Health and Medical Psychology – Samenvattingen Hoorcolleges
HC 1: Explaining health behavior
Health and medical psychology is found in health care.
→ Medical psychologists are often working in health care:
- Primary health care
- Private practice
- Organizational health/burn out prevention
- Secondary health care:
VB: Medical health organizations, pain clinics, rehabilitation centers.
- Medical psychology department in the hospital
VB: Pain management, oncology, endocrinology, cardiology, etc.
→ Health psychologists are often working in primary prevention, policy and training:
- Companies
- Health organizations
VB: Voedingscentrum, Trimbos
But also in research and policy:
- Universities and research insititutes
VB: TNO
- Governments and ministeries
Medical and health psychology is about:
- Body and mind
- Chronic disease
- Capacity and empowerment
- Stress and disease
- Prevention and health
- eHealth and self management
Perception of health differs for everyone, the definition of health can relate to different concepts:
- Not ill:
No symptoms, no visits to a doctor.
- Reserve/resources:
Strong family/genes, able to recover quickly.
- Behavior:
Looking after oneself.
- Physical fitness and vitality:
Being energetic.
- Psychological well being:
In harmony, balance, feeling proud and enjoyment.
- Function:
Being able to do wat you have or want to do.
,The formal definition of health= a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.
→ This definition is often used, but complete wellbeing is difficult to define. This makes this definition
difficult to apply; when can you speak of complete wellbeing? And are you unhealthy when you’re
thriving physically and mentally but not socially?
When understanding health and illness, health and medical psychology chooses to use other models:
- The biomedical model:
This model focusses on the underlying pathology, neural and/or biochemical activity. But there are
also other factors that predict health.
VB: Health behavior, stress, social relations, etc.
- The biopsychosocial model:
Takes into account the biological factors but also the other predictors of health. This model states
that the body and mind interact and determine health and illness. Health and illness are a
consequence of a complex interplay between the biological, psychological and social factors; these
systems influence each other continuously.
1. Biological factors:
o Gender
o Physical illness
o Disability
o Genetic vulnerability
o Immune function
o Neurochemistry
o Stress reactivity
o Medication effects
2. Psychological factors:
o Learning/memory
o Attitude/beliefs
o Personality
o Behaviors
o Emotions
o Coping skills
o Past trauma
3. Social context:
o Social supports
o Family background
o Cultural traditions
o Social economic status
o Education
Different types of prevention:
1. Primary prevention:
It focusses on the prevention of a problem, illness or casualty.
- Target group: a healthy population.
- Aim: keep this population healthy/early symptoms from occurring.
VB: Exercise sufficiently, eating a healthy diet.
2. Secondary prevention:
It focusses on tracing early phases of a disease to be able to provide early treatment or prevention of
more serious complaints.
- Target group: population presenting with early symptoms, or are at a higher risk of
developing these symptoms.
, - Aim: detecting early stages, preventing early symptoms from becoming a full blown disease.
VB: Screening, early treatment.
3. Tertiary prevention:
It focusses on the prevention of complications and worsening of symptoms using optimal care.
- Who: population having a certain disease, or irreversible symptoms.
- Aim: maintaining a healthy life despite these symptoms, or making sure the symptoms don’t
get worse over time.
VB: revalidation, exercise and a nutritious diet which focusses on a particular target group
with particular symptoms.
Behavior influences our health. There are many cohort studies (=following people over time and seeing if a
certain outcome develops and what factors are related to is) that prove this:
VB: Framingham Heart Study;
This study tracked people in a certain American town. They reported their behavior and over time this
behavior could be related to health outcomes. This is de first study that proves that things like exercise, diet,
blood pressure, smoking and alcohol are related to cardiovascular disease.
VB: British doctor study;
This first study that showed a relation between smoking and negative health outcomes.
VB: Alameda 7;
This study showed that there are 7 health factors that contribute to longevity=living a healthy and long life.
1. Exercising
2. Drinking less than 5 drinks in one sitting
3. Sleeping 7-8 hours a night
4. Not smoking
5. Maintaining a desirable weight for your height
6. Avoid snacks
7. Eating breakfast
→ Ofcourse these factors have evolved over time, so drinking less than 5 drinks in one sitting is not an advise
that would be given nowadays.
Types of health behavior (Matarazzo):
1. Behavioral pathogens:
These are health risk behaviors.
VB: Smoking, sharing needles of drugs, unprotected sex, no ear protection.
2. Behavioral immunogens:
These are health protective behaviors.
VB: Physical activity, healthy nutrition, sun protection, vaccination, helmet.
, It is important to influence health behavior and encourage a healthy lifestyle because:
- Health behavior is related to morbidity (=onset of disease) and mortality (=death/life expectancy).
VB: Massive decrease in mortality related to infectious diseases occurred just before the introduction
of antibiotics treating these infections. This decrease was due to increased hygiene and sanitation.
This illustrates how health behavior can have a massive impact on mortality.
→ Ofcourse improvements in mortality is also partly due to medical developments that improve early
detection and treatment of diseases.
- The prevalence of risk behaviors is high:
This prevalence depends on what risk behavior you’re looking at. Prevalence is very high in smoking,
drinking alcohol and not following nutritious guidelines regarding fat, salt and sugar. Because of this
high prevalence, there’s a lot to gain in promoting healthy behavior.
- There are socio-economic differences in health outcomes and health behaviors:
Partly, this has to do with living circumstances, working conditions, but also health behavior. People
with a lower SEP smoke more often, engage in binge drinking, do less physical activity and eat less
healthy. This is not to blame them, because there are other factors contributing to this behavior. But
there is a lot to gain here as well.
VB: In the NL, people with a lower socio-economic position (SEP) live 7 years less than people with a
higher SEP.
VB: People with a lower SEP live 20-25 years shorter in health than people with a higher SEP. So the
onset of disease occurs way earlier in people with a lower SEP.
- Health behavior is not always an informed choice:
Unhealthy behavior can be made very appealing. This may lead us to make unhealthy choices even
though we want to make healthy choices for the long term benefits.
VB: Unhealthy snacks at the register in a supermarket or at the train station.
But there are also adverse effects to promoting health:
- Intervention generated inequalities:
A lot of the time, the interventions that are made to improve healthy behavior reach the healthy
people better than the people who actually need it more. By this, inequality is increased instead of
decreased.
- Hardening:
People can harden against public health institutions.
VB: With the covid vaccination, from a public health perspective it was better to get vaccinated. But a
lot of people got mad and hardened against the institutions promoting vaccination.
- Stigmatizing:
Focusing on health behavior can be stigmatizing, not everyone is to blame in regard to their behavior
when they have a certain health risk factor. Health behavior is not always the solution for certain
conditions. It is important that stigmatizing is not engaged with when promoting healthy behavior.
VB: People who are overweight are not to blame for being overweight, for some people exercising
may be beneficial but there can be many other factors that can cause someone to be overweight that
have nothing to do with health behavior.
HC 1: Explaining health behavior
Health and medical psychology is found in health care.
→ Medical psychologists are often working in health care:
- Primary health care
- Private practice
- Organizational health/burn out prevention
- Secondary health care:
VB: Medical health organizations, pain clinics, rehabilitation centers.
- Medical psychology department in the hospital
VB: Pain management, oncology, endocrinology, cardiology, etc.
→ Health psychologists are often working in primary prevention, policy and training:
- Companies
- Health organizations
VB: Voedingscentrum, Trimbos
But also in research and policy:
- Universities and research insititutes
VB: TNO
- Governments and ministeries
Medical and health psychology is about:
- Body and mind
- Chronic disease
- Capacity and empowerment
- Stress and disease
- Prevention and health
- eHealth and self management
Perception of health differs for everyone, the definition of health can relate to different concepts:
- Not ill:
No symptoms, no visits to a doctor.
- Reserve/resources:
Strong family/genes, able to recover quickly.
- Behavior:
Looking after oneself.
- Physical fitness and vitality:
Being energetic.
- Psychological well being:
In harmony, balance, feeling proud and enjoyment.
- Function:
Being able to do wat you have or want to do.
,The formal definition of health= a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.
→ This definition is often used, but complete wellbeing is difficult to define. This makes this definition
difficult to apply; when can you speak of complete wellbeing? And are you unhealthy when you’re
thriving physically and mentally but not socially?
When understanding health and illness, health and medical psychology chooses to use other models:
- The biomedical model:
This model focusses on the underlying pathology, neural and/or biochemical activity. But there are
also other factors that predict health.
VB: Health behavior, stress, social relations, etc.
- The biopsychosocial model:
Takes into account the biological factors but also the other predictors of health. This model states
that the body and mind interact and determine health and illness. Health and illness are a
consequence of a complex interplay between the biological, psychological and social factors; these
systems influence each other continuously.
1. Biological factors:
o Gender
o Physical illness
o Disability
o Genetic vulnerability
o Immune function
o Neurochemistry
o Stress reactivity
o Medication effects
2. Psychological factors:
o Learning/memory
o Attitude/beliefs
o Personality
o Behaviors
o Emotions
o Coping skills
o Past trauma
3. Social context:
o Social supports
o Family background
o Cultural traditions
o Social economic status
o Education
Different types of prevention:
1. Primary prevention:
It focusses on the prevention of a problem, illness or casualty.
- Target group: a healthy population.
- Aim: keep this population healthy/early symptoms from occurring.
VB: Exercise sufficiently, eating a healthy diet.
2. Secondary prevention:
It focusses on tracing early phases of a disease to be able to provide early treatment or prevention of
more serious complaints.
- Target group: population presenting with early symptoms, or are at a higher risk of
developing these symptoms.
, - Aim: detecting early stages, preventing early symptoms from becoming a full blown disease.
VB: Screening, early treatment.
3. Tertiary prevention:
It focusses on the prevention of complications and worsening of symptoms using optimal care.
- Who: population having a certain disease, or irreversible symptoms.
- Aim: maintaining a healthy life despite these symptoms, or making sure the symptoms don’t
get worse over time.
VB: revalidation, exercise and a nutritious diet which focusses on a particular target group
with particular symptoms.
Behavior influences our health. There are many cohort studies (=following people over time and seeing if a
certain outcome develops and what factors are related to is) that prove this:
VB: Framingham Heart Study;
This study tracked people in a certain American town. They reported their behavior and over time this
behavior could be related to health outcomes. This is de first study that proves that things like exercise, diet,
blood pressure, smoking and alcohol are related to cardiovascular disease.
VB: British doctor study;
This first study that showed a relation between smoking and negative health outcomes.
VB: Alameda 7;
This study showed that there are 7 health factors that contribute to longevity=living a healthy and long life.
1. Exercising
2. Drinking less than 5 drinks in one sitting
3. Sleeping 7-8 hours a night
4. Not smoking
5. Maintaining a desirable weight for your height
6. Avoid snacks
7. Eating breakfast
→ Ofcourse these factors have evolved over time, so drinking less than 5 drinks in one sitting is not an advise
that would be given nowadays.
Types of health behavior (Matarazzo):
1. Behavioral pathogens:
These are health risk behaviors.
VB: Smoking, sharing needles of drugs, unprotected sex, no ear protection.
2. Behavioral immunogens:
These are health protective behaviors.
VB: Physical activity, healthy nutrition, sun protection, vaccination, helmet.
, It is important to influence health behavior and encourage a healthy lifestyle because:
- Health behavior is related to morbidity (=onset of disease) and mortality (=death/life expectancy).
VB: Massive decrease in mortality related to infectious diseases occurred just before the introduction
of antibiotics treating these infections. This decrease was due to increased hygiene and sanitation.
This illustrates how health behavior can have a massive impact on mortality.
→ Ofcourse improvements in mortality is also partly due to medical developments that improve early
detection and treatment of diseases.
- The prevalence of risk behaviors is high:
This prevalence depends on what risk behavior you’re looking at. Prevalence is very high in smoking,
drinking alcohol and not following nutritious guidelines regarding fat, salt and sugar. Because of this
high prevalence, there’s a lot to gain in promoting healthy behavior.
- There are socio-economic differences in health outcomes and health behaviors:
Partly, this has to do with living circumstances, working conditions, but also health behavior. People
with a lower SEP smoke more often, engage in binge drinking, do less physical activity and eat less
healthy. This is not to blame them, because there are other factors contributing to this behavior. But
there is a lot to gain here as well.
VB: In the NL, people with a lower socio-economic position (SEP) live 7 years less than people with a
higher SEP.
VB: People with a lower SEP live 20-25 years shorter in health than people with a higher SEP. So the
onset of disease occurs way earlier in people with a lower SEP.
- Health behavior is not always an informed choice:
Unhealthy behavior can be made very appealing. This may lead us to make unhealthy choices even
though we want to make healthy choices for the long term benefits.
VB: Unhealthy snacks at the register in a supermarket or at the train station.
But there are also adverse effects to promoting health:
- Intervention generated inequalities:
A lot of the time, the interventions that are made to improve healthy behavior reach the healthy
people better than the people who actually need it more. By this, inequality is increased instead of
decreased.
- Hardening:
People can harden against public health institutions.
VB: With the covid vaccination, from a public health perspective it was better to get vaccinated. But a
lot of people got mad and hardened against the institutions promoting vaccination.
- Stigmatizing:
Focusing on health behavior can be stigmatizing, not everyone is to blame in regard to their behavior
when they have a certain health risk factor. Health behavior is not always the solution for certain
conditions. It is important that stigmatizing is not engaged with when promoting healthy behavior.
VB: People who are overweight are not to blame for being overweight, for some people exercising
may be beneficial but there can be many other factors that can cause someone to be overweight that
have nothing to do with health behavior.
