BulletPointsummary of Introduction to Health Psychology by Morrison and Bennett - 4th edition

What is health? - BulletPoints 1

• Health consists of domains of 'having', 'doing' and 'being', where health is a reserve, an absence of illness, a state of psychological and physical well-being
• Health is evident in the ability to perform physical acts, as fitness, and is generally something that is taken for granted until it is challenged by illness
• Views of health have shifted from fairly holistic views, where mind and body interact, to more dualist views, where the mind and body are thought to act independently of one another. 
• Dualists like Descartes saw the body as a machine. This mechanism means that people think that behaviour can be reduced to the physical functioning of the body. This approach is the basis of the biomedical model, which sees symptoms of illnesses as being caused by a pathology, and that this can be cured by a medical treatment.
• The dualistic view is shifting back towards holism, with the medical model being challenged by a more biopsychosocial approach.
• The biopsychosocial model takes into account the physical, psychological and cultural aspects when trying to explain an illness or symptoms. 
• In the 20th century, the life expectancy has increases a lot in western countries. This can be explained by more treatment with medication, vaccinations, developments in teaching and in agriculture.
• Cultures can be grounded in collective or individualistic orientations, and these will influence explanations for health and illness as well as the behaviour of those within the culture. 
• Children can explain health and illness in complex and multidimensional terms, and human expectations of health change over the lifespan as a function of background and experience as well as of cognitive development.
• Erik Erikson (1959 and 1989) described eight developmental stages which are about the development of a picture and character considering health. That eight stages can be divided into the following four things: cognitive and intellectual functioning, language and communication skills, an understanding about disease and health-care and keeping healthy behaviour.
• According to Piaget, the cognitive development of children takes place following 4 stages: the sensorimotor (0-2 years), the pre-operational (2-7 years), the concrete operational (7-11 years) and the formal operational stage (>12 years). 
• The World Health Organization describes health as a state of physical, mental and social well-being and the absence of illness. However, the socio-economic and cultural influences on health are not considered in this definition, nor is the role of the psyche. 
• The self-concept is relatively stable when getting older. It is often thought that getting older is a negative process, which makes changes in self-concept inevitable. But, getting older brings along new challenges, but people don’t need to see that as a problem.
• Five models of successful aging are: the biomedical model, the broader biomedical model, the social functioning model, the psychological resources model and the lay model. 
• Health Psychology is the study of health, illness and health-care practices (professional and personal).
• Health Psychology aims to understand, explain and ideally predict health and illness behaviour in order that effective interventions can be developed to reduce the physical and emotional costs of risky behaviour and illness. 
• Health Psychology offers a holistic but fundamentally psychological approach to issues in health, illness and healthcare.

How do culture and social backgrounds influence health? - BulletPoints 2

• Poverty is the main cause of ill health throughout the world. However, psychosocial factors may also influence health where the profound effects of poverty are not found. 
• One broad social factor that has been found to account for significant variations in health within societies is the socio-economic status of different groups. This relationship appears to be the result of a number of factors, including: differential levels of behaviours (such as smoking and levels of exercise), differing levels of stress associated with the living environment, levels of day-to-day stress and the presence or absence of uplifts, differential access to health care and differential uptake of health care that is provided, and low levels of social capital and its associated stress in some communities. 
• The World Health Organization has developed a method to measure the expected life expectancy of people, which is called the healthy life expectancy. It is remarkable that the most wealthy country, the United States, is in the 29th place with respect to life expectancy of the inhabitants. This could be due to a lot of social groups living in poverty in the US, the high prevalence of HIV, a lot of tobacco related illnesses in the US and a lot of violence, especially domestic violence. 
• Poverty has probably the most important social and economical influence on health. In a developmental country, one third of the society dies at the age of five. The most prevalent causes of death are diarrhea, blood in the stool and lower airway infections.
• Most studies show that low SES is the cause of bad health. When people change jobs often because of for example reorganizations, research has shown that these people experience emotional and physical problems.
• The relationship between work and health is complex. Having a job is better for one's health than not having a job. However, if the strain of having a job is combined with significant demands away from the job, this can adversely impact on health. 
• Many women, for example, appear to have high levels of work-home spillover, with its adverse effects on both mental and physical health. 
• Jobs with high levels of demand and low levels of autonomy appear to be more stressful and more related to ill-health than other types of jobs. 
• The Job Strain Model of Karasek and Theorell describes how different factors determine how many workstress a work situation causes. Three factors are considered: what does the job ask from the employee, how much freedom does the employee have (autonomy), how much social support is available. 
• The financial uncertainties associated with unemployment also appear to have a negative impact on health. 
• A third factor that may influence health is being part of a social minority. The experience of prejudice may contribute significantly to levels of stress and disease. 
• As many people in minority ethnic groups may alo occupy lower socio-economic groups, they may experience further stress as a result of this double inequity. 
• Gender may influence health, but not only because of biological differences between the sexes. Many biological differences may result from the different psychosocial experiences of men and women. In addition men engage in more health-compromising behaviours than women; men are less likely to seek help following the onset of illness than women; many women are economically inactive or in lower-paid jobs than men. This makes them vulnerable to the problems associated with low socio-economic status. Furthermore, a lot of women don't have a drivers licence, which makes them more socially isolated than men. 

What are health-risk behaviors? - BulletPoints 3

• The World Health Organization has made up a list of risk factors that account for 1/3 of all deaths in one year. This list includes: high blood pressure; smoking; a high blood sugar; physical inactivity; obesity; high cholesterol; unsafe sex; alcohol consumption; low weight in children; smoke by fuels. 
• Nicotine is in the third place of most used psycho-affective drugs. The substances in tobacco cause narrowing of the arteries and increase the likelihood of thrombosis. Passive smoking is also dangerous. 
• The prevalence of smoking is lower among minority groups than among the total population.
• Alcohol is the second most used drug in the world. There seems to be a decrease in alcohol use since 2010. 
• Alcohol is a central nervous system depressant. Low doses can cause behavioural disinhibition, and high levels increase the likelihood of an accident. Extremely high doses can cause coma and even death. 
• The chance of dying because of alcohol is twice as high for men than for women. 
• Alcohol use can lead to physical or mental illnesses, behavioural problems and problems in school. There can also be negative social consequences. 
• There is some evidence that moderate drinking can be protective for health, especially for women and red wine. 
• Regular illicit drug use is especially common for cannabis. Drug use can lead to HIV and Hepatitis C due to the method of delivery. 
• The reasons for people to start using drugs are: genes, curiosity, modelling/social learning/reinforcement, social pressure, weight control, image, risk taking, stress, health cognitions, self-concept and self-image. 
• People who continue using drugs, give the following reasons: direct pleasure due to the reinforcing effects, it has become a habit, it has become a method to cope with stress, people don't believe they are able to quit using drugs.
• In the 20th century, a treatment was developed for addictions according to the behavioristic principles. The social learning theory and conditioning theory assumes that learning takes place through observation and reinforcement. 
• The prevalence of sexually transmitted diseases is rising. A virus known as HPV is associated with the development of genital warts and cervical cancer. Condom use is not enough to protect against HPV, because HPV lives on the whole genital area. 
• Condom use is more prevalent among young people than among older people.
• Alcohol use causes a decrease in condom use among yound and old people. 
• Women use condoms less often than men, because of 1) anticipated male objection to a female suggesting condom use (denial of their pleasure); 2) difficulty/embarrassment in raising the issue of condom use; 3) worry that suggesting use to a potential partner implies that either themselves or the partner is HIV-positive or has another STD; 4) lack of self-efficacy or mastery in condom use. 
• 35% of the cancer deaths are attributable, in part, to poor diet. A diet involving significant intake of high-fat foods, high levels of salt and low levels of fibre appears to be particularly implicated. 
• Fatty foods contain low-density lipoproteins (LDLs), a kind of 'bad' cholesterol. This can lead to the formation of plaques in the arteries when circulating in the blood stream. 
• artherosclerosis is a condition in which plaques are laid down on the artery walls, causing them to thicken and restrict blood flow to the heart. A related condition is arteriosclerosis, which means that increased blood pressure causes artery walls to lose elasticity and harden. 
• Salt intake is also a target of preventive health measures, with high salt intake, much of it coming from an increasing overreliance on processed foods. 
• Obesity is not a behaviour but is contributed to mainly by a combination of poor diet and lack of exercise. 
• Obesity is measured in terms of body mass index, which is calculated as a person's weight in kilograms divided by their height in metres squared. BMI does not, however, take age, gender or body frame/muscle build into consideration. 
• Obesity is a risk factor in a range of physical illnesses, including hypertension, heart disease, type 2 diabetes, osteoarthritis, respiratory problems, lower back pain and some forms of cancer. 
• There are genetic explanations to obesity: obese individuals re born with a greater number of fat cells; obese individuals inherit lower metabolic rates and burn calories more slowly; obese individuals may have deficiencies in a hormone responsible for appetite regulation.

What does health protective behavior entail? - BulletPoints 4

• Depending on the kind of literature you read (medical, psychological or pharmacological) terms like adherence, compliance and concordance are used. The term adherence is used in this book and means 'the extent to which the patient's behaviour corresponds with agreed recommendation from a health-care provider'. 
• The WHO estimated that about a half of all medicines prescribed for chronic conditions are not taken as prescribed, and over all conditions, acute and chronic, about 25% are non-adherent. 
• Reasons for non-adherence fall into the following groupings: patient-related factors (e.g. culture and age); condition-related factors (e.g. symptom type, perceived severity); treatment-related factors (e.g. the number, type, timing of medication); socio-economic factors (e.g. low educational level, costs of treatment); system-related factors (e.g. communication with health-care provider). 
• For most people, non-adherence will be influenced by a mixture of the above.
• Fruit and vegetables are essential for a good health because of the vitamins, fibers and antioxidants. They can also protect the body against some forms of cancer, heart diseases and stroke. 
• Food preferences are learned through socialisation within the family, with the food provided by parents to their children often setting the child's future preferences for: cooking methods, product, tastes, textures and food components.
• Physical inactivity is the fourth leading risk factor for global mortality and regular exercise is health-protective, reducing the risk of diseases as cardiovascular and coronary heart disease. 
• Regular exercise strengthens the heart muscles, increases cardiac and respiratory efficiency, tends to reduce blood pressure and reduces the tendency of a person to accumulate body fat. 
• Exercise has benefits for people already with disease. 
• Furthermore, exercise has psychologisch benefits in terms of elevated mood and reduced anxiety and depression and improved self-esteem or body-image and prosocial behaviour. 
• Biological mechanisms concerned in these psychological benefits are: exercise-induced release of natural opiates - endorphines - into the bloodstream; stimulation of the release of catecholamines such as noradrenaline and adrenaline; muscle relaxation. 
• Reasons to engage in exercise are among others desire for physical fitnes, desire to lose weight, desire to maintain or enhance health status, desire to improve self-image and mood, a means of stress reduction or as a social activity. 
• Potential barrières include lack of time, cost, lack of access, embarrassment, lack of self-belief, lack of someone to go with to provide support. 
• Two purposes of health screening are: identification of risk factors for illness to enable behaviour change and to detect early asymptomatic signs of disease in order to treat. 
• General criteria for screening programs are: the condition should be important, there should be a recognisable early stage to the condition or clear benefit to identifying changeable risk; treatment at an early stage should have clear benefits; a suitable test should be available; the test should be acceptable; adequate facilities should exist; screening frequency and follow-up should be agreed; the costs should be considered; evidence-based information should be provided to participants; sub-groups should be identified.
• A range of factors are associated with the non-uptake of screening opportunities or self-examination, including lower levels of education and income; age; lack of knowledge; embarrassment regarding the procedures involved; fear that something bad will be detected; fear of pain; lack of self-belief.
• Vaccination is the oldest form of immunisation, in which a small amount of an antigen is injected to the body, which triggers the development of antibodies to that specific antigen. 
• A new vaccine has emerged which targets the HPV, which is present in 70-95% of cervical cancers. 
• There is evidence of emotional and cognitive predictors of uptake of vaccination, for example parents who exhibite anxiety about the risks of vaccination and the low perceptions of the potential benefits of vaccination.  

How can health behavior be explained? - BulletPoints 5

• Many proximal and distal factors influence our behavior and health behaviour. Examples of distal influences are culture, environemt, ethnicity, socio-economic status, age, gender and personality. Proximal influences are for example specific beliefs and attitudes towards health-risk and health-protective behaviour.
• A lot of health behaviours set down in childhood or early adulthood.
• Gender has a significant influence on the nature and performance of health-protective or health-risk behaviour. Perceptions of health and the meanings attached to health behaviours offer a partial explanation for gender differences in health behaviour.
• Personality also influences health behaviour. The Big Five traits include: neuroticism, extroversion, openness, agreeableness and conscientiousness.
• Neuroticism tends to be associated with health-risk behaviour, but it has also been associated with greater health-care use due to their greater attention to bodily sensations and to label them as potential threat.
• The multidimensional health locus of control scale identified three dimensions: internal, external and powerful others. These are however weak predictors of behaviour.
• The self-determination theory distinguishes between intrinsic and extrinsic motivation.
• In relation to health-risk behaviour, social influence is seen in the many sources of information that a person is exposed to, for example televised advertisements.
• The social cognition theory is a model of social knowledge and behaviour that highlights the explanatory role of cognitive factors (e.g. beliefs and attitudes).
• Attitudes are relatively enduring and generalizable and made up of three related parts: cognition, emotion and behaviour. These three components were considered to predict behaviour. However, the empirical evidence to support a direct association between attitudes and behaviour is inconclusive.
• People often engage in risky or unhealthy behavior because they do not consider themselves to be at risk, which is called unrealistic optimism. Factors that are associated with unrealistic optimism are: a lack of personal experience with the behaviour or problem concerned; a belief that their individual actions can prevent the problem; the belief that if the problem has not emerged already, it is unlikely to do so in the future; the belief that the problem is rare.
• The Health Belief Model (HBM) proposes that the likelihood that a person will engage in particular health behaviour depends on demographic factors. The HBM predicts that preventative behaviour follows from beliefs of susceptibility to serious health threats and beliefs that the perceived benefits of behaviour outweigh any perceived barriers to that behavior.
• The Theory of Reasoned Action (TRA) and the Theory of Planned Behaviour (TPB) derive from social cognition theory. These models assume that social behaviour is determined by a person’s beliefs about behaviour in given social contexts and by their social perceptions and outcome expectations.
• People may not always translate their good intentions into action because they have not made plans as to how, when and where they will implement their intention. Individuals need to shift from a mindset typical of the motivation towards an implementational mindset. This is called implementation intentions.
• The transtheoretical model describes processes of elicitation and maintainance of intentional behavioural change. The stages are: 1) pre-contemplation; 2) contemplation; 3) preparation; 4) action; 5) maintenance. To additional stages are termination and relapse.
• The precaution adoption process model (PAPM) has seven stages and highlights important omissions in the TTM. The PAPM gives greater consideration to the pre-action stages. The stages are: 1) a person is unaware of the threat; 2) a person is unengaged; 3) people become engaged for some reason and enter a consideration stage; 4) some people actively decide not to act; stage 5) some enter a decide to act phase, similar to intention/preparation; 6) the action stage; 7) this stage is about maintenance.
• The health action process approach (HAPA) highlights the role of post-motivational self-efficacy and action planning. The HAPA model suggests that the adoption, initiation and maintenance of health behaviours must be explicitly viewed as a process that consists of at least a pre-intentional motivation phase and a post-intentional volition phase.
• The models of health behaviour primarily used in health psychology research perhaps focus more on individual cognitions than is warranted. Behaviour is influenced hugely by environmental context, by socio-economic resources, by culture and by laws, sanctions and habits.

What are the mechanisms and approaches behind changing behavior? - BulletPoints 6

• The PRECEDE-PROCEED model provides a strong framework for the development of public health programs. Key stages to their development include: social diagnosis, epidemiological behaviour, environmental diagnosis, educational and ecological diagnosis and programma implementation.
• A number of approaches can be used to motivate behavioural change: information provision, the central and peripheral routes of the elaboration likelihood model, appropriate informational framing and motivational interviewing.
• The NICE guidelines on behavioural change identified several ways of presenting information in order to increase the motivation. Key messages should influence: outcome expectancies, personal relevance, positive attitude, self-efficacy, descriptive norms, subjective norms and personal and moral norms.
• The elaboration likelihood model suggests that attempts to motivate people who are not interested in a particular issue using rational argument will not work. Only individuals with a pre-existing interest in the issue are likely to attend to such information and perhaps act on it.
• According to the ELM, central processing takes place when a message is congruent with their pre-existing beliefs, has personal relevance to them, recipients have the intellectual capacity to understand the message. Peripheral processing is likely to occur when individuals are not motivated to receive an argument, have low issue involvement and hold incongruent beliefs.
• Key questions in motivational interviewing are: what are some of the good things about your present behaviour? What are the not so good things about your present behaviour?
• A number of approaches can be used to change behaviour: problem-action approaches, implementation plans, modelling and practice and cognitive interventions.
• Counselling is a problem-oriented approach to change behaviour and has three distinct phases: 1) problem exploration and clarification; 2) goal setting; 3) facilitating action.
• Cognitive interventions attempt to change cognitions directly and in particular those that drive an individual to engage in behaviours that may be harmful for their health or prevent them making appropriate behavioural changes.
• Categories of relevant cognitions are attitudes towards the behaviour and relevant social norms, beliefs about the costs and benefits of disease prevention and behavioural change, and beliefst about an illness or condition and the ability to manage it.
• Bandura identifies three basic models of observational learning: a live model which involves an actual individual demonstrating or acting out a behaviour, a verbal instructional model which involves descriptions and explanations of a behaviour and a symbolic model which involves real or fictional characters displaying behaviours in books, films etcetera.
• A third approach to changing behaviour involves adopting the environment to facilitate or reward behavioural change and to inhibit engagement in health-damaging behaviour.
• The Health Belief Model provides a simple guide to key environmental factors that can be influenced to encourage behavioural change. The model suggests that an environment that encourages healthy behaviour should: 1) provide cues to engage in healthy behaviours or remove cues to unhealthy behaviour; 2) minimize the costs and barriers associated with engaging in healthy behaviours; 3) maximize the costs of engaging in health-damaging behaviour.
• Some change may filter through society in a natural way, known as diffusion of innovation. This process may be facilitated through the use of early adopters or opinion leaders as advocates of appropriate behavioural change.
• Rogers segmented the population in terms of their responses to innovation and their influence on the behaviour of others: innovaters (a small group of individuals with high status), early adopters (a larger group of people with a wider sphere of influence), early majority (a group that adopts ideas early but does not have the power to influence the wider population), and the late majority (people who adopt the innovation only after adopting by the early majority), and the laggards (people who are the latest to adopt or never adopt an innovation).
• Information provision should include information about the consequences of the behaviour in general, the consequences of behaviour to the individual, others’ approval of behavioural change, normative information about other’s behaviour.
• Problem-focused approaches include: goal setting, action planning, barrier planning/problem solving and the setting of graded task.

How can health problems be prevented? - BulletPoints 7

• Risk factor screening may be of benefit to some individuals, but has not consistently been found to reduce risk for disease. And it may contribute to health anxieties.
• Motivational interviewing may be more beneficial in both motivating and maintaining health behaviour change, although its impact is not guaranteed.
• Problem-focused approaches are significantly more effective than those that simply provide health information
• Screening for health risk can result in significant anxieties. For some individuals, these may be alleviated by teaching simple coping strategies.
• Simple media campaigns have proven of little benefit in achieving behavioural change. Augmentation through refining communication based on theories such as the elaboration likelihood model, combining fear and fear reduction messages, appropriate information framing and audience segmentation may be of benefit.
• Interventions based entirely on fear arousal are likely to be of little benefit. If fear messages are used, they need to be accompanied with simple easily accessible strategies of reducing the fear.
• No strong a priori judgements about what type of framing will affect particular populations – emphasizing the need to test out any intervention as a pilot before it is finally aired in public.
• Environmental interventions may also be of benefit. These may provide cues to action or remove cues to unhealthy behaviour, enable healthy behaviour by minimizing the costs and barriers associated with it, or maximize the costs of engaging in health-damaging behaviour.
• Traditional CHD prevention programs have achieved only modest health gains in the population targeted unless aimed at relatively naïve populations.
• Interventions targeted at HIV and AIDS have been more successful across industrialized and developing countries because of the use of peers.
• Peer-led interventions have proven more successful across a range of behaviours. In this approach, opinion leaders and other key players within specific communities are involved in projects and form a key part of the program.
• The worksite offers a key environment to foster and facilitate health behaviour change.
• A variety of formats have been utilized at the worksite, including some innovative approaches: screening for risk factors for disease, providing health education, provision of healthy options, such as healthy food in eating areas, providing economic incentives for risk behaviour change, manipulating social support to facilitate individual risk behaviour change and provision of no-smoking areas.
• The framework which schools involve in interventions include: healthy policies such as a no-helmet, no bike at school policy for cycle safety, establishing a safe, healthy physical and social environment, teaching health-related skills, providing adequate health services within the school, providing healthy food, school-site health-promotion programs for staff, availability of school counselling or psychology programs and a school physical educational program.
• Another approach to health education in schools involves peer education, which involves training influential pupils in a school about a particular health issue such as smoking and encouraging them to educate their peers about the issues.
• Analysis of the effectiveness of internet interventions shows both their reach in terms of the number of people they can potentially access and their effectiveness.
• Text messages are also used to remind people of the need to change, provide skills and prompts to engage in change and record any behavioural change. These interventions have proven effective.
• Technology can be attractive for modern health promoters, but the temptation to ignore more traditional approaches must be met with caution. The uptake of written self-help materials is higher than those that are electronically available.
• More complex and interactive interventions using the internet may be more engaging and more likely to engage its recipients.

What is the effect of health and illness on the human body? - BulletPoints 8

• Key functional areas in the brain are the medulla oblongata, which controls respiration, blood pressure and heartbeat; the hypothalamus, which controls appetite, sexual arousal and thirst. It also exerts some control over our emotions; the amygdala, which links situations of threat and relevant emotions such as fear or anxiety and controls the autonomic nervous system response to such threats.
• One of the key systems controlled by the brain is the autonomic nervous system. This comprises two parallel sets of nerves: the sympathetic nervous system is responsible for activation of many organs of the body; the parasympathetic nervous system is responsible for rest and recuperation.
• The highest level of control of the autonomic nervous system within the brain is the hypothalamus, which coordinates reflexive changes in response to a variety of physical changes, including movement, temperature and blood pressure.
• The hypothalamus also responds to emotional and cognitive demands, providing a link between physiological systems and psychological stress.
• Activation of the sympathetic nervous system involves two neurotransmitters: norepinephrine and epinephrine, which stimulate organs via the sympathetic nerves themselves.
• Sustained activation is maintained by their hormonal equivalents, released from the adrenal medulla.
• A second system, controlled by the hypothalamus and pituitary gland, triggers the release of corticosteroids from the adrenal cortex. These increase the energy available to sustain physiological activation and inhibit inflammation of damaged tissue.
• The immune system provides a barrier to infection by viruses and other biological threats to our health. Key elements of the system include phagocytes, such as macrophages and neutrophils, which engulf and destroy invading pathogens.
• A second group of cells, known as lymphocytes, including cytotoxic T cells and B cells, responds particularly to attacks by viruses and developing tumour cells. Both groups of cells can collaborate in the destruction of pathogens.
• Slow viruses, including HIV, attack the immune system, by infecting CD4+ cells, and prevent the T and B cell systems rom responding effectively. This leaves the body open to attack from viruses and cancers, either of which may result in life-threatening conditions.
• The immune system may cause problem by treating its own cells as external invading agents. This can result in diseases such as multiple sclerosis and type 1 diabetes.
• The digestive tract is responsible for the ingestion, absorption and expulsion of food. Activity within it is controlled by the enteric nervous system, which is linked to the autonomic nervous system.
• Activity in the system is therefore responsive to stress and other psychological states.
• Some conditions thought to be the result of stress are now thought to be the result of physical as well as psychological factors. Gastric ulcers are thought to result from infection by Helicobacter pylori, while irritable bowel syndrome is no longer seen as entirely the result of stress but as having a multi-factor etiology of which stress is but one strand.
• The cardiovascular system is responsible for carrying oxygen, nutrients and various other materials around the body. Its activity is influenced by the autonomic nervous system.
• Two long-term silent conditions that may lead to acute illnesses such as myocardial infarction or stroke are hypertension and atheroma. Both involve long-term processes.
• One way in which long-term hypertension may develop is by repeated short-term increases in blood pressure through the action of the autonomic nervous system in response to stress.
• Atheroma develops as a result of repair processes to the artery wall. Two obvious outcomes of this process are myocardial infarction, in which an artery supplying the heart muscle is blocked and dies. Angina presents with similar symptoms but is the result of spasm of the arteries and is reversible.
• The respiratory system is responsible for inspiring and carrying oxygen around the body, and the expulsion of carbon dioxide. It is prone to a number of disease processes, including chronic obstructive airways disease and lung cancer, all of which are significantly exacerbated by cigarette smoking.

How can symptoms be experienced and be interpreted? - BulletPoints 9

• Illness is what the patient feels when he goes to the doctor. Disease is considered as being something of the organ, cell or tissue that suggests a physical disorder or underlying pathology.
• Research has highlighted an array of biological, psychological and contextual influences upon symptom perception, with bottom-up influences upon perception arising from the physical properties of a bodily sensation, and top-down influences being seen in the influence of attentional processes on mood.
• Symptoms that receive attention and interpretation as a symptom are likely to be painful or disruptive, novel, persistent, pre-existing chronic disease.
• Individual differences exist in the amount of attention people give to their internal state and external states. Two attentional systems influence how symptom information is processed: the primary attentional system (PAS) operates below the level of consciousness, and the secondary attentional system (SAS), which is considered more amenable to executive control.
• It is often proposed that gender socialization provides women with a greater readiness to attend to and perceive bodily signs and symptoms. However, the evidence appears to vary according to the symptoms explored.
• Increasing age tends to be associated with increased symptom self-report. Whether children perceive specific symptoms differently to adults is unclear.
• People who are in a positive mood tend to rate themselves as more healthy and indicate fewer symptoms. Negative emotional states may increase symptom perception by means of its effect on attention as well as by increasing rumination and recall of prior negative health events.
• Neuroticism is described as a trait-like tendency to experience negative emotional states and is related to the broader construct negative affectivity (NA). Trait NA, like neuroticism, has been found to affect the perception, interpretation and reporting of symptoms.
• Symptom interpretation is influenced by individual differences. Women interpret a bodily sign as symptomatic of underlying illness more than men. Women are seen to present to health services more frequently than men.
• People scoring high on NA are more likely to seek health care than those low in NA. Moderate levels of neuroticism can however benefit health: for example, in terms of better adherence to treatment or quicker presentation to medical services following actual illness events.
• The interpretation of symptoms also differs depending on a person’s current social identity.
• People believe they are sick when the symptoms a person is experiencing fit a model of illness retrieved from their memory and it is here that health psychology draws from models dominant in cognitive psychology.
• The common-sense model states that mental representations provide a framework for understanding and coping with illness and help a person to recognize what to look out for.
• Five consistent themes in illness representations are: identity, consequences, cause, timeline and curability or controllability.
• Illness representations have a direct effect on a wide range of outcomes, including seeking and using/adhering to medical treatment, engagement in self-care behaviour or behaviour change, attitudes towards the use of brand-specific vs. generic medicines, and treatment choices, illness-related disability and return to work, caregiver anxiety and depression and quality of life.
• Causal attributions are about where a person locates the cause of an event, or symptoms and/or illness. This is partially influenced by culture.
• The behaviour of those who are experiencing symptoms but who have not yet sought medical advice and received a diagnosis is called illness behaviour.
• The lay referral system is an informal network of individuals (e.g. friends, family, colleagues) turned to for advice or information about symptoms and other health-related matters. Often but not solely used prior to seeking a formal medical opinion.
• Delay behaviour refers to an individual’s delay in seeking health advice as opposed to delays inherent in the health-care system itself.
• There are many potential reasons for not seeking medical attention (delay behaviour). A few important factors are symptom type, location and perceived prevalence, financial reasons, cultural influences, age, gender, influence of others, treatment beliefs and emotions and traits.

How does intervention in health psychology take place? - BulletPoints 10

• There has been a shift from the paternal doctor knows best type of consultation to more patient-centred approaches and the ultimate outcome of this shift – shared decision-making.
• It was noted that while this has many benefits, many patients are cautious in adopting it, as it raises concerns over the apparent expertise of health professionals and may place a responsibility on patients for their treatment that they are unwilling to carry.
• Some other elements of the consultation that may influence its outcome, including: the gender of the health professional (women appear more empathic and caring, factors usually associated with greater satisfaction with the interview); the way information is given; the input of the patient: people who ask more questions tend to gain more information from the consultation.
• Breaking bad news involves telling patient that they have a serious illness, and that they may die from it. It is a stressful process for both patient and health professional.
• Key factors in optimizing this process include: give the news in person, in private, with enough time and without interruptions, find out what the patients knows about their diagnoses, find out what the patient wants to know, share the information, stating with a warning shot, respond to the patient’s feelings, plan and follow through.
• Medical decision-making can be influenced by a number of factors. Doctors often employ heuristics to help them arrive at a diagnosis. This can speed the process up, but increases the risk of diagnostic errors. Typical errors are those of availability, representativeness and differing pay-offs of differing diagnoses.
• Adherence to recommended medical treatments is influenced by a number of factors, including social factors, psychological factors, treatment factors, family dynamics and beliefs about the nature of the illness and its treatment regimen.
• Adherence may be enhanced by: the use of patient-centred approaches and shared decision-making; maximizing satisfaction with the process of treatment; maximizing understanding of the condition and its treatment and maximizing memory for information given.
• A simple strategy for maximizing memory for information given is providing information in a structured manner. The most important information should be given early or late in the flow of information to maximize primacy and recency effects, and its importance should be emphasized. Further strategies include repetition and the use of specific statements.
• Beyond the consultation, these factors may be added to be a number of strategies including: convenient timing of drug taking, relevant information, reminders to take medications, self-monitoring, reinforcement of appropriate use of medication.
• Adherence to behavioural programs is also far from maximal. This may result from different factors, including cost-benefit analysis of change, low motivation and difficulties in planning or executing consistent change.
• Key theoretical variables associated with adherence to behavioural programs are: confidence in the ability to exercise, intentions to exercise, perceived control over exercise, belief in the benefits of previous physical activity, perceived barriers to exercise, action planning.
• Self-regulation-based interventions that take these factors into account appear to be the most effective means of achieving sustained behavioural change.
• Based on evidence, the ERIC database suggested a number of components that should be central to any program of behavioural change. These can be divided into self-regulation and motivational strategies.
• Self-control strategies are successful because participants are more likely to adhere to a program if they attribute any successful behavioural change to their own effort rather than those of health professionals. This can be enhanced by teaching self-management skills such as self-monitoring, goal setting, planning and so on.
• Relapse prevention involves identifying high-risk situations that may result in relapse and planning how to avoid or cope with them.
• Motivational strategies may include a stepwise progression in the degree of behaviour change made, using social support where available, using a structured but flexible approach, setting achievable personal goals and measuring successes in reaching them, rewarding oneself for success.
• Make change habitual is important, and therefore change should be continuous and sustained, not intermittent.

How can stress affect health? - BulletPoints 11

• When stress is seen as stimulus, it is about the events of which people think that they maybe they can’t handle it, or that it’s going to get really though.
• Besides stressful and rare life events, research has shown the stressful nature of daily hassles.  
• A remarkable difference between men and women is that women are psychologically influenced by both positive and negative events, while men only suffer from the negative events.
• According to Lazarus, stress is the result of someone’s character and way of thinking, the interna land external events and the internal and external resources someone has to cope with it.
• When people get involved into a new or challenging situation, they enter a process of appraisal, which can be primary or secondary.
• In primary appraisal someone considers the quality and nature of the event. Dependent on the kind of stressor, someone considers whether the event is relevant for him/her, whether it is positive or negative, and if something needs to be done with it and if it is a threat.
• Secondary appraisal means that someone considers how to use his or her possible resources to cope with the stressor.
• Smith changed the two kinds of appraisals into four: internal or external appraisal, problem-focused coping, emotion focused coping and expectations for the future.
• The conservation of resources model says that people try to keep their valuable resources. Stress will develop when the conservation is threatened or when the resources are temporarily lost.
• The environmental stress theory sees stress as a combination of psychological and physiological reaction on the demands of the new surroundings.
• The Yerkes-Dodson law says that there is an optimal stress level which is good for performance, but that too much or too low stress can have a negative influence. For more complex tasks, a lower stress level is better and for simpler tasks a somewhat higher stress level is better.
• Burn-out is described as exhaustion, depersonalization and the blocking of reaching personal goals.  
• The environmental fit theories and the goodness-of-fit theory of Lazarus claim that stress develops when the combination of environmental factors and personal factors is not optimal.
• The Job demand-control model (JDC) of work stress describes the following features that would lead to stress: work demands, controllability, predictability and ambiguity.
• An event needs to be approached in a certain way. The central nervous system is needed for this. Sensory information and appraisal together cause automatic and endocrine reactions.
• The general adaptation syndrome (GAS) consists of three phases: the alarm reaction, the resistance phase and the exhaustion phase.
• Different kinds of stress can be associated with different kind of reaction. More adrenaline is found in the blood when someone experiences mental stress and more noradreline is found in the blood when someone experiences physical stress.
• The ANS can be divided into two related systems: the sympathic system (SNS) and the parasympathic system (PNS).
• The SNS is involved in arousal and extension of energy, while the PNS is involved in the decrease of arousal and the recovery of energy.
• Stress can cause changes in the immune system and the endocrine system that can lead to the development of illnesses. This happens mainly when the stress is chronic.
• The reactivity hypothesis describes how genetic or environmental factors together can influence someone’s vulnerability for a physiological reaction after stress and negative emotions, which can be harmful for health.
• CHD is a disease of the cardiovasculair system that develops slowly. It can be caused by a genetic vulnerability or by someone’s lifestyle.
• Because of stress, more cholesterol and catecholamines are released, which accumulate against the blood vessels. This can limit or even block the blood flow.
• Nowadays there are enough research results to assume that coping style (helplessness or hopelessness) and mood can influence outcome and prognosis of cancer.
• The irritable bowel syndrome is a disease of the colon, which causes stomach ache and diarrhea or constipation, while there is no organic cause for this.
• Another bowel syndrome is the inflammatory bowel disease, IBD, which can be divided into the disease of Crohn and colitis ulcerosa.
• In researches into diseases, people are found in which these diseases are influenced by stress, but there are also people in which these diseases are not influenced by stress.
• There are clues that seem to show that stress plays a rol in the vulnerability for the HIV-virus, and it is very probable that stress plays a rol in the infection when someone has the virus.

What are the moderators for stress and illness? - BulletPoints 12

• Coping means everything someone does to make the situation more bearable, which means also the things that make the situation worse or more annoying in the end
• Coping strategies which are frequently used are searching for social support, to enter into the confrontation, making a positive reappraisal and using alcohol or drugs.
• Problem-focused coping is more often used when something can actually be done to change the stressful situation or to get it under control.
• A psychological way of coping is the ‘fighting spirit’. This is characterized by thoughts like ‘I really want to get through this situation’ or ‘I’m going to beat this disease’. This is associated with better outcomes when someone is ill.
• According to Alport (1961), personality can be defined as ‘the organization of psychophysical systems in a person that determine someone’s characteristics, thoughts and behaviour’.
• The Big Five theory of personality uses the following five dimensions: agreeableness, conscientousness, extroversion, neuroticism and openness. 
• It is suggested that individuals who score high on neuroticisms, face more negative stressors and have the intention to use non-effective, emotion-focused coping strategies.
• Conscientiousness is defined as being a responsible person who follows social norms, is persistent and disciplined. This has positive outcomes on stress and health.
• Agreeableness is also adaptive because it leads to a more flexible coping reaction when someone is faced with a stressor. Extraversion is sometimes positive, but on the other hand leads to risk behaviour like smoking.
• Hardiness is described as rich, varied, and rewarding experiences in youth and feelings of commitment, control and challenge.
• Type a personalities show the following behaviours: competition, doing too much in too less time, being quickly irritated, aggressive or unkind, impatient, focused on performance and have a strong way of talking.
• Hostile people show risky and unhealthy behaviour more often. They also profit less from psychosocial institutions and social support of friends and colleagues. In this way, they miss an important buffer. This is called the psychosocial vulnerability hypothesis.
• Type C personality needs to have the following characteristics: being cooperative and calming, accommodating and passive, sacrifice oneself and holding back negative emotions. It leads to worse outcomes following disease.
• People with type D personality are sensitive for cardiovascular diseases. They score high on scales that measure negative affectivity and social inhibition.
• The so called Locus of Control (LoC), as being proposed by Rotter, says that behaviour can be a reward when the responsibility for events is seen as internal and not as external.
• According to Rotter, people with an internal LoC take the responsibility for what happens to them, while people with an external LoC blame external factors.
• There are different types of control: behavioural control, cognitive control, control over decisions, information control and retrospective control.
• Causal attributions are the ways in which a person attributes a cause or an event to feelings or actions of oneself or someone else.
• A number of researches have confirmed that negative affectivity in combination with social inhibition can partially predict the outcome of heart disease.
• People with a strong social network live longer and more healthy than people who are socially isolated.
• The hypothesis of direct effect: independent of the extent of stress, social support has a positive influence. The absence of social support is also harmful when no stress or illness is present.
• Social support as buffer: social support protects people against stress because it works as a buffer because it influences the cognitive appraisal of people and it influences someone’s coping reactions.
• Women receive and offer more support than men. Besides, women have more friends than men.
• In (collectivistic) Asian cultures, people do not search for or expect support. The group is the most important thing, and these individuals don’t want to disturb the relations by talking about personal problems. In western countries, individuals search for support in friends and family.

How can stress be managed? - BulletPoints 13

• Stress management training is the common term for interventions designed to teach participant show to manage stress. These interventions are based on the cognitive-behavioural theories about stress.
• Beck has identified different categories of thinking which lead to negative emotions: catostrophic thinking, over-generalisation, arbitrary inference en selective abstraction.
• One of the most often used approaches to identify and change triggers is invented by Egan. This identifies and changes triggers in three stages: Problem exploration and clarification, goal setting en facilitating action.
• Relaxation exercises help to diminish feelings of stress in specific situations, and they help people to feel more relaxed in general.
• In 1985, Meichenbaum developed a strategy which is called ‘self-instruction’. The purpose of this strategy is to identify stress-inducing thoughts and replacet hem with more positive thoughts.
• A more complex form of cognitive interventions works as follows: the individual needs to see their negative thoughts as possibilities instead of facts. Most of the times, this happens in therapy sessions by using the socratic method.
• The ‘Stress inoculation training’ is a method for stress reduction which focusses on reflection and becoming relaxed before someone enters a situation.
• The conditioning theories of Pavlov and Skinner are known as first wave therapies. These were not concerned with changing cognitions.
• The second wave therapies saw cognitions as the development and treatment of emotional problems.
• The third wave therapies are getting more and more attention and are known because they are a combination of cognitive and behavioural changes.
• According to a boeddhistic tradition, mindfulness is needed to get enlighted. Someone focusses his or her thoughts on the present moment. In this way, people learn that thoughts are just thoughts, which can be true or not true.
• To reach more psychological flexibility, people use obligations, acceptation, mindfulness and behavioural change. This can be achieved by focusing on the following five core processes: acceptance, cognitive defusion, contact with the present moment, values en committed action.
• Research shows that people who do engage more in relaxation exercises and other stress reducing exercises experience less stress than people who don’t do this.
• The disadvantage of work-related stress interventions is that not every employee or employer wants to join these kind of programs. And if employees have the choice to join these programs, most often the people with relatively low stress levels join these programs.
• If you want to do something about the stress at work, the best way to do this is in three stages: identifying the causes of stress at work, identify the solutions of people who are most involved in it, and start a process to change the things discovered in the second stage.
• The fear for operations influences the amount of painkillers someone takes and the time that is needed to recover.
• Because of the fact that people can’t numb their selves and they can’t operate themselves, the feeling of control needs to arise because someone has enough information and can say whether he/she is ready for the surgery.
• What way is best to inform patients, differs per patient. Giving information is always better than letting someone figure out themselves what happens, but within that extra care, it is good to adapt the intervention to the needs of the patient.
• A colonoscopy is a small chirurgic procedure, in which a small piece of the stomach wall is being removed. This piece can then be tested for the presence of strange cells.
• When children need to be operated, it is sometimes good to show them prior to the procedure what is going to happen on the basis of a small book or a doll.

What are the impacts and outcomes of illness? - BulletPoints 14

• People with a chronic disease need to overcome a number of difficulties, namely: Uncertainty, Disruption, Striving for recovery en Restoration of wellbeing.
• Fatigue is present in many conditions. There are also associations between fatigue, depression and anxiety. Such negative emotional correlates of fatigue can strengthen the negative effects of illness on someone’s life.
• Depression and anxiety are common after heart diseases and heart attacks. The prevalence of emotional distress in cancer patients is 70%, and anxiety as well as depression are common.
• Levels of anxiety in cancer patients are increasing on certain points in treatments: when someone is waiting for test results, or when an end stage of a treatment is reached and the treatment stops without foresight on a cure.
• Depressive people are less capable of adhering to treatment, for example taking their medication or exercising. People with depression also take more risks, for example in unprotected sex.
• Emotion regulation is important in the outcome of diseases. In other words, how a person experiences emotions, how someone processes emotions and copes with them influences adaptation, in which avoidance and repression are maladaptive, and expression is adaptive.
• Being optimistic is associated with less severe pain and less fatigue among cancer patients ten weeks after chemotherapy. Pessimists use more maladaptive coping strategies.
• Acceptance coping means that the individual sees the reality of the situation and the fact that the situation can’t be changed.
• Social comparison is the process in which a person or a group of people compares themselves to other people.
• The denial of an experience is an easy and effective way to cope with what happened on the short term, but on the long term it ends in inefficient coping strategies and leads to more depression and more sadness and worries.
• Problem-focused coping is associated with a better, more positive mood, while emotion-focused coping is associated with a more negative mood.
• Religious convictions are associated with more appreciation, more optimism, more hope and a more positive appraisal of events and personal growth and better emotional and physical adaptation in elderly.
• According to the World health organisation (WHO) QoL (Quality of Life) consists of the following aspects: physical health, psychological health, level of independence, social relationships, relation to environment and spirituality, religion and personal beliefs.
• In western cultures, health and health care is seen as something individual, while in non-western cultures the health-care is often collective.
• Aspects of disease are important: pervasive and persistent pain and impairment are associated with a lower quality of life. Severity of the disease is not inevitable or consistently associated with lower QoL.
• Among physical healthy people, anxiety and anxiety disorders are negatively influencing QoL.
• Ethnicity does also influence QoL. Non-white people have on average a lower QoL than white people, according to research.
• Using an avoidant coping style to cope with the situation, positively contributes to QoL when the situation can’t be controlled.
• When a disease causes someone to be unable to reach their goals, this can distort QoL as well.
• When someone is being asked for his or her QoL, the professional gets more insight into the broad well-being of the patient. This can also improve communication between patient and professional. The professional has a better picture of the difficulties of the patient.
• When measuring the general QoL, different diseases can be very well compared. On the other hand, you can miss points specifically important for a certain disease, like the anxiety for cancer to come back.
• Some individuals with impairing diseases sometimes have a higher QoL than healthy people on self-rate measures. Researchers think that this is because of the response shift: changes in the subjective reports of people whose health status has been changed.
• In some conditions it is difficult to measure QoL. For example, for people with a disease in which communication is distorted, no interviews can be taken.

What are the impacts and outcomes of illness from family and informal caregivers perspective? - BulletPoints 15

• The extent to which informal care is used differs per country. This depends on the national system. Informal caregivers are often untrained family members or friends without contractual hours.
• The need for informal care is increasing given the fact that the health care system can no longer serve the demands.
• There are cultural variations in aspects of collectivism and in belief and value systems among which familiarity and the obligations of respect, support and care for older family member.
• The relationship between the potential caregiver and recipient and intrinsic motivation to take care against the extrinsic motivation are crucial for the well-being of the caregiver.
• McCubbin and Patterson describe how pressure can disturb or change a family system, with stages in a continuum: the stage of resistance, the stage of restructuring and the stage of consolidation. 
• Rolland’s Family-Systems Illness Model offers a more systemic view on illness and takes into account that a biopsychosocial model of illness needs to recognize the disease in a time course, and that all persons within a family influence the course of an illness and the well-being of the patient.
• Three integrated dimensions of the family system are emphasized by Olson and Stewart: cohesion, adaptation and communication, with the proof that families that are balanced on these factors, have a better adaptation in reaction to stressors.
• The use of active solutions of problems and less use of avoidance and passive reactions is associated with less anxiety and depression of the parents.
• Taking care for an older person is a heavy task for a child, because it is about reversing the rolls.
• There are a number of aspects of care that are useful for patients of different diseases. Examples of those aspects are practical help, showing love, understanding and concern.
• Men and women don’t differ in their capacities of caring fort heir spouse or in the amount of care they offer, but women are more responsive for the changing needs of their partners.
• The protecting effects of marriage on health and health measures are often reported. It is not the absolute amount of care that makes the difference, but mainly the perceived quality and the perceived usefulness which do good for the patient.
• Patients that are very well protected by the caregiver think that they can handle less on their one and have less motivation to recover.
• Research shows that at least three quarters of the people who take care for someone have significant emotional problems. Their physical health and satisfaction with life are also less optimal.
• It has often been shown that care suppresses the effectivity of the immune system on the long term.
• If the patient asks a lot of their caregiver or shows difficult behaviour, that has more impact on the caregiver than when the physical care is difficult.
• When the negative features of the disease increase or become worse, that predicts depression in the caregiver, and when the positive fetaures decrease, that makes the task harder for the caregiver.
• Personality features like optimism and neuroticism have direct influences on the mental health of the caregiver and indirect effects via the influence on perceived stress.
• The self-efficacy of the caregiver has a significant influence on emotional outcomes and perceptions of burden.
• Spouses deny or conceal negative information, thoughts or feelings fort heir partners to protect them, but in this way they can increase their own stress level.
• Disease can cause a stress spill-over effect by contributing to existing challenges in marriage and by introducing further opportunities for conflict.
• The extent to which a healthy partner considers his or her relationship with the ill partner as part of their self-concept partially mediates the effects of tension, challenges in the relationship and the loss of independency on mental health scores.
• Relationships with shared positive perceptions fare better in terms of lower impairments, less sexual problems, less health related stress, better vitality and better general adaptation.
• Patients and partners who received more support from their partner reported less stress after time, but only when they had low personal control.

What is pain and how to deal with pain? - BulletPoints 16

• There are different kinds of pain. Most people experience acute pain which lasts for no longer than a few minutes, but the definition of acute pain describes pain that lasts for no longer than three to six months. Chronic pain is defined as pain that lasts longer than six months.
• You can also make a distinction in the nature of the pain, the severity of the pain and the pattern.
• Of all reasons why people visit the doctor, 40% has to do with pain. Most people are also limited in their freedom of movement and physical possibilities because of the pain.
• The most simple theory about pain is that there are pain receptors in the skin and other parts of the body and that these, when they are being activated, cause pain.
• They send information to the pain centre in the brain, which is then activated and causes the sensory experience of pain. This theory is also called the specificity theory.
• Phantom pain means that people have sensations that can be extremely painful sometimes, which they feel in their limbs that they don’t have anymore. They feel tingling, cramp or stabbing for example in their amputated leg.
• Anxiety and depression decrease the pain treshold and causes someone to experience more pain. It works the other way around as well: pain influences mood.
• When you give attention to pain, the experience of pain if amplified.
• When you think the pain will become worse, that is an sich enough to experience the pain as worse.
• People who think that their pain is caused by psychological factors will exercise more often than people who think that their pain is physically caused. This last group of people is scared that by moving, the pain will become worse.
• There seems to be an advantage in simply getting what seems tob e a treatment, whether this is a pill, an injection or another treatment. This is called the placebo effect.
• Two important mechanisms of the placebo effect are probably a classical conditioning proces, and our expectations of pain or the decrease of pain.
• According to the gate control theory (GCT) we experince pain as the result of two processes: 1) pain receptors in the skin and other organs give information over physical damage to a few target points in the spine, 2) at the moment that the pain stimulus arrive in the brain, we also experience emotions and cognitions.
• The A delta fibers cause the experience of sharp pain. The C polymodal fibers work more slowly and transfer information about dull, beating pain.
• Information from the A fibers goes to the thalamus in order to make someone able to take action to leave the source of the pain. Information from the C fibers goes to the limbic system, the hypothalamus and the autonomic nervous system (ANS).
• Melzich suggested that the anatomic substrate of the ‘body-self’ is a big network of neurons which are connected to the thalamus, the cortex and the limbic system in the brain. He called the system ‘the neuromatrix’.
• A ‘neurosignature’ is a network of information about the source of emotional reactions to a pain stimulus.  
• The McGill questionnaire measures: the kind of pain, the emotional reaction to the pain, the intensity of the pain and the timing of the pain.
• There are a few things that people can do to decrease acute pain. Most approaches focus on increasing someone’s feelings of control over the pain and medical interventions.
• A popular way to master pain is by means of electrical stimulation of the A beta fibers. By this method, the C fibers are stimulated as well to deliver endorphines. This method is known under the name transcutaneous electrical nerve stimulation (TENS).
• The relaxing of specific muscle groups is often difficult, but can be reached by using biofeedback techniques. Because the patient gets feedback from his/her body all the time, the patient knows exactly what his or her status is, and he knows immediately when the relaxin has succeeded.
• A specific problem in which biofeedback is used with success is in chronic headaches. In other kinds of pain it is often no more effective than relaxing an sich.
• To prevent people from showing pain behaviour, you need to make sure that this kind of behaviour is no longer rewarded and that other behaviour will be rewarded instead. This method is mainly effective when the physical cause of pain is small, or when nothing can be done to change it.
• The aims of cognitive behavioural therapy are helping the patient with getting insight that their pain can be regulated, helping with making associations between thoughts, emotions and behaviour, and getting tips and tricks en learning strategies which help regulating the pain, the emotional distress and the psychological problems.
• A lot of research has shown that cognitive behavioural interventions are really effective. It is often more effective than pharmacological or educational therapies and other methods.
• Mindfulness interventions are used more often nowadays. Daily mindfulness meditating is effective in decreasing pain.

How can health and quality of life be improved? - BulletPoints 17

• People with a serious illness worry about the prognosis, treatment and possible effects of their illness on their quality of life. The stress is the highest in the beginning, when the illness has just been discovered, and when there are rapid changes in the course of the illness.
• When people have more information and know better what they can expect, the stress can decrease somewhat.
• They way in which bad news is told to the patient, especially when it is about a disease with a very bad or fatal prognosis, is very important. It influences the way in which people will handle their disease.
• When someone is told only medical information, this will not reduce the anxiety, and the anxiety can even increase. Hence, it is important that people do also get information about how they can handle the medical information and treatment.
• There are also educational programs that give information about how to handle the disease and how to take care to not let the disease influence mood.
• Stressmanagement programs focus on problem solving, cognitive restructuring and relaxation.
• Research has shown that people who follow a kind of stress management feel up to 60% better than people who don’t.
• Sears et al. Compared two active stress management programs after ICD implantation. One lasted a day, and the other one lasted six weekly sessions. Both interventions were associated with decreases in anxiety and cortisol levels on the short term.
• Mindfulness-based stress reduction (MBSR) leads tob etter coping with symptoms, better well-being and quality of life, and better health status.
• It has been shown that a lot of social interventions are effective, but this is not true for all social interventions. A lot of patients want to fall back on familie and friends and don’t want to be part of professional help any longer.
• The best programs not only focus on what should be changed, but also on how someone is able to do that and how someone can persevere.
• Nowadays everyone can find a lot of information on the internet. On the one hand, this is really positive because everybody has access to a lot of information. On the other hand, this is disadvantage because different sources of information can contradict each other, and some information has not been scientifically proofed.  
• The best way to learn people regulate their illness is by self-management training. This method is based on the social cognition theory of Bandura, which suggests that people can learn self-management by practicing and looking at others.
• The self-management training is a training which consists of structured stages. The next stage won’t be started when someone does not yet master the other skills, the same as when a new behaviour is being learned.
• Most of the time, the self-management training is focused on the practical aspect of controlling the disease, and the emotional aspect gets less attention.
• Self-management is not only trained in group sessions or during personal meetings. More often nowadays programs are being developed which people can follow at home. For example with video, internet or by telephone conversations.
• Despite the fact that friends, family, colleagues and other people in the direct surroundings of an ill person have a lot of influence on the emotions and well-being of the patient, there are barely interventions or programs which focus on the social environment.
• The positive effect of countering stress is that someone feels more relaxed and feels better as a consequence. Furthermore, relaxation also has a positive influence on blood sugar levels.
• When people enter a program for expressing emotions, they often report a short increase in depressive or anxious feelings. On the long term, they feel better and the physical health improves as well.

What is the future perspective of health psychology? - BulletPoints 18

• Important variables that influence behaviour are included in theories about health. These theories are always developing and are more and more expanded. In this way, the theories are recent and form a basis for interventions.
• It needs to be discovered what the beliefs about disease are in the patient. If these are not correct of do not make sense, they may need to be changed, and it needs to be seen if the patient tries to change this.
• It is important for patients to learn how they can handle their (severe) disease as effectively as possible. Teach patients, dependent of the context, the problem-focused coping or emotion-focused coping.
• The intervention needs to be adapted to the individual and is subject to changes caused by the environment and people.
• Besides theories, psychologists and health professionals are very important in bringing theory into practice.
• The three most important tasks of a health psychologist are: promoting and sustaining health, preventing and managing disease, identification of psychological factors that contribute to physical diseases, improving the health care system and formulating health policy.
• The Netherlands do not have a traineeship for health psychologist, and the same is true for different south-european countries.
• According to Lazarus, the lack of cooperation and communication between researchers and clinicians is a well-known and painful subject for most of the psychologists. Reaching professionals is hard.  
• The factors that contribute to the fact that clinical guidelines are not followed are among others weakness in communication of proof to professionals, conflicting sources of information and opinions for professionals, difficulty in getting the right people together to work together for change and resistance against change.
• Other factors are personal attitudes and beliefs about the target behaviour, personal characteristics of the professional, the content of information, the transmission of information and organizational issues.