HEALTH PSYCHOLOGY second australasian edition

� WILEY

hiopsychosocial interactions

EDWARD P. Sara fino The College of New Jersey

MARIE L. Caltabiano James Cook University

DON Byrne Australian National University

John Wiley &.. Sons Australia, Ltd

: ,J I

Second edition published 2008 by John Wiley & Sons Australia, Ltd 42 McDougall Street, Milton Qld 4064

First edition published 2002

Typeset in 10/12 pt Berkeley

Australian editions © John Wiley & Sons Australia, Ltd 2002, 2008

Authorised adaptation of Health Psychology 3e (ISBN 978 0 471 169 17 8) , published by John Wiley & Sons, Inc. , New York, United States of America. © 1997 in the United States of America by John Wiley & Sons Inc. All rights reserved.

The moral rights of the authors have been asserted.

National Library of Australia Cataloguing-in-Publication data

Caltabiano, Marie, 1959-Health psychology: biopsychosocial interactions. Second Australasian edition

Includes index. Bibliography.

ISBN 978 0 470 81345 4 (pbl<.)

Marie L Caltabiano; Don Byrne; Edward P. Sarafino. 2nd ed. Clinical health psychology. Psychology. Byrne, D. G. (Donald Glenn) Sarafino, Edward P., 1940-

616.0019

Reproduction and communication for educational purposes The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of the pages of this work, whichever is the greater, to be reproduced andlor communicated by any educational institution for its educational purposes provided that the educational institution (or the body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) .

Reproduction and communication for other purposes Except as permitted under the Act (for example, a fair dealing [or the purposes of study, research, criticism or review) , no part of this book may be reproduced, stored in a retrieval system, communicated or transmitted in any form or by any means without prior written permission. All inquiries should be made to the publisher.

Cover and internal design images: photodisc; © 2002 Digital Vision

Edited by Catherine Spedding

Printed in Singapore by Markono Print Media Pte Ltd

10 9 8 7 6 5 4 3 2 1

To my parents AIfio and Rosetta, and my uncle Albert.

In memory and gratitude.

Marie L. Caltabiano

PART 1

Chapter 1

Chapter 2

PART 2

Chapter 3

Chapter 4

Chapter 5

PART 3

Chapter 6

Chapter 7

Chapter 8

PART 4

Chapter 9

Chapter 10

PART 5

Chapter 11

Chapter 12

PART 6

Chapter 13

Chapter 14

PART 7

Chapter 15

An introduction: basic issues and processes 1

An overview of psychology and health 2

The body's physical systems 45

Stress, illness and coping 85

Stress - its meaning, impact and sources 86

Stress, biopsychosocial factors and illness 130

Coping with and reducing stress 178

Lifestyles to enhance health and prevent illness 213

Health-related behaviour and health promotion 214

Reducing substance use and abuse 272

Improving nutrition, weight control and diet, physical activity and safety 323

Becoming ill and getting medical treatment 373

Using health services 374

In the hospital: the setting, procedures and effects on patients 420

Physical symptoms: pain and discomfort 459 -

The nature and symptoms of pain 460

Managing and controlling clinical pain 498

Chronic and life-threatening health problems 533

Serious and disabling chronic illnesses: causes, management and coping 534

Heart disease, stroke, cancer and AIDS: causes, management and coping 575

Looking to the future 623

What's ahead for health psychology? 624

Preface xii FootS on research

To the student xv / The Australian Longitudinal Study of Ageing 40

About the authors xvii Genetics research 41

Acknowledgements xviii

PART 1 An introduction: basic

issues and processes 1

Chapter 1 An overview of psychology and health 2

What is health? 3

An illness/wellness continuum 4

Illness today and in the past 5

Viewpoints from history: physiology, disease processes

and the mind 8

Early cultures 8

Ancient Greece and Rome 8

The Middle Ages 9

The Renaissance and after 10

Seeing a need: psychology's role in health 11

Overcoming problems with the Australian health

care system 11

The person' in health and illness 12

A Assess yourself

• How health conscious are you? 14

How the role of psychology emerged 15

Health psychology in Australia 18

Where is health psychology taught in Australia? 22

Current perspectives on health and illness 22

The biopsychosocial perspective 22

The life-span perspective 26

Relating health psychology to other science fields 27

Related fields 27

Health and psychology across cultures 28

Highlight on issues

Careers relating to health and psychology 30

Research methods 33

Experiments 33

Correlational studies 36

Quasi-experimental studies 37

Which research method is best? 42

Summary 42

Chapter 2 The body's physical systems 45

The nervous system 46

How the nervous system works 46

The central nervous system 48

The peripheral nervous system 53

The endocrine system 56

The endocrine and nervous systems working

together 56

Adrenal glands 57

Other glands 57

The digestive system 58

Food's journey through digestive organs 58

HigltligJlt on issues

Our physiological individuality 60

Using nutrients in metabolism 62

The respiratory system 64

The respiratory tract 64

A Assess yourself

• How many calories do you bum while resting? 65

Respiratory function and disorders 65

The cardiovascular system 66

The heart and blood vessels 67

Blood pressure 68

Blood composition 70

Cardiovascular disorders 71

The immune system 72

Antigens 72

The organs of the immune system 73

Soldiers of the immune system 74

Highlight on issues

When the immune system turns on itself 76

Defending the body with an immune response 77

Less-than-optimal defences 78

The reproductive system and heredity 79

Conception and prenatal development 79

Genetic processes in development and health 79

FootS on research

/ Immunity and ageing 81

Summary 83

PART 2 Stress, illness and

coping 85

Chapter 3 Stress - its meaning, impact and

sources 86

Experiencing stress in our lives 88

What is stress? 88

Appraising events as stressful 91

Biopsychosocial aspects of stress 94

Biological aspects of stress 94

Psychosocial aspects of stress 96

Sources of stress throughout life 100

Sources within the person 101

Sources in the family 102

Sources of stress in the community and

society 105

Highlight on issues

The burden of caregiving 106

FoatS on research

/ Occupational stress in Australia 108

Measuring stress no

Physiological arousal 110

Psychological symptoms of distress III

FoatS on research

/ Stress and measures of phYSiological arousal 112

Life events - or stressors 114

Daily hassles 119

Disaster and traumatic events 121

Psychosocial responses to disaster and trauma

Can stress be good for you? 124

Q Assess yourself

• Hassles in your life 126

Summary 128

[ vi 1 C O N T E NTS

121

Chapter 4 Stress, biopsychosocial factors and

illness 130

Psychosocial modifiers of stress 132

Social support 132

Q Assess yourself

• How much social support do you get? 139

A sense of personal control 143

A hardy personality 149

Type A and Type B behaviour patterns 153

How stress affects health 161

Stress, behaviour and illness 162

Stress, physiology and illness 162

Highlight on issues

Sudden 'voodoo' death 163

Psychoneuroimmunology 164

Psychophysiological disorders 167

Digestive system diseases 167

Asthma 168

Chronic headache 169

Other disorders 169

Stress and cardiovascular disorders 170

HypertenSion 171

FootS on research

/ Reactivity and hypertension: a meta-analysis 173

Coronary heart disease 174

Stress and cancer 175

Summary 176

Chapter 5 Coping with and reducing stress 178

Coping with stress 179

What is coping? 179

Functions and methods of coping 180

Q Assess yourself

• Your focuses in coping 182

Reducing the potential for stress 188

Enhancing social support 188

Improving one's personal control 190

Organising one's world better 190

Highlight on issues

Coping with telTorism 191

Exercising: links to stress and health

Preparing for stressful events 193

191

Reducing stress reactions: stress management 195

Medication 195

Behavioural and cognitive methods 195

FootS on researdl

/ Stl'ess management at the population level 203

Massage, meditation and hypnosis 204

Using stress management to reduce coronary risk 206

Modifying Type A behaviour 206

Treating hypertension 209

Minimising risk of cardiac recurrence 210

Summary 211

PART 3 Lifestyles to enhance health

and prevent illness 213

Chapter 6 Health-related behaviour and health

promotion 214

Health and behaviour 215

Lifestyles, risk factors and health 216

Interdisciplinary perspectives on preventing

illness 220

G HighligJlt on issues

, Two health behaviours: breast and testicular

examinations 22 1

Problems in promoting wellness 224

What determines people's health-related

behaviour? 226

General factors in health-related behaviour 226

The role of beliefs and intentions 229

The role of less rational processes 238

Developmental, gender and sociocultural factors

in health 241

Development and health-related behaviour 241

Gender and health-related behaviour 245

Sociocultural factors and health-related

behaviour 246

Programs for health promotion 248

Methods for promoting health 248

Promoting health in schools 254

Workplace health promotion 255

G Highlight on issues

, Indigenous childrens health 257

Community health promotion 258

Prevention with specific targets: community and

school approaches in the prevention of obesity 261

FoOtS on research

/ Socioeconomic status and food purchaSing 264

Prevention with specific targets: fOCUSing on

AIDS 265

A Assess yourself

• Your knowledge about AIDS 266

Summary 270

Chapter 7 Reducing substance use and abuse 272

Substance abuse 273

Addiction and dependence 273

Processes leading to dependence 274

Smoking tobacco 276

Who smokes? 277

How much smokers smoke 279

Why people smoke 279

Smoking and health 285

Highlight 011 issues

Does someone elses smoking affect your

health? 288

Preventing smoking 289

Quitting smoking 291

Alcohol use and abuse 298

Who drinks, and how much? 299

A Assess yourself • Whats true about drinking? 300

Why people use and abuse alcohol 302

A Assess yourself

• Do you abuse alcohol? 303

Drinking and health 304

FoOtS 011 researdl

/ How does heredity lead to alcohol abuse? 305

Preventing alcohol abuse 307

Treatments for alcohol abuse 308

Drug use and abuse 314

Highlight on issues

Types and effects of drugs 315

Who uses drugs, and why 316

Drug use and health 318

Preventing and stopping drug abuse 318

Summary 320

C O N TE NTS [vii 1

Chapter 8 Improving nutrition, weight control and diet,

physical activity and safety 323

Nutrition 324

Components of food 325

What people eat 326

Nutrition and health 329

FoaLS on research

/ Interventions to improve dietary components 332

Weight control and body image 333

FoaLS on research

/ Messages to prevent body dissatisfaction 337

Overweight and obeSity 337

Dieting and treatments to lose weight 346

A Assess yourself

• How do you score on eating efficacy? 347

Anorexia and bulimia 352

A Assess yourself

• Your weight control patterns 353

Physical activity 358

The health effects of exercise 358

Highlight on issues

Types and amounts of healthy exercise 360

Who gets enough physical acttvity, who does not -

and why 362

Promoting physical activity 364

Safety and harm reduction 366

Accidents 366

Environmental hazards 367

Summary 370

PART 4 Becoming ill and getting medical treatment 373

Chapter 9 Using health services 374

Types of health services 375

Specialised functions of practitioners 375

Office-based and in-patient treatment 376

The Australian health care system 377

The New Zealand health and disability system 378

Health care systems in other countries 379

Perceiving and interpreting symptoms 380

Perceiving symptoms 381

[ viii 1 CO NIE NIS

Interpreting and responding to symptoms 384

FOOlS on research

/ People� ideas about illness 386

Illness cognition and self-regulation 387

Using and misusing health services 389

Who uses health services? 389

Why people use, don't use and delay using health

services 392

Using complementary and alternative

medicine 394

Misusing health services 396

FoaLS on research

/ Neuroticism and symptom presentation 397

The patient-practitioner relationship 398

Patient preferences for participation in medical

care 398

The practitioner's behaviour and style 400

HighligJlt on issues

Fighting for your life 401

The patient's behaviour and style 403

A Assess yourself

• Do you know what medical terms mean? 403

Adherence: adhering to medical advice 405

Extent of the non-adherence problem 405

Why patients do and do not adhere to medical

advice 407

Patient-practitioner interactions 412

Increasing patient adherence 414

Summary 417

Chapter 10 In the hospital: the setting, procedures

and effects on patients 420

The hospital - its history, setting and

procedures 421

How the hospital evolved 422

The organisation and functioning of hospitals 423

Roles, goals and communication 424

A Assess yourself

• Who� who in physician care 425

The funding of medical services 427

Being hospitalised 429

Relations with the hospital staff 429

Sick-role behaviour in the hospital 431

Focus on research

/ Burnout among health care professionals 431

Patient satisfaction 436

Emotional adjustment in the hospital 436

Coping processes in hospital patients 437

Preparing patients for stressful medical

procedures 440

c; Highlight on issues

, Lamaze training as a method of psychological

preparation for a medical procedure 446

When the hospitalised. patient is a child 447

How health psychologists assist hospitalised

patients 453

Initial steps in helping 453

Tests for psychological assessment of medical

patients 454

Promoting patients' health and adjustment 455

Summary 456

PART 5 Physical symptoms:

pain and discomfort 459

Chapter 11 The nature and symptoms of pain 460

What is pain? 461

The qualities and dimensions of pain

Perceiving pain 464

G Highlight on issues

, Acute pain in burn patients 465

HigflligJlt on issues

462

Trauma and pain: the Bali bombing and its

aftermath 467

Theories of pain 470

Early theories of pain 470

The gate-control theory of pain 471

Focus Oll research

/ Inducing pain in laboratory research 471

Biopsychosocial aspects of pain 476

Neurochemical transmission and inhibition

of pain 476

Personal and social experiences and pain 478

G Highlight Oll issues

, Placebos and pain 479

Emotions, coping processes and pain 482

Assessing people's pain 486

Self-report methods 486

Behavioural assessment approaches 489

Q Assess yourself

• DeSCJibing your pain 490

Psychophysiological measures 493

Pain in children 494

Pain and children's sensory and cognitive

development 494

Assessing pain in children 495

Summary 496

Chapter 12 Managing and controlling clinical pain 498

Clinical pain 499

Acute clinical pain 500

Chronic clinical pain 500

Medical treatments for pain 501

Surgieal methods for treating pain 502

Chemical methods for treating pain

1 Highlight Oll issues

Types of pain-relieving chemicals

Behavioural and cognitive methods for

treating pain 507

The operant approach 507

Relaxation and biofeedback 508

Cognitive techniques 512

Focus Oll research

502

504

/ How durable are the effects of psychological

treatments for pain? 513

Preparation for events with potentially painful

consequences 518

Q Assess yourself

• Would behavioural or cognitive methods help

your pain? 519

Hypnosis and insight-oriented psychotherapy 520

Hypnosis as a treatment for pain 521

InSight therapy for pain 522

Physiotherapy and stimulation therapies

for pain 524

Stimulation therapies 524

Physiotherapy 526

Pain clinics 527

Multidisciplinary programs 527

CO NTE NTS [ ix 1

Highlight on issues

Physical activity and bach pain 528

Evaluating the success of pain clinics 529

Summary 530

PART 6 Chronic and life-threatening health problems 533

Chapter 13 Serious and disabling chronic illnesses:

causes, management and coping 534

Adjusting to a chronic illness 535

Initial reactions to having a chronic

condition 536

Influences on coping with a health crisis 537

The coping process 541

Impacts of different chronic conditions 543

Asthma 544

Epilepsy 548

C;; Hig'dig'lt on issues

, What to do for a seizure 549

Nervous system injuries 550

Diabetes 553

A Assess yourself

• Do you have diabetes?

Highlight on issues

Self-managing diabetes

Arthritis 561

Alzheimer's disease 564

556

559

Psychosocial interventions for people with chronic conditions 567

Education and support services 569

Relaxation and biofeedback 570

Cognitive approaches 571

Insight therapy 571

Family therapy 571

FoalS on researdl

/ Cognitiveibehaviotlral approaches in managing

arthritis 572

Summary 573

[X 1 CO NTENTS

Chapter 14 Heart disease, stroke, cancer and AIDS:

causes, management and coping 575

Coping with and adapting to high-mortality illness 577

Adapting while the prospects seem good 577

Adapting in a recurrence or relapse 578

Heart disease 579

Who is at risk of heart disease, and why? 580

Medical treatment and rehabilitation of cardiac

patients 582

The psychosocial impact of heart disease 585

Psychosocial interventions for heart disease 587

Stroke 588

Causes, effects and rehabilitation of stroke 588

Psychosocial aspects of stroke 592

Cancer 593

/

The prevalence and types of cancer 594

The sites, effects and causes of cancer 594

Diagnosing and treating cancer 597

The psychosocial impact of cancer 599

FOOlS on research

Coping with chemotherapy and its side effects 601

Psychosocial interventions for cancer 602

G Highlight on issues

, Can patients 'will away' their cancer? 604

Childhood cancer 604

AIDS 605

Risk factors, effects and treatment of AIDS 605

The psychosocial impact of AIDS 608

Psychosocial interventions for AIDS 609

Adapting to a terminal illness 610

The patient's age 610

Psychosocial adjustments to terminal illness 612

The quality of life in death 614

Medical and psychological care of dying

patients 615

A Assess yourself

• Your living will choices 616

A place to dieL hospital, home or hospice? 617

The survivors: and life goes on 619

Summary 621

PART 7 Looking to the future 623

Chapter 15 What's ahead for health psychology? 624

Goals for health psychology 625

Enhancing illness prevention and treatment 625

Improving efforts for helping patients cope 628

Documenting the efficacy and cost-benefit ratio

of care 628

Enhancing psychologists' acceptance in medical

settings 630

Careers and training in health psychology 631

Career opportunities 632

Training programs 632

Issues and controversies for the future 633

Environment, health and psychology 633

Quality of life 634

Ethical decisions in medical care 635

Future focuses in health psychology 638

Critical health psychology 638

Q Assess yourself

• Some ethical dilemmas: what do you thinh? 639

Life-span health and illness 640

FoolS on l'esearcJt

/ Treating infant sleep disturbance (ISD) - the

Canterbwy Infant Sleep Project 641

Sociocultural factors in health 642

Gender differences and women's health issues 643

Factors affecting health psychology's future 643

Summary 644

Appendix 646

Glossary 647

References 657

Index 745

CO NTE NTS [ x i 1

[ xii 1 PREFA CE

I t was with great enthusiasm and pleasure that we embarked on wntmg this second Australasian edition of Health Psychology. When I (Marie Caltabiano) was originally approached by John Wiley Australia to write an Australasian adaptation of Edward Sarafino's Health Psychology: Biopsychosocial Interactions, I was extremely excited and felt very privi­leged to be involved in the project. I have taught health psychology in the psychology degree program atJames Cook University since 1992, and have also taught variations of the subject to nursing science and social work students. While I have adopted several different texts for these courses, I have often returned to Sara fino's book. This widely respected text is comprehensive, easy to read and well liked by students. Over time, however, I came to recognise the need for a text that was relevant to the experience of students in Australia and the neighbouring region. Students needed a resource book that was similarly comprehen­sive, but that cited up-to-date Australian and New Zealand statistics on disease incidence and prevalence, discussed the Australian health care system and the New Zealand Health and Disability System, examined the findings of national surveys, reviewed Australian health promotion programs and discussed studies by Australasian researchers.

The objective of this second Australasian edition has been to update Sara fino's text with recent research conducted both within Australia and internationally. We have incorporated Australian and New Zealand statistics (for example, on disease and mortality incidence, and health risk) and documented Australian health programs and research conducted by health psychologists, public health researchers and those working in related fields.

Our task was facilitated by the wealth of creative ideas and innovative research in Australia and the nearby region coming out of professions such as public health, psychology and nursing. Although it was not possible to incorporate all these ideas, I believe that the research included represents the high quality of work being done in Australia and New Zealand.

This second edition still retains historical material on infectious diseases during the early settlement of Australia, trends over time in eating, drinking and smoking patterns, an historical account of hospitals in Australia and the organisational structure within hospi­tals, along with anecdotal data and the recounted experiences of well-known Australians. Also retained are the sections unique to the original text adaptation, such as psychosocial responses to disaster and traumatic events (chapter 3); social support as transactional process (chapter 4); applications of the theories of reasoned action and planned behaviour (chapter 6); and the use of the PRECEDE/PROCEED model as a guiding framework for health promotion in community health psychology (chapter 6). New to the second edition are recent smoking, drug and alcohol statistics for Australia and New Zealand, and preva­lence rates for obesity and physical inactivity in the region. Also included in this edition is new material on stress (chapter 3) and social support (chapter 4); prevention with specific targets: focusing on community and school approaches in the prevention of obesity (chapter 6); overweight and body image (chapter 8); the New Zealand health and disabil­ity system, illness cognition and self-regulation (chapter 9); and advances in research and theory, technology and medical research, and critical health psychology (chapter 15). Other features include new prologues to chapters; Australasian research canvassed in the 'Focus on research' vignettes of respective chapters; the latest international research; Significant and recent national health promotion initiatives; contemporary health issues; examples of applied theory in randomised controlled trials and interventions; recent global threats to health; and the psychological impact of terrorism. This new material serves to complement Sarafino while maintaining the integrity of the original text.

One additional theme makes this book unique - namely, its sustained focus on life­span development in health and illness. The book discusses how health and health-related behaviour change with age, and describes health care issues and examples that pertain to pediatric and elderly patients. With the increasing trend towards an elderly population in Australia and neighbouring countries, throughout the book you will find examples of research specifically on the elderly; for example, immune functioning in older persons (chapter 2), and social support systems of elderly Australians (chapter 1). At the other end of the lifespan, health issues such as infant sleep disturbance and its treatment are considered. Developmental trajectories in smoking, drinking and drug usage are described in chapter 7.

The biopsychosocial model remains the basic explanatory theme for understanding the whole person in health and illness. The components of the model interrelate in a dynamic and continuous fashion, consistent with the concept of systems. The psychological research cited reflects an eclectic orientation and supports a variety of behavioural, physiological, cognitive and social-personality viewpoints. In addition, gender and sociocultural differ­ences in health and related behaviours are addressed at many points in the book. In these ways, this book presents a balanced view of health psychology, positioning it squarely in the mainstream of current thinking in the field.

Health Psychology: Biopsychosocial Interactions, second Australasian edition draws on the research and theoretical perspectives of many disciplines to illustrate the inter­relationship of psychology and health. This depth makes it a teaching resource suitable for undergraduate and postgraduate courses on health psychology or behavioural medicine taught within psychology degree programs, nursing science or medicine. The material will be relevant and interesting to students from diSCiplines other than psychology, such as public health, nursing, medicine, allied health and social work. Undergraduate training in health psychology has developed rapidly and can play an important role in helping students from many disciplines to understand the interplay of biological, psychological and social factors in people's health. The text, and the exhaustive bibliography, will also be a valuable resource for practitioners and researchers in allied health professions.

The field of health psychology is exciting because of its relative infancy in Australia. It can be seen as a focal point for the application of psychological principles and psycho­logical theory emanating from many other fields within psychology. Health psychology is particularly interesting because of its relevance to the lives of students, the researchers who study biopsychosocial aspects of health and illness, and the people students will work with in the future. Researchers from many diSCiplines, including psychology, are uncover­ing fascinating relationships between behaviour and health, and learning more about the roles of cognition, emotion and personality in health, adjustment to medical conditions and rehabilitation. Keeping up to date across such a broad field has been a challenge. In ad­dition to some 2000 publications cited by Sarafino , close to another 1000, most published in the past few years, have been cited in this Australasian edition.

Writing this book has been both a major undertaking and a very rewarding experience. We have read more deeply in the literature than could possibly be acknowledged here, and we are greatly indebted to all those researchers whose work we have cited. As Sarafino has remarked, without their endeavours there would be no health psychology. Professor Don Byrne agreed to co-author this second edition and to offer his expertise, accrued over many years of working in this field. Thanks are extended also to Professor Paul Martin for his work on the original chapters 11 and 12.

PREFACE [xiii 1

[ xiv 1 PREFAC E

There are a number of other people whose contribution we would like to acknowledge. At John Wiley & Sons Australia, we are indebted to publishing editor Nina Crisp for her enthusiasm in the early stages of this project, and later to development editor Dan Logovik for his patience, encouragement and assistance in making this second edition possible. A special thank you is extended to manuscript development manager, Jason Gray, for his inSight, guidance and helpful suggestions. A number of other people deserve special acknowledgement - namely, project editor Catherine Spedding, coordinating editor Gabrielle Brady and the Wiley production staff.

Other individuals deserve mention. Thanks are extended to the Head of the School of Arts and Social Sciences at James Cook University, Professor Colin Ryan, for his support and many kind words of encouragement during the early stages of writing this book. Marie Caltabiano would also like to thank the Head of the Psychology Discipline, Associate Professor Frances Quirk, for her patience and understanding. She would also like to thank the countless academics both within and outside her field who have had a significant influence on her work. Of her family, she would like to thank most especially her best friend, sister and colleague, Dr Nerina Caltabiano, and her niece Amelia for their unwaver­ing support. Don Byrne would like to thank Mrs Kerry Thomas, his research assistant, for her help in finding and keeping track of many new references. He became Head of School during the writing of this edition and has appreciated the forbearance of his School Admin­istrator when other tasks gave way to the book. And as always, Anne and Edward were there to provide that essential work-life balance - and for being there, he is deeply grate­ful. Finally, thank you to the students, who make all this work worthwhile.

Marie L. Caltabiano Don Byrne

December 2007

'I wish I could help my father stop smoking' , a student in one of our health psychology courses said. Maybe she did help - he had quit by the end of the semes­ter. This example points out two things that will probably make health psychology interesting to you: (1) the material is personally relevant and (2) many of the things you learn can actually be applied in your everyday life. Studying health psychology will also help you answer important questions you may have considered about health and psychology in the past. Does the mind affect our health - and if so, how? What effect does stress have on health and recov­ery from illness? What can be done to help people lead healthier lives than they do? Why don't patients follow their doctors' advice, and what can health care workers do to help? What special needs do children have as patients, and how can parents and health care workers address these needs? How can families, friends, and health care workers help patients adjust to disabling or life-threatening health problems?

As these questions indicate, a knowledge of health psychology can be relevant both now and later when you enter your future career. This is so whether you are studying to be a psychologist, medical social worker, nurse or doctor, physical or occupational therapist, public health worker or health educator. You will learn in this book that the relationship between a person's health and psychology involves a 'two-way street' - each affects the other. Psychological factors go hand in hand with medical approaches in prevent­ing and treating illness and in helping patients adjust to the health problems they develop.

THE BOOK This book was designed for you, the reader. First and foremost, it provides a thorough and up-to-date pres­entation of the major issues, theories, concepts and research in health psychology undertaken both within and outside Australia. Throughout the book, the major point of view is 'biopsychosocial' - that is, that health and illness influence and result from the inter­play of biological, psychological and social aspects of people's lives. Because integrating these aspects involves complex concepts and technical material, we have made special efforts to write in a straight­forward, clear and engaging fashion. When a new term is introduced it is defined immediately; important

terms are set in bold type, listed as 'key terms' at the end of the chapter and defined in the glossary at the back of the book. Examples and case studies are included to clarify sometimes complex concepts.

Three types of boxed feature are presented throughout the book in order to illustrate or elaborate on surrounding content. These features are identified in the text by the corresponding icons.

/

Highlight on issues. Applied, high-interest and new frontier topics are highlighted here. They feature issues such as when the immune system turns on itself, sudden 'voodoo' death, the burden of caregiving, careers relating to health and psychology, breast and testicular self­examination, coping with terrorism, and acute pain in burn patients.

Focus on research. These features spotlight the research methods used in health psychology, reviewing unique or interesting research findings on topics such as heredity and alcohol abuse, socioeconomic status and food purchaSing behaviour, inducing pain in laboratory research, stress management at the population level, and coping with chemotherapy and its side effects.

Assess yourself. Here students are given the opportunity to examine their own health-related characteristics, knowledge and beliefs on issues such as daily hassles, eating self-efficacy, alcohol use, AIDS, responding to pain, social support and ethical questions.

To help you absorb the material and remember it longer, the book also includes the follOwing learning aids. • Chapter contents and prologue. Each chapter

begins with a contents list that outlines the major topiCS in the order in which they are covered. The prologue then introduces the chapter with a vignette that is relevant to the material ahead and gives an overview of the ideas you will read about.

• Illustrations. The many figures and tables in each chapter are designed to clarify concepts and research findings and help them stick in your mind.

TO THE STUDENT [xv 1

• Summary and key terms. Each chapter closes with two features: (1) the summary, which presents the most important ideas covered, and (2) tl1e key terms - a list of the most important terms in the chapter.

• Glossary. The glossary at the back of the book gives definitions of important terms and concepts, along with pronunciation keys for the most diffi­cult words. It will be useful when you are studying or reading and are not sure of the exact meaning or pronunciation of a term.

ORGANISATION The text is organised so that the main focus progresses across chapters from primary prevention (parts 1 to 3), through secondary prevention (parts 4 and 5), to ter­timy prevention and care (part 6). The book is divided into seven parts.

Part 1. Chapter 1 presents a history and overview of health psychology, and introduces the main concepts and research methods used. Chapter 2 introduces the body's physical systems to help the student to under­stand how these systems interrelate. This introduction provides students with a useful resource to refer to when each system is discussed in later chapters. (You will note in the sections on metabolism and body weight that we have retained the imperial unit of measure, the calorie, since this term remains more generally recognised than the kilojoule. The metric equivalent of one calorie is 4.186 kilojoules.)

Part 2. Chapters 3 and 4 examine stress in relation to illness, and chapter 5 looks at ways of coping with and reducing stress. The position of this discussion early in the book recognises stress's influence on a wide range of health-related problems.

Part 3. The following chapters consider largely non-clinical approaches to enhancing health and preventing illness. Chapter 6 discusses health-related behaviours and public health promotion programs. Chapter 7 focuses on smoking, and on alcohol and drug use and abuse. Chapter 8 considers nutrition, weight control, body image, physical activity and safety issues.

Part 4. Chapter 9 describes the kinds of health services available in Australia and New Zealand, the patient-practitioner relationship, patients' adherence to medical regimes, and the effect of illness cognition on self-regulation of health. Chapter 10 introduces the hospital setting, staff and procedures, how patients cope with the physical and mental stresses they experience there, and the role of health psychologists in this coping process.

Part 5. Pain is the focus of the next two chapters. Chapter 11 explores the nature of clinical pain and its symptoms, while chapter 12 discusses medical and

[xvi 1 TO THE STUDENT

psychosocial approaches to managing and controlling pain.

Part 6. The following two chapters emphasise tertiary prevention through an examination of chronic and life-threatening health problems. Chapter 13

addresses serious chronic illnesses, such as asthma, diabetes and arthritis, along with their medical and psychOSOcial treatments. Chapter 14 examines four high-mortality illnesses - heart disease, stroke, cancer and AIDS - and people's experiences with terminal illness and death.

Part 7. Finally, chapter 15 looks to the future of health psychology; its goals and controversies and, not least, career opportunities in the field in Australia.

STUDY HINTS There are many ways you can use the features of this book to learn and study well, and you may want to 'experiment' to find the best way for you. The follow­ing is one method that works well for many students.

Survey the chapter first. Read the contents list and browse through the chapter, examining the figures and tables. Some students also find it useful to read the summary first, even though it contains terms they may not yet understand. Then read the prologue. As you begin each new section of the chapter, look at its title and turn it into a question. Thus, the heading early in chapter 1, 'An illness/wellness continuum' , might become 'What is an illness/wellness continuum?' Doing this helps you focus on your reading. After reading the section, reflect on what you have just read. Can you answer the question you asked when you reworded the title?

When you have finished the body of the chapter, review what you have read by reading the summary and trying to define the items in the list of key terms. If there is something you do not understand, look it up in the chapter or glossary. Last, re-read the chapter at least once, concentrating on the important concepts or ideas. You may find it helpful to underline or high­light selected material now that you have a good idea of what is important. If your exam will consist of 'objective' questions, such as multiple choice, using this approach intensively should be effective. If your exam will have essay items, you will probably find it helpful to develop a list of likely questions and write an outline or a complete answer for each one.

We hope that you enjoy this book, that you learn a great deal from it, and that you will share our enthu­siasm and fascination for health psychology by the time you finish the course.

Edward P. Sarafino Marie L. Caltabiano

Don Byrne

Dr Marie L. Caltabiano is a senior lecturer in the Department of Psychology, within the School of Arts and Social Sciences at james Cook University, Cairns campus. Her interest in health psychology began with her doctoral research into the stress-moderating benefits of leisure. Her research has been in the areas of the psychosocial aspects of stress, stress management, immunocompetence, burnout, craving and disordered eating, parental coping, adolescent health risk behaviours, resilience in the elderly, women's health, fatigue in renal patients, performance appraisal in casual nursing and self-regulation in diabetes. She has published papers in the Australian and New Zealand

Journal oj Public Health, Climacteric, Psychological

Reports, the Journal oj Social Psychology, the Austral­

ian Journal oJMamage and Family, Nursing and Health

Sciences, Journal oj Clinical NurSing, Leisure Studies,

Society and Leisure and Adolescence. Dr Caltabiano is a member of the Australian Psychological Society, the APS College of Health Psychologists, the Ameri­can Psychological Society, the Public Health Associ­ation of Australia and the International Federation of University Women. She has been on the advisory board of the international journals Human Relations

and Perceptual and Motor Shills.

From 1995 to 1997 Dr Caltabiano was an Associ­ate Dean within the Faculty of Arts at james Cook University. In 1997 and 1998 she was Chair of the Editorial Board of the Centre for Social and Welfare Research. She is co-editor, with Richard Hil and Rose­mary Frangos (1996), of the book Achieving Inclu­

sion: ExplOring Issues in Disability, and co-author of Menopausal Health and the Family and Influences oj

Healthy Eating Practices in Ethnic Communities (1997), both published by the Centre for Social and Welfare Research, james Cook University.

Professor Don Byrne is Professor of Clinical and Health Psychology, and Head of the School of Psy­chology at the Australian National University. For six years he was Deputy Dean of the Faculty of Science at the ANU and has chaired the University's research grants committee. His research interests include the

roles of stress and behaviour in mediating risk of cardiovascular disease; the measurement, causes and management of occupational stress; and the role of stress in the development of health risk behaviours in children and adolescents. Research in these and related areas has resulted in the publication of 12 books (as author or editor) and more than 130 papers in refereed journals or as invited book chapters. Professor Byrne is a Fellow of the Academy of the Social Sciences in Australia, and of the Australian Psychological Society. He is also a member of the College of Clinical Psychologists of the Australian Psychological SOCiety. He is a past president of the International College of Psychosomatic Medicine. Professor Byrne retains an active interest in the training of psychologists in Australia, and sits on the Professional Develop­ment and Accreditation Committee of the Australian Psychology Accreditation Council. He was foundation chair of the Australian Capital Territory Psychologists Board from its inception in 1995 and chaired the Board until 2001.

Edward P. Sarafino received his PhD from the Univer­sity of Colorado and began his affiliation with the Department of Psychology at The College of New jersey more than three decades ago. His scholarship has combined areas of health and developmental and behavioural psychology, particularly with regard to the study of asthma. In addition to having published dozens of research articles and chapters, he is the author of six books. He is a fellow of Division 38 (Health Psychology) of the American Psychological Association, served as an officer (Secretary) of that division, and has been a member of several commit­tees of Division 38 and of the Society of Behavioural Medicine.

ABO U T THE AUT H 0 R S [xvi i 1

The authors and publisher would like to thanl< the following copyright holders, organisations and individuals for their permission to reproduce copyright material in this book

Images p. 445, fig. 10.2: © American Psychological Society · p . 7: © AIHW Graph: expected total life span at various years since 1 9 1 0 . Health Psychology Ie, p . 7 • p. 390, fig. 9.2: © AIHW Graph: hospitalisation rates for Australian males and females of different ages. Australia's Health 2006, p. 212, http://www.aihw.gov.au/publications/aus/ah06/ah06.pdf • p. 40, fig. 1 .6: Nelson-Aalen cumulative hazard estimates by type of social network, p. 577, Giles, Lynne C, Glonel<, Gary F. v., Luszcz, Mary A., Andrews, Gary R. 2005, 'Effect of social networks on 10 year survival in very old Australians, journal of Experimental Psychology • p. 1 5 1 : cartoon, 'Really, I'm fine. It was just a fleeting sense of purpose - I'm sure it will pass', © 2001 The New Yorher, Tom Cheney. Collection from cartoonbankcom. All rights reserved. The cartoon can be found on this website http://www.cartoonbankcom • p. 326: © CSIRO Human Nutrition · p. 2 3 1 : Health belief model, taken from Health Care and Human Behaviour by Steptoe and Mathews, p. 181 • p. 232: © journal of Experi­mental Social Psychology. 'Prediction of goal-directed behav­ior: Attitudes, intentions, and perceived behavioral control', leek Ajzen and Thomas J. Madden, Sept. 1986, vol. 22, no. 5, p. 22 • p. 442 , fig. 10. 1 : 'Preoperative preparation for cardiac surgery facilitates recovery, reduces psychological distress, and reduces the incidence of acute post-operative hypertension'. Erling A. Anderson, journal of Consulting and Clinical Psychology, vol. 55, pp. 5 13-20 • p:" 509: © Guild­ford Press • p. 48: 'The postnatal development of the human cerebral cortex', by Jesse LeRoy Conel © Harvard University Press • p . 1 70: Drawing by 1 1 year old Meghan of her experience of migraine headache pain. Figure 18. 1 from F. Andrasik, D. D. Blake & M. S. McCarran ( 1986), Child Health Behaviour: A BehavioL!ral Pediatrics Perspec­tive, © 1996, John Wiley & Sons Inc. • p. 60: Plate 446.4, 'Variations in arterial branching of the aortic arch and the approximate percentages of their occurrence', Grant's Atlas of Anatomy, J. C Boileau Grant, 1972 • p. 394, fig. 9.3: M. A. Safer, Q. J. Tharps, T. C Jackson, H. Leventhal, Medical Care journal 1979, vol. 17, fig. 1 , pp. 1 1-19, 'Determinants of three stages of delay in seeking care at a medical clinic'. © Lippincott Williams & Wilkins • pp. 490-1: The McGill Pain Questionnaire: major properties and scoring methods, Pain, 277-99, R. Melzack, 1975. http://www.med.ualberta. ca/uofapainidocuments!McGiIlPainQuestRevisited2005. pdf • p. 254: The PRECEDEIPROCEED planning model, from Health Promotion Planning by Lawrence Green and Marshall Kreuter, 2nd edition © 1 99 1 , ISBN: 08784847796. Reprinted by permission of McGraw Hill Companies, Inc . •

p . 397, fig. 9.4: Graph: Psychosocial information. journal of Health Psychology, An InterdiSciplinary, International journal, 1st edn, p. 369, Ellington & Wiebe · p . 388, fig. 9 . 1 : Self-

[ xviii 1 A C K N O W L E D G E M E N TS

regulatory model, Cogll itive Therapy and Research. 'Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions', pp. 143-63, Howard Leventhal · p. 448, fig. 10.3: Sara fino & Armstrong 1986, figure 5.3, ' Children's tendency to exhibit separation distress'. © Thomson Learning Global Rights Group.

Text pp. 5 1 9-20: 'PainSelf-Management Checklist', frompp. 1 2-13 of Manage Your Pain by Dr Michael Nicholas, Dr Allan Malloy, Lois Tonkin and Lee Beeston. ISBN: 07330883X ©ABC Books · p. 595 (above): © AIHW Cancer in Australia, December 2004, p. 9. http://www.aihw.gov.aulpublications/ can/caOl/ca0 1.pdf • p . 595 (below) : © AIHW Most frequently occurring cancers in females, Cancer' ill AL!stralia, December 2004, p. 9, http://www.aihw.gov.aulpublications/ can/caOl/ca01 .pdf · pp. 1 14-1 5 : Reprinted from joumal of Psychosomatic Research, vol. 26, S. Henderson, D. G. Byrne and P. Duncan-Jones, NeL!rosis and the Social Environment, 1982, with permission from Elsevier • p . 556: Diabetes

Australia - VlC • p. 1 9 7: © Edward Sara fino • p. 183: 'Searching for the structure of coping: Review and critique of category systems for classifying ways of coping', taken from the Psychological Bulletin, 1 29, pp. 216-69. © Ellen Skinner · p. 1 1 3 : © Elsevier publication, journal of Psycho­somatic Research, The social readjustment rating scale, Thomas H. Holmes and Richard H. Rahe • p. 338: © Allan Borushek's Pochet Calorie & Fat Counter (2007) • pp. 5 1 6, 523: © Guildford Press • pp. 126-7: table 3.3, Hassles assessment scale for students in college: Measuring the frequency and unpleasantness of and dwelling on stressful events. journal of American College of Health, vol. 48, no. 2, pp. 75-83, Sept. 1999 • pp. 19-22: table 1 . 1 , Core and specialist competencies in training of health psychologists © Australian Psychological Society. Permission granted by John Toumbourou • p. 646: Appendix: Requirements for the training of health psychologists and membership © Australian Psychological SOCiety. Permission granted by

John Toumbourou • p. 208: Extract of 'Examples of Anger Management Self-Statements Rehearsed in Stress-Inoculation Training, from Cognitive Behaviour Therapy: Research and Application, by John Foreyt and Diana Rathjen (eds), © 1978, Plenum ISBN:03063 1 1453, p. 150 • p. 347: 'How do you score on eating efficacy?', from S. M. Glynn and A. J . Ruderman 1986, The development and validation of an eating self-efficacy scale', Cognitive Therapy and Research

journal, 10, 403-20. Reproduced by permission of Klewer Academic • p. 306: © Transport Accident Commission, Victoria, Australia, www.tacsafety.com.au

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