October 9, 2012
Psychology Applied to Health
Prologue: The Causes of Death
1. Healthy Benefits
2. Changing Unhealthy Behaviours (and Beliefs)
3. Knowing that we are Ill
4. Patient-Provider Communication
Prologue: The Causes of Death
1900: Acute infectious diseases (e.g., influenza)
develop quickly, quickly lead to death,
Today, few people in North America die from these diseases. Why?
o Less likely to become infected due to:
Better personal hygiene,
Better public sanitation (sewage, water)
Vaccines that inoculate us.
o Effective drugs to treat infections.
Leading causes of death in North America today:
Heart disease, cancer, and stroke
o “chronic” diseases (develop slowly; no effective cure; live with them for a long
o preventable (stem from unhealthy behaviours that can be changed.) E.g.,
o quit smoking (implicated in all three causes);
o don’t drink and drive (& don’t speed; wear seatbelts);
o wear condoms (AIDS prevention)
o regular exercise; limit alcohol; use sun screen; get early testing (e.g., breast
Question: How can we encourage people to engage in healthy behaviours?
Health Psychology offers two answers
1. Encourage Healthy Beliefs (which will translate into healthy behaviours)
2. Directly change unhealthy behaviours Part 1: Healthy Beliefs
o Unhealthy behaviours stem from unhealthy beliefs.
o To change behaviour, must change beliefs (by encouraging “healthy” beliefs)
Health-relevant beliefs (e.g., to quit smoking)
1. General health values (I’m interested and concerned about having good health)
2. Belief in a “health threat”. Influenced by:
Perceived severity of threat (smoking causes lung cancer, which is deadly)
Perceived vulnerability to threat (I could die from lung cancer if I smoke)
i. BUT: “unrealistic optimism” (bad things won’t happen to me).
3. Response efficacy: The health behaviour (quitting) will reduce the threat (if I quit
now, I won’t die from lung cancer)
i. BUT: Person might say “It’s too late for me, I’ve smoked too long, I’ll
get lung cancer even if I quit”.
4. Self efficacy: Person is capable of performing the healthy behaviour (e.g., I can do
5. Outcome beliefs: Weigh costs and benefits of healthy behaviour (quitting)
If perceived benefits exceed perceived costs, will try to quit
If costs exceed benefits, less likely to try.
i. Important in adolescents: Don’t care about long term negative
outcomes of unhealthy behaviours (e.g., I might die in 40 years);
Better to emphasize immediate costs (my teeth will be yellow;
my clothes will be smelly; I’ll have bad breath)
6. Subjective norms (two elements):
Normative beliefs: What we think other people want us to do. E.g.,
Family and doctor say “yes” (quit)
Smoking friends say “no” (don’t quit)
Motivation to comply with these other people (can be high or low).
Intervention: want to add normative pressures to quit and increase
motivation to comply (my family wants me to quit… and I really want to
make them happy by quitting).
Part 2: The Cognitive-Behavioural Approach to Changing Unhealthy Behaviours (and Beliefs)
Basic idea: Unhealthy behaviours (and beliefs) are learned; so they can be unlearned
(e.g., reducing unhealthy snacks)
o Systematically observe the problem behaviour (self-monitoring): Record
behaviour and circumstances of behaviour.
What are the stimuli that control the behaviour? Stimuli in the environment (if so, behaviour is under stimulus
control); to control the behaviour, we must change the controlling
o TV (if so, remove link between snacking and TV)
o Availability of snacks (is so, remove snacks)
Consequences of behaviour (behavioural control). E.g.,
o Snacking makes you “feel relaxed”;
o Snacks taste good!