga, mindfulness and biofeedback.
7.1 INTRODUCTION
Rahul was a Human Resource Manager in an MNC. He noticed that the
performance and effectiveness of the employees of his organization was
getting affected due to occupational stress. Therefore, he spoke to his
management and arranged for a half an hour meditation session everyday
for the employees, that really made a difference.
Neha worked as a counsellor in a school. She noticed that one of her
teacher colleagues, Snehal was stressed. She decided to speak to Snehal
and found that she was stressed due to some issues that she was facing
at home. Neha discussed cognitive restructuring technique with Snehal and
asked her to practice the same. Post vacation when Neha met Snehal,
Snehal informed that there was a huge difference in the way she approached
the problems that she was facing and that her stress had gone down
considerably.
Niharika was a home manager. Her friend Sheela lately noticed that
Niharika was getting stressed due to her hectic routine. She suggested
Niharika to take up Yoga classes so as to help her deal better with the
stress that she was experiencing.
In the above cases, we can see that certain stress management techniques have Stress Management
Techniques-I
been used (meditation, cognitive restructuring and Yoga). These and many more
can be used by individuals to deal effectively with stress.
In the previous Unit we discussed about coping with stress and covered the
definition and nature of coping and also discussed about coping styles.
In the present Unit and the next, we will focus on stress management techniques.
There are various stress management techniques that can be used by
individuals to deal with stress and as students of psychology, we need to
understand these techniques and how they help individuals deal effectively with
stress. Stress management techniques ranging from relaxation techniques,
meditation, mindfulness, cognitive restructuring and so on can help individual
manage stress effectively.
Before we actually start with discussion on various stress management
techniques, let us do a simple breathing exercise:
Sit straight and close your eyes before you start with the exercise
Then, breath in and breath out gently (as you normally do).
Do this for five to ten minutes
Focus on your thoughts and concentrate on your breathing
Rub your palms together, put them on your eyes and then slowly open
your eyes
I hope you are feeling refreshed after this exercise and all set to study
further about stress management.
The above exercise can be carried out from time to time in a day as required
so as to refresh your mind and body. Important point is to do it with all your
heart and seriousness.
In the Units three, four and five, we discussed about stress, its nature and effects.
These are very important in order to understand stress management. Individual
differences exist in the way stress is perceived and experienced and in a similar
manner, the techniques of stress management found to be effective by different
individuals will also differ. Some may find Yoga to be more suitable, whereas
others may want to go for relaxation techniques.
There are various stress management techniques that will be discussed by us
in the present and the next Units.
7.2 RELAXATION TECHNIQUES

As discussed by us in earlier units there are a number of physiological changes
that take place in the individual who is experiencing stress. These could range
from rapid breathing to increased heartbeat and pulse rate, tightening of muscles
and so on. In such a situation relaxation techniques can be effectively used,
especially, to reduce the muscle tension experienced by the individual undergoing
stress. Relaxation techniques help not only in relieving stress but they also help
in dealing with anxiety, help sleep better, help in regulation of blood pressure,
reduce headaches and migraine and so on.
89
Stress Management One such relaxation technique is Jacobson’s Progressive Muscle Relaxation. This
technique involves deep muscle relaxation. The main assumption of this technique
is that relaxation and tension cannot occur at the same time, mainly because
both are as a result of two different autonomic nervous systems, that is,
sympathetic and parasympathetic nervous systems. And these systems cannot
be active at the same time as they reciprocally inhibit each other.
The technique mainly involves contracting various body muscles and then relaxing
them. The exercise can be carried out for approximately 15 to 20 minutes and
could be practiced twice a day. The following needs to be kept in mind before
practicing this technique (Ghosh, 2015):
1) It is to be practiced in a place that one finds comfortable.
2) Preferably it needs to be carried out at a time when there are least
distractions.
3) It needs to be carried out with belief in one self and should not be hurriedly
carried out.
4) Any drugs or medications should not be used for relaxation and those
on medication may practice after seeking medical advice.
5) Caution must be maintained by persons suffering from problems like
backaches, fractures and other injuries.
The technique mainly starts with breathing in, holding the breath and letting go.
It is important to be calm as well as comfortable while practicing this technique.
Eyes can be closed during the technique. Breathing exercise could be repeated
a few times and that can be followed by tensing and relaxing of different muscles.
This technique involves contracting and relaxing 16 muscle groups alternatively.
These muscles include arms, hands, shoulders, neck, forehead-eyes-scalp, jaws
- mouth, chest - trunk, stomach, lower back, buttocks, thigh, foot-calf (Ghosh
2015). The contracting and relaxing of muscle is to be carried out as follows:
 Bend the arms up to the elbow, hold for few seconds and relax.
 Hands can be clenched in a fist, hold for some time and open.
 Shoulders can be pulled in upward direction, held in this position for a

while and then released.
 For relaxing the neck, head can be pushed back for a few seconds and
then brought in the original position. Similarly, chin can be brought down
towards the chest, for a few seconds and then brought in the original
position.
 For chest, deep breaths to be taken, held for few seconds and then relaxed.
 Stomach can be pulled in for a few seconds and relaxed.
 For thighs, knees can be pulled together for a while and then relaxed by
drifting them apart.
 Buttocks can be squeezed together and relaxed.

90
 For feet, pull your toes up in the direction of your knees, hold this position Stress Management
Techniques-I
briefly and then relax by letting go. Heels can be pressed against the ground
for a few seconds and the relaxed by letting go.
Post exercise it is important to remain relaxed and not make jerky
movements, though you can have a final stretch. Before you open your eyes
count backwards from ten to one and then rub your palms together and put
them on your eyes. Then, eyes can be opened slowly and the feeling of being
relaxed can be enjoyed.
Box 6.1: Quick method for relief from stress

1) Close your eyes.
2) Try to relax your arms and shoulders.
3) Rotate your head in a circle a few times - first to the right, then to
the left.
4) Take a deep breath and exhale, repeat this for five to ten minutes.
5) Concentrate on your breathing.
6) Put aside all stressful thoughts.
7) Count backwards from ten to one.
8) Rub your palms together and put them on your eyes.
9) Slowly open your eyes.

1) What is the main assumption of Jacobson’s Progressive Muscle Relaxation?
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7.3 MEDITATION
Meditation is yet another technique that can be used to deal with stress.
Meditation is the English word for Sanskrit term ‘Dhyana’. It can be described
as a process of “quieting the mind in order to spend time in thought for relaxation
with a goal to attain inner state of awareness and intensify personal and spiritual
growth” (https://www.yogapedia.com/definition/4949/meditation). Meditation will
relax your body and thus the negative impact of stress on the body is reduced.
Meditation not only leads to relaxation of body but it also helps in increasing
self-awareness. And regular practice of meditation will have long term benefits.
There are different types of meditation (Villines, 2017, Welch, 2019). Some
of these are briefly explained as follows: 91
Stress Management  Mindfulness meditation: This mainly includes becoming aware about
one’s thoughts. It involves sitting in a place without any distractions and
non-judgmentally observing one’s thoughts and emotions.
 Transcendental meditation: This involves chanting of a ‘mantra’/ chant
or a word repeatedly in certain manner. This again can be done in a quiet
place. One can sit straight but comfortably and practice this meditation
for 15 to 20 minutes.
 Guided meditation: As the name suggests, in this meditation, there is often
a guide who will take you through the meditation process. This meditation
mainly involves visualisation of certain images that you may find relaxing.
It also involves utilising one’s senses. The person may be asked to sit in
a quiet and calm place with eyes closed and visualise certain images that
he/ she finds relaxing.
 Vipassana meditation: The main aim of this meditation is self-observation
in order to transform oneself. It requires attention to be paid to different
bodily sensations in order to create a connection between body and mind.
 Loving kindness meditation (Metta meditation): This meditation
includes directing love and kindness towards others. The individual is
required to sit straight but in a comfortable position in a quiet place. He/
she is then required to take a few deep breaths and repeat to oneself
words that express kindness to self, then to family, friends and other
significant people in his/her life and then to everyone.
 Chakra (means wheel) meditation: In our body there are different energy
centers and power that are spiritual in nature and they are referred to as
chakras or wheels. There are a total of seven such chakras that are located
in different parts of our body and each chakra is represented by a colour.
The main aim of this meditation is to bring about an equilibrium in these
chakras.
The benefits of meditation include not only reduction of stress but it can also
help in managing anxiety, promoting affective health, enhancing self-awareness,
increasing the span of attention and so on. Initially it can be practiced once
in a day for a few minutes and later on, the duration can be increased and
it can also be practiced twice a day.
Box 6.2: A simple way to meditate is given as follows:

 You need to sit on a chair comfortably with your back straight. Let
your feet touch the floor and do not cross your legs or arms. You
can either rest you arms in your lap or keep them on the armrest.
 Then you need to close your eyes.
 Breath in deeply and breath out gently and try to relax your body.
 Keep your eyes closed and you can either repeat a mantra, a word
to your self or can have a (prewritten) self dialogue with your self.
 If you get distracted, repeat the mantra, word or continue with the
self dialogue.
92
Stress Management
 You can do this for 15 to 20 minutes (initially it can be done for Techniques-I
smaller time period and later the duration can be gradually increased).
 As you complete the meditation, count backwards from ten to one.
 Rub your palms together and put them on your eyes.
 Slowly open your eyes.

1) What is transcendental meditation?
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2) What are the benefits of meditation?
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7.4 YOGA
You all must be aware that we celebrate International Day of Yoga on 21st
June every year. Such is the effectiveness of Yoga that it is now promoted at
International level in order to create awareness and promote practice of Yoga
amongst the individuals so as to help them enhance their health and wellbeing.
Yoga as a practice originated in India and the term Yoga is derived from Sanskrit
meaning ‘to unite’, indicating a union of consciousness and body (https://
www.un.org/en/events/yogaday/). The main goal of Yoga is self realisation (Balaji,
2012). Yoga finds its mention in Bhagwad Gita, where a whole chapter is devoted
to it. Three main types of yoga have been mentioned in this regard.
Karma Yoga: That is yoga related to one’s actions.
Bhakti Yoga: Yoga related to devotion.
Jnana Yoga: That is Yoga related to knowledge.
There is also a fourth type that was put forth by Patanjali. He introduced Ashtang
Yoga, that is, power yoga. This yoga involves a movement or a flow from posture
to posture (Balaji, 2012). Figure 7.1 shows various dimensions of Yoga, Balaji,
2012). 93
Stress Management
Fig 7.1: Dimensions of Yoga
Yoga mainly involves bodily postures (Asanas), breathing exercises and meditation
that are to be carried out in a specific manner.
Types of Asanas
There are various types of asanas, some of these have been briefly discussed
as follows:
1) Padmasana: This is also referred as the lotus pose that can be used during
meditation. Padmasana is practiced by sitting straight on the ground with
your feet on top of your thighs. This asana is quite difficult and may need
practice before one is able to carry it out adequately.
2) Sukhasana: This involves sitting cross-legged. This is an easy asana and
like Padmasana, it can be used during meditation.
3) Siddhasana: This is similar to Padmasana but less difficult. In this. you
need to sit with your toes tucked in to your thighs.
94 Fig. 7.2: Siddhasana

4) Vajrasana: Vajra is a Sanskrit term that can be translated as ‘diamond’ Stress Management
Techniques-I
(Balaji, 2012). This involves sitting on one’s heels by placing palms on
the knees. (Figure 7.3)
Fig. 7.3: Vajrasana
5) Trikonasana: In this asana, you need to stand on the floor with legs apart
and then you need to stretch your body to the left in such a way that
spine is straight and your body is facing towards front and your arms are
perpendicular to the floor, with left hand resting on the floor and right hand
straight up (Balaji, 2012, pg. 3). Refer to figure 7.4.
Fig. 7.4: Trikonasana
6) Bhujangasana: Also referred to as cobra pose, in this the person has

to lie face down on the floor, with hands on the floor below the shoulder.
Then he/ she has to lift his/ her head and chest slowly. The elbows are
to be kept near the body, with neck straight and eyes looking up.
Fig. 7.5: Bhujangasana 95

Stress Management Pranayam
Pranayam is a breathing exercise that can be carried out for stress relief, though
it has number of other health benefits as well. In this you need to put your
right thumb on your right nostril and deeply inhale through your left nostril. Then
you close your left nostril with your right index finger and hold your breath
for a few seconds. Then exhale through your right nostril. The same can be
repeated with your left nostril (Balaji, 2012, pg 3). Refer to figure 7.6.
Fig. 7.6: Pranayam
Yoga has a number of benefits including relief from stress, higher productivity,
mindfulness and overall better physical and mental health. But it is important
that one develops its understanding and take suitable training before it is
practiced.
Note: Figures for Asanas and Pranayam have been taken from Balaji
Deekshitulu PV (2012) Stress and Yoga. Journal of Yoga and Physical
Therapy, 2:109.doi:10.4172/2157-7595.1000109
1) What are the three main types of Yoga?
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7.5 MINDFULNESS
Mindfulness denotes awareness about ones thinking, the way one feels, physical
sensations and one’s surrounding in the present moment. It mainly involves
becoming non-judgmental in one’s awareness about one’s thoughts and feelings.
It mainly involves paying attention to things that we generally do not notice as
we are too occupied with our lives, thinking about future and past and are
seldom focusing on present. Mindfulness is often termed as a contrast to
automatic pilot mode (or a default mode) where we do things without much
thought or attention. Often, we are doing certain activities like driving, household
chores or even eating which we may do by not paying our complete attention
to the task and most often our attention and thought process may be somewhere
else rather than on these activities. Thus, we are in auto pilot mode. Whereas,
mindfulness involves becoming aware and focusing our attention on these
activities. The main characteristics of mindfulness according to Kabat-Zinn (1990)
96 are being nonjudgmental, cultivating patience, being open minded, having trust,
non-striving, acceptance and letting go. In fact Kabat-Zinn was also responsible Stress Management
Techniques-I
for starting a programme on Mindfulness- Based Stress Reduction in 1997 at
University of Massachusetts Medical School. It is also important that when
mindfulness is practiced, one involves in observing one’s experiences including
thoughts, feelings and physiological sensations. Though when one is focusing at
varied experiences, it is to be done one at a time. Besides observation, it also
involves description of what is being observed but this is to be done non-
judgmentally. Mindfulness also requires complete participation, thus complete
attention and focus needs to be provided to the task at hand. While practicing
mindfulness, it is possible that one’s attention and focus may drift, in which case
one needs to gently bring back the focus and attention on observing the
experience.
Practicing mindfulness can have a positive impact on an individual’s body and
mind. It not only helps in dealing with certain illnesses by strengthening one’s
immune system but it also helps deal with stress and promote positive mental
health. Even memory, attention, problem solving and decision making can improve
with the help of mindfulness. It can also enhance one’s self esteem and can
play a role in building and maintaining positive relationships.
One of the most important activities that we often do mindlessly is eating. We
eat so that our body gets the necessary nourishment. But most often we do
this activity on an auto pilot mode while we either watch television or browse
our mobiles or engage in social networking. Next time you have your lunch
or dinner try to exercise mindfulness eating. Do this by switching off the television,
keeping aside the mobile and concentrate on your food. Appreciate your food
and pay attention to its taste, colour, sound, texture, aroma and so on (sense
it with all your senses) and be nonjudgmental in doing so. And even while
carrying out other activities as well, try to carry them out in a mindful manner.
1) What is mindfulness?
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2) What are the main characteristics of mindfulness according to Kabat-Zinn?
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Stress Management
Box 7.3: Practicing mindfulness breathing
 You need to sit or lie down (on your back) comfortably. If you sit,
ensure that your back is straight.
 Then you need to close your eyes.
 Breath in and breath out naturally.
 Focus on your breathing.
 As you do this there will be thoughts in your mind, you may experience
emotions, there will be sensations, you may also hear some sounds.
What you need to do is accept these without being judgemental.
 If you get distracted, try to bring back your attention gently on your
breathing.
7.6 BIOFEEDBACK
As described by Ghosh (2015, as cited on pg 179), “biofeedback is a technique
of making unconscious or involuntary bodily processes (as heartbeat or
brainwaves) perceptible to the senses (as by the use of an oscilloscope) in order
to manipulate them by conscious mental control”. It can also be described as
a process that is non-invasive in nature and helps in comprehending the effect
of stress on one’s body. It helps monitor the bodily changes that take place
when stress is experienced and with the help of such a feedback, the bodily
reactions can be managed and resilience towards stress can be improved. Thus,
the individual will get immediate feedback about varied physiological processes.
Biofeedback can be obtained for breathing, blood pressure, heart rate, Galvanic
skin response etc. that mainly includes measurement of amount of sweat on
skin, temperature of skin, tension in muscles and so on.
When stress is experienced, there are various physiological changes that take
place in the individual experiencing stress. When individual becomes aware about
these changes with the help of biofeedback, he/ she will be in a better position
to manipulate and control them. Thus, the physiological arousal that is
experienced during stress can be dealt with by using varied techniques including
deep breathing, relaxation and so on. And as the body is relaxed there is no
negative effect of stress on health of the individual. Biofeedback can also help
an individual identify what he/ she needs to manipulate or control and which
technique is more effective while doing so. Accordingly, the individual can
effectively manage stress experienced by him/ her. Biofeedback can be obtained
by becoming more aware about one’s physical responses. For instance, we can
notice our rapid breathing while experiencing stress. Biofeedback can also be
obtained by using certain tools like thermometer or weighing scales.
We discussed a few techniques of stress management in this unit and many

more will be discussed in the subsequent unit. We have to remember that each
of us experience and react to stress in different manner and thus the techniques
that we may find effective to manage stress will also vary. You need to become
aware about your stress, understand it and then select one or more techniques
that will help you deal effectively with your stress.
98
Check Your Progress V Stress Management
Techniques-I
1. What is biofeedback?
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7.7 LET US SUM UP

To summarise, in the present Unit we discussed various techniques of stress
management including relaxation techniques, meditation, Yoga, mindfulness and
biofeedback. There are a number of physiological changes take place in the
individual who is experiencing stress. This could range from rapid breathing to
increased heartbeat and pulse rate, tightening of muscles and so on. In such
a situation relaxation techniques can be effectively used especially to reduce
the muscle tension experienced by the individual undergoing stress. Relaxation
techniques help not only in relieving stress but they also help in dealing with
anxiety, help sleep better, help in regulation of blood pressure, reduce headaches
and migraine and so on. Jacobson’s Progressive Muscle Relaxation was also
discussed in this context. Meditation is yet another technique that can be used
to deal with stress. Meditation will relax your body and thus the negative impact
of stress on the body is reduced. Meditation not only leads to relaxation of
body but it also helps in increasing self-awareness. And regular practice of
meditation will have long term benefits. Different types of meditations like
mindfulness meditation, transcendental meditation, guided meditation, Vipassana
meditation, loving kindness meditation (Metta meditation) and Chakra (means
wheel) meditation were also briefly described. With regard to the next technique,
Yoga is derived from Sanskrit meaning ‘to unite’, indicating a union of
consciousness and body. The main goal of Yoga is self-realisation. Yoga find
its mention in Bhagwad Gita, where a whole chapter is devoted to it. Under
this section, various Asanas and Pranayam were explained. Mindfulness was
the next technique discussed and it denotes awareness about ones thinking, the
way one feels, physical sensations and one’s surrounding in the present moment.
It mainly involves becoming non-judgemental in one’s awareness about one’s
thoughts and feelings. It mainly involves paying attention to things that we
generally don’t notice as we are too occupied with our lives, thinking about
future and past and thus seldom focusing on present. Lastly, we discussed
biofeedback that is a technique of making unconscious or involuntary bodily
processes (as heartbeat or brainwaves) perceptible to the senses (as by the
use of an oscilloscope) in order to manipulate them by conscious mental control.
7.8 REFERENCES
Asanas Retrieved from http://www.yoga-age.com/modern/asanas.html on
11th November, 2019 at 1:20 pm.
Bartram, D., & Gardner, D. (2008). Coping with Stress. In Practice,
30, 228-231. 99
Stress Management Bjarnadottir, A. (2019). Mindful Eating 101 — A Beginner’s Guide. Retrieved
from https://www.healthline.com/nutrition/mindful-eating-guide on 7th November,
2019 at 7:00 pm.
Balaji, D. P. V. (2012). Stress and Yoga. Journal of Yoga and Physical

Therapy 2, 109. doi:10.4172/2157-7595.1000109
Calucchia, C. (2019). Transcendental Meditation: Meditation for Busy Minds.

Retrieved from https://www.mydomaine.com/how-to-do-transcendental-meditation
on 7th November, 2019 at 8:00 pm.

International Day of Yoga. Retrieved from https://www.un.org/en/events/yogaday/

on 9th November, 2019 at 10: 00 pm.
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of your

Body and Mind to Face Stress, Pain and Illness. New York: Delacourt.
Hawton, K., Salkovskis, P., Kirk, J., & Clark, D. (1989). Cognitive behaviour
Therapy for Psychiatric problems. Oxford: Oxford University Press.
Meditation Retrieved from https://www.yogapedia.com/definition/4949/meditation

on 11th November, 2019 at 4: 00 pm.
Mindfulness Retrieved from https://greatergood.berkeley.edu/topic/mindfulness/

definition#how-cultivate-mindfulness on 6th November, 2019 at 3:00 pm.

Wadsworth.
Scott, E. (2019). the Benefits of Yoga for Stress Management Retrieved from
https://www.verywellmind.com/the-benefits-of-yoga-for-stress-management-
3145205 on 9th November, 2019 at 10: 30 pm.
The Difference between Sukhasana, Siddhasana, Padmasana Retrieved from

https://yogafirsthand.com/2013/04/21/the-difference-between-sukhasana-
siddhasana-padmasana/ on 11th November, 2019 t 2:00 pm.
Villines, Z. (2017). What is the Best Type of Meditation? Retrieved from https:/
/www.medicalnewstoday.com/articles/320392.php on 6th November, 2019 at
9:30 am.
Welch, A (2019). A Guide to 7 Different Types of Meditation Retrieved

from https://www.everydayhealth.com/meditation/types/on 5th November 2019
at 3:00 pm.
8 Steps to Mindful Eating, Retrieved from https://www.health.harvard.edu/

staying-healthy/8-steps-to-mindful-eating on 7th November, 2019 at 7:00 pm.
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Stress Management
7.9 KEY WORDS Techniques-I
Biofeedback : Biofeedback can be described as a process

that is non-invasive in nature and helps in
comprehending the effect of stress on one’s
body.
Meditation : It can be described as a process of quieting
the mind in order to spend time in thought
for relaxation with a goal to attain inner state
of awareness and intensify personal and
spiritual growth.
Mindfulness : Mindfulness denotes awareness about
ones thinking, the way one feels, physical
sensations and one’s surrounding in the present
moment.
Yoga : Yoga as a practice originated in India and
the term Yoga is derived from Sanskrit
meaning ‘to unite’, indicating a union of
consciousness and body. The main goal of
Yoga is self realisation. Yoga mainly involves
bodily postures (Asanas), breathing exercises
and meditation that are to be carried out in
a specific manner.

1) What is the main assumption of Jacobson’s Progressive Muscle Relaxation?
Jacobson’s Progressive Muscle Relaxation technique involves deep muscle
relaxation. The main assumption of this technique is that relaxation and
tension cannot occur at the same time, mainly because both are as a result
of two different autonomic nervous systems, that is, sympathetic and
parasympathetic nervous system.s
1) What is transcendental meditation?
Transcendental meditation involves chanting of a ‘mantra’/ chant or a word
repeatedly in certain manner.
2) What are the benefits of meditation?
The benefits of meditation include not only reduction of stress but it can
also help in managing anxiety, promoting affective health, enhancing self-
awareness, increasing the span of attention and so on.
1) What are the three main types of Yoga?
The three main types of Yoga are
101
Stress Management Karma Yoga: That is yoga related to one’s actions.
Bhakti Yoga: Yoga is related to devotion.
Jnana Yoga: That is Yoga related to knowledge.
1) What is mindfulness?
Mindfulness denotes awareness about ones thinking, the way one feels,
physical sensations and one’s surrounding in the present moment. It mainly
involves becoming non-judgmental in one’s awareness about one’s thoughts
and feelings.
2) What are the main characteristics of mindfulness according to Kabat-Zinn?
The main characteristics of mindfulness according to Kabat-Zinn (1990)
are being nonjudgmental, cultivating patience, being open minded, having
trust, non-striving, acceptance and letting go.
1) What is biofeedback?
Biofeedback is a technique of making unconscious or involuntary bodily
processes (as heartbeat or brainwaves) perceptible to the senses (as by
the use of an oscilloscope) in order to manipulate them by conscious mental
control.

1) Discuss in detail relaxation technique.
2) Explain different types of meditation.
3) Discuss in detail various types of Asanas in Yoga.
4) Describe mindfulness.
5) Explain biofeedback as a technique of stress management.
102
UNIT 8 STRESS MANAGEMENT
TECHNIQUES-II*
Structure
8.0 Objectives
8.1 Introduction
8.2 Cognitive Restructuring
8.3 Time Management
8.3.1 Time Management Matrix
8.3.2 Techniques of Time Management
8.3 Let Us Sum Up

8.4 References
8.5 Key Words
8.0 OBJECTIVES
 explain cognitive restructuring; and
 discuss time management.
8.1 INTRODUCTION
Let us start with an exercise
Rate the state of your mind right now at this instance on the scale given
below (you can circle the number):
0 1 2 3 4 5 6 7 8 9 10
Unpleasant Pleasant
Some statements have been given below, you need to read each statement and
think of how it is applicable to you. You can even remember examples of these
statements in form of images.
 I have people around me who support me (remember the people and
instances when you received the support).
 I feel satisfied (remember the moments that generate these feelings).
 I have done certain things that make me very happy (remember the moments
that generate these feelings).
 I have done well in life (remember the moments of your success).
 Life seems to be positive and meaningful (remember the moments and
people that generate these feelings).
Stress Management  I have been appreciated many times (remember the moments and events).
 I have done things that make me very happy (remember the moments
and events).
 I have helped and supported others in a meaningful manner (remember
the moments, events and people).
 I have moments of fun in my life (remember the moments and events).
 I have taken good decisions (remember the moments and events).
Now re-rate the state of your mind right now on the scale below (you
can circle the number):
0 1 2 3 4 5 6 7 8 9 10
Unpleasant Pleasant
It is more likely that your rating is higher later, that is, after remembering the
events based on the statements than before. This happens as you think about
all the positive things, events and people in your life. The exercise also reflects
the strength of positive thinking and attitude, which again can help individuals
deal effectively with stress.
In the previous Unit, we discussed about some of the stress management
techniques like relaxation, meditation, Yoga and biofeedback. In the present Unit
we will discuss some more techniques like cognitive restructuring and time
management.
8.2 COGNITIVE RESTRUCTURING

Cognitive restructuring can be described as “a process of replacing stress
provoking negative thoughts and beliefs with more constructive and realistic ones
which reduce cognitive appraisal of the threat” (Ghosh, 2015 pg 185). Thus,
cognitive restructuring mainly involves changing the thinking process and making
it more rational and positive. For instance, if a student gets very low marks
in an examination, instead of thinking oneself as a failure, he/ she can take a
learning lesson and decide to try harder next time.
Activating Event
Belief
Ratio na l Irrational
Con s eq ue n ce s
Emotional Emotional
Beha vioural Beha vioural
Dispating:
1. Detecting
2. Di scri mi ning
3. De la ti ng
Effect
104 Fig. 8.1: ABCDE Technique
In this context, the ABCDE technique of Rational Emotive Behaviour Therapy Stress Management
Techniques-II
(REBT), that was proposed by Albert Ellis can be discussed. The ABCDE
technique has been given in figure 8.1.
As can be seen in figure 8.1, there is an activating event (A), that is perceived
based on one’s belief (B) which can be rational or irrational. This in turn will
have consequences (C), both emotional and behavioural. If a belief is irrational
it can be disputed (D) which includes detecting that the belief is irrational,
discriminating it from a rational belief and then debating it in order to develop
a rational belief. Lastly there is effect (E), that is nothing but effect of disputing
the irrational belief.
Made a mistake during presentation at

work
Belief
It happens sometimes I am inadequate
Con s eq ue n ce s
Slightly sad Feel Dejected
Will try harder Will give up and will

next time avoid making presentations
in future
Fig. 8.2: Example of ABCDE Technique
As can be seen in the above example, the activating event is ‘mistake made
by an individual during his/ her presentation at work’. To this he/ she can either
have a rational or irrational belief. A rational belief to this activating event could
be ‘It happens sometimes’, ‘a mistake is not end of the world’. The consequence
of a rational belief would be that the individual will feel momentarily sad
(emotional consequence), but he/she will work harder next time to avoid
repeating the mistakes (behavioural consequence).
However, the individual could have irrational beliefs towards the activating event
like ‘I am inadequate’, ‘I am not good enough’, to which the emotional
consequence would be that the individual will feel dejected and he/ she would
give up and will avoid making presentations in future (behavioural consequence).
It is important that the irrational beliefs are disputed by detecting, discriminating
and debating them (as can be seen in figure 8.1). Once the individual is able
to dispute the irrational belief, he/ she will develop a more rational outlook
towards the activating event, that will be the effect of disputing. In this example, 105
Stress Management the individual will have to rationalise with one self that just one mistake is not
the end of the world and that such mistakes happen sometimes and he/ she
has much more potentialities and just this mistake does not mean that he/ she
is good for nothing or inadequate.
In our day to day lives as well we will come across numerous activating events
that evoke our beliefs. We need to ensure that we have a more rational outlook
towards these activating events. This in turn will help us manage stress in an
effective manner.
Box 8.1: Stress Relieving Exercise

1) Take it seriously as if your whole life depends on it.
2) Look at a particular point in front of you.
3) Close your eyes.
4) Visualise a pleasant place or a happy moment of your life. Imagine
that you are there for a few moments.
5) Breath in deeply and breath out gently.
6) Focus on your breathing.
7) Feel your muscles relaxing as the stress goes out of your body.
8) Keep doing the breathing exercise for around five to ten minutes.
9) Have a positive self dialogue regarding any of your goals or a difficulty
or stress that you are facing. Assure yourself that you will be able
to achieve the goal you have in mind or will be able to overcome
the difficulty that you are facing.
10) Visualise the pleasant place or the happy moment (as above) of your
life. Pretend that you are there for a few moments.
11) Count backwards from 25 to one.
12) Rub your palms together and put them on your eyes.
13) Open your eyes slowly.

1) What is cognitive restructuring?
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2) State what ABCDE stand for in ABCDE technique
A: ___________________________________
B: ___________________________________
C: ___________________________________
D: ___________________________________
106 E: ___________________________________
Stress Management
8.3 TIME MANAGEMENT Techniques-II
Effective and systematic management of time could be a key to stress

management. Time is a precious resource and time management basically involves
making the best use of the time that one has. It also includes planning, controlling
the waste of time, implementation of various techniques to manage time as well
as carrying out evaluation that can help one improve. Seaward (2014, pg 147)
explains time management as “prioritisation, scheduling and execution of
responsibilities to personal satisfaction”.
Main aspects that have been reflected in this definition are prioritisation,
scheduling and execution.
Prioritisation: Prioritisation involves listing tasks and responsibilities according

to their priority or how important and urgent they are to be carried out. Here
the difference needs to be made between what is urgent and what is important.
Based on urgency and importance, a time management matrix was proposed
by Stephen Covey, that will be discussed later in this section. Also, in order
to identify and direct our attention towards urgent tasks, ABC rank order method
(that will be discussed under planner system) can be used, where A is assigned
to urgent tasks, B to tasks with moderate urgency and C to least urgent tasks.
Scheduling: Scheduling is related to assigning time schedule to each task. It

mainly deals with how to get the tasks done at the right time and also how
to carry them out. There are various techniques under scheduling that are
discussed as follows (Seaward, 2014):
Clustering: In clustering tasks can be grouped together. For example, bank

related work, shopping for vegetables and buying a gift for a friend can be
clustered together.
Time boxing: In time boxing, a large amount of time in a day, referred as

time box, is allotted for certain tasks. For instance, time box can be allotted
for writing assignments.
Dismantling: In dismantling, large tasks are broken down in to smaller tasks

that are comparatively easy to manage. For example, studying a certain course
can be divided based on units in course material/chapters given in a book.
Scheduling is this important in management of time. And while time mapping

(where, certain amount of time is assigned in order to carry out various activities),
some time can be allotted to carry out scheduling.
Execution: This has to do with actually carrying out the task as mere planning
and scheduling is not enough. Thus, one needs to be motivated enough to carry
out the task. One way to motivate one self is by self rewarding one’s self for
every completed task. These rewards could be tangible or intangible or big
or small. Though, it is a good idea to motivate oneself intrinsically to carry
out the task.
107
Stress Management 8.3.1 Time Management Matrix
In this matrix there are four quadrants based on the Urgency and Importance
of the task. When we say that a certain task is urgent, it means that it requires
immediate attention and when we refer a task as important, it means the task
in a way will contribute to our goals. The time management matrix is given
in figure 8.3
IMPORTANT URGENT NOT URGENT
1 2
- Emergencies - Planning
- Crises or problems - Exercise
- Projects having - Training
deadline - Health
- Pressing issues
NOT 3 4
IMPORTANT - Interruptions - Junk mail
- E-Mails and phone - Tasks that are routine
calls - Time wasters
- Minor issues
- Certain meetings
Fig. 8.3: Time Management Matrix
The first quadrant, is the quadrant that includes tasks that are Urgent and
Important. These tasks are absolutely necessary to be carried out. These are
the activities that one need to manage with top priority. Such tasks cannot wait.
For instance, if there is a medical emergency in an individual’s family, immediate
action needs to be taken.
The second quadrant is important but not urgent. These activities though not
urgent require one’s focus as they are important to be carried out. These tasks
also need to be focused on because they is significant in terms of goals that
are long term. For instance, exercising daily will improve one’s health and will
have long term benefits.
The third quadrant is urgent but not important. These are the activities that could
be avoided or could be delegated. This quadrant is also referred to as quadrant
of deception. The forth quadrant is not urgent and not important and could
result in waste of time and these again can be avoided.
Time management matrix can help one in one’s life to manage time effectively.
It is important to focus on the second quadrant that is related to development
on long term basis and focusing on this quadrant in a way will help reduce
the tasks in the first quadrant.
8.3.2 Techniques of Time Management

Planner System: One of the major techniques of time management is Planner
System. This system can help one make most of one’s time. This planner system
can be in form of a diary or a notebook or any other form that one finds
108 to be convenient. These days planners can be created on the mobile phones
or computers as well. In fact, many phone companies today have planners as Stress Management
Techniques-II
default apps as well. Once you adopt the planner system, it is important that
at least around ten minutes of a day are kept aside to do the planning. Planner
can be helpful in various ways. Planning will not only provide clear picture of
the activities to be carried out in a day but will also help in preventing one
from doing activities at wrong time in wrong ways. Also, it will bring one’s
focus on the activities that need to be carried out especially on priority basis.
A planner needs the following five things:
1) A place where tasks can be listed and priorities can be assigned to them.
2) A place where notes and any follow up information can be recorded.
3) A place where goals and values can be mentioned.
4) A place where frequently referred information like addresses, phone

numbers, birthdays etc. can be mentioned.
5) The planner needs to be flexible enough to meet one’s needs.
As was mentioned earlier, the smart phones these days have the required features
to enable us to plan. However, the same needs to be adequately used.
The following are the steps in planning:
Step 1: This includes developing a list of tasks that need to be carried out
each day. Here all tasks that are not routine could be mentioned. For instance:
 Call Manager of the Bank. (10:30 am)
 Wish Sara on her birthday (7:30 am)
 Buy a gift for Sara. (6:30 pm)
 Meeting with Project Supervisor (11:45 am)
 Get the Assignment ready. (4:30 pm)
 Pay electricity bill (10:00 am)
Step 2: A priority letter is assigned to each task on the list created in the previous
step. Here the ABC system could be used to assign priorities, where
A: Must do items (Items/activities that must be completed).
B: Should do items (Items/activities that should be completed).
C: Could do items (Items/activities that could be completed)
For instance:
 Call Manager of the Bank. (10:30 am) A
 Wish Sara on her birthday (7:30 am) B
 Buy a gift for Sara. (6:30 pm) B 109

Stress Management
 Meeting with Project Supervisor (11:45 am) A
 Get the Assignment ready. (4: 30 pm) C
 Pay electricity bill (10:00 am) A

Step 3: Now a number is to assigned to the task
For instance
 Call Manager of the Bank. (10:30 am) A2
 Wish Sara on her birthday (7:30 am) B1
 Buy a gift for Sara. (6:30 pm) B2
 Meeting with Project Supervisor (11:45 am) A1
 Get the Assignment ready. (4:30 pm) C1
 Pay electricity bill (10: 00 am) A3

Step 4: Symbols can be assigned for the status of the tasks.
 (3) Task has been completed. Colour coding also can be used.
 () When task needs to be rescheduled.
 (O) Task delegated to someone else.
 (X) Task that has been deleted.
For instance
 Call Manager of the Bank. (10:30 am) A2 (3)
 Wish Sara on her birthday (7:30 am) B1 (3)
 Buy a gift for Sara. (6:30 pm) B2 O
 Meeting with Project Supervisor (11: 45 am) A1 X
 Get the Assignment ready. (4: 30 pm) C1 ()
 Pay electricity bill (10: 00 am) A3 ()

While creating a planner, it needs to be ensured that one’s goals and values
are incorporated in it and that one’s activities are in sync with them.
Blocking Time Wasters: Yet another way to manage time is by blocking the
time wasters. There could be time wasting mails and emails. It is good idea
to not let any paper work get piled up. Any time you receive a mail or an
email, go through it once thoroughly and then and there decide what is to be
done. Thus, they can either be filed, or responded to, passed on to someone
else or disposed off if felt unimportant. Sometimes time wasters could also be
people, in which case one needs to handle the situation in a delicate manner.
The person can be politely and specifically asked to meet again or have a brief
conversation without sounding sarcastic or accusing.
110
Delegation: Delegation can also be used whenever possible to manage time Stress Management
Techniques-II
effectively. Delegation is nothing but assigning the task to someone else. For
instance, if a manager wants a get together organized for the employees, he/
she may delegate different tasks like arranging for food, arranging for
entertainment, sending out invites to the employees, to others. Most often
individuals do not delegate because they feel that they will be able to do the
task on their own, or lack confidence in others, or they fear that the person
delegated with work will take all the credit and recognition for completion of
the task or they lack the skill, time or both in delegating work to others. In
order to delegate effectively, one needs to trust others with responsibility. They
also need to be given necessary freedom to carry out the task. Though delegation
is effective in managing time, it could go wrong when there is a communication
gap or blocked communication between the delegator and the delegatee or the
delegator fails to follow-up or does not provide enough freedom and authority
to the delegatee to complete the task. Delegation could also go wrong if the
delegator is not clear in his/ her communication of the task and its requirements.
Dealing with Procrastination: We discussed about procrastination under Unit 4
that dealt with factors contributing to stress proneness. In order to manage time
effectively, one also needs to deal with procrastination. Procrastination involves
intentional postponement or delaying of task or activities. Some of the valid
reasons why one may procrastinate could be because of stress, lack of
information, caution and so on. However, one may also procrastinate due to
certain inappropriate causes like uncertainty, tasks seems to be difficult to handle,
perfectionism and also because one waits for things to happen rather than take
the matter in one’s hand. Procrastination can be dealt by as follows:
 Certain issues problems that seem difficult can be tackled at one’s body’s
peak time, when one is fresh in mind and body and thus alert.
 Certain tasks that appear to be difficult can be broken down into smaller
tasks.
 Maintain a ‘to do’ list on daily basis and have a specific goal.
 Avoid perfectionism.
 Seek help from others as and when required.
1) What is time boxing?
.................................................................................................................
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Stress Management 2) List the steps in a planner.
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8.4 LET US SUM UP

The present Unit is a continuation of the previous one and discusses two more
techniques of stress management, namely, cognitive restructuring and time
management. Cognitive restructuring can be described as a process of replacing
stress provoking negative thoughts and beliefs with more constructive and realistic
ones which reduces cognitive appraisal of the threat. Thus, cognitive restructuring
mainly involves changing the thinking process and making it more rational and
positive. In this context, the ABCDE technique was also discussed with the
help of an example. The next technique discussed was time management.
Effective and systematic management of time could be a key to stress
management. Time is a precious resource and time management basically involves
making the best use of the time that one has. It also includes planning, controlling
the waste of time, implementation of various techniques to manage time as well
as carrying out evaluation that can help one improve. Time management can
be explained as “prioritization, scheduling and execution of responsibilities to
personal satisfaction”. The time management matrix was also discussed in which
there are four quadrants based on the Urgency and Importance of the task.
When we say that a certain task is urgent, it means that it requires immediate
attention and when we refer a task as important, it means the task in a way
will contribute to our goals. Further, various techniques of time management
like planner system, blocking time wasters, delegation and dealing with
procrastination were also discussed.
8.5 REFERENCES
Bartram, D., & Gardner, D. (2008). Coping with Stress. In Practice, 30, 228-
231.
Hawton, K., Salkovskis, P., Kirk, J., & Clark, D. (1989). Cognitive behaviour
Therapy for Psychiatric Problems. Oxford: Oxford University Press.
Wadsworth.
8.6 KEY WORDS

Cognitive restructuring : Cognitive restructuring can be described as a
process of replacing stress provoking negative
thoughts and beliefs with more constructive
and realistic ones which reduce cognitive
112 appraisal of the threat.
Delegation : Delegation is assigning the task to someone Stress Management
Techniques-II
else.
Time management : Time management can be explained as
prioritisation, scheduling and execution of
responsibilities to personal satisfaction.
Time Management Matrix : In time management matrix, there are four
quadrants based on the Urgency and
Importance of the task.

1) What is cognitive restructuring?
Cognitive restructuring can be described as a process of replacing stress
provoking negative thoughts and beliefs with more constructive and realistic
ones which reduce cognitive appraisal of the threat.
2) State what ABCDE stand for in ABCDE technique
A: Activating Event
B: Belief
C: Consequence
D: Disputing
E: Effect
1) What is time boxing?
In time boxing, a large amount of time in a day, referred as time box,
is allotted for certain tasks. For instance, time box can be allotted for writing
assignments.
2) List the steps in a planner.
Step 1: This includes developing a list of tasks that need to be carried
out each day. Here all tasks that are not routine could be mentioned.
Step 2: A priority letter is assigned to each task on the list created in
the previous step.
Step 3: Now a number is to assigned to the task.
Step 4: Symbols can be assigned for the status of the tasks.

1) Discuss cognitive restructuring.
2) Explain ABCDE technique with the help of an example.
3) Describe time management matrix.
4) Discuss various techniques of time management.
113
114
BLOCK 4
PROMOTION OF PHYSICAL AND MENTAL
HEALTH
115
UNIT 9
Physical Illness Experiences I 117
UNIT 10
Physical Illness Experiences II 132
UNIT 11
Mental Illness Experiences 144
UNIT 12
Prevention, Management and Intervention 162
116
UNIT 9 PHYSICAL ILLNESS
EXPERIENCES I*
Structure
9.0 Objectives
9.1 Introduction
9.2 Illnesses Related to Food, Diet, Obesity
9.3 Problems Related to Sexual Health
9.4 Let Us Sum Up
9.5 References
9.6 Key Words
9.0 OBJECTIVES
 discuss illnesses related to food, diet, obesity; and
 explain problems related to sexual health.
9.1 INTRODUCTION
Deepak was in his late 20s. He had a job that he loved and he was doing
well in it. He was also happily married. He paid full attention to his work
and personal life and balanced them well. Though what he majorly ignored
was his lifestyle. He would often indulge in junk food and sweet treats
and he barely exercised. All this resulted in him putting on a lot of weight
and he suffered from obesity, as a result of which he became susceptible
to various health issues.
Arun’s friend met with an accident and was in need of blood transfusion.
Arun voluntarily agreed to donate blood and rushed to the hospital. He
donated blood but received a call from hospital within a few days. They
had asked him to come and meet the Doctor there. He felt worried about
his friend. But upon meeting the Doctor, he was informed that he was
diagnosed as HIV (Human Immunodeficiency Virus) positive. The floor
slipped under Arun’s feet and he was devastated. Arun was informed that
he will have to start Antiretroviral therapy and was also offered counselling
to help him cope with this illness.
Both the cases discussed above relate to our physical health. The first one is
related to obesity, the second one is related to HIV. As we can see, these
physical health related issues have a strong impact on psychological health and
wellbeing as well. Thus, as students of psychology, it is important for us to
understand physical illness experiences that can lead to development of
psychological issues and problems in individuals suffering from them.
Promotion of Physical In the present unit we will focus on illnesses related to food, diet, obesity and
and Mental Health
problems related to sexual health. In the next unit, that is continuation of this
unit, we will discuss acute and chronic pain and chronic illnesses. We also need
to note here that though the illness experiences have been categorised in to
physical and mental illness experiences, these illnesses have both physical and
psychological ramifications.
9.2 ILLNESSES RELATED TO FOOD, DIET,

OBESITY
“Eat to live, don’t live to eat.” said Benjamin Franklin (https://www.goodreads.com/
quotes/115710-eat-to-live-don-t-live-to-eat). But we often do it the other way
round. Food is essential for our survival and development, but with innumerable
variety of food that is easily accessible, literally on our finger tips, we often
indulge in eating stuff that may not be right for our health and wellbeing. And
with technological advancement, fast pace of life, we often do not get an
opportunity to shed the extra calories and fat that gets accumulated, making
us susceptible to various health related issues. In the present section of this
unit we will mainly focus on illnesses related to food, diet and obesity.
Food has a relevant impact on our day to day functioning, the way we look
and behave and feel. Food has five main components (Sarafino and Smith, 2011,
pg. 195) that are necessary for metabolic process of our body. These five
components are discussed as follows:
 Carbohydrates: Carbohydrates constitute sugars, both simple (like glucose

and fructose) and complex sugars (like sucrose, lactose and starch). It
is a major source of energy. Some of the sources of carbohydrates include
wheat, potatoes and maize.
 Lipids: These constitute the saturated and polyunsaturated fats, and

cholesterol. These are also a source of energy. Some of the sources of
lipids are butter and cooking oils.
 Proteins: Proteins are made up of amino acids that are organic molecules
and they are important for our development as well as functioning mainly
because they play a role in synthesis of new cell material. Some of the
sources of protein include milk, eggs, fish, cheese and lean meat.
 Vitamins: These can be termed as chemicals that are organic. They not
only play a role in regulation of metabolism but in physiological functioning
as well. They also play a role in conversion of nutrients in to energy and
production of hormones. Waste products and toxins are also broken down
with the help of vitamins. Vitamins can be fat soluble, that is they dissolve
in fats that are then stored in the fat tissue of the body, like vitamins A,
D, E and K and they can also be water soluble, like vitamins B and C
that are stored in the body in little quantities and any excess amount is
flushed out of the body as waste. Vitamin B is found in dairy products,
poultry, seafood, eggs, leafy vegetables etc. Vitamin C is found in lime,
oranges, tomatoes etc. Vitamin D is found in milk, fish, eggs etc. Vitamin
E is found in leafy vegetables, milk, butter, tomatoes etc. Vitamin K is
found in cabbage, soya bean, spinach etc.
118
Physical Illness
 Minerals: Minerals constitutes calcium, phosphorus, potassium, sodium, Experiences-I
iron, iodine, and zinc, that are inorganic in nature. These also play an
important role in physiological functioning and development. Sources of
calcium include milk and milk products, beans, leafy vegetables etc. Sources
of phosphorus include ragi, nuts, bajra, milk etc. Sources of potassium
include banana, sweet potato, peas, mushrooms etc. Sources of sodium
include celery, milk etc. Sources of iron include eggs, liver etc. Sources
of iodine include seafood, iodised salt etc. And sources of zinc include
oysters, poultry, whole grains etc.
Yet another important aspect, we need not forget is Fiber, that is extremely
important for the digestion process, though it is not considered as a nutrient
as the above five components discussed earlier. Fiber is found in oatmeal, beans,
apples, berries, pears etc.
Our diet thus needs to include all of the above but in right proportions. Diet
in this context can be explained as what we eat. And what we eat is determined
by a number of factors (Sarafino and Smith, 2011). Some of these factors have
been discussed as follows:
 Inborn processes: In born processes can determine our preference for

certain types of food. The chemicals in our brains may play a role in what
we eat and often pleasure centres are activated when fatty foods are
consumed.
 Environmental factors: These include exposure to food, culture, Socio-

Economic Status, accessibility to junk and fast foods, influence of media
(advertisements about food products that may not exactly be healthy for
us but are attractive and mouth watering) and so on.
 Ability to manage and control ones food buying and eating habits:
This is also an important factor that determines what kind of food we buy
and eat. It is necessarily a skill as we determine the food that we eat
based on whether it is nutritious or not and thus make healthy choices.
Though, if we lack such control, we would indulge in consumption of food
that may not necessarily be healthy or as per requirement of our body.
It is important that our diet is nutritious as well as having sufficient fiber. Though,
a suitable diet plan for each of us will vary based on our developmental stage,
gender, health/ illness and so on. In order to improve one’s diet numerous
interventions can be used, including, consultations with nutritionists who will guide
us about what should be our dietary intake based on our physiological parameters
and health. On a larger scale in order to promote healthy diet, various
programmes promoting healthy diet can be created and introduced. Interventions
can be designed in order to replace unhealthy eating habits with healthy eating
habits. Thust the focus of proper diet needs to be on being healthy. Diet also
helps in regulation of weight that plays an important role in determining our
health status.
An unhealthy diet can lead to numerous health related issues including
atherosclerosis, hypertension, diabetes and even cancer. Though yet another
aspect of unhealthy diet that makes us susceptible to health related problems
is obesity.
119
Promotion of Physical When an individual’s Body Mass Index (BMI) is 30 or more, then he/ she
and Mental Health
is termed as obese. A BMI obtained between 19 and 24 is considered as ideal
and a BMI between 25 and 29 is considered as moderately overweight
(Sanderson, 2013).
To compute BMI, the following formula can be used:
BMI= weight (kg) / [height (m)]2
Though BMI is often criticised as it does not take in to consideration the amount
of fat in the body.
There are various factors that can be associated with obesity (Ghosh, 2015),
these are discussed as follows:
 The type of food that we eat can be associated with our weight gain.
Frequent indulgence in junk food and sugary treats (coupled with lack of
physical activity such as exercise) can lead to obesity. Food is more than
just a source of nutrition, it is a part and parcel of our culture. And whether
it is a festive season or when expecting guests, individuals are encouraged
to eat and food is many a times also consumed as courtesy. And thus
individuals may often end up eating more than they should, in terms of
calories as well as the amount of food.
 The number and the size of fat cells (attributed to genetics as well as eating
habits) also determines obesity. Thus, a moderately obese person will have
larger size of fat cells and an extremely obese person will have both large
amount as well as size of fat cells. The large number of fat cells also enables
a person to store more fat, thus leading to obesity.
 Obesity also has genetic basis and obese parents are more likely to have
obese children. The metabolism rate (rate at which the calories are burned)
is also determined by genes and persons with obesity have lower rate of
metabolism.
 Every individual has a ‘set point’ that determines his/ her weight range
(thus indicating that obesity could also be attributed to the ‘set point’, that
could be of higher weight range in individuals with obesity). This is referred
to as the ‘Set point theory of weight’. This ‘set point’ regulates one’s weight
and individual difference exists in this set point. Though it needs to be
kept in mind that besides physiological factors and environmental factors
also play a role.
 Obesity can also be attributed to stress as it not only has an impact on

one’s metabolism but also influences eating habits.
 Obesity leads to slow metabolism, which in turn works in order to maintain

the increased weight. Increased weight makes it difficult for the individual
to indulge in physical activities, which in turn will lead to more gain in
weight. So, it is like a vicious circle, till the person cannot do much about
it as he/ she feels no way out and could become negligent.
Obesity can be linked to various physiological and psychological illnesses and

120 social problems. Obese individuals are more susceptible to developing hypertension,
diabetes, kidney related ailments, gall bladder related ailments, cardiovascular Physical Illness
Experiences-I
diseases and also cancer in some cases (Sanderson, 2013). And most of these
illnesses come with their own complications, both physical and psychological.
It can also lead to menstrual disorders in women, stroke infertility and
osteoarthritis (Ghosh, 2015).
Obesity can also have psychological consequences, as such individuals will
display lower self esteem, stress and anxiety as well. Further, they may also
develop depression and eating disorders. With exposure to media and the modern
culture that promotes body type that is slim and toned, individuals with obesity
are left with a poor body image. Body image can be explained as a subjective
evaluation of how one appears (Harriger and Thompson, 2012). Thus, they
feel and think negatively about their bodies and this again can negatively impact
their self esteem.
Obese people are often stigmatised and are perceived as being lazy, slow and
lacking a strong will power. There is a negative social attitude towards them
and they are also subjected to weight related teasing as well as bullying (Harriger
and Thompson, 2012).
Though it would seem that diet can help loose weight, but it is important to
ensure that the body gets enough nutrition and the individuals do not suffer from
nutritional deficits. Further, diet may not be effective on its own and needs to
be combined with exercise (Sanderson, 2013). Exercise not only helps loose
weight but also increases the rate of metabolism. Lean body mass also increases
and appetite decreases as a result of regular exercise (Sanderson, 2013). Overall
exercise helps in enhancing one’s health, both physical and psychological. While
using exercise as a weight management technique, it important to set short term
goals for both exercise and diet rather than long term goals. Also certain positive
reinforcements or rewards can be given for achieving the goals. It is also
important to regularly monitor the nature and time of one’s food intake. Family
members and significant others also play an important role in encouraging and
supporting the individuals willing to manage his/her weight. In certain cases,
surgery (for example, Bariatric surgery) is also carried out, that involves reducing
the size of the stomach by stapling it, thus restraining the amount of food taken.
We focused above on how obesity can be treated, but nothing better than
prevention and to prevent being overweight, obese and to overall maintain one’s
health, we need to adopt a healthy lifestyle that includes regular physical exercise
and activities, nutritious diet and management of stress. Self monitoring one’s
food intake can also help in this direction. Awareness also needs to be created
amongst parents about the type of food (diet plan) that can be given to the
children so as to avoid obesity amongst them and also to keep them physically
active and healthy.
Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 includes Feeding
and eating disorders, that are denoted by a continuing disturbance of eating
or behaviour related to eating. And the outcome of which is change in food
consumption and food absorption that has a negative impact on the health as
well as psychological and social functioning of an individual.
Some of the feeding and eating disorders, as per DSM 5 are pica, rumination
disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia
nervosa and binge-eating disorder. 121
Promotion of Physical These are briefly discussed as follows:
and Mental Health
 Pica: Pica includes consumption of items that are not thought of as food
and as such do not have any nutritional value. For example, hair.
 Rumination disorder: Regular regurgitation (bringing up the swallowed

food) of food occurring for minimum one month.
 Avoidant/restrictive food intake disorder: This disorder was earlier

referred to as Selective Eating Disorder and involves limiting the amount/
type of food that is consumed. Though this can be differentiated from
Anorexia as the individual does not experience any anxiety or distress related
to shape and size of his/ her body or have fear of being fat.
 Anorexia nervosa: This involves loss of weight or inability to gain weight

due to avoiding food, difficulty in maintenance of weight as per one’s height,
age and stature. Further individuals any also have body image that is
distorted.
 Bulimia nervosa: This involves binge eating that is followed by

compensatory behaviours like vomiting that is self-induced so as to undo
the effects of binging.
 Binge-eating disorder. This involves repeated episodes of consuming large

amount of food (often quickly and even causing discomfort), having feelings
of loss of control during binging, and experiences of shame, guilt and distress
after the binging. There may not be regular use of compensatory behaviours
that are unhealthy, like purging.
It is important to note here that these disorders are to be diagnosed by a trained

professional like a clinical psychologist and cannot be diagnosed based on mere
observation of symptoms.
As with any other disorder, these disorders can also cause psychological distress
and can have a negative impact on physical health of the individual as he/ she
is not eating healthy or appropriately and in some cases unhealthy compensatory
behaviour is also involved. Some of these disorders can also be life threatening.
Individual or group therapy besides family therapy can be helpful for individuals
with these disorders, besides nutritional counselling. Some of the psychotherapies
that can be useful are Acceptance and Commitment Therapy, Cognitive
Behaviour Therapy (CBT), Cognitive Remediation therapy (CRT), Dialectical
Behaviour Therapy, Interpersonal Psychotherapy and Psychodynamic
Psychotherapy. In certain cases medical treatment also needs to be provided.
Social support from family members and significant others play an important
role in recovery process.

1) List the components of food.
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122
2) State any one factor that can be associated with obesity. Physical Illness
Experiences-I
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9.3 PROBLEMS RELATED TO SEXUAL HEALTH

Before we go on to discuss the problems related to sexual health, let us discuss
what is sexual health.
World Health Organisation (2020) defines sexual health as “a state of physical,
mental and social well-being in relation to sexuality. It requires a positive and
respectful approach to sexuality and sexual relationships, as well as the possibility
of having pleasurable and safe sexual experiences, free of coercion, discrimination
and violence”. As you can see this definition is similar to the definition of health
that we studied in the first unit, though the aspects of definition are specifically
in the context of sexuality. Further, the focus is on positive approach to sexuality
and respect in sexual relationships. The definition also highlights the need for
safe sexual experience that is not forceful and is without any discrimination and
violence. Thus, maintaining, protecting and fulfilling the sexual rights leads to
attainment and maintenance of sexual health (WHO, 2020).
American Sexual Health Association (2020) explains being sexually health as
- Comprehension of sexuality being a natural part of life and involving more
than sexual behaviour.
- Sexual rights are recognised as well as respected.
- Access to information, education and care related to sexual health.
- Efforts in direction of avoiding unintended pregnancies and Sexually
Transmitted Diseases and seeking care and treatment as and when required.
- Ability to experience sexual pleasure, satisfaction and intimacy when desired
by the individual.
- Ability to have communication about sexual health with others, including
sexual partners and health care providers.
Sexual health plays an important role in maintaining health as well as wellbeing
of not only individuals, couples and families but the health and wellbeing of
community and society as well.
We also need to understand that problems related to sexual health may vary
not only based on gender, but they can vary based on developmental stages
as well. Males and females may experience different problems. Further, the
problems faced by adolescents may also differ from those of other older age
groups.
As the meaning of sexual health is now clear, let us discuss about problems
related to sexual health.
Problems related to sexual health can range from Sexually Transmitted Infections,
Human Immunodeficiency Virus (HIV), and Reproductive Tract Infections (RTIs) 123
Promotion of Physical to resulting outcomes, for instance, cancer and infertility; unwanted/ unintended
and Mental Health
pregnancy and abortion; sexual dysfunction; sexual violence; and harmful practices,
for instance female genital mutilation (WHO, 2020).
Problems related to sexual health can be attributed to conditions related to the
individual, relationship between the individuals and societal conditions (WHO,
2020). It is important to note here that problems related to sexual health can
be physical, psychological or both.
Let us now discuss some of the problems related to sexual health:
 Sexually Transmitted Infections (STI): As the name suggests, these are

infections that spread through vaginal, oral or anal sex with an individual
having STI. Though, certain STIs may spread through blood and blood
products (for instance, from mother to child during pregnancy or during
child birth (WHO, 2020). STIs like HIV, Human Papilloma Virus (HPV),
Hepatitis B, Herpes are caused as a result of virus and STIs like Syphilis,
Gonorrheas and Chlamydia are caused due to bacteria (American Academy
of Family Physicians, 2020). Some of the symptoms of STI include
discharge from vagina/ penis, experiencing pain during urination or while
having sex, pain in pelvic region and so on. Though, it is also possible
that there are no or very mild symptoms. STI can transmit from mother
to child, lead to stillbirths and deaths in new borns and the individual is
also under risk of acquiring HIV and cancer. A person suffering from STIs
may also develop psychological problems. Cure with the help of antibiotics
is available for STIs that are caused due to bacteria. However, for STIs
caused as a result of virus, like HIV, there is no cure and as such symptoms
can be treated to manage the infection (American Academy of Family
Physicians, 2020). Early diagnoses and treatment plays an extremely
important role. Though, most important is prevention for which awareness
and educations needs to be carried out especially amongst the high risk
groups that are vulnerable of acquiring STIs.
 Human Immunodeficiency Virus (HIV): HIV is a virus that attacks the

immune system (the T cells or CD4 cells). This results in weakening of
the immune system and thus the individual becomes prone to various
infections and illnesses. If treatment is not received and symptoms are not
managed then the individual can also develop Acquired Immuno Deficiency
Syndrome (AIDS). Though there is no cure, HIV can be controlled (with
the help of Antiretroviral therapy) and individuals with HIV can lead a
healthy life. Some of the symptoms include headache, fever, rash, muscle
pain, swelling in lymph glands etc. HIV has been further discussed under
AIDS in subsection on chronic illnesses. Pharmacology can be used to
treat the individuals with HIV.
 Reproductive Tract Infections (RTIs): Reproductive Tract Infections

(RTIs) include “three types of infections: Sexually Transmitted Infections,
such as Chlamydia, Gonorrhea, Chancroid, and Human Immunodeficiency
virus (HIV); endogenous infections, which are caused by overgrowth of
organisms normally present in the genital tract of healthy women, such as
bacterial vaginosis or vulvovaginal candidiasis; and iatrogenic infections,
which are associated with improperly performed medical procedures”
124 (Wasserheit and Holmes, 1992, page 7). STIs, are more common in men
as compared to the other two infections, namely, endogenous and iatrogenic. Physical Illness
Experiences-I
RTIs can lead to maternal and perinatal morbidity and mortality. RTIs are
linked to infertility, miscarriages, cervical cancer, ectopic pregnancy amongst
women, still births, low birth weight in infants, infant blindness, and neonatal
pneumonia. RTIs can be caused due to unsafe abortions, improper use
of contraceptions, female sterilisation in an unhealthy conditions and so on.
Pharmacology can be used to treat certain RTIs. Though, prevention is
definitely better than cure and awareness needs to be created with regard
to RTIs and other problems related to sexual health with a focus on risk
behaviours that can cause RTIs. Individuals diagnosed with RTIs may also
require psychological intervention and counselling to help them cope with
the illness.
 Sexual Dysfunction Disorder: Problems related to sexual health could

be temporary that is related to relationship issues or they could be long
term like sexual dysfunction disorder. According to Diagnostic and Statistical
Manual of Mental Disorders (DSM) 5, for sexual dysfunction disorder to
be diagnosed, the problems need to exist for at least six months that causes
distress as well as impairment (Ray, 2015, pg. 401).
Three main perspectives are relevant when we discuss about sexual disorders:
 The influence of medical and physiological factors: Illnesses like

diabetes can interfere with sexual functioning. Further, sexual responding
can get affected due to lack of physical activity, inability to manage weight
and consumption of alcohol and tobacco.
 The influence of psychological factors: One’s past experiences can also

influence one’s sexual functioning. For instance, abuse during childhood or
even previous sexual encounter can have an influence on sexual functioning.
Psychological disorders like anxiety and depression can also have a negative
impact on sexual functioning of an individual.
 Relationship issues: Issues related to relationship such as conflict, lack

of communications, expectations and desire from partner can also have an
impact sexual functioning,
The sexual dysfunction disorders (IsHak and Tobla, 2013) are as follows:
 Erectile disorder: This is denoted by recurrent and consistent inability

of a man to attain/ maintain penile erection in order to carryout sexual
activity.
 Female orgasmic disorder: This disorder is denoted by delayed orgasm

that follows normal excitement and sexual activity. While diagnosing this
disorder a number of factors need to be considered (including age and
situation of the person).
 Delayed ejaculation: This disorder is characterised by an undue delay

in achieving the climax or ejaculation during sexual activity.
 Early ejaculation: Ejaculation that takes place with minimal sexual

stimulation either before or soon after penetration and it occurs before the
individual would want it to occur. 125
Promotion of Physical  Female sexual interest/ arousal disorder: This disorder includes
and Mental Health
significantly reduced or lack of sexual arousal/interest.
 Male hypoactive sexual desire disorder: This is characterised by

recurrent or persistent deficiency in sexual thoughts, fantasies and desire
for sexual activity.
 Genito-Pelvic pain/ penetration disorder: This disorder includes

experiencing pain and extreme discomfort during or while attempting
intercourse. It was earlier referred as Sexual pain disorder that included
dyspareunia and vaginismus.
 Substance/medication induced sexual dysfunction: This disorder denotes

sexual dysfunction as a result of use of alcohol or other drugs or medications.
 Other specified sexual dysfunctions and Unspecified sexual

dysfunction: Both these categories indicate that though the criteria for any
other sexual dysfunctional disorders are not met but the individual displays
symptoms of sexual dysfunction that is causing distress in him/ her. However
in other specified sexual dysfunction, the clinician who carries out the
diagnosis mentions certain reasons why the criteria is not completely met.
And in unspecified sexual dysfunction, the clinician does not list the reasons
that the criteria is not completely met, including circumstances when enough
information is not available to make a diagnosis.
As we can see above, there are various disorders though they are mainly
characterised by disturbance (that is clinically significant) in an individual’s ability
with regard to sexual responding and to experience sexual pleasure. It is also
possible that an individual has more than one sexual dysfunction.
Sexual disorders can be treated with the help of pharmacological approach.
Further, sexual therapy can also be used. Psychotherapy can also play an
important role
Sexual health to a greater extent can be promoted with the help of awareness
programmes that provide information about sex and sexuality and deals with
any misconceptions and negative attitudes. Awareness and knowledge about risky
sexual behaviour along with its consequences is also important. Further, it is
also important to provide an environment that is conducive for promoting sexual
health/ becoming sexual healthy, where there is also easy access to care related
to sexual health. Further, the focus of intervention needs to be not only on
identification and treatment but on prevention as well.
1) What is sexual health?
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126
2) What is full form of HIV and AIDS? Physical Illness
Experiences-I
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The present block mainly focuses on promoting physical and mental health. In
the present unit we mainly discussed about physical illness experiences. Early
diagnosis of illnesses is definitely important. But the most important thing is
prevention. And in order to prevent an illness (and even for early diagnosis)
the individuals need to be aware (refer to box 9.1).
Box 9.1: Promoting Health

When our objective is promoting health, one of the important aspects that
we need to focus on is awareness, that is, how aware the people are
with regard to health related issues. What is their knowledge, attitude and
practices? This is important because, based on this suitable intervention
or awareness programme can be developed and implemented. However,
before that is done, we also need suitable tools to measure the health related
knowledge, attitude and practices amongst the individuals. One such scale
is Health Modernity Scale by A. K. Singh. Health Modernity can be defined
as “Scientifically correct information, attitudes and behaviour in relation to
physical and mental health, diet and nutrition, family planning and child-
care including breast feeding, personal hygiene and environmental sanitation
and such other issues which are essential pre-requisites for healthy living
and, therefore, for human and social development” (A. K. Singh, 1983).
The scale constitutes ten dimensions, namely, Physical Health, Mental
Health, Nutrition and Diet, Family Planning, Child Care, Breast Feeding,
Mental Retardation, Attitudes towards Females, Cancer, and AIDS. With
the help such scales and other tools, misconception and ignorance can be
identified and accordingly a suitable intervention strategy or awareness
programmes can be developed. Further, while dealing with any issue or
problem, we need to deal with it at different levels, like, individual level,
family level, community level, national and international level. So that the
issue/problem is effectively dealt with.
9.4 LET US SUM UP

To summarise, in the present unit we focused on illnesses related to food, diet,
obesity and problems related to sexual health. Food is essential for our survival
and development, but with innumerable variety of food that is easily accessible,
literally on our finger tips, we often indulge in eating stuff that may not be right
for our health and wellbeing. The five components, namely carbohydrates, lipids,
proteins, vitamins and minerals were discussed. Obesity was also discussed with
a focus on various factors that can be associated with obesity. The consequences
of obesity along with treatment were also briefly discussed. The next subtopic
that was explained in the present unit was problems related to sexual health.
Sexual health was described as a state of physical, mental and social well-being
in relation to sexuality. It requires a positive and respectful approach to sexuality
127
Promotion of Physical and sexual relationships, as well as the possibility of having pleasurable and
and Mental Health
safe sexual experiences, free of coercion, discrimination and violence. Some of
the problems related to sexual health, namely Sexually Transmitted Infections,
Human Immunodeficiency Virus, Reproductive Tract Infections and Sexual
dysfunction disorders, were also discussed.
9.5 REFERENCES
American Academy of Family Physicians. (2020). Sexually Transmitted Infections
(STIs), Retrieved from https://familydoctor.org/condition/sexually-transmitted-
infections-stis/ on 17th January, 2020 at 2:00 pm.
American Sexual Health Association (2020). Understanding Sexual Health.
Retrieved from http://www.ashasexualhealth.org/sexual-health/ on 14th January,
2020 at 6:00 pm.
Avasthi, A; Grover, S and Rao, T.S.S. (2017). Clinical Practice Guidelines for
Management of Sexual Dysfunction. Indian Journal of Psychiatry, 59 (Suppl 1).
doi: 10.4103/0019-5545.196977
Benuto, L. (2020). Other Sexual Dysfunction Disorders, Retrieved from https:/
/www.swamh.com/poc/view_doc.php?type=doc&id=60994&cn=10 on 22nd
January, 2020 at 9:00 pm.
Genito-Pelvic Pain or Penetration Disorder (Sexual Pain Disorder), Retrieved
from https://www.psychologytoday.com/intl/conditions/genito-pelvic-pain-or-
penetration-disorder-sexual-pain-disorder on 21st January, 2020 at 6:00 pm.
Ghosh, M. (2015). Health Psychology: Concepts in Health and Well-being. Delhi:
Pearson.
Hatzimouratidis, K and Hatzichristou, D. (2007). Sexual Dysfunctions:
Classifications and Definitions. The Journal of Sexual Medicine, Volume 4, Issue
1, https://doi.org/10.1111/j.1743-6109.2007.00409.x.
Healthline Editorial Team. (2018). Early Signs of HIV, Retrieved from https:/
/www.healthline.com/health/hiv-aids/early-signs-hiv-infection on 16th January, 2020
at 11:00 pm.
High- Fiber Foods, Retrieved from https://www.helpguide.org/articles/healthy-
eating/high-fiber-foods.htm on 13th January, 2020 at 10:40 pm.
IsHak, W. W and Tobla, G. (2013). DSM-5 Changes in Diagnostic Criteria
of Sexual Dysfunctions. Reproductive System and Sexual Disorders: Current
Research, 2:2, DOI: 10.4172/2161-038X.1000122.
Jennifer A. Harriger & J. Kevin Thompson (2012) Psychological Consequences
of Obesity: Weight Bias and Body Image in Overweight and Obese Youth,
International Review of Psychiatry, 24:3, 247-253, DOI: 10.3109/
09540261.2012.678817.
MacGill, M. (2017). What’s to know about Erectile Dysfunction? Retrieved
from https://www.medicalnewstoday.com/articles/5702.phpon 21st January, 2019
at 3:00 pm.
Marks, D. F; Murray, M; Evans, B; Willig, C; Woodall, C and Sykes, C.
M. (2008). Health Psychology: Theory, Research and Practice. New Delhi: Sage
128 Publications.
McCulloch, M. (2018). 15 healthy Foods High in B Vitamins, Retrieved from Physical Illness
Experiences-I
https://www.healthline.com/nutrition/vitamin-b-foods on 13th January, 2020 at
10:20 pm.
Meston, C and Stanton, A. M. Female Sexual Interest/Arousal Disorders
Retrieved from https://labs.la.utexas.edu/mestonlab/?page_id=1432 on 21st January,
2020 at 5:00 pm.
Meston, C and Stanton, A. M. Hypoactive Sexual Desire Disorder Retrieved
from https://labs.la.utexas.edu/mestonlab/?page_id=586 on 21st January, 2020
at 5:30 pm.
Nail, R. (2017). Unstable Angina, Retrieved from https://www.healthline.com/
health/unstable-angina on 12th January, 2020 at 8:00 pm.
Potassium Rich Foods, Retrieved from https://www.webmd.com/diet/foods-rich-
in-potassium#1 on 13th January, 2020 at 10:30 pm.
Prusty, R. K and Unisa, S. (2013). Reproductive Tract Infections and Treatment
Seeking Behavior among Married Adolescent Women 15-19 Years in India.
The International Journal of Maternal and Child Health (MCH) and AIDS, 2
(1): 103-110.
Sanderson, C. A. (2013). Health Psychology. USA: John Wiley & Sons, Inc.
Sarafino, E. R and Smith, E. W. (2011). Health Psychology: Biopsychosocial
Interactions. USA: John Wiley & Sons, Inc.
Sexual Dysfunctions, Retrieved from https://dsm.psychiatryonline.org/doi/10.1176/
appi.books.9780890425596.dsm13 on 16th January, 2020 at 12:15 pm.
Singh, A.K. (1983). Health Modernity Education in India. Social Change, 12
(2), 27-34.
Singh, A.K. (1984). Health Modernity: Concept and Correlates. Social Change,
14 (3). 3-16.
Sodium Sources: Where does all that Sodium Come from? Retrieved from https:/
/www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sodium-sources on
13th January, 2020 at 10:00 pm.
Ray, W. J. (2015). Abnormal Psychology. Delhi: Sage Publications.
Wasserheit JN, Holmes KK. (1992). Reproductive Tract Infections: Challenges
for International Health Policy, Programs, and Research. In: Germain A, Holmes
KK, Piot P, Wasserheit JN, Editors. Reproductive Tract Infections: Global
Impact and Priorities for Women’s Reproductive Health. New York: Plenum
Press; p. 7–33.
What Are Eating Disorders? Retrieved from https://www.nationaleating
disorders.org/ what-are-eating-disorders on 21st February, 2020 at 2:00 pm.
World Health Organisation (2020). Sexual Health, Retrieved from https://
www.who.int/topics/sexual_health/en/ on 14th January, 2020 at 11:00 am.
World Health Organisation (2020). Sexual Health, Retrieved from https://
www.who.int/westernpacific/health-topics/sexual-health on 16th January, 2020 at
7:00 pm.
World Health Organisation (2020). Sexual and Reproductive Health, Retrieved 129
Promotion of Physical from https://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/
and Mental Health
on 14th January, 2020 at 11:15 am.
World Health Organisation (2020). Sexual Health Issues, Retrieved from https:/
/www.who.int/sexual-and-reproductive-health/sexual-health-issues on 14th January,
2020 at 11:45 am.
Zinc Retrieved from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/ on
13th January, 2020 at 10: 15 pm.
9.6 KEY WORDS

Obesity : When an individual’s Body Mass Index (BMI)
is 30 or more, then he/ she is termed as obese.
Body Mass Index (BMI) : BMI is computed with help of formula: BMI=
weight (kg) / [height (m)]2
Reproductive Tract : Reproductive Tract Infections (RTIs) include
Infections (RTIs) three types of Infection: Sexually Transmitted
Diseases (STDs), such as chlamydia, gonorrhea,
chancroid, and Human Immunodeficiency Virus
(HIV); endogenous infections, which are caused
by overgrowth of organisms normally present
in the genital tract of healthy women, such as
bacterial vaginosis or vulvovaginal candidiasis;
and iatrogenic infections, which are associated
with improperly performed medical procedures.
Sexual health : Sexual health can be explained as a state of
physical, mental and social well-being in relation
to sexuality. It requires a positive and respectful
approach to sexuality and sexual relationships,
as well as the possibility of having pleasurable
and safe sexual experiences, free of coercion,
discrimination and violence.
Sexually Transmitted : These are infections that spread through
Infections (STI) vaginal, oral or anal sex with an individual
having STI.

1) List the five components of food.
The five components of food are:
 Carbohydrates
 Lipids
 Proteins
 Vitamins
130  Minerals
2) State any one factor that can be associated with obesity. Physical Illness
Experiences-I
Obesity can be attributed to stress as it not only has an impact on one’s
metabolism but also influences eating habits.
1) What is sexual health?
Sexual health is a state of physical, mental and social well-being in relation
to sexuality. It requires a positive and respectful approach to sexuality and
sexual relationships, as well as the possibility of having pleasurable and
safe sexual experiences, free of coercion, discrimination and violence.
2) What is full form of HIV and AIDS?
Full form of HIV is Human Immunodeficiency Virus (HIV) and full form
of AIDS is Acquired Immuno deficiency Syndrome

1) Discuss the components of food.
2) Explain obesity with a focus on its effect.
3) Discuss eating disorders.
4) Define sexual health and discuss various problems related to sexual health.
5) Explain sexual dysfunction disorders.
131
UNIT 10 PHYSICAL ILLNESS
EXPERIENCES II*
Structure
10.0 Objectives
10.1 Introduction
10.2 Acute and Chronic Pain
10.3 Chronic Illnesses
10.4 Let Us Sum Up
10.5 References
10.6 Key Words
10.0 OBJECTIVES
 describe acute and chronic pain; and
 discuss chronic illnesses.
10.1 INTRODUCTION
Susheela often suffered from migraine headaches and when she had these
episodes, she would feel unwell and could not concentrate on what she
was doing. It was taking a toll on her as she not only suffered physically,
but psychologically as well, as she became more and more anxious and
lived in fear in anticipation of the pain.
Sabina was in her late 30s, when she was diagnosed with breast cancer
and her whole world collapsed. Though her cancer was in early stages,
she found it very difficult to cope and that added to her misery as she
suffered not only physically but psychologically as well. Though her husband
was very supportive, her mother could not see her child suffer and felt
sick.
As you read the above cases, you may realise that the first one is related to
pain and the second one is about cancer. Pain can play an important role in
our life as it is a sign that something is wrong and needs to be treated, but
it can have negative impact on physical as well as psychological wellbeing of
the individual suffering from it. The case with chronic illnesses (like cancer) is
similar. We also have to mention that pain (especially, chronic pain) and chronic
illnesses will not only disrupt the day today day functioning but can also affect
the family members and significant others in the life of the individuals suffering
from them.
In the present unit we will focus on acute and chronic pain and chronic illnesses.
Physical Illness
10.2 ACUTE AND CHRONIC PAIN Experiences-II
Pain can be an outcome of actual or threatened damage or irritation of tissue

that results in the individual experiencing discomfort, both sensory and emotional
(Sarafino and Smith, 2011). The term clinical pain is used when the pain
necessarily requires professional care. Though its experience is negative, pain
is important as it leads an individual to seek treatment. Pain can be described
as complex as well as a multidimensional phenomenon as it has multiple
components, namely, physiological, behavioural, cognitive and emotional (Marks
et al, 2008). Pain can negatively impact day to day functioning, social, familial
and work life of the individual experiencing it. It also has economic consequences.
Pain can be characterised (Marks et al, 2008) as follows:
 Pain can be progressive, that is it becomes worse over a period of time,

for example, arthritis.
 It can be intermittent, that is, it fluctuates over a period of time and its
intensity may also fluctuate.
 Pain could be associated with an illness that is progressive or it’s underlying

cause could be (malignant) or it can harmless (benign).
 Pain could also be intractable, that is, it does not respond to the treatment.
 It can also be recurrent, that is it occurs at regular intervals.
 Pain can also be referred, that is it may originate in one area of the body,
but is perceived as originating from some other area.
Pain can also be classified as organic pain, psychogenic pain, acute pain and
chronic pain. Organic pain is as a result of tissue damage or pressure. For
example, pain due to sprain. In psychogenic pain, there is as such no tissue
damage or pain and the pain is mainly an outcome of underlying psychological
issue. Most of the pain experienced though can be termed as having both
psychological and physical factors playing a role. Thus, organic and psychogenic
pain can be perceived as two ends of a continuum.
Pain can also be categorised as acute and chronic pain, that are the focus of
this unit and discussed in detail.
Acute and chronic pain
Acute pain can be described as pain that is experienced on temporary basis
and could last for a few months, that is, less than six months (Sanderson, 2013).
As such acute pain can also be described as a physiological response that is
essential and is caused as a result of an injury or disease. Fractured limb, labour
pain during child birth and bruises are examples of acute pain. Pharmacological
treatment can be given to relieve such pain (Marks et al, 2008). It needs to
be kept in mind that acute pains can transit in to chronic pain. Though acute
pain is not for a longer duration, the individuals suffering from this pain often
experience psychological distress at least till the pain lasts.
Chronic pain, on the other hand, is experienced for a longer duration, it does
not go away even after six months (Sanderson, 2013). Individuals with chronic 133
Promotion of Physical pain may not respond to pharmacological treatment (Marks et al, 2008). Cancer
and Mental Health
and arthritis are examples of chronic pain.
Further, individuals suffering from chronic pain not only experience psychological
distress but may also display signs of helplessness and lack of hope. They may
not get proper sleep which leads to exhaustion and fatigue. Pain often leads
to disruption of sleep, not only due to the distress that it causes, but also due
to worry and disrupting thoughts that the individuals in pain experience. Further,
deprivation of sleep over a long period of time will lead to individuals experiencing
negative emotions and they may also become more sensitive to pain.
As a result of chronic pain, the day to day activities of the individuals experiencing
it also gets disturbed and they are not able to focus on their life and career
goals. In fact, pain takes a central place in their lives. There are financial
implications as well, as the individuals are not able to maintain their jobs due
to physical and psychological distress and also because the treatment could be
expensive.
The effect of chronic pain as experienced by the individuals will depend on
the following (Sarafino and Smith, 2011):
- Whether the underlying cause is harmless (benign) or harmful (malignant)

and getting worse.
- If the distress experienced is continuous in nature or it is experienced in

episodes that are intense in nature and occur frequently.
Based on the above chronic pain can be categorised as follows:
1. Chronic- recurrent pain: Here the underlying cause is harmless, though
there are episodes of pain that are intense in nature and occur frequently.
For example, migraine headaches.
2. Chronic-intractable-benign pain: Here the underlying cause is harmless,
but the pain experienced is continuous in nature. For example, back pain.
3. Chronic-progressive pain: Here the underlying cause is harmful and the
distress experienced is continuous in nature. For example, rheumatoid
arthritis and cancer.
Pain can interfere with the treatment and also has negative impact on the
adjustment process.
Pain can be measured using tools like self report inventories (that is the person
undergoing pain is asked to describe the pain). Inventories and questionnaires
can also be used based on behavioural measures ( that constitute physiological
symptoms and verbal and non verbal expressions). Further, physiological
measures can also be used to measure pain (where pain is measured based
on temperature of the skin, heart rate, tension in muscles), though this may not
be a valid way to measure pain as compared to the other two (Sanderson,
2013).
Various psychological factors including stress can have an influence on the way
pain is experienced. Individuals undergoing stress are more likely to complain
of pain (headaches, stomach aches and so on). Further, learning also plays a
role in the way we react to an injury or illness. We may learn these reactions
134 through observation. Pain may also elicit positive reinforcement from other as
the individuals under pain receives attention and others express their concern Physical Illness
Experiences-II
towards him/ her. Also activities that individuals associate with pain are avoided
by them. For example, if an individual gets a stomach ache after consuming
certain food items, he/ she is likely to avoid the same in future due to fear
of pain. Experiencing pain also depends on the individual’s perception about
his/ her own capacity to bear and cope with pain. Further, individuals
experiencing anxiety and depression are more likely to experience pain and the
other way is also true, where individuals experiencing pain may experience anxiety
and depression (Sanderson, 2013).
Treatments for pain include medication and surgery. Physiotherapy (physical
therapy) is also often used in order to help individuals gain relief from pain.
Various behavioural and cognitive methods can also be used. Techniques to
reduce fear associated with pain can also be helpful. Relaxation techniques and
biofeedback can also be used besides interpersonal therapy and group
psychotherapy. Multidisciplinary programmes can also be used for pain relief.
These programmes can be termed as most effective as they combine multiple
approaches including medical, psychosocial, physical therapy, occupational
therapy and vocational approaches (Sarafino and Smith, 2011, pg. 324).
1) Explain organic and psychogenic pain.
.................................................................................................................
.................................................................................................................
.................................................................................................................
2) List the three categories of chronic pain.
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10.3 CHRONIC ILLNESSES

A chronic illness in simple terms can be explained as an illness that continues
for a long duration of time. Some of the chronic illnesses are Arthritis, Diabetes,
Coronary Heart Disease, HIV/ AIDS, Cancer, Epilepsy, Alzheimer’s disease,
and so on.
Let us now briefly discuss about some of the chronic illnesses:
 Diabetes: Diabetes is denoted by hyperglycaemia, where there is more

than required glucose in an individual’s body. The blood sugar levels in
our body are controlled by insulin. But in diabetic individuals, there is
insufficient insulin, because the pancreases have not produced enough insulin
or because the body is not responding normally to the insulin. Diabetes
is of following types:
- Type I: This has an early onset, that is during childhood or adolescence.

This can be due to the destruction of cells of pancreas as a result of 135
Promotion of Physical autoimmune processes. Individuals with type I diabetes have to use insulin
and Mental Health
injections to keep their glucose levels in check and avoid any complications.
- Type II: This mostly develops later in life, that is after 40. Though it can
also develop earlier. Individuals with type II diabetes need not necessarily
take insulin injections. But they do have to take medication and make
lifestyles changes and change their food habits and consumption.
In this context we can also discuss about pre-diabetes. Individuals are termed
as pre-diabetic when they have moderately high levels of glucose in their blood
and also display insensitivity to insulin. Such individuals are likely to develop
diabetes later in their lives and therefore need to make diet and lifestyle changes.
We can also mention about gestational diabetes, that is high levels of glucose
in blood during pregnancy in women who did not have diabetes earlier. Such
women have to take insulin injections and are also required to regularly monitor
the glucose levels (that should not be too high or too low) so that there is
no negative effect on the development of the foetus.
Individuals suffering from diabetes, not only need to take regular medications,
but they also have to make major lifestyle changes so that the glucose levels
are maintained within the limits. Self esteem and social support play an important
role in helping individuals cope with this chronic illness. Experiencing stress and
emotional distress can lead to difficulty in management of diabetes.
 Coronary Heart Disease (CHD): Also referred to as coronary artery

disease, it is an outcome of narrowing of the walls of coronary arteries
due to atheroma, the fatty material. CHD can be categorised in to two
(Marks el al, 2008):
- Myocardial Infarction (MI): MI is commonly termed as heart attack

and is an outcome of blocked coronary artery due to blood clot due
to which part of the heart does not receive oxygen. The symptoms
include chest pain that is severe, besides, sweating, dizziness, nausea
or shortness of breath. Heart attack is often seen as one of the first
signs of CHD.
- Angina: In angina, there is narrowing of arteries due to atheroma.

Thus, the heart muscles are deprived of the blood consisting of oxygen,
especially when the demand is much more such as during heavy
physical activity. Symptoms of angina include severe pain in the chest
that spreads to other parts like face, neck, jaw, arms, back and so
on. Angina can further be categorised as stable and unstable. Stable
angina occurs during exertion or when high levels of stress is
experienced. The pain does not get worse over a period of time and
also its frequency does not change. In unstable angina, the chest pain
takes place due to exertion, or while resting or while experiencing
stress and the pain experienced worsens both in its severity and
frequency (Nail, 2017).
Individuals diagnosed with CHD not only find it difficult to cope, but their quality
of life also decreases. The treatment process is also stressful and it negatively
influences their day to day life, both personal and work. They can also experience
136 anxiety and are prone to developing depression as well.
Individuals suffering from CHD not only need to take prescribed medications, Physical Illness
Experiences-II
but also have to make major lifestyle changes. Cognitive Behaviour Therapy
can be used in order help such individuals adjust to the illness. Besides stress
management techniques can also be used. Social support plays an important
role in recovery from CHD. Family members of individuals having CHD may
also need help and psychological counselling and intervention to help them cope
with the situation and provide adequate help and support to the individuals
suffering from CHD.
 Cancer: The very term ‘cancer’ evokes fear in our minds. This is yet
another chronic illness that we will be discussing. Cancer can be described
as ‘a disease of cells’ (Sarafino and Smith, pg. 370). It is as a result of
proliferation of cell that is uncontrolled and that generally results in
neoplasm (a growth of tissue in body that is new or not normal) that is
malignant. There are five main types of cancer (Sarafino and Smith, 2011
pg. 370):
- Carcinoma: Neoplasm that is malignant that forms in the skin and

the linings of organs like respiratory system, digestive system and
reproductive tracts.
- Melanomas: These are neoplasm of skin cell that produces melanin,

that is the skin pigment.
- Lymphomas: These are cancers related to the lymphatic system.
- Sarcomas: Neoplasm of muscles, bones or corrective tissue.
- Leukemias: These are cancers of blood- forming organs, like, bone

marrow that results in white blood cells proliferation.
Cancer can also spread through lymph system to other parts of the body, that
is termed as metastasis.
Treatment of cancer involves surgery, radiation and chemotherapy. There are

side effects of cancer treatment as well, that are mainly fatigue and nausea and
vomiting. Besides the physical pain and suffering, a cancer patient will also
undergo psychological distress and upheaval as he/ she tries to cope with the
illness and its treatment as well. There is also uncertainty about the future, as
he/she is not sure if the cancer will be cured. If cured, there could also be
a relapse. It is also difficult for the family members to cope as they also have
play a role of caregivers and often to experience care givers burden. Social
support plays an extremely important role in helping individuals cope with this
illness. Some of the psychological interventions that can be used for cancer
patients include relaxation techniques, systematic desensitisation, stress management,
mindfulness, Yoga, meditation and so on. (Sarafino and Smith, 2011). Besides,
music therapy, art therapy, hypnosis and biofeedback can also be used effectively
(Marks et al, 2008).
 Acquired Immune Deficiency Syndrome (AIDS): This is a disease that

is infectious and is as a result of Human Immunodeficiency Virus (HIV).
It spreads through blood and semen. Thus, if the blood or semen of an
HIV positive person or individual with AIDS comes in contact with bodily 137
Promotion of Physical fluids of an uninfected individual, then this individual can also become HIV
and Mental Health
positive. This can take place in three ways (Sarafino and Smith, 2011):
 Unsafe sexual activity between an infected and uninfected person,

where they are exposed to each others bodily fluids.
 When contaminated syringes are used (in drug use).
 Infected mother to her baby.
A person may be HIV positive and it can take many years before he/she develops
AIDS. Medical treatment for HIV/ AIDS involves using antiretroviral agents.
Highly Active Antiretroviral Therapy (HAART) is also used, that involves
combined use of two or more than two antiretroviral agents.
As in cancer, there is fear about HIV/ AIDS as well, but this mainly stems
from being infected by an HIV positive person, which results in stigmatisation
and rejection of HIV positive individuals. Thus, HIV positive individuals may
not get adequate support even from their family members. This also results in
individuals hiding their HIV positive status from others, even their own family
members. Family members also find it difficult to cope because of stigmatisation
attached with this illness.
HIV positive individuals often require psychological intervention in order to deal
with the psychological distress that they experience, management of pain and
deal to with sleep related issues. Such individuals also experience anxiety and
stress and can also develop depression. Exercises, relaxation techniques and
group counselling can play an important role in helping such individuals cope.
Family members also need to be provided with adequate counselling and
intervention in order to help them cope with the situation and also be able to
adequately support the individual diagnosed with HIV.
 Asthma: According to Sarafino and Smith ( 2011, pg. 334) “Asthma is
a respiratory disorder involving episodes of impaired breathing when the
airways become inflamed and obstructed”. It can be triggered due to various
factors like environmental conditions including pollution, presence of pollen,
cold temperature and so on; personal factors such as experiencing stress/
anxiety or suffering from a respiratory infection; physical activities like
strenuous workout or activity (Sarafino and Smith, 2011). Further,
psychosocial factors (stress, anxiety, experiencing negative affect) can not
only trigger asthma, but can make it worse as well.
 Epilepsy: Epilepsy includes episode of sudden and repeated seizures that

can be attributed to the electrical disturbances of the cerebral cortex
(Sarafino and Smith, 2011). Epilepsy has been linked to psychosocial factors
like stress, anxiety and any emotional arousal, that can lead to increase
in likelihood of the individual experiencing epilepsy. Further, these factors
can also make the epileptic episode more severe. Individuals suffering from
epilepsy often face stigmatisation due to the way they act when experiencing
seizure and also due to lack of awareness amongst general public. Further,
the family members may also find it difficult to cope with this illness and
may not be able to provide adequate and required help and support to
138 the individuals suffering from epilepsy.
Adjusting and coping with a chronic illness is not easy and individuals suffering Physical Illness
Experiences-II
from such illnesses may have to go through not only physical pain but
psychological suffering as well, especially, when they are not able to cope well
with the illness. Their initial reaction, when they come to know about their illnesses
is that of shock, that is often followed by denial.
Crisis theory can be discussed here in order to understand the coping process
of individuals diagnosed with chronic illnesses. As per this theory, the coping
process will depend on the factors related to the illness, personal and
background factors and physical and social environmental factor (Sarafino and
Smith, 2011).
Factors related to illness include the threat posed by the illness, whether it is
life threatening, painful and whether it would lead to any disfiguration, stigma
and so on.
Personal and background factors include personality traits of the individual, his/
her age, socio economic status, gender besides his/ her self esteem, emotional
maturity and so on.
Physical factors include, the physical set up of the hospital or the home
environment, social environmental factors include the social support available.
All these three factors are interrelated and affect each other.
As we have discussed under various chronic illnesses, they negatively impact

individuals. Not only their health, but their family and work life is also affected.
Such illnesses also have a major negative impact on family members and
significant others in lives of these individuals. The treatment process, side effects
experienced, frequent trips to hospitals and clinics, financial issues that develop
as a result of the illness (including cost of treatment, loss of working hours
etc.) can all take a toll on the individuals. Individuals thus have to cope with
not only the illness but also with guilt that they may experience when they see
their family members suffer. Various psychological issues ranging from stress,
anxiety, loneliness, depression and so on are also experienced by such individuals.
Therefore, besides early diagnosis and adequate treatment, proper social support
and counselling also needs to be made available to these individuals. Suitable
intervention and counselling also needs to be provided to the family members.
Thus, besides treatment that focuses on curing or alleviating the symptoms of

the illness, psychological interventions are equally important. And these
interventions mainly focus on bringing about a behavioural change. (Sarafino
and Smith, 2011).

1) List the five main types of cancer.
.................................................................................................................
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139
Promotion of Physical 2) What is epilepsy?
and Mental Health
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.................................................................................................................
.................................................................................................................
In the present unit and the previous unit (unit 9), we mainly focused on the
physical and mental illness experiences. We discussed some of the prominent
illnesses and disorders that have significant impact on the wellbeing of the
individuals suffering from them. It is important to understand these illnesses and
disorders, mainly in order to device awareness programmes that can help prevent
them/ detect them early and treat them adequately. Mainly, the focus needs to
be on helping individuals change/ modify their attitude and behaviours, especially
health related attitudes and behaviours. Refer to box 10.1 that focuses briefly
on promoting health.
Box 10.1: Promoting Health

Individuals often know that consumption of junk food can have a negative
impact on one’s health. But they still consume junk food on regular basis.
The same is true with smoking as well and various other health behaviours.
It can be said that healthy practices, lifestyle and attitudes can go a long
way in ensuring positive health and wellbeing of an individual. Thus, in order
to promote health we need to focus on the relationship between health
behaviour and health related attitudes. Some of the beliefs that are relevant
in the context of relationship between health behaviours and health related
attitudes (Sears, Peplau and Taylor, 1991) are:
 Values with regard to general health, that is the interest and concern
that the individual has with regard to the health.
 Danger and threats to health, denoting the severity of the disease/
disorder and its threat.
 Individual vulnerability to the disease or disorder, denoting how
vulnerable he/ she thinks he/ she is to the disease or disorder.
Individual’s self efficacy (confidence about one’s ability) for dealing
with the threat of the disease or disorder.
 Response efficacy denoting whether the efforts taken by the individual
for dealing with the illness will lead to outcomes desired by him/ her.
In this context we also need to focus on few models that can be
utilised to bring about changes in health related behaviour. Some of
these models are discussed as follows:
 Health Belief Model: According to this model the health related
behaviour displayed by an individual will depend on:
a) His/ her perceived vulnerability/susceptibility to the illness,
b) The severity of the illness as perceived by the individual,
c) The benefits of health behaviour as perceived by the individual, that
140
Physical Illness
is, whether the perceived vulnerability/ susceptibility will decrease if Experiences-II
the health related behaviour is followed,
d) And lastly, the perception with regard to barriers or obstacles regarding
the health related behaviour.
 Theory of Planned Behaviour: This theory was proposed by Ajzen
and it mainly highlights behaviour intentions of an individual that can
play a role in health related behaviours. And behaviour intentions can
be determined by attitude towards behaviour. And attitude towards
behaviour is determined by
a) The beliefs and evaluation related to outcome of following certain health
related behavior,
b) Subjective norms, that denotes the belief related to the expectations
of significant others,
c) And the motivation of individual to follow the health related behaviour.
 Stages of change model: This model was proposed by Prochaska
and Diclemente. The stages in this model are described as follows:
Stage 1: Precontemplation (the individual does not intent to change the
behaviour).
Stage 2: Contemplation ( realisation and contemplation regarding need to
change the behaviour)
Stage 3: Preparation (steps and measure to change behaviour)
Stage 4: Action (bringing about change in behaviour)
Stage 5: Maintenance (maintaining the changed behaviour)
10.4 LET US SUM UP

To summarise, in the present unit we focused on acute and chronic pain and
chronic illnesses. Acute pain can be described as pain that is experienced on
temporary basis and could last for a few months, that is, less than six months.
Chronic pain, on the other hand, is experienced for a longer duration and it
does not go away even after six months. Effect of pain and treatment were
also briefly touched upon in the unit. The last subtopic discussed was chronic
illnesses. A chronic illness in simple terms can be explained as an illness that
continues for a long duration of time. Some of the chronic illnesses discussed
in the unit were are diabetes, Coronary Heart Disease, Cancer, AIDS, Asthma
and Epilepsy.
10.5 REFERENCES
Pearson.
Healthline Editorial Team. (2018). Early Signs of HIV, retrieved from https://
www.healthline.com/health/hiv-aids/early-signs-hiv-infection on 16th January, 2020
at 11:00 pm. 141
Promotion of Physical Marks, D. F; Murray, M; Evans, B; Willig, C; Woodall, C and Sykes, C.
and Mental Health
publications.
Nail, R. (2017). Unstable Angina, retrieved from https://www.healthline.com/

health/unstable-angina on 12th January, 2020 at 8:00 pm.
Sarafino, E. R and Smith, E. W. (2011). Health psychology: Biopsychosocial

Ray, W. J. (2015). Abnormal Psychology. Delhi: Sage publications.
10.6 KEY WORDS

Acute pain : Acute pain can be described as pain that
is experienced on temporary basis and
could last for a few months, that is, less
than six months.
Asthma : Asthma is a respiratory disorder involving

episodes of impaired breathing when the
airways become inflamed and obstructed
Chronic pain : Chronic pain is experienced for a longer

duration, it does not go away even after
six months.
Coronary Heart Disease (CHD): Also referred to as coronary artery disease,

is an outcome of narrowing of the walls
of coronary arteries due to atheroma, the
fatty material.

1) Explain organic and psychogenic pain.
Organic pain is as a result of tissue damage or pressure. For example,

pain due to sprain. In psychogenic pain, there is as such no tissue damage
or pain and the pain is mainly an outcome of underlying psychological issue.
2) List the three categories of chronic pain.
The three categories of chronic pain are:
- Chronic- recurrent pain
- Chronic-intractable-benign pain
- Chronic-progressive pain
142
Check Your Progress II Physical Illness
Experiences-II
1) List the five main types of cancer.
The five main types of cancer are:
- Carcinoma
- Melanomas
- Lymphomas
- Sarcomas
- Leukemias
2) What is epilepsy?
Epilepsy includes episode of sudden and repeated seizures that can be
attributed to the electrical disturbances of the cerebral cortex.

1) Explain acute and chronic pain.
2) Describe any Diabetes and Asthma as chronic illnesses.
3) Discuss Coronary Heart Disease (CHD).
4) Explain AIDS.
143
UNIT 11 MENTAL ILLNESS EXPERIENCES*
Structure
11.0 Objectives
11.1 Introduction
11.2 Depression
11.3 Anxiety
11.4 Psychosomatic Illnesses
11.5 Substance Use
11.6 Let Us Sum Up
11.7 References
11.8 Key Words
11.0 OBJECTIVES
 explain the concepts depression, anxiety, psychosomatic illnesses and
substance use.
11.1 INTRODUCTION
After Salil lost his best friend in an accident, he was not like before. He
not only isolated himself from others but his appetite and sleep were also
affected. He even lost interest in his studies. His parents initially consulted
a physician, who could not find any physical ailment that Salil was suffering
from and therefore the physician suggested that Salil could be taken to
clinical psychologist to help him deal with any psychological problems that
he could be facing.
Shaila was in 10th standard and was preparing very hard for her board
examinations. Her parents had high expectations from her and she wanted
to make her parents happy by securing good marks in her board
examinations. She would study regularly and was a hard worker. But
recently her parents noticed that she was often complaining about head
ache. There were instances when the head aches would become so bad
that she had to miss school and rest at home. Her physician initially treated
her for the pain, which would subside for a while and then return. They
also consulted an ophthalmologist and a neurologist but the source of head
ache could not be traced. Shaila’s aunt suggested that they consult a clinical
psychologist to see if the recurrent headaches were due to some psychological
issue.
Everybody saw Sunaina as a happy go lucky person, always smiling and Mental Illness
Experiences
approachable, until she attempted suicide. Everybody was shocked to hear
the news. Though, Sunaina could be saved, her near and dear ones realised
that she was fighting a battle within herself, trying to cope with her
situations and issues and required both help and support. We often come
across news about individuals committing suicide. One of the causes of
suicide can be that the person is undergoing depression.
The above mentioned examples discuss three different cases related to
psychological issues/ mental illnesses. There are various mental illnesses that need
to be focused on or need to be understood as we study the course on
psychological health and wellbeing. It is important to be observant and note
any changes in behaviours of people with whom we interact on day to day
basis, so that they receive help and support on time.
In the previous units (Unit 9 and 10) we discussed about some of the physical
illness experiences. In the present unit we will focus on some of the mental
illness experiences. Mainly we will discuss the terms, depression, anxiety,
psychosomatic illnesses and substance use. Though the focus of this unit will
not be on symptoms and diagnosis of these disorders (as is the case with courses
like Psychological disorders/ Understanding Psychological Disorders) but on how
these disorders have an impact on the day to day functioning of the individual.
You need to understand these mental illnesses so as to be able to comprehend
the nature of the illness and how they lead to psychological distress so that
prevention/diagrosis and treatment can be carried out at the earliest.
11.2 DEPRESSION
We often feel upset or sad in certain situations. A failure or loss can make
us sad or upset. And often the feelings experienced in such situations is referred
to as depression by lay persons. However, when we talk about depression in
the context of psychological disorder, it is much more than instances of sadness.
Depression can be differentiated from sadness not only in terms of degree but
also in terms of duration. Being sad is an emotion and is often experienced
as a result of situations like a failure, break up (in relationship), death of a
near or dear one and so on. But a person with depression may experience
depressed mood, lack of hope, interest and pleasure in any situation. An
individual with depression may have all the valid reason to be happy and cheerful
but they are not able to experience any pleasure or interest and feel hopeless
and depressed.
Depression is one of the mental illnesses categorised under mood disorder as
per DSM (Diagnostic and Statistical Manual) 5. Depressive disorders have been
classified in DSM 5 as follow:
 Disruptive mood dysregulation disorder: Can be described as a
condition in childhood adolesence that is characterised by extreme irritability
and anger and intense and recurrent outbursts of temper.
 Major depressive disorder (including major depressive episode): This
disorder is also called unipolar depression and includes symptoms like
continuing depressed mood, decreased interest in day to day activities,
increased or decreased appetites, slow thought process and decreased
physical movement, fatigue and energy loss and experiencing guilt insomnia
or hypersomnia, lack of concentration and inability to take decisions, 145
Promotion of Physical recurring suicidal ideation (with or without a specific plan for committing
and Mental Health
suicide) and also recurrent thoughts related to death. Though there is an
elaborate criteria (as specified in DSM 5) that needs to be considered
while diagnosing depression in an individual.
 Persistent depressive disorder (dysthymia): In order to diagnose an
individual with dysthemia, the symptoms of depression need to persist for
more than two years and individual is not without symptom for more than
two months.
 Premenstrual dysphoric disorder: In this disorder, the symptoms related
to severe depression, irritation, and tension occur before menstruation in
women, And these symptoms are intense as compared to Premenstrual
Syndrome (PMS).
 Depressive disorder due to another medical condition: This disorder
includes depression that occurs due to medical conditions like hypothyroidism,
brain injury and so on.
Further, the depressive disorders can also be categorised by specifiers including
peripartum onset, seasonal pattern, melancholic features, mood-congruent or
mood-incongruent psychotic features, anxious distress, and catatonia as per
DSM 5.
Depressive disorders are characterised by sadness, emptiness, irritability along
with cognitive and bodily changes that have considerable impact on the
functioning of an individual. Though they may differ based on their duration,
timing and assumed aetiology.
It is important to remember that the diagnosis is to be carried out using suitable
tools and methods by a clinical psychologist. And just based on mere symptoms
one cannot judge or label any individual as suffering from depression.
According to WHO, depression is one of the major causes of disability and
it not only has psychological and physiological impact but also affects family
and social life of the individual. Further, it is also an expensive psychological
disorder (Ray, 2015). An individual suffering from this disorder is not able to
function adequately in his/ her work setup and his/ her family life also gets
affected. If untreated, the symptoms will only aggravate and this again can have
detrimental effect on the individual. Also it can affect individuals at any
developmental stage from childhood to old age.
Box 11.1: DSM and ICD

DSM: The full form of DSM is Diagnostic and Statistical Manual of Mental
Disorders. It is basically a handbook that provides detailed guidelines that
can be followed in order to diagnose mental disorders. Each mental disorder
is categorised and criteria for their diagnosis is clearly given in this manual.
It is released by American Psychiatric Association. And the latest, DSM 5,
was released in 2013, before which DSM IV-TR was followed.
ICD: Though in the present course we have discussed the psychological
disorders as per DSM, there is ICD as well that is followed for classification
of disorders. ICD stands for International Statistical Classification of
Diseases and Related Health problems and is maintained by WHO. The
latest version of ICD, that is ICD 11, was accepted in 2019 and will come
in to effect 2022 onwards.
146
Early diagnosis of depression is important as are efforts to prevent it altogether. Mental Illness
Experiences
Treatment of depression includes techniques that can be employed to manipulate
brain activities, medication that can have an effect on neurotransmitters so that
the brain processes can be controlled (facilitated or inhibited), psychotherapy
(including Cognitive Behaviour Therapy (CBT), Emotion Focused Therapy and
Psychodynamic therapy) and even exercise and meditation (Ray, 2015). Though
social support from the family members and significant others also play an
important role in management and treatment of depression.
1) How is depression different from sadness?
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2) List the treatments for depression.
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11.3 ANXIETY
Anxiety in simple terms can be explained as worry. “Anxiety is defined as the
response to prolonged, unpredictable threat, a response which encompasses
physiological, affective, and cognitive changes” ( Robinson at al, 2013, pg. 1).
Like stress, every individual will experience anxiety many times through out his/
her life time. It is important at this point to distinguish between anxiety and
anxiety disorders. Anxiety is often experienced by individuals, though it may
not interfere with their day to day lives to an extent where their functioning
is disrupted. Whereas, individuals having anxiety disorder will have difficulty
functioning effectively.
Let us first discuss about anxiety and then we will also focus on anxiety disorders.
As was stated earlier, anxiety can be denoted as worry. Though, it can also
constitute feelings of nervousness, apprehension and fear. As discussed under
stress, anxiety as well plays a significant role in our lives and is important in
order to save us from certain dangers and make certain changes. As stress
that goes beyond an optimal level can have detrimental impact on the wellbeing
and functioning of the individual, in a similar manner, anxiety that is persistent
can have detrimental effect on the day today functioning of the individual. Further,
like stress, anxiety can also have an impact on physiology and psychology of
the individual. 147
Promotion of Physical The short term effects of anxiety include rapid breathing and increased heart
and Mental Health
rate. Also the blood flow concentrates more in the brain. Long term/ chronic
anxiety can be detrimental to the quality of life of the individual. Experiencing
stress can also lead to development of anxiety in an individual as can substance
use disorder and a critical medical condition (Cherney, 2018).
Experiencing anxiety can also lead to developmental of digestion related issues,
high risk for infection, and functioning of respiratory system and cardiovascular
system can also get affected (Leonard, 2018).
Some of the symptoms experienced during anxiety are feelings of nervousness
and fear, feeling restless, experiencing panic attacks, increased heart rate, rapid
breathing, perspiring, tiredness, feeling weak and dizzy, inability to concentrate,
sleep related problems, feeling nauseous, chest pain and so on (Leonard, 2018).
It is important to differentiate between anxiety and anxiety disorders. Anxiety
can be termed as a reaction to stress that is normal. And from time to time
each one of us faces anxiety. As there are various techniques to manage stress,
in a similar manner anxiety can also be managed in order to avoid its detrimental
effect. With regard to anxiety disorders there may not be any stressors that
creates anxiety and in fact the individual may experience anxiety at all times.
Further, the degree and duration of anxiety experienced by an individual with
anxiety disorder is much more. In anxiety disorders, there are other physical
and psychological symptoms as well besides worry. Most importantly, an
individual with anxiety disorder will not be able to function adequately.
Let us now briefly focus on various anxiety disorders.
The disorders that are categorised under anxiety disorders have certain common
features like experiencing anxiety or worry and experiencing excessive fear as
a result of which the individual experiences behavioural disruptions.
Following are the anxiety disorders as stated in DSM 5 (Ray, 2015):
 Separation Anxiety Disorder: This is irrational fear of being separated
from individuals that one has attachment with. And such a fear is not age
appropriate and also interferes with the individual’s day to day functioning.
 Selective Mutism: This disorder can be termed as an anxiety disorder
during childhood that is denoted by inability to speak and communicate
in certain social situations like school. Such children communicate normally
in other setups, in which they are at ease and feel safe.
 Panic Disorder: Includes panic attacks that are recurrent along with
experiencing distress that is both physiological and psychological.
 Agoraphobia: Phobia can be explained as an irrational fear. And Agora
means open spaces in Greek. Agoraphobia can be explained as an irrational
fear of finding oneself in situations from which it would be difficult to escape
or possibility of experiencing share and humiliation. Or fear of being in
a situation where help may not be available in case panic symptoms are
experienced. Individuals with this phobia have fear of being in open or
enclosed spaces, using public transport, being in crowded places etc.
148
 Specific phobia: Specific phobia can be termed as persistent and intense Mental Illness
Experiences
fear of certain objects, situations, events and activities that as such are
harmless. Individuals diagnosed with such phobia find it difficult to cope
with the fear despite of knowing that it is excessive.
 Social Anxiety Disorder (Social Phobia): This mainly relates to speaking
in public or being in social set up, in company of others that induces anxiety.
 Generalised Anxiety Disorder: The individual diagrosed with this disorder
is persistently and excessively anxious/ worried and that interferes with his/
her day to day functioning.
 Substance- Induced Anxiety Disorder: This disorder is diagnosed when
the symptoms such as being restless, nervous and experiencing panic attacks
are caused as a result of consumption of certain drugs or due to
discontinuing the consumption of certain drugs.
 Anxiety Disorder Attributable to Another Medical Condition: Certain
medical conditions will lead to an individual experiencing anxiety, panic
attack and so on.
 Other Specified and Unspecified Anxiety Disorder: Other specified
anxiety disorder is diagnosed when the complete criteria for certain anxiety
disorder is not met but anxiety symptoms are displayed by the individual
that cause distress in him/ her. And unspecified anxiety disorder is diagnosed
when symptoms related to anxiety disorder are displayed by an individual
that cause distress as well, however, sufficient information is not available
to diagnose certain anxiety disorder. Such a situation is likely to occur in
emergency room set up where the case history and appropriate evaluation
are not possible or not available (Jacofsky et al. 2020).
In DSM IV-TR, Obsessive Compulsive disorder was included under Anxiety
disorder, but in DSM 5, it is discussed separately.
Anxiety disorders can have a negative impact on psychological, physical as well
as social wellbeing of an individual.
In order to treat anxiety disorders psychotherapies like Cognitive Behaviour
Therapy (CBT) can be used. Though different therapies can be used for different
anxiety disorders. For Generalised Anxiety Disorder, for instance, CBT and
behaviour therapy can be used. Besides medication may also be given. Exposure
therapy and social skills training can be used for social anxiety disorder. Further
mindfulness meditation can also be helpful in dealing with anxiety disorders.
It is again to be remembered that the diagnosis and treatment of these disorders
need to be carried out by necessarily qualified individuals with required expertise.
1) What is Anxiety?
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................................................................................................................ 149
Promotion of Physical 2) List any five anxiety disorders.
and Mental Health
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11.4 PSYCHOSOMATIC ILLNESSES

In previous two units, we discussed about physical illness experiences and also
highlighted how each of the illnesses can have an impact on psychological
wellbeing of the individuals suffering from them. And in this unit we are focusing
on various mental illness experiences that mainly display psychological distress
and symptoms. In psychosomatic illnesses, physical symptoms are an outcome
of some underlying psychological issues.
In simple terms, psychosomatic illness can be explained as an illness that involves
both mind and body (Psyche means mind and soma means body) (Weiss, 2015).
Katz (2017) defines psychosomatic illnesses as “any illness that is caused,
exacerbated, or perpetuated–either fully or partially– by psychological factors”.
Individuals may display certain symptoms like lack of energy or fatigue, headache,
stomach ache and so on (these could range from common to severe illnesses)
that cannot be attributed to any illness.
Weiss (2015) classified psychosomatic illness in to the following:
 The first form of psychosomatic illnesses constitutes those individuals who

display both psychological as well as medical issues. Management of such
an illness can be a challenge.
 The second form constitutes individuals who display psychological issues

that could be linked to a medical issue or its treatment. For instance, an
individual having a terminal illness may develop depression.
 The third form of psychosomatic illnesses constitutes individuals who display

physical symptoms that can be attributed to certain psychological causes
and issues rather than medical issues. For instance, stomach upset as a
result of experiencing stress.
Psychosomatic illnesses can be attributed to personality traits, environmental
influences, genetic and biological factors and so on. They can also be as a
result of learned behavior. Stress, anxiety and depression can also lead to
development of psychosomatic disorders.
Psychosomatic illness can also have a negative impact on the day today
functioning and quality of life of an individual. A person with psychosomatic
illnesses will experience both mental and physical difficulties and issues.
In this context, we can discuss about Somatic Symptom and Related Disorders
as given in DSM 5. In DSM IV- TR it was termed as somatoform disorders.
The disorder constitutes somatisation disorders, pain disorders and hypochondriasis
that were earlier included under somatoform disorders. Individuals diagnosed
with this disorder display physiological symptoms that are distressful in nature
and the reaction to these symptoms is in terms of thoughts, feelings and behaviour
150 that are not normal. Ray (2015, pg. 349) described Somatic Symptom Disorders
as “a condition in which a person’s somatic or bodily symptoms cause Mental Illness
Experiences
distress or disruption in physical health that is not consistent with a medical
disorder”.
Individuals suffering from this disorder display persistent and excessive thoughts
with regard to the severity of their symptoms. Further, they also display increased
and persistent anxiety about their health or the symptoms experienced by the
and are preoccupied with the health related concern or symptoms and thus invest
their significant time and energy in focusing on them.
Following are the Somatic Symptom and Related Disorders as stated in DSM 5:
 Somatic Symptom Disorder: This disorder is diagnosed when the
indivdual displays excessive focus on physical symptoms like pain and
tiredness that lead to affective distress and interferes with day to day
functioning. Another medical condition may or may not be present. But
the reaction of the individual towards the symptoms experienced is not
normal.
 Illness Anxiety Disorder: This was earlier referred to as Hypochondriasis.
Individuals with this disorder display fear that they have or will acquire
a serious illness or disorder.
 Conversion Disorder (Functional Neurological Symptom Disorder):
In this, despite of lack of any medical condition, the individual experiences
neurological symptoms. The symptoms are realistic and can have an impact
on the motor and sensory functioning.
 Psychological Factors Affecting Other Medical Conditions: This
disorder is diagnosed when there is a negative effect of psychological or
behavioural factors (not related to another psychological disorder) on a
general medical condition, that not only interferes with the treatment process
but can lead to morbidity and mortality.
 Factitious Disorder: In this disorder an individual behaves as if he/ she
is suffering from some physical or mental illness. This is not on purpose
as they wish to be perceived by others as being unwell or injured. This
disorder is often linked to affective issues and situations that are perceived
as stressful.
 Other Specified and Unspecified Somatic Symptom and Related
Disorder: Other specified somatic symptoms and related disorder are
denoted by presence of symptoms of somatic symptoms and related
disorders that cause distress but they do not meet the full criteria of any
of the symptoms and related disorders. Unspecified somatic symptom and
related disorder denotes presence of somatic symptoms but the information
available is not sufficient to carry out any specific diagnosis.
Individuals having this disorder often visit a physician, who upon examination
realises that the individuals are not having any physical issue. Though we need
to note that such individual are not lying about their symptoms as any pain
or distress that is experienced by them is real, though there may not be any
physical cause. Further, the pain and distress interferes with their day to day
activities. We also need to distinguish Somatic Symptom Disorder from
malingering (that is, faking an illness) (Ray, 2015).
151
Promotion of Physical Psychotherapy like Cognitive Behaviour Therapy (CBT) and behaviour therapy
and Mental Health
can be used for Somatic Symptom and Related Disorders. Psychoanalysis can
also play an important role in treating individuals with these disorders. Practicing
stress management techniques and relaxation techniques can also be helpful,
besides being aware about the impact of stress and anxiety on one’s physiology.
Often medication is also prescribed to help individuals cope with pain and
physical distress.
1) Define psychosomatic illnesses.
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11.5 SUBSTANCE USE

Substance use was earlier referred to as substance abuse. To define substance
abuse, according to Buddy (2019), it is “a pattern of harmful use of any substance
for mood-altering purposes. “Substances” can include alcohol and other drugs
(illegal or not) as well as some substances that are not drugs at all. Now the
term abuse has been replaced with use because, when we say ‘abuse’ we mean
that certain substance is used in a way that is not supposed to be used or
recommended and it is possible that individuals use substances but are not
addicted (based on criteria given in DSM 5).
Substance abuse, as discussed above, involves use of psychoactive substances
that are harmful if consumed. These substances could be alcohol or illegal drugs
and use of these could lead to development of dependence syndrome that
includes various behavioural, cognitive and physiological repercussions as a result
of frequent use of the substance. It also includes an intense desire to consume
the drug, difficult in having control over its use despite of negative consequences
and more priority is given to the drugs than to other activities and duties. Further
there is an increased tolerance and the person may also experience physical
withdrawal (WHO, 2020). The individual using such substances over a period
of time develop physical dependence. The body adjusts itself to the substance
and the individual will have to consume it in more quantities to achieve same
effect. This is because the body becomes tolerant to the substance. The individual
will also start craving for the substance and will not only develop physical
dependence but psychological dependence as well, which eventually will lead
to addiction and if the individual stops consumption of the substance he/ she
will experience withdrawal symptoms (including headaches, nausea, tremors and
so on) (Ghosh, 2015).
Substance use can have negative repercussions not only on physical health and
wellbeing of the individual, but it has an impact on his/ her psychological health
and wellbeing as well. His/ her social relationships are also affected. Such
individuals are not able to take any responsibilities in their personal and work
life and their quality of life can also get affected. The individual consuming drugs,
especially, intravenous are also at the risk of HIV infection. Other risks involve
accidents when riding, driving or handing heavy machinery under influence of
152
alcohol and drugs. Besides a negative impact on the individual’s, health and Mental Illness
Experiences
wellbeing, substance abuse has detrimental effect on the wellbeing his/her family
as well. Aggression can also be linked to substance use that can then lead to
violent behaviour.
In DSM 5, the substance use disorder is stated as Substance- related and
Addictive Disorders. The disorder includes ten different classes of drugs, namely,
alcohol; caffeine; cannabis; hallucinogens (with separate categories for phencyclidine
[or similarly acting arylcyclohexylamines] and other hallucinogens); inhalants;
opioids; sedatives, hypnotics, and anxiolytics; stimulants (amphetamine-type
substances, cocaine, and other stimulants); tobacco; and other (or unknown)
substances (Hartney, 2019). DSM 5 also gives a criteria for diagnosis of the
disorder that are mainly divided in to four categories (there are total of 11
criteria), impairment of control, social impairment, risky use and pharmacological
indicators (tolerance and withdrawal). Besides, severity of the disorder is also
stated where an individual having two to three criteria is termed as having mild
disorder, four to five as moderate and six or more as severe. In general, treatment
for these disorders includes use of medication and also psychotherapies like
Cognitive Behaviour Therapy and behaviour therapy. Group counselling is also
used for the individuals as well as their spouses.
Some of the addictions are discussed as follows:
 Tobacco: Tobacco is often consumed through smoking cigarettes or even

through smokeless forms, like chewing pan, pan masala, snuff and so on
(Ghosh, 2015). Consumption of tobacco can lead to various types of
cancer, including cancer of lungs, mouth, throat, bladder, liver, stomach,
colon and so on. Further, when an individual indulges in smoking cigerrettes
around others, he/ she subjects them to passive smoking thus putting them
at risk of developing health hazards as well. Other health related risks
of tobacco consumption include cardiovascular diseases and chronic
obstructive pulmonary diseases (Ghosh, 2015, pg. 230). Smoking can also
lead to aggravation of asthma symptoms. Tobacco can thus have harmful
effect on the physical health of the individuals and the individuals become
addicted to it. If they stop its consumption they will experience physical
and psychological distress. Thus, such individuals need suitable treatment
and help in dealing with the addiction. Medications are sometimes required
besides therapies like behaviour therapy and Cognitive Behaviour Therapy.
Motivational interviewing and mindfulness can also play an important role.
Though it is most important to focus on why the individuals engaged in
tobacco consumption, whether it was due to cultural practices or peer
pressure or media influence. This is important as accordingly interventions
can be designed in order to develop awareness programmes in order to
make individuals aware about the negative effects of tobacco consumption.
 Alcohol consumption and addiction: Like tobacco, alcohol is yet another

substance that can lead to addiction when consumed over a period of
time. Alcohol addiction is described as a state in which the individual
becomes physically and psychologically dependent on alcohol and lack of
its consumption will lead to his/ her experiencing withdrawal symptoms.
Alcohol leads to indirect stimulation of Gamma-Aminoobutyric Acid
(GABA), that is a neurotransmitter and when the release of GABA is
153
Promotion of Physical increased, the functioning of the brain is inhibited and becomes slow, thus
and Mental Health
negatively affecting the individual’s speed, reaction time as well as motor
skills (Ghosh, 2015). Therefore it is said that one should not drive or
even carry out any heavy physical activity after consumption of alcohol
as there is danger of accidents and individuals getting hurt badly or even
death. Excessive consumption of alcohol can have numerous repercussion
from health related issues (including liver cirrhosis and cancer), to socio
economic adversities and so on. There is also negative impact on the family
members. The work life of the individual may also suffer as he/ she may
remain absent from work or he/she may also be at risk of injuring himself/
herself if he/she indulges in using heavy machinery or hazardous substances
like chemical etc. while under influence of alcohol. The coworkers and
other employees may also be at risk due to this and also because such
individual may have behavioural issues and problems as well. In order to
help an individual deal with alcoholism, he/ she may have to go through
the process of detoxification. Sometimes such individuals also need to be
in Alcohol Anonymous, as they not only have to deal with the withdrawal
symptoms but also need to develop social skills. Psychotherapies like
Cognitive Behaviour therapy, Body Psychotherapy, Dialectical Behaviour
Therapy can be used. It is also important to provide intervention to the
family members. Counselling can be carried out for the family members
and significant others and psychotherapy can also be used if required. They
also need be encouraged to become part of support groups, where they
can interact with family members of alcoholics.
 Drug abuse: Here we mainly refer to the psychoactive drugs. Consumption

of these drugs can lead to dependence both physical and psychological
and they also have a negative impact on the cognitive processes and
behaviour of the individuals who consume them. The four main classes
of psychoactive drugs (Ghosh, 2015, pg. 236) are:
- Depressants: The main effect of these drugs include decrease in
anxiety and feeling of being relaxed. Alcohol, Valium, Barbiturates can
be categorised under this category.
- Stimulants: These stimulate the individuals and leads to alertness and
experience of euphoria. Amphetamines, Benzadrine and Dexdrine can
be categorised under this category.
- Narcotics/ Opiates: These lead individuals to become alert and
euphoric. Further, they can also lead to experiencing hallucinations.
Examples of this category are cocaine, heroin, morphine, opium,
nicotine etc. These may also help in controlling pain.
- Hallucinogens/ Psychedelics: These can lead to alterations in
individuals’ perception, hallucinations and euphoria. They can also make
individuals feel relaxed. Some examples of this category are LSD
(Lysergic Acid Diethylamide), Marijuana, Cannabis, Hashis etc.
Consumption of psychoactive drugs have health and socio-economic repercussions.

Medical treatment is often required in treating individuals that abuse such drugs.
154
Detoxification needs to be used and focus also needs to be on prevention of Mental Illness
Experiences
relapse. Psychotherapies like Cognitive Behaviour Therapy, Multidimensional
family therapy and behaviour therapy besides others can be used.
1) State the ten different classes of drugs under Substance- related and
Addictive Disorders as stated in DSM 5.
................................................................................................................
................................................................................................................
................................................................................................................
Box 11.2: Diagnoses and Treatment of Psychological Disorders

The most important step in determining the treatment process of any
psychological disorder is diagnosis. It is important to note that mere
presence of symptoms is not an indication of presence of a disorder. For
instance, we may often feel anxious before an interview or an examination
or we may also feel upset about a certain loss but that does not mean
that we are suffering from an Anxiety Disorder or Depression. DEGREE
and DURATION of symptoms is often relevant in diagnosis. Also it is
important that the diagnosis is carried out by a professional and certified
person so that the individual receives adequate treatment. If a person has
fever due to malaria but is wrongly diagnosed as having flu, there could
be detrimental effects on health of the individual as the symptoms will not
alleviate and the illness can deteriorate. This holds true for diagnosis of
phychological disorders as well. Diagnosis of psychological disorder includes
taking a detailed case history of the individual, carrying out Mental Status
Examination (MSE), using interview with the individual as well as his/ her
family and significant others (could be friends and colleagues), using
psychological tests for diagnosis and also behavioural assessment. Once
the diagnosis is carried out then psychotherapy can be used. Though for
certain psychological disorders medication is also required but the same
are prescribed by a Psychiatrist. A clinical psychologist cannot prescribe
medication. In simple terms psychotherapy can be explained as an
interaction between two individuals, one of whom is displaying distress and
the other is skilled and qualified, having necessary expertise in psychotherapy.
And these individuals decide to work together with an aim to help the
individual in distress deal with his/her distress. Psychotherapy is different
from counselling (that you must frequently heard about). Psychotherapy is
much more in-depth and a long term process when compared with
counselling. In psychotherapy various therapies are used and in counselling
certain techniques like listening, questioning and so on are employed. Some
of the psychotherapies are listed below:
- Psychodynamic Approach
- Existential Therapy
- Behaviour Therapy
- Cognitive Therapy 155
Promotion of Physical
and Mental Health - Cognitive Behaviour Therapy (CBT)
- Person Centered Therapy
- Gestalt Therapy
- Rational Emotive Behaviour Therapy (REBT)
- Family Therapy
- Group Therapy
- Solution Focused therapy
- Narrative Therapy
- Acceptance and Commitment Therapy (ACT)
- Body Psychotherapy
- Multicultural Therapy
- Choice and Reality Therapy
The next unit will further focus on prevention, management and intervention for
physical and mental health.
11.6 LET US SUM UP

To summarise, the main focus of this unit was on depression, anxiety,
psychosomatic illnesses and substance use. A person with depression may
experience depressed mood, lack of hope, interest and pleasure in any situation.
An individual with depression may have all the valid reason to be happy and
cheerful but they are not able to experience any pleasure or interest and feel
hopeless and depressed. The classification of depression as per DSM 5 was
also discussed. The next subtopic discussed was anxiety. Anxiety in simple terms
can be explained as worry. Anxiety can be denoted as worry and it also includes
feelings of nervousness, apprehension and fear. Like stress, every individual will
experience anxiety many times through out his/her life time. Distinction was also
made between anxiety and anxiety disorder. As there are various techniques
to manage stress, in a similar manner anxiety can also be managed in order
to avoid its detrimental effect. Anxiety disorders were also discussed in the unit.
The unit also discussed about psychosomatic illness, that can be explained as
an illness that involves both mind and body (Psyche means mind and soma
means body). Individuals may display certain symptoms like lack of energy or
fatigues, headaches, stomach ache and so on (these could range from common
to severe illnesses) that cannot be attributed to any illness. Lastly, in this unit
substance use was explained. In the unit, the term substance abuse was
described, as a pattern of harmful use of any substance for mood-altering
purposes. “Substances” can include alcohol and other drugs (illegal or not) as
well as some substances that are not drugs at all. In DSM 5, the substance
use disorder is stated as Substance- related and Addictive Disorders.
156
Mental Illness
11.7 REFERENCES Experiences
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my.clevelandclinic.org/health/diseases/9832-an-overview-of-factitious-disorders on
23rd January, 2020 at 11:00 pm.
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5th January, 2020 at 2:00 pm.
Bhatt. N. (2019). Anxiety Disorders, Retrieved from https://

emedicine.medscape.com/article/286227-overview#a2 on 22nd January, 2020 at
2:00 pm.
Buddy T (2019). Substance Use Overview, Retrieved from https://

www.verywellmind.com/substance-use-4014640 on 7th January, 2019 at 10:00
pm.
Cherney, K. (2018) Effects of Anxiety on the Body. Retrieved from https://

www.healthline.com/health/anxiety/effects-on-body#1 on 5th January, 2020 at
1:37 pm.
Conversion Disorder: Definition, Symptoms, and Treatment (2020), Retrieved

from https://www.psycom.net/conversion-disorder-definition-symptoms-and-
treatment/ on 23rd January, 2020 at 11:30 pm.
Depression Definition and DSM-5 Diagnostic Criteria, Retrieved from https:/

/www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/ on 1st January,
2020 at 10:00 am.
Depressive Disorder Due to Another Medical Condition DSM-5 293.83 (ICD-

10-CM Multiple Codes), Retrieved from https://www.theravive.com/therapedia/
depressive-disorder-due-to-another-medical-condition-dsm—5-293.83-(icd—
10—cm-multiple-codes) on 21st January, 2020 at 2:00 pm.
Disruptive Mood Dysregulation Disorder, Retrieved from https://www.nimh.nih.gov/

health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-
dysregulation-disorder.shtml on 21st January, 2020 at 3:20 pm.
DSM-5 Criteria for Major Depressive Disorder Retrieved from https://

www.mdcalc.com/dsm-5-criteria-major-depressive-disorder on 1st January, 2020
at 10:30 am.
DSM 5 Somatic Symptom and Related Disorders, Retrieved from http://

www.workingfit.co.uk/medical-evidence/unexplained-and-exaggerated-symptoms/
dsm-5-somatic-symptom-and-related-disorders on 23rd January, 2020 at 10:00
pm.
Fundamentals of Addiction, Retrieved from https://www.porticonetwork.ca/web/

fundamentals-addiction-toolkit/introduction/dsm-critieria on 7th January, 2020.

Pearson. 157
Promotion of Physical Hartney, E. (2019). DSM 5 Criteria for Substance Use Disorders, Retrieved
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from https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-
21926 on 7th January, 2019 at 10:30 pm.
Jacofsky, M. D; Santos, M. T; Khemlani-Patel, S and Neziroglu, F. (2020).

Other Anxiety-Related Disorders, Retrieved from https://
www.gracepointwellness.org/1-anxiety-disorders/article/38489-other-anxiety-
related-disorders on 22nd January, 2020 at 11:00 am.
Katz, E (2017). Psychosomatic Illness, Retrieved from https://

www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/
psychosomatic-illness/ on 5th January, 2020 at 8:00 pm.
Kumar NN, Panchaksharappa MG, Annigeri RG. Psychosomatic Disorders: An

Overview for Oral Physician. J Indian Acad Oral Med Radiol 2016;28:24-9
Leonard, J. (2018). What does Anxiety Feel Like and how does it Affect the
Body? Retrieved https://www.medicalnewstoday.com/articles/322510.php.
Levenson, J. L; Dimsdale, J and Solomn, D. (2019). Psychological Factors

Affecting other Medical Conditions: Clinical Features, Assessment, and Diagnosis.
Retrieved from https://www.uptodate.com/contents/psychological-factors-affecting-
other-medical-conditions-clinical-features-assessment-and-diagnosis#H2749316 on
23rd January, 2020 at 10:30 pm.
Marks, D. F; Murray, M; Evans, B; Willig, C; Woodall, C and Sykes, C.

publications.
Premenstrual Dysphoric Disorder, Retrieved from https://medlineplus.gov/ency/

article/007193.htm on 20th January, 2020 at 5:00 pm.
Rauch, J. (2017). Different Types of Anxiety Disorders: How Are They

Classified? Retrieved from https://www.talkspace.com/blog/different-types-anxiety-
disorders-classified/ on 22nd January, 2020 at 2:30 pm.
Ray, W. J. (2015). Abnormal Psychology. Delhi: Sage Publications.
Robinson, O. J; Vytal, K; Cornwell, B. R and Grillon, C. (2013). The Impact

of Anxiety upon Cognition: Perspectives from Human Threat of Shock Studies.
Frontiers in Human Neuroscience. doi: 10.3389/fnhum.2013.00203.
Sarafino, E. R and Smith, E. W. (2011). Health Psychology: Biopsychosocial

Sears, D. O. Peplau, A. L; and Taylor, S. E; (1991) Social Psychology.

Englewood Cliffs, New Jersey: Prentice Hall.
Shipon-Blum, E. (2020). What is Selective Mutism? Retrieved from https://

selectivemutismcenter.org/whatisselectivemutism/ on 22nd January, 2020 at 11:00
158 pm.
Somatic Symptom Disorder, Retrieved from https://www.mayoclinic.org/diseases- Mental Illness
Experiences
conditions/somatic-symptom-disorder/symptoms-causes/syc-20377776 on 6th
January, 2019 at 11:00 pm.
The Difference between Regular Feelings of Anxiety and a True Anxiety Disorder,
retrieved from http://www.ulifeline.org/articles/439-anxiety-vs-anxiety-disorders
on 5th January, 2020 at 5:45 pm.
Weiss, T. C. (2015). Psychosomatic and Somatoform Disorders: Information,

Types and Treatment, Retrieved from https://www.disabled-world.com/disability/
types/psychological/psychosomatic.php on 6th January, 2020 at 10:00 pm.
What Are Anxiety Disorders? Retrieved form https://www.psychiatry.org/patients-

families/anxiety-disorders/what-are-anxiety-disorders on 22nd January, 2020 at
3:00 pm.
What is Substance- Induced Anxiety Disorder? retrieved from https://

www.summ itm edi calgr oup.c om/ li brary/ad ult _heal th/
bha_substance_induced_anxiety_disorder/ on 22nd January, 2020 at 2:15 pm.
WHO releases new International Classification of Diseases (ICD 11), Retrieved

from https://www.who.int/news-room/detail/18-06-2018-who-releases-new-
international-classification-of-diseases-(icd-11) on 22nd January, 2020 at 3:45
pm.
Veeraraghavan, V and Singh, S. (2014). A Textbook of Abnormal and Clinical

Psychology. New Delhi: Mc- Graw Hill Education (India) Private Limited.
11.8 KEY WORDS

Anxiety : Anxiety is defined as the response to prolonged,
unpredictable threat, a response which
encompasses physiological, affective, and
cognitive changes
Depression : Depression is one of the mental illnesses and

categorised under mood disorder as per DSM
(Diagnostic and Statistical Manual) 5
Psychosomatic illnesses : Psychosomatic illness can be defined as any

illness that is caused, exacerbated, or
perpetuated–either fully or partially – by
psychological factors.
Substance abuse : Substance abuse can be defined as a pattern

of harmful use of any substance for mood-
altering purposes. “Substances” can include
alcohol and other drugs (illegal or not) as well
as some substances that are not drugs at all.
159
and Mental Health 11.9 ANSWERS TO CHECK YOUR PROGRESS
1) How is depression different from sadness?
Depression can be differentiated from sadness not only in terms of degree

but also in terms of duration. Being sad is an emotion and is often
experienced as a result of situations like a failure, break up (in relationship),
death of a near or dear one and so on. But a person with depression
may experience depressed mood, lack of hope, interest and pleasure in
any situation. An individual with depression may have all the valid reason
to be happy and cheerful but they are not able to experience any pleasure
or interest and feel hopeless and depressed.
2) List the treatments for depression.
 Techniques that can be employed to manipulate brain activities
 Medication that can have an effect on neurotransmitters so that the

brain processes can be controlled (facilitated or inhibited)
 Psychotherapy (including Cognitive Behaviour Therapy, Emotion Focused

Therapy and Psychodynamic therapy)
 Exercise and meditation
1) What is Anxiety?
Anxiety is defined as the response to prolonged, unpredictable threat, a

response which encompasses physiological, affective, and cognitive changes.
2) List any five anxiety disorders.
 Separation Anxiety Disorder
 Panic Disorder
 Agoraphobia
 Social Anxiety Disorder (Social Phobia)
 Generalised Anxiety Disorder
1) Define Psychosomatic illnesses.
Psychosomatic illness can be defined as any illness that is caused,

exacerbated, or perpetuated–either fully or partially– by psychological
factors.
160
Check Your Progress IV Mental Illness
Experiences
1) State the ten different classes of drugs under Substance- related and
Addictive Disorders as stated in DSM 5.
The Substance- related and Addictive Disorders include ten different classes
of drugs, namely, alcohol; caffeine; cannabis; hallucinogens (with separate
categories for phencyclidine [or similarly acting arylcyclohexylamines] and
other hallucinogens); inhalants; opioids; sedatives, hypnotics, and anxiolytics;
stimulants (amphetamine-type substances, cocaine, and other stimulants);
tobacco; and other (or unknown) substances

1) Explain depression with a focus on how it is stated and classified under
DSM 5.
2) Discuss anxiety and anxiety disorders.
3) Describe psychosomatic illnesses.
4) Explain Substance use disorders.
161
UNIT 12 PREVENTION, MANAGEMENT
AND INTERVENTION*
Structure
12.1 Objectives
12.2 Introduction
12.3 Cultivating Human Strengths and Virtues
12.4 Hope and Optimism
12.4.1 Approaches to Optimism
12.4.2 Hope Theory
12.5 Gainful Employment

12.5.1 The Strength-Based Approach to Work
12.6 Work Life Balance

12.7 Exercise and Nutrition
12.8 Yoga and Meditation
12.9 Let Us Sum Up
12.10 References
12.12 Key Words
12.1 OBJECTIVES
After reading the Unit, you will be able to:
 describe different ways of promoting health and well-being;
 elucidate the preventive approaches as well as intervention measures for
health behaviours;
 discuss the character strengths model and its use in health and well-being;
 know the approaches to optimism and hope theory and their application
for human well-being;
 discuss the ways of gainful employment and how it helps in the individual’s
well-being; and
 explain the role of exercise, nutrition, yoga and meditation in health and
well-being of people.
12.2 INTRODUCTION
As you have learned in the previous units, health is not an uni-dimensional
concept. It is better understood and effectively managed from a multi-dimensional
approach. You have learned the role of biological, psychological and social
162 * Prof. Swati Patra, Faculty, Discipline of Psychology, SOSS, IGNOU, New Delhi
factors in explaining health and illness. The biopsychosocial model plays a crucial Prevention, Management
and Intervention
role in health behaviours. We need to be aware about the health compromising
behaviours such as smoking, substance use etc. that negatively impact both our
physical and mental health. And the focus should be on the health enhancing
behaviours and health protective behaviours. Hence a multi-centric approach
involving preventive approach as well as intervention approach towards health
and well-being is required. This can focus on the different aspects of our life
including physical health, personal character development, relationships, employment
and career, and mental health. In this Unit, you will learn about different ways
in which we can promote our health and well-being.
Health is defined by the WHO as a “state of complete physical, mental and
social well-being, and not merely the absence of disease or infirmity”. Both
physical and mental health are affected by our health behaviours. Health
behaviours refer to the behaviours or actions undertaken by people to maintain
and enhance their health. Certain behaviours can protect our health and some
enhance our health. Examples of some positive forms of health behavior are
exercise, balanced diet, avoiding drugs, adequate sleep, friendship and social
relations. Thus, the health behaviours are crucial as they prevent health problems,
and maintain and enhance our health and well-being.
Pursuit of good health and wellbeing is an important life goal. Managing our
health can be preventive, taking care of the things before the problem occurs
as well as intervention based, after the illness has occurred. Both are essential
and affect our health and well being.
We will discuss in the present Unit various strategies to promote health and
well-being that can be used both as a preventive and intervention measure.
12.3 CULTIVATING HUMAN STRENGTHS AND

VIRTUES
Psychology has always focused on the mental illness and the problems in human
life. However, with the advent of positive psychology, emphasis has shifted to
focusing on the strengths in human beings. It goes beyond the medical model
of diseases and illness only and strives to enhance life by cultivating inner strengths
and virtues. As the World Health Organization (WHO) has stated, mental health
is not merely the absence of disorders or mental illness, but also to achieve
psychological well-being. The WHO defines mental health as “a state of well-
being in which the individual realises his or her own abilities, can cope with
the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to his or her community”.
Thus, we need to focus on the potentials and character strengths each of us
has to live our life fully.
Similar to the Diagnostic and Statistical Manual which classifies the mental
disorders, Peterson and Seligman (2004) have devised a Values in Action (VIA)
model that classifies the human strengths. Strengths refer to the dispositional
qualities present in the people that act like their assets in their achievement of
things and promotion of health and well-being. They have organised the 24
character strengths under six broad virtues such as Wisdom and Knowledge,
Courage, Humanity, Justice, Temperance and Transcendence. Each of these
163
virtues has a subgroup of 3 to 5 character strengths resulting in a total of 24
Promotion of Physical strengths. The focus is on how each of these strengths contribute to optimal
and Mental Health
development and functioning (Park & Peterson, 2006a). Important point here
is that these human strengths are malleable (Peterson, 2006) and hence have
implications for their training and intervention.
Table 12.1: List of Character Strengths

VIRTUES CHARACTER STRENGTHS
WISDOM Creativity Curiosity Judgment Love Perspective

of
Learning
COURAGE Bravery Perseverance Honesty Zest
HUMANITY Love Kindness Social

Intelligence
JUSTICE Teamwork Fairness Leadership
TEMPERANCE Forgiveness Humility Prudence Self-

regulation
TRANSCENDENCE Appreciation Gratitude Hope Humor Spirituality

of Beauty
& Excellence
A growing body of research indicates the impact of the character strengths on

mental health, well-being and life satisfaction of people. In a recent study (Wagner
et. al., 2019), the 24 character strengths were examined across the PERMA
which represents five dimensions of well-being such as Positive emotions,
Engagement, Positive Relationships, Meaning and Accomplishment. It was found
that each of these well-being dimensions is related with various strengths. The
top two strengths for each dimension were as follows: zest and hope (positive
emotions); creativity and curiosity (engagement); love and kindness (positive
relationships); curiosity and perspective (meaning); and perspective and
perseverance (accomplishment).
Zhang and Chen (2018), in another study, found well-being to have robust
correlations with the strengths of hope, curiosity, zest, perseverance and love
among the university students. Gander et. al. (2019) also reported well-being
to have strongest relationships with zest, hope, curiosity and love. A comprehensive
review (Harzer, 2016) of research studies on character strengths pointed at
significant correlations with different aspects of well-being. Positive affect was
found to be related with strengths of curiosity, zest and hope; whereas negative
affect was related to strengths of honesty, forgiveness and humility. Environmental
mastery was related to zest and hope; personal growth related to strengths of
love of learning and curiosity; purpose in life was related to self-regulation,
perseverance, curiosity, zest and hope; autonomy related to honesty, bravery
and perspective; self-acceptance related with strengths of zest and hope; and
positive relationships related to love and social intelligence.
The character strength of transcendence was found to be associated with higher

levels of happiness and better mental health among the university students while
164
the strengths of temperance was associated with less happiness (Petkari & Ortiz- Prevention, Management
and Intervention
Tallo, 2016). The five character strengths showing a high and consistent
relationship with life satisfaction are hope (r =.53), zest (r = .52), gratitude
(r = .43), curiosity (r = .39), and love (r = .35) (Park, Peterson & Seligman,
2004).
Thus, various studies indicate association of different strengths with health and
wellbeing. This has implications for the promotion of health and well-being by
taking steps to inculcate these strengths in people.
1) Define Mental Health.
..............................................................................................................
..............................................................................................................
..............................................................................................................
..............................................................................................................
..............................................................................................................
12.4 HOPE AND OPTIMISM

The key to human survival, development and progress is the quality and strength
of hope and optimism. These character strengths are important inputs in the
making of a society and nation. The popular question of ‘Is the glass half full
or half empty?’ indicates the person’s orientation towards positive approach.
Each one answers as per his/her view of the world and the surroundings. People
vary in their overall level of optimism and pessimism, an optimist takes a positive
view of the situation whereas the latter takes a negative view of the same situation.
Having a positive view also involves a sense of personal control where the person
feels capable over the situation.
Personal control or personal causation involves a feeling that you are the
originator of action in your life (Baumeister, 1998) and this has been found
to be related to well-being (Argyle, 2001). In general, people have the need
for control and the perception of the self as capable of controlling the environment
(Carr, A. 2004). It helps reduce the stress response of the individual. This is
termed as a positive bias where people view themselves in an optimistic way.
This positive illusion (Shelly Taylor, 1989) involves the illusion of self
enhancement (viewing oneself in a very positive light or high self worth), an
unrealistic sense of personal control and an unfounded sense of optimism that
the future will be very rosy and safe. Thus, positive illusions act as self-deceptive
strategies that protect us from the feeling of helplessness and uncertainty and
to manage negative information.
Positive illusions include the following cognitive aspects (Taylor & Brown, 1994):
a) Selective attention and benign forgetting: It refers to focusing only on
the positive side of ourselves and not recalling the negative information about
the self. We forget the negative things about ourselves, thus selectively
attending to positive things only;
b) Pockets of incompetence: We identify areas of our incompetence where
we are not so good and then ring-fence those areas, thus pushing them
to the periphery. We pay attention to the aspects of the self having the
165
Promotion of Physical good attributes only. We do not consider the incompetence areas and thus
and Mental Health
maintain our self esteem and self worth.
c) Negative self-schema: Self schema refers to a set of beliefs about the
self. Negative self schema refers to the schema regarding the negative
characteristics or attributes of the self. So the person is able to explain
or justify negative evaluation of the self in any situation by attributing it
to the negative self-schema. For example, since I am an introvert, I could
not speak out well and the teacher selects only those students who can
speak well for the debate competition. This helps maintain the self esteem
of the individual.
These positive illusions get shattered in cases of traumatic events and chronic
illnesses. People facing such situations doubt their self worth, experience a sense
of lack of control and perceive a bleak future for themselves.
12.4.1 Approaches to Optimism
There are two major approaches to optimism: Optimism as a broad
personality trait characterized by general optimistic expectations (Scheier &
Carver, 1992), and optimism as an explanatory style (Seligman, 1998).
Dispositional Optimism : It is defined as a global expectation that the future
will bring a bounty of good things and a scarcity of bad things (Scheier &
Carver, 1992). Dispositional optimism views optimism as a broad personality
trait which refers to having a positive future outlook that good things will happen.
The opposite, that is pessimism refers to a negative expectation that future
outcomes will be bad. Optimistic people persist in the face of adversities and
they believe in themselves. Further, they self-regulate them and use effective
coping strategies to deal with the difficulties and achieve the desired goals.
Optimistic Explanatory Style : This approach explains optimism in terms of
how optimistic people explain the negative events or the setbacks. They use
an explanatory style that points to causes that are external, transient and specific.
For example, I failed in the exam because there were tough questions. On the
other hand, pessimists explain the negative events by attributing their cause to
internal, stable and global factors, For example, I am not good in studies. Thus,
an optimistic explanatory style points at the circumstances/situations whereas the
pessimist attributes it as a personal failure.
Optimism acts as a source of motivation. In optimistic explanatory style, when
we say the cause of the negative experience is external, we point to outside
situations and these are not under our control; transient means it is temporary
and may go away (Example, I could not attend the classes because of my
illness); specific refers to a particular cause. Thus, this attribution style offers
control over the situation and generates a positive future outcome expectation.
12.4.2 Hope Theory
Hope is positively correlated with optimism. Snyder (2000) has proposed that
hope consists of two key aspects such as (a) the ability to plan pathways to
desired goals despite obstacles, and (b) agency or motivation to use these
pathways. We can see that the ability to plan pathways is related to the positive
future expectations as involved in dispositional optimism, whereas the agency
is emphasized in optimistic explanatory style. Thus, Snyder has combined these
166 two elements of expectation and agency in his Hope Theory.
Hope is characterized by a goal-directed behavior. The individual faces an Prevention, Management
and Intervention
obstacle while working towards achieving a goal. The individual will find ways
to overcome the challenges, thus exploring the possible pathways and having
a positive expectation regarding the effectiveness of the pathways. Here, the
thoughts focusing on personal agency, that is, how effective one will be in
following the pathways to reach the goal, also plays a role.
These three aspects of a goal-directed behavior, pathways and agency operate
in the context of the thoughts/ learning experiences of the individual acquired
during the developmental stages of life. These affect the way we perceive cause
and effect relationship related to events and situations and the self as instrumental
in this. Agency thoughts is related to the efficacy expectancy and the pathways
thoughts are related to the outcome expectancy.
Snyder (2000) suggests that hope develops in a clearly defined way over the
developmental stages of infancy, childhood and adolescence. The developmental
milestones achieved in these stages help them to develop goal-directed activities,
plan paths to overcome barriers to valued goals, and engage in hopeful pursuits.
A secure attachment with parents, supportive family environment and consistent
and structured rules at home help children develop a hopeful disposition.
Optimism and hope are related to positive outcomes. Studies have found these
to be related to physical health, mental health and well-being (Jahanara, 2017;
Hasnain, Wazid, & Hasan, 2014; Arnau, Rosen, Finch, Rhudy, & Fortunato,
2007; Bailey, Eng, Frisch & Snyder, 2007; Schiavon, Marchetti, Gurgel,
Busnello, & Reppold, 2016). Other studies have explored the role of hope
in job performance (Peterson & Byron, 2008). Further, Verma, Agarwal, &
Mishra (2018) found academic achievement to have significant positive correlation
with hope and optimism, and advocated for developing programmes on hope
and optimism to help students to improve their academic performance.
Thus, both hope and optimism are positive feelings and motivational states and
help us overcome life challenges. Positive expectancies are involved in both,
that everything is good in future. However, hope involves going beyond this
and integrates conceptualisation of goals, pathways or strategies to achieve those
goals and the motivation to pursue those goals. It is pertinent to note here that
hope, optimism and self-efficacy are related terms, all focusing on the
expectancies towards goal attainment. However, they also differ from each other
in important ways. People with self-efficacy expect that they will master a domain.
Optimism involves a positive expectancy for future outcomes without considering
one’s personal control over the outcome. On the other hand, people with hope
have both the will and the pathways and strategies necessary to achieve their
goals (Kaufman, 2011). It involves beliefs about the self as agency to control
the things, to pursue in face of difficulties, be resilient and bring in changes.
1) Explain dispositional optimism.
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................................................................................................................. 167
Promotion of Physical 2) What is positive illusion?
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3) Hope theory emphasises on the two elements of ................................. and
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12.5 GAINFUL EMPLOYMENT

One’s work or employment occupies an important place in one’s life. Work
is the most important determinant of quality of life after personal relationships
(Linley & Joseph, 2004). It significantly affects every other aspects of one’s
life. Gainful employment in psychology refers to the benefits derived from work
that contributes to our well-being. The term ‘gainful employment’ was coined
by Snyder, Lopez and Pedrotti (2011) to highlight the role of one’s work in
producing a healthy life. According to them, gainful employment includes the
following nine components.
 Happiness and satisfaction out of the work: Work or employment has
a central role in the well-being of the individual. It gives an identity to
the individual. It offers meaning to the life of the individual. Getting ready
in the morning to get to the work makes life more organized and structured.
In fact, happiness from work is the main benefit of gainful employment
as it is related to all other aspects. For instance, our job provides us the
income to support ourselves and our family. It engages us in some work,
and gives us a feeling of contributing and achieving something. Our work
also connects us to other people and caters to the fulfillment of our social
needs and support. It fulfills our need to belong and relate to others. Gainful
employment has clinical implications as well (Perkins, Raines, Tschopp, &
Warner, 2009). It reduces the stigma associated with people who have
suffered from mental disorders. Thus, our work affects how others perceive
us. It also acts as a buffer against stress, depression and anxiety. If we
talk in terms of Maslow’s hierarchy of needs, work contributes to the
satisfaction of all the needs either directly or indirectly. Thus, our work
is related to our physical well-being, psychological well-being as well as
social well-being, and is instrumental for our happiness and satisfaction in
life.
 Positive engagement: Work is fulfilling when the individual is involved
in it in a very positive way. There is engagement with the work, spending
time and energy willingly to do various things as part of one’s work. Here,
the employee is aware and have clear idea of the tasks and expected
responsibilities at work. Thus, positive engagement refers to those
circumstances in which employees “know what is expected of them, have
what they need to do their work, have opportunities to feel something
significant with coworkers whom they trust, and have chances to improve
and develop” (Harter et.al., 2002, pg. 269). We will feel engaged to our
work when we are able to perform and deliver in the workplace. This
will require a matching between the work expectations and the skills and
abilities of the employee. In such situation, the employee will feel motivated
to get involved in the work and perform well. It also leads to satisfaction
168 and happiness regarding one’s work.
 Income for family and self: One of the main aspects of work is the Prevention, Management
and Intervention
income which plays an important role in meeting the needs and requirements
in one’s life. It also serves as a great incentive for employee performance.
Though money is not everything, still it has a crucial role as it is required
to meet the basic needs and maintain a decent lifestyle. The general
conception is that the more one earns, the more one is happy in life. It
follows from this that richer people are more happy. However, research
has shown that more money does not necessarily lead to happiness.
However, a decent income is required so that the employee is able to
take care of self and the family.
 Variety in work: Life is monotonous without any variety in it. This holds
true with regard to our work also. We become lethargic, and uninvolved
if our work is repetitive, routine without any challenge and creativity. As
it is said, variety is the spice of life. Our work also needs to include as
much variety and stimulation as possible in their work activities (Hackman
& Oldham, 1980). Employees will feel excited to go to the work every
day if it offers opportunity to be involved in a variety of activities. It will
enable to use their skills and thus enhance their self concept and positive
engagement at work.
 Performing well and meeting goals: Employees need to have a sense
of achievement in work to call it as a gainful employment. This sense of
achieving at workplace will be generated when the employee is able to
complete the work tasks and meet the goals as required. Importance of
this can be observed in the spillover from work to home and family. If
we feel happy at work because we are able to achieve the desired work
related goals, this also affects positively our interaction at home with the
family. Performance at work is related to a sense of effectiveness and leads
to general satisfaction.
 Safe work environment: Perceived safety of the workplace was found
to be one of the strongest predictors of employee satisfaction (Harter et.
al., 2002). Employees need to have a safe and healthy physical environment
so that they can focus more on work and be productive and happy.
 Respect and appreciation for diversity at work: Workplace may have
employees from diverse backgrounds and abilities. This is more so in the
present globalised work culture. One basic thing in a multi-cultural work
environment is the need for respect and appreciation for each individual
coming from a variety of backgrounds including their gender, abilities and
disabilities, social, economic and cultural contexts. An inclusive work
environment gives a sense of being valued and happiness among the
employee. Further, it also leads to effective decision-making as it considers
the workforce diversity.
 Companionship and loyalty at work: Work offers us an opportunity to
form companions and friends. It leads to bonding together over shared
work experiences and contexts, both in physical space as well as
psychological aspects. The workplace offers a social world of its own that
creates friendships, support systems and loyalty to the institution. All these
fulfills the need for belongingness and creates a work identity for the
employees. 169
Promotion of Physical  A sense of purpose in doing the work: If there is no purpose derived
and Mental Health
from doing one’s work, the employee will lack in positive engagement and
happiness in one’s work. Purpose gives a sense of contribution to other
people and to the society (Snyder, Lopez and Pedrotti, 2011). It provides
meaning to one’s life in this world. Here, the employee is not concerned
about the physical and material aspects of the work, but is focused on
the commitment and passion towards the work.
Thus, gainful employment offers several benefits. Another major element in gainful
employment includes a focus on the strengths of the employee.
12.5.1 The Strength-based Approach to Work
The general approach in the employment sector is to follow a “fix it” model.
If an employee is lacking in something, then fix it, that is, train him in that aspect.
Thus the focus is on improving on what is not there in the employee which
the organization/company requires. However, why not focus on what is there
in the employee, the strengths? A strengths-based approach to work will make
use of the strengths or the resources available with the employee for the benefit
of the company. It will require to assign the employee those tasks that make
use of his strengths or design the job activities around his skills and talents.
This will lead to gainful employment for the employee in terms of the nine aspects
described earlier. Thus, finding out the strengths and building on those strengths
are more important and helpful than addressing the weaknesses (Hodges &
Clifton, 2004, pg. 256).
There are three stages in the strengths-based approach to gainful employment
(Clifton & Harter, 2003):
 Identification of the assets or strengths in the employee.
 Integration of these strengths or talents into the employee’s self-image, so
that s/he consciously becomes aware of these.
 Attribution of any success or achievement in job to these strengths of the
employee, thus highlighting behavioural change in the employee where s/
he focuses and owns the strengths or assets she or he has.
1) Explain gainful employment.
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12.6 WORK LIFE BALANCE

In the changing work scenario of the 21st century, an emerging issue facing
the population is the work life balance. The changing work culture, shift work,
effect of globalisation, increased work time, dual income families, decreased
social support, increase in nuclear families etc. have made it challenging for the
working individuals to maintain a happy and healthy balance between their work
on the one hand and personal and social life on the other hand.
170
The present generation is facing a hard time trying to maintain a balance between Prevention, Management
and Intervention
their personal life and professional life. This negatively affects the health and
well-being of people. It leads to various life style related disorders such as high
blood pressure, cardiac related problems, diabetes etc. and mental health
problems also. Maintaining a work life balance will help us to prevent and manage
these and enhance our well-being.
The concept of work life balance refers to striking a balance between work
related activities and personal life related activities. Work here refers to paid
work. When the person is engaged in work, there are certain work related
demands which the person needs to do to effectively perform in the work. At
the same time, the person also needs to give time to himself for his own enjoyment
and leisure activities and also take out time for his family and friends. Splitting
of time between the two becomes a challenging prospect for the person as
he finds hard to allot equal time for both. There is always a spill over from
work to family and also from family to the work. This creates tensions, stress
and frustration and leads to negative health conditions.
Therefore, we need to take steps for maintaining a healthy work life balance.
A few things need to be taken care of in this regard. Work life balance does
not mean allocating equal time and energy to work and personal life. Rather,
it is achieving a harmony between the two fields. As Hudson (2005) puts it,
work life balance refers to a satisfactory level of involvement or ‘fit’ between
the multiple roles in a person’s life. Work life balance also involves prioritizing
of different demands on oneself. Work life balance is about understanding your
priorities, both at professional level in terms of work demands, targets, career
goals, advancements, job performance etc. and at personal level in terms of
family interaction, leisure time, pursuing hobbies, social life and so on. Thus,
it depends on each individual to prioritise the things and achieve a balance
between the roles in a way which ultimately leads to a sense of happiness and
satisfaction in the individual. Thus, the right balance may differ from one individual
to another.
1) What are the reasons for lack of work life balance in the today’s society?
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12.7 EXERCISE AND NUTRITION

Good food and proper exercise go a long way in preventing diseases and
disorders in people. Studies have time and again emphasised the benefits of
having a proper nutrition and a regular proper regimen of exercise in contributing
to our physical health and mental health. Godman (2018) presents the findings
that regular exercise improves memory and thinking skills of the brain. Studies
have also reported evidence of the effectiveness of regular physical activity in
the primary and secondary prevention of several chronic diseases (e.g.,
cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and
osteoporosis) and premature death (Warburton, Nicol, & Bredin, 2006). In a
171
Promotion of Physical systematic review of fifteen longitudinal studies on the health benefits of physical
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activity, the researchers reported positive long-term influence of physical activity
on non-communicable diseases such as coronary heart disease, type 2 diabetes
mellitus, alzheimer’s disease, dementia, obesity and weight gain (Reiner,
Niermann, Jekauc, & Woll, 2013).
Further, exercise has also been found to improve mental health, reduce anxiety,
depression and improve the mood (Sharma, Madaan, & Petty, 2006; Callaghan,
2004; and Guszkowska, 2004).
Relationship between food and our physical health has always been known.
However, what we eat also affects how do we feel. Various studies have pointed
out the effect of food on the mental health of people (O’Neil et. al., 2014).
Research has also focused on the relationship between diet and mental health
in children and adolescents (O’Neil, Quirk, Housden, Brennan, Williams, Pasco,
et.al., 2014). The study of food affecting our mental health has been emerging
as the field of ‘Nutritional Psychiatry’ which focuses on how what we eat
affects not only our physical health but also our psychological well-being. Food
plays an essential role in our health and we need to be aware of it so that
we make an informed choice about what to eat and what not to eat.
Hence, one needs to make it a habit to engage in exercise and have good
nutrition. We need to think these as prescriptive medicines which we need to
take on a regular basis for our health and well-being.
1) List three benefits of exercise.
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12.8 YOGA AND MEDITATION

Yoga and meditation are ancient practices that have been used in the Indian
cultural practices since long. They have impact on both physical and mental
health (Gangadhar & Porandla, 2015; Khalsa, 2013; Shroff & Asgarpour, 2017;
Gururaja, Harano, Toyotake, & Kobayashi, 2011; Büssing, Michalsen, Khalsa,
Telles, & Sherman, 2012). Yoga as practiced in the ancient Indian context had
the objective of going beyond oneself, cultivating awareness and developing self-
realization. Yoga is being used predominantly in the present times in three main
ways: asanas or postures, breathing exercises, and meditation. Practice of these
brings about better physical and mental health. The United Nations has declared
21st June every year as the International Yoga Day to create awareness and
encourage people to practice yoga for their betterment and well-being.
The term meditation refers to a family of self regulation practices that focus
on training attention and awareness in order to bring mental processes under
greater voluntary control and thereby foster general mental well-being (Walsh
& Shapiro, 2006, pg. 228). Mindfulness meditation is a practical tool to focus
172 on oneself – one’s thoughts, feelings and actions. As Kabat-Zinn
(1990 pg. 26) points out, mindfulness is not a mystical or spiritual activity, rather Prevention, Management
and Intervention
it helps to see all life’s problems more clearly through a clear mind). We usually
go about our day-to-day life without giving much attention to our thoughts or
feelings. In the process, we do not stay connected to the present moment. Either
we live in the past, constantly comparing things with the past situation, or worried
by future uncertainties and fears. For example, when you are performing on
stage, you may start linking it to your past performance where you could not
do it properly, or get stressed that the audience will point your mistakes and
make fun of you.
Mindfulness thus involves paying attention to and be aware of the present moment
or moment-to-moment experience without judging or evaluating it. Thus, it can
be said to consist of the following seven attributes such as, Non-judging,
Patience, Open mind, Trust, Non-striving, Acceptance, and Letting go (Kabat-
Zinn, 1990). One needs to practice these seven essential qualities to develop
mindfulness.
People do have mindfulness moments in their life, for example, when one is
fully engrossed in a cricket match or writing a story. However, this needs to
be practiced in all aspects of life, whether eating, walking, listening or studying
or doing any work. Hence, mindfulness, as a personal quality, needs to be first
cultivated gradually in the limited context of meditation, and then it begins to
transfer to other aspects of life (Baumgardner & Crothers, 2015, pg. 290).
Check Your Progress VI
1. Mention the main attributes of mindfulness.
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12.9 LET US SUM UP

The present Unit focused on the prevention and intervention strategies for
achieving health and well-being. Following a biopsychosocial approach to health,
factors related to all these dimensions need to be taken into account as having
an impact on our health. Thus, various ways and strategies were discussed
including good nutrition, exercise, yoga and meditation. Positive psychological
constructs such as optimism and hope were explained as being crucial in
maintaining our well-being. A strengths –based approach was also highlighted
in the context of work, focusing on the employee assets. This results in gainful
employment which has significant influence on employee health and well-being.
It is not only the factor of money but there are other factors also associated
with gainful employment and having an impact on our well-being. In this context,
maintaining a work life balance was also explained as impacting our health and
well-being. 173
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12.11 KEY WORDS

Strengths : Strengths refer to the dispositional qualities
present in the people that act like their assets
in their achievement of things and promotion of
health and well-being.
Positive illusion : It involves the illusion of self enhancement
176 (viewing oneself in a very positive light or high
self worth), an unrealistic sense of personal Prevention, Management
and Intervention
control and an unfounded sense of optimism that
the future will be very rosy and safe (Shelly
Taylor, 1989).
Hope : It consists of two key aspects such as (a) the
ability to plan pathways to desired goals despite
obstacles, and (b) agency or motivation to use
these pathways (Snyder, 2000).
Gainful employment : It refers to the role of one’s work in producing
a healthy life.
Work life balance : It refers to a satisfactory level of involvement
or ‘fit’ between the multiple roles in a person’s
life (Hudson, 2005).
Mindfulness : Mindfulness involves paying attention to and be
aware of the present moment or moment-to-
moment experience without judging or evaluating
it.

1) Define Mental Health.
The WHO defines mental health as “a state of well-being in which the
individual realises his or her own abilities, can cope with the normal stresses
of life, can work productively and fruitfully, and is able to make a
contribution to his or her community”.
1) Explain dispositional optimism.
Dispositional optimism is defined as a global expectation that the future
will bring a bounty of good things and a scarcity of bad things (Scheier
& Carver, 1992).
2) What is positive illusion?
Positive illusion involves the illusion of self enhancement (viewing oneself
in a very positive light or high self worth), an unrealistic sense of personal
control and an unfounded sense of optimism that the future will be very
rosy and safe (Shelly Taylor, 1989).
3) Hope theory emphasises on the two elements of expectation and agency.
1) Explain gainful employment.
Gainful employment in psychology refers to the benefits derived from work
that contributes to our well-being. The term ‘gainful employment’ was coined
by Snyder, Lopez and Pedrotti (2011) to highlight the role of one’s work
in producing a healthy life. 177
Promotion of Physical Check Your Progress IV
and Mental Health
1) What are the reasons for lack of work life balance in the today’s society?
The reasons for lack of work life balance in the today’s society changing
work culture, shift work, effect of globalisation, increased work time, dual
income families, decreased social support, increase in nuclear families etc.
1) List three benefits of exercise.
Exercise has been found to improve mental health, reduce anxiety and
depression and improve the mood.
Check Your Progress VI
1) Mention the main attributes of mindfulness.
Mindfulness consist of seven attributes, namely, non-judging, patience, Open
mind, Trust, Non-striving, Acceptance, and Letting go (Kabat-Zinn, 1990).

1) Discuss the nine elements of gainful employment.
2) Explain the strengths based approach to work.
3) What is mindfulness and how it can help us in achieving health and well-
being?
4) Discuss the role of optimism and hope in contributing to good health.
178
SUGGESTED READINGS
Agarwal. R. (2001). Stress in Life and at Work. New Delhi: Sage Publications.
Baumgardner, S., & Crothers, M. (2015). Positive Psychology. Noida, UP, India:
Pearson.
Carr, A. (2004). Positive Psychology: The Science of Happiness and Human
Strengths, NY: Routledge.
Cartwright, S and Cooper, C. L. (1997). Managing Workplace Stress. New
Delhi: SAGE.
Davidson, J. (2004). Stress Management. Petaling Jaya, Malaysia: Advantage
Quest.
Edworthy, A. (2000). Managing Stress. Philadelphia. Open University Press.
Gregson, S. (2000). Stress Management. Mankato, MN: Capstone Press.
Hancock, P. A., & Desmond, P. A. (2008). Stress, Workload and Fatigue.
Boca Raton, Fla: CRC Press.
Hariharan, M., & Rath, R. (2008). Coping with Life Stress. New Delhi: Sage
Publication.
Johnson, S. L., Hayes, A. M., Field, T., Schneiderman, N. & McCabe, P.
M. (2000). Stress, Coping, and Depression. New Jersey: Lawerence Erlbaum
Associates.
Lazarus, R. S. & Folkman, S. (1984). Stress, Appraisal and Coping. New
York: Van Nostrand.
Linden, W. (2005). Stress Management. Thousand Oaks, Calif.: SAGE
Publications.
Marks, D.F., Murray, M., Evans, B., & Estacio, E.V. (2015). Health Psychology.
(4th ed.). London: Sage.
Sarafino, E. (2004). Behavior Modification. Long Grove, IL: Waveland Press.
Sarafino, E.P., & Smith, T.W. (2017). Health Psychology: Biopsychosocial
Interactions, (9th ed.). John Wiley & Sons.
Snyder. C. R. (2001). Coping with Stress. Oxford: Oxford University Press.
Snyder, C.R., Lopez, S.J. & Pedrotti, J.T. (2011). Positive Psychology: The
Scientific and Practical Explorations of Human Strengths (2nd ed.), New Delhi:
Sage Publications.
Pestonjee, D. (1999). Stress and Coping. New Delhi: Sage Publications.
Pettinger, R. (2002). Stress Management. Oxford, U.K.: Capstone Pub.
Wainwright, D. & Calnan, M. (2009). Work Stress. Maidenhead: Open
University Press.
179
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BPCG-173

PSYCHOLOGY FOR HEALTH

School of Social Sciences

Block 2 Introduction to Stress

Course Coordinator : Prof. Suhas Shetgovekar

BLOCK 4 : PROMOTION OF PHYSICAL AND MENTAL

Unit 10 : Physical Illness Experiences II ................................... 132

Unit 11 : Mental Illness Experiences .......................................... 144

Unit 12 : Prevention, Management and Intervention ................ 162

1.4 Health-Illness Continuum

1.2 CONCEPT AND DEFINITION OF HEALTH

1.3.1 Western Perspective

As we have now developed an understanding of the concept of health, let us

Fig. 2.1: Health-Illness continuum

According to the Health-Illness continuum, health is dynamic. Our health moves

2) Complete the figure of Health-Illness continuum.

1.5 LET US SUM UP

Boyd, K. M. (2000). Disease, Illness, Sickness, Health, Healing and Wholeness:

Brannon, L., Feist, J., & Updegraff, J. A. (2013). Health Psychology: An

Dalal, A. K., & Misra, G. (Eds.). (2012). New Directions in Health

Ghosh, M. (2015). Health Psychology: Concepts in Health and Wellbeing.

Marks, D. F; Murray, M; Evans, Brian; Willig, C; Woodall, C and Sykes, C.

Melquiades, 2015. Concept of Health, Illness and Wellness. Retrieved from

Morrison, V., & Bennett, P. (2009). An Introduction to Health Psychology.

Rao, K., Paranjpe, A. C., & Dalal, A. K. (2008). Handbook of Indian

Svatastog, A. L; Doney, D; Kristoffersen, N. J and Gajovic, S. (2017), Concepts

Health: As defined by WHO, “it is a dynamic state of complete physical, mental,

Illness: An individual’s experiences and descriptions of his/her ill health.

Wellbeing: Wellbeing is a subjective feeling, which involves evaluation of those

1.8 ANSWERS TO CHECK YOUR PROGRESS

Health is a dynamic state of complete physical, mental, spiritual and social

2) List the three domains of health

The three domains of health are restoration, maintenance, and growth.

Check Your Progress II

1) Complete the sentences.

a) Ancient Greek culture believed in the role of four humors, namely

c) The Sanskrit word for health is Swastha.

Check Your Progress III

1) Who introduced Health-Illness Continuum?

2) Complete the figure of Health-Illness Continuum.

1.9 UNIT END QUESTIONS

2) Discuss the cross-cultural perspectives of health.

3) Write a note on Indian perspective on health.

4) Explain Health-Illness continuum.

Box 2.1: Health Psychology

2.2 MEDICAL MODEL OF HEALTH AND

Treatment: Since the focus of the medical model is always on biological or

Practitioner-Physician relationship: This model considers that

 It has a reductionist approach to human body and views it in the mechanistic

 It ignores any role of social, emotional, spiritual and psychological factors

 It is not always effective in treating many diseases. Specifically, any

 The issue of affordability is also associated with this model. Hospital

1) Why is medical model characterised as techno-oriented model?

2.3 HOLISTIC MODEL OF HEALTH

Box 2.1: A Summary of Major Differences between the Medical

Medical Model Holistic Models

1. Health: Absence of disease. Health: A sense of wellbeing.

2. Disease: Pathogenic agents, Disease: Disharmony between the

3. Healing: Is the treatment of Healing: Healing must entail a