Amity Institute of Psychology & Allied Sciences

Course Title- Psychological Interventions in Health Care

Module I : Introduction

A historical overview
Concept of psychological health in India
Nature of health and illness
Methodological developments
Scope of Health Psychology

Faculty: Dr. Zuby Hasan

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What do all of these examples have in common?

• Peyton is a first-year student at a prestigious law school. She is taking four
courses and works 10 hours a week as a paralegal to help pay her tuition.
Peyton is also busy applying for summer jobs and is a writer for the law
review journal. Although Peyton is under pressure, she takes a yoga class
three times a week and frequently gets together with friends for dinner. She
feels happy and healthy.

• Phillip is a senior in high school and smokes about a pack of cigarettes a

day. Although he knows that smoking causes some types of cancer, he
intends to quit smoking when he starts college next year, and he doesn’t
really see how smoking for just a few years is such a big deal. Most of his
friends smoke, and he would feel uncomfortable being the only one at a
party not smoking.

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Definition of Health Psychology

• Health psychology is an exciting and relatively new field devoted to

understanding psychological influences on
• how people stay healthy,
• why they become ill, and
• how they respond when they do get ill.

• Health psychologists both study such issues and develop interventions to

help people stay well or recover from illness.

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Psychological factors include

1. Stressors (taking exams, bereavement)

-Do you sometimes develop a headache when you are feeling tense?
-Do you sometimes feel nauseous before a ‘‘big game’’ or an important exam?
But how, can just taking an exam make you sick?

2. Personality factors (optimism, hostility, extraversion)

3. Social factors (social support , social influences)

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Historical review
• Prehistoric times- Humoral theory of illness by Hippocrates

• Middle ages- Supernatural explanation for illnesses

• Penance – through prayers and good works

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Biomedical Model-
• States that all illness can be explained on the basis of aberrant somatic bodily
processes, such as
biochemical imbalances or neurophysiological abnormalities.
• Disease is because of biological factors

Psychosomatic medicine
• based on the assumption that certain diseases and illnesses are caused by
psychological factors.
• Example- Hysterical paralysis by Freud
• Psychosomatic illnesses like peptic ulcers, essential hypertension, asthma

Biopsychosocial Model
• This model is an integration of biomedical perspective and psychosocial
perspective
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DIFFERENCE BETWEEN BIOMEDICAL AND BIO-PSYCHO-SOCIAL MODEL

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Concept of Psychological Health in India

• Vedas: Among the four Vedas - rigveda, samaveda, yajurveda and atharvaveda,
atharvaveda deals with mental health and illness.

• Atharvaveda has a certain norm, i.e., optimal functioning of the 'trigunas', and any
deviation results in abnormality.

TRIGUNAS (mental forces of living) are :

• Sattva (stability, spiritual quality),
• Rajas (activation, passion & desire, self interest), and
• Tamas (inertia, material quality and illusions)
'Satva' does not get corrupted. If there is an extraordinary increase or decrease in 'rajas' or
'tamas', then there is a resulting abnormality.

TRIDOSHAS (physical forces of living) are:

• vata (air), pitta (fire), and kapha(water & earth)
When there is an extraordinary increase or decrease in any of these, there is resulting
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Yoga
• Yoga, which is considered to be the advanced branch of Indian psychology, is a
comprehensive practical of self culture.

Self-culture means the physical, mental, moral, and spiritual unfolding of an individual.
Yoga aims at the evolution of personality.

• Patanjali gives eight steps

in his Ashtanga Yoga to achieve self culture, and ultimately a healthy personality.

• Thus, Yoga deals with the healthy personality and further development of it.

• It is only recently that Yoga is being applied with clinical cases with positive
findings, thus yoga is a preventive measure and also a curative one.

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Use of yoga and meditation in management of psychiatric

disorders

Yoga therapy is an effective adjunct treatment for

• depression,
• anxiety,
• PTSD
• schizophrenia.

It may provide relief for symptoms left untreated through common treatments such as
psychopharmacology and psychotherapy.

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Upanishads
• Following the Vedas, the Upanishads evolved its approach to mental health.

• In the Upanishads it is found that, personality consists of many dimensions –

• Anna maya (consist of)- physical body- bones tissues and muscles
• Pranamaya- energy, breath
• Manomaya- thoughts, feelings, mind and emotion
• Vignanamaya- subtle knowledge or wisdom
• Anandamaya- means bliss or spiritual

• These should collectively function to maintain equilibrium, i.e., homeostasis,

resulting in tranquility, which is the ultimate goal in life (Rao, 1975).

• Healthy personality means the healthy state of these components (Khurana &
Singh, 1984).

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Nature of health and illness

Models of Health Promotion and Illness Prevention

• The Health Belief Model the health belief model was developed in the 1950s by social
psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and
Howard Leventhal 

• The health belief model is concerned with what people perceive, or believe, to be true
about themselves in relation to their health.

• This model is based on 4 components of individual perceptions of threat of a disease:

• 1. Perceived susceptibility to a disease (risk)
• 2. Perceived seriousness of a disease (knowledge of disease)
• 3. Perceived benefits of action
• 4. Perceived barriers
• Cues to action and self efficacy
• https://youtu.be/EH0qPSzHdNc?t=632 13
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Methodological developments
• Observational/ Naturalistic methods
- Archival research, Case report/ Case study

• Survey methods

• Experimental methods (Quasi experiments)

• Clinical Methods

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1. NATURALISTIC / OBSERVATION
Naturalistic methods are used to describe behavior that occurs naturally in everyday
situations.

• This is the most commonly method used. Observations can be made either by directly
observing behavior by being present in scene of action or through indirect methods.

• Researchers use participant observation ,in which they observe a group's behavior and
interaction by being part of the group and rate the group. Researchers need not always
observe behavior directly as that may influence behavior, Thus is called non-participant
observation

Limitation :
Researcher has no control over any of the factors ,therefore are unable to study the impact of
several variables.
• Observer own bias influences the investigation and interpretation despite all measures in
trying to be objective.
• Verifiability is minimal in this method
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2. CASE STUDY

• This kind of research ,also known as single - subject design is useful in describing the
development and treatment of unusual medical and psychological problems.

• It is an in-depth analysis of an individual ,group or event in which a trained researcher

constructs a systematic biography based on observation , interviews and available records.

• It helps in determining the causes of the person's behavior and also to understand and
predict behavior of others who are similar.

Limitations

• Can't directly test the hypothesis and determine the cause-effect relationship.
• Generalizing of findings on large population from case study method can be questionable.
• Their is lack of objectivity in the way data is gathered and interpreted ,since it is based on
researcher's subjective impression.
• They alone can't give scientific evidence ,it needs to be backed by other empirical data
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3. CORRELATION METHOD

• Not a experimental research in a strict sense but this research is useful in

tracking down the variables that are more relevant to the research .

• Correlation-statistical procedure that assess relationship between 2 or more

variables.

• Helps in determining whether a given set of variables are associated/correlated

Limitations
• Not allows us to say causative effects.

• Measures the variables as it exists without having any control over them.

• Leaves out any other factors that could have possibly been responsible.
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Much research in health psychology is correlational research, in which the health

psychologist measures whether a change in one variable corresponds with changes in
another variable.

A correlational study, for example, might reveal that people who are more hostile have a
higher risk for cardiovascular disease. The disadvantage of correlational studies is that
it is difficult to determine the direction of causality unambiguously.

For example, perhaps cardiovascular risk factors lead people to become more hostile.

On the other hand, correlational studies often have advantages over experiments
because they are more adaptable, enabling us to study issues when variables cannot be
manipulated experimentally.

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4. EXPERIMENTAL METHOD

• Most powerful techniques used in scientific study.

• Often used by health psychologist to study several aspects of human behavior.

• This is the method wherein the researcher manipulate an independent variable.

• All other variables are held constant except the independent variable.

Ex: suppose if a researcher wants to know whether yoga removes stress. A team of
volunteers and all those who have stress will only be selected. Then they are randomly
divided into groups to ensure that attributes like gender , personality traits are equally
distributed.
EXPERIMENTAL GROUP- provided yoga training for specific period.
CONTROL GROUP- which is not provided with any training, groups are made for possible
comparisons in dependent variable. If experimental groups feels less stress after yoga
training then the hypothesis is supported. Yoga is found to reduce stress.
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What kinds of experiments do health psychologists undertake?

To determine if social support groups improve adjustment to cancer, cancer patients might
be randomly assigned to participate in a support group or to a comparison condition, such as
an educational intervention. The patients could be evaluated at a subsequent time to pinpoint
how the two groups differed in their adjustment.

Experiments have been the mainstay of science, because they typically provide more
definitive answers to problems than other research methods.

When we manipulate a variable and see its effects, we can establish a cause-effect
relationship definitively.

For this reason, experiments and randomized clinical trials are the gold standards of health
psychology research. However, sometimes it is impractical to study issues experimentally.
People cannot, for example, be randomly assigned to diseases. In this case, other methods,
such as correlational methods, may be used.
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• You are interested in examining the association

between television watching and obesity in children.
• How would you test this association using survey
methods as compared to experimental methods?

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Methodological Tools
1. Tools of Neuroscience
• functional magnetic resonance imaging (fMRI) that permit glimpses into the brain.

• This area of research has also produced burgeoning knowledge of the autonomic,
neuroendocrine, and immune systems that have made a variety of breakthrough studies
possible.

• For example, health psychologists can now connect psychosocial conditions, such as
social support and positive beliefs, to underlying biology in ways that make believers out
of skeptics

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2. Mobile and Wireless Technologies

• The revolution in technology has given rise to a variety of tools to intervene in and assess
the health environment (Kaplan & Stone, 2013).
• Ecological momentary interventions (EMI) (Heron & Smyth, 2010) make use of cell
phones, pagers, palm pilots, tablets, and other mobile technologies to deliver
interventions and assess health-related events in the natural environment. Interventions
using EMI have included studies of smoking cessation, weight loss, diabetes
management, eating disorders, healthy diet, and physical activity.

• Mobile health technologies can assess some biological processes.

Ambulatory blood pressure monitoring devices are available to people who are at risk for or
have already been diagnosed with hypertension to help them manage their blood pressure
more successfully.
People with diabetes can monitor their blood glucose levels multiple times a day.

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3.Meta-analysis

• Meta-analysis combines results from different studies to identify how strong the
evidence is for particular research findings.

• For example, a meta-analysis might be conducted on 100 studies of dietary

interventions to identify which characteristics of these interventions lead to more
successful dietary change.

• Such an analysis might reveal, for example, that only those interventions that
enhance self-efficacy, that is, the belief that one will be able to modify one’s diet,
are successful. Meta-analysis is a particularly powerful methodological tool,
because it uses a broad array of diverse evidence to reach conclusions.

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Scope of Health Psychology

• Health psychologists can be involved in helping people to change unhealthy
behaviours, such as advising them on giving up smoking, changing their diet or
taking exercise.

• Others are more research focused, sometimes creating tools to help other health
professionals know more about health behaviours.
For example, health psychologists are often involved in devising and researching
questionnaires to identify which people are at risk from heart disease or who would
most benefit from complementary therapy.
• Health psychologists are also involved in the training of other health psychologists
by teaching and supervising students on postgraduate courses in health psychology.

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• Health psychology is not just of interest to psychologists, but also to anyone

interested in human health and illness.  
• Health psychologists endeavour to discover why people behave in ways that might
endanger their health. They work on achieving ways in which information can be
provided to promote health so that people understand it, remember it and act on it.
• Health psychologists do not, generally, deal with mental illness (this is largely the
province of clinical psychology and psychiatry), and certainly never seek to ‘cure’
it directly.

• Some people argue that health psychology should only be the academic study of
health, others that health psychologists have practical skills to offer. You will find
health psychologists employed as researchers and lecturers in universities, but also
as researchers and clinicians within hospitals and other health-care settings.

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Book references
• Health Psychology by Shelley E. Taylor (2015)

• Health Psychology by Catherine A Sanderson (2013)

• Advanced Psychology: Health Psychology by Mark Forshaw

(2003)

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Q&A

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