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Health Psychology (Health problem: Stress (Physiological aspects of stress…

- - - - One of the difficulties of studying and managing stress is that 'stress' is not a single phenomenon. Stress management can be complicated and confusing because there are different types of stress- acute stress, episodic acute stress and chronic stress.
      - Acute stress
        Acute stress is the most common form of stress. It comes from demands and pressures of day to day life. The demands can be actual or perceived. Acute stress is short term and has a foreseeable end in sight. Therefore, it doesn't cause damage associated with long term stress
        
        The most common symptoms:
        
        Emotional distress: some combination of anger or irritability, anxiety and depression.
        
        muscular problems including tension headache, back pain, jaw pain, and muscular tensions that can lead to pulled muscles.
        
        Stomach, gut and bowel problems such as heartburn, acid stomach, flatulence, diarrhoea, constipation and irritable bowel syndrome.
        
        Over arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heat palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath or chest pain
      - Episodic Acute Stress
        There are those who suffer acute stress frequently, whose lives are so disordered that they are studies in chaos and crisis. They take on too much and can't manage their time or meet all commitments. It is common for people with acute stress reactions to be over aroused, short-tempered, irritable, anxious, and tense. Always in a hurry, tend to be abrupt and interpersonal relationships suffer. Friedman and Rosenman labeled this pattern of behaviour as Type A personality.
        
        Another form of episodic acute stress comes from ceaseless worry. Pessimists often see disaster around every corner and forecast catastrophe in every situation. This perception of the world leads to hyperarousal that is characteristic of episodic stress. Symptoms include, persistent tension, headaches, migraines, hypertension, chest pain and heart disease. Treating this stress requires professional help. Lifestyle and personality issues are so ingrained and habitual that they see nothing wrong with the way they conduct their lives.
      - Chronic Stress
        
        Chronic stress has a serious effect on our heath- both physically and psychologically. Chronic stress very often is a response to something that an individual cannot change in his/her life. Chronic stressors include poverty, dysfunctional families, domestic violence, chronic illness, institutionalised discrimination and war/conflict. As a result, the problem-focused coping strategies that are often used in acute stress situations. Chronic stress kills through suicide, violence, heart attack, stroke, and even cancer. Has a negative effect on memory and attention.
  - - - The effects of the sympathetic nervous system include:
        
        An increase in heart rate and blood pressure
        
        Pupils dilate to take in as much light as possible
        
        Increased circulation to the major muscle groups
        
        increased breathing rate
        
        Digestion, the reproductive system and the immune system are suppressed to allow more energy for emergency functions.
        
        At the same time, the hypothalamus activates the adrenal-cortical system. Over 30 hormones are released into the bloodstream, including cortisol.
        
        General Adaptation Syndrome
        
        Hans Selye )1956) took our understanding of the effects of stress on our physiological systems a step further with this model.
        Seyle's findings were accidental. He was trying to discover a new hormone and was injecting mice with ovarian extract. Over time the rats developed symptoms such as swollen lymph nodes, bleeding ulcers and enlarged adrenal glands. Even the control group that were injected with saline solution showed these symptoms. Stress was seen to be the culprit of these symptoms.
        
        There are three stages. During the alarm stage the hypothalamus responds to the stressor by activating the fight or flight response.
        In the resistance stage, the adrenal cortex continues to release glucocorticoids to help the body react to the stressor until the stress is resolved.
        The negative outcome is the exhaustion stage. During this phase, the stress has been persistent for a longer period. The body' s ability to cope with the stressor is depleted and the body is not able to maintain normal function. The immune system is depleted. Major health effects can be seen at this stage.
        The positive outcome is the recovery stage. This happens when the stressor is gone or coping has been successful. Homeostasis of the physiological systems is restored.
        
        Studies
        
        Cohen (1993) carried out a study to see if stress leads to colds. In his study he gave 276 healthy participants a series of tests to determine their overall general health and their recent exposure to stress. He then exposed them to either a cold virus or to a simple saline solution, which served as the placebo. They were then quarantined for five days. They checked daily for any signs of illness.
        Researchers found that the nature and duration of stress that an individual experiences is a strong predictor of who gets a cold. Those who had high levels of stress for a month or more were twice as likely to get ill than those who had no such stress. The type of stress also seems to matter. Those who were unemployed were three times as likely to develop colds.
        
        Kiecolt-Glaser et al (1984) analysed blood samples from volunteer medical students for one month before and after students had completed the first two examinations. The participants were given the Social Readjustment Rating Scale to account for life changes that occurred within the last year that would raise their level of stress. As a result they were divided into high stress and low stress groups. Levels of loneliness were also recorded and they were also divided into groups of high loneliness and low loneliness.
        Natural killer cell activity was measured, these are lymphocytes which provide rapid responses to viral-infected cells. A low level of NK activity indicates a poorly functioning immune system.
        There was significant decrease in NK cell activity between the first and second blood test. High stress group had lower levels. Stress experienced previous to exams played a role in their immune systems ability to cope with the stress of exams. High loneliness has lower levels of NK showing that the role of social support is a good protective factor.
        
        Unlike Cohen's study, this actually used biological markers to determine the effects of stress in the exhaustion stage, rather than simply observing whether someone gets ill or not. But even with this, the cause and effect relationship is still rather difficult to fully establish. As it was a natural experiment, the controls over the experiment were not as good as a lab experiment. Some of the participants may have better coping strategies which would better regulate their stress response. The study was naturalistic so has high ecological validity. It also seems to reflect the personal experience that many students experience with regard to illness during and immediately following exam experiences.
        
        The Whitehall study
        
        Marmot et al (1991) analyzed data from over 7000 participants of both male and female civil servants working in London offices of 20 different Whitehall departments. Participants were given an initial screening to make sure that all were free of heart problems prior to the study.
        The aim was to find out whether employees in the lower position jobs- less control over their work environment- would develop heart problems over the five year period. This is an example of a prospective longitudinal study. Although it is still correlational, it establishes that heart disease developed over the course of the study- eliminating pre-conditions as a confounding variable.
        
        In order to gather their data, the researchers used a series of questionnaires as well as carries out health screenings. The participants were invited to the research clinic and a questionnaire was sent to their homes at five year intervals. Self reported non-fatal heart problems and cases of cancer and diabetes were verified by hospital records.
        The final data showed an inverse correlation between one's position in the Whitehall civil service and one's level of heart disease. The rate of heart problems in the lowest levels of the system were 1.5 times the rate in the highest levels, even when matches for such factors such as exercise, diet and smoking.
        It appears that there is a relationship between one's sense of control in their working environment and health of the cardiovascular system. They study has been supported by animal research by Sapolsky.
        
        The fact that this is a longitudinal prospective study is a key strength of the research. Since everyone in Britain receives the same quality healthcare, the level of healthcare can not be a confounding variable.
        However, there are some limitations of the study, it is primarily based off self reported questionnaires. Social desirability may have an effect, access to hospital records was not always available. Study may not be representative of conditions experienced in the average workplace. Researchers may have overly attributed the effects on health to the hierarchy, rather than to dispositional factors.
    - - Stress is said to have a negative effect on memory eg on the hippocampus. Sustained increased levels of cortisol lead to hippocampal cell death, which leads to memory impairment.
        
        Newcomer et al (1999) carried out an experiment to test whether high levels of cortisol interfere with verbal declarative memory. All participants were employees or students at Medical centre. They were all asked to listen and recall parts of a prose paragraph.
        
        The experiment had three experimental conditions.
        
        high levels of cortisol. The participants in the high level cortisol group were given a tablet containing 160mg or cortisol on each day of the four day experiment.
        
        Low levels of cortisol: The participants in the low level of cortisol group were given a tablet containing 40mg of cortisol per day. This dose is similar to the amount circulating the blood everyday.
        
        Placebo group. The participants were given placebo tablets to act as the control.
        
        This experiment was done under a double blind control. Results indicated that high cortisol levels impaired performance in the memory task, but the effect of high levels of cortisol were not permanent.
        
        It appears that cortisol interferes with the transfer of short-term memory to long term memory that takes place in the hippocampus. There are several cortisol receptor sites on the hippocampus.
  - - - Cognitive appraisal is defined as one's personal interpretation of a situation. It is how an individual views a situation in terms of expecting either a negative or positive outcome. The transactional model defines stress as arising from the appraisal that a stressor in the environment will threaten one's wellbeing. The theory argues there are two types of cognitive appraisal.
        
        In primary appraisal a situation is perceived as being either irrelevant, beneficial or stressful. In secondary appraisal, the individual considers what can be done about this. Cognitive appraisal leads to the stress response, or lack of.
        
        The theory is criticised because it doesn't consider the physiological response to a stressor. It just argues that when we don't have the resources for coping with a stressor, we experience stress.
        BUT it does explain individual differences when confronted with a stressor.
        Modern interpretations of this model also consider the role of optimism and pessimism as schema through which we interpret a stressor. This has been the basis for positive psychology. The theory is that those with an optimistic outlook on life are cognitively more likely to recall positive strategies for resolving stressful situations and see that they have the ability to change the situation if they want to. Could be more to do with the lifestyle of the optimist. Optimists tend to live healthier lifestyles that include more physical activity and a healthier diet.
        
        Jobin et al (2014)
        Looked at the role of optimism on stress and health. Participants reported that the level of stress they perceived in their daily lives. They also took a test to measure their level of optimism and pessimism. Researchers measured cortisol levels over a 6 year period in a sample of 135 adults. Jobin found that on days were participants experienced higher than average stress, thats when the pessimists cortisol levels were elevated and those levels of cortisol were sustained for a longer period of time than what was observed in optimists.
        
        Longitudinal studies show that HIV positive people who have more pessimistic expectations develop HIV related symptoms more quickly and die of Aids sooner.
        Social Self preservation theory suggests that threats to one's social self or to social esteem and status are associated with specific negative cognitive and affective responses such as shame and humiliation.
        
        According to Kemeny (2004), HIV infection often occurs in stigmitized groups and is a stigmatising sexually transmitted disease itself. HIV positive gay and bisexual men who are particularly sensitive to rejection related to their sexuality show more rapid progression of the disease than those who are less sensitive to such social-self threats. Social self preservation theory predicts that biological responses to stress are mediated by self conscious emotions such as shame and sensitivity to rejection.
        The psychological aspects of stress are bidirectional - our cognition can lead to stress and stress can have a negative impact on our cognition.
  - - - Poverty and Social Hierarchy
        
        Sapolsky's research on the physiological effects in baboon troops demonstrated that social hierarchy could effect our health and challenged the idea that those at the top must be the most stressed.
        
        Tung et al (2012)
        Carried out research with female macaques that shows ones place in the hierarchy leads to some genes to express themselves. they manipulated the hierarchy by using middle-ranking female macaques and introducing them to a new group one at a time. The researchers took blood samples to determine the effect of the hierarchy on the genetic expression of monkeys.
        They found that monkeys at the bottom of the hierarchy had more activity in genes associated with the production of immune related cells and inflammation. In humans, chronic inflammation and stimulation of the immune system is a risk factor for many different diseases.
        
        Evans and Kim (2007) argue that poverty exposes people to risk factors that lead to a higher vulnerability to stress and therefore, poorer health. Their vulnerability theory was tested by evaluating the health of 207 13 year olds living in poverty in the US. Qualitative data was also gathered regarding their exposure to risk factors such as domestic violence, crime in their neighbourhood or lack of quality housing. The researchers found that the greater number of years spent living in poverty, the greater the number of health issues. Children who had lived in poverty for an extended period of time had higher overnight levels of cortisol and showed early signs of poor cardiovascular health.
        
        However, the argument about risk factors cannot account for the fact that in the poorest societies on the planet, we still see the trend in that those at the top if the hierarchy have better health than those below. Living in a wealthy country does not guarantee that you will be healthier than people living in a less wealthy country.
        
        Wilkinson (2001)has argues that it is the level of income inequality that is the most predictive of one's health rather than one's socioeconomic status.
        This was demonstrated by a study conducted by Operario et al (2014) In their study participants looked at a diagram of a ladder with 10 rungs and then they were asked, 'In society, where on this ladder would you rank yourself in terms of how well you're doing?' The ladder was not labelled up in any way to indicate income level. Researchers found that one's subjective assessment of his/her socioeconomic status was a predictor of one's level of cardiovascular health, obesity and stress hormones. It may be that an upward comparison- comparing yourself to those who have more in society may be the root of poor health.
      - Social support as a protective factor
        
        It appears that positive social support of high quality can enhance resilience to stress. In the Alameda County study 7000 participants completed questionnaires regarding their health, social network and personal characteristics. Follow up interviews and questionnaire took place at intervals for up to 20 years. The findings indicated that men and women without ties to others were 1.9 to 3 times more likely to die from heart disease, stoke, cancer, over the duration of the study compared to individuals with many more social contacts.
- - - - Coan, Schaefer and Davidson (2006)
        Shows how social support may play a key role in stress reduction. 16 married women were threatened with an electric shock while holding their husbands hand, the hand of an anonymous male experimenter or no hand at all while they were in a fMRI brain imaging scanner. While in the fMRI the women were shown 12 non-threat cues and 12 threatening images that indicated an electric shock was possible.
        Results showed that the brain's threat response was lowest when holding their husband's hand and strongest when no hand was held. There was a negative correlation between the reported martial quality and the threat response.
      - Heinrichs et al (2003) argue that in addition to the fact that social support gives us informational emotional and practical support, it also increases our level of oxytocin, which is a protective factor against stress. In their double blind study, 37 healthy men were randomly assigned to receive intranasal oxytocin or a placebo 50 min before carrying out a stressful interview process. They were given 5 mins to prepare a 5 min presentation. In one condition, the participant received some social support from their best friend during presentation time. In the other condition, participants worked alone, without any social support. The researchers found that the combination of oxytocin and social support exhibited the lowest cortisol concentrations as well as decreased anxiety during stress. Indicates there may be some biological underpinnings of the role of social support on stress reduction.
      - Taylor (2002) has argued that there are gender differences when it comes to actively seeking out social support during times of stress. Taylor's arguement is that this is due to evolutionary-based differences between men and women- where men activate the fight or flight responce whereas women activate the 'tend and befriend' response- that is women tend to use social support more as a coping mechanism than men do. Psychologists suggest that culture is a variable that may moderate how social support is perceived, for example in individualistic cultures and collectivitic cultures.
      - Evaluation of the strategy
        
        There are several studies that show how social support groups reduce stress
        
        Much of the research is done based on self-reports about how much support has been received.
        
        It is difficult to isolate social support as a variable.
        
        It is not clear how social support is related to coping. The relationship between social support and appraisal strategies has not been reliably demonstrated
        
        There may be gender and culturally based differences in the likelihood to actively pursue social support.
    - - Another way to reduce stress is to increase one's level of physical activity. When the body is under threat, there is a biochemical response that takes place, a increased secretion of glucocorticoids and noradrenaline, and the activation of the sympathetic nervous system. Evidence supports the beneficial effects of regular exercise in preventing or lessening the physiological effects of chronic stress. Exercise increases your overall health and your sense of wellbeing. Physical activity also helps to increase the production of your brain's feel-good neurotransmitters, called endorphins.
      - Exercise changes our focus and often allows us to stop thinking about the stressors that are bothering us.
        Exercise also improves your mood. Regular exercise can increase self confidence, relax you and it can lower symptoms associated with mild depression or anxiety. Exercise can also improve sleep, which is often disrupted by stress. All these benefits can help to counteract the negative effects of stress.
      - Brown and Siegel (1988) carried out a prospective longitudinal study of 384 female middle school students. The researcher gave the student's a 'life events survey' to determine which stressors they had experienced as well as an activity questionnaire. The tests were given at the beginning and at the end of the academic year. In addition, they carried out a medical health check up. They found that the negative impact of stressful life events on health declined as exercise levels increased.
      - King et al (1993) carried out a 12-month study of adults aged 50-65. They were randomly assigned a low or high intensity exercise training program. The researchers found that regardless of the exercise regime, an increase of exercise was related to lower levels of stress and depression
      - Hamer, Stamatakis and Steptoe
        
        Hamer et al (2008) carried out a survey of 20,000 men and women inScotland to determine the effect of exercise or physical activity on their health. The survey was carried out over two household visits. During the first visit, the participants discussed their levels of physical activity, and their weight and height were measured. During the second visit, they were asked about their general health and physical activity. The participants took the General Health Questionnaire, which measures psychological distress which consists of 12 questions about participants level of happiness, experience if depressive and anxiety symptoms and sleep disturbance over the last 4 weeks.
        
        The researchers found that any form of daily physical activity was linked to a lower risk of psychological distress. The more physical activity people engaged in, the less likely they were to indicate psychological distress on their questionnaires. The research also showed that the different activities including domestic tasks, walking and sports all showed a reduced chance of psychological distress. The strongest effects were observed for those who played sports.
        The researchers concluded that stress reduction benefits were observed at a minimal level of at least 20 minutes a week of any physical activity. In addition, there was a greater risk reduction for activity that was undertaken for longer or a higher intensity.
        
        The study does suffer from bidirectional ambiguity- there is a possibility that results are actually showing that those who suffer from stress or anxiety are less likely to take part in physical activity instead of the other way around.
      - Evaluation of the strategy
        
        There is clear biological evidence of the positive effects of exercise.
        
        Exercise may promote self esteem, social activity and provide time away from stressors such as work or family. Difficult to determine the extent to which exercise alone is effective against stress
        
        Several studies on the effect of exercise use a very loose definition of stress.
  - - - Mindfulness aims to teach people how to respond to stressful situations 'mindfully' that is being able to appraise stressors realistically and step back from related thoughts and emotions. It is believed that the positive or neutral appraisal of environmental stressors is what decreases the stress response.
      - Shapiro et al (1998) carried out a controlled study with a group of premedical students who were offered the MBSR course at the university of Arizona. People who signed up for the course were randomly assigned to the course or to a waiting list. Participants in the MBSR group and the waiting list group filled out a self-questionnaire assessing stress before the course and during exams after the course. The study was designed to coincide with exams, since it's known to be a high stress period. Also completed a questionnaire on empathy.
        Researchers found no difference between the two groups at the beginning of the term but they did identify differences around the time of the exams. People on the waiting list expressed more anxiety compared to those who had participated in the MBSR class who were less anxious than at the start.
      - Speca et al (2000) performed a controlled test with a sample of cancer patients. they recruited the participants by publishing the MBSR course in the cancer clinic in Calgary. Those who were interested were randomly allocated to the experimental group or to a waiting list. The effectiveness of MBSR was assessed using a stress symptoms questionnaire. The experimental group showed a reduction in total mood disturbance of an impressive 65% and a reduction of 35% in stress symptoms. No changes in the average scores for the control group, but this may be due to social desirability bias.
      - Evaluation of the Strategy
        
        There is research that demonstrates that MSBr is a successful treatment method for many people
        
        It is not clear how meditation affects physiological processes with regard to stress
        
        Mindfulness as a construct is not well defined, difficult to measure.
        
        There is not enough research to account for placebo effects of the treatment.
- - - - Engel proposed that health was influenced by different systems, which in turn interacted with and influenced each other. These systems; biological , psychological and social determined one's health. This became known as the biopsychosocial model. According to this model, none of these factors in isolation is sufficient to lead definitively to health or illness- it is the deep interrelation of all three components that leads to a given outcome.
      - Among the advantages of the biopsychosocial model is that it looks at the individual holistically rather than passive responders to their biological destiny. It believes that a person can take control over their health behaviour. The model also puts a focus on prevention with the goal of avoiding health problems as a result of promoting positive behaviours such as a healthy dirt, exercise and stress management. A growing amount of research suggests that it is the combination of health status, beliefs about health and sociocultural barriers to accessing health care that influence the likelihood of an individual engaging in health promoting behaviours.
      - There are some limitations of such a model. It is not always clear how and to what extent these factors interact. When carrying out research on one aspect of the model, it is often not possible to isolate that variable from other factors. For example, when studying the cognitive origins of stress, one cannot control for physiological factors. As a result, the model's predictive validity is often questioned. Another limitation is simply its practical application. Being able to diagnose or treat an individual patient with regard to biological, psychological and sociocultural considerations is both time and resource consuming.
      - Steptoe and Marmot 2003
        
        Conducted a survey on the interaction of social, psychological and physiological aspects of stress. The researchers used a sample of 227 British men and women, aged 47-59. The aim of the study was to look at differences in physiological stress responses to a number of stressors. They used 7 questionnaires, each related to a different stressor. Blood samples were also taken in order to have a physiological measure for stress eg levels of cortisol.
        
        The 7 stressors in this investigation were: job stress, environmental stress, neighbourhood and housing issues, economic problems, lack of social support from close relatives, loneliness, lack of feelings or control over one's life, and lack of self-efficacy in relation to stressors.
        The researchers found that a person scoring high on one stressor did not necessarily have a high score on another. However, participants who had a high mean score on all 7 stressors also had blood tests indicating they were in the high risk group for developing heart problems. Researchers argue on the basis of these results, research must focus on specific stressors in isolation as well as combinations of stressors. Knowing which stress factors are implicated in heart disease can help to design interventions.
  - - - Health impairing habits include those such as smoking, drinking and a sedentary lifestyle.
        Health protective behaviours include those such as a healthy diet, regular exercise and regular health check ups.
        Psychologists assume that humans are rational information processors. It is assumed that if we are presented with a good argument regarding the dangers of drinking two or three glasses of alchohol on a daily basis, we would change our behaviour. This is not the case for all behaviours.
        
        Risk perception
        Can be defined as the extent to which an individual feels that they are at risk of developing a health problem. Often related to family experience. If no one in you family has ever had breast cancer- you may feel you are at low risk.
        Psychologists suggest that one of the reasons that we have this irrational perception of risk is due to optimism bias. We tend to overestimate the number of our health-protective behaviours and underestimate the significance of our health impairing habits.
        
        Weinstein (1983)
        Carried out a study of 88 undergraduates to test their level of optimism bias. He asked participants to fill out a questionnaire about 11 health and safety risks, ranging from tooth decay and injury in a car accident to cancer and diabetes. Then asked to answer the following question ' compared to other people you age and sex, what are your chances of getting [the problem]- greater than, less than, the same as?
        Also asked about their level of worry about the chance of developing the health problem.
        The study was experimental. There were three conditions in which the participants answered the questionnaire. In the first condition, (control) participants were simply asked to fill out the questionnaires.
        In the second condition (own risk) the questionnaire included a list of risk factors. But before filling the questionnaire they were told 'not clear and they are only possible risk factors'
        
        In the third condition, (informational group) was shown the list of risk factors and were told 'Each of the questions about risk factors has a number which shows the response of typical Rutgers male or female based on data we gathered earlier this semester.' They were then asked to complete the rest of the questionnaire.
        Results showed that the 'own risk' group felt that they had least chance of developing the health problems and were the least worried of the three groups. An unexpected finding was that merely rating oneself on risk factors substantially increased optimistic biases. The results also showed that when participants were given information about the risk status of their peers the optimistic bias was significantly reduced.
        
        In a study carried out by Hoppe and Ogden (1996), the researchers wanted to see if the level of unrealistic optimism would be affected if participants focused on their health impairing habits rather than their health protective behaviour. In their study, the risk increasing behaviour was unsafe sex and the risk decreasing behaviour was 'safe sex'. The sample consisted of heterosexual participants only. The participants completed a questionnaire under 1 of 2 conditions. The 'risk increasing' condition, they were asked questions which would most likely be answered negatively. In the risk decreasing condition, they were asked questions that would most likely be answered positively. The results showed that when focused on risk-decreasing questions, their own sense of risk was lower- optimism bias higher.
      - Self efficacy Bandura defined self efficacy as one's belief in one's ability to succeed in specific situations or accomplish a task.
        
        Neupert et al (2009) studied the role of self efficacy in exercise behaviour. The sample was made up of a group of older adults, all committed to begin a strength training program. Levels of self efficacy were measured before and six months into the program. The study found that the participants who had higher self efficacy at 6 months were more likely to be exercising 12 months later. Findings indicate a correlation between self-efficacy and exercise behaviour. One's beliefs developed during an exercise program are important for commitment to continue. This shows potential importance of feedback given by coach or trainer.
        
        Based on the concept of self efficacy, Ajzen (1985) proposed the theory of planned behaviour. The theory outlines three factors that predict behavioural intentions which are linked to behaviours.
        Attitude towards behaviour- it can be negative or positive
        Subjective norms- this means whether a behaviour will be executed depends also on what one's significant others attitude towards the behaviour is.
        Self efficacy- level to which someone beliefs they are able to execute the behaviour and preserve.
        The theory of planned behaviour is a holistic theory that looks at several factors that influence behaviours, so role of self efficacy is difficult to measure. Research is correlational in nature and ignores cultural and environmental factors in explaining one's behaviour.
      - Personality and health problems
        
        Five factor model of personality.
        Openness to experience: One's level of intellectual curiosity and willingness to try new things.
        Conscientiousness: Characterised by impulse control. A person with a high level of conscientiousness is goal directed, likes to plan, is able to delay gratification and follows norms and rules
        Extraversion: One's level of engagement with the external world
        Agreeableness: One's level of concern for others over oneself as well as optimism with regard to human nature.
        Neuroticism: one's tendency to experience negative emotions, such as anger, anxiety or depression. Those with high levels of neuroticism are more prone to stress.
        
        Health psychologists use the Five factor model to determine if specific personality traits may play a greater role in the development of health impairing habits than others. Ingledew and Ferguson (2006) investigated the role of personality in predicting safer sex in university students by administering a standardised personality test as well as a questionnaire about their sexual behaviours in the last year. The researchers concluded that traits of agreeableness and conscientiousness were the greatest predictors of safer sex practises.
  - - - Social factors
        
        One of the basic forms of learning is imitating the behaviours that we see around us -social cognitive theory- it becomes a very important health protective factor when one's parents and peer's have a healthy lifestyle; one is more likely to eat healthy food, exercise, drink alcohol moderately, sleep well. Sadly the same is true about the opposite.
        
        Mays et al (2014)
        Carried out a study of 406 adolescents ages 12 to 17 to determine the effect of parental smoking behaviour. Interviews were carried out both with the adolescents and their parents. The adolescents then had a follow up interviews one and five years later. The parental interviews focused on parental smoking history, current smoking and nicotine dependence. They found that adolescents with nicotine-dependant parents were more susceptible to more intense smoking patterns and this risk increases with longer exposure.
        
        Economic factors are extremely important as protective as well as risk factors in health behaviour. Poverty is one of the major risk factors when it comes to health. People living in poverty tend to have significantly higher levels of stress. they also have less access to appropriate healthcare. They often live in insufficient housing conditions and are more likely to be malnourished and experience physical violence. Statistically have more health problems.
        
        Hann et al (1987) looked at the mortality rate of residents in a poor neighbourhood in the US over a period of 9 years. All participants in the study were 35 years or older. The members of the community were matched with the national averages based on several variables. These included, age, sex, income, employment status, access to medical care, health insurance coverage, smoking, alcohol consumption, physical activity and body mass index, sleep patterns, social isolation, martial status and diagnosis of depression.
        Found the rate of mortality was 1.71 higher than the national average across all variables. This means that residents of the poor neighbourhood were almost twice as likely to die of health related causes. Support the hypothesis that one's socioeconomic environment may be an important risk factor for poor health and early mortality.
        
        Jessor, Turbin and Costa (1998)
        Conducted a longitudinal questionnaire study on protective and risk factors in adolescent health behaviours. Looked at proximal risk factors, proximal protective factors and distal protective factors. Found all these variables had a significant relationship with health related behaviour in adolescents, therefore they are all to a certain extent, valid predictors of health related behaviour.
      - Dispositional factors
        
        Personal factors are also crucial in one's health related behaviour. Many aspects of one's personality influence health such as risk taking tendency or self efficacy. One aspect of personality that appears to have a direct effect on health is one's locus of control.
        
        Locus of control is an individual's perception of personal agency. Some people tend to think they have control over events in their life and they believe that they determine their own fate; these people would have an internal locus of control. On the other end of the spectrum, there are people who believe they have minimal influence on their lives and its rather luck of some other external force that that decides what is going to happen to them, these people have external locus of control.
        
        Having an internal locus of control is a protective factor in health behaviour whereas having external locus of control is a risk factor. Individuals with a internal locus of control are more likely to lead a healthy lifestyle as they believe that by doing so they can influence their health situation. People who have an external locus of control believe that whatever they do, their health is predetermined and they can not do anything about their situation, 'so why bother?'. If seriously ill, someone with internal locus of control will try to get better whereas external would feel helpless and not be able to change their fate.
        
        Sangeeta et al (2015) researched the relationship between heath promoting behaviour and locus of control. Their sample consisted of 200 college students. They found that a significant positive relationship between internal locus of control and health responsibility, physical activity, good nutrition, spiritual growth and even interpersonal relationships and stress management. Confirms the suggestion that internal locus of control is a good predictor of a healthy lifestyle.
- - - - Predicts that individuals will take a health related action if they think that a negative health problem can be avoided by taking the recommended action and they would be successful in doing so.
      - It is based on the assumption that for a behavioural change to succeed, individuals must have the incentive to change, feel threatened by their current behaviour, and feel that change will be beneficial and be at acceptable cost. They must also feel competent to implement that change.
      - Sees people as rational and suggests that the likelihood that a person will engage in healthy behaviour depends on a number of factors such as:
        Evaluation of threat: Eg Bing overweight may result in developing a heart condition.; smoking may result in lung cancer. The person will probably recognise this as a serious condition but may also believe that it does not happen to people like them. Claims people only act if they perceive a threat.
        Cost- benefit analysis: the person will evaluate whether the perceived benefits will be higher than the perceived barriers.
      - The HMB model also includes self efficacy beliefs. This feeling of competence will influence perception, motivation and performance. People make judgements of self efficacy primarily on the basis of precious achievements. Other sources of judgment include:
        
        Observations of the performance of others
        
        Social and self persuasion
        
        Monitoring emotional states
      - The HBM argues that a person's readiness to change is based on five factors. An example of how these factors can be applied can be seen in the campaigns to promote the use of condoms to avoid HIV infection.
        
        Perceived vulnerability: people have to believe they can get HIV and know how one gets the disease.
        
        Perceived severity: People need to believe that the consequences of getting HIV are significant enough that they want to avoid contracting it.
        
        Perceived benefits: people have to understand the benefit of using condoms to avoid HIV infection
        
        Perceived barriers: Barriers need to be explicitly identified and plans need to be developed to overcome them. People may be embarrassed to ask a partner to use or condom or may not want to buy them.
        
        Cues to action: People need to be reminded of safe sex practice in newsletters, a conversation with a friend etc...
        
        A problem in the HBM is the focus on individual cognitions. It does not include emotional, social and economic factors, which are known to influence health behaviours as well. It seems difficult to make standard measurements of many of the concepts.
        the HBM is also criticised for assuming that people are rational which is not always the case. Research has found that awareness of health risks alone does not necessarily inhibit people from engaging in potentially risky behaviour. Studies have found that people are quite optimistic about their health.
        Weinstein (1987) asked people to rate their risk of developing various disorders compared to people like them. Individuals usually rate their chances of illness as lower than for other people.
        
        People tend to believe that if a problem has not appeared yet, then it is unlikely to happen in the future.
        
        People tend to think that personal action can prevent the problem
        
        People believe the problem is rare
        
        People have little or no experience of the problem.
        
        Evaluating the HBM
        The health belief model has been successfully applied in many cases to change behaviours from as varied as smoking to safe sex.
        Ignores the role of social and environmental factors on health such as pressure and social norms. The model assumes that health behaviour change can happen simply by conscious choice. This may not always be the case. People suffering with nicotine addiction may want to quit but simply cant. Since health behaviour is seen as a choice, there is the temptation to blame the victim rather than recognising the complexities of changing behaviour.
        
        Social Cognitive Learning Theory
        
        Suggests that health promoters act as 'change agents', facilitating change through modification of the social environment and the development of skills and capacities that enable individuals to make healthy changes.
        
        Observational learning
        
        Expectations
        
        Reciprocal determinism describes the way in which behaviour and the environment continuously interact and influence one another. Stresses the need for addressing environmental influences in order to promote change.
        
        Self efficacy
        
        Health promotion campaigns which are based on the Social Cognitive Learning Theory include an informational component to increase perceptions of the risks and benefits associated with a particular behaviour change, building self-efficacy to promote behaviour maintenance and building social support to sustain change. One example is the Sabido Method. The goal is to change not just an individual's behaviour but to also improve the general society by changing attitudes and behaviour.
        
        The first attempt of this method was in a soap opera. The results invloved:
        
        Phone calls to the CONAPO requesting family planning information increased from 0 to an average of 500 a month.
        
        More than 2,000 women registered as voluntary workers in the national program of family planning. Contraceptive sales increased 23% in one year.
        
        Increase 33% in women enrolling in family planning clinics.
        
        The method is based on several factors that promote social cognitive theory.
        
        viewers are committed to the show
        
        observe both rewards and punishments perceived by characters.
        
        Identify with the characters an connect with them
        
        Evaluating Social Cognitive Learning Theory
        
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        Effectiveness of health promotion programs
        
        The goal of health promotion strategies is to enhance good health and prevent illness. It is not easy to get people to believe in healthy ways due to the factors that influence health habits eg: social class, gender, education and culture.
        Psychologists know that one on one contact is an effective way to change behaviour in individuals or small groups, but this approach is not possible when one wants to change habits of the whole population.
        
        .
        
        Modern health promotion activities include:
        
        Public health campaigns that aim to change beliefs, attitudes, and motivations eg informing smokers about the dangers of smoking.
        
        Changing the wider determinants of health- more stairs
        
        Public or private health services that can help people change their behaviour.
        
        Political activities- for example, implementing smoking bans or reducing tax on healthy food.
        
        Health campaigns
        
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      - Quist-Paulsen et al (2003)
        
        Conducted a field experiment in which they investigated patients who had been treated for heart problems in a Norwegian hospital. It is known that mortality is reduced by 50% beyond three to five years if such patients stop smoking.
        Wanted to see if a longer intervention, including fear arousal, would get more people to stop smoking and prevent relapse. They randomly assigned participants to a treatment group and a control group. Patients in the control group received no further counselling on how to stop smoking.
        Patients in the treatment group had personal advice from trained nurses, and received material that stressed the risks of continue smoking and the improved outcomes of cessation. Patients were advised to stop, and nicotine replacement was offered to those with cravings. Spouses were also advised to stop smoking.
        The nurses contacted the patients nine times after they went home, to encourage them to stop smoking. They stressed the negative aspects of smoking on their condition. patients also had two consultations in the year after leaving hospital. The researchers found that 57% of intervention group and 37% of the control group had stopped smoking.
        They concluded that the program based on fear arousal and relapse prevention was effective for this group of patients.