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14
Health
Psychology
Does It Take a Village to Lose Weight?
T
roubled by the growing problem of obesity, community leaders in the United States are taking steps to help citizens
become more active, eat healthier diets, and lose weight (Ockene & others, 2012; Wieland & others, 2012). Some localities
have formed community weight-loss clubs through churches and other organizations (Yeary & others, 2012). The town
of Lakeland, Florida, sponsored a “Dance Off” and awarded prizes for weight loss (R. Brown, 2012). A child-care center
for Native Americans in California started its own vegetable garden, allowing the children to eat fresh vegetables that
they themselves had planted and cared for (Sripada, 2012). In the small town of Hernando, Mississippi, a pastor took
the drastic step of banning fried chicken from church social events (Hauser, 2012). Communities elsewhere in the
worldare also banding together to combat obesity. In Ghent, Belgium, city council members declared their community
offi cially vegetarian (at least one day a week) in order to reduce obesity as well as the city’s environmental footprint
(Mason, 2009).
Embracing a healthy lifestyle is a choice that is made not only by individuals but sometimes by whole communities.
Clearly, our physical health is infl uenced by our contexts, behaviors, motivations, thoughts, and feelings—factors at the
very heart of the science of psychology.
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514 // CHAPTER 14 // Health Psychology
The focus of this chapter is health psychology, the eld devoted to promoting healthy
practices and understanding the psychological processes that underlie health and illness.
After rst defi ning the eld, we examine the ways psychologists explain the process of
making healthy life changes and the resources on which individuals can draw to achieve
positive change. Next we survey the psychology of stress and coping and consider
psychological perspectives on making wise choices in four vital areas: physical activity,
diet, the decision to smoke or not to smoke, and sex. Fittingly, the chapter (and the
book) closes with a look at psychology’s role in shaping a good life.
Health psychology emphasizes psychology’s role in establishing and maintaining health
and preventing and treating illness. Health psychology re ects the belief that lifestyle
choices, behaviors, and psychological characteristics can play important roles in health
(Acevedo, 2012; Koenig, King, & Carson, 2012; Marks, 2013; S. E. Taylor, 2012). A
related discipline, behavioral medicine , i s a n i n t e r d i s c i p l i n a r y eld that focuses on
developing and integrating behavioral and biomedical knowledge to promote health and
reduce illness. The concerns of health psychology and behavioral medicine overlap:
Health psychology primarily focuses on behavioral, social, and cognitive factors (Pbert
& others, 2012; Rhodes & Mark, 2012; Sheffer & others, 2012), whereas behavioral
medicine centers on behavioral, social, and biomedical factors (Hamer, 2012; McBride
& others, 2012; Parada & others, 2012).
Related to health psychology and behavioral medicine are the elds of health promo-
tion and public health (Fafard, 2012; Muntaner & others, 2012). Health pr o motion
involves helping people change their lifestyle to optimize their health and assisting them
in achieving balance in physical, emotional, social, spiritual, and intellectual health and
wellness. Health promotion can be a goal of a company’s human resources department,
as well as state and city health departments, and it is sometimes a specialty for social
workers and other members of the helping professions. Public health is concerned with
studying health and disease in large populations to guide policymakers (Khubchandani
& Simmons, 2012). Public health experts identify public health concerns, set priorities,
and design interventions for health promotion. An important goal of public health is to
ensure that all populations have access to cost-effective healthcare and health promotion
services (O’Donnell, 2012; Stav & others, 2012).
A job in health promotion or public health can involve creating attention-grabbing
public service advertisements and brochures to alert the public to health-related issues.
If you have noticed a “Click It or Ticket” sign on the highway or seen one of thetruth.
com’s antismoking ads on TV, you have a good feel for what health promotion and
public health are all about.
The Biopsychosocial Model
The interests of health psychologists and behavioral medicine researchers are broad
(Accordini & others, 2012; Ferdinand & others, 2012). The biopsychosocial model we
examined in Chapter 12 in the context of psychological disorders applies to health psy-
chology as well, because health psychology integrates biological, psychological, and
social factors in health (Friedman & Ryff, 2012; Shimizu & others, 2012).
health psychology
A subfi eld of
psychology that
emphasizes
psychology’s role
in establishing
and maintaining
health and
preventing and
treating illness.
behavioral medicine
An interdisciplinary fi eld that
focuses on developing and
integrating behavioral and
biomedical knowledge to
promote health and reduce
illness; overlaps with and is
sometimes indistinguishable
from health psychology.
1
Health Psychology and
Behavioral Medicine
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Making Positive Life Changes // 515
For example, stress is a focal point of study across the broad eld of psychology
(Manne, 2013). Study of the brain and behavior (Chapter 2 of this book), for instance,
acknowledges the impact of stress on the autonomic nervous system. Furthermore, an
individual’s state of consciousness (Chapter 4), as well as his or her process of thinking
about events in particular ways (Chapter 7), can in uence the experience of stress. Stress-
ful events also affect our emotions (Chapter 9), which are themselves psychological and
physical events. Aspects of our personalities, too, may be associated with stress (Chap-
ter10) and can in uence our health. Finally, social contexts (Chapter 11) can shape both
an individual’s experience of stress and his or her ability to cope with it.
Connections Between Mind and Body
From the biopsychosocial perspective, the many diverse aspects of each human being
are tightly intertwined. Our bodies and minds are deeply connected, a link introduced in
Chapter 1. After suffering a heart attack, one health psychologist ruefully noted that none
of his colleagues in the eld had thought to ask him whether heart disease was part of
his family history, ignoring the obvious question that a medical doctor would ask rst.
Although the mind is responsible for much of what happens in the body, it is not the
only factor. Even as we consider the many ways that psychological processes contribute
to health and disease, we must understand that sometimes illness happens for other
reasons—affecting even those who have led healthy lives.
W h i l e i t m i g h t b e f a s c i n a t i n g t o t h i n k a b o u t h o w t h e m i n d m a y i n uence bodily
health, it is also important to appreciate that the body may in uence the mind as well.
Health psychology and behavioral medicine are concerned not only with how psycho-
logical states in uence health, but also with how health and illness may in uence the
person’s psychological experience, including cognitive abilities, stress, and coping
(Dedert & others, 2012; Lutwak & Dill, 2012). A person who is feeling psychologically
run-down may not realize that the level of fatigue is the beginning stage of an illness.
In turn, being physically healthy can be a source of psychological wellness.
1. Health psychologists believe that
_________ are the key factors in
health.
A. psychological characteristics
B. lifestyles
C. behaviors
D. all of the above
2. According to the text, health psychol-
ogy overlaps in significant ways with
A. philosophy.
B. behavioral medicine.
C. neuroscience.
D. behaviorism.
3. The experience of stress can depend on
A. one’s state of consciousness.
B. one’s personality.
C. one’s social situation.
D. all of the above
APPLY IT! 4. Anastasia is committed
to getting all A’ s this semester. In her pur-
suit of academic excellence, she decides to
sleep only three hours a night, to drink a
lot of coffee, and to stop wasting time at
the gym. She studies nearly 12 hours every
night. During finals week, Anastasia is so
exhausted that she sleeps through one of
her exams and fails another because she
cannot concentrate. Which of the following
best explains what happened?
A. Anastasia probably didn’t study as hard
as she claimed.
B. Anastasia forgot that the body can
affect the functioning of the mind.
C. Anastasia took too many hard classes
this semester.
D. Anastasia set her goals too high.
One of health psychology’s missions is to help individuals identify and implement ways
they can effectively change their behaviors for the better (Grif n & others, 2012; S. E.
Taylor, 2012). Health behaviors p r a c t i c e s t h a t h a v e a n i m p a c t o n p h y s i c a l w e l l -
being—include adopting a healthy approach to stress, exercising, eating right, brushing
one’s teeth, performing breast and testicular exams, not smoking, drinking in moderation
health behaviors
Practices that have an im-
pact on physical well-being.
2
Making Positive Life Changes
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516 // CHAPTER 14 // Health Psychology
(or not at all), and practicing safe sex. Before exploring what health psychologists have
learned about the best ways to make healthy behavioral changes, we rst focus on the
process of change itself.
Theoretical Models of Change
In many instances, changing behaviors begins by changing attitudes. Psychologists have
sought to understand how changing attitudes can lead to behavioral changes.
A number of theoretical models have addressed the factors that likely play roles in
effective health behavior changes. For example, the theory of reasoned action suggests
that effective change requires individuals to have speci c intentions about their behaviors,
as well as positive attitudes about a new behavior, and to perceive that their social group
looks positively on the new behavior as well (Ajzen, 2012a, 2012b; Ajzen & Albarracin,
2007; Ajzen & Fishbein, 1980, 2005). If, for example, you smoke and want to quit
smoking, you will be more successful if you devise an explicit intention of quitting, feel
good about it, and believe that your friends support you. Icek Ajzen (pronounced “I-zen”)
modi ed the theory of reasoned action to include the fact that not all of our behaviors
are under our control. The theory of planned behavior includes the basic ideas of the
theory of reasoned action but adds the person’s perceptions of control over the outcome
(Ajzen, 2002, 2012a, 2012b).
The theory of reasoned action and its extension, the theory of planned behavior, have
accurately predicted whether individuals successfully enact healthy behaviors (Ajzen &
Manstead, 2007), including cancer screening (Ross & others, 2007), HIV prevention
(Kalichman, 2007), prevention of smoking and marijuana use in adolescents and
binge drinking in college students (Elliott & Ainsworth, 2012; Guo & others,
2007; Lac & others, 2009), exercise (Plotnikoff & others, 2011), healthy eating
(Dunn & others, 2011; White & others, 2012), and avoidance of gambling on
the part of college students (H. S. Lee, 2012).
The Stages of Change Model
The stages of change model describes the process by which individuals give up bad
habits and adopt healthier lifestyles. The model breaks down behavioral changes
into ve steps, recognizing that real change does not occur overnight with one
monumental decision, even if that night is New Year’s Eve (Norcross, Krebs, &
Prochaska, 2011; Prochaska, DiClemente, & Norcross, 1992; Prochaska,
N o r c r o s s , & D i C l e m e n t e , 1 9 9 4 ) ( F i g u r e 1 4 . 1 ) . R a t h e r , c h a n g e o c c u r s i n p r o g r e s -
sive stages, each characterized by particular issues and challenges. Those stages are
Precontemplation
Contemplation
Preparation/Determination
Action/Willpower
Maintenance
P R E C O N T E M P L A T I O N The precontemplation stage occurs when individuals are
not yet genuinely thinking about changing. They may even be unaware that they have a
problem behavior. Individuals who drink to excess but are not aware that their drinking
is affecting their work may be in the precontemplation phase. At this stage, raising one’s
consciousness about the problem is crucial.
A woman who smokes may nd her consciousness raised by the experience of becom-
ing pregnant. A man who is stopped for drunk driving may be forced to take a good
look at his drinking. Similarly, overweight individuals may not recognize their problem
theory of
reasoned action
Theoretical
model stating
that effective
change requires
individuals to
have specifi c
intentions about
their behaviors,
as well as posi-
tive attitudes
about a new
behavior, and to
perceive that
their social group
looks positively
on the new
behavior as well.
theory of planned behavior
Theoretical model that in-
cludes the basic ideas of the
theory of reasoned action
but adds the person’s per-
ceptions of control over the
outcome.
stages of change
model
Theoretical
model describing
a fi ve-step pro-
cess by which in-
dividuals give up
bad habits and
adopt healthier
lifestyles.
As we wi ll s ee l at er ,
per cei vi n g t hat on e h as cont r ol
can hav e i mpor t an t i mpl i cat i ons
for a number of life domains.
Hav e y ou mad e a heal t hy
life change recent ly? As we go
over t hese st ag es, ask your sel f
whet her t hey appl y t o your
ex per i ence.
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Making Positive Life Changes // 517
until they see photos of themselves taken at a family reunion or until they learn that an
order of a McDonald’s Big Mac, large fries, and large chocolate shake amounts to over
2,000 calories, the recommended adult caloric intake for an entire day. If you have seen
Morgan Spurlock’s documentary lm Super Size Me, you probably have had your con-
sciousness raised about how harmful fast food can be to health. Spurlock ate every meal
at McDonald’s for a month. By the end of lming he felt ill, had gained weight (he
jumped from 185 to 210 pounds), and could not wait for the experience to end.
It is common for individuals in the precontemplation phase to deny that their behav-
ior is a problem and to defend it, claiming that “I don’t drink/smoke/eat that much.
Overweight individuals may discover that they do eat “that much” when they start keep-
ing track of calories.
C O N T E M P L A T I O N In the contemplation stage, individuals acknowledge the prob-
lem but may not be ready to commit to change. As the name of the stage suggests, at
this point individuals are actively thinking about change. They might reevaluate them-
selves and the place of this behavior in their life. They understandably may have mixed
feelings about giving up a bad habit. For example, how will they deal with missing their
friends on a smoke break? Or going out drinking? Or packing a healthy lunch instead
of heading to the drive-thru? They may weigh the short-term gains of the harmful behav-
ior against the long-term bene ts of changing. As we considered in Chapter 5, future
rewards can be dif cult to pursue when immediate pleasures beckon. Sure, it would be
nice to be thinner, but losing weight is going to take time, and that hot fudge sundae is
right there, looking very delicious.
P R E P A R A T I O N / D E T E R M I N A T I O N I n t h e preparation/determination stage,
individuals are getting ready to take action. At this point, self-belief and especially beliefs
about one’s ability to “see it through” are very important. A key consideration is whether
individuals truly feel they are ready to change.
During the preparation/determination stage, individuals start thinking concretely about
how they might take on their new challenge. For example, they explore options for the
best ways to quit smoking or drinking or to start an exercise program. Some smokers
might consider trying a nicotine patch or participating in a support group for people
FIGURE 14.1
Stages of Change
Model Applied to
Losing Weight The stages
of change model has been
applied to many different
health behaviors, including
losing weight.
1
2
3
4
5
Individuals are not yet ready to
think about changing and may not
be aware that they have a problem
that needs to be changed.
Individuals acknowledge that they
have a problem but may not yet be
ready to change.
Individuals are preparing to take
action.
Individuals commit to making a
behavioral change and enact a
plan.
Individuals are successful in
continuing their behavior change
over time.
Precontemplation
Contemplation
Preparation/
Determination
Action/Willpower
Maintenance
Stage Description Example
Overweight individuals are not
aware that they have a weight
problem.
Overweight individuals know
they have a weight problem
but aren’t yet sure they want
to commit to losing weight.
Overweight individuals explore
options they can pursue in losing
weight.
Overweight individuals begin a
diet and start an exercise
program.
Overweight individuals are able
to stick with their diet and
exercise regimens for 6 months.
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518 // CHAPTER 14 // Health Psychology
wanting to quit. Individuals who are seeking to
lose weight might think about joining a gym or
setting the alarm clock for a 6:00 a . m . run.
A C T I O N / W I L L P O W E R A t t h e action/
willpower stage, individuals commit to making
a real behavioral change and enact an effective
plan. An important challenge at this stage is to
nd ways to support the new, healthy behavior
pattern. One approach is to establish reinforce-
ments or rewards for the new behavior. Indi-
viduals who have quit smoking might focus on
how much better food tastes after they have
given up cigarettes. Successful dieters might
treat themselves to a shopping trip to buy new,
smaller-size clothes. Acknowledging, enjoying,
and celebrating accomplishments can motivate
consistent behavior.
Another source of support for new behaviors is the individual’s social network (S. E.
Taylor, 2012). Friends, family, and members of a support group can help through their
encouraging words and behaviors (Antonucci, Birditt, & Ajrouch, 2013; Manne,
2013). Members of a family might all quit smoking at the same time or join the
individual in physical activities or healthier eating.
Finally, individuals may focus on alternative behaviors that replace the
unhealthy ones. Instead of bar hopping, they might join a group dedicated to
activities not associated with drinking alcohol, such as a dance club or com-
munity theater group. In other words, effective change also involves avoiding
temptations.
M A I N T E N A N C E In the maintenance stage, individuals successfully avoid tempta-
tion and consistently pursue healthy behaviors. They may become skilled at anticipating
tempting situations and avoid them or actively prepare for them. If smokers seeking to
kick the habit know that they always enjoy a cigarette after a big meal out with friends,
they might mentally prepare themselves for that temptation before going out. Successful
dieters might post a consciousness-raising photograph on the refrigerator.
At some point, individuals in maintenance may nd that actively ghting the urge to
indulge in unhealthy behaviors is no longer necessary. Transcendence means that they
are no longer consciously engaged in maintaining their healthy lifestyle; rather, the life-
style has become a part of who they are. They are now nonsmokers, healthy eaters, or
committed runners.
R E L A P S E One challenge during the maintenance stage is to avoid relapse , a return
to former unhealthy patterns. Relapse is a common aspect of change, and it can be dis-
couraging. However, the majority of people who eventually do change do not succeed
on the rst try. Rather, they try and fail and try again, cycling through the ve stages
several times before achieving a stable, healthy lifestyle. Consequently, individuals who
are experts in changing health behavior consider relapse to be normal (Prochaska &
Norcross, 2010; Prochaska, Norcross, & DiClemente, 1994).
If you have ever tried to adopt a healthier lifestyle by dieting, starting an exercise
program, or quitting smoking, you might know how bad you feel when you expe-
rience relapse. One slip, however, does not mean that you are a failure and will
never reach your goal. Rather, when a slipup occurs, you have an opportunity
to learn, to think about what led to the relapse, and to devise a strategy for
preventing it in the future. Successful dieters, for example, do not let one lapse
in the doughnut shop ruin the week (Phelan & others, 2003).
relapse
A return to former unhealthy
patterns.
Can y ou qui t s m ok i n g i f y ou
ar e spendi ng t i me wi t h s moker s ?
Can y ou av oi d bi n ge d r i n k i ng i f y ou
regularly go to keg part ies?
Rel apse i s a nor mal par t
of chang e. What does t hi s pr i nci pl e
suggest about r ecover y f r om
dr ug addi ct i on?
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Resources for Effective Life Change // 519
EVALUATION OF THE STAGES OF CHANGE MODEL
The stages of change model has been applied successfully to a
broad range of behaviors. These include cigarette smoking (C. L.
Kohler & others, 2008; Schumann & others, 2006), exercise
(Lippke & Plotnikoff, 2006), safe-sex practices (Arden &
Armitage, 2008; Naar-King & others, 2006), substance use and
abuse (DiClemente, 2006; Migneault, Adams, & Read, 2005;
Walker & others, 2006), weight loss (MacQueen, Brynes, &
Frost, 2002), and return to work (Lam & others, 2010).
Despite its relevance to a variety of behaviors, the stages of
change model is controversial (Brug & others, 2004; Joseph,
Breslin, & Skinner, 1999). Some critics have questioned whether
the stages are mutually exclusive and whether individuals move
from one stage to another in the order proposed (Littrell & Girvin,
2002). Critics of the model also point out that it refers more to
attitudes that change than to behaviors (West, 2005). On the more
positive side, recent evidence suggests that the stages of change
model does a good job of capturing the ways that individuals
make positive life changes (Lippke & others, 2009; Schuz &
others, 2009). A recent meta-analysis of 39 studies that encompassed more than 8,000
psychotherapy clients found that the stages of change model was effective in predicting
psychotherapy outcomes (Norcross, Krebs, & Prochaska, 2011).
Experts have argued that the model can be a tool for therapists who are trying
to help clients institute healthy behavior patterns. Sometimes, sharing the model
with individuals who are trying to change provides them with a useful language
for understanding the change process, for reducing uncertainty, and for develop-
ingrealistic expectations for the dif cult journey (Hodgins, 2005; Schuz & others,
2009).
“Wayne, have you ever given any thought to
changing completely?”
Used by permission of CartoonStock, www.CartoonStock.com.
1. The theoretical model that breaks down
behavioral change into five distinct
steps is the
A. theory of planned behavior.
B. theory of reasoned action.
C. cognitive theory of change.
D. stages of change model.
2. When someone who is trying to change a
behavior returns to unhealthy patterns,
we say that he or she is in a state of
A. denial.
B. relapse.
C. plateau.
D. maintenance.
3. The stages of change model
A. is not at all controversial.
B. applies to a wide variety of
behaviors.
C. does not apply to cigarette smoking.
D. does not apply to safe-sex practices.
APPLY IT! 4. Malcolm has been trying
to quit smoking for two years. During his
last attempt, he went three full months
without smoking but then had a cigarette
after a big fight with his girlfriend. He is
feeling hopeless about his chances of quit-
ting. What does the stages of change model
say about Malcolm’s situation?
A. Relapse is a normal part of change.
Malcolm might think about why he
r elapsed and try to move on from there
with a new strategy.
B. Malcolm has blown it and will probably
never quit smoking.
C. Malcolm is stuck in the contemplation
phase of change.
D. Malcolm is unusual in that he had a re-
lapse after three full months. He prob-
ably has a particularly strong addiction
to cigarettes.
Making positive changes to promote health can be very challenging. Fortunately, we all
have various psychological, social, and cultural resources at our disposal to help us in
the journey to a healthier lifestyle. In this section we consider some of these tools that
can help us achieve effective change and, ultimately, a healthier life.
3
Resources for Effective Life Change
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520 // CHAPTER 14 // Health Psychology
Motivation
Recall from Chapter 9 that motivation refers to the “why” of behavior. Motivational
tools for self-change involve changing for the right reasons. Change is most effec-
tive when you are doing it for you—because you want to. An analysis of interven-
tion programs aimed at reducing childhood and adolescent obesity found that those
who had joined voluntarily were more likely to lose weight than
their counterparts who had been required to join (Stice, Shaw, &
Marti, 2006).
S e l f - d e t e r m i n a t i o n t h e o r y , presented in Chapter 9, distinguishes
between intrinsic motivation (doing something because you want to)
and extrinsic motivation (doing something for external rewards). Research
has shown that creating a context in which people feel more in control,
more autonomous, and more competent is associated with enhanced out-
comes for a broad array of health behaviors, including controlling diabetes
through diet (Bhattacharya, 2012), quitting smoking (Deci & Ryan, 2012),
and getting regular physical exercise (Fortier & others, 2012). Individuals
are more likely to succeed in their New Year’s resolutions if they approach
them with a sense of both self-ef cacy and autonomy (Koestner & others, 2006).
Planning and goal setting are also crucial to making effective change.
Researchers have found that individuals who come up with speci c strategies,
or implementation intentions , for dealing with the challenges of making a
life change are more successful than others at navigating change (Armitage,
2006; Prestwich & others, 2012). Setting short-term, achievable goals also
allows individuals to experience the emotional payoff of small successes
along the way to self-change (R. F. Kushner, 2007). The novice exerciser
who catches a glimpse of his new biceps in the mirror gets a mood boost.
These feelings of satisfaction can help to motivate continued effort toward
achieving health goals (Finch & others, 2005). A recent meta-analysis
revealed that implementation intentions were more effective for including
healthy food in one’s diet but were not as effective in reducing unhealthy
eating patterns (Adriaanse & others, 2011).
Enjoying the payoffs of our efforts to change also means that we must monitor our
goal progress. As anyone who has watched The Biggest Loser will attest, stepping
on a scale can be a scary prospect for someone who is trying to lose weight.
However, it is important to get feedback on one’s progress in the pursuit of
any goal. If an individual nds out that she is falling short, she can try to
identify areas that need work. On the other hand, discovering that she is doing
well can be a potent motivator for future progress.
Social Relationships
R e s e a r c h h a s s h o w n , a g a i n a n d a g a i n , t h a t s o c i a l t i e s a r e a n i m p o r t a n t , i f n o t t h e m o s t
important, variable in predicting health (Norman & others, 2012). In a landmark study,
social isolation had six times the effect on mortality rates that cigarette smoking had
(House, Landis, & Umberson, 1988). In another study involving 1,234 cardiac patients,
those living alone were nearly twice as likely to have a second heart attack (Case &
others, 1992). Loneliness is linked with impaired physical health (cardiovascular disease,
for example) (Hawkley & Cacioppo, 2012a, 2012b; Momtaz & others, 2012) and mental
health (depression, for example) (Aylaz & others, 2012), and chronic loneliness can lead
to an early death (Luo & others, 2012). Being connected to others is crucial to survival.
One way that social connections make a difference in our lives is through social support
(Antonucci, Birditt, & Ajrouch, 2013).
implementation intentions
Specifi c strategies for deal-
ing with the challenges of
making a life change.
Wh e t h e r t h e n e w s i s g o o d
or bad, i nf or mat i on i s i mpor t ant
for making real progress.
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Resources for Effective Life Change // 521
Find a quiet place to write.
Pick just one topic to explore through
writing.
Dedicate yourself to at least 20 minutes
of writing about that topic.
While writing, do not be concerned with
grammar or spelling; just let yourself go
and write about all of the emotions,
thoughts, and feelings associated with
the experience you are writing about.
If you feel that writing about something
negative is not for you, try writing about
your most positive life experiences,
about the people you care about, or all
the things you feel grateful for in life.
Social support is information and feedback from others indicating that one is loved
and cared for, esteemed and valued, and included in a network of communication and
mutual obligation. Social support has three types of bene ts (S. E. Taylor, 2012):
Tangible assistance : Family and friends can provide goods and services in stressful
circumstances, as when gifts of food are given after the death of a loved one.
Information: Individuals who extend support can also recommend speci c strategies
to help the person under stress cope. Friends may notice that a coworker is overloaded
with work and suggest ways of better managing time or delegating tasks.
Emotional support : Individuals under stress often suffer emotionally and may develop
depression, anxiety, or loss of self-esteem. Friends and family can reassure the stressed
person that he or she is valuable and loved. Knowing that others care allows a person
to manage stress with greater assurance.
O n e w a y t h a t p e o p l e g a i n s u p p o r t d u r i n g d i f cult times is through social sharing
turning to others who act as a sounding board or a willing ear. Individuals who are
striving to make healthy life changes might join a group of others who are also struggling
with the same issue. Social sharing can also occur in online support groups.
Sometimes social sharing does not have to be very social to be helpful. James
Pennebaker and his colleagues (Pennebaker, 1997a, 1997b, 2004) have demonstrated that
writing about traumatic life events for 20 minutes a day over two or three days is asso-
ciated with improved health, fewer illnesses, greater immune system function, and supe-
rior reactions to vaccines. Although writing about trauma is usually linked to increased
distress in the short term, over the long run it brings physical and psychological health
bene ts (Baddeley & Pennebaker, 2011; Frattaroli, 2006; Pennebaker & Chung, 2007,
2011; Smyth, 1998). In most of these studies, the participants were college students
writing about their most traumatic life events, and the studies’ results suggest that anyone
can bene t from writing about negative life events. Subsequent studies have found health
bene ts for writing about life goals and intensely positive life
experiences (Burton & King, 2004, 2008; King, 2002). If
you would like to give this simple intervention a try, see
Figure 14.2.
G e t t i n g s u p p o r t f r o m o t h e r s i s i m p o r t a n t , b u t giving
support can also have bene ts. A study of 423 older adult
couples who were followed for ve years revealed how
helping others bene ts physical health (S. L. Brown &
others, 2003). At the beginning of the study, the couples
were asked about the extent to which they had given or
received emotional or practical help in the past year. Five
years later, those who said they had helped others were
half as likely to have died. One possible reason for this
nding is that helping others may reduce the output of
stress hormones, an effect that improves cardiovascular
health and strengthens the immune system (Hackett & oth-
ers, 2012; Hawkley & Cacioppo, 2012a, 2012b).
Having many different social ties may be especially
important during dif cult times (Hawkley & Cacioppo, 2012a,
2012b; S. E. Taylor, 2012). People who participate in more
diverse social networks—for example, having a close relation-
ship with a partner; interacting with family members, friends,
neighbors, and fellow workers; and belonging to social and reli-
gious groups—live longer than people with fewer types of social
relationships (Vogt & others, 1992). One study investi-
gated the effects of diverse social ties on the susceptibility
to getting a common cold (S. Cohen & others, 1998).
I n d i v i d u a l s r e p o r t e d t h e e x t e n t o f t h e i r p a r t i c i p a t i o n i n
social support
Information and feedback
from others indicating that
one is loved and cared for,
esteemed and valued, and
included in a network of
communication and mutual
obligation.
FIGURE 14.2 Harnessing the Power of Writing
Try this simple exercise to explore the health bene ts of writing.
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522 // CHAPTER 14 // Health Psychology
12types of social ties. Then they were given nasal drops containing a cold virus
and monitored for the appearance of a cold. Individuals with more diverse social
ties were less likely to get a cold than their counterparts with less diverse social
networks.
A l t h o u g h s u c h r e s u l t s s u g g e s t a p o w e r f u l r o l e f o r s o c i a l c o n n e c t i o n s i n
health, research ndings on the link between social support and health are not
always clear-cut. To read more about this issue, see the Intersection.
I
t is hard to imagine any factor as
crucial to human survival as hav-
ing connections to a social net-
work and friends to provide
support in times of need. Yet many
studies have been unable to establish
a relationship between individuals’
perceptions of the levels of compas-
sion and encouragement they have
received during stressful times and
their physical and psychological func-
tioning (Bolger & Amarel, 2007). How
might we understand such research?
Consider that being on the receiv-
ing end of social support can mean different things to different
people. On the one hand, having someone express support and
encouragement during times of stress might give a person a
feeling of being genuinely cared for. In this sense, getting help
might be truly helpful. However, receiving help from another
might also make a person feel incompetent: Why am I unable to
handle this problem on my own? Culture is one factor that illu-
minates when and for whom emotional support might come at
an emotional cost.
Jiyoung Park and her colleagues (2012) proposed that in West-
ern cultures, which place a high value on personal independence,
perceptions of support from others might entail an emotional
cost, including concerns about being needy or incompetent. In
this cultural context, receiving support may be viewed as threaten-
ing a person’s sense of independence (Uchida & others, 2008). In
contrast, in East Asian cultures that emphasize the interdepen-
dent nature of the self, providing and receiving help from others is
an important way to enact cultural values. Rather than indicating
incompetence or failure, in this context getting help from others is
a sign of succeeding at the culturally esteemed goal of being a
valued member of one’s group. Based on these proposed distinc-
tions between Western and Eastern cultures, Park and her col-
leagues hypothesized that the link between health and
perceptions of emotional support
from others would be especially posi-
tive for individuals in East Asian
cultures.
To test this prediction, the
researchers surveyed over 1,000
adults in Japan and the United
States. Participants completed ques-
tionnaires measuring stress, emo-
tional support from others, and
psychological and physical health.
Insupport of the researchers’ predic-
tions, the relationship between per-
ceptions of emotional support and
health reports was strong and positive for Japanese but not for
U.S. respondents (J. Park & others, 2012). Interestingly, among
Japanese participants, support was most likely to be associated
with better health reports when individuals were experiencing high
levels of stress. These results might indicate that within more
interdependent cultures, it is important that support come during
times when it is clearly warranted and does not indicate that the
person is making unjusti able demands on the social group
(Uchida & others, 2008).
Does this research have a lesson for Westerners? Park and
her colleagues suggest that Americans might bene t most from
subtle forms of support that do not draw attention to their own
coping capacities. Speci cally, for Westerners, receiving help
might be less emotionally costly when it occurs in ways that pre-
serve the supported person’s sense of self-ef cacy and indepen-
dence. Theresearchers liken social
support to an insurance policy: Just
asinsurance provides peace of mind
when things are going well, knowing
that we have a network of social sup-
port may promote health and well-
being even when we do not feel the
need to use it.
Health and Cross-Cultural Psychology: How Does
Culture Infl uence the Meaning of Social Support?
INTERSECTION
\\
How and to whom do you
typically offer support?
\\
When others have
supported you in difficult
times, how have you felt?
Et h i c s gu i d el i n es w ou l d
have di ct at ed t he n eed f or t he
par t i ci pant s i nf o r med consent ,
me a n i n g t h a t t h e y a g r e e d t o b e
inject ed wit h t he cold virus.
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Resources for Effective Life Change // 523
Religious Faith
R e l i g i o u s f a i t h i s s t r o n g l y r e l a t e d t o m a i n t a i n i n g a h e a l t h y l i f e s t y l e a n d t o g o o d h e a l t h
(Koenig, 2012a, 2012b; Koenig, King, & Carson, 2012). Many religions frown on excess
and promote moderation. Indeed, weekly religious attendance relates to a host of healthy
behaviors, including not smoking, taking vitamins, walking regularly, wearing seatbelts,
exercising strenuously, sleeping soundly, and drinking moderately or not at all (Haber,
Koenig, & Jacob, 2011; T. D. Hill & others, 2006). A number of studies have de nitively
linked religious participation to a longer and healthier life (Campbell, Yoon, & Johnstone,
2009; Koenig, 2012b; Krause, 2006; McCullough & Willoughby, 2009).
R e l i g i o u s p a r t i c i p a t i o n m a y a l s o b e n e t health through its relationship to social support
(George, 2009; S. E. Taylor, 2012). Belonging to a faith community may give people
access to a warm group of others who are available during times of need. This community
is there to provide transportation to the doctor, to check in with the individual during hard
times, and simply to stand next to the individual during a worship service, as a fellow
member of the community. The social connections promoted by religious activity can
forestall anxiety and depression and help to prevent isolation and loneliness (Dein, Cook,
& Koenig, 2012; Rosmarin, Krumrei, & Andersson, 2009; Ross & others, 2009a).
Religious faith and spirituality more generally may also be important factors in good
health because they provide a sense of life meaning and a buffer against the effects of
stressful life events (C. L. Park, 2012). Religious thoughts can play a role in maintaining
hope and stimulating motivation for positive life changes. Studies have shown that some
individuals with AIDS who lived much longer than expected had used religion as a
coping strategy—speci c bene ts came from participating in religious activities such
as praying and attending church services (Ironson & others, 2001)—and that an
increase in spirituality after testing positive for HIV is associated with slower disease
progression over four years (Ironson, Stuetzle, & Fletcher, 2006). Faith may also help
individuals to avoid burnout at work (Murray-Swank & others, 2006) and to negotiate
life’s dif culties without feeling overwhelmed (Mascaro & Rosen, 2006). Belief in the
enduring meaningfulness of one’s life can help one keep perspective and see life’s hassles
in the context of the big picture (C. L. Park, 2012).
Personality Characteristics
Personality traits are powerful instruments in the self-change toolbox. Here we survey
some of the personality characteristics related to health.
C O N S C I E N T I O U S N E S S Recall from Chapter 10 that conscientious individuals
are responsible and reliable; they like structure and seeing a task to its completion.
Conscientiousness is not the sexiest trait, but it might well be the most important of the
big ve traits when it comes to health, healthy living, and longevity (Roberts & others,
2009). Various studies show that conscientious people tend to do all the things that they
are told are good for their health, such as getting regular exercise, avoiding drinking and
smoking, wearing seatbelts, monitoring their blood pressure, and checking smoke detec-
tors (D. B. O’Connor & others, 2009; Rush, Becker, & Curry, 2009; Turiano & others,
2012). Research has also shown that conscientious individuals are not as likely to die as
their counterparts who are less conscientious (Fry & Debats, 2009; Iwassa & others,
2008, 2009; Kern & Friedman, 2008; Wilson & others, 2004).
P E R S O N A L C O N T R O L Another personality characteristic associated
with taking the right steps toward a long, healthy life is a sense of personal
control, what we referred to in Chapter 10 as an internal locus of control
(Baumeister & Alquist, 2009; K. W. Grif n & others, 2012). Feeling in control
can reduce stress during dif cult times (S. E. Taylor, 2012; Thompson, 2001) and
How m i ght t h es e
results apply to a person
who i s not r el i gi ous?
A person wit h a low level
of per s onal cont r ol may f ee l t hat
what ever h appens happensi t i s
me a n t t o b e o r a ma t t e r o f
(good or bad) luck.
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524 // CHAPTER 14 // Health Psychology
Challenge
YOUR THINKING
R
esearch demonstrating the role of psy-
chological variables in health, disease,
and mortality is extremely appealing
because it gives us a sense we have some
control over our physical health. Yet as
assuring as such ndings might be, these
factors are not a psychological recipe for
immortality. When scientists nd a link
between some psychological factor and
an important health outcome, the popu-
lar media often latch on to the results as
if they mean that such factors play a
causal role in disease. Such research
can sometimes lead to victim blaming:
thinking that a person is ill or has died
because of a de cit of self-ef cacy or
optimism.
A compelling case in point is provided
by research on “ ghting spirit” in combat-
ting breast cancer. In a study published over
three decades ago, 69 women were interviewed three months
after undergoing surgery for breast cancer (Greer, Morris, &
Pettingale, 1979). Based on these interviews, the researchers
categorized the women’s responses to breast cancer as de-
nial, ghting spirit, quiet resignation, or helplessness. The
researchers then followed up on the women ve years
later to see whether they had experienced a recurrence.
The results of the follow-up study showed that women
whose responses were characterized by either denial
or ghting spirit were less likely to have had a recur-
rence of cancer. This study led to the conclusion
that women with breast cancer should be en-
couraged to adopt a ghting attitude to-
ward their cancer. The idea that a ghting
spirit is important to breast cancer sur-
vival continues to hold sway in interven-
tions for women coping with the disease
(Coyne & Tennen, 2010).
Crucially, this nding, based on a sin-
gle study with a relatively small sample,
How Powerful Is the Power of Positive Thinking?
p
s
y-
a
se,
g
e
three decades ago, 69
w
after undergoing surger
y
Petti
ng
ale, 1979). Bas
e
c
ate
go
rized the wo
m
n
ial,
gh
ti
ng
spiri
t
r
esearchers th
e
later to see w
h
T
he results of
whose resp
o
or
g
htin
g
r
ence
tha
c
can lead to the development of problem-solving strategies to deal with life’s dif culties.
An individual with a good sense of personal control might reason, “If I stop smoking
now, I will not develop lung cancer.
A s e n s e o f p e r s o n a l c o n t r o l h a s b e e n l i n k e d t o a l o w e r r i s k f o r c o m m o n c h r o n i c d i s -
eases such as cancer and cardiovascular disease (Sturmer, Hasselbach, & Amelang, 2006).
Further, like conscientiousness, a sense of personal control might also help people
avoid a risky lifestyle that involves health-compromising behaviors. Consider a
study of East German migrants to West Germany who found themselves
unemployed (Mittag & Schwarzer, 1993). Individuals in the study often
turned to heavy drinking for solace—unless, that is, they had a sense of
personal control (as measured by survey items such as “When I’m in trouble,
I can rely on my ability to deal with the problem effectively”). Overall, across
a wide range of studies, a sense of personal control has been related to emotional
well-being, successful coping with a stressful event, healthy behavior change, and
good health (Hughes, Berg, & Wiebe, 2012; Little, Snyder, & Wehmeyer, 2006; Sproesser
& others, 2011; Stanton, Revenson, & Tennen, 2007; S. E. Taylor, 2012).
S E L F - E F F I C A C Y R e c a l l t h a t s e l f - e f cacy is an individual’s belief that he or she can
master a situation and produce positive outcomes. Albert Bandura (1997, 2001, 2010b,
2011a) and others have shown that self-ef cacy affects behavior in many situations, rang-
ing from solving personal problems to going on diets. Self-ef cacy in uences whether
individuals try to develop healthy habits, how much effort they expend in coping with
stress, how long they persist in the face of obstacles, and how much stress they experience.
Research has shown that self-ef cacy is related to success in a wide variety of positive
life changes. These include sticking to a New Year’s resolution (Norcross, Mrykalo, &
Blagys, 2002), achieving weight loss (Byrne, Barry, & Petry, 2012), exercising regularly
(Lippke & Plotnikoff, 2006), quitting smoking (Berndt & others, 2012), reducing
In Chapter 12 we
ex ami ned t he r ol e of l ear ned
hel pl essn ess i n d epr essi on . L ear n ed
hel pl essn ess mean s bel i evi ng t hat
one has no cont r ol over
out comes i n one s l i f e .
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Resources for Effective Life Change // 525
has not withstood the test of time. Subsequent research, espe-
cially studies employing much larger samples, hasfailed to
show any link between adopting a ghting spirit and breast can-
cer outcomes (Petticrew, Bell, & Hunter, 2002; Phillips & oth-
ers, 2008; Watson & others, 2005). Although the reality that a
ghting spirit does not improve a womans chances of beating
cancer might seem disappointing, many have welcomed this
news. As one expert commented, such ndingsmay help to
remove any continuing feelings of guilt or sense of blame for
breast cancer relapse from those women who worry because
they cannot always maintain a ghting spirit or a positive atti-
tude” (Dobson, 2005, p. 865). The widespread belief that
adopting a ghting spirit was key to cancer survival imposed
aburden on individuals already dealing with a dif cult life
experience.
Does this conclusion mean that psychosocial variables have
no role to play in disease? Certainly not. One study that found no
effect of ghting spirit did show that initial helplessness in re-
sponse to diagnoses was a predictor of poorer outcomes among
women with breast cancer (Watson & others, 2005). Knowing that
a person feels helpless early on may prompt professionals to pro-
vide much needed information about treatment and the potential
for long-term recovery. Indeed, among the factors that (happily)
complicate this type of research are that many cancers have
effective treatments and that, especially with early detection, rela-
tively few individuals die or experience a recurrence (Coyne &
Tennen, 2010). Professionals can also use information about
psychological characteristics to build in behavioral supports that
might be needed to help a person stick with treatment and
optimize her outcomes.
People deal with potentially
life-threatening diagnoses in
different ways. Dutch swimmer
Maarten van der Weijden was di-
agnosed with leukemia in 2001
at the age of 20 but went on to
win Olympic gold in 2008. With
respect to his diagnosis, he re-
marked, “I . . . simply surren-
dered to the doctors. You always
hear those stories that you have
to think positively, that you have
to ght to survive. This can be a
great burden for patients. It has
never been proven that you can
cure cancer by thinking positively
or by ghting(quoted in Coyne,
Tennen, & Ranchor, 2010, p. 40).
What Do You Think?
In the 1979 study, ghting
spirit and denial both were
associated with better
outcomes. Why do you think
people latched on to ghting
spirit rather than denial as a
key intervention?
If someone you love were
diagnosed with cancer, how
would the research reported
here in uence the support
you would provide to that
person?
substance abuse (Goldsmith & others, 2012), practicing safe sex (Buhi & others, 2011),
and leading a healthy lifestyle (Axelsson & others, 2012). Recent evidence suggests that
self-ef cacy is strongly linked to cardiovascular functioning following heart failure and
that individuals high in self-ef cacy not only are less likely to suffer a second hospital-
ization due to heart failure but also are likely to live longer (Maeda & others, 2012;
Sarkar, Ali, & Whooley, 2009). If there is a problem to be xed, self-ef cacy—having
a can-do attitude—is related to nding a solution.
Throughout this book, we have examined the placebo effect as a positive response to
a treatment that has no medicinal power. The placebo effect results from the
i n d i v i d u a l s b e l i e f i n t h e e f f e c t i v e n e s s o f t h e t r e a t m e n t . C a n y o u r e a l l y l o s e
those 10 pounds? Maybe or maybe not, but believing that you can allows you
to harness the placebo effect. Self-ef cacy is the
power of belief in yourself.
O P T I M I S M O n e f a c t o r t h a t i s o f t e n l i n k e d t o p o s i t i v e f u n c -
tioning and adjustment is optimism. Researchers have found that
optimism is associated with taking proactive steps to protect
one’s health, while pessimism is linked to engaging in health-
compromising behaviors (Carver, Scheier, & Segerstrom, 2010;
Ramirez-Maestre, Esteve, & Lopez, 2012). Martin Seligman
(1990) views optimism as a matter of how a person explains the
causes of bad events. Optimists identify the causes of bad events
as external, unstable, and speci c, whereas pessimists identify
them as internal, stable, and global. Studies have associated
explaining life events optimistically with positive outcomes,
including a better quality of life (Jowsey & others, 2012; Reivich
& Gillham, 2002).
How m i ght c ul t ur e
influence t he roles of self-efficacy
and per s onal cont r ol i n heal t h?
HOW OPTIMISM WORKS
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526 // CHAPTER 14 // Health Psychology
1. All of the following are powerful tools
for self-change except
A. ethnic heritage.
B. religious faith.
C. personality traits.
D. motivation.
2. The benefits of social support include all
of the following except
A. information.
B. tangible assistance.
C. emotional support.
D. victim blaming.
3. According to Seligman, optimists
explain the causes of bad events as
A. external.
B. internal.
C. global.
D. stable.
APPLY IT! 4. Daniel was recently diag-
nosed with diabetes. His doctor gave him a
new diet to control his condition. Which of
the following situations offers the best
chances that Daniel will stick with the diet?
A. Daniel loves junk food and does not
want to follow the diet, but his
motherand aunt, both diabetics, are
pressuring him to follow the doctor’s
recommendations.
B. Daniel has always had trouble following
through on doing what is good for him,
though he says he wants more structure
in his life.
C. Clark, Daniel’s roommate, has a diabetic
brother, and Clark tells Daniel about how
his brother has coped and what diet he
follows; Clark offers to introduce them.
D. Daniel has a pessimistic personality and
expects things to work out badly.
If you could change one thing about your behavior, what would you choose? Would the
change perhaps have to do with feeling stressed out much of the time? Maybe you wish
you could stop facing every daily challenge with tension. Lets look at the problems that
can arise when you feel chronically stressed and the ways you can better manage your stress.
Stress and Its Stages
A s d e s c r i b e d i n C h a p t e r 2 , s t r e s s i s t h e r e s p o n s e t o e n v i r o n m e n t a l s t r e s s o r s , t h e
circumstances and events that threaten individuals and tax their coping abilities. Hans
Selye (1974, 1983), the founder of stress research, focused on the body’s response
to stressors, especially the wear and tear due to the demands placed on the body. After
observing patients with different problems—the death of someone close, loss of income,
arrest for embezzlement—Selye concluded that any number of environmental events or
4
Toward a Healthier Mind (and Body):
Controlling Stress
Other researchers de ne optimism as the expectancy that good things are more likely
and that bad things are less likely to occur in the future (Carver & Scheier, 2009). This
view focuses on how people pursue their goals and values. Even when faced with mis-
fortune, optimists keep working to reach their goals, whereas pessimists give up.
N u m e r o u s s t u d i e s r e v e a l t h a t o p t i m i s t s g e n e r a l l y f u n c t i o n m o r e e f f e c t i v e l y a n d a r e
physically and mentally healthier than pessimists (Boehm & Kubzansky, 2012; Tindle &
others, 2012). Optimism has been linked to more effective immune system functioning
and better health (O’Donovon & others, 2009; Segerstrom & Sephton, 2010). Optimism
can also be a powerful tool against hopelessness and is associated with decreased thoughts
of suicide in adolescents and emerging adults (Ayub, 2009; Hirsch, Conner, & Duberstein,
2007; Nauta & others, 2012). And a recent study of centenarians (people who live to be
100 or more years of age) revealed that those who were in better health had a higher level
of optimism than their pessimistic counterparts (Tigani & others, 2012).
As you think about the traits we have examined—conscientiousness, personal control,
self-ef cacy, and optimism—and their relationship to good health, an important practical
tip to keep in mind is that you can cult i vate t h e s e q u a l i t i e s . S t u d i e s s h o w t h a t e v e n
conscientiousness, the most stable of these characteristics, can increase, especially in
young adulthood.
I n t e r e s t i n g l y , r e s e a r c h r e s u l t s p o i n t i n g t o t h e l i n k s b e t w e e n v a r i o u s p e r s o n a l i t y c h a r a c -
teristics and better health outcomes can sometimes create a burden on individuals who are
struggling with illness. To read about this issue, see Challenge Your Thinking on p. 524.
Get t i ng mar r i ed, hav i ng
a baby, gr aduat i ng f r om col l ege—
al t hough pos i t i ve l i f e event s ,
these achievements can be
st r essf ul because t hey ar e
al so maj or l i f e changes.
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Toward a Healthier Mind (and Body): Controlling Stress // 527
stimuli would produce the same stress symptoms:
loss of appetite, muscular weakness, and decreased
interest in the world.
General adaptation syndrome (GAS) is
Selye’s term for the common effects on the
body when demands are placed on it (Fig-
ure 14.3). The GAS consists of three stages:
alarm, resistance, and exhaustion. Selye’s model
is especially useful in helping us understand the
link between stress and health.
The body’s rst reaction to a stressor, in the
alarm stage, is a temporary state of shock dur-
ing which resistance to illness and stress falls
below normal limits. In trying to cope with the initial effects of stress, the body releases
hormones that, in a short time, adversely affect the functioning of the immune system,
the body’s network of natural defenses. During this time the individual is prone to infec-
tions from illness and injury.
In the resistance stage of Selye’s general adaptation syndrome, glands throughout the
body manufacture different hormones that protect the individual. Endocrine and sympa-
thetic nervous system activity are not as high as in the alarm stage, although they still
are elevated. During the resistance stage, the body’s immune system can ght off infec-
tion with remarkable ef ciency. Similarly, hormones that reduce the in ammation nor-
mally associated with injury circulate at high levels.
If the body’s all-out effort to combat stress fails and the stress persists, the individual
moves into the exhaustion stage. At this point, wear and tear takes its toll—the person
might collapse in exhaustion, and vulnerability to disease increases. Serious, possibly
irreversible damage to the body—such as a heart attack or even death—may occur.
T h e b o d y s y s t e m t h a t p l a y s t h e g r e a t e s t r o l e i n S e l y e s G A S m o d e l i s t h e hypothalamic-
pituitary-adrenal axis (HPA axis) . The HPA axis is a complex set of interactions among
the hypothalamus (part of the brain’s limbic system), the pituitary gland (the master gland
of the endocrine system), and the adrenal glands (endocrine system glands located on
top of each kidney). The HPA axis regulates various body processes, including digestion,
immune system responses, emotion, and energy expenditure. The axis also controls
reactions to stressful events, and these responses will be our focus here.
W h e n t h e b r a i n d e t e c t s a t h r e a t i n t h e e n v i r o n m e n t , i t s i g n a l s t h e h y p o t h a l a m u s t o
release corticotropin-releasing hormone (CRH). In turn, CRH stimulates the pituitary
gland to produce another hormone that causes the adrenal glands to release cortisol.
Cortisol is itself the “stress hormone” that directs cells to make sugar, fat, and protein
available so the body can take quick action. Cortisol also suppresses the immune system.
In Chapter 2 we distinguished between acute stress and chronic stress. Acute stress
can sometimes be adaptive, and in acute stress cortisol plays an important role in helping
us to take the necessary action to avoid dire consequences. Typically, once the body has
dealt with a given stressor, our cortisol level returns to normal. However, under chronic
stress, the HPA axis can remain activated over the long haul.
T h e a c t i v i t y o f t h e H P A a x i s v a r i e s f r o m o n e p e r s o n t o t h e n e x t . T h e s e d i f f e r e n c e s m a y
be explained by genes as well as by particular stressful experiences (Boersma & others,
2012). Research with rats and humans has shown that prenatal stress can in uence the
development of the HPA axis (Green & others, 2011; O’Connor & others, 2012; Peters
& others, 2012). When the HPA is chronically active, various systems in the body suffer.
Stress and the Immune System
C h r o n i c s t r e s s c a n h a v e s e r i o u s i m p l i c a t i o n s f o r t h e b o d y , i n p a r t i c u l a r t h e i m m u n e s y s t e m .
Interest in links between the immune system and stress spawned a new eld of scienti c
inquiry, psychoneuroimmunology , which explores connections among psychological
general
adaptation
syndrome (GAS)
Selye’s term for
the common
effects of stressful
demands on the
body, consisting
of three stages:
alarm, resistance,
and exhaustion.
hypothalamic-pituitary-
adrenal axis (HPA axis)
The complex set of interac-
tions among the hypothala-
mus, the pituitary gland,
and the adrenal glands that
regulates various body pro-
cesses and controls reac-
tions to stressful events.
psychoneuroimmunology
A new fi eld of scientifi c in-
quiry that explores connec-
tions among psychological
factors (such as attitudes
and emotions), the nervous
system, and the immune
system.
FIGURE 14.3 Selye’s General Adaptation Syndrome The
general adaptation syndrome (GAS) describes an individual’s response to stress
in terms of three stages: (1) alarm, in which the body mobilizes its resources;
(2) resistance, in which the body strives mightily to endure the stressor; and
(3)exhaustion, in which resistance becomes depleted.
Normal level
of resistance
to stress
1
Alarm stage
2
Resistance
3
Exhaustion
EXPERIENCE IT!
Chronic Stress and
the Brain
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528 // CHAPTER 14 // Health Psychology
f actors (such as attitudes and emotions), the nervous system, and the immune system (Cho
& others, 2012; Lamkin & others, 2012; Stowell, Robles, & Kane, 2013).
The immune system and the central nervous system are similar in their modes of
receiving, recognizing, and integrating signals from the external environment (Sternberg
& Gold, 1996). The central nervous system and the immune system both possess
“sensory” elements that receive information from the environment and other parts
of the body, and “motor” elements that carry out an appropriate response. Both
systems also rely on chemical mediators for communication. A key hormone
shared by the central nervous system and the immune system is corticotropin-
releasing hormone (CRH), which is produced in the hypothalamus, as we saw above,
and unites the stress and immune responses.
Stress can profoundly in uence the immune system (Broadbent & Koschwanez, 2012;
Haroon, Raison, & Miller, 2012). Acute stressors (sudden, stressful, one-time life events)
can produce immunological changes. For example, in relatively healthy HIV-infected
individuals, as well as in individuals with cancer, acute stressors are associated with
poorer immune system functioning (McIntosh & Rosselli, 2012; Pant & Ramaswamy,
2009). In addition to acute stressors, chronic stressors (long-lasting agents of stress) are
associated with an increasing downturn in immune system responsiveness (Pervanidou
& Chrousos, 2012). This effect has been documented in a number of circumstances that
include worries about living next to a damaged nuclear reactor, failures in close relation-
ships (divorce, separation, and marital distress), negative relationships with family and
friends, and burdensome caregiving for a family member with a progressive illness
(Friedman & others, 2012; Gouin & others, 2012).
R e s e a r c h e r s h o p e t o d e t e r m i n e t h e p r e c i s e l i n k s a m o n g p s y c h o l o g i c a l f a c t o r s , t h e b r a i n ,
and the immune system (DeWitt & others, 2012; Facciabene, Motz, & Coukos, 2012).
Preliminary hypotheses about the interaction that causes vulnerability to disease include:
Stressful experiences lower the ef ciency of immune systems, making individuals
more susceptible to disease.
Stress directly promotes disease-producing processes.
Stressful experiences may cause the activation of dormant viruses that diminish the
individual’s ability to cope with disease.
T h e s e h y p o t h e s e s m a y l e a d t o c l u e s f o r m o r e s u c c e s s f u l t r e a t m e n t s f o r s o m e o f t h e m o s t
challenging diseases to conquer, AIDS and cancer among them (Hill, Rosenbloom, &
Nowak, 2012; Vigano & others, 2012).
Sheldon Cohen and his colleagues have carried out a number of studies on the
effects of stress, emotion, and social support on immunity and susceptibility to infec-
tious disease (Cohen & Janicki-Deverts, 2009; Cohen & Lemay, 2007; S. Cohen &
others, 2009, 2012; Sneed & others, 2012).
In one such study, Cohen and his col-
leagues (1998) focused on 276 adults who
were exposed to viruses and then quaran-
tined for ve days. Figure 14.4 shows the
dramatic results. The longer the partici-
pants had experienced major stress
in their lives before the study, the
more likely they were to catch
a cold. Cohen concluded that
stress-triggered changes in the
immune system and hormones
might create greater vulnerability to
infection. These ndings suggest that when
we are under stress, we need to take better
care of ourselves than usual (S. Cohen &
others, 2009, 2012).
0
1
2
3
4
No stressor <1
Duration of life stressor (in months)
>6, 241, 6 >24
Relative risk of a cold
FIGURE 14.4 Stress and the Risk of Developing a
Cold In a study by Cohen and others (1998), the longer individuals had
a life stressor, the more likely they were to develop a cold. The four-point
scale is based on the odds (0 ! lower; 4 ! higher) of getting a cold.
Recal l f r om Chapt er 5
that the immune system can
learn t hrough classical
con di t i on i ng.
Medi t at ion, descr i bed i n
Chapt er 4 , i s a gr eat way t o cope
wi t h st r ess and has posi t i v e
be ne f i t s f or t he i mmune syst e m.
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Toward a Healthier Mind (and Body): Controlling Stress // 529
Stress and Cardiovascular Disease
There is also reason to believe that stress increases an individual’s risk for cardiovascu-
lar disease (Emery, Anderson, & Goodwin, 2013; Hollander & others, 2012). Chronic
emotional stress is associated with high blood pressure, heart disease, and early death
(Schulz, 2007). Apparently, the adrenaline surge caused by severe emotional stress causes
the blood to clot more rapidly—and blood clotting is a major factor in heart attacks
(Strike & others, 2006). Emotional stress can contribute to cardiovascular disease in other
ways. Individuals who have had major life changes (such as the death of a spouse and
the loss of a job) have a higher incidence of cardiovascular disease and early death
(Mostofsky & others, 2012; S. E. Taylor, 2012). People in a chronically stressed condi-
tion, such as that stemming from work stress or prolonged loneliness, are also more
likely to take up smoking, start overeating, and avoid exercising, behaviors linked with
cardiovascular disease (Steptoe & Kivimaki, 2012; Zimmerman, 2012).
Just as personality characteristics such as a sense of control or self-ef cacy can help
buffer an individual against stress, other personality characteristics have been shown to
worsen stress, with special signi cance for cardiovascular illness. In particular, people
who are impatient or quick to anger or who display frequent hostility have an increased
risk for cardiovascular disease (Ohira & others, 2012).
In the late 1950s, a secretary for two California cardiologists, Meyer Friedman and
Ray Rosenman, observed that the chairs in their waiting rooms were tattered and worn,
but only on the front edges. The cardiologists had also noticed the impatience of their
cardiac patients, who often arrived exactly on time and were in a great hurry to leave.
Intrigued by this consistency, they conducted a study of 3,000 healthy men between the
ages of 35 and 59 over eight years to nd out whether people with certain behavioral
characteristics might be prone to heart problems (Friedman & Rosenman, 1974). During
the eight years, one group of men had twice as many heart attacks or other forms of
heart disease as the other men. Further, autopsies of the men who died revealed that this
same group had coronary arteries that were more obstructed than those of the other men.
Friedman and Rosenman described the common personality characteristics of the men
who developed coronary disease as the Type A behavior pattern . They theorized that
a cluster of characteristics—being excessively competitive, hard-driven, impatient, and
hostile—is related to the incidence of heart disease. Rosenman and Friedman labeled the
behavior of the healthier group, who were typically relaxed and easygoing, the Type B
behavior pattern .
Further research on the link between Type A behavior and coronary disease indicates
that the association is not as strong as Friedman and Rosenman believed (Suls & Swain,
1998; R. B. Williams, 2001, 2002). However, researchers have found that certain com-
ponents of Type A behavior are more precisely linked with coronary risk (Spielberger,
2004). The Type A behavior component most consistently associated with coronary prob-
lems is hostility (Ohira & others, 2012). People who are hostile outwardly or who turn
anger inward are more likely to develop heart disease than their less angry counterparts
(Eng & others, 2003; K. A. Matthews & others, 2004). Such people have been called
“hot reactors” because of their intense physiological reactions to stress: Their hearts race,
their breathing quickens, and their muscles tense up. One study found that hostility was
a better predictor of coronary heart disease in older men than smoking, drinking, high
caloric intake, or high levels of LDL cholesterol (Niaura & others, 2002).
T h e r e h a s b e e n i n c r e a s e d i n t e r e s t i n t h e Type D behavior pattern , which describes
individuals who are generally distressed, frequently experience negative emotions, and
are socially inhibited (Beutel & others, 2012; Cosci, 2012; Molloy & others, 2012).
Even after adjustment for depression, Type D individuals face a threefold increased
risk of adverse cardiovascular outcomes (Denollet & Conraads, 2011). A recent meta-
analysis also found that Type D persons with cardiovascular disease are at a higher
risk for major adverse cardiac events and have a lower health-related quality of life
(O’Dell & others, 2011).
Type A behavior pattern
A cluster of characteristics—
including being excessively
competitive, hard-driven,
impatient, and hostile—
that are related to a higher
incidence of heart disease.
Type B behavior
pattern
A cluster of
characteristics—
including being
relaxed and
easygoing—that
are related to a
lower incidence
of heart disease.
Type D behavior pattern
A cluster of characteristics—
including being generally
distressed, having negative
emotions, and being socially
inhibited—that are related
to adverse cardiovascular
outcomes.
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530 // CHAPTER 14 // Health Psychology
Stress and Cancer
G i v e n t h e a s s o c i a t i o n o f s t r e s s w i t h p o o r h e a l t h b e h a v i o r s
such as smoking, it is not surprising that stress has also
been related to cancer risk (Nezu & others, 2013). Stress
sets in motion biological changes involving the auto-
nomic, endocrine, and immune systems. If the immune
system is not compromised, it appears to help provide
resistance to cancer and slow its progression. Research-
ers have found, however, that the physiological effects of
stress inhibit a number of cellular immune responses
(Hayakawa, 2012). Cancer patients show diminished
natural killer cell (NK-cell) activity in the blood (Rosental
& others, 2012) (Figure 14.5). Low NK-cell activity is
linked with the development of further malignancies, and
the length of survival for the cancer patient is related to
NK-cell activity (Buchser & others, 2012).
Thus, stress is clearly a factor not only in immune system functioning and cardiovas-
cular health but also in the risk for cancer. In light of these links, understanding the
psychological processes by which individuals can effectively handle stressful circum-
stances is a crucial topic in health psychology (Stowell, Robles, & Kane, 2013).
Cognitive Appraisal and
Coping with Stress
What stresses you out? Stressors can be anything from losing irreplaceable notes from
a class, to being yelled at by a friend, to failing a test, to being in a car wreck.
Although everyone’s body may respond similarly to stressors, not every-
one perceives the same events as stressful. Whether an experience “stresses
you out” depends on how you think about that experience (Rogers & Maytan,
2012). For example, you may perceive an upcoming job interview as a
threatening obligation, whereas your roommate may perceive it as a challenging
opportunity—a chance to shine. You might view a D on a paper as a crushing blow; your
roommate may view the same grade as an incentive to work harder. To some degree,
then, what is stressful depends on how one thinks about events (Schroder & others, 2012;
Visser & others, 2012).
S T E P S I N C O G N I T I V E A P P R A I S A L Cognitive appraisal refers to an indi-
vidual’s interpretation of an event as either harmful, threatening, or challenging, and the
person’s determination of whether he or she has the resources to cope effectively with
the event. Coping is essentially a kind of problem solving. It involves managing taxing
circumstances, expending effort to solve life’s problems, and seeking to
master or reduce stress.
Richard Lazarus articulated the importance of cognitive appraisal to stress
and coping (1993, 2000). In Lazarus’s view, people appraise events in two
steps: primary appraisal and secondary appraisal. In primary appraisal,
individuals interpret whether an event involves harm or loss that has
already occurred, a threat o f s o m e f u t u r e d a n g e r , o r a chal-
lenge to be overcome. Lazarus believed that perceiving a
stressor as a challenge to be overcome rather than as a
threat is a good strategy for reducing stress. To understand
Lazarus’s concept of primary appraisal, consider two stu-
dents, each with a failing grade in a psychology class at
midterm. Sam is almost frozen by the stress of the low
cognitive appraisal
Individuals’ interpretation
ofthe events in their life as
harmful, threatening, or
challenging and their deter-
mination of whether they
have the resources to cope
effectively with the events.
coping
A kind of problem solving
that involves managing tax-
ing circumstances, expend-
ing effort to solve life’s
problems, and seeking to
master or reduce stress.
FIGURE 14.5 NK Cells and Cancer Two natural killer
(NK) cells (yellow) are shown attacking a leukemia cell (red). Notice
the blisters that the leukemia cell has developed to defend itself.
Nonetheless, the NK cells are surrounding the leukemia cell and are
about to destroy it.
Let s face it . Just reading
about t he negat i ve ef f ect s of
st r ess can be st r essf ul .
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Toward a Healthier Mind (and Body): Controlling Stress // 531
grade and looks at the rest of the term as a threatening prospect. In contrast, Pam does not
become overwhelmed by the harm already done and the threat of future failures. She sees
the low grade as a challenge that she can address and overcome.
In secondary appraisal, individuals evaluate their resources and determine how effec-
tively they can be marshaled to cope with the event. This appraisal is secondary because
it both comes after primary appraisal and depends on the degree to which the event is
appraised as harmful, threatening, or challenging. Sam might have some helpful resources
for coping with his low midterm grade, but he views the stressful circumstance as so
harmful and threatening that he does not take stock of and use his resources. Pam, in
contrast, evaluates the resources she can call on to improve her grade. These include
asking the instructor for suggestions about how to improve her studying for the
tests, managing time to include more study hours, and consulting with high-achieving
classmates.
T Y P E S O F C O P I N G Research has identi ed two types of coping. Problem-focused
coping is the cognitive strategy of squarely facing one’s troubles and trying to solve
them. For example, if you are having trouble with a class, you might go to the campus
study skills center and sign up for a program to learn how to study more effectively.
Having done so, you have faced your problem and attempted to do something about it.
Problem-focused coping might involve coming up with goals and implementation inten-
tions, the problem-solving steps we examined earlier in this chapter.
Emotion-focused coping entails responding to the stress that one is feeling—trying
to manage the emotional reaction—rather than confronting the root problem. If you use
emotion-focused coping, you might avoid going to a class that is a problem for you.
Instead, you might say the class does not matter, deny that you are having dif culty with
it, joke about it with your friends, or pray that you will do better.
In some circumstances, emotion-focused coping can be bene cial in dealing with
life’s problems. Denial is one of the main protective psychological mechanisms
for navigating the ood of feelings that occurs when the reality of death or
dying becomes too great. For example, one study found that following the
death of a loved one, bereaved individuals who directed their attention away
from their negative feelings had fewer health problems and were rated as
better adjusted by their friends, compared to bereaved individuals who did
not use this coping strategy (Coifman & others, 2007). Denial can be used
to avoid the destructive impact of shock by postponing the time when one
has to deal with stress. In other circumstances, however, emotion-focused
coping can be a problem. Denying that the person you dated does not love you
anymore when he or she has become engaged to someone else keeps you from
getting on with life.
Many individuals successfully use both problem-focused and emotion-focused coping
when adjusting to a stressful circumstance. For example, in one study, individuals said
they employed both problem-focused and emotion-focused coping strategies in 98 per-
cent of the stressful situations they encounter (Folkman & Lazarus, 1980). Over the long
term, though, problem-focused coping rather than emotion-focused coping usually works
best (Nagase & others, 2009).
Strategies for Successful Coping
A stressful circumstance becomes considerably less stressful when a person successfully
copes with it. Effective coping is associated with a sense of personal control, a healthy
immune system, personal resources, and positive emotions.
Multiple coping strategies often work better than a single strategy, as is true with any
problem-solving challenge (Folkman & Moskowitz, 2004). People who have experienced
a stressful life event or a cluster of dif culties might actively embrace problem solving
problem-focused coping
The cognitive strategy
ofsquarely facing one’s
troubles and trying to
solvethem.
emotion-focused
coping
The coping strat-
egy that involves
responding to
the stress that
one is feeling—
trying to manage
one’s emotional
reaction—rather
than focusing on
the root problem
itself.
Emo t i o n - f oc us ed c op i n g
can be ad apt i v e i n si t uat i on s i n
whi c h t her e i s no sol ut i on t o a
pr obl em, such a s gr i evi ng over a l oved
one’ s deat h, whe n i n f act i t makes
sense t o f ocus on f eeli ng bet t er
and accept i ng t he pr esent
ci r cumst ances.
EXPERIENCE IT!
Stress and Coping
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532 // CHAPTER 14 // Health Psychology
and consistently take advantage of opportunities for
positive experiences, even in the context of the bad
times they are going through. Positive emotion can
give them a sense of the big picture, help them
devise possible solutions, and allow them to make
creative connections.
Optimism can play a strong role in effective cop-
ing (Z. E. Taylor & others, 2012). Lisa Aspinwall
has found, for example, that optimistic people are
more likely to attend to and remember potentially
threatening health-related information than are pes-
simists (Aspinwall, 1998; 2011; Aspinwall, Leaf, &
Leachman, 2009; Aspinwall & Pengchit, 2012).
Aspinwall views optimism as a resource that allows
individuals to engage constructively with
potentially frightening information. Opti-
mists are more likely than others to seek
out genetic testing in order to learn
about their risk for disease (Aspinwall
& others, 2012). Optimists engage with
life from a place of strength, so when an
optimist nds out, for instance, that a favor-
ite pastime, tanning, is related to an elevated risk of skin cancer, the information is
important but not overwhelming. In contrast, pessimists are already living in a bleak
world and prefer not to hear more bad news.
A n o t h e r p e r s o n a l i t y t r a i t t h a t a p p e a r s t o p r o m o t e t h r i v i n g d u r i n g d i f cult times is
hardiness. Hardiness is characterized by a sense of commitment rather than alienation,
and of control rather than powerlessness, as well as a perception of problems as chal-
lenges rather than threats (Maddi & others, 2006). Hardiness is the trait displayed by the
basketball player whose team is down by two points with seconds remaining on the clock
when he shouts, “Coach! Give me the ball!” Many of us would shrink from such a high-
pressure moment.
The links among hardiness, stress, and illness were the focus of the Chicago Stress
Project, which studied male business executives 32 to 65 years of age over a ve-year
period (Kobasa, Maddi, & Kahn, 1982; Maddi, 1998). During the ve years, most of the
executives experienced stressful events such as divorce, job transfers, a close friend’s
death, inferior work-performance evaluations, and reporting to an unpleasant boss.
Figure 14.6 shows how hardiness buffered these individuals from stress-related illness
(Kobasa & others, 1986).
O t h e r r e s e a r c h e r s a l s o h a v e f o u n d s u p p o r t f o r t h e r o l e o f h a r d i n e s s i n i l l n e s s a n d
health (Hystad, Eid, & Brevik, 2011; M. K. Taylor & others, 2012). The results of
hardiness research suggest the power of multiple factors, rather than any single factor,
in cushioning individuals against stress and maintaining their health (Maddi, 1998, 2008).
Stress Management Programs
Avoid stress may be good advice, but life is full of potentially stressful experi-
ences. Sometimes just checking e-mail or answering a phone can be an invitation for
stress.
Because many people have dif culty regulating stress, psychologists have developed
techniques that individuals can learn (Artemiadis & others, 2012; Pollard, 2012). Stress
management programs teach individuals how to appraise stressful events, develop cop-
ing skills, and put these skills to practical use. Some stress management programs teach
a range of techniques to handle stress; others focus on a speci c technique, such as
relaxation or assertiveness training.
hardiness
A personality trait character-
ized by a sense of commit-
ment rather than alienation
and of control rather than
powerlessness; a perception
of problems as challenges
rather than threats.
stress
management
program
A regimen that
teaches individu-
als how to ap-
praise stressful
events, how to
develop skills
forcoping with
stress, and how
to put these skills
into use in every-
day life.
Op t i mi s t s ar e n o t j us t
denyi ng t hat anyt hi ng bad can
happen . T hey ar e ac t i vel y en gaged
wi t h r eal i t y, even when i t
con t ai n s t hr eat eni n g news.
0
20
40
60
80
100
None One
High levels of buffers
ThreeTwo
Percent increase in illness probability
92.5
7.7
57.7
71.8
FIGURE 14.6 Illness in High-Stress Business
Executives In one study of high-stress business executives,
a low level of all three buffers (hardiness, exercise, and social
support) involved a high probability of at least one serious
illness in that year. High levels of one, two, and all three
buffers decreased the likelihood of at least one serious illness
occurring in the year of the study.
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Toward a Healthier Body (and Mind): Behaving as If Your Life Depends upon It // 533
Stress management programs are often taught through workshops,
which are becoming more common in the workplace (Jensen & oth-
ers, 2012; S. E. Taylor, 2012). Aware of the high cost in lost produc-
tivity due to stress-related disorders, many organizations have become
increasingly motivated to help their workers identify and cope with
stressful circumstances. Colleges and universities similarly run stress
management programs for students.
Do stress management programs work? In one study, researchers
randomly assigned men and women with hypertension (blood pres-
sure greater than 140/90) to one of three groups (Linden, Lenz, &
Con, 2001). One group received 10 hours of individual stress manage-
ment training; a second group was placed in a wait-list control group
and eventually received stress management training; and a third group
(a control group) received no such training. The two groups that
received the stress management training showed signi cantly reduced
blood pressure. The control group experienced no reduction in blood
pressure. Also, the reduced blood pressure in the rst two groups was linked to a reported
decrease in psychological stress and improved ability to cope with anger (Linden, Lenz,
& Con, 2001).
C o p i n g e f f e c t i v e l y w i t h s t r e s s i s e s s e n t i a l f o r p h y s i c a l a n d m e n t a l h e a l t h ( C o x & o t h -
ers, 2012; Xanthopoulos & Daniel, 2013). Still, there is a lot more we can do to promote
our health. Healthful living—establishing healthy habits and evaluating and changing
behaviors that interfere with good health—helps us avoid the damaging effects of stress
(Emery, Anderson, & Goodwin, 2013). Just as the biopsychosocial perspective predicts,
healthy changes in one area of life can have bene ts that ow to other areas.
“Dean, for you, the stress management seminar
is not, I repeat, not optional.”
Used by permission of CartoonStock, www.CartoonStock.com.
1. Selye’s term for the pattern of common
effects on the body when demands are
placed on it is
A. exhaustion syndrome.
B. the Type A behavior pattern.
C. the Type B behavior pattern.
D. general adaptation syndrome.
2. A personality trait that is characterized
by a sense of commitment and control,
as well as by a perception of problems
as challenges rather than threats, is
A. self-effi cacy.
B. self-determination.
C. hardiness.
D. self-confi dence.
3. Dealing with difficult circumstances,
expending effort to solve life’s problems,
and seeking to control or reduce stress
are key aspects of
A. coping.
B. cognitive appraisal.
C. primary appraisal.
D. secondary appraisal.
APPLY IT! 4. In addition to taking a
full load of classes, Bonnie works at two
part-time jobs and helps her sister care for
two toddlers. Bonnie is achievement ori-
ented and strives to get As in all of her
courses. Because of her many commitments,
she is often in a hurry and regularly does
more than one thing at a time, but she tells
people that she enjoys her busy routine.
Which answer best assesses whether Bonnie
is Type A and at risk for cardiovascular
disease?
A. Bonnie’s hurriedness and achievement
orientation indicate that she is Type A
and probably at risk for cardiovascular
disease.
B. Although Bonnie may experience stress,
the lack of hostility mentioned in this
description suggests that she is not
Type A or at risk for cardiovascular
disease.
C. Bonnie is a “hot reactor” and thus at
risk for cardiovascular disease.
D. Bonnie is Type A, but her enjoyment of
life means that she is not at risk for
cardiovascular disease.
There is no escaping it: Getting stress under control is crucial for a healthy mind and
body. It is also important to make wise behavioral choices in four additional life
domains where healthy habits can bene t both body and mind. In this section we
examine the advantages of becoming physically active, eating right, quitting smoking,
and practicing safe sex.
5
Toward a Healthier Body (and Mind):
Behaving as If Your Life Depends upon It
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534 // CHAPTER 14 // Health Psychology
Becoming Physically Active
I m a g i n e t h a t t h e r e w a s a t i m e w h e n , t o c h a n g e a T V c h a n n e l , p e o p l e
had to get up and walk a few feet to turn a knob. Consider the time
when people physically had to go to the library and hunt through
card catalogs and shelves to nd information rather than going online
and googling. As our daily tasks have gotten increasingly easy, we
have become less active, and inactivity is a serious health problem
(Acevedo, 2012).
A n y a c t i v i t y t h a t e x p e n d s p h y s i c a l e n e r g y c a n b e p a r t o f a h e a l t h y
lifestyle. It can be as simple as taking the stairs instead of an elevator,
walking or biking to class instead of driving, or getting up and danc-
ing instead of sitting at the bar. One study of older adults revealed
that the more they expended energy in daily activities, the longer they
were likely to live (Manini & others, 2006).
In addition to its link to longevity, physical activity corresponds
with other positive outcomes, including a lower probability of devel-
oping cardiovascular disease and cancer (Eheman & others, 2012;
Emery, Anderson, & Goodwin, 2013), weight loss in overweight
individuals (Stehr & von Lengerke, 2012), improved cognitive func-
tioning (Etnier & Labban, 2012), positive coping with stress (Hamer,
2012), and increased self-esteem and body image (Ginis, Bassett, &
Conlin, 2012). Physical exercise also reduces levels of anxiety
(Petruzzello, 2012) and depression (Herring & others, 2012). Even
a real pig bene ts from exercise; Figure 14.7 shows the positive
effects of physical activity in hogs. Being physically active is like
investing energy in a wellness bank account: Activity enhances
physical well-being and gives us the ability to face life’s potential
stressors energetically.
Exercise is one special type of physical activity . Exercise f o r -
mally refers to structured activities whose goal is to improve health. Although exercise
designed to strengthen muscles and bones or to improve exibility is important to
tness, many health experts stress the bene ts of aerobic exercise , which is sustained
activity—jogging, swimming, or cycling, for example—that stimulates heart and lung
functioning.
In one study, exercise meant the difference between life and death for middle-aged
and older adults (Blair & others, 1989). More than 10,000 men and women were
divided into categories of low tness, medium tness, and high tness (Blair & oth-
ers, 1989). Then they were studied over eight years. As shown in Figure 14.8, seden-
tary participants (low tness) were more than twice as likely to die during the
study’s eight-year time span than those who were moderately t, and more
than three times as likely to die as those who were highly t. The positive
effects of physical tness occurred for both men and women. Further,
another study revealed that adults aged 60 and over who were in the low-
est fth in terms of physical tness as determined by a treadmill test were
four times more likely to die over a 12-year period than their counterparts who
were in the top fth of physical tness (Sui & others, 2007). This study also showed
that older adults who were overweight but physically t had a lower mortality risk
over the 12 years than their normal-weight counterparts who were low in tness (Sui
& others, 2007). In addition, a longitudinal study found that men who exer-
cised regularly at 72 years of age had a 30 percent higher probability of
being alive at 90 years of age than their sedentary counterparts (Yates &
others, 2008).
H e a l t h e x p e r t s r e c o m m e n d t h a t a d u l t s e n g a g e i n a t l e a s t 3 0 m i n u t e s o f
moderate physical activity on most, preferably all, days of the week and that
exercise
Structured
activities whose
goal is to im-
prove health.
aerobic exercise
Sustained
activity—jogging,
swimming, or
cycling, for
example—that
stimulates heart
and lung
functioning.
FIGURE 14.7 The Jogging Hog
Experiment Jogging hogs reveal the dramatic
effects of exercise on health. In one investigation,
a group of hogs was trained to run approximately
100miles per week (Bloor & White, 1983). Then
the researchers narrowed the arteries that supplied
blood to the hogs’ hearts. The hearts of the jogging
hogs developed extensive alternate pathways for
blood supply, and 42 percent of the threatened
heart tissue was salvaged, compared with only
17percent in a control group of non-jogging hogs.
Fi t n ess
her e r ef er s t o
the bodys ability to supply fuel
dur i ng sust ai ned physi cal act i v i t y .
Make t i me in your day t o
ex er ci se. I t mi ght mean waki ng up
ear l i er or f or goi ng wat chi ng T V.
The benef i t s ar e wel l wor t h i t .
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Toward a Healthier Body (and Mind): Behaving as If Your Life Depends upon It // 535
PSYCHOLOGICAL INQUIRY
FIGURE 14.8 Physical Fitness and Mortality This graph
presents the results of an eight-year longitudinal study of more than 10,000
men and women (Blair & others, 1989). The horizontal, or X, axis shows the
participants divided by their levels of tness as well as their sex. The verti-
cal, or Y, axis shows the death rates. > Which groups had the highest and
lowest death rates? > Comparing the results for men and women, what
role does biological sex play in mortality? > This is a correlational study,
so causation cannot be assumed. What third variables (see Chapter 1)
might explain the results?
0
10
20
40
60
30
50
70
Low Medium
Fitness category
High
Age-adjusted death rate per 10,000 persons
Women
Men
children exercise for 60 minutes daily. Most
specialists advise that exercisers raise their
heart rate to at least 60 percent of their max-
imum rate. Only about one- fth of adults
areactive at these recommended levels. Fig-
ure 14.9 lists physical activities that qualify
as moderate and, for comparison, vigorous.
Research suggests that both moderate and
intense activities may produce important
physical and psychological gains and improve
quality of life (Focht, 2012).
One often-welcome payoff for increasing
physical activity is weight loss. Frequently,
researchers have found that the most effective
component of weight-loss programs is regular
exercise (Stehr & von Lengerke, 2012). Another
way to combat weight problems is through
changes in diet.
Eating Right
Americans’ biggest health risk is being over-
weight or obese. The Centers for Disease Con-
trol and Prevention (CDC) uses the labels
“overweight” and “obese” for ranges of weight
that are greater than what experts consider
healthy for an individual’s height (CDC,
2012c). In recent years, the percentage of overweight or obese individuals has been
increasing at a stunning rate. In 1960, less than 50 percent of U.S. adults were overweight
Walking briskly (34 mph)
Cycling for pleasure or
transportation (10 mph)
Swimming, moderate effort
Conditioning exercise, general
calisthenics
Racket sports, table tennis
Golf, pulling cart or carrying clubs
Canoeing, leisurely (2.03.9 mph)
Home care, general cleaning
Mowing lawn, power mower
Home repair, painting
Walking briskly uphill or with a load
Mode rate Vigorous
Cycling, fast or racing (>10 mph)
Swimming, fast treading crawl
Conditioning exercise, stair ergometer,
ski machine
Racket sports, singles tennis, racketball
Golf, practice at driving range
Canoeing, rapidly (4 mph)
Moving furniture
Mowing lawn, hand mower
Fix-up projects
FIGURE 14.9 Moderate and Vigorous Physical Activities At minimum, adults should strive for 30 minutes of moderate activity each day. That
activity can become even more bene cial if we “pump it up” to vigorous.
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536 // CHAPTER 14 // Health Psychology
Environments That Support Active Lifestyles
F
rench food—featuring delicious cheeses, heavy sauces, and buttery pastries—is one of the
richest cuisines on the planet. Yet the obesity rate in France is 11.5 percent, which ranks
28th among nations in a report by the Organisation for Economic Co-operation and Development
(OECD, 2012). In comparison, the United States ranks rst, with nearly 34
percent of the population qualifying as obese. Part of the gap may be due
to differences in food portions (Rozin & others, 2003), but another factor is
how people get to their food. In the United States grocery shopping typi-
cally involves a trip in a car, whereas in France individuals are more likely to
walk or ride a bicycle (Ferrières, 2004).
A major obstacle to promoting exercise in the United States is that many
U.S. cities are not designed in ways that promote walking or cycling. Advo-
cates for change say that by making life too easy and too accommodating
tocars and drivers, urban designers have created an obesogenic (obesity-
promoting) environment—a context where it is challenging for people to
engage in healthy activities (Henderson, 2008; Lydon & others, 2011). Countries such as the
Netherlands and Denmark have adopted urban planning strategies that promote walking and biking
and discourage car use. In the Netherlands, 60 percent of all journeys taken by people over age
60 are by bicycle (Henderson, 2008).
Environmental contexts that invite physical activity increase activity levels. For example, one
quasi-experimental study examined the effects of changes to the physical environment on activity.
The study focused on an urban neighborhood in which a greenway (a biking and walking trail) was
retrofi tted to connect with pedestrian sidewalks. Researchers counted the number of people outside
engaging in physical activity in that neighborhood for a two-hour period at various times over two
years. Compared to two other similar neighborhoods, the neighborhood with the trail featured more
people walking and biking (Fitzhugh, Bassett, & Evans, 2010). Environmental characteristics that
welcome physical activity are also associated with health and wellness. In one study, elderly peo-
ple who lived near parks, tree-lined streets, and areas for taking walks showed higher longevity
over a ve-year study period (Takano, Nakamura, & Watanabe, 2002).
Other aspects of city design can infl uence obesity rates, including access to nutritious foods
(Lydon & others, 2011) and the perceived safety of neighborhoods (Eisenstein & others, 2011). By
shedding light on how environmental factors infl uence healthy lifestyles, research on human behav-
ior can meaningfully impact public policy.
PSYCHOLOGY IN OUR WORLD
or obese, and this gure changed little from 1960 to 1980. However, as Figure 14.10
illustrates, from 2009 to 2010, 69 percent of U.S. adults were overweight or obese, with
35 percent of those in the obese category (Flegal & others, 2012). In the relevant study,
females were less likely to be overweight or obese than were males (64 percent versus
74 percent). And when non-Latino White, African American, and Latino adult females
and males were compared, African American females and Latino males were the most
overweight or obese (82 percent), while non-Latino White females (59.5 percent) were
the least overweight or obese.
E x e r c i s i n g r e g u l a r l y i s o n e g r e a t w a y t o l o s e w e i g h t . M a k i n g h e a l t h y d i e t a r y c h o i c e s
is another (Corsica & Perri, 2013; Nicklas & others, 2012). Eating right means selecting
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Toward a Healthier Body (and Mind): Behaving as If Your Life Depends upon It // 537
sensible, nutritious foods that maximize health and wellness. Despite our seemingly
boundless food options, many of us are unhealthy eaters. We take in too much sugar and
not enough foods high in vitamins, minerals, and ber, such as fruits, vegetables, and
grains. We eat too much fast food and too few well-balanced meals—choices that increase
our fat and cholesterol intake, both of which are implicated in long-term health problems
(Barnes & Kimbro, 2012).
H e a l t h y e a t i n g m e a n s i n c o r p o r a t i n g t a s t y , h e a l t h y f o o d s i n t o m e a l s a n d s n a c k s . H e a l t h y
eating is not just about weight loss but also about committing to lifelong healthy food
habits. Several health goals can be accomplished through a sound nutritional plan. Not
only does a well-balanced diet provide more energy, but it also can lower blood pressure
and lessen the risk for cancer (Eguchi & others, 2012; Eheman & others, 2012). Two
recent studies totaling more than 110,000 U.S. adults found that a high level of red meat
consumption was linked to an increased risk of earlier death due to cardiovascular disease
and cancer (Pan & others, 2012).
Losing weight and opting for healthier foods can be dif cult, especially when one is
just starting out. Many weight-loss fads promise weight loss with no effort, no hunger,
and no real change in one’s food consumption. These promises are unrealistic. Making
genuine, enduring changes in eating behavior is hard work—but this does not mean that
pessimism is required. Rather, positive expectations and self-ef cacy are important
because the task at hand is challenging.
The National Weight Control Registry is an ongoing study of people who have lost
at least 40 pounds and kept it off for at least two years. Research on these suc-
cessful dieters gives us important tips on how people who keep the weight off
achieve this goal (L. G. Ogden & others, 2012; Raynor & others, 2005). Suc-
cessful dieters show consistency in what they eat, sticking to the same regimen
even on weekends and during holidays (Gorin & others, 2004). A study of
approximately 2,000 U.S. adults found that exercising 30 minutes a day, planning
meals, and weighing themselves daily were the main strategies of successful dieters
(Kruger, Blanck, & Gillespie, 2006).
The truth is that keeping weight off is an ongoing process. Moreover, the longer
a dieter keeps the weight off, the less likely he or she is to gain it back (McGuire
& others, 1999). Further, recent research suggests that making small changes in
the availability of junk food can have an impact on eating and weight (Rozin &
others, 2011).
Percent
70
10
0
20
30
40
50
60
1960
1962
1971
1974
1976
1980
1988
1994
2003
2004
1999
2000
2005
2006
2007
2008
2009
2010
Year
Overweight including obese,
20–74 years
Obese, 20–74 years
PSYCHOLOGICAL INQUIRY
FIGURE 14.10 Changes in the
Percentage of U.S. Adults 20 to 74
Years of Age Classified as Over-
weight or Obese, 1960–2010 Being
overweight or obese poses the greatest overall
health risk for Americans today. In this graph,
the vertical, or Y, axis shows the percentage of
people considered overweight or obese, and
the horizontal, or X, axis shows the years for
these values. > Thinking of these lines as
data points, is time positively or negatively
correlated with overweight/obesity? Why?
> Find the year of your birth on the X axis.
How has the body weight of Americans
changed during your lifetime? > What years
show the steepest rise in weight gain? What
factors might explain this increase?
On e k e y p r a c t i c e i s e at i n g
br eakf ast , especi al l y whol e- gr ai n
cer eal s.
So, j ust don t buy
the junk food! If it is not
ar ound, you won t eat i t .
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538 // CHAPTER 14 // Health Psychology
Quitting Smoking
Another health-related goal is giving up smoking. Evidence
from a number of studies underscores the dangers of smoking
and being around smokers (American Cancer Society, 2012).
For example, smoking is linked to 30 percent of cancer
deaths, 21 percent of heart disease deaths, and 82 percent of
chronic pulmonary disease deaths. Secondhand smoke is
implicated in as many as 9,000 lung cancer deaths a year.
Children of smokers are at special risk for respiratory and
middle-ear diseases (Accordini & others, 2012; Bisgaard,
Jensen, & Bonnelykke, 2012).
Fewer people smoke today than in the past, and almost
half of the living adults who ever smoked have quit. In 2010,
19.3 percent of all adults in the United States smoked, with
men being more likely to smoke (21.5 percent) than women (17.3 percent) (CDC,
2012a). Although these numbers represent a substantial decline from 40 years ago,
when 50 percent of men smoked, many individuals still smoke.
Quitting smoking has enormous health bene ts. Figure 14.11 shows that
when individuals kick the habit, their risk of fatal lung cancer declines over
time. There is little doubt that most smokers would like to quit, but their
nicotine addiction makes quitting a challenge. Nicotine, the active drug in
cigarettes, is a stimulant that increases the smoker’s energy and alertness, a
pleasurable and reinforcing experience. In addition, nicotine stimulates neu-
rotransmitters that have a calming or pain-reducing effect (Johnstone & oth-
ers, 2006).
Research con rms that giving up smoking can be dif cult, especially in
the early days of quitting (McCarthy & others, 2006). There are various ways
to quit (Cahill, Stead, & Lancaster, 2012; Sachs & others, 2012; Tahiri & others,
2012), including:
Going cold turkey: Some individuals succeed by stopping smoking without making
any major lifestyle changes. They decide they are going to quit, and they do. Lighter
smokers usually have more success with this approach than heavier smokers.
Using a substitute source of nicotine: N i c o t i n e g u m , t h e n i c o t i n e p a t c h , t h e n i c o t i n e
inhaler, and nicotine spray work on the principle of supplying small amounts of nico-
tine to diminish the intensity of withdrawal (Larzelere &
Williams, 2012). Nicotine gum, a v a i l a b l e w i t h o u t a p r e -
scription, delivers nicotine orally when an individual gets
the urge to smoke. The nicotine patch i s a n o n p r e s c r i p t i o n
adhesive pad that releases a steady dose of nicotine to the
individual. The dose is gradually reduced over an 8- to
12-week period. Nicotine spray d e l i v e r s a h a l f - m i l l i g r a m
squirt of nicotine to each nostril. The usual dosage is one
to two administrations per hour and then as needed to
reduce cravings. The spray is typically used for three to
six months. Success rates for nicotine substitutes are
encouraging. All of these nicotine replacement therapies
enhance the chances of quitting and remaining smoke-free.
Seeking therapeutic help: Some smokers get professional
help to kick the habit. Therapies for helping smokers quit
include prescribing medication such as antidepressants
and teaching behaviorally based therapeutic techniques.
Bupropion SR, an antidepressant sold as Zyban, helps
smokers control their cravings while they ease off nicotine.
Relative risk for
fatal lung cancer
10
15
5
0
5 5–9 10–14 15
Years since quitting
10.2
6.4
3.3
1.8
FIGURE 14.11 Fatal Lung Cancer
and Years Since Quitting Smoking One
study compared more than 43,000 former male
smokers with almost 60,000 males who had never
smoked (Enstrom, 1999). For comparison purposes,
a zero level was assigned as the risk for fatal
lung cancer for men who had never smoked. Over
time, the relative risk for former smokers declined,
but even after 15 years it was still above that of
nonsmokers.
If you smoke, quit.
Many smoker s bel i eve t hat t hey
have t o wai t f or t he per f ect
time to quita moment when life
is not st ressful. The t rut h is
that any moment is a good moment
to quit smoking. Every cigarette
you avoi d s moki ng i s a s t ep i n
the right direction.
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Toward a Healthier Body (and Mind): Behaving as If Your Life Depends upon It // 539
Zyban works at the neurotransmitter level in the brain by inhibiting the uptake of
dopamine, serotonin, and norepinephrine. Smokers using Zyban to quit have had a 21
percent average success rate after 12 months of taking the antidepressant (Paluck &
others, 2006), which is similar to results for individuals using nicotine replacement.
More recently, varenicline (trade name Chantix) was approved to help smokers quit.
This drug partially blocks nicotine receptors, reducing cravings and also decreasing
the pleasurable sensations of smoking. Varenicline, especially when combined with
counseling/psychotherapy, is more effective for smoking cessation than bupropion SR
(Garrison & Dugan, 2009).
N o o n e m e t h o d f o r q u i t t i n g s m o k i n g i s f o o l p r o o f ( F a n t & o t h e r s , 2 0 0 9 ) . O f t e n a
combination of approaches is the best strategy. Furthermore, quitting for good typically
requires more than one try, as the stages of change model suggests.
Practicing Safe Sex
One certainty in the human experience is that satisfying sexual experiences are part of
a happy life. Sexual behavior also has important implications for physical health. In
Chapter 9, we examined research ndings on unplanned pregnancy and on educational
approaches that can help prevent teen pregnancy. Here we look at another aspect of
sexuality: protecting oneself from sexually transmitted infections (STIs). Naturally, by
not having sex, individuals can avoid both unplanned pregnancy and STIs. However, even
for those whose goal is abstinence, knowledge about preventing unwanted pregnancy and
STIs is important, because as the stages of change model suggests, we sometimes fall
short of our goals.
P R O T E C T I N G A G A I N S T S E X U A L L Y T R A N S M I T T E D I N F E C T I O N S A
sexually transmitted infection (STI) is an infection that is contracted primarily through
sexual activity—vaginal intercourse as well as oral and anal sex. STIs affect about one
of every six adults (CDC, 2012d). Some STIs are bacterial in origin, as in the case of
gonorrhea and syphilis, and others are caused by viruses, as in the case of genital herpes
and AIDS. STIs are an important health concern because they can have implications for
a person’s future fertility, risk of cancer, and life expectancy.
No single STI has had a greater impact on sexual behavior in the past decades than
AIDS (Campbell, 2009). Acquired immune de ciency syndrome (AIDS) is caused by
the sexually transmitted human immunode ciency virus (HIV), which destroys the body’s
immune system. Without treatment, most people who contract AIDS are vulnerable to
germs that a normal immune system can destroy. Through 2009, 619,400 AIDS deaths
had occurred in the United States since the epidemic began, including more than 17,000
in 2009 (CDC, 2012b). In 2010, more than 47,000 new HIV infections were reported in
the United States.
Recent improvements in drug therapies have given rise to the view that AIDS is a
chronic rather than a terminal condition. However, responses to treatment vary among
individuals, and keeping up with the cocktail of drugs necessary to ght HIV continu-
ously is challenging. The treatment known as highly active antiretroviral therapy
(HAART) can involve taking between 6 and 22 pills each day, although the FDA has
approved the rst one-pill-per-day treatment for AIDS (Onen & others, 2009).
Because of increased education and improved drug therapies, deaths due to AIDS have
begun to decline in the United States (CDC, 2012b). There are no solid estimates for the
life expectancy of someone who is HIV-positive because the existing treatments have
been around for only about a decade. Even in this era of treatment advances, however,
AIDS remains incurable. Importantly, it has been estimated that as many as one-half of
HIV-positive individuals are not in treatment and that one- fth do not know that they
have contracted the virus (CDC, 2012b). Globally, HIV/AIDS rates have remained alarm-
ingly high. Recent estimates in 2010 indicate that approximately 34 million people
sexually transmitted
infection (STI)
An infection that is con-
tracted primarily through
sexual activity—vaginal
intercourse as well as oral
and anal sex.
acquired immune defi ciency
syndrome (AIDS)
A sexually transmitted infec-
tion, caused by the human
immunodefi ciency virus
(HIV), that destroys the
body’s immune system.
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540 // CHAPTER 14 // Health Psychology
worldwide are living with HIV. These data reveal increases of 8 million from 1990 and
of 27 million from 2000 (UNAIDS, 2012).
All sexually active people are at risk of contracting HIV and other STIs. The only
100 percent safe behavior is abstinence from sex, which many individuals do not
view as an option. Sensual activities such as cuddling, massage, and mutual
masturbation (without the exchange of bodily uids) present no risk of develop-
ing an STI. Sexual activities that involve penetration, including vaginal or anal
intercourse as well as oral sex, are riskier behaviors that can be made less risky
with the use of proper protection.
In your own sexual experience, it may be dif cult to gauge the accuracy of
a partner’s estimates of risk and his or her HIV status. The wisest course is always
to protect yourself from infection by using a latex condom. When correctly used, latex
condoms help to block the transmission of many STIs. Condoms are most effective in
preventing gonorrhea, syphilis, chlamydia, and AIDS. Research suggests that consistent
condom use also signi cantly reduces the risk that males will transmit to their female
partners the human papilloma virus (HPV), some types of which can cause cervical
cancer (Miksis, 2008). Although condoms are less effective against the spread of herpes
than against other STIs, consistent condom use reduces the risk of herpes infection for
both men and women (Stanaway & others, 2012).
Research has shown that safe-sex programs are especially effective if they include the
eroticization of condom use—that is, making condoms part of the sensual experience of
foreplay (Scott-Sheldon & Johnson, 2006). Analyses of HIV prevention programs (includ-
ing over 350 intervention groups and 100 control groups) by Dolores Albarracin and
her colleagues have produced important recommendations for the best ways to in uence
behavior (Albarracin, Durantini, & Earl, 2006; Albarracin & others, 2005, 2008; Durantini
& Albarracin, 2009, 2012). The studies have found that fear tactics are relatively less
effective and that programs emphasizing active skill building (for example, role playing
the use of condoms), self-ef cacy, and positive attitudes about condom use are success-
ful with most groups.
Anyone who t hi nks
that condom use is inconvenient
mi g h t w e l l c o n s i d e r w h i c h i s mo r e
conven i ent usi ng a con dom or
con t r act i n g gon or r hea or HI V.
1. Regular physical activity and, in particu-
lar, exercise are associated with all of
the following except
A. weight loss.
B. increased self-esteem.
C. less incidence of depression.
D. premature death in middle-age and
older adults.
2. The biggest health risk facing most
Americans today is
A. heart disease.
B. cancer.
C. overweight and obesity.
D. stress.
3. Typically, the best approach to quitting
smoking is to
A. go cold turkey.
B. use a nicotine patch.
C. use a combination of methods.
D. get help from a therapist.
APPLY IT! 4. J. C. and Veronica pro-
mote student health causes on their college
campus. This year, they are targeting wise
sexual choices. Which of the following is
the most promising strategy for their
campaign?
A. They should focus on fear of disease as
a motivator for condom use.
B. They should focus on promoting non-
risky sexual activities, eroticizing con-
dom use, and teaching students skills for
effective condom use, reminding stu-
dents that even if they do not intend to
have sex, it is best to be safe.
C. They should focus only on students who
are already engaging in sexual behavior.
D. They should encourage students, before
having sex, simply to ask their partners
how many sexual partners they have had.
I n t h i s d i s c u s s i o n o f h e a l t h p s y c h o l o g y , w e h a v e e x a m i n e d h o w t h e m e n t a l a n d p h y s i c a l
aspects of your existence intertwine and in uence each other. The eld of health psychol-
ogy illustrates how all of the various areas of psychology converge to reveal that interplay.
A s a h u m a n b e i n g , y o u a r e b o t h a p h y s i c a l e n t i t y a n d a s y s t e m o f m e n t a l p r o c e s s e s
that are themselves re ected in that most complex of physical organs, the brain. At every
6
Psychology and Your Good Life
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Summary // 541
moment, both body and mind are present and affecting each
other. Caring for your brain and mind—the resources that
make it possible for you to read this book, study for tests,
listen to lectures, fall in love, share with friends, help others,
and make a difference in the world—is worthy of being a life
mission.
Many pages ago, we de ned psychology as the scienti c
study of behavior and mental processes, broadly meaning the
things we do, think, and feel. Re ect for a moment on the
psychological dimensions of vision. When we studied the
human visual system, we examined the processes by which
those amazing sense organs, our eyes, detect color, light, dark,
shape, and depth. We probed the ways that the brain takes that
information and turns it into perception—how a pattern of
colors, shapes, and light come to be perceived as a ower, a
fall day, a sunset. Visual systems, we discovered, are generally
the same from one person to the next. Thus, you can memorize
the different parts of the human eye and know that your under-
standing is true for just about all the human eyes you will
encounter in life.
However, even something as deceptively simple as perceiv-
ing a sunset through the sense of vision becomes amaz-
ingly complex when we put it in the context of a
human life. Is that sunset the rst you see while on
your honeymoon, or right after a painful romantic breakup, or as a new par-
ent? Placing even the most ordinary moment in the context of a human life
renders it extraordinary and fascinating.
This fascination is a primary motivation for the science of psychology
itself. Humans have always pondered the mysteries of behavior, thought, and
emotion. Why do we do the things we do? How do we think and feel? In
this book, we have explored the broad range of topics that have interested
psychologists throughout the history of this young science.
Coming to the close of this introduction to psychology allows you to take
stock of what psychology has come to mean to you now, as well as to con-
sider what it might mean to you in the future. Whether or not you continue
coursework in psychology, this book has highlighted opportunities for your
future exploration about yourself and your world. In each of the real-life
examples of human experience described in these pages—moments of hero-
ism, weakness, joy, pain, and more—psychology has had a lesson to share
with respect to the person that is you. Making the most of what you have
learned about psychology means making the most of yourself and your life.
An experience as deceptively simple as taking
in and perceiving a sunset becomes stunningly
complex in the context of a human life.
Turn to the Table of Contents of this
book. Which chapter or topic did you
nd most interesting? Go to your
school’s library and locate the
journals that are devoted to that
subject (you can ask a librarian for
help). Browse a recent issue. What
specifi c topics are scientists studying?
If a particular study described in this
book sounded interesting, you can
probably obtain it online. Do a Google
“Scholar” search on the authors and
take a look at the original article.
What did the authors conclude?
What did you learn?
Health psychology and behavioral medicine bring the relationship of
the mind and body to the forefront. These approaches examine the re-
ciprocal mind–body relationship: how the body is in uenced by psycho-
logical states and how mental life is in uenced by physical health.
2 Making Positive Life Changes
The theory of reasoned action suggests that we can make changes by
devising speci c intentions for behavioral change. We are more likely to
follow through on our intentions if we feel good about the change and if
S U M M A R Y
1 Health Psychology and
Behavioral Medicine
Health psychology emphasizes biological, psychological, and social
factors in human health. Closely aligned with health psychology is be-
havioral medicine, which combines medical and behavioral knowledge
to reduce illness and promote health. These approaches demonstrate the
biopsychosocial model by examining the interaction of biological, psy-
chological, and social variables as they relate to health and illness.
Stress is an example of a biological, psychological, and social construct.
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542 // CHAPTER 14 // Health Psychology
we believe that others around us also support the change. The theory of
planned behavior incorporates these factors as well as our perceptions
of control over the behavior.
The stages of change model posits that personal change occurs in a
series of ve steps: precontemplation, contemplation, preparation/
determination, action/willpower, and maintenance. Each stage has its
own challenges. Relapse is a natural part of the journey toward change.
3 Resources for Effective Life Change
Motivation is an important part of sustaining behavioral change. Change
is more effective when people do it for intrinsic reasons (because they
want to) rather than extrinsic reasons (to gain rewards). Implementation
intentions are the speci c ways individuals plan to institute changes.
Social relationships are strongly associated with health and survival.
Social support refers to the aid provided by others to a person in need.
Support can take the form of tangible assistance, information, or emo-
tional support. Social support is strongly related to functioning and
coping with stress.
Religious faith is associated with enhanced health. One reason for
this connection is that religions often frown on excess and promote
healthy behavior. In addition, religious participation allows individuals
to bene t from a social group, and religion provides a meaning system
on which to rely in times of dif culty.
Personality characteristics related to positive health behaviors in-
clude conscientiousness, personal control, self-ef cacy, and optimism.
Conscientious individuals are likely to engage in healthy behaviors and
live longer. Personal control is associated with better coping with stress.
Self-ef cacy is the person’s belief in his or her own ability to master a
situation and produce positive outcomes. Optimism refers to a particular
explanatory style as well as to the inclination to have positive expecta-
tions for the future. Studies have shown that both of these types of opti-
mism relate to positive health outcomes.
4 Toward a Healthier Mind (and
Body): Controlling Stress
S t r e s s i s t h e r e s p o n s e o f i n d i v i d u a l s w h e n l i f e c i r c u m s t a n c e s t h r e a t e n
them and tax their ability to cope. Selye characterized the stress response
with his concept of a general adaptation syndrome (GAS), which has
three stages: alarm, resistance, and exhaustion.
Chronic stress takes a toll on the body’s natural disease- ghting
abilities. Stress is also related to cardiovascular disease and cancer.
To kick the stress habit means remembering that stress is a product
of how we think about events in our lives. Taking control of our apprais-
als allows us to see potentially threatening events as challenges. Hardi-
ness is associated with thriving during stressful times.
The Type A behavior pattern, particularly the hostility component, is
associated with stressing out angrily when things are going badly. This
hostility leads to poor health outcomes. There is growing interest in the
Type D behavior pattern, seen in individuals who experience general-
ized and frequent distress, negative emotions, and social inhibition; re-
search has associated this pattern with an elevated risk of cardiovascular
problems. When a person is unable to manage stress alone, stress man-
agement programs provide options for relief.
5 Toward a Healthier Body (and
Mind): Behaving as If Your Life
Depends upon It
E x e r c i s e h a s m a n y p o s i t i v e p s y c h o l o g i c a l a n d p h y s i c a l b e n e ts. Tips for
increasing one’s activity level include starting small by making changes in
ones routine to incorporate physical activity and keeping track of progress.
Overweight and obesity pose the greatest health risks to Americans
today. They can be largely avoided by eating right, which means select-
ing nutritious foods and maintaining healthy eating habits for a lifetime,
not just while on a diet. A combination of healthy eating and exercise is
the best way to achieve weight loss.
Despite widespread knowledge that smoking causes cancer, some
people still smoke. Methods of quitting include going cold turkey, using
a substitute source of nicotine, and seeking therapy. Quitting for good is
dif cult and usually takes more than one try. Usually a combination of
methods is the best strategy for quitting.
Practicing safe sex is another aspect of health behavior of interest to
health psychologists. Condoms help prevent both unwanted pregnancy
and the transmission of sexually transmitted infections (STIs). Interven-
tions to promote condom use are most successful when they include
making condom use sexy, promoting contraceptive skills and self-
ef cacy, and encouraging positive attitudes about condoms.
6 Psychology and Your Good Life
Psychology is all about you. This book has aimed to show the relevance
of psychology to your health and wellness and to help you appreciate
the many, and deep, connections between this comparatively new
science and your life.
health psychology, p. 514
behavioral medicine, p. 514
health behaviors, p. 515
theory of reasoned action, p. 516
theory of planned
behavior, p. 516
stages of change model, p. 516
relapse, p. 518
implementation intentions, p. 520
social support, p. 521
general adaptation syndrome
(GAS), p. 527
h y p o t h a l a m i c - p i t u i t a r y - a d r e n a l
axis (HPA axis), p. 527
psychoneuroimmunology, p. 527
Type A behavior pattern, p. 529
Type B behavior pattern, p. 529
Type D behavior pattern, p. 529
cognitive appraisal, p. 530
coping, p. 530
problem-focused coping, p. 531
emotion-focused
coping, p. 531
hardiness, p. 532
stress management
program, p. 532
exercise, p. 534
aerobic exercise, p. 534
sexually transmitted infection
(STI), p. 539
acquired immune de ciency
syndrome (AIDS), p. 539
K E Y T E R M S
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Self-Test // 543
S E L F -T E S T
Multiple Choice
1. If you are involved in the process of trying
to change a maladaptive behavior, the
stage in which you would most likely ex-
pend the most energy and effort is the
A. preparation stage.
B. contemplation stage.
C. action stage.
D. maintenance stage.
2. Individuals who have high self-effi cacy are
least likely to
A. carry on when faced with challenges.
B. expend effort in coping with stress.
C. experience less stress in challenging
situations.
D. perceive that they have no control over
the situation.
3. A distinct physiological pattern emerges
when people are exposed to strong and
prolonged stress. Selye labeled this
response pattern the
A. transactional stress response (TSR).
B. two-factor theory of stress.
C. general adaptation syndrome (GAS).
D. chronic stress response (CSR).
4. When a rat is fi rst introduced to an over-
crowded cage, it will likely enter the
_____ stage of the general adaptation
syndrome.
A. alarm
B. resistance
C. exhaustion
D. none of the above
5. Numerous research studies support the
idea that perhaps the most important
variable in predicting health is
A. life goals.
B. social ties.
C. consistent safe-sex practices.
D. independence.
6. Religious faith is related to health because
it promotes or is associated with all of the
following except
A. increased social support.
B. sturdy moral fi ber.
C. a sense of meaning in life.
D. moderation.
7. The aspect of Type A behavior that re-
search most consistently associates with
coronary problems is
A. neuroticism.
B. pessimism.
C. conscientiousness.
D. hostility.
8. According to the text, smoking contributes
to all of the following except
A. increased risk of middle-ear disease in
children.
B. death from cancer.
C. death from heart disease.
D. death from accidents.
9. A person who tries to quit smoking cold
turkey is
A. pairing unpleasant consequences (like
smoking until he or she feels nause-
ated) with the undesirable behavior
(smoking).
B. taking antipsychotic drugs.
C. trying to stop without making any
major lifestyle changes.
D. using nicotine substitutes.
10. The most probable reason that the United
States has one of the highest rates of
adolescent pregnancy in the developed
world is that
A. the contraceptive methods used by U.S.
adolescents have higher failure rates
than those used by adolescents in other
developed countries.
B. U.S. adolescents learn more about sex
through school programs than do ado-
lescents in other developed countries.
C. U.S. adolescents are more sexually
active than are adolescents in other
developed countries.
D. compared to other nations, the United
States has less comprehensive sex edu-
cation and less use and availability of
condoms.
Apply It!
11. Cory is interested in becoming more physi-
cally active. Using the stages of change
model, outline a plan for Cory to achieve
his goal.
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