third third edition edition Health Psychology: A Textbook third edition Praise for the previous edition: "The volume of work undertaken by Ogden for the first edition of her textbook was impressive, and the second edition is even better... As a text aimed at undergraduate psychology students, it is hard to fault. " Times Higher Education Supplement (The Textbook Guide) Health Psychology: A Textbook has made a major contribution to the teaching and study of this rapidly expanding discipline.
Maintaining its strong review of theory and research and its details of behaviours such as smoking, exercise, eating and screening, the third edition has been substantially revised to provide increased coverage of the biological aspects of health and illness. This book now provides the most accessible and comprehensive guide to the field. JANE OGDEN Praise for this edition “This third edition has now been extensively updated and considerably strengthened in a number of key areas ... it provides a clear, comprehensive and up-to-date overview of a wide range of research and theory ... t clearly deserves to maintain its place as the number one choice of health psychology textbook. " John Weinman, King’s College, London HEALTH PSYCHOLOGY A TEXTBOOK Many new features have been incorporated into this edition to further aid students and teachers, including: The new two-colour layout has been designed with students in mind, including clear illustrations, boxed discussion points, and specific research boxes. New to this edition: Online Learning Centre (OLC) www. openup. co. uk/ogden with great materials for students and lecturers.
Resources include further readings, "Focus on Research" boxes, web links, sample essay questions, chapter overviews, PowerPoint slides and an instructor resource manual. The OLC content enhances the learning experience for students and provides support for lecturers teaching the subject. Health Psychology: A Textbook is essential reading for all students and researchers of health psychology and for students of medicine, nursing and allied health courses. Jane Ogden is a Reader in Health Psychology at Guy’s, King’s and St.
Thomas’s School of Medicine, University of London, where she carries out research into health-related behaviours and teaches health psychology to both medical and psychology students. cover design: Kate Prentice H E A LT H P S Y C H O L O G Y • Additional, entirely new chapter on stress; now two chapters address this key topic • Expanded and improved section on psychoneuroimmunology (PNI) • Expanded chapter on pain • New section on the consequences of coronary heart disease (CHD) and rehabilitation of CHD patients • New chapter on eating behaviour • New coverage of problems associated with social cognition models
ISBN 0-335-21471-1 9 780335 214716 JANE OGDEN Page 1 Black blue Health Psychology Page 1 Black blue Page Page 2 Black blue Page 2 Black blue Page 3 Black blue Health Psychology A Textbook Third edition Jane Ogden Page 3 Black blue Page 4 Black blue Health Psychology: A textbook 3rd edition Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: enquiries@openup. co. uk world wide web: www. openup. co. uk and Two Penn Plaza, New York, NY 10121-2289, USA First published 2004 Copyright © Jane Ogden 2004 All rights reserved.
Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of 90 Tottenham Court Road, London, W1T 4LP. A catalogue record of this book is available from the British Library ISBN 0 335 21471 1 (pb) 335 21487 8 (hb) Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by Re? neCatch Limited, Bungay, Su? olk Printed in Spain by Mateu Cromo Artes Gra? cas, SA, Madrid Page 4 Black blue Page 5 Black blue B RIEF TABLE OF CONTENTS Detailed table of contents vi List of ? gures and tables xx Preface to the third edition xxii Technology to enhance learning and teaching Acknowledgements xxvii 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 xxv An introduction to health psychology 1 Health beliefs 13 Illness cognitions 47 Doctor–patient communication and the role of health rofessionals’ health beliefs 75 Smoking and alcohol use 99 Eating behaviour 133 Exercise 167 Sex 183 Screening 211 Stress 233 Stress and illness 251 Pain 285 Placebos and the interrelationship between beliefs, behaviour and health 307 HIV and cancer: psychology throughout the course of illness (1) 327 Obesity and coronary heart disease: psychology throughout the course of illness (2) 351 Measuring health status: from mortality rates to quality of life 383 The assumptions of health psychology 397 Methodology glossary References 405 Index 459 403 v Page 5 Black blue Page 6 Black blue D ETAILED TABLE OF CONTENTS
List of ? gures and tables xx Preface to the third edition xxii Technology to enhance learning and teaching Acknowledgements xxvii xxv 1: An introduction to health psychology CHAPTER OVERVIEW 1 1 THE BACKGROUND TO HEALTH PSYCHOLOGY WHAT IS THE BIOMEDICAL MODEL? THE TWENTIETH CENTURY 2 2 3 Psychosomatic medicine 3 Behavioural health 3 Behavioural medicine 3 Health psychology 4 WHAT ARE THE AIMS OF HEALTH PSYCHOLOGY? WHAT IS THE FUTURE OF HEALTH PSYCHOLOGY? 6 7 The clinical health psychologist 7 A professional health psychologist 8 WHAT ARE THE AIMS OF THIS BOOK? 8 A note on theory and health psychology 8
A note on methodology and health psychology 9 9 THE STRUCTURE OF THIS BOOK 10 QUESTIONS 11 FOR DISCUSSION 11 FURTHER READING 11 THE CONTENTS OF THIS BOOK 2: Health beliefs CHAPTER OVERVIEW 13 13 14 WHY STUDY HEALTH BEHAVIOURS? 14 McKeown’s thesis 14 LAY THEORIES ABOUT HEALTH 18 PREDICTING HEALTH BEHAVIOURS 18 Attribution theory 19 Health locus of control 20 Unrealistic optimism 21 The stages of change model 22 WHAT ARE HEALTH BEHAVIOURS? Integrating these different health beliefs: developing models 24 COGNITION MODELS 24 vi Page 6 Black blue Page 7 Black blue DETAILED TABLE OF CONTENTS The health belief model 24
The protection motivation theory 27 FOCUS ON RESEARCH 2. 1: TESTING A THEORY – PREDICTING SEXUAL 28 BEHAVIOUR SOCIAL COGNITION MODELS 31 The theories of reasoned action and planned behaviour 31 The health action process approach 34 PROBLEMS WITH THE MODELS 36 Conceptual problems 36 Methodological problems 36 Predictive problems 37 Predicting intentions: the need to incorporate new cognitions 37 Predicting behaviour: exploring the intention–behaviour gap 39 Developing theory based interventions 41 Putting theory into practice 42 Existing theory based interventions 43 TO CONCLUDE QUESTIONS 43 44 44 FOR DISCUSSION
ASSUMPTIONS IN HEALTH PSYCHOLOGY 44 45 FURTHER READING 3: Illness cognitions CHAPTER OVERVIEW 47 47 WHAT DOES IT MEAN TO BE HEALTHY? WHAT DOES IT MEAN TO BE ILL? WHAT ARE ILLNESS COGNITIONS? 48 49 49 Evidence for these dimensions of illness cognitions 50 Measuring illness cognitions 51 LEVENTHAL’S SELF-REGULATORY MODEL OF ILLNESS COGNITIONS 53 Stage 1: Interpretation 54 Stage 2: Coping 54 Stage 3: Appraisal 54 WHY IS THE MODEL CALLED SELF-REGULATORY? 54 FOCUS ON RESEARCH 3. 1: TESTING A THEORY – ILLNESS REPRESENTATIONS AND COPING 55 Problems with assessment 58 STAGE 1: INTERPRETATION 58 Symptom perception 58
Social messages 60 STAGE 2: COPING 61 Coping with a diagnosis 61 Coping with the crisis of illness 62 Page 7 Black blue vii Page 8 viii Black blue HEALTH PSYCHOLOGY Adjustment to physical illness and the theory of cognitive adaptation 67 The role of illusions 68 Implications for the outcome of the coping process 69 THE POSITIVE INTERPRETATION OF ILLNESS 69 USING THE SELF-REGULATORY MODEL TO PREDICT OUTCOMES 70 Predicting adherence to treatment 70 Predicting recovery from stroke 70 Predicting recovery from MI 71 TO CONCLUDE QUESTIONS 71 72 FOR DISCUSSION 72 ASSUMPTIONS IN HEALTH PSYCHOLOGY 72 73 FURTHER READING : Doctor–patient communication and the role of health professionals’ health beliefs 75 CHAPTER OVERVIEW 75 WHAT IS COMPLIANCE? 77 PREDICTING WHETHER PATIENTS ARE COMPLIANT: THE WORK OF LEY 77 Patient satisfaction 77 Patient understanding 78 FOCUS ON RESEARCH 4. 1: TESTING A THEORY – PATIENT SATISFACTION 79 Patient’s recall 81 HOW CAN COMPLIANCE BE IMPROVED? 81 The role of information 82 Recommendations for improving compliance 82 THE WIDER ROLE OF INFORMATION IN ILLNESS 83 Information and recovery from surgery 83 Using information to improve recovery 83 THE ROLE OF KNOWLEDGE IN DOCTOR–PATIENT COMMUNICATION 84
Problems with the traditional approach to doctor–patient communication 85 The adherence model of communication 85 THE PROBLEM OF DOCTOR VARIABILITY 85 Explaining variability – clinical decision making as problem solving 86 Explaining variability – the role of health professionals’ health beliefs 89 Communicating beliefs to patients 91 Explaining variability – an interaction between health professional and patient 92 Patient centredness 92 Agreement between health professional and patient 93 TO CONCLUDE 95 QUESTIONS 95 FOR DISCUSSION 96 Page 8 Black blue Page 9 Black blue DETAILED TABLE OF CONTENTS ASSUMPTIONS IN HEALTH PSYCHOLOGY
FURTHER READING ix 96 96 5: Smoking and alcohol use 99 99 CHAPTER OVERVIEW 100 WHO DRINKS? 101 WHO SMOKES? HEALTH IMPLICATIONS OF SMOKING AND ALCOHOL USE 101 Is smoking bad for health? 101 Is alcohol consumption bad for health? 102 WHAT IS AN ADDICTION? 103 HISTORICAL CHANGES IN ATTITUDE AND THEORETICAL APPROACH 104 The seventeenth century and the moral model of addictions 104 The nineteenth century and the 1st disease concept 105 The twentieth century and the 2nd disease concept 105 The 1970s and onwards – social learning theory 105 106 A pre-existing physical abnormality 106 WHAT IS THE 2ND DISEASE CONCEPT?
A pre-existing psychological abnormality 107 Acquired dependency 107 107 WHAT IS THE SOCIAL LEARNING PERSPECTIVE? 108 PROBLEMS WITH A DISEASE MODEL OF ADDICTION The processes involved in learning an addictive behaviour 108 Integrating a disease and social learning perspective 109 THE STAGES OF SUBSTANCE USE 110 STAGES 1 AND 2: INITIATING AND MAINTAINING AN ADDICTIVE BEHAVIOUR 110 Smoking initiation and maintenance 110 Alcohol initiation and maintenance 112 Psychological predictors of alcohol limitation and maintenance 112 STAGE 3: THE CESSATION OF AN ADDICTIVE BEHAVIOUR 113 The process of cessation 113 FOCUS ON RESEARCH 5. : TESTING A THEORY – STAGES OF SMOKING CESSATION INTERVENTIONS TO PROMOTE CESSATION 115 116 Clinical interventions: promoting individual change 116 Public health interventions: promoting cessation in populations 120 FOCUS ON RESEARCH 5. 2: PUTTING THEORY INTO PRACTICE – WORKSITE SMOKING BAN 122 Methodological problems evaluating clinical and public health interventions STAGE 4: RELAPSE IN SMOKING AND DRINKING 124 Baseline state 125 Pre-lapse state 126 No lapse or lapse? 126 The abstinence violation effect 127 Page 9 Black blue 124 Page 10 x Black blue HEALTH PSYCHOLOGY A CROSS-ADDICTIVE BEHAVIOUR PERSPECTIVE 128
Smoking and eating behaviour 128 129 QUESTIONS 130 FOR DISCUSSION 130 TO CONCLUDE ASSUMPTIONS IN HEALTH PSYCHOLOGY 130 131 FURTHER READING 6: Eating behaviour CHAPTER OVERVIEW 133 133 WHAT IS A HEALTHY DIET? 134 HOW DOES DIET AFFECT HEALTH? 134 Diet and illness onset 135 Diet and treating illness 135 WHO EATS A HEALTHY DIET? 136 DEVELOPMENTAL MODELS OF EATING BEHAVIOUR 137 Exposure 137 Social learning 138 Associative learning 141 Problems with a developmental model 142 COGNITIVE MODELS OF EATING BEHAVIOUR 143 Using the TRA and TPB 143 Adding extra variables 144 Problems with a cognitive model of eating behaviour 145
A WEIGHT CONCERN MODEL OF EATING BEHAVIOUR 146 The meaning of food and weight 146 What is body dissatisfaction? 146 THE CAUSES OF BODY DISSATISFACTION SOCIAL FACTORS 148 148 The role of the media 148 Ethnicity 149 Social class 149 The family 150 PSYCHOLOGICAL FACTORS Beliefs DIETING 150 151 153 Dieting and undereating 153 Dieting and overeating 153 The causes of overeating 154 FOCUS ON RESEARCH 6. 1: TESTING A THEORY – OVEREATING AS A REBELLION Dieting and weight loss 162 The role of dieting in mood and cognitive changes 163 Problems with a weight concern model of eating behaviour 164 TO CONCLUDE 164 Page 10
Black blue 160 Page 11 Black blue DETAILED TABLE OF CONTENTS QUESTIONS 164 FOR DISCUSSION FURTHER READING 7: Exercise 164 165 167 CHAPTER OVERVIEW 167 DEVELOPING THE CONTEMPORARY CONCERN WITH EXERCISE BEHAVIOUR 168 168 169 WHY EXERCISE? 169 WHAT IS EXERCISE? WHO EXERCISES? The physical bene? ts of exercise 170 The psychological bene? ts of exercise 171 FOCUS ON RESEARCH 7. 1: TESTING A THEORY – EXERCISE AND MOOD WHAT FACTORS PREDICT EXERCISE? 173 174 Social/political predictors of exercise 174 FOCUS ON RESEARCH 7. 2: TESTING A THEORY – PREDICTING EXERCISE EXERCISE RELAPSE 179 181 181 182 FOR DISCUSSION 182 TO CONCLUDE
QUESTIONS ASSUMPTIONS IN HEALTH PSYCHOLOGY FURTHER READING 8: Sex 182 182 183 CHAPTER OVERVIEW 183 DEVELOPING THE CONTEMPORARY RESEARCH PERSPECTIVES ON SEX Sex as biological, for reproduction 184 Sex as biological, for pleasure 184 Sex as a risk to health 185 Sex as interaction 186 Sex as a risk and pregnancy avoidance 186 What is contraceptive use? 187 Who uses contraception? 187 Developmental models 187 Decision-making models 190 Integrating developmental and decision-making approaches to contraception use 192 SEX AS A RISK IN THE CONTEXT OF STDs/HIV AND AIDS Do people use condoms? 195 Predicting condom use 197
Social cognition models 197 Perceptions of susceptibility – are you at risk? 200 Sex as an interaction between individuals 201 Page 11 Black blue 194 184 xi Page 12 xii Black blue HEALTH PSYCHOLOGY FOCUS ON RESEARCH 8. 1: TESTING A THEORY – THE SITUATION AND CONDOM USE 201 THE BROADER SOCIAL CONTEXT 204 Sex education 204 Power relations between men and women 206 Social norms of the gay community 206 Discourses about sex, HIV and illness 207 207 208 FOR DISCUSSION 208 TO CONCLUDE QUESTIONS ASSUMPTIONS IN HEALTH PSYCHOLOGY 209 FURTHER READING 9: Screening 208 211 CHAPTER OVERVIEW WHAT IS SCREENING? 211 212
THE HISTORY OF THE SCREENING ETHOS 212 Early screening programmes 212 Recent screening programmes 213 213 GUIDELINES FOR SCREENING 214 SCREENING AS A USEFUL TOOL PSYCHOLOGICAL PREDICTORS OF THE UPTAKE OF SCREENING 215 Patient factors 215 Health professional factors 216 FOCUS ON RESEARCH 9. 1: TESTING A THEORY – PREDICTING SCREENING Organizational factors 220 SCREENING AS PROBLEMATIC 220 Is screening ethical? 221 Is screening cost-effective? 224 The effects of screening on the psychological state of the individual 226 The debates 226 Why has this backlash happened? 229 230 230 FOR DISCUSSION 230 TO CONCLUDE
QUESTIONS ASSUMPTIONS IN HEALTH PSYCHOLOGY 10: Stress 230 231 FURTHER READING 233 233 234 CHAPTER OVERVIEW WHAT IS STRESS? THE DEVELOPMENT OF STRESS MODELS 234 Cannon’s ? ght or ? ight model 234 Page 12 Black blue 217 Page 13 Black blue DETAILED TABLE OF CONTENTS Selye’s general adaptation syndrome 234 Life events theory 235 A ROLE FOR PSYCHOLOGICAL FACTORS IN STRESS 238 The transactional model of stress 238 Does appraisal in? uence the stress response? 239 What events are appraised as stressful? 240 Self-control and stress 240 241 STRESS AND CHANGES IN PHYSIOLOGY Stress reactivity 242 243 Laboratory setting 243
Naturalistic setting 243 MEASURING STRESS Physiological measures 244 Self-report measures 244 FOCUS ON RESEARCH 10. 1: PUTTING THEORY INTO PRACTICE 246 Laboratory versus naturalistic measures 247 Physiological versus self-report measures 248 THE INTERACTION BETWEEN PSYCHOLOGICAL AND PHYSIOLOGICAL ASPECTS 248 TO CONCLUDE 248 QUESTIONS 249 FOR DISCUSSION 249 OF STRESS ASSUMPTIONS IN HEALTH PSYCHOLOGY FURTHER READING 250 11: Stress and illness CHAPTER OVERVIEW 250 251 251 DOES STRESS CAUSE ILLNESS? 252 How does stress cause illness? 252 The chronic process 253 The acute process 253 STRESS AND CHANGES IN BEHAVIOUR 54 Smoking 254 Alcohol 255 Eating 255 Exercise 256 Accidents 256 Illness as a stressor 256 STRESS AND CHANGES IN PHYSIOLOGY 257 Stress and illness onset and progression 257 Interaction between the behavioural and physiological pathways 258 INDIVIDUAL VARIABILITY IN THE STRESS–ILLNESS LINK Stress reactivity 258 Stress recovery 259 Page 13 Black blue 258 xiii Page 14 xiv Black blue HEALTH PSYCHOLOGY Allostatic load 259 Stress resistance 259 PSYCHONEUROIMMUNOLOGY (PNI) 260 The immune system 260 Conditioning the immune system 260 Measuring immune changes 261 Psychological state and immunity 261 Mood 261 Beliefs 262
Emotional expression 262 Stress 264 THE IMPACT OF CHRONIC STRESS 265 Job stress 265 Relationship stress 266 WHICH FACTORS MODERATE THE STRESS–ILLNESS LINK? 267 COPING 268 What is coping? 268 Ways of coping 269 Measuring coping 271 SOCIAL SUPPORT 273 What is social support? 273 Does social support affect health? 273 How does social support in? uence health? 273 FOCUS ON RESEARCH 11. 1: TESTING A THEORY: SOCIAL SUPPORT AND HEALTH PERSONALITY 276 Who is hostile? 277 How does hostility link to stress? 277 How does hostility link to illness? 277 CONTROL 278 What is control? 278 Does control affect the stress response? 278
Does control affect health? 279 How does control mediate the stress–illness link? 280 The possible bene? ts of low control 280 CONTROL AND SOCIAL SUPPORT IN STRESS AND ILLNESS 281 282 FOR DISCUSSION 282 TO CONCLUDE QUESTIONS ASSUMPTIONS IN HEALTH PSYCHOLOGY FURTHER READING 12: Pain 282 283 285 CHAPTER OVERVIEW WHAT IS PAIN? 285 286 EARLY PAIN THEORIES – PAIN AS A SENSATION Page 14 286 Black blue 280 274 Page 15 Black blue DETAILED TABLE OF CONTENTS INCLUDING PSYCHOLOGY IN THEORIES OF PAIN THE GATE CONTROL THEORY OF PAIN 287 287 Input to the gate 288 Output from the gate 288 How does the GCT differ from earlier models of pain? 88 What opens the gate 289 What closes the gate 289 Problems with the GCT 289 THE ROLE OF PSYCHOSOCIAL FACTORS IN PAIN PERCEPTION SUBJECTIVE-AFFECTIVE-COGNITIVE PROCESSES 290 291 The role of learning 291 The role of affect 291 The role of cognition 292 Behavioural processes 294 The interaction between these different processes 294 295 THE ROLE OF PSYCHOLOGY IN PAIN TREATMENT Cognitive behavioural therapy 296 FOCUS ON RESEARCH 12. 1: PUTTING THEORY INTO PRACTICE – TREATING 298 CHRONIC PAIN Placebos and pain reduction 301 THE OUTCOME OF PAIN TREATMENT AND MANAGEMENT – A ROLE FOR PAIN 302 303 Self-reports 303
ACCEPTANCE? MEASURING PAIN Observational assessment 303 Physiological measures 303 304 QUESTIONS 304 FOR DISCUSSION 304 TO CONCLUDE ASSUMPTIONS IN HEALTH PSYCHOLOGY FURTHER READING 305 305 13: Placebos and the interrelationship between beliefs, behaviour and health 307 CHAPTER OVERVIEW WHAT IS A PLACEBO? 307 309 A HISTORY OF INERT TREATMENTS 309 Modern-day placebos 310 Placebos – to be taken out of an understanding of health? 310 HOW DO PLACEBOS WORK? 310 Non-interactive theories 311 Interactive theories 312 Physiological theories 315 THE CENTRAL ROLE OF PATIENT EXPECTATIONS Page 15 315 Black blue xv Page 16 xvi
Black blue HEALTH PSYCHOLOGY FOCUS ON RESEARCH 13. 1: TESTING A THEORY – ‘DOING AS YOU’RE TOLD’ AS A PLACEBO 316 COGNITIVE DISSONANCE THEORY 319 The effect of investment 319 Justi? cation and changes in symptoms 319 Evidence for the role of justi? cation 320 An example of Totman’s theory 321 Support for cognitive dissonance theory 321 Problems with cognitive dissonance theory 322 THE ROLE OF PLACEBO EFFECTS IN HEALTH PSYCHOLOGY 322 Health beliefs 322 Illness cognitions 323 Health professionals’ health beliefs 323 Health-related behaviours 324 Stress 324 Pain 324 Implications for dualism 324 325 325 FOR DISCUSSION 325
TO CONCLUDE QUESTIONS ASSUMPTIONS IN HEALTH PSYCHOLOGY 325 326 FURTHER READING 14: HIV and cancer: psychology throughout the course of illness (1) 327 CHAPTER OVERVIEW HIV AND AIDS 327 329 The history of HIV 329 What is HIV? 329 The progression from HIV to AIDS 330 The prevalence of HIV and AIDS 330 331 Psychology and susceptibility to the HIV virus 333 Psychology and progression from HIV to AIDS 334 Psychology and longevity 335 THE ROLE OF PSYCHOLOGY IN THE STUDY OF HIV FOCUS ON RESEARCH 14. 1: TESTING A THEORY – PSYCHOLOGY AND IMMUNE FUNCTIONING CANCER 336 338 What is cancer? 338 The prevalence of cancer 339
The role of psychology in cancer 339 The psychosocial factors in the initiation and promotion of cancer 339 Psychological consequences of cancer 342 Page 16 Black blue Page 17 Black blue DETAILED TABLE OF CONTENTS xvii Psychology and the alleviation of symptoms 343 Psychological factors in longevity 344 FOCUS ON RESEARCH 14. 2: PUTTING THEORY INTO PRACTICE – TREATING CANCER SYMPTOMS 345 348 QUESTIONS 348 FOR DISCUSSION 348 TO CONCLUDE ASSUMPTIONS IN HEALTH PSYCHOLOGY FURTHER READING 348 349 15: Obesity and coronary heart disease: psychology throughout the course of illness (2) 351 351 CHAPTER OVERVIEW OBESITY 353
The role of psychological factors in obesity 353 353 WHAT IS OBESITY? HOW COMMON IS OBESITY? 354 WHAT ARE THE PROBLEMS WITH OBESITY? 355 Physical problems 355 Psychological problems 355 356 Physiological theories 356 Behavioural theories 358 WHAT CAUSES OBESITY? What does all this research mean? 365 OBESITY TREATMENT 365 Traditional treatment approaches 365 Multidimensional behavioural programmes 366 The role of dieting in treating obesity 367 SHOULD OBESITY BE TREATED AT ALL? 368 The bene? ts of treatment 368 The treatment alternatives 369 Drug treatments of obesity 369 Surgical treatments of obesity 370 CONCLUSION 370
CORONARY HEART DISEASE (CHD) 371 What is CHD? 371 The prevalence of CHD 371 Risk factors for CHD 372 The role of psychology in CHD 372 Beliefs about CHD 372 The psychological impact of CHD 373 FOCUS ON RESEARCH 15. 1: TESTING A THEORY: THE CONSEQUENCES OF DISEASE Predicting and changing behavioural risk factors for CHD 376 Psychology and rehabilitation of patients with CHD 377 Page 17 Black blue 374 Page 18 xviii Black blue HEALTH PSYCHOLOGY Conclusion 379 379 379 FOR DISCUSSION 380 TO CONCLUDE QUESTIONS ASSUMPTIONS IN HEALTH PSYCHOLOGY FURTHER READING 16 380 380 Measuring health status: from mortality rates to quality f life 383 383 MORTALITY RATES 384 MORBIDITY RATES 384 CHAPTER OVERVIEW 384 385 WHAT IS QUALITY OF LIFE? 385 MEASURES OF FUNCTIONING SUBJECTIVE HEALTH STATUS Creating a conceptual framework 386 How should it be measured? 387 FOCUS ON RESEARCH 16. 1: PUTTING THEORY INTO PRACTICE – EVALUATING HIP 388 390 REPLACEMENT SURGERY A SHIFT IN PERSPECTIVE Value 390 Subjectivity of the subject 390 Subjectivity of the researcher 391 De? nition of health 391 391 Quality of life as an outcome measure 392 Quality of life as a predictor of longevity 393 TO CONCLUDE 393 QUESTIONS 394 FOR DISCUSSION 394 ASSUMPTIONS IN HEALTH PSYCHOLOGY 394
FURTHER READING 395 USING QUALITY OF LIFE IN RESEARCH 17 The assumptions of health psychology CHAPTER OVERVIEW 397 397 THE ASSUMPTIONS OF HEALTH PSYCHOLOGY 398 The mind–body split 398 Dividing up the soup 398 The problem of progression 398 The problem of methodology 399 The problem of measurement 399 Integrating the individual with their social context 399 Data are collected in order to develop theories; these theories are not data 400 Page 18 Black blue Page 19 Black blue DETAILED TABLE OF CONTENTS Theories concerning different areas of health psychology are distinct from each other 400 STUDYING A DISCIPLINE
FURTHER READING 400 401 Methodology glossary References 405 Index 459 403 Page 19 Black blue xix Page 20 Black blue L IST OF FIGURES AND TABLES Fig. 1-1 Fig. 1-2 Fig. 2-1 Fig. 2-2 Fig. 2-3 Fig. 2-4 Fig. 2-5 Fig. 2-6 Fig. 2-7 Fig. 3-1 Fig. 3-2 Table 3-1 Table 3-2 Fig. 4-1 Fig. 4-2 Fig. 4-3 Fig. 5-1 Fig. 5-2 Fig. 5-3 Fig. 5-4 Fig. 5-5 Fig. 5-6 Fig. 5-7 Fig. 6-1 Fig. 6-2 Fig. 6-3 Fig. 6-4 Fig. 6-5 Fig. 6-6 Fig. 6-7 Fig. 6-8 Fig. 6-9 Fig. 7-1 Fig. 8-1 Fig. 8-2 Fig. 8-3 Fig. 9-1 The biopsychosocial model of health and illness Psychology and health: direct and indirect pathways Decline in mortality from tuberculosis
The effect of smoking on increase in expectation of life: males, 1838–1970 Basics of the health belief model Basics of the protection motivation theory Basics of the theory of reasoned action Basics of the theory of planned behaviour The health action process approach Leventhal’s self-regulatory model of illness behaviour Coping with the crisis of illness Adaptive tasks Coping skills Ley’s model of compliance A simpli? ed model of problem solving Diagnosis as a form of problem solving Changes in smoking, 1972–92 Current smokers, ex-smokers and non-smokers by sex, 1972–92 Alcohol consumption levels by sex, 1992 The stages of substance use
Relapse curves for individuals treated for heroin, smoking and alcohol addiction The relapse process Relapse prevention intervention strategies The balance of good health A developmental model of eating behaviour Social eating Measuring body dissatisfaction Overeating in dieters in the laboratory A boundary model explanation of overeating in dieters A comparison of the boundaries for different types of eaters The ‘what the hell’ effect as a form of relapse From dieting to overeating Participation in sport, 1990 Percentage using no contraception at ? rst intercourse, by age at ? rst intercourse Contraception use at ? st intercourse in those aged 16–24 Changes in the use of condoms as the usual method of contraception by age, 1983–91 Costs per potential cancer prevented for different screening policies xx Page 20 Black blue 4 6 15 16 25 28 32 32 34 53 64 64 65 77 87 88 100 101 102 110 125 126 127 135 138 139 147 154 155 156 159 160 169 188 189 196 224 Page 21 Black blue LIST OF FIGURES AND TABLES Fig. 10-1 Fig. 10-2 Fig. 10-3 Fig. 10-4 Fig. 11-1 Fig. 11-2 Fig. 11-3 Fig. 11-4 Fig. 11-5 Fig. 12-1 Fig. 12-2 Fig. 12-3 Fig. 13-1 Fig. 13-2 Fig. 13-3 Fig. 14-1 Fig. 14-2 Fig. 15-1 Fig. 15-2 Fig. 15-3 Fig. 15-4 Fig. 15-5 Fig. 15-6 Fig. 15-7 Fig. 16-1
Selye’s three-stage general adaptation syndrome The role of appraisal in stress Stress and changes in physiology The interaction between psychological and physiological aspects of stress Chronic/acute model of stress–illness link Stress-diathesis model The stress–illness link: physiological moderators The stress–illness link: psychological moderators Incidence of CHD by number of children: the role of work stress on illness in women The gate control theory of pain Psychosocial aspects of pain Psychology and pain treatment The central role of patient expectations in placebo effects Totman’s cognitive dissonance theory of placebo effects
The interrelationship between beliefs, behaviour and health The potential role of psychology in HIV The potential role of psychology in cancer Potential role of psychology in obesity Grades of obesity by height and weight Relationship between BMI and mortality Changes in physical activity and obesity Changes in food intake from the 1950s to the 1990s Changes in calorie consumption and obesity The potential role of psychology in CHD A shift in perspective in measuring health Page 21 Black blue xxi 235 239 242 249 252 253 258 268 281 288 290 296 316 320 323 331 340 353 354 355 360 363 363 371 390 Page 22 Black blue
