Health psychology

Presented by: Kiran Javed

 Psychological considerations
• Living with arthritis as a chronic pain condition, can lead to significant
psychological problems such as helplessness, depression and anxiety that
further exacerbate pain and disability (Katz and Yelin 1994). 

• People with chronic pain are often faced with difficulty in performing basic
activities of daily living such as dressing, eating, shopping, doing household
chores and engaging in social activities (Katz 1995).

• Main emotions experienced in an acute injury include anxiety, increased bodily

awareness and fear are helpful as a threat warning, when accompanied by
depression and anger, are maladaptive in sub-acute and chronic pain.

• These emotions are heightened by their pain and disability

• Anxiety
• It may manifest itself as insomnia or a loss of appetite, poor
concentration or irritability. Anxiety cause disturbance in treatment
but excessive or prolonged anxiety can become harmful.
• Although it is one of the most basic of emotions in illness, it can
have a major impact on consulting and health care.

• Hypervigilance
• individuals who are excessively attentive to their bodily symptoms
and is associated with monitoring bodily sensations for threat.
• This assumed to maintain bodily sensations and is seen in the
various fear-avoidance models where fearful patients become
increasingly vigilant for signals of bodily threat, which in turn leads
to avoidance behavior and increased disability.
• Fear
• Fear of pain
• Fear of hurt and harm
• Fear of disability
• Fear of loss of control
• Fear of surgery
• Fear of effect on family and relationships
• Fear of losing employment, loss of earnings etc.
• It is a normal reaction in the first instance to avoid
what appeared to be the cause of the pain.
• However, fear may lead to complete avoidance of that
activity.
• Depressive Symptoms

• Patients with chronic pain often describe depressive

symptoms which are rarely severe enough to be
regarded as a depressive illness,

• Negative view of oneself, the environment and the

future, lack of energy and interest in life with a slowing
up of mental function. They may feel sad, hopeless and
demonstrate a pessimistic view of their future. Sleep,
appetite and sex drive may be affected and many
describe unexplained problems such as aches and
pains, headaches, weakness and constipation.
• Anger

• A patient may be angry with the causal factor of their pain, which
may be secondary to a work related problem or trauma.

• The patient may direct their anger towards the clinicians for
suggesting weight loss, exercise or being unable to cure the pain.

• Clinicians also become angry and frustrated with patients for failure
to respond to treatment, This can cause the clinicians to lose patience
and sympathy leading to a breakdown in communication.

• Without a feeling of mutual trust and cooperation between the

patient and clinician the feeling of anger and hostility may lead to
failed
 Beliefs about pain and illness
• There appear to be four main aspects to a patient’s beliefs
about illness.
• The nature of the illness – beliefs about the cause and
meaning of the illness and symptoms
• The future course of the illness i.e. duration and outcome
• The consequences of that illness on the patient’s life and work
• Cure or control – beliefs about the expectations and personal
responsibility associated with treatment of the illness.
• Patients can be concerned not only with the damage that may
have already occurred, but also about the risk of further
damage in the future.
Fear avoidance model
 Psychotherapy

• An interaction between a trained

therapist and someone suffering from
psychological difficulties.
 Psychological Therapies
We will look at four major forms of
psychotherapies based on different theories of
human nature:

1. Psychoanalytic theory
2. Humanistic theory
3. Behavioral theory
4. Cognitive theory

10
 Four Major Forms of Insight Therapy
• Psychoanalysis/
psychodynamic
• Cognitive

• Group,
Family,
• Humanistic and
Marital
 Freud’s Psychoanalysis
• Psychoanalysis - an insight therapy
based on the theory of Freud,
emphasizing the revealing of
unconscious conflicts.
– Dream interpretation
• Manifest content – the actual content of one’s
dream.
• Latent content – the symbolic or hidden meaning
of dreams.
– Free association – Freudian technique in
which a patient was encouraged to talk
about anything that came to mind without
fear of negative evaluations.
 Freud’s Psychoanalysis
• Resistance - occurring when a patient
becomes reluctant to talk about a certain
topic, either changing the subject or
becoming silent.
• Transference - in psychoanalysis, the
tendency for a patient or client to project
positive or negative feelings for important
people from the past onto the therapist.
 Rogers’ Person-Centered Therapy
• Person-centered therapy - a nondirective
insight therapy based on the work of Carl
Rogers in which the client does all the talking
and the therapist listens.
• Four Elements:
1. Reflection - therapy technique in which the therapist
restates what the client says rather than interpreting
those statements.
2. Unconditional positive regard - referring to the warmth,
respect, and accepting atmosphere created by the
therapist for the client in person-centered therapy.
3. Empathy - the ability of the therapist to understand the
feelings of the client.
4. Authenticity - the genuine, open, and honest response of
the therapist to the client.
Behavioral Therapy and Classical Conditioning
• Behavior therapies - action therapies based on the
principles of classical and operant conditioning and aimed
at changing disordered behavior without concern for the
original causes of such behavior.

• Behavior modification or applied behavior analysis – the use of

learning techniques to modify or change undesirable behavior and
increase desirable behavior.
 Behavioral Therapy and Classical
Conditioning
• Systematic desensitization - behavior
technique used to treat phobias, in which a
client is asked to make a list of ordered fears
and taught to relax while concentrating on
those fears.
• Token economy - the use of objects called tokens to
reinforce behavior in which the tokens can be
accumulated and exchanged for desired items or
privileges.
 Behavioral Therapy and
Operant Conditioning
• Modeling - learning through the observation and
imitation of others.
– Participant modeling - technique in which a model
demonstrates the desired behavior in a step-by-step,
gradual process while the client is encouraged to
imitate the model.
• Reinforcement - the strengthening of a response
by following it with a pleasurable consequence or
the removal of an unpleasant stimulus.
 Behavioral Therapy and
Operant Conditioning
• Extinction – the removal of a
reinforcer to reduce the
frequency of a behavior.
– Time-out - an extinction process in
which a person is removed from the
situation that provides
reinforcement for undesirable
behavior, usually by being placed in
a quiet corner or room away from
possible attention and
reinforcement opportunities.
 Cognitive-Behavioral Therapies
• Cognitive-behavioral therapy (CBT) - action
therapy in which the goal is to help clients
overcome problems by learning to think more
rationally and logically.
• Three goals:
– Relieve the symptoms and solve the problems.
– To develop strategies for solving future problems.
– To help change irrational, distorted thinking.
Psychology: An Exploration
Ciccarelli © 2010
Menu
 Social and cognitive development
• Piaget (1936) was the first psychologist to make a systematic
study of cognitive development.
• Basic Components To Piaget's Cognitive Theory:
1. Schemas (building blocks of knowledge).
2. Adaptation processes that enable the transition from one
stage to another (equilibrium, assimilation and 
accommodation).
3 Stages of  Development:
– Sensorimotor (0-2)
– Preoperational (2-7)
– concrete operational (7-11)
– formal operational (11-up)
• Schemas-
• A schema describes both the mental and physical actions involved in understanding and
knowing.
• Schemas are categories of knowledge that help us to interpret and understand the world.
• Assimilation
• – Which is using an existing schema to deal with a new object or situation. 
• Accommodation
• – This happens when the existing schema (knowledge) does not work, and needs to be
changed to deal with a new object or situation. 
• Equilibration
• –Equilibrium occurs when a child's schemas can deal with most new information through
assimilation.
• However, an unpleasant state of disequilibrium occurs when new information cannot be
fitted into existing schemas (assimilation).
• Equilibration is the force which drives the learning process as we do not like to be frustrated
and will seek to restore balance by mastering the new challenge (accommodation).
• Once the new information is acquired the process of assimilation with the new schema will
continue until the next time we need to make an adjustment to it.
 • The Sensorimotor Stage:
• Intellectual development largely non verbal
• Child mainly concerned with learning to coordinate the purposeful
movements.
• Infants are only aware of what is immediately in front of them.
• learning about the world through trial and error.
• Between ages 7 and 9 months, infants begin to realize that an object exists
even if it can no longer be seen.
• After infants start crawling, standing, and walking, their increased physical
mobility leads to increased cognitive development.
• Preoperational Stage
• Young children are able to think about things symbolically. Their language
use becomes more mature. They also develop memory and imagination,
which allows them to understand the difference between past and future,
and engage in make-believe.
 • Concrete Operational Stage
• 7 to 11 -- demonstrate logical, concrete reasoning.
• Children's thinking becomes less egocentric and they
are increasingly aware of external events. They begin
to realize that one's own thoughts and feelings are
unique and may not be shared by others or may not
even be part of reality.
• Formal Operational Stage
• 11-plus -- are able to logically use symbols related to
abstract concepts, such as algebra and science. They
can think about multiple variables in systematic
ways, formulate hypotheses, and consider
possibilities. They also can ponder
abstract relationships and concepts such as justice.
 What is Psychogeriatrics?
• Psychogeriatrics is the study of the behavioral and
mental problems of the elderly. In older persons,
physical, emotional and social changes that occur with
the aging process can result in psychological problems.
• Cognitive changes, which are associated with mental
processes such as sensation and perception, memory,
intelligence, language, thought, and problem-solving,
occur among aging adults
• Long-term memory shows substantial changes with age,
while short-term memory shows less age-related decline.
 Psychological problems associated with aging:
• Six percent of older adults suffer from anxiety disorders
• The incidence of sexual dysfunction increases with age
for both men and women. 
• Sleep problems increase with age
• 15 percent of older adults exhibit hypochondriasis
• prescription medication abuse
• Depression is common in older people it is negative
emotion frequently characterized by sadness, feelings
of helplessness, and a sense of loss
• Behavior disorders including physical aggression, motor overactivity
(wandering), and disruptive verbal outbursts.
• Common causes of behavior disorders include delirium, depression,
dementia, and psychosis.

• Dementia is a broad category of brain diseases that cause a long term and

often gradual decrease in the ability to think and remember such that a
person's daily functioning is affected. Other common symptoms include
emotional problems, problems with language, and a decrease
in motivation

• Alzheimer's Disease is a progressive disease that leaves a victim unable to

form new memories and is marked by the loss of other mental functions.

• Delirium is sudden severe confusion due to rapid changes in brain

function that occur with physical or mental illness.
 Adolescence problems
• Adolescence is the transition period from childhood to adulthood, a period
that brings sometimes tumultuous physical, social, and emotional changes. 
• Adolescence can be a time of both disorientation and discovery. The
transitional period can bring up issues of
• independence and self-identity
• many adolescents and their peers face tough choices regarding schoolwork 
• Sexuality
• drugs
• Alcohol
• social life
• Peer groups, romantic interests and external appearance tend to naturally
increase in importance for some time during a teen's journey toward
adulthood
• According to Erik Erikson, appropriate social
development in adolescence requires solving
the major challenge of ego‐identity vs. role
diffusion.
 Psychological problems in adolescents
• Peer pressure
– Peer pressure, a term used to denote legitimization of activities by a peer group, has
been used to explain many adolescent societal difficulties.
• Problems during adolescence. 
– Adolescents relationships with their peer group
– search for identity.
• Substance abuse 
– Legal and illegal substances available to adolescents include tobacco, caffeine, alcohol,
glue, paint vapors, and pills. In one survey, 30% of the adolescents reported using illicit
drugs, such as amphetamine and cocaine. The spread of AIDS infections by use of dirty
needles increases the seriousness of this health threat.
• Eating disorders
– Increased dramatically among adolescents, particularly females. 
– Anorexia nervosa 
– Bulimia  nervosa
• Suicides and attempted suicides
– increased among adolescents
 Can mental illness be cured?
• caring and supportive environment, focusing on
nurturing their existing strengths and skills to reach
their full potential. Treatment options include:
• Individual psychotherapy
• Family counseling
• Medication
• Skill development
• Sensory stimulation
• Relaxation and exercise therapy
Association between psychological stress and
physical well being
• Research shows that stress can contribute to the development of major
illnesses
• Excessive chronic stress, can be psychologically and physically debilitating.
• Unhealthy chronic stress management, such as overeating "comfort"
foods, has contributed to the growing obesity epidemic disease,
depression and obesity
• Chronic stress can occur in response to everyday stressors that are
ignored or poorly managed
•  Stress contributes to anxiety and depression. 
•  People who suffer from depression and anxiety are at twice the risk for
heart disease than people without these conditions
• There is an association between both acute and chronic stress and a
person's abuse of addictive substances