Going Beyond Stress: The Psychology of Health

Psychologists don’t stop at the intersection of stress, disease, and coping. They’re also attempting to apply what they know about human behavior and mental processes to the problems of health in general. They’re looking for ways to keep people physically well and trying to find out how people’s behavior contributes to illness. Psychology researchers work in the field of health psychology, the psychological study of health and illness.

Health psychologists work in many types of settings, ranging from universities (conducting research) to clinics and hospitals, which involve the direct care of patients. Their main activities include preventing illness, helping people and families cope with illness, and developing programs for health-related behavior change and maintaining a healthy lifestyle.

Illness prevention for health psychologists

Health psychologists engage in three types of illness prevention:

• Primary: Preventing an illness from occurring in otherwise healthy people. Examples of primary prevention programs are childhood immunization, condom use, and HIV-awareness campaigns.
• Secondary: Focusing on the early identification and treatment of a developing illness or disease. Secondary prevention programs include breast cancer awareness campaigns and the promotion of self-examinations for testicular cancer.
• Tertiary: Helping people cope with already developed diseases and preventing them from getting worse. Tertiary prevention programs include helping people reduce high blood pressure, quit smoking, and treat obesity.

Health changes

Have you ever kept a New Year’s resolution to start doing something healthy — exercise more often, take a yoga class, eat better, get more rest, wear your seat belt? Why not? You’re probably thinking it was harder than you thought it would be. Take a minute to think about what keeps you from doing what’s most healthy?

A common problem with health-related behavior is people not sticking to the course they know is right. Part of this problem falls under the heading of compliance — whether or not someone follows through with a physician’s recommendations and treatment or their own health-related plans.

But what determines whether or not someone engages in health-promoting behavior to begin with? Some people make it look so easy. They go to the gym regularly. They eat right consistently. They don’t smoke — ever.

People do unhealthy things for numerous reasons. For starters, a lot of people won’t start or stick with a health-related behavior if substantial barriers are in the way. It’s too easy to give up if something or someone makes it hard. Perhaps you don’t go to the gym because it’s too expensive, or you don’t sleep enough because you don’t have a nice set of pajamas. Money is a commonly cited barrier to engaging in healthy behavior.

Another reason people don’t just do it is that the health-related behavior may cut into something more fun or necessary. If I go to the gym, I’ll miss my television programs. If I eat right, I’ll have to go to the grocery store, and then I’ll have to cook, and then I’ll never finish any of my other household duties.

Commitment to change is most often brought about when a person believes that he can make a difference. A lot of people have a fatalistic attitude toward their physical health — the “you go when you go” philosophy. They don’t see their behavior as contributing to their health and, therefore, don’t bother to change.

This mindset is also known as having an external locus of control — thinking that control over something rests outside of oneself.

Having the belief that the power to change a situation or event resides inside yourself, that it’s under your control, is called an internal locus of control. When someone feels that they can control something, they are more likely to try and do something about it.

After you’ve changed, either because of external rewards or because of your belief that you can make a difference, how do you maintain those changes? It’s easy to quit smoking, for example, but staying smoke-free is another story. You can maintain a commitment to healthy behavior by first examining the pros and cons of changing and not changing. Your ability to develop an accurate tally depends on having access to reliable information. Confusing or conflicting health messages don’t quite do the job.

A number of factors influence people’s tendencies to listen to and believe a particular source of information. Research on persuasion — getting somebody to do something he may not do on his own accord — has supplied psychologists with much of their knowledge in the area of source believability. Who do people believe?

For a message to be persuasive, it must grab your attention, be easy to understand, and be acceptable and worthwhile. You also have to be able to remember it. If you don’t remember the message, who cares what it said? Persuasive arguments tend to present both sides of an issue, making the arguments look fair and unbiased. Fear-inducing messages work best when attainable steps are mentioned along with the scary stuff.

Decisions to engage or not to engage in healthy behavior are based on many factors, including your beliefs about the behavior and your locus of control. Researchers Hochbaum, Rosenstock, and Kegels, working in the US Public Health Services in the 1950s, came up with the health belief model to demonstrate the psychological processes someone goes through when making health-related decisions. The model is based on beliefs about the following:

• Severity: How bad can the illness or disease get if I don’t do something about it?
• Susceptibility: How likely am I to get sick if I don’t engage in healthy behavior?
• Benefits outweighing costs: What’s in it for me, and is it worth it?
• Efficacy: How effective will my attempts at change be? I don’t want to work for nothing.

The answers to these questions play a role in determining the likelihood that a person will do the healthy thing. If I arrive at a high-severity, high-susceptibility, high-benefits-over-costs, and high-efficacy conclusion, then the likelihood that I’ll choose the healthy option goes up. Otherwise, the healthy path may not seem to be worth the sacrifice and effort.

Interventions

What’s the next step after you decide to do something about your unhealthy lifestyle? What can you actually do to get the ball rolling? A health psychologist or other health professional can design interventions that help you change and then maintain that change.

Behavior modification is a powerful method of behavior change. The most basic, yet very powerful, form of behavior modification is to use punishments and rewards for either not engaging or engaging in the target behavior. For example, if I schedule myself to run three times a week at 5:30 p.m. and I don’t do it, then I have to clean the kitchen and bathroom, and do the laundry that night. If I comply, I get to treat myself to a nice dip in the spa. The trick with this technique is to enlist a partner to keep you from cheating on your rewards and punishments. I may decide to skip the laundry and go in the spa even if I don’t run. A partner helps keep you honest.

Cognitive change is a process by which I examine the mental messages I give myself that may prevent me from changing a behavior or maintaining a change. Everyone has automatic thoughts — thoughts that they don’t realize automatically go through their minds in certain situations. I may tell myself that I really want to run three times a week, but I also may be having the automatic thought, “You’ll never do it; you never follow through with anything.” Well, thanks for the positive reinforcement, me!

The good news is that automatic thoughts can be replaced with positive self-statements. This process takes a lot of practice and encouragement from other people, but the conversion is usually worth the hard work.

This article only begins to scratch the surface of health psychology and stress-related issues, but I hope this overview of the subject whets your appetite for more knowledge about living a less stressful and healthier life. Remember to relax, believe in yourself, and don’t avoid things. And reward yourself when you follow through with this advice!