What is health psychology?

Health psychology is the study of behaviour when it comes to health, illness and healthcare. Health psychology focuses on individual strengths and puts emphasis on prevention and adaption during all phases from health to illness. Questions like How to remain healthy for as long as possible? and How to adapt in the most healthy way? are related to this.

Health psychologists work in health care (private practice, medical psychology department in the hospital, rehabilitation centres, medical centres), research, policy (local or federal government, developmental aid organisations) and primary prevention and training centres (Hersenstichting, KWF, Voorlichtingsbureau Voeding).

How can we prevent unhealthy behaviour?

There are three forms of prevention. Primary prevention is a method to keep people healthy for as long as possible. The target group of this form of prevention is healthy people. Secondary prevention focuses on finding early signs of an illness. This is done by screening and early treatment. The symptoms that may occur are still reversible at this stage. The target group for secondary prevention is (healthy) people with an increased risk of developing a certain condition. Tertiary prevention is based on the prevention of symptoms growing worse and rehabilitation. The people who this type of prevention is aimed at have already developed a certain condition.

What is ‘health’?

There are different opinions on the exact meaning of health. Some people see health as being not ill, which means showing no symptoms and not having to visit a doctor. Others see health as a reserve/resource (quick recover, strong family), behaviour (looking after yourself), physical fitness and vitality, psychological well-being (being in balance, enjoyment, harmony) or as a function (being able to do what you have to do or what you want to do).

According to the WHO, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Why do we become ill?

According to the biopsychological model there are multiple factors which influence the development of illness. These factors are biology, psychology and social context. These three factors are work together and is shown in an overview on slide 13. Health behaviour (sleep, nutrition, smoking, drinking, gender, disability), stress/emotions (past trauma, behaviour, personality, attitudes/beliefs), social relations (support, conflict, education) are related to these three main factors. These three main factors influence each other continuously. Within health and health psychology there is an body-mind interaction which determines health and illness.

The Alameda Seven Study is a research projected that investigated the seven main health factors for longevity. These factors are:

• Sleep 7 to 8 hours
• No eating between meals
• Eat breakfast regularly
• Maintain proper weight
• Regular exercise
• Moderate or no use of alcohol
• No smoking

According to the biomedical model exposure to contagious agents, like viruses and bacteria, together

What is health promotion?

When talking about health promotion at the worksite, many things may pop up in your mind, like dealing with the (un)healthy food offered in the canteen, dealing with those who are smoking, bad sitting positions and offering fitness at the workplace.

There have been multiple generations of WHP programmes. The first programmes mainly focused on safety and quality of the products. For example, they wanted to make sure that the remains of cigarettes would not end up in the food, since some would smoke while producing food.

In the 60s/70s the focus of WHP programmes shifted to the top management. It became clear that top management experienced a lot of stress and that there was a higher prevalence of heart attacks and such among top management. Those WHP programmes focused on improving their health behaviour, by motivating them to quit smoking, exercise and eat healthy food.

The third generation of WHP programmes focused on improving medical risk factors. Now it was easier to assess things like glucose and blood pressure. Therefore, questions like Can we reduce high blood pressure/glucose/cholesterol? were asked, since risk factors like these were associated with things like strokes.

In the 80s, the fourth generation of WHP programmes shifted their focus to health improvement and health behaviour, by promoting healthy nutrition and exercising.

Nowadays, WHP programmes focus on health wellness and psychological well-being. This generation of WHP programmes will be discussed later on.

Why health promotion at the worksite?

It is important to promote health behaviour at the worksite, since life styles are connected with mortality and morbidity, but to other things as well, like absenteeism, health care costs (which are higher for those who show unhealthy behaviour) and productivity. In the USA the health insurance is based on the employer paying health care costs of employees. Therefore it is important for those employers to promote health behaviour for their employees. The more lifestyle risks/unhealthy behaviour, the lower the productivity. Each additional risk factor has been associated with a 2.4% excess productivity reduction, in medium risk employees 6.2% and in high risk employees are even 12.2% less productive.

Those with higher risks have higher rates of absenteeism. A graphic is shown on slide 11.

Smokers have a higher absence frequency (1.5x) and a higher number of absenteeism (14 days) than non-smokers). The estimated costs for a smoking employee are about 105 more euros than those for non-smokers. A risk of work disability is higher in those who are overweight and those have a higher absenteeism rate than employees with a healthy weight, about 14 more days. Employees who exercise are less often absent, but especially their absence spells are shorter.

Return investment means that when an employer invests in healthy nutrition, exercise in workplace and promoting employees to quit smoking gets less absenteeism and less additional costs in return.

There are many factors which influence symptoms and symptom perception. An experiment is done to show this. Factors like temperature, background information and cognition, colours of the objects and environment are examples. The experiment consists of two parts. During the first part of the experiment, the scientist said touching the ice water with chemical substances in the tank would increase pain and during the second part of the experiment, the scientist said the water tank was filled with pain reducing substance. This kind of information and the different appearances of the substances in the tanks can influence one’s perception of their symptoms and stated level of pain.

Complaints

About two third of the general practitioner’s come across patients’ complaints which they have no explanation for. Somatically unexplained physicial symptoms are quite common in general practice. About 20-50% of the complaints are somatic. This means that no objective physical distortions or disrupted bodily processes can explain the complaints. These complaints often disappear spontaneously, usually after reassurance by the general practitioner.

The Symptom Perception Model describes how psychological factors influence symptom perception. One of these factors is negative affectivity. Negative affectivity is the tendency to experience negative mood, feel distressed and feel critical about oneself, and to view the self and the world in generally negative terms. It is related to neuroticism. Symptom perception can lead to long-term activation and reactivation of symptom related cognitive networks, like paying attention to and earlier detection of somatosensory signals, interpretation of ambiguous internal and external information in terms of somatosensory symptoms and attribution of signals as somatosensory symptoms. There is a bidirectional relationship between the attention paid to the symptoms and the perception of those symptoms. An overview of this model is shown on slide 12.

Mood also influences symptoms and symptom perception. Negative mood results in more pain and itch reports in healthy subjects. Anger and sadness enhance pain in response to experimental pain exposure in healthy controls and chronic pain in patients with fibromyalgia.

Pennebaker once did an experiment in which he investigated the role of somatic attribution in symptom perception. According to this research, misattribution of physical arousal may occur due to certain information, e.g. information about catching a common cold or not. Subjects who received information about common cold reported more symptoms of a common cold.

Placebo and nocebo effects also play a role in symptom perception. Placebo and nocebo effects are (un)favourable treatment effects not due to treatment mechanisms itself. The effects are induced by expectations of improvement or worsening symptoms. An example is decreasing pain when only seeing a pain killer. Once an experiment was done in which they concluded that pain killers may not work if the person doesn’t know he or she is receiving the pain killer. Other examples of placebo and nocebo effects are a decrease of willingness to take medication after reading an information leaflet, an increase in their occurrence

Why do we have pain?

Pain is a phenomenon which occurs in a wide variety of medical conditions, but it also occurs in the absence of any physical problems. Pain warns us that something is wrong with our bodies and therefore we can act in certain ways to prevent injuries from getting worse. Of all psychical symptoms presented in practice, 50% of the symptoms are pain, 20-30% are respiratory related symptoms and 20-25% of the symptoms are non-pain and non-respiratory in nature, for example fatigue and dizziness.

Pain can be defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain has a sensory and emotional component (fear and anxiety of developing pain and actual physical pain). Tissue damage is not necessary to experience pain: pain may occur in the absence of any physical problem.

The two most frequently reported reasons for consulting a primary care physician are common colds, low back pains (in 85% of patients consulting for low back pains, only minor pathology is present) and headaches (usually no clear physical can be determined).

How can pain be classified?

Pain can be classified either according to cause or according to duration.

According to cause there are four types of pain. Nociceptive pain is (musculoskeletal) pain due to tissue damage and causes pain in muscles, bones, joints and/or skin. For example a fracture, burn wounds or RA cause pain receptors to be activated and therefore cause the feeling of pain.

Neuropathic pain is a consequence of damage to (or pathology of) the central/peripheral nervous system. It causes changes at the level of the nervous system to become permanent in nature over time and it therefore is difficult to treat. Many compare it to a sensation of needle pricks, electrical shocks, burning or freezing sensation or the sensation as if ants are crawling up and under their skin. Allodynia is when pain is experienced as a consequence of a stimulus that does not normally cause pain, for example rubbing a cotton swab on your skin causing excruciating pain. It is a painful response to an innocuous stimulus. Hyperalgesia is when pain is experienced as disproportional to the pain stimulus. The pain stimulus is painful to begin with, but it is experienced way worse in hyperalgesia. For neuropathic pain, the pain threshold often becomes very low for any kind of pain.

Mixed pain is a mixture of neuropathic and nociceptive pain. An example is when a buffer disci in the spinal cord has been damaged (herniated disc, nociceptive element), causing fluid to drip in the spinal canal, causing inflammation of the nerves and then eventually causing dull pain in the lower back (neuropathic element) which can lead to paralysis.

Idiopathic pain is pain for which no clear organic cause can be found. There is no diagnosis referring to a