HEALTH

PSYCHOLOGY
THIRD EDITION

Shelley E. Taylor
University of California, Los Angeles

s.S
'Ay
A1

Technische Hochschuie Darmstadt Q

Fachbereich3 . N 1
InstitutfOrPsychologie "IV- INI

9teuhenplatz 12, 64293 Darmstadt

McGraw-Hill, Inc.
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Institut fur Psychologie TU Darmstadt

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 CONTENTS

Preface xm Advantages of the Biopsychosocial

Model 12
The Biopsychosocial Model as
PART ONE
a Research Tool 13
The Interaction of Biopsychosocial
INTRODUCTION TO Variables 14
HEALTH PSYCHOLOGY Clinical Implications of the
Biopsychosocial Model 14

What Do Health Psychologists Do? 15

1. WHAT IS HEALTH Health Psychology: An Overview 17
PSYCHOLOGY? 3
Definition of Health Psychology 3
The Mind-Body Relationship: 2. THE SYSTEMS
A Brief History 4 OF THE BODY 23
Why Is the Field of Health The Nervous System 23
Psychology Needed? 7 Overview . 23
Changing Patterns of Illness 7 The Brain 24
Expanded Health Care Services 10 The Spinal Cord 26
Increased Medical Acceptance 10 The^Autonomic Nervous System 27
Demonstrated Contributions to Health 11 The Role of Neurotransmitters 27
Methodological Contributions 11 Disorders of the Nervous System 28

The Biopsychosocial Model in The Endocrine System 29

Health Psychology 12 Overview 29
The Biopsychosocial Model versus The Adrenal Glands 30
the Biomedical Model 12 Diabetes 31
VI Contents

The Cardiovascular System 33 Role of Behavioral Factors in Disease

Overview 33 and Disorder 63
The Heart \ 33 What are Health Behaviors? 64
Diseases of the Heart 34 Intervening with Children and
Blood Pressure 35 Adolescents 65
Blood 36 Interventions with At-Risk People 66
Blood-Related Disorders 37 Health Promotion: An Overview 69
The Respiratory System 38 Barriers to Effective Health
Overview: The Structure and Promotion 71
Functions of the Respiratory System 38 Barriers to Health Promotion within
Disorders of the Respiratory System 39 the Structure of Medicine 71
Alleviating Respiratory Diseases 41 Individual Barriers to Health
The Digestive System and the Promotion 72
Metabolism of Food 42 Health-Habit Factors That
Overview 42 Undermine Health Practice 75
The Functioning of the Digestive Factors Influencing the Practice
System 42 of Health Behaviors 77
Disorders of the Digestive System 43 Determinants of Health Behavior:
The Renal System 44 An Overview 77
Overview 44 Individual Differences in the Practice
Disorders of the Renal System 45 of Good Health Behavior 79
The Reproductive System and an Health Promotion: A Preliminary
Introduction to Genetics 46 Evaluation 81
The Ovaries and Testes 46
4. THE MODIFICATION
Fertilization and Gestation 47
OF HEALTH BEHAVIORS 83
Genetics and Health 47
Changing Health Behaviors by
The Immune System 51
Changing Health Beliefs 84
The Course of Infection 51
Attitude Change and Health Behavior 84
Immunity 53
The Health Belief Model 87
Diseases of the Immune System 55
Theory of Reasoned Action 91
Cognitive-Behavioral Approaches
PART TWO to Health Behavior Change 92
Self-Observation and Self-Monitoring 95
Classical Conditioning 96
HEALTH BEHAVIOR AND Systematic Desensitization 97
PRIMARY PREVENTION Operant Conditioning 98
Shaping 100
Modeling 100
3. HEALTH PROMOTION Stimulus Control 101
AND THE PRACTICE The Self-Control of Behavior 102
OF HEALTH BEHAVIORS 61 Broad-Spectrum, or Multimodal,
An Introduction to Health Cognitive-Behavioral Therapy 107
Behaviors 63 Relapse Prevention 108
 Contents VU

Stages of Health Behavior Change 114 Treatment of Alcohol Abuse 176

Changing Health Behaviors Can Recovered Alcoholics Ever Drink
through Social Engineering 117 Again? 181
Drinking and Driving 185
The Appropriate Venue for
Drinking: A Postscript 186
Health-Habit Modification .. 118
The Private Therapist's Office 119 Smoking 186
The Physician's Office 119 Synergistic Effects of Smoking 187
Self-Help Groups 120 A Brief History of the Smoking
Schools 120 Problem 189
Worksite Interventions 121 Why Do People Smoke? 191
Community-Based Interventions 123 Factors Associated with Smoking
The Mass Media 125 in Adolescents ' 191
Conclusions Regarding the Venue The Nature of Addiction in Smoking 194
for Health-Habit Change 127 Interventions to Reduce Smoking 196
5. H E A L T H - E N H A N C I N G Changing Attitudes toward Smoking 196
BEHAVIORS 131 The Therapeutic Approach
to Smoking 198
Exercise 132
Evaluation of Multimodal
Benefits of Exercise 133
Interventions 202
Determinants of Regular Exercise 135
Who Is Best Able to Induce People
Accident Prevention 138 to Stop Smoking? 205
Home and Workplace Accidents 139 Why Is Smoking So Hard to Change? 206
Motorcycle and Automobile Accidents 139 People Who Stop on Their Own 209
Cancer-Related Health Behaviors 141 Smoking Prevention 209
Breast Self-Examination 141 Advantages of Smoking Prevention
Mammography 144 Programs 210
Testicular Self-Examination 145 Social Influence Interventions 210
Weight Control 145 The Life-Skills-Training Approach 213
The Regulation of Eating 145 Social Engineering and Smoking 213
Why Obesity Is a Health Risk 146
Factors Associated with Obesity 146 PART THREE
Treatment of Obesity 151
Evaluation of Cognitive-Behavioral
Weight-Loss Techniques 157
STRESS AND COPING
Prevention and Weight Control ' 160
Obesity: An Evaluation 160
7. WHAT IS STRESS? 219
Eating Disorders 161
Stress Defined 219
Diet 165
Early Contributions to the Study
6. H E A L T H - C O M P R O M I S I N G of Stress 220
BEHAVIORS 173 Selye's General Adaptation Syndrome 221
Alcoholism and Problem Drinking 173 Psychological Appraisal and the
Origins of Alcoholism and Problem Experience of Stress 222
Drinking ' 175 Responses to Stress 223
Vlll Contents

What Makes Events Stressful? 225 Recognition, and Interpretation

Dimensions of Stressful Events 225 of Symptoms 297
Must Stress Be Perceived as Such Recognition of a Symptom 298
to Be Stressful? 227 Interpretation of Symptoms 300
Can People Adapt to Stress? 228 Cognitive Representation of Illness 303
Must a Stressor Be Ongoing - The Beginning of Treatment 304
to Be Stressful? 230
The Use of Health Services 306
Theories of Stress: Why Is Stress A Portrait of the User of Health
Stressful? 232 Services: Demographic Factors 306
Theories of Cognitive Costs 232 The Sociocultural Approach to
Arousal and Stress 234 the Use of Health Services 308
Theories of Emotional Functioning 234 Social-Psychological Determinants
Helplessness and Stress 235 of the Use of Health Services 309
How Stress Has Been Studied 237 Individual Preferences for
Stressful Life Events 237 Involvement in Health Care 311
Stress in the Workplace 246
Work Stress and Families 251
The Misuse of Health Services 312
Using Health Services
8. MODERATORS OF THE for Emotional Disturbances 312
STRESS EXPERIENCE 255 Delay Behavior 315
Stress and Illness 256 The Patient in the Hospital
Coping with Stress 257 Setting 318
Personality and Coping 258 Structure of the Hospital 319
Coping Style 267 Functioning of the Hospital 320
Coping Strategies 270 Recent Changes in Hospitalization 321
Coping and External Resources 273 The Impact of Hospitalization
Social Support 276 on the Patient 324
Coping Outcomes 284 Interventions to Increase Control
The Management of Stress 287 in Hospital Settings 327
Basic Techniques of Stress Coping with Surgery through
Management 288 Control-Enhancing Interventions 327
Relaxation Training and Stress Coping with Stressful Medical
Management 291 Procedures through Control-
Ancillary Skills of Stress Enhancing Interventions 333
Management 292 The Hospitalized Child 335
Preparing Children for Medical
PART FOUR Interventions 336

THE PATIENT IN THE 10. PATIENT-PRACTITIONER

TREATMENT SETTING INTERACTION 341
What Is a Health Practitioner? 341
Nature of Patient-Practitioner
9. THE USE OF HEALTH Communication 342
SERVICES 297 The Setting 343
 Contents IX

The Structure of the Health Care Gate Theory of Pain 385

Delivery System 344 Neurochemical Bases of Pain
Changes in the Philosophy of and Its Inhibition 387
Health Care Delivery 347 Clinical Management of Pain 388
Practitioners' Behaviors that Acute versus Chronic Pain 389
Contribute to Faulty - Pain and Personality 391
Communication 348
Pain Control Techniques 393
Patients' Contributions to Faulty
Pharmacological Control of Pain 394
Communication
Surgical Control of Pain 395
Interactive Aspects of the
Sensory Control of Pain 395
Communication Problem
Biofeedback 396
Results of Poor Patient- Relaxation Techniques . 398
Practitioner Communication 354 Hypnosis 401
Nonadherence to Treatment Acupuncture 402
Regimens 355 Distraction ' 403
Causes of Nonadherence 356 Guided Imagery 404
Patient-Practitioner Communication Additional Cognitive Techniques
and Malpractice Litigation 360 to Control Pain 405
Improving Patient-Practitioner Management of Chronic Pain 407
Communication and Reducing Pain Management Programs 407
Nonadherence 362 Pain: A Postscript 410
Teaching Practitioners How
to Communicate 362
Reducing Nonadherence 365 PART FIVE
The Placebo as Healer 370
A Historical Perspective 370
MANAGEMENT OF
What Is a Placebo? 371 CHRONIC AND TERMINAL
Practitioner Behavior and ILLNESS
Placebo Effects 372
Patient Characteristics and
Placebo Effects 373 12. MANAGEMENT OF
Patient-Practitioner Communication CHRONIC ILLNESS 415
and Placebo Effects 373 Quality of Life 416
Situational Determinants
of Placebo Effects 3 74 Emotional Responses
Social Norms and Placebo Effects 374 to Chronic Illness 418
Denial 418
Generalizability of Placebo Effects 375
The Placebo as a Methodological Anxiety 419
Tool 375 Depression 420
Are There Stages of Emotional
11. PAIN AND ITS MANAGEMENT Adjustment? 422
Significance of Pain 379 Coping with Chronic Disease 423
Elusive Nature of Pain 381 Coping Strategies and Chronic Illness 423
Measuring Pain 381 Patients' Beliefs about Chronic Illness 424
Physiology of Pain 383 Rehabilitation and Chronic Illness 427
 Contents

Physical Problems Associated with Family Therapy with the

Chronic Illness 427 Terminally III 479
Vocational Issues in Chronic Illness 432 The Management of Terminal Illness
Social Interaction Problems in in Children 480
Chronic Illness 433
Personal Issues in Chronic Illness ** 438
Alternatives to Hospital Care
for the Terminally 111 482
When the Chronically III Patient Is
Hospice Care 482
a Child 443
Home Care 486
Interventions for Psychological Problems of Survivors 487
Issues after Chronic Illness 443 The Adult Survivor 488
Pharmacologic Interventions 444
The Child Survivor 490
Individual Therapy 445 Death Education 491
Brief Psychotherapeutic Interventions 445
Relaxation and Exercise 446
Social Support Interventions 446 14. HEART DISEASE,
Support Groups 448 HYPERTENSION, STROKE,
AND DIABETES 495
13. PSYCHOLOGICAL ISSUES Coronary Heart Disease 495
IN ADVANCING AND Type A Behavior 497
TERMINAL ILLNESS 451 Cardiovascular Reactivity, Hostility,
Death across the Life Span 452 and CHD 499
Death in Infancy and Childhood 452 Mechanisms Linking Coronary-
Death in Young Adulthood 453 Proneness to CHD 502
Death in Middle Age 454 Modification of CHD Risk-Related
Death in Old Age 457 Behavior 502

Psychological Issues in Advancing Management of Myocardial

Infarction 503
Illness 458
Cardiac Rehabilitation 504
Continued Treatment and Advancing
Implementation of Lifestyle Changes 506
Illness 458
Problems of Social Support 507
Changes in the Patient's Self-Concept 464
Psychosocial Responses to MI 508
Issues of Social Interaction 466
Communication Issues 466 Hypertension 510
The Issue of Nontraditional Overview 510
Treatment 467 Relationship between Stress and
Are There Stages in Adjustment Hypertension 512
to Dying? , 468 Personality Factors and
Kubler-Ross's Five-Stage Theory 468 Hypertension 514
Evaluation of Kubler-Ross's Theory 471 Treatment of Hypertension 517

Psychological Management Stroke 521

of the Terminally 111 472 Consequences of Stroke 522
Medical Staff and the Terminally Types of Rehabilitative Interventions 524
III Patient 472 Management of Diabetes 525
Individual Counseling with the Types of Diabetes 525
Terminally III 477 Implications of Diabetes 526
 Contents XI

Causes of Diabetes 527 Adjusting to Cancer 570

Problems in Self-Management Physical Problems 570
of Diabetes \ 528 Psychological Problems 571
Interventions with Diabetics 530 Types of Rehabilitative Interventions 572
Special Problems of Adolescent Arthritis 574
Diabetics "- 532 Rheumatoid Arthritis 575
Osteoarthritis 577
15. PSYCHOIMMUNOLOGY, Gout 578
AIDS, CANCER, AND
PART SIX
ARTHRITIS 535
Psychoimmunology 535
The Immune System 535
TOWARD THE FUTURE
Assessing Immunocompetence 536
Stress and Immune Functioning 536
Academic Stress and Immune 16. HEALTH PSYCHOLOGY:
Functioning 538 CHALLENGES FOR THE
Stress, Immune Functioning, and FUTURE 583
Interpersonal Relationships 539 The Research Agenda of Health
Negative Affect and Immune Psychology 583
Functioning 541 Health Promotion 583
Coping and Coping Resources as Stress and Its Management 589
Moderators of the Stress-Immune Use of Health Services 591
Functioning Relationship 541 Patient-Practitioner Communication 592
Interventions to Enhance Management of Pain 593
Immunocompetence 543 Management of Chronic Illness 594
The Conditioning of Immunity 544 Advances-in Management
Pathways from Stress of Terminal Illness 595
to Immunocompromise 545 Specific Health Disorders: Causes
AIDS 546 and Consequences 596
AIDS in the United States 546 Trends for the Future 597
Interventions to Reduce Risk The Changing Nature of Medical
Behaviors for AIDS 551 Practice 597
Coping with HPV+ Status 558 Systematic Documentation
The Diagnosis of AIDS and Its of Treatment Effectiveness 598
Course 558 Systematic Documentation
Coping with AIDS 560 of Cost-Effectiveness 599
Psychosocial Factors That Affect Remaining Issues 600
the Course of AIDS 563
Cancer 564 References 605
Who Gets Cancer? A Complex Profile 564
Psychosocial Factors and Cancer 565
Glossary TOO

Psychosocial Factors and the Course

Indexes
of Cancer 568
Mechanisms Linking Stress and Name Index 737
Cancer 569 Subject Index 764