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HEALTH PSYCHOLOGY second australasian edition
� WILEY
hiopsychosocial interactions
EDWARD P. Sara fino The College of New Jersey
MARIE L. Caltabiano James Cook University
DON Byrne Australian National University
John Wiley &.. Sons Australia, Ltd
: ,J I
Second edition published 2008 by John Wiley & Sons Australia, Ltd 42 McDougall Street, Milton Qld 4064
First edition published 2002
Typeset in 10/12 pt Berkeley
Australian editions © John Wiley & Sons Australia, Ltd 2002, 2008
Authorised adaptation of Health Psychology 3e (ISBN 978 0 471 169 17 8) , published by John Wiley & Sons, Inc. , New York, United States of America. © 1997 in the United States of America by John Wiley & Sons Inc. All rights reserved.
The moral rights of the authors have been asserted.
National Library of Australia Cataloguing-in-Publication data
Caltabiano, Marie, 1959-Health psychology: biopsychosocial interactions. Second Australasian edition
Includes index. Bibliography.
ISBN 978 0 470 81345 4 (pbl<.)
Marie L Caltabiano; Don Byrne; Edward P. Sarafino. 2nd ed. Clinical health psychology. Psychology. Byrne, D. G. (Donald Glenn) Sarafino, Edward P., 1940-
616.0019
Reproduction and communication for educational purposes The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of the pages of this work, whichever is the greater, to be reproduced andlor communicated by any educational institution for its educational purposes provided that the educational institution (or the body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) .
Reproduction and communication for other purposes Except as permitted under the Act (for example, a fair dealing [or the purposes of study, research, criticism or review) , no part of this book may be reproduced, stored in a retrieval system, communicated or transmitted in any form or by any means without prior written permission. All inquiries should be made to the publisher.
Cover and internal design images: photodisc; © 2002 Digital Vision
Edited by Catherine Spedding
Printed in Singapore by Markono Print Media Pte Ltd
10 9 8 7 6 5 4 3 2 1
To my parents AIfio and Rosetta, and my uncle Albert.
In memory and gratitude.
Marie L. Caltabiano
PART 1
Chapter 1
Chapter 2
PART 2
Chapter 3
Chapter 4
Chapter 5
PART 3
Chapter 6
Chapter 7
Chapter 8
PART 4
Chapter 9
Chapter 10
PART 5
Chapter 11
Chapter 12
PART 6
Chapter 13
Chapter 14
PART 7
Chapter 15
An introduction: basic issues and processes 1
An overview of psychology and health 2
The body's physical systems 45
Stress, illness and coping 85
Stress - its meaning, impact and sources 86
Stress, biopsychosocial factors and illness 130
Coping with and reducing stress 178
Lifestyles to enhance health and prevent illness 213
Health-related behaviour and health promotion 214
Reducing substance use and abuse 272
Improving nutrition, weight control and diet, physical activity and safety 323
Becoming ill and getting medical treatment 373
Using health services 374
In the hospital: the setting, procedures and effects on patients 420
Physical symptoms: pain and discomfort 459 -
The nature and symptoms of pain 460
Managing and controlling clinical pain 498
Chronic and life-threatening health problems 533
Serious and disabling chronic illnesses: causes, management and coping 534
Heart disease, stroke, cancer and AIDS: causes, management and coping 575
Looking to the future 623
What's ahead for health psychology? 624
Preface xii FootS on research
To the student xv / The Australian Longitudinal Study of Ageing 40
About the authors xvii Genetics research 41
Acknowledgements xviii
PART 1 An introduction: basic
issues and processes 1
Chapter 1 An overview of psychology and health 2
What is health? 3
An illness/wellness continuum 4
Illness today and in the past 5
Viewpoints from history: physiology, disease processes
and the mind 8
Early cultures 8
Ancient Greece and Rome 8
The Middle Ages 9
The Renaissance and after 10
Seeing a need: psychology's role in health 11
Overcoming problems with the Australian health
care system 11
The person' in health and illness 12
A Assess yourself
• How health conscious are you? 14
How the role of psychology emerged 15
Health psychology in Australia 18
Where is health psychology taught in Australia? 22
Current perspectives on health and illness 22
The biopsychosocial perspective 22
The life-span perspective 26
Relating health psychology to other science fields 27
Related fields 27
Health and psychology across cultures 28
Highlight on issues
Careers relating to health and psychology 30
Research methods 33
Experiments 33
Correlational studies 36
Quasi-experimental studies 37
Which research method is best? 42
Summary 42
Chapter 2 The body's physical systems 45
The nervous system 46
How the nervous system works 46
The central nervous system 48
The peripheral nervous system 53
The endocrine system 56
The endocrine and nervous systems working
together 56
Adrenal glands 57
Other glands 57
The digestive system 58
Food's journey through digestive organs 58
HigltligJlt on issues
Our physiological individuality 60
Using nutrients in metabolism 62
The respiratory system 64
The respiratory tract 64
A Assess yourself
• How many calories do you bum while resting? 65
Respiratory function and disorders 65
The cardiovascular system 66
The heart and blood vessels 67
Blood pressure 68
Blood composition 70
Cardiovascular disorders 71
The immune system 72
Antigens 72
The organs of the immune system 73
Soldiers of the immune system 74
Highlight on issues
When the immune system turns on itself 76
Defending the body with an immune response 77
Less-than-optimal defences 78
The reproductive system and heredity 79
Conception and prenatal development 79
Genetic processes in development and health 79
FootS on research
/ Immunity and ageing 81
Summary 83
PART 2 Stress, illness and
coping 85
Chapter 3 Stress - its meaning, impact and
sources 86
Experiencing stress in our lives 88
What is stress? 88
Appraising events as stressful 91
Biopsychosocial aspects of stress 94
Biological aspects of stress 94
Psychosocial aspects of stress 96
Sources of stress throughout life 100
Sources within the person 101
Sources in the family 102
Sources of stress in the community and
society 105
Highlight on issues
The burden of caregiving 106
FoatS on research
/ Occupational stress in Australia 108
Measuring stress no
Physiological arousal 110
Psychological symptoms of distress III
FoatS on research
/ Stress and measures of phYSiological arousal 112
Life events - or stressors 114
Daily hassles 119
Disaster and traumatic events 121
Psychosocial responses to disaster and trauma
Can stress be good for you? 124
Q Assess yourself
• Hassles in your life 126
Summary 128
[ vi 1 C O N T E NTS
121
Chapter 4 Stress, biopsychosocial factors and
illness 130
Psychosocial modifiers of stress 132
Social support 132
Q Assess yourself
• How much social support do you get? 139
A sense of personal control 143
A hardy personality 149
Type A and Type B behaviour patterns 153
How stress affects health 161
Stress, behaviour and illness 162
Stress, physiology and illness 162
Highlight on issues
Sudden 'voodoo' death 163
Psychoneuroimmunology 164
Psychophysiological disorders 167
Digestive system diseases 167
Asthma 168
Chronic headache 169
Other disorders 169
Stress and cardiovascular disorders 170
HypertenSion 171
FootS on research
/ Reactivity and hypertension: a meta-analysis 173
Coronary heart disease 174
Stress and cancer 175
Summary 176
Chapter 5 Coping with and reducing stress 178
Coping with stress 179
What is coping? 179
Functions and methods of coping 180
Q Assess yourself
• Your focuses in coping 182
Reducing the potential for stress 188
Enhancing social support 188
Improving one's personal control 190
Organising one's world better 190
Highlight on issues
Coping with telTorism 191
Exercising: links to stress and health
Preparing for stressful events 193
191
Reducing stress reactions: stress management 195
Medication 195
Behavioural and cognitive methods 195
FootS on researdl
/ Stl'ess management at the population level 203
Massage, meditation and hypnosis 204
Using stress management to reduce coronary risk 206
Modifying Type A behaviour 206
Treating hypertension 209
Minimising risk of cardiac recurrence 210
Summary 211
PART 3 Lifestyles to enhance health
and prevent illness 213
Chapter 6 Health-related behaviour and health
promotion 214
Health and behaviour 215
Lifestyles, risk factors and health 216
Interdisciplinary perspectives on preventing
illness 220
G HighligJlt on issues
, Two health behaviours: breast and testicular
examinations 22 1
Problems in promoting wellness 224
What determines people's health-related
behaviour? 226
General factors in health-related behaviour 226
The role of beliefs and intentions 229
The role of less rational processes 238
Developmental, gender and sociocultural factors
in health 241
Development and health-related behaviour 241
Gender and health-related behaviour 245
Sociocultural factors and health-related
behaviour 246
Programs for health promotion 248
Methods for promoting health 248
Promoting health in schools 254
Workplace health promotion 255
G Highlight on issues
, Indigenous childrens health 257
Community health promotion 258
Prevention with specific targets: community and
school approaches in the prevention of obesity 261
FoOtS on research
/ Socioeconomic status and food purchaSing 264
Prevention with specific targets: fOCUSing on
AIDS 265
A Assess yourself
• Your knowledge about AIDS 266
Summary 270
Chapter 7 Reducing substance use and abuse 272
Substance abuse 273
Addiction and dependence 273
Processes leading to dependence 274
Smoking tobacco 276
Who smokes? 277
How much smokers smoke 279
Why people smoke 279
Smoking and health 285
Highlight 011 issues
Does someone elses smoking affect your
health? 288
Preventing smoking 289
Quitting smoking 291
Alcohol use and abuse 298
Who drinks, and how much? 299
A Assess yourself • Whats true about drinking? 300
Why people use and abuse alcohol 302
A Assess yourself
• Do you abuse alcohol? 303
Drinking and health 304
FoOtS 011 researdl
/ How does heredity lead to alcohol abuse? 305
Preventing alcohol abuse 307
Treatments for alcohol abuse 308
Drug use and abuse 314
Highlight on issues
Types and effects of drugs 315
Who uses drugs, and why 316
Drug use and health 318
Preventing and stopping drug abuse 318
Summary 320
C O N TE NTS [vii 1
Chapter 8 Improving nutrition, weight control and diet,
physical activity and safety 323
Nutrition 324
Components of food 325
What people eat 326
Nutrition and health 329
FoaLS on research
/ Interventions to improve dietary components 332
Weight control and body image 333
FoaLS on research
/ Messages to prevent body dissatisfaction 337
Overweight and obeSity 337
Dieting and treatments to lose weight 346
A Assess yourself
• How do you score on eating efficacy? 347
Anorexia and bulimia 352
A Assess yourself
• Your weight control patterns 353
Physical activity 358
The health effects of exercise 358
Highlight on issues
Types and amounts of healthy exercise 360
Who gets enough physical acttvity, who does not -
and why 362
Promoting physical activity 364
Safety and harm reduction 366
Accidents 366
Environmental hazards 367
Summary 370
PART 4 Becoming ill and getting medical treatment 373
Chapter 9 Using health services 374
Types of health services 375
Specialised functions of practitioners 375
Office-based and in-patient treatment 376
The Australian health care system 377
The New Zealand health and disability system 378
Health care systems in other countries 379
Perceiving and interpreting symptoms 380
Perceiving symptoms 381
[ viii 1 CO NIE NIS
Interpreting and responding to symptoms 384
FOOlS on research
/ People� ideas about illness 386
Illness cognition and self-regulation 387
Using and misusing health services 389
Who uses health services? 389
Why people use, don't use and delay using health
services 392
Using complementary and alternative
medicine 394
Misusing health services 396
FoaLS on research
/ Neuroticism and symptom presentation 397
The patient-practitioner relationship 398
Patient preferences for participation in medical
care 398
The practitioner's behaviour and style 400
HighligJlt on issues
Fighting for your life 401
The patient's behaviour and style 403
A Assess yourself
• Do you know what medical terms mean? 403
Adherence: adhering to medical advice 405
Extent of the non-adherence problem 405
Why patients do and do not adhere to medical
advice 407
Patient-practitioner interactions 412
Increasing patient adherence 414
Summary 417
Chapter 10 In the hospital: the setting, procedures
and effects on patients 420
The hospital - its history, setting and
procedures 421
How the hospital evolved 422
The organisation and functioning of hospitals 423
Roles, goals and communication 424
A Assess yourself
• Who� who in physician care 425
The funding of medical services 427
Being hospitalised 429
Relations with the hospital staff 429
Sick-role behaviour in the hospital 431
Focus on research
/ Burnout among health care professionals 431
Patient satisfaction 436
Emotional adjustment in the hospital 436
Coping processes in hospital patients 437
Preparing patients for stressful medical
procedures 440
c; Highlight on issues
, Lamaze training as a method of psychological
preparation for a medical procedure 446
When the hospitalised. patient is a child 447
How health psychologists assist hospitalised
patients 453
Initial steps in helping 453
Tests for psychological assessment of medical
patients 454
Promoting patients' health and adjustment 455
Summary 456
PART 5 Physical symptoms:
pain and discomfort 459
Chapter 11 The nature and symptoms of pain 460
What is pain? 461
The qualities and dimensions of pain
Perceiving pain 464
G Highlight on issues
, Acute pain in burn patients 465
HigflligJlt on issues
462
Trauma and pain: the Bali bombing and its
aftermath 467
Theories of pain 470
Early theories of pain 470
The gate-control theory of pain 471
Focus Oll research
/ Inducing pain in laboratory research 471
Biopsychosocial aspects of pain 476
Neurochemical transmission and inhibition
of pain 476
Personal and social experiences and pain 478
G Highlight Oll issues
, Placebos and pain 479
Emotions, coping processes and pain 482
Assessing people's pain 486
Self-report methods 486
Behavioural assessment approaches 489
Q Assess yourself
• DeSCJibing your pain 490
Psychophysiological measures 493
Pain in children 494
Pain and children's sensory and cognitive
development 494
Assessing pain in children 495
Summary 496
Chapter 12 Managing and controlling clinical pain 498
Clinical pain 499
Acute clinical pain 500
Chronic clinical pain 500
Medical treatments for pain 501
Surgieal methods for treating pain 502
Chemical methods for treating pain
1 Highlight Oll issues
Types of pain-relieving chemicals
Behavioural and cognitive methods for
treating pain 507
The operant approach 507
Relaxation and biofeedback 508
Cognitive techniques 512
Focus Oll research
502
504
/ How durable are the effects of psychological
treatments for pain? 513
Preparation for events with potentially painful
consequences 518
Q Assess yourself
• Would behavioural or cognitive methods help
your pain? 519
Hypnosis and insight-oriented psychotherapy 520
Hypnosis as a treatment for pain 521
InSight therapy for pain 522
Physiotherapy and stimulation therapies
for pain 524
Stimulation therapies 524
Physiotherapy 526
Pain clinics 527
Multidisciplinary programs 527
CO NTE NTS [ ix 1
Highlight on issues
Physical activity and bach pain 528
Evaluating the success of pain clinics 529
Summary 530
PART 6 Chronic and life-threatening health problems 533
Chapter 13 Serious and disabling chronic illnesses:
causes, management and coping 534
Adjusting to a chronic illness 535
Initial reactions to having a chronic
condition 536
Influences on coping with a health crisis 537
The coping process 541
Impacts of different chronic conditions 543
Asthma 544
Epilepsy 548
C;; Hig'dig'lt on issues
, What to do for a seizure 549
Nervous system injuries 550
Diabetes 553
A Assess yourself
• Do you have diabetes?
Highlight on issues
Self-managing diabetes
Arthritis 561
Alzheimer's disease 564
556
559
Psychosocial interventions for people with chronic conditions 567
Education and support services 569
Relaxation and biofeedback 570
Cognitive approaches 571
Insight therapy 571
Family therapy 571
FoalS on researdl
/ Cognitiveibehaviotlral approaches in managing
arthritis 572
Summary 573
[X 1 CO NTENTS
Chapter 14 Heart disease, stroke, cancer and AIDS:
causes, management and coping 575
Coping with and adapting to high-mortality illness 577
Adapting while the prospects seem good 577
Adapting in a recurrence or relapse 578
Heart disease 579
Who is at risk of heart disease, and why? 580
Medical treatment and rehabilitation of cardiac
patients 582
The psychosocial impact of heart disease 585
Psychosocial interventions for heart disease 587
Stroke 588
Causes, effects and rehabilitation of stroke 588
Psychosocial aspects of stroke 592
Cancer 593
/
The prevalence and types of cancer 594
The sites, effects and causes of cancer 594
Diagnosing and treating cancer 597
The psychosocial impact of cancer 599
FOOlS on research
Coping with chemotherapy and its side effects 601
Psychosocial interventions for cancer 602
G Highlight on issues
, Can patients 'will away' their cancer? 604
Childhood cancer 604
AIDS 605
Risk factors, effects and treatment of AIDS 605
The psychosocial impact of AIDS 608
Psychosocial interventions for AIDS 609
Adapting to a terminal illness 610
The patient's age 610
Psychosocial adjustments to terminal illness 612
The quality of life in death 614
Medical and psychological care of dying
patients 615
A Assess yourself
• Your living will choices 616
A place to dieL hospital, home or hospice? 617
The survivors: and life goes on 619
Summary 621
PART 7 Looking to the future 623
Chapter 15 What's ahead for health psychology? 624
Goals for health psychology 625
Enhancing illness prevention and treatment 625
Improving efforts for helping patients cope 628
Documenting the efficacy and cost-benefit ratio
of care 628
Enhancing psychologists' acceptance in medical
settings 630
Careers and training in health psychology 631
Career opportunities 632
Training programs 632
Issues and controversies for the future 633
Environment, health and psychology 633
Quality of life 634
Ethical decisions in medical care 635
Future focuses in health psychology 638
Critical health psychology 638
Q Assess yourself
• Some ethical dilemmas: what do you thinh? 639
Life-span health and illness 640
FoolS on l'esearcJt
/ Treating infant sleep disturbance (ISD) - the
Canterbwy Infant Sleep Project 641
Sociocultural factors in health 642
Gender differences and women's health issues 643
Factors affecting health psychology's future 643
Summary 644
Appendix 646
Glossary 647
References 657
Index 745
CO NTE NTS [ x i 1
[ xii 1 PREFA CE
I t was with great enthusiasm and pleasure that we embarked on wntmg this second Australasian edition of Health Psychology. When I (Marie Caltabiano) was originally approached by John Wiley Australia to write an Australasian adaptation of Edward Sarafino's Health Psychology: Biopsychosocial Interactions, I was extremely excited and felt very privileged to be involved in the project. I have taught health psychology in the psychology degree program atJames Cook University since 1992, and have also taught variations of the subject to nursing science and social work students. While I have adopted several different texts for these courses, I have often returned to Sara fino's book. This widely respected text is comprehensive, easy to read and well liked by students. Over time, however, I came to recognise the need for a text that was relevant to the experience of students in Australia and the neighbouring region. Students needed a resource book that was similarly comprehensive, but that cited up-to-date Australian and New Zealand statistics on disease incidence and prevalence, discussed the Australian health care system and the New Zealand Health and Disability System, examined the findings of national surveys, reviewed Australian health promotion programs and discussed studies by Australasian researchers.
The objective of this second Australasian edition has been to update Sara fino's text with recent research conducted both within Australia and internationally. We have incorporated Australian and New Zealand statistics (for example, on disease and mortality incidence, and health risk) and documented Australian health programs and research conducted by health psychologists, public health researchers and those working in related fields.
Our task was facilitated by the wealth of creative ideas and innovative research in Australia and the nearby region coming out of professions such as public health, psychology and nursing. Although it was not possible to incorporate all these ideas, I believe that the research included represents the high quality of work being done in Australia and New Zealand.
This second edition still retains historical material on infectious diseases during the early settlement of Australia, trends over time in eating, drinking and smoking patterns, an historical account of hospitals in Australia and the organisational structure within hospitals, along with anecdotal data and the recounted experiences of well-known Australians. Also retained are the sections unique to the original text adaptation, such as psychosocial responses to disaster and traumatic events (chapter 3); social support as transactional process (chapter 4); applications of the theories of reasoned action and planned behaviour (chapter 6); and the use of the PRECEDE/PROCEED model as a guiding framework for health promotion in community health psychology (chapter 6). New to the second edition are recent smoking, drug and alcohol statistics for Australia and New Zealand, and prevalence rates for obesity and physical inactivity in the region. Also included in this edition is new material on stress (chapter 3) and social support (chapter 4); prevention with specific targets: focusing on community and school approaches in the prevention of obesity (chapter 6); overweight and body image (chapter 8); the New Zealand health and disability system, illness cognition and self-regulation (chapter 9); and advances in research and theory, technology and medical research, and critical health psychology (chapter 15). Other features include new prologues to chapters; Australasian research canvassed in the 'Focus on research' vignettes of respective chapters; the latest international research; Significant and recent national health promotion initiatives; contemporary health issues; examples of applied theory in randomised controlled trials and interventions; recent global threats to health; and the psychological impact of terrorism. This new material serves to complement Sarafino while maintaining the integrity of the original text.
One additional theme makes this book unique - namely, its sustained focus on lifespan development in health and illness. The book discusses how health and health-related behaviour change with age, and describes health care issues and examples that pertain to pediatric and elderly patients. With the increasing trend towards an elderly population in Australia and neighbouring countries, throughout the book you will find examples of research specifically on the elderly; for example, immune functioning in older persons (chapter 2), and social support systems of elderly Australians (chapter 1). At the other end of the lifespan, health issues such as infant sleep disturbance and its treatment are considered. Developmental trajectories in smoking, drinking and drug usage are described in chapter 7.
The biopsychosocial model remains the basic explanatory theme for understanding the whole person in health and illness. The components of the model interrelate in a dynamic and continuous fashion, consistent with the concept of systems. The psychological research cited reflects an eclectic orientation and supports a variety of behavioural, physiological, cognitive and social-personality viewpoints. In addition, gender and sociocultural differences in health and related behaviours are addressed at many points in the book. In these ways, this book presents a balanced view of health psychology, positioning it squarely in the mainstream of current thinking in the field.
Health Psychology: Biopsychosocial Interactions, second Australasian edition draws on the research and theoretical perspectives of many disciplines to illustrate the interrelationship of psychology and health. This depth makes it a teaching resource suitable for undergraduate and postgraduate courses on health psychology or behavioural medicine taught within psychology degree programs, nursing science or medicine. The material will be relevant and interesting to students from diSCiplines other than psychology, such as public health, nursing, medicine, allied health and social work. Undergraduate training in health psychology has developed rapidly and can play an important role in helping students from many disciplines to understand the interplay of biological, psychological and social factors in people's health. The text, and the exhaustive bibliography, will also be a valuable resource for practitioners and researchers in allied health professions.
The field of health psychology is exciting because of its relative infancy in Australia. It can be seen as a focal point for the application of psychological principles and psychological theory emanating from many other fields within psychology. Health psychology is particularly interesting because of its relevance to the lives of students, the researchers who study biopsychosocial aspects of health and illness, and the people students will work with in the future. Researchers from many diSCiplines, including psychology, are uncovering fascinating relationships between behaviour and health, and learning more about the roles of cognition, emotion and personality in health, adjustment to medical conditions and rehabilitation. Keeping up to date across such a broad field has been a challenge. In addition to some 2000 publications cited by Sarafino , close to another 1000, most published in the past few years, have been cited in this Australasian edition.
Writing this book has been both a major undertaking and a very rewarding experience. We have read more deeply in the literature than could possibly be acknowledged here, and we are greatly indebted to all those researchers whose work we have cited. As Sarafino has remarked, without their endeavours there would be no health psychology. Professor Don Byrne agreed to co-author this second edition and to offer his expertise, accrued over many years of working in this field. Thanks are extended also to Professor Paul Martin for his work on the original chapters 11 and 12.
PREFACE [xiii 1
[ xiv 1 PREFAC E
There are a number of other people whose contribution we would like to acknowledge. At John Wiley & Sons Australia, we are indebted to publishing editor Nina Crisp for her enthusiasm in the early stages of this project, and later to development editor Dan Logovik for his patience, encouragement and assistance in making this second edition possible. A special thank you is extended to manuscript development manager, Jason Gray, for his inSight, guidance and helpful suggestions. A number of other people deserve special acknowledgement - namely, project editor Catherine Spedding, coordinating editor Gabrielle Brady and the Wiley production staff.
Other individuals deserve mention. Thanks are extended to the Head of the School of Arts and Social Sciences at James Cook University, Professor Colin Ryan, for his support and many kind words of encouragement during the early stages of writing this book. Marie Caltabiano would also like to thank the Head of the Psychology Discipline, Associate Professor Frances Quirk, for her patience and understanding. She would also like to thank the countless academics both within and outside her field who have had a significant influence on her work. Of her family, she would like to thank most especially her best friend, sister and colleague, Dr Nerina Caltabiano, and her niece Amelia for their unwavering support. Don Byrne would like to thank Mrs Kerry Thomas, his research assistant, for her help in finding and keeping track of many new references. He became Head of School during the writing of this edition and has appreciated the forbearance of his School Administrator when other tasks gave way to the book. And as always, Anne and Edward were there to provide that essential work-life balance - and for being there, he is deeply grateful. Finally, thank you to the students, who make all this work worthwhile.
Marie L. Caltabiano Don Byrne
December 2007
'I wish I could help my father stop smoking' , a student in one of our health psychology courses said. Maybe she did help - he had quit by the end of the semester. This example points out two things that will probably make health psychology interesting to you: (1) the material is personally relevant and (2) many of the things you learn can actually be applied in your everyday life. Studying health psychology will also help you answer important questions you may have considered about health and psychology in the past. Does the mind affect our health - and if so, how? What effect does stress have on health and recovery from illness? What can be done to help people lead healthier lives than they do? Why don't patients follow their doctors' advice, and what can health care workers do to help? What special needs do children have as patients, and how can parents and health care workers address these needs? How can families, friends, and health care workers help patients adjust to disabling or life-threatening health problems?
As these questions indicate, a knowledge of health psychology can be relevant both now and later when you enter your future career. This is so whether you are studying to be a psychologist, medical social worker, nurse or doctor, physical or occupational therapist, public health worker or health educator. You will learn in this book that the relationship between a person's health and psychology involves a 'two-way street' - each affects the other. Psychological factors go hand in hand with medical approaches in preventing and treating illness and in helping patients adjust to the health problems they develop.
THE BOOK This book was designed for you, the reader. First and foremost, it provides a thorough and up-to-date presentation of the major issues, theories, concepts and research in health psychology undertaken both within and outside Australia. Throughout the book, the major point of view is 'biopsychosocial' - that is, that health and illness influence and result from the interplay of biological, psychological and social aspects of people's lives. Because integrating these aspects involves complex concepts and technical material, we have made special efforts to write in a straightforward, clear and engaging fashion. When a new term is introduced it is defined immediately; important
terms are set in bold type, listed as 'key terms' at the end of the chapter and defined in the glossary at the back of the book. Examples and case studies are included to clarify sometimes complex concepts.
Three types of boxed feature are presented throughout the book in order to illustrate or elaborate on surrounding content. These features are identified in the text by the corresponding icons.
/
Highlight on issues. Applied, high-interest and new frontier topics are highlighted here. They feature issues such as when the immune system turns on itself, sudden 'voodoo' death, the burden of caregiving, careers relating to health and psychology, breast and testicular selfexamination, coping with terrorism, and acute pain in burn patients.
Focus on research. These features spotlight the research methods used in health psychology, reviewing unique or interesting research findings on topics such as heredity and alcohol abuse, socioeconomic status and food purchaSing behaviour, inducing pain in laboratory research, stress management at the population level, and coping with chemotherapy and its side effects.
Assess yourself. Here students are given the opportunity to examine their own health-related characteristics, knowledge and beliefs on issues such as daily hassles, eating self-efficacy, alcohol use, AIDS, responding to pain, social support and ethical questions.
To help you absorb the material and remember it longer, the book also includes the follOwing learning aids. • Chapter contents and prologue. Each chapter
begins with a contents list that outlines the major topiCS in the order in which they are covered. The prologue then introduces the chapter with a vignette that is relevant to the material ahead and gives an overview of the ideas you will read about.
• Illustrations. The many figures and tables in each chapter are designed to clarify concepts and research findings and help them stick in your mind.
TO THE STUDENT [xv 1
• Summary and key terms. Each chapter closes with two features: (1) the summary, which presents the most important ideas covered, and (2) tl1e key terms - a list of the most important terms in the chapter.
• Glossary. The glossary at the back of the book gives definitions of important terms and concepts, along with pronunciation keys for the most difficult words. It will be useful when you are studying or reading and are not sure of the exact meaning or pronunciation of a term.
ORGANISATION The text is organised so that the main focus progresses across chapters from primary prevention (parts 1 to 3), through secondary prevention (parts 4 and 5), to tertimy prevention and care (part 6). The book is divided into seven parts.
Part 1. Chapter 1 presents a history and overview of health psychology, and introduces the main concepts and research methods used. Chapter 2 introduces the body's physical systems to help the student to understand how these systems interrelate. This introduction provides students with a useful resource to refer to when each system is discussed in later chapters. (You will note in the sections on metabolism and body weight that we have retained the imperial unit of measure, the calorie, since this term remains more generally recognised than the kilojoule. The metric equivalent of one calorie is 4.186 kilojoules.)
Part 2. Chapters 3 and 4 examine stress in relation to illness, and chapter 5 looks at ways of coping with and reducing stress. The position of this discussion early in the book recognises stress's influence on a wide range of health-related problems.
Part 3. The following chapters consider largely non-clinical approaches to enhancing health and preventing illness. Chapter 6 discusses health-related behaviours and public health promotion programs. Chapter 7 focuses on smoking, and on alcohol and drug use and abuse. Chapter 8 considers nutrition, weight control, body image, physical activity and safety issues.
Part 4. Chapter 9 describes the kinds of health services available in Australia and New Zealand, the patient-practitioner relationship, patients' adherence to medical regimes, and the effect of illness cognition on self-regulation of health. Chapter 10 introduces the hospital setting, staff and procedures, how patients cope with the physical and mental stresses they experience there, and the role of health psychologists in this coping process.
Part 5. Pain is the focus of the next two chapters. Chapter 11 explores the nature of clinical pain and its symptoms, while chapter 12 discusses medical and
[xvi 1 TO THE STUDENT
psychosocial approaches to managing and controlling pain.
Part 6. The following two chapters emphasise tertiary prevention through an examination of chronic and life-threatening health problems. Chapter 13
addresses serious chronic illnesses, such as asthma, diabetes and arthritis, along with their medical and psychOSOcial treatments. Chapter 14 examines four high-mortality illnesses - heart disease, stroke, cancer and AIDS - and people's experiences with terminal illness and death.
Part 7. Finally, chapter 15 looks to the future of health psychology; its goals and controversies and, not least, career opportunities in the field in Australia.
STUDY HINTS There are many ways you can use the features of this book to learn and study well, and you may want to 'experiment' to find the best way for you. The following is one method that works well for many students.
Survey the chapter first. Read the contents list and browse through the chapter, examining the figures and tables. Some students also find it useful to read the summary first, even though it contains terms they may not yet understand. Then read the prologue. As you begin each new section of the chapter, look at its title and turn it into a question. Thus, the heading early in chapter 1, 'An illness/wellness continuum' , might become 'What is an illness/wellness continuum?' Doing this helps you focus on your reading. After reading the section, reflect on what you have just read. Can you answer the question you asked when you reworded the title?
When you have finished the body of the chapter, review what you have read by reading the summary and trying to define the items in the list of key terms. If there is something you do not understand, look it up in the chapter or glossary. Last, re-read the chapter at least once, concentrating on the important concepts or ideas. You may find it helpful to underline or highlight selected material now that you have a good idea of what is important. If your exam will consist of 'objective' questions, such as multiple choice, using this approach intensively should be effective. If your exam will have essay items, you will probably find it helpful to develop a list of likely questions and write an outline or a complete answer for each one.
We hope that you enjoy this book, that you learn a great deal from it, and that you will share our enthusiasm and fascination for health psychology by the time you finish the course.
Edward P. Sarafino Marie L. Caltabiano
Don Byrne
Dr Marie L. Caltabiano is a senior lecturer in the Department of Psychology, within the School of Arts and Social Sciences at james Cook University, Cairns campus. Her interest in health psychology began with her doctoral research into the stress-moderating benefits of leisure. Her research has been in the areas of the psychosocial aspects of stress, stress management, immunocompetence, burnout, craving and disordered eating, parental coping, adolescent health risk behaviours, resilience in the elderly, women's health, fatigue in renal patients, performance appraisal in casual nursing and self-regulation in diabetes. She has published papers in the Australian and New Zealand
Journal oj Public Health, Climacteric, Psychological
Reports, the Journal oj Social Psychology, the Austral
ian Journal oJMamage and Family, Nursing and Health
Sciences, Journal oj Clinical NurSing, Leisure Studies,
Society and Leisure and Adolescence. Dr Caltabiano is a member of the Australian Psychological Society, the APS College of Health Psychologists, the American Psychological Society, the Public Health Association of Australia and the International Federation of University Women. She has been on the advisory board of the international journals Human Relations
and Perceptual and Motor Shills.
From 1995 to 1997 Dr Caltabiano was an Associate Dean within the Faculty of Arts at james Cook University. In 1997 and 1998 she was Chair of the Editorial Board of the Centre for Social and Welfare Research. She is co-editor, with Richard Hil and Rosemary Frangos (1996), of the book Achieving Inclu
sion: ExplOring Issues in Disability, and co-author of Menopausal Health and the Family and Influences oj
Healthy Eating Practices in Ethnic Communities (1997), both published by the Centre for Social and Welfare Research, james Cook University.
Professor Don Byrne is Professor of Clinical and Health Psychology, and Head of the School of Psychology at the Australian National University. For six years he was Deputy Dean of the Faculty of Science at the ANU and has chaired the University's research grants committee. His research interests include the
roles of stress and behaviour in mediating risk of cardiovascular disease; the measurement, causes and management of occupational stress; and the role of stress in the development of health risk behaviours in children and adolescents. Research in these and related areas has resulted in the publication of 12 books (as author or editor) and more than 130 papers in refereed journals or as invited book chapters. Professor Byrne is a Fellow of the Academy of the Social Sciences in Australia, and of the Australian Psychological Society. He is also a member of the College of Clinical Psychologists of the Australian Psychological SOCiety. He is a past president of the International College of Psychosomatic Medicine. Professor Byrne retains an active interest in the training of psychologists in Australia, and sits on the Professional Development and Accreditation Committee of the Australian Psychology Accreditation Council. He was foundation chair of the Australian Capital Territory Psychologists Board from its inception in 1995 and chaired the Board until 2001.
Edward P. Sarafino received his PhD from the University of Colorado and began his affiliation with the Department of Psychology at The College of New jersey more than three decades ago. His scholarship has combined areas of health and developmental and behavioural psychology, particularly with regard to the study of asthma. In addition to having published dozens of research articles and chapters, he is the author of six books. He is a fellow of Division 38 (Health Psychology) of the American Psychological Association, served as an officer (Secretary) of that division, and has been a member of several committees of Division 38 and of the Society of Behavioural Medicine.
ABO U T THE AUT H 0 R S [xvi i 1
The authors and publisher would like to thanl< the following copyright holders, organisations and individuals for their permission to reproduce copyright material in this book
Images p. 445, fig. 10.2: © American Psychological Society · p . 7: © AIHW Graph: expected total life span at various years since 1 9 1 0 . Health Psychology Ie, p . 7 • p. 390, fig. 9.2: © AIHW Graph: hospitalisation rates for Australian males and females of different ages. Australia's Health 2006, p. 212, http://www.aihw.gov.au/publications/aus/ah06/ah06.pdf • p. 40, fig. 1 .6: Nelson-Aalen cumulative hazard estimates by type of social network, p. 577, Giles, Lynne C, Glonel<, Gary F. v., Luszcz, Mary A., Andrews, Gary R. 2005, 'Effect of social networks on 10 year survival in very old Australians, journal of Experimental Psychology • p. 1 5 1 : cartoon, 'Really, I'm fine. It was just a fleeting sense of purpose - I'm sure it will pass', © 2001 The New Yorher, Tom Cheney. Collection from cartoonbankcom. All rights reserved. The cartoon can be found on this website http://www.cartoonbankcom • p. 326: © CSIRO Human Nutrition · p. 2 3 1 : Health belief model, taken from Health Care and Human Behaviour by Steptoe and Mathews, p. 181 • p. 232: © journal of Experimental Social Psychology. 'Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control', leek Ajzen and Thomas J. Madden, Sept. 1986, vol. 22, no. 5, p. 22 • p. 442 , fig. 10. 1 : 'Preoperative preparation for cardiac surgery facilitates recovery, reduces psychological distress, and reduces the incidence of acute post-operative hypertension'. Erling A. Anderson, journal of Consulting and Clinical Psychology, vol. 55, pp. 5 13-20 • p:" 509: © Guildford Press • p. 48: 'The postnatal development of the human cerebral cortex', by Jesse LeRoy Conel © Harvard University Press • p . 1 70: Drawing by 1 1 year old Meghan of her experience of migraine headache pain. Figure 18. 1 from F. Andrasik, D. D. Blake & M. S. McCarran ( 1986), Child Health Behaviour: A BehavioL!ral Pediatrics Perspective, © 1996, John Wiley & Sons Inc. • p. 60: Plate 446.4, 'Variations in arterial branching of the aortic arch and the approximate percentages of their occurrence', Grant's Atlas of Anatomy, J. C Boileau Grant, 1972 • p. 394, fig. 9.3: M. A. Safer, Q. J. Tharps, T. C Jackson, H. Leventhal, Medical Care journal 1979, vol. 17, fig. 1 , pp. 1 1-19, 'Determinants of three stages of delay in seeking care at a medical clinic'. © Lippincott Williams & Wilkins • pp. 490-1: The McGill Pain Questionnaire: major properties and scoring methods, Pain, 277-99, R. Melzack, 1975. http://www.med.ualberta. ca/uofapainidocuments!McGiIlPainQuestRevisited2005. pdf • p. 254: The PRECEDEIPROCEED planning model, from Health Promotion Planning by Lawrence Green and Marshall Kreuter, 2nd edition © 1 99 1 , ISBN: 08784847796. Reprinted by permission of McGraw Hill Companies, Inc . •
p . 397, fig. 9.4: Graph: Psychosocial information. journal of Health Psychology, An InterdiSciplinary, International journal, 1st edn, p. 369, Ellington & Wiebe · p . 388, fig. 9 . 1 : Self-
[ xviii 1 A C K N O W L E D G E M E N TS
regulatory model, Cogll itive Therapy and Research. 'Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions', pp. 143-63, Howard Leventhal · p. 448, fig. 10.3: Sara fino & Armstrong 1986, figure 5.3, ' Children's tendency to exhibit separation distress'. © Thomson Learning Global Rights Group.
Text pp. 5 1 9-20: 'PainSelf-Management Checklist', frompp. 1 2-13 of Manage Your Pain by Dr Michael Nicholas, Dr Allan Malloy, Lois Tonkin and Lee Beeston. ISBN: 07330883X ©ABC Books · p. 595 (above): © AIHW Cancer in Australia, December 2004, p. 9. http://www.aihw.gov.aulpublications/ can/caOl/ca0 1.pdf • p . 595 (below) : © AIHW Most frequently occurring cancers in females, Cancer' ill AL!stralia, December 2004, p. 9, http://www.aihw.gov.aulpublications/ can/caOl/ca01 .pdf · pp. 1 14-1 5 : Reprinted from joumal of Psychosomatic Research, vol. 26, S. Henderson, D. G. Byrne and P. Duncan-Jones, NeL!rosis and the Social Environment, 1982, with permission from Elsevier • p . 556: Diabetes
Australia - VlC • p. 1 9 7: © Edward Sara fino • p. 183: 'Searching for the structure of coping: Review and critique of category systems for classifying ways of coping', taken from the Psychological Bulletin, 1 29, pp. 216-69. © Ellen Skinner · p. 1 1 3 : © Elsevier publication, journal of Psychosomatic Research, The social readjustment rating scale, Thomas H. Holmes and Richard H. Rahe • p. 338: © Allan Borushek's Pochet Calorie & Fat Counter (2007) • pp. 5 1 6, 523: © Guildford Press • pp. 126-7: table 3.3, Hassles assessment scale for students in college: Measuring the frequency and unpleasantness of and dwelling on stressful events. journal of American College of Health, vol. 48, no. 2, pp. 75-83, Sept. 1999 • pp. 19-22: table 1 . 1 , Core and specialist competencies in training of health psychologists © Australian Psychological Society. Permission granted by John Toumbourou • p. 646: Appendix: Requirements for the training of health psychologists and membership © Australian Psychological SOCiety. Permission granted by
John Toumbourou • p. 208: Extract of 'Examples of Anger Management Self-Statements Rehearsed in Stress-Inoculation Training, from Cognitive Behaviour Therapy: Research and Application, by John Foreyt and Diana Rathjen (eds), © 1978, Plenum ISBN:03063 1 1453, p. 150 • p. 347: 'How do you score on eating efficacy?', from S. M. Glynn and A. J . Ruderman 1986, The development and validation of an eating self-efficacy scale', Cognitive Therapy and Research
journal, 10, 403-20. Reproduced by permission of Klewer Academic • p. 306: © Transport Accident Commission, Victoria, Australia, www.tacsafety.com.au
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