Unit 2 behavor health note

Behavioural Science and Mental Health
BPH 5th sem
6/5/21 Ashok Pandey 1

Unit 2: Behavioural health 20 Hours
Health behaviour
o Definitions of Health Behaviour and Health Status.
o Relation of behaviour with morbidity and mortality
o Behavioural risk factor related to health
o Models of Health Behaviour.
- Social Cognition Models
The Health Belief Model
Self-efficacy Theory
The Theory of Reasoned Action and
Theory of Planned Behaviour
- The stages of change model
Precontemplation
Contemplation
Preparation
Action
Maintenance

Definitions of Health Behaviour and Health Status
• Behavioral health refers to how our daily cognitive habits
affect our overall well-being, emotions, biology, and behavior.
It’s often used interchangeably with mental health, but is
actually a far more expansive term that incorporates not just
our mental wellness, but the way our thoughts play out in real
life.
• Good behavioral health means engaging in behaviors that help
you achieve an ideal mental and physical balance. That means
exercising, eating a healthy diet, and taking necessary steps to
manage an existing disease or injury.

• Health behavior refers to the actions of individuals, groups, and
organizations, as well as the determinants, correlates, and consequences, of
these actions which include social change, policy development and
implementation, improved coping skills, and enhanced quality of life.
• David Gochman proposed, which includes not only observable, overt
actions but also the mental events and emotional states that can be reported
and measured.
• Gochman defined health behavior as "those personal attributes such as
beliefs, expectations, motives, values, perceptions, and other cognitive
elements; personality characteristics, including affective and emotional
states and traits; and overt behavior patterns, actions, and habits that relate
to health maintenance, to health restoration, and to health improvement."

Behavioral health describes the
connection between behaviors
and the health and well-being
of the body, mind and spirit.
This would include how
behaviors like eating habits,
drinking or exercising impact
physical or mental health.

What Are Symptoms of Behavioral Health
Symptoms of poor behavioral health, on the other hand, are
behaviors that negatively impact an individual’s well-being. In
many cases, this includes behaviors associated with mental
illness such as:
• Disordered eating
• Substance abuse
• Social isolation
It can also refer to less severe behaviors that still bring about
negative outcomes, such as inefficient sleep habits or poor
hygiene.

⚫Motivation which leads to health influencing
behaviour may also not be
related to health per se
⚫Motivation for health behaviour is dynamic
and not static
Human Health Behavior

⚫Health-directed behavior
◦ Observable acts that are undertaken with
a specific health outcome in mind
⚫Health-related behavior
◦ Those actions that a person does that may
have health implications, but are not
undertaken with a specific health
objective in mind
Types of Health Behavior

Types Of Health-related Behaviour
⚫Preventive Health Behaviour
◦ action taken when a person wants to avoid being ill or
having a problem e.g. a mother takes her child for
immunisation
⚫Illness Behaviour
◦ action taken when a person recognizes signs or
symptoms that suggest a pending illness e.g. a
mother gives her child cough medicine after hearing
her wheeze

Types of health-related
behaviour
⚫Sick-role Behavior
◦ action taken once an individual has been
diagnosed (either self or medical diagnosis)
e.g. an employee takes a vacation because
he is ill, he takes treatment and obeys his
doctor’s advice

Feeling symptoms
Go to
pharmac
y
Do
nothi
ng
Self
treatment
Go to
doctor
complianc
e
cure
No
complianc
e
complicat
ion
Behavior in illness

Factors that affect illness behavior
⚫ Age, sex, level of education, culture, religion, past
experience
⚫ Seriousness of symptoms/signs
⚫ If these symptoms affect the ordinary life
⚫ Persistence and frequency of symptoms
⚫ Personal tolerance to symptoms
⚫ Level of knowledge, cultural opinion about these
symptoms
⚫ Severity of illness or being fatal.
⚫ Stigma : community opinion towards patients of that
illness
⚫ Availability of medical services & treatment
⚫ Trusted services and health providers

Health Status
Health status is an individual's
relative level of wellness and
illness, taking into account the
presence of biological or
physiological dysfunction,
symptoms, and functional
impairment. Health perceptions (or
perceived health status) are
subjective ratings by the affected
individual of his or her health
status

Health status
• Health status is a holistic concept that is
determined by more than the presence or
absence of any disease.
• It is often summarised by life expectancy or
self-assessed health status, and more broadly
includes measures of functioning, physical
illness, and mental wellbeing.

What is a health indicator
Indicators are only an indication of a given
situation or a reflection of that situation.
According to WHO guidelines for health
programme evaluation; Indicators are defined as
“variables which help to measure changes.”

Classification of health indicators
1.Mortality Indicators.
2.Morbidity Indicators.
3.Disability Rates
4.Nutritional Status Indicators
5.Health care delivery indicators
6.Utilization rates
7.Indicators of social and mental health
8.Environmental health
9.Socioeconomic Indicators
10.Health policy Indicators
11.Indicators of quality of life
12.Other Indicators

Sullivan’s Index
Sullivan’s index (Expectation of life free of
disability) is computed by subtracting from the
life expectancy the probable duration of bed
disability and inability to perform major
activities, according to cross sectional data from
the population surveys.

Behavior risk factor related to health
• A risk factor is any attribute, characteristic or
exposure of an individual that increases the
likelihood of developing a disease or injury.
• Some examples of the more important risk
factors are underweight, unsafe sex, high blood
pressure, tobacco and alcohol consumption,
and unsafe water, sanitation and hygiene

• Alcohol
• Sanitation
• Tobacco
• Obesity
• Substance abuse
• Water

Relation of behaviour with morbidity and
mortality

Mortality and Morbidity
• Together they measure the health status of the population. Two populations with
same level of could have quite different health statuses but overall relatively close
(good) relationship (especially in the past).
• There is evidence showing that when mortality declines morbidity levels decline as
well.
• Focus mostly on mortality rather than morbidity.
• Old tradition in demography more interested in mortality because it has
implications for population size, population growth, and population age structure.
• But mortality is an imperfect (incomplete) picture of health status of a population.
Some people prefer to measure “healthy life expectancy”.
• Problem with health measures: health/diseases are more difficult to measure than
deaths (not as well recorded [hospital based]).
• Also more difficult to define: distinction between healthy/non-healthy not as clear
cut as for dead/alive.

Models of Health Behaviour.
Social Cognition Models

Albert Bandura
0 Albert Bandura was born
in Alberta, Canada in
1925
0 Doctorate studies
University if Iowa.
0 Interested in behaviorist
learning theories
0 Stanford University he
began to examine
influences of social
observations and
learning in more depth
(Famous People Info,
2011)

Social Cognitive Theory
Bobo doll experiment:
Adults were recorded being aggressive to bobo dolls
Children were shown the video and then allow to play in a room full
of toys
Children were aggressive to the bobo doll just as the
adults were in the video (Cherry, 2014).

Social Cognitive Theory
0 Through his research, Bandura observed that
components of learning occur though observation
and modeling behaviors
0 This concept led to the theoretical framework of
the social cognitive learning theory (Famous
People Info, 2011).

Assumptions Of Social Cognitive Theory
0 Learning occurs by observing others and modeling
0 Internal processes and cognition of observed behavior may or may not lead to a
learned behavior ( learning performance distinction).
0 Behavior is goal directed- goals are set and behavior is directed to
accomplishing the goal (motivation driven)
0 Behavior is eventually self-regulated
0 Punishment and reinforcement have indirect effects on the learning process (Hurst,
2014).

Reciprocal Causation Model
Environment
Learning
Perso
n
Behavio
r

Environmental
factors:
Social models
Instruction
Feedback
Personal factors:
(cognitive)
Goals
Sense of efficacy
Attributions
Process of self-regulation
 Behaviors:
Goal progress
Motivations
Learning (Zimmerman,
1989).

Types of Learning:
0Enactive Learning- learning by
doing and is reinforced by the
consequences of
actions/outcomes
0Vicarious Learning- learning
through observation not
performance (Hurst, 2014).

The Learning Process Requires:
0Attention
0Retention
0Reproduction
0Motivation

Social Cognitive Theory: Modeling
0 Models can bereal people
(teachers, coaches etc.)
0 Models can also come from
media: books, TV, Magazines
(symbolic)
0 Models can influence behavior:
positively or negatively (Schunk,
2012).

Characteristics of Models
Models, both real and symbolic, have:
0 Have prestige and power
0 Models are competent
0 Perform tasks well that others would like
to be able to do (Hurst, 2014).

Modeling Example
John Observers
Sally
succeed
John Models
Sally’s
Behavior

Evaluation of Learning and Behavior
0 Perceivedself-efficacy
0 Outcomeexpectations
0 GoalSetting
0Self-evaluation
0 GoalProgress
0 Cognitivemodeling
0Self-instruction
(Schunk, 2012).

Strengths of Theory
0 A great deal of learning occurs from
watching others
0 Strong research to support theory
0 People have considerable control over
behaviors learning (motivation) (Hurst,
2014)

Weaknesses of Theory
0 The theory is loosely
structured
0 Doesn’t take emotional
responses into account
0 Ignores biological differences
between individuals –genetic
factors
0 Assumes that all behavior is a
result of modeling, not genetics,
illness, or other influences
(Flamand, 2014).

Application of The Theory
Scenario-based learning:
This is the process of dividing students into small groups and then
providing a situational learning environment (example CPR).
The instructor demonstrates the procedure of providing CPR and then
students emulate the behavior. Feedback is provided and students are
able to self-correct. Students gain increased self-efficacy as they
progress in the activity ( Johnson, Dana, Jordan, Draeger, Schmitt-
Olabisi, Reich, 2012).

Application of The Theory
The use of discussion boards in distance learningprograms:
Peers have active discussions about various topics
Students are engaged and encouraged by other’s posts and topics
Self-efficacy increases, leading to better discussion
The use of video clips, pod casts, and audio clips enhance the learning
process by demonstrating concepts or tasks and allowing for modeling and
better understanding (Hill, Song, West, 2009).

THE HEALTH BELIEF MODEL
(Rosenstock and Becker - 1974)

“Two major factors influence the likelihood that
a person will adopt a recommended preventive
health action
First they must feel personally threatened by
disease i.e. they must feel personally
susceptible to a disease with serious or severe
consequences
Second they must believe that the benefits of
taking the preventive action outweigh the
perceived barriers to (and/or cost of) preventive
action”
HEALTH BELIEF MODEL

HEALTH BELIEF MODEL
Demographic variable
[age, sex, race
ethnicity, etc.]
Socio-psychological
variables
Perceived Threat of
Disease “X”
Perceived
Susceptibility to
Disease “X”
Perceived Severity
of Disease “X”
Perceived benefits
of preventive
action
minus
Perceived barriers
to preventive
action
Likelihood of Taking
Recommended
Preventive Health
Action
Cues T o Action
Mass Media Campaigns
Advice from others
Reminder postcard from physicilan or dentist
Illness of familiy member or friend
Newspaper or magazine article
I N D I V I D U A L
P E R C E P T IO N S
M O DIFYIN G
F A C T O R S
L IK E L IH O O D
O F A C T I O N

Concept Definition Application
Perceived
Susceptibility
One’s opinion of chances of
getting a condition
Define population(s) at risk based
on a person’s features or behaviour.
Heighten perceived susceptibility
if too low
Perceived
Severity
One’s opinion of how serious a
condition and its sequelae are
Specify consequences of risk and
condition
Perceived
Benefits
One’s opinion of the efficacy of the
advised action to reduce risk or
seriousness of impact
Define action to talk: how, where,
when; clarity the positive effects to
be expected
Perceived
Barriers
One’s opinion of the tangible and
psychological costs of the advised
action
Identify and reduce barriers
through reassurance, incentives,
assistance
Cues to Action Strategies to activate “readiness” Provide how-to information,
promote awareness, reminders
HEALTH BELIEF MODEL (Detailed)

P e r c e i v e d
s u s c e p t i b i l i t y
Y o u n g m a n h a s
b e e n e n g a g i n g i n
s e x w i t h m u l t i p l e
p a r t n e r s .
P e r c e i v e d
S e v e r i t y
Y o u n g m a n
b e l i e v e s t h a t
A I D S i s a d e a t h
s e n t e n c e s i n c e
t h e r e i s n o c u r e .
P e r c e i v e d
T h r e a t
Y o u n g m a n
b e l i e v e s t h a t h e
i s a t r i s k b e c a u s e
f r i e n d i s ill.
C u e s t o A c t i o n
R a d i o m e s s a g e s
e x p l a i n i n g t h e
n e e d f o r s a f e s e x .
P e e r e d u c a t i o n o n
s a f e s e x a n d H I V.
B e n e f i t s / b a r r i e r s
 C o n d o m s a r e
e a s y t o u s e , o n e
c a n f e e l s a f e
 C o n d o m s n o t
r e a d i l y a v a i l a b l e ,
c o s t l y
D e s i r e d
B e h a v i o u r
Y o u n g m a n b u y s
a n d u s e s c o n d o m s
r e g u l a r l y.
S e l f - e f f i c a c y
Y o u n g m a n h a s
h a d p r a c t i c e u s i n g
c o n d o m s a n d f e e l s
c o n f i d e n t t o u s e
t h e m .
MODIFIED HEALTH BELIEF MODELAS APPLIED TO
HIV/AIDS PROGRAMME

THEORY OF REASONED ACTION
(Fishbein and Atzen - 1975)

THE THEORY OF REASONED ACTION
⚫ Proposes that voluntary behaviour is predicted by one’s intention to
perform the behaviour (e.g. how likely is it that you will take up a
quit smoking programme?)
⚫ Intention, in turn, is a function of :
◦ attitude towards the impending behaviour (do you feel good or
bad about quitting?), and
◦ subjective norms (do most people who are important to you
think you should quit?)

⚫ Attitude is a function of beliefs about the consequences of the
behaviour (how important do you think it is to quit?) weighted by
an evaluation of the importance of that outcome (how important is
it to you to quit?)
⚫ Subjective norms are a function of expectations of significant others
(does your spouse think you should quit?) weighted by the
motivation to conform (how important is it to do what your spouse
wants?)

⚫Unlike the Health Belief Model and the Social Learning
Theory, this model is based on rationality and does not
provide explicitly for emotional ‘fear- arousal’ elements such
as the perceived susceptibility to illness
⚫Basically more emphasis is put on intention rather than
attitudes.

THEORY OF REASONED
ACTION
External variables
Demographic
variables
Age, sex, occupation
socio-economic
status, religion,
education.
Attitudes towards
targets
Attitude towards
people
Attitudes towards
institutions
Personality traits
Introversion-
extraversion
Neuroticism
Authoritarianism
Dominance
Beliefs that the
behaviour leads to
certain outcomes
Evaluation of the
outcomes
Beliefs that specific
referents think I
should not perform
the behaviour
Motivation to
comply with the
specific referents.
Attitudes towards
the behaviour
Relative
importance of
attitudinal and
normative
components
Subjective norm
Intention Behaviour
Possible explanations for observed relations between external variables and behaviour.
Stable theoretical relations linking beliefs to behaviour.

THEORY OF REASONED ACTION AND PERSONAL BEHAVIOUR
APPLIED TO HIV/AIDS PROGRAMME ACTION
(Adapted to key focus areas)
Subjective n o r m
(perceived social
pressure)
Y o u n g m a n believes
that his friends thinks
c o n d o m s are not cool.
Perceived
behavioural control
Y o u n g m a n feels
confident that h e c a n
use c o n d o m s a n d
handle his sexual drive.
Personal attitude
Y o u n g m a n is afraid of
getting A I D S a n d
believes that wearing
c o n d o m s is g o o d
protection. B e h av io u ral
intention
Y o u n g m a n
indicates a
willingness to
use c o n d o m s
regularly a n d
ask for
information o n
w h e r e he can
obtain t h e m
heaply.
D e s i r e d b e h a v i o u r
t a ke n
Y o u n g m a n b u ys
c o n d o m s a n d begins to
use t h e m regularly.

STAGES OF CHANGE MODEL
(Prochaska and DiClemente -1984)

(Prochaska J & DiClemente C, 1984)
Pre-contemplation
Not interested in
changing ‘risky’
lifestyle
Exit:
Maintaining
‘safer’lifestyle
Action:
Making
changes
Maintenance:
Maintaining
change
Relapse:
Relapsing
back
Commitment:
Ready to
change
Contemplating:
Thinking
about change

⚫ The model identifies a number of stages which a person
can go through during the process of behaviour change
⚫ It takes a holistic approach, integrating a range of factors
such as the role of personal responsibility and choices,
and the impact of social and environmental forces that set
very real limits on the individual potential for behaviour
change
⚫ It provides a framework for a wide range of potential
interventions by health promoters

⚫Pre-contemplation stage: The stage which precedes
entry into the change cycle. At this stage the person has not
considered changing their lifestyle or become aware of any
potential risks in their health behaviour.
⚫Contemplation stage: Although the individual is aware
of the benefits of change, they are not yet ready and may
be seeking information or help to make the decision. This
stage may last a short while or several years.

⚫Commitment stage: When the perceived benefits
seem to outweigh the costs and when the change seems
possible as well as worthwhile, the individual may be ready
to change, perhaps seeking some extra support.
⚫Action stage: The early days of change require positive
decisions by the individual to do things differently. A clear
goal, a realistic plan, support and rewards are features of
this stage.

Stages Of Change Model As Applied To Hiv/Aids Programme
Precontemplation
Young man has heard
aboutAIDS but
doesn’t think it is
relevant to his life.
Contemplation
Young man
believes that he
and his friends
are at risk and
thinks that he should
do something.
Decision/
Determination
Young man is
ready & plans to
use condoms
so goes to a shop
to buy them.
Maintenance
Wearing condoms
has become a habit
and young man
regularly buys them.
Action
Young man buys
and uses condoms.

⚫Maintenance stage: The new behaviour is sustained
and the person moves into a healthier lifestyle
⚫Relapse stage: Although individuals experience the
satisfaction of a changed lifestyle for varying amounts of
time, most of them cannot exit from the revolving door
first time around. Typically, they relapse back. Of great
importance, however, is that they do not stop there, but
move back into the contemplation stage.

Concept Definition
Pre-contemplation Unaware of the problem hasn’t
though about change.
Contemplation Thinking about change, in the
near future.
Commitment Making a plan to change.
Action Implementation of specific
action plans.
Maintenance Continuation of desirable
actions, or repeating periodic
recommended step(s).
Application
Increase awareness of need
change, personalize
information on risks and
benefits.
Motivate, encourage to mak
specific plans.
Assist in developing concret
action plans, setting gradual
goals.
Assist with feedback, proble
solving, social support,
reinforcement.
Assist in coping, reminders,
finding alternatives, avoidin
slips/relapses (as applies).

Illness Behavior
Concept, definition, types and interpretations of
illness behavior

Concept
Illness behavior refers to any actions or
reactions of an individual who feels unwell for
the purpose of defining their state of health and
obtaining physical or emotional relief from
perceived or actual illness.

Illness is a state in which the physical, social,
developmental, intellectual, emotional or
spiritual functioning of the individual is
diminished or impaired.
Acute illness
Chronic illness

Acute illness
• Short duration
• Mostly severe
• Starts abruptly and subsides in relatively short period (less than 6 months)
Chronic illness
• Persist for more than six months
• May affect functioning of body in any dimension
• Up to the level of disability
• Major health problem

The way the sick person acts is called illness
behavior.
Factors
• How the interpret and view the symptoms
• Use remedial measures
• Utilize the health care facilities
• Nature of illness

• The term illness behavior was introduced by Mechanic and Volkart to
describe the individuals' different ways to respond to their own health
status.
• Pilowsky's concept of abnormal illness behavior encompasses several
clinical conditions characterized by a maladaptive mode of
experiencing, perceiving, evaluating and responding to one's own health
status.
• The concept of somatization was criticized because it implies the presence
of psychological distress or an underlying psychiatric disturbance when an
organic cause for somatic symptoms is not found.
• Thus, more a theoretical terms, such as functional somatic symptoms and
medically unexplained symptoms, were introduced.

• Illness behaviour thus involves the manner in which
persons monitor their bodies, define and interpret
their symptoms, take remedial action, and utilize
various sources of help as well as the more formal
health-care system.
• Any of the ways in which an individual acts or reacts
to his or her own illness or the illness of a family me
mber.
• Commonreactions include frustration, anxiety, denial,
anger, and withdrawal.

Concept of illness behavior
• The concept of illness behavior describes the ways in
which people respond to the bodily indications and
the conditions under which they come to view them
as abnormal.
• It also is concerned with how people monitor and
respond to symptoms and symptoms change over the
course of an illness and how this affects behavior,
remedial actions taken and response to treatment.

Illness belief
• The dimensions of illness beliefs
• A model of illness behavior
• Health professional beliefs

Illness Behavior

Concept
• not feeling normal, for example, ‘I don’t feel right’
• specific symptoms, for example, physiological/psychological
• specific illnesses, for example, cancer, cold, depression
• consequences of illness, for example, ‘I can’t do what I usually
do’
• time line, for example, how long the symptoms last
• the absence of health, for example, not being healthy.

Definition
• Lau (1995) defined the illness behavior as not
only the manifestations of the symptoms of
illness but also the belief of being sick.

Illness Behavior
• Manifestation of the symptoms
• Cognition of the illness
• Belief about the illness
• Motivation for treatment
• Seek help from professionals and visit
• Medication and self-care

Illness Belief
• Leventhal and his colleagues (Leventhal et al.
1980, 1997; Leventhal and Nerenz 1985)
defined illness cognitions/belief as ‘a patient’s
own implicit common sense beliefs about their
illness’.

5 Dimensions of Illness Belief
1 Identity: This refers to the label given to the illness
(the medical diagnosis) and the symptoms
experienced (e.g. I have a cold – ‘the diagnosis’, with
a runny nose – ‘the symptoms’).
2 The perceived cause of the illness: These causes may
be biological, such as a virus or a lesion, or
psychosocial, such as stress- or health-related
behaviour.

Cont …
3 . Time line: This refers to the patients’ beliefs about how
long the illness will last.
4 Consequences: This refers to the patient’s perceptions of
the possible effects of the illness on their life. Such
consequences may be physical (e.g. pain, lack of mobility),
emotional (e.g. loss of social contact, loneliness, ….)
5 Curability and controllability: Patients also represent
illnesses in terms of whether they believe that the illness
can be treated and cured .

Comparison with Health Belief
The original core beliefs are the individual’s perception of:
• susceptibility to illness (e.g. ‘my chances of getting lung cancer are
high’)
• the severity of the illness (e.g. ‘lung cancer is a serious illness’)
• the costs involved in carrying out the behaviour (e.g. ‘stopping smoking
will make me irritable’)
• the benefits involved in carrying out the behaviour (e.g. ‘stopping
smoking will save me money’)
• cues to action, which may be internal (e.g. the symptom of
breathlessness), or external
(e.g. information in the form of health education leaflets).

Health Belief Model

Model of Illness Behavior

Health professionals belief
• It has been suggested that health care
professional (HCP) attitudes and beliefs may
negatively influence the beliefs of patients ,
but this has not been systematically reviewed.

Health professionals’ beliefs
• The nature of clinical problems If a health professional
believes that illness is determined by biomedical factors (e.g.
lesions, bacteria, viruses), they will develop a diagnosis that
reflects this perspective.
• But a professional who places the emphasis on psychosocial
factors may develop a different diagnosis.
• For example, if a patient reports feeling tired all the time, the
first professional might point to anaemia as the cause, and the
second to stress.

• The probability of the disease Health professionals
also have different beliefs about how common a
health problem is.
• For example, some doctors may regard childhood
asthma as a common complaint and hypothesize that
a child presenting with a cough has asthma.
• Another doctor who believes that childhood asthma is
rare might not consider this diagnosis.

• The seriousness of the disease Health professionals are
motivated to consider the ‘pay-off’ in reaching a correct
diagnosis, which is related to their beliefs about the
seriousness and treatability of an illness.
• For example, if a child presents with abdominal pain, the
professional may diagnose appendicitis, as this is a serious but
treatable condition.
• In this case, the benefits of arriving at the correct diagnosis for
this condition far outweigh the costs involved (such as time
wasting) if the diagnosis is actually wrong

The patient
• The original diagnosis will also be influenced
by the health professional’s existing
knowledge of the patient, including medical
history, degree of support at home,
psychological state, and beliefs about why the
patient came to see the doctor.

• Similar patients We know that stereotypes can confound a decision-making
process.
• Yet without them, consultations between health professionals and patients
would be extremely time consuming.
• Stereotypes reflect the process of ‘cognitive economy’.
• They play a central role in developing and testing a hypothesis and
reaching a management decision.
• So a health professional will typically base their decision partly on factors
such as how the patient looks/talks/walks, and whether they are reminiscent
of previous patients

Communicating beliefs to patients
• Health professionals’ own health-related beliefs may be
communicated to patients. A study by McNeil et al. (1982)
examined the effects of health professionals’ own language on
patients’ choice of treatment.
• They found that patients are more likely to choose surgery if
they are told it will ‘increase the probability of survival’ rather
than ‘decrease the probability of death’.
• The results indicate that the subjective views of health
professionals may be communicated to the patient, and
subsequently influence the patient’s choice of treatment.

The stress-illness link
• Stress models
Cannon’s “fight or flight” models
Selye’s general adaptations syndrome
Life event theory
- Chronic illness
Profile of an illness
Psychology’s role
Health professional beliefs

Illness or Disease
• Disease : something of the organ, cell or tissue
which denotes a physical disorder or
underlying pathology
• Illness: what the person experiences.

Stress illness link
Stress models : Throughout the twentieth century,
stress models have varied in terms of their definition of
‘stress’, their emphasis on physiological and
psychological factors, and their description of the
relationship between the individual and their
environment.

Cannon’s ‘fight or flight’ model
• One of the earliest models of stress was developed by Cannon
(1932).
• The ‘fight or flight’ model suggested that external threats elicit
the ‘fight or flight’ response, increasing activity rate and
arousal.
• These physiological changes enable the individual either to
escape from the source of stress or fight.
• Cannon defined ‘stress’ as a response to external stressors that
is predominantly seen as physiological.
• https://www.youtube.com/watch?v=mtRrxNTnyh8

Selye’s general adaptation syndrome
• Developed in 1956, Selye’s general adaptation syndrome describes three
stages in the stress process:
• ‘alarm’, which describes an increase in activity and occurs immediately
the individual is exposed to a stressful situation.
• ‘resistance’, which involves coping and attempts to reverse the effects of
the alarm stage.
• ‘exhaustion’, which is reached when the individual has been repeatedly
exposed to the stressful situation and is incapable of showing further
resistance.
https://www.youtube.com/watch?v=9FdmxfXrygA

Cont …

Life events theory
• In an attempt to depart from models that emphasize physiological changes, the life
events theory examines stress and stress related changes as a response to life
change.
• Research has shown links between life events and health status, in terms of both
the onset of illness and its progression (Yoshiuchi et al., 1998).
• These results were obtained using Holmes and Rahe’s (1967) ‘Schedule of Recent
Experiences’ (SRE) an extensive list of possible life changes or life events.
• These range in supposed objective severity from serious events, such as ‘death of a
close family member’ and ‘jail term’, through more moderate events, such as ‘son
or daughter leaving home’ and ‘pregnancy’, to minor events, such as ‘vacation’ and
‘change in eating habits’.

• Each event has a predetermined point score to reflect
its impact, with the combined score reflecting the
adjudged stress rating of the assessed individual.
• For example, ‘death of spouse’ would result in more
changes to an individual’s life schedule than ‘trouble
with boss’, and is therefore allocated a higher point
score.
• For example, whilst a divorce may be very stressful for
one person, it might be liberating for another

Life Event Stress Scale
In the past 12 months, which of the following major life events have taken place in your life?
Make a check mark next to each event that you have experienced this year . When you
are done, add up the points for each event. Calculate your score at the end.
Event Stress Scores
__ Death of Spouse 100
__ Divorce 73
__ Marital Separation 65
__ Jail Term 63
__ Death of close family member 63
__ Personal injury or illness 53
__ Marriage 50
__ Fired from work 47
__ Marital reconciliation 45
__ Retirement 45
__ Change in family member's health 44
__ Pregnancy 40

__ Sex difficulties 39
__ Addition to family 39
__ Business readjustment 39
__ Change in financial status 38
__ Death of close friend 37
__ Change to a different line of work 36
__ Change in number of marital arguments 35
__ Mortgage or loan over Rs 8,00,000 31
__ Change in work responsibilities 29
__ Trouble with inlaws 29
__ Outstanding personal achievement 28
__ Spouse begins or stops work 26
__ Starting or finishing school 26
__ Change in living conditions 25

__ Revision of personal habits 24
__ Trouble with boss 23
__ Change in work hours, conditions 20
__ Change in residence 20
__ Change in schools 20
__ Change in recreational habits 19
__ Change in Temple activities 19
__ Change in social activities 18
__ Mortgage or loan under Rs 8,00,000 17
__ Change in sleeping habits 16
__ Change in number of family gatherings 15
__ Change in eating habits 15
__ Vacation 13
__ Minor violation of the law 11

Result
• CALCULATE Your total score:
___________
• This scale shows the kind of life
pressure that you are facing.
SCORE SCALE:
• 0-149 Low susceptibility to stress
related illness
• 150-299 Medium susceptibility to stress
related illness
• 300 and over High susceptibility to
stress related illness

Schedule of Recent Experiences (SRE)
Accident
Abroad for job
Engagement and marriage
Boredom
Religious visit
Picnic (Recreation)
Gathering
Talkative
Change in college
Corona positive
Home sick
Dallima from routine
Lost
Broken leg
Bike accident
Unconscious
Intern life
Found egg of Kaliz
Illness of Grand pa
Crime
Lost of teacher
House separation
Isolation
Oxygen saturation lower
down
Job stress
Hiking
Punishment
Broke down of cooker

Summary
Life event: Sarika, Swikriti
Selyes General adaptation: Sano karki,
Anusha

Stress causing illness

• In 1995, the Penn State research team interviewed 435
participants each day for eight days to gauge the stress
levels they experienced and their reactions to the stress.
The team also did saliva tests to measure their levels of
the stress hormone, cortisol. A decade later, in 2005, the
team repeated the testing regimen.
• Published recently in the Annals of Behavioral
Medicine, the study found emotional reactivity to daily
stress was "associated with an increased risk" that a
participant would report a chronic physical health
condition 10 years later.
https://www.heraldextra.com/lifestyles/health-and-fitness/manage-stress-or-it-will-tax-your-health/article_4952021a-37dc-11e2-b91f-0019bb2963f4.html

• "Daily stressors are less severe than chronic stressors,
but they are nonetheless associated with adverse same-
day physical health outcomes," the study says, noting
the occurrence of fatigue, sore throat, headache and
backache.
• Reactivity to daily hassles also can lead to
hypertension, stressful social interactions that increase
the risk for metabolic syndrome that's a precursor to
type 2 diabetes and even cardiovascular disease. The
study says the problem isn't stress but a person's
reaction to it.

Stress causing illness
• The relationship between stress and illness is not straightforward, and there
is a lot of evidence to suggest that several factors mediate the stress–illness
link, including exercise, coping styles, life events, personality type, social
support and actual or perceived control.
• Stress can affect health through a behavioural pathway or through a
physiological pathway.
• Behaviours that may change as a result of stress include sleep, food intake
and alcohol consumption.
• Stress can also induce changes in the body’s biochemicals, changes in
activity, such as heart rate.

Stress and behaviour
• The effect of stress on specific health-related behaviours, such as exercise,
smoking, diet and alcohol consumption, in terms of initiation, maintenance
and relapse.
• It has also highlighted the impact of stress on general behavioural change.
• Individuals who experience high levels of stress show a greater tendency
to perform behaviours that increase their chances of becoming ill or injured
(Wiebe & McCallum, 1986) and of having accidents at home, work and in
the car ( Johnson, 1986).
• when under stress a person may smoke more, sleep less, drive faster and be
less able to focus on the task in hand, which, in turn, may result in heart
disease, cancer or accidents.

CHRONIC
ILLNESS

https://www.cdc.gov/chronicdisease/about/index.htm

CHRONIC ILLNESS
• Chronic illnesses, such as asthma, AIDS, cancer,
coronary heart disease and multiple sclerosis, are
another important focus for health psychologists.
• This section uses coronary heart disease (one of the
leading causes of death in the present day) to
illustrate the role of psychology at every stage, from
predicting risk factors through to rehabilitation.

PROFILE OF AN ILLNESS

PROFILE OF AN ILLNESS
• Coronary heart disease (CHD) is caused by hardening of the arteries
(atherosclerosis), which are narrowed by fatty deposits. This can result in angina
(pain) or a heart attack (myocardial infarction).
• CHD is responsible for 33% of deaths in men under 65 and 28% of all deaths.
• The highest death rates from CHD are found in men and women with a manual
occupation and men and women of Asian origin.
• In middle age, the death rate is up to five times higher for men than women, but
this evens out in old age, when CHD is the leading cause of death for everyone,
regardless of gender.
• Many risk factors for CHD have been identified, some less modifiable (e.g.
educational status, social mobility, social class, age, gender, family history and
race) than others (e.g. smoking behaviour, obesity, sedentary lifestyle, perceived
work stress and type of behaviour).

PSYCHOLOGY’S ROLE

PSYCHOLOGY’S ROLE
1. Psychological factors influence the onset of CHD.
• Our beliefs about both behaviour and illness can influence
whether we become ill or stay healthy.
• For example, someone who believes that ‘lots of people
recover from heart attacks’ may lead an inactive and sedentary
lifestyle, and a belief that ‘smoking helps to deal with stress’ is
hardly likely to help someone give up smoking.
• Beliefs such as these therefore result in unhealthy behaviours
that can lead to CHD.

2. Once ill, people also hold beliefs about their illness and will cope in
different ways.
• Psychology therefore continues to play a role as the disease progresses.
• For example, if someone believes ‘my heart attack was caused by my
genetic makeup’, they may cope by thinking ‘there is nothing I can do
about my health; I am the victim of my genes’.
• Beliefs like this are likely to influence the progression of the illness either
by affecting behaviour or by having an impact on the immune system.

3. Psychology also has a role to play in the outcome of CHD.
• For example, believing that a heart attack is due to a genetic weakness
rather than a product of lifestyle may mean that a person is less likely to
attend a rehabilitation class and be less likely to try and change the way
they behave.
• People also differ in other ways regarding their experiences of illness and
their ability to adjust to such a crisis in their lives.
• For example, whilst some people cope by taking definite action and making
plans about how to prevent the illness getting worse, others go into a state
of denial or cope by indulging in unhealthy behaviours, making the
situation worse.
• Such factors can impact upon their quality of life, possibly even influencing
how long they live.

Unit 2 behavor health note

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Unit 2 behavor health note