What does health psychology involve? - Chapter 1

What is health psychology?

Health psychologists examine psychological influences with regard to how people stay healthy, why people get sick and how people respond when they become ill. For example, they examine which behavioral and social factors contribute to health or illness. The focus is on the prevention and treatment of diseases. Promoting a healthy lifestyle plays a role in this. It is important to keep an eye on the definition of health. Rather than defining health as the absence of illness, health is recognized to be an achievement involving balance among physical, mental and social well-being.

What relationship exists between body and mind?

Throughout history, the interaction between body and mind has been an important subject of research for philosophers and scientists. The ancient Greeks were among the earliest civilizations to identify the role of bodily factors in health and illness.

Before the ancient Greeks, in prehistoric times, disease was thought to arise when evil spirits entered the body. By the Middle Ages, the pendulum had swung to supernatural explanations for illlness. After that, during the Renaissance, great strides were made in understanding the technical bases of medicine. This could be done because of the development of the science of autopsy and the invention of the microscope.

The biomedical model resulted out of medical practice and has been used as a guideline for the past 300 years. This model assumes that psychological and social processes are largely irrelevant to the disease process and that all illness can instead be explained on the basis of somatic bodily processes, such as biochemical imbalances of neurophysiological abnormalities. The absence of psychological and social processes in the causes of illness called for a new model: The biopsychosocial model.

What is the Biopsychosocial model?

The biopsychosocial model assumes that health and illness are the result of an continual interaction between biological, psychological and social factors. This involves both macrolevel processes (for example the lack of support) and microlevel processes (deviations in cells).

Which developments have contributed to the development of health psychology?

There are several factors that have contributed to the rise of health psychology. Examples are the growth of lifestyle-related and chronic diseases such as cancer and cardiovascular diseases, the expansion of health care services and the the increasing acceptance of health psychologists within the medical community.

What tasks do health psychologists have?

Health psychologists have different tasks. They develop theories and study the interaction between biological, psychological and social factors that contribute to health and/or disease. To study these interactions they use experiments, prospective research and search for links.The results of their studies can be used to prevent and treat diseases among the population such as epidemies.

Another important task of health psychologists is to treat and supervise patients who are sick, including those who are suffering from psychological problems that can arise from being ill.

How does the human body work? - Chapter 2

How does the nervous system work?

The nervous system is a complex network of interconnected nerves. The nervous system is consists of the central nervous system (brain and spinal cord) and the peripheral nervous system (all the other nerves). The peripheral nervous system consists of the autonomic nervous system (functioning of the internal organs) and the somatic nervous system (controlling movements). The regulation of the autonomic nervous system occurs in the sympathetic nervous system (preparing body in times danger / stress) and the parasympathetic nervous system (activity of organs in normal situations).

How does the brain work?

The brain serves as the command center of the body. The brain can be divided into different parts. At the back of the brain is the cerebellum (balance, muscles), the pons (link between the hindbrain and midbrain) and the medulla (regulation heartrate, blood pressure, etc.). The midbrain is involved in the regulation of sensory and motor functions. In addition, visual and auditory reflexes are coordinated here.

The forebrain consists of the hypothalamus and the thalamus. The thalamus plays an important role in the selection of stimuli to be passed on to the various parts of the brain. The hypothalamus helps the heart to function, regulates blood pressure and water balance and also regulates feelings of hunger, thirst and satiety. The cerebral cortex is also located in the forebrain. In this part of the brain, memory and personality are regulated. The cerebral cortex consists of:

1. The frontal lobe, involved in movement;
2. The temporal lobe, auditory information;
3. The parietal lobe, processes information from the skin (pain, touch, etc.);
4. The occipital lobe, visual information.

What is the role of neurotransmitters?

The nervous system functions on the basis of neurotransmitters. Stimulation of the sympathetic nervous system causes two neurotransmitters to be released: epinephrine and norepinephrine. These substances are also referred to as catecholamines. The release of catecholamine ensures that the body prepares for a stressful situation: the heartrate becomes faster, blood pressure increases and hunger is reduced. Parasympathetic functions then ensure that the body returns to its normal, homeostatic, state.

What is the endocrine system?

The endocrine system (hormone system) works by secreting hormones into the blood, stimulating changes in target organs. It is regulated by the hypothalamus and pituitary gland. Growth and development are controlled in the endocrine system. The endocrine and nervous system depend on each other, stimulating and inhibiting each other’s activities.

What is the cardiovascular system?

The cardiovascular system is the transport center of the body, consisting of the heart, blood vessels and blood. It ensures that oxygen and nutrients are brought to the body's cells and also removes waste from these cells.

The heart functions as a pump that circulates blood throughout the body. The left ventricle of the heart causes oxygenated blood to be pumped from the lungs to the aorta. This blood is then transported by the aorta through the veins to other parts of the body. The oxygen is exchanged for waste during this process, which then ends up in the right ventricle of the heart. Here the blood is pumped back to the lungs, where the blood is supplied with oxygen again.

The cardiovascular system is sensitive to a number of problems that can occur through infection or congenital abnormalities. However, the biggest threat to the cardiovascular system is poor health habits such as smoking and little exercise. Atherosclerosis is the major cause of heart disease. It is a slowly progressing disease in which fatty substances are deposited in the wall of arteries, making them narrower. This can result in, among other things, chest pain or a heart attack.

What are blood and how does blood pressure work?

Blood pressure is the pressure blood exerts to the walls of the blood vessels. The heart constantly pumps blood through the veins. Blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure with each heartbeat.

The body of an adult person contains an average of 5 liters of blood. Blood consists of two main components: blood plasma (liquid, 55%) and blood cells (red and white blood cells, platelets, 45%).

How does the respiratory system work?

Breathing has three important functions: regulating the absorption of oxygen, discharging carbon dioxide and regulating the composition of the blood.

Air that is inhaled through the nose and mouth goes through the esophageal head and larynx to the tracheae. The trachea branches into the right and left main bronchus, which form an entrance to the lungs. All respiratory movement is controlled by the brain. Coughing is also regulated there.

The airways are susceptible to various diseases such as asthma, (bacterial) infections, COPD, pneumonia, tuberculosis and lung cancer.

What is the digestive system?

Before food can be used as energy it must be converted into substances that can be absorbed by the body. This conversion process is called digestion. The digestive system is responsible for producing energy and heat needed to restore and grow cells.

Food we eat sequentially passes through the mouth, the esophagus, the stomach, the small intestine, the large intestine and the rectum. Indigestible food remains then leave our body through the anus.

Hepatitis, heartburn, diarrhea and stomach ulcers are conditions that can occur within the digestive system.

How does the renal system work?

The renal system consists of the kidneys, ureters, urinary bladder and urethra. It produces urine, which is then drained by the body. Urine contains surplus water, surplus electrolytes and waste products from the metabolism of food and surplus acids or alkalis. Urine can offer important diagnostic clues to many disorders. For example, an excess of glucose may indicate diabetes.

How does the reproductive system work?

There is a difference between the male and female reproductive system. Women have two ovaries that located in the pelvis. The ovaries have an important function in reproduction. Each month, a mature egg cell is released in one of the ovaries, which is charged into the fallopian tubes during ovulation. After sexual intercourse, the egg cell can be fertilized there by a sperm cell. If this does not happen, the egg remains in the uterine cavity for 14 days and is then flushed out during menstruation.

The hormones estrogen and progesterone are produced in the ovaries. Estrogen is responsible for the development of external characteristics, such as breasts and body hair. Progesterone prepares the body for a pregnancy.

In men, estrogen brings about the production of sperm and the development of secondary sex characteristics such as beard growth, deepening of the voice and muscle growth.

Pregnancy?

When sperm is released into the vagina, it may fertilize an egg in the ovaries (an ovum). The fertilized egg then enters the uterine cavity, via the fallopian tube, where the egg embeds itself in the uterine wall and develops over the next 9 months into a human being.

Diseases and disorders with the reproductive system are, for example fertility problems and sexually transmitted diseases (STDs). The menopause is not a disease or disorder.

What are genetic codes?

The fetus starts life as a single cell, which contains the inherited information from both parents that will determine its characteristics. The genetic code regulates factors such as eye and hair color as well as behavioral factors.

Genetic studies have provided valuable information regarding the heritability of the susceptibility to diseases. Studies of families, for example, can reveal whether members of the same family are more likely to develop a disorder, such as heart disease, than are unrelated individuals in similar environments. Twin research is another method for examining the genetic basis of a characteristic.

Health psychologists have important roles to play in research and counseling related to genetic risks, especially if they can help people modify their risk status and manage their distress.

What is the immune system?

How do infections develop?

Disease is caused by a variety of factors. One of these factors is that microbes enter the body and cause an infection there. Microbes can enter the body in different ways:

• Direct transmission, physical contact is required;
• By indirect transmission via particles in the air, dust, food or water;
• By biological transfer: A vector (transmission of diseases) ensures that the pathogenic microbe is transmitted;
• By mechanical transmission, the microbe is transferred by a carrier that is not directly involved in the disease process, think of dirty hands or bad water.

Whether microbes that enter the body actually cause an infection depends on a number of factors: the number of microbes, the virulence of the organism (depending on aggressiveness and toxigenicity) and the immune systems of the body.

How is the course of the infection determined?

When a microbe successfully enters the body, the development of an infection starts. The course of this infection consists of different phases. First there is the incubation period during which signs of disease are showing. During this period the microbes adapt to the body and multiply in such a way that they can cause an infection. The acute phase comes after the incubation phase. During the acute phase the illness and its symptoms are at their height. Unless the infection proves fatal, the organisms are expelled.

Infections may be localized, focal or systemic.

How does the Immune System work?

The immune system protects the body against invading organisms. Immunity can occur on a natural (genetically or been sick in the past) or artificial (vaccinations and inoculations) way.

A distinction can be made between general and specific defense. The so-called general defense does not specifically focus on one pathogen, but on all pathogens that occur in the body. Specific defense focuses only on one pathogen in special. The general and special defense work together to expel diseases quickly.

The immune system may have to deal with various diseases and diseases. Examples of such diseases are cancer and AIDS. In addition, there are autoimmune diseases. This means that the body attacks the body's own tissues, because it sees them as foreign.

What is the influence of behavior on health? - Chapter 3

How can good health be promoted?

Good health is a personal and collective goal. That is why good health should be promoted. This can be done through media, through doctors and through the government with policy plans. It turns out that promotion of health costs less and is more successful than disease prevention, which used to happen more often. People will experience less illnesses having good health habits.

Do health behaviors play a role in the development of illnesses?

Health behaviors play a role in the development of diseases. These are behaviors performed by people to improve or maintain their health (for example, brushing their teeth). Bad health behaviors can easily turn into bad health habits and play a role in the development of illnesses.

Primary prevention has the task to develop good health habits and to change bad ones. This primary prevention is aimed at changing / removing the risk factors of a disease before the disease develops. This can be done by: behavioral change methods to change problematic health behaviors, and by preventing people from developing bad health habits.

Which factors influence healthy behavior?

There are several factors that influence healthy behavior and health habits.

Demographic factors: people with little stress, highly educated, young and with many sources of social support generally have better health habits than people with a lot of stress, little social support and people with fewer sources such as people with a lower SES.

• Age: health habits are good in childhood, become worse during adolescence and young adulthood. The health habits improve as people get older.

• Values: the value society attaches to certain health habits influences the exercise of these health habits. An example of this is the different values that are attached to the physical exercise of women from different cultures.

• Personal control: people who see their health as something under their personal control will have better health habits than people who relate their health to chance factors.

• Social influence: friends, family, colleagues and other social contacts can influence health behavior, both negative and positive.

• Personal goals: the goals that a person has set up influence the exercise of healthy behavior. If the goal is 'being fit', then someone will have more physical activity.

• Symptoms received: certain symptoms may induce people to engage in health behaviors.

• Access to healthcare: if people have poor access to health care, they will have fewer regular checks (a mammogram), which may result in fewer healthy habits. This group of people will also receive fewer lifestyle advice from doctors, as a result of which poor health habits will change less quickly.

• Cognitive factors: people can believe that certain behavior is beneficial and if they do not comply with certain health behaviors they are more vulnerable to disease.

Why is it difficult to change bad health habits?

Often poor health habits at the time of exercise have little effect on health. These habits develop in childhood and puberty, so when people are healthy. The cumulative effect of bad health habits, such as smoking, drinking, and poor nutrition, is not noticed until later in life. Emotions also play a role, so the change can be counteracted because the unhealthy behavior is an addiction, happens automatically and is enjoyable. To prevent distress, the behavior continues.

Unhealthy habits can be enjoyable so that people are not motivated to change them. Unhealthy habits are not related to each other. It is therefore important to tackle the bad habits separately.

A final reason that health habits are difficult to change is the instability of healthy behavior. This is because:

• different health habits are controlled by different factors (smoking can be caused by stress and little physical exercise can be caused by a lack of access to the fitness school).

• several factors can control the same health habits for different people (people can eat from a 'social' point of view, but also because they feel lonely).

• factors that control a health habit can change during the course of the behavior (someone can start smoking under social pressure, but continue with it because it helps against stress).

• factors that control a health habit can change during the course of a person's life (during school time someone can exercise often, but when this person starts working, this may become less).

• health-like habits, their development and the factors that influence them can vary between individuals.

It means that health habits arise and are preserved under the influence of different factors for different people; these factors can change during the course of life and during the course of the habit.

Is the development of health habits important for children and adolescents?

Early socialization is very important for the development of health habits. The influence of parents who are role models is very high. Parents teach their children that they have to wear a seat belt in the car and that they have to brush their teeth every day. As the children grow older, they can start to ignore these learned habits. Adolescents are very sensitive to all kinds of unhealthy behavior (smoking, drinking, etc). It is important that parents supervise these adolescents well.

The development of good health habits also depends on the moment the habit is learned. A good educational moment must be chosen, because one moment is more suitable to learn a certain healthy behavior or to prevent a bad development than another.

Many educational moments occur in childhood. Others are present because the health system creates these moments. Doctors visit young parents and learn them basic skills and provide information about accident prevention.

Educational moments can also occur if someone is pregnant, which is a good reason to stop smoking and drinking.

Identifying the right educational moment is of great importance for primary prevention, because this is the moment that someone can learn good behavior and has not yet developed bad behavior.

Many health habits are developed at primary school. These are then choices with regard to eating, snacking and dieting. Adolescence is also compared with a window of vulnerability, because young people are exposed to bad behavior in their friends and senior citizens.

Research shows that precautions taken during adolescence are a better predictor of diseases after age 45 than adult health habits. It may therefore be that for adults who suddenly start developing good habits it is already too late, because they have already caused a chronic illness because of their behavior during their teenage years.

Which risk groups are more likely to become ill?

In addition to children and adolescents, people who are at risk for certain diseases are a vulnerable group that can be the target of health promotion. For example, a daughter of a woman with breast cancer can learn how to examine her own breasts on bumps. Health promotion in this group is becoming increasingly important because the genetic basis of many diseases is known.

Working with people with a higher risk of certain diseases has a number of advantages. If these people are known, this can lead to prevention or elimination of bad health habits that contribute to the vulnerability. Even if nothing can be done about prevention, the knowledge and information for people can be an incentive to change their situation (for example women with breast cancer).

There is also a cost advantage. Because only people who are at higher risk get a health-care intervention, people without this risk do not have to get this intervention. This saves money. Due to the concentration on high-risk populations, other risk factors may be determined which also contribute to the risk factor mentioned in the development of an unfavorable outcome.

There are, however, also disadvantages. People who run a higher risk often can not correctly assess their risk. In general, people are unrealistically positive when it comes to their own vulnerability to health risks. It is possible that people who are identified as having a risk factor will behave excessively cautiously and impose all sorts of restrictions on themselves. Another extreme is that people do not care about the risk factor and do not seek the help they can possibly use.

Ethical issues are tied to working with risk-based populations. When should people be informed of their risk if their risk is low. If a young daughter of a woman with breast cancer is told that she has an increased risk of breast cancer, this can cause major psychological problems.

Many risk factors are genetic and therefore can not be changed. An intervention does not have to be of use. No clear interventions have been devised for many disorders. For example, alcoholism is partly caused by a genetic factor. However, it is not known how this fact should be handled by the children of an alcoholic. The disclosure of risk factors can have major consequences within a family. For example, when people start asking who the source of the increased risk is.

How does health promotion work in the elderly?

Health promotion among the elderly was first seen as a waste, but now more and more policymakers are acknowledging that a healthy elderly population brings fewer health costs. The promotion of health in older people has therefore become increasingly important. Attention is focused on maintaining a healthy and balanced diet, taking steps to prevent accidents, exercise regularly, smoking cessation, controlled use of alcohol and reducing the misuse of medication.

Especially regular physical exercise is important because it keeps people mobile and ensures that they can continue to take care of themselves. In addition, it is important that older people remain active, so that they continue to participate in activities.

Alcohol consumption is a priority because the risks of alcohol increase as people age; the capacity for alcohol decreases with aging. Alcohol consumption also increases the risk of accidents. In addition, older people can develop drinking problems, for example as a result of loneliness.

Are there differences in risky behavior between men and women?

There are differences between sexes with regard to risky behavior and certain health behaviors. For example, men generally drink more alcohol than women. Anglican men also smoke more on average than other groups. Some ethnic groups have a higher risk of certain health behaviors. There are also differences between the performance of certain health behaviors. Black and Spanish women have less physical exercise than Anglican women.

How can health habits be changed?

What is the influence of changing attitudes?

Changing attitude towards healthy behavior can be achieved by means of education. This assumes that people will change their health habits if they have the right information. Education as a way to change health behaviors works best when the following conditions are met:

• Communication must be lively and colorful. Cases from the past should be used as examples.

• The speaker must be an expert who is reliable, friendly and equal to the public.

• The message must be short, clear and direct.

• Strong arguments must be reported in the beginning and at the end of the story, so not in the middle.

• Conclusions must be drawn explicitly. It must be clear what the public must do to change his / her situation.

More extreme messages have greater effects, although the messages must not be too extreme either. If a public is inclined to accept the message, favorable effects must be mentioned. If the public still has to be persuaded to accept a message, two sides have to be highlighted. The beneficial effects of adopting good health behaviors, but also the pleasant consequences of carrying out the bad health behavior should be mentioned.

How does the Health belief model work?

The health belief model assumes that there are two factors that determine whether someone has certain health habits:

• The extent to which someone experiences a certain health threat. This is again influenced by general values ​​about health, certain ideas about the vulnerability to a particular disease and certain ideas about the consequences of a disease.

• The extent to which someone believes that adopting certain health behavior will be effective to reduce the threat and that the benefits of acting on health habits exceed the disadvantages.

The health belief model explains many types of behavior, for example AIDS-related risk behavior. The health belief model is not only suitable for explaining why people exhibit certain behavior, but also for explaining why they change their behavior under certain circumstances. The health belief model is also used to design ways of communicating that encourage people to adopt different behaviors. The emphasis should be placed on the vulnerability of people and on the fact that adopting healthy behavior can reduce the threat to the disease. The health belief model only does not address the idea of ​​whether someone can maintain healthy behavior.

What is self-regulation?

People can not only change bad health habits through interventions, they can also change themselves. People are responsible for their own actions, emotions and thoughts (self-regulation). This can happen unconsciously, but also consciously.

What is the theory of self-determination?

This theory states that individuals are actively motivated to achieve set goals. The autonomous motivation and own assessed competences are central here. Research showed the importance of autonomous motivation and support for this theory.

Although the theories explain a lot, they are not very successful in explaining spontaneous behavioral changes and they do not predict long-term behavioral changes. When people are encouraged to change their behavior, they can respond defensively or become irritated. People may falsely think that they are less vulnerable than other people. A health threat can also be perceived as less threatening than it really is. Thinking about illness makes people depressed. That is why they often ignore the information or act defensively.

Unrealistic images about a person's own health, illness and treatment blocks the possibility of changing health behavior through carefully composed messages. Only giving information is often not enough to change health habits. That is why health psychologists now also use certain forms of therapy.

Can health habits be changed by a cognitive-behavioral approach?

Cognitive behavioral therapy can contribute to the change of a health habit. The approach of cognitive behavioral therapy changes the focus of the intended behavior. This concerns the conditions and factors that cause, maintain and strengthen it. Cognitive behavioral therapy can also influence someone's ideas about their ability to change behavior. With this kind of therapy thoughts and behavior are dealt with together.

The thoughts that someone has, largely determine his / her behavior.

Which techniques are associated with cognitive behavioral therapy?

The first steps to behavioral change are self-observation and self-monitoring. By self-observation and self-monitoring, someone can analyze his / her own behavior. In doing so, the frequency of the behavior, the factors that play a role in the behavior and the consequences of the behavior, must be considered. By inciting a patient to self-observation, he is forced to make efforts to change health behavior. Someone must learn to recognize his / her behavior. Once this is successful, the behavior and situations in which it occurs and the feelings that come with it can be recorded. When this documentation is ready, a structured behavioral change program can be drawn up. Self-observation is the beginning of therapy, but in some cases this can also cause a change in behavior. However, this change through self-monitoring is often short-lived.

Another way to change behavior is classic conditioning. With classical conditioning, an unconditioned reflex is coupled to a new stimulus, creating a conditioned reflex. Classical conditioning is one of the first methods used to change behavior. For example, it can be used in the treatment of alcoholism, smoking or for addictions. It is very important that the patient is willing to change, because sometimes this means that people get sick when they drink alcohol or smoke cigarettes (when you give them a medicine for it) so they can not act out their addictive behaviour anymore without getting sick.

Another form of conditioning is operant conditioning. With operant conditioning, voluntary behavior is linked to systematic consequences. The behavior is strengthened. Behavior is followed by positive reinforcement, making it more likely that the behavior will occur again. Conversely, if certain behavior is punished, it will then happen less often. An example of an operant conditioning is a drinker who continues to drink because his mood improves with the alcohol. The improved mood is a positive reinforcer.

Operant conditioning is very useful when trying to change health habits. First, people are rewarded when they perform an action that brings them closer to their goal. As the change gets closer, a larger change in behavior can be achieved by providing the same reward.

Another technique is modeling. This is learning by looking at someone else's behavior. Observing and then modeling can lead to behavioral changes. People will imitate someone faster who is equal to themselves. Equality is therefore an important principle in modeling.

Modeling can be important in a long-term behavioral change technique. For example, alcoholics can really benefit from talking with ex-alcoholics and exchanging information about how to fight their addiction.

Modeling can also work to reduce anxiety (eg, for a jab) that can cause poor health habits. Someone can look how an other person handles a scary situation and learn from this. In such cases it is better to look at someone who is afraid of the situation, but can deal with it than to look at someone who has no fear at all. An anxious person can identify himself better with another anxious person than with someone who has no fear. Modeling is therefore most effective when it is a realistic situation.

Checking stimuli can be very useful in controlling behavior. Certain discriminatory stimuli can incite someone to certain behavior, such as smoking, drinking or other bad health habits. If these stimuli can be controlled it could lead to less bad behaviors. First, someone has to get rid of the stimuli that cause problem behavior; subsequently, new discriminatory stimuli are needed instead of these stimuli, which will cause a new response.

Will behavioral therapy work better when there is self-control?

Cognitive behavior therapy is increasingly working with self-control takes place. Someone must be his / her own therapist and learn to check the antecedents and consequences of the specific behavior that has to be changed. This self-control can occur through self-reinforcement. This means that someone rewards himself each time the wanted behavior takes place or the unwanted behavior doesn't happen. Someone can reward himself positively with something he / she would like to have after changing behavior. Research shows that people lose weight more easily when they reward themselves. Self-reward has proven useful, also because people can be their own therapist and are not controlled by someone else. It has to come from within, which makes it easier to adopt the wanted behavior.

People with a sense of self-efficacy are better able to sustain certain behavior. Research has shown a strong relationship between a person's ideas about self-motivation and changing a health habit and changing behavior in the long term.

What is the theory of planned behavior?

This theory assumes that a health habit is the direct result of an intent to behavior. An intention to conduct consists of three things:

• Attitude towards the specific action (based on the likely outcomes of the action and its evaluation);

• Subjective norms regarding the action (these are someone's ideas about what others think he / she should do);

• Expected behavioral control (the idea of ​​whether someone is capable of showing the required behavior and whether this behavior has the desired effect).

If these factors have ensured a behavioral intention, the change of behavior will automatically follow.

The theory of planned behavior creates a model in which ideas are directly linked to behavior. In addition, it provides a comprehensive picture of someone's intentions in relation to certain health habits.

With the theory of planned behavior, different health behaviors can be explained. Examples are: the use of a condom, the use of sunscreen, the use of a contraceptive pill, exercising, smoking, AIDS-related risk behavior and self-examination of breasts in women.

Punishing yourself can also work. Positive punishment (there is an unpleasant stimulus after the wrong behavior has occurred) works better than negative punishment (a pleasant stimulus is removed). Punishing yourself works best when coupled with self-reward.

Self-punishment only works if the person who has to change the behavior actually executes these punishments. There is a way of self-punishment that works well, this is contingency contracting. A contract is concluded with someone else, for example a therapist, who determines whether there is a reward or punishment for the behavior of the person being treated.

With covered self-control, individuals learn to recognize the thoughts that precede certain behaviors. By changing these thoughts, the behavior can also change. These thoughts can also occur after the behavior. Then it is the intention that these "after" thoughts stimulate the right behavior and do not abort the right behavior. The internal dialogues (the thoughts) that people have can be changed and then strengthened in order to change the behavior. The restructuring of these internal dialogues has proved very useful in dealing with stress disorders.

Through self-instruction and self-talk people can change their thoughts and their behavior. These instructions can first be said out loud and later be internalized.

Another technique to involve people in their learning process is giving behavioral assignments to do at home. Both the patient and the therapist can get homework after the session to ensure that both parties stay involved in the process. It is useful to write down these assignments and not just make verbal agreements. By writing it down, the assignments become clear.

The advantages besides the fact that the patient is involved in his / her treatment are:

• The patients make an analysis of their behavior which can be useful in planning future interventions.

• The patients are involved in the process through a contractual agreement that entails certain responsibilities.

• The person responsible for the behavioral change is to a large extent more and more dependent on the patient.

• The sense of self-control of the patient is increased by the homework assignments.

To change behavior or to ensure that it does not arise, social skills can also be taught. This is because the lack of social skills or having social fears can cause people to show certain behavior. For example, young people start to smoke because they want to be part of the group. The goals of this therapy are to reduce fears, to learn new skills for dealing with anxious situations and to learn to adopt alternative behaviors for the behavior that one normally showed in the anxious situation. By learning relaxation techniques it is possible that people become less anxious socially, so that they will show the bad health habits less quickly. In addition, more and more motivational conversation techniques are used to get less motivated clients to move. Furthermore, it can be helpful for dealing with resistance.

What makes people fall back into wrong behavior?

A major problem in changing behavior is that people often fall back into their unwanted behavior after the change. This problem mainly occurs with addictive habits such as smoking, drinking and drug use. Falling back into the old habit can be very gradual. For example, smoking one cigarette at a party, which is the beginning of returning to normal smoking behavior. Why people fall back into old habits is not entirely clear. Rejuvenation symptoms that occur after stopping an addictive drug can be a reason. Vulnerable moments are also a reason for people to fall back. If people used to smoke or drink at a party, it is difficult not to do so when they are at a party again. If people experience stress, anxiety or depression, there is a greater chance that people will fall back into their old habits. Social support from friends and family can help to fall back less quickly.

If people violate the rules they have set themselves once, an 'abstinence violation effect' may occur. This is a sense of loss of control that arises when someone breaks his own rules. If this has happened, a real relapse can occur more easily.

The consequences of a relapse are negative emotional effects, such as disappointment, frustration, anger and unhappiness. People get a reduced sense of self-motivation due to a relapse. If people make a new attempt to change their behavior after a relapse, this can cause problems. People will start less quickly with a new attempt. A paradoxical effect of a relapse can also occur. People become more convinced of their own control. It then seems as if several attempts are needed to finally reach the goal, for example to quit smoking.

The possibility that relapse occurs can be reduced by, for example, giving a few 'spur' sessions a week before the end of the treatment. A few months after stopping the treatment some 'clearing' sessions can be given. A better way than these sessions is to add more behavior-changing elements, such as the relaxation exercises or training of assertiveness.

A third way to reduce relapse is to let the therapy go on for their entire life. Disadvantages of this are that people keep feeling that they are very vulnerable to relapse. This also suggests that people can not exercise control over their habit. A better option is to rebalance the client's lifestyle. Like this, people keep control and there is also a positive behavioral change.

What is the Transtheoretical Model of Behavior Change?

The change in unhealthy behavior does not happen at once. There are several steps that can be displayed in the Transtheoretical model:

The stages of change are:

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

Where can behavior change be achieved?

Behavioral change can be achieved in several places: under the treatment of a professional, with family, self-help groups, school, workplace interventions, community-based interventions, via media and / or the Internet. The relapse prevention must be integrated in the therapy. It appears that people who are very motivated at the beginning of the therapy have less chance of relapse. That is why at the start of the therapy much attention is paid to increasing motivation and maintaining compliance. Another way is to do a screening and remove people who do not really want their behavior to change. However, this is ethically dubious, because people are turned away from a therapy, while it can be very good for their health. On the other hand, someone who is not very enthusiastic can reduce the motivation of others, reducing the chances of success for them.

People can prevent relapse by avoiding situations in which their incorrect health habits take place. For some people, such as smokers, it is impossible to avoid all situations where their old behavior occurred. Then people have to learn skills to deal with these situations. This can increase the self-confidence of people.

Many of us know how health can be achieved and what kind of behavior this requires. Intentions for a new year often include: eating healthy, exercising a lot and saving money. These good intentions are often difficult to sustain, but this health-promoting behavior is important. Health promoting behavior should be a high priority for all of us.

What is the influence of physical activity, sleep and nutrition on health? - Chapter 4

What influence does physical exercise have on health?

Researchers have focused on aerobic exercise in recent years. This is physical exercise that stimulates and strengthens the heart and lungs and improves the oxygen consumption of the body. Aerobic exercise has a long duration and high intensity for which people need a high stamina. Examples are swimming, jogging, cycling, running and jumping rope.

Women are physically more inactive than men. White people get more exercise than black people and spanish people, older people are less active than young people. People with high incomes are also more active than people with lower incomes. Physical activity is the most important form of health behavior for the elderly.

Physical activity provides cardiovascular fitness and endurance. The chance of a heart attack is also reduced. Furthermore, it increases the efficiency of the cardio-respiratory system, improves the physical work capacity, improves and maintains muscle tension and muscle strength, optimizes body weight, improves joint flexibility, can reduce hypertension, improves movement of the cholesterol level and it can improve the possibilities of dealing with stress. In addition, it can reduce the effects of bad health habits, such as smoking, unhealthy eating and alcohol consumption. Regular physical exercise improves life expectancy and slows the mortality of, for example, cancer and cardiovascular disease.

The prescribed amount of physical exercise for a normal adult is 30 minutes of modest exercise most (preferably every day) days of the week and 20 minutes or more intense exercise at least three days a week.

During exercise, the same hormones (epinephrine) are released as when experiencing stress. Nevertheless, physical exercise does have a beneficial effect on health and stress does not. This may be because epinephrine has a beneficial effect if it is released intermittently and a negative effect if it is permanently present in the blood, such as during stress. It is also possible that epinephrine is metabolized differently during exercise than during stress. A final possibility is that the activation of the Hypothalamic-Pituitary-Adrenocortical system (HPA-axis) is responsible for the harmful effects of stress and not the activation of the sympathetic nervous system such as during physical exercise and also during stress.

Physical activity has a good influence on depression, tensions, moods and fears. Immediately after physical exercise, people's mood and feelings can be uplifted. The effects of long-term regular effort can improve the overall mood, even if this effect is slightly less than the direct effect. This influence on mood is partly due to the social aspect of physical activity, the feeling that you are among others. Social support also ensures that people adhere to a physical activity program. Physical activity also has a beneficial effect on people's self-image, which is why it is often used in the treatment of depression and in menopausal symptoms. However, the effects of physical activity on the well-being of people should not be exaggerated, because the effects are often small. An important factor seems to be whether people believe that physical activity has a positive effect on mood.

Because physical exercise improves well-being, it can be a way to deal with stress. A study has shown that the negative effects of stressful events on health decrease as physical activity increases.

This positive effect of exercise on the experience of stress can come from the positive influence of physical exercise on the immune system. The activity of immunity would also be modulated by the release of endogenous opioids, stimulated by physical activity. By exercise, the concentration and attention-orientedness is increased. However, this cognitive effect can also spread to the other side, because the muscles get too tired. Through physical exercise, people would also be less absent from work and would be able to get a greater satisfaction from their work.

How are interventions for physical activity used?

Different types of interventions are successful in their intention to get people moving. People get help to build intrinsic motivation to work out. For example, a whole family can be encouraged to exercise more, or more exercise on the work floor will be encouraged.

Prevent accidents through prevention?

Many deaths could be prevented by the prevention of accidents. This concerns traffic accidents, but also poisonings and accidents at work. The biggest cause of death and accidents among children younger than 5 years are accidents in the house. Parents usually take measures to prevent this as well as possible; after all, they have control over the environment in which the child is. Many general practictioners teach parents skills in taking these measures. Parents can be informed about the most common toxic substances through parent classes. Nevertheless, older people in particular are at greater risk of an accident. In addition, about 25% of the elderly remain dependent on hospital care for at least a year after an accident.

Better safety measures lead to less accidents at home and at work in recent years. An example are safety caps on medicines. The strict rules regarding work safety also contributed to this decline. The interventions that have been used to reduce these accidents have thus been successful.

Car and motorcycle accidents are the biggest cause of death when it comes to death from accidents. Little research has been done into ways to prevent people from traffic accidents. There are many measures that can be taken to prevent accidents. Obvious measures are: reducing maximum speed, wearing a seat belt and putting children in a child seat. However, it is difficult to encourage people to comply with these measures. To achieve this, information about health, psychological interventions and social awareness are necessary. These interventions may not be as effective to really learn the right behavior. Legal solutions are probably better for this, such as fines.

What are the benefits of vaccination and screening?

Through vaccination and screening, many cases of illness and therefore causes of death can be prevented. Unfortunately, too few people use these sources. Health psychologists try to make themselves hard for the importance of these elements.

Parents do well to have children vaccinated at a young age against, among other things, polio and measles. Later in life, screening is important, especially in people who are in an increased risk group (cancer in the family). For example, there may be a study of breast cancer in women. They can then have a mammography made, where the breasts are checked for breast cancer. Unfortunately, there are still many women who do not opt ​​for this option, because they are scared or feel ashamed.

Another important screening is screening for colorectal cancer.

Why is the use of sunscreen so important?

The last 30 years there has been an increase in the number of people with skin cancer. This is due to excessive exposure to ultraviolet radiation. To reduce the risk of skin cancer, psychologists try to encourage people to use sunscreen. Here only education is not enough. This is because having a tanned skin is very attractive and people do not want to give up just because of the use of sunscreen. If people use sunscreen, the strength of the sunscreen is often not sufficient to guard against the radiation. The type of skin that someone has determines to a large extent whether someone will use sunscreen. Someone who burns quickly will use sunscreen faster than someone who never gets burned. Furthermore, someone's thoughts about the effectiveness of sunscreen are important. In addition, the social standards that apply to the use of sunscreen also play a role.

When communicating this to adolescents and young adults, it is important that the gains (free of skin cancers) and the direct risks are emphasized. In the development of knowledge about cancer, more types of self-examination and prevention measures will be discovered.

What is the effect of diet on health?

Eating healthy should be a goal for everyone. Unhealthy eating is a risk factor for many causes of death and also for the development of many diseases. A healthy diet is therefore very important. Dietary factors are related to the cholesterol level and especially to the LDL content.

A cholesterol and LDL content are risk factors for cardiovascular disease. Salt affects hypertension and can also contribute to cardiovascular disease in some individuals. Eating habits would also contribute to different types of cancer, such as breast, stomach, pancreatic and colon cancer. Poor nutrition combined with other risk factors, such as stress, is very dangerous. This can, for example, cause a change in fat reactivity. Changing health can improve a person's health. For example, dietary changes can lower cholesterol levels in the blood, reducing the risk of arteriosclerosis.

Why is it so difficult to change a diet?

If people have to change their diet, this is usually an adjustment that must be sustained throughout life. This is often a difficult adjustment. People tend to eat healthier more often because they want a better appearance than they do for their health.

When people actually reduce the salt and fat in their diet, in many cases they absorb more from other types of food. This does not reach the goal of the diet. However, it is doubtful whether a low-fat diet causes weight loss and prolongation of life.

It is therefore difficult to get people to diet, but it is also difficult to let people maintain this diet. One reason for this may be that there is too little attention for the reasons why the diet should be sustained. It is also possible that insufficient attention has been paid to relapse prevention techniques. People are responsible for their own diet. Doctors and other health care providers can only influence this from a distance. If people have a strong sense of self-motivation (they believe they can change their diet), have a lot of social support and have the idea that a different diet brings health benefits, then chances are that people will also keep the diet full. A permanent change in the food is then possible.

Poor dietary habits can be the result of a weak feeling of self-motivation, a low level of health awareness, a preference for meat or little knowledge about the relationship between eating habits and illnesses.

Some dietary patterns change the mood or personality of someone. Low cholesterol in the diet can result in a mood that is sad. Another study suggests that low cholesterol reduces the number of heart attacks, but increases the number of deaths caused by behavioral causes (suicides, accidents and murders). This could be due to lower serotonin levels in the brain due to low cholesterol.

In what ways can a diet be changed?

Interventions to change dietary patterns are usually done on an individual level, so that the diet can be adapted directly to the individual. Every way that is used to change dietary patterns begins with education and training self-monitoring. This is to make it clear to people how much of everything is in their food and how much they may have. Afterwards, various cognitive behavioral therapy techniques can be used. These are stimulus control, contingency contracting, etc. If these techniques are coupled with relapse prevention techniques, chances are that people will be able to change their dietary pattern.

It may be useful not to focus the intervention on one individual but on a whole family. It is easier for those who have to change their diet to keep this up when the other family members also stick to this adapted diet. The family members often meet with the therapist who must make clear to them the importance of changing the family's dietary pattern. The specific changes that have to be made are discussed. With other families, who also had to change their dietary pattern, recipes can be exchanged and experiences discussed.

In the social field, there are also ways that can affect the dietary pattern of people. However, these ways do not guarantee a long-term change. There are training campaigns about nutrition that can have some success. A modern way is to tackle a certain group and to design interventions for this. This is then a group for whom it is very important that the diet changes with respect to health. An example of such a group is people with a low income who live in the city.

What is the influence of sleep on health?

Sleeping is an essential health habit. It ensures that depression, infections and the progression of chronic diseases are less likely. There are two types of sleep: NREM and REM. NREM sleep consists of four phases:

• Sleep phase 1: Light sleep: the consciousness is reduced, but it is still easy to wake up;

• Sleep phase 2: You lose consciousness completely, brain and heart go into 'rest mode', body temperature drops;

• Sleeping phase 3 and 4: Deep sleep: difficult to wake up, but during the REM sleep that occurs, the brain is just as active as in an awake state. The eyes show rapid movements.

Sufficient sleep, rest and renewal are important healthy behaviors. Many people do not make good use of sleeping hours or suffer from insomnia (not being able to sleep). This can have an effect on cognitive functioning, mood and quality of life. There are different techniques for building more relaxation. As a result, people are more positive about life and experience less stress.

Which behavior is harmful to health? - Chapter 5

Health-damaging behaviors are behaviors which reduce or damage current or future health. Because many of these behaviors are habits and also addictive, they are difficult to change. However, if the right attitude, motivation and help are available, every habit can be changed. If someone has changed one health habit, such as quitting smoking, there will often be other lifestyle changes, for example eating healthy.

What are the characteristics of health-damaging behavior?

Health-damaging behaviors have addictive characteristics. For example, there is a high vulnerability in adolescence for the development of these behaviors. This involves smoking, excessive drinking, use of drugs, unsafe sex, and risk behavior that can lead to accidents.

Adolescence is not the only vulnerable age. For example, alcoholism can also develop at a later age, while obesity can develop at a young age. These health-reducing behaviors are under the influence of environmental factors, such as friends. Children and adolescents learn from and imitate their friends. In addition, adolescents and young adults want to feel cool. These behaviors can then be developed as part of their self-presentation. A third similarity between all these behaviors is that they are enjoyable. They also increase the possibilities of adolescents to deal with stressful situations. Any health-reducing behavior is dangerous and they are all risk factors for diseases or death, for example smoking.

The development of this type of behavior happens gradually. An individual first learns about the behavior, then experiments with it and then uses it regularly. Abuse of different types, such as drinking, smoking and taking drugs, are determined by the same factors as the development of this health-impairing behavior.

If adolescents have a tendency to deviant behavior, have a weak self-esteem and stay in a complicated family situation, they will often develop health-deteriorating behaviors. This also applies to the misuse of certain resources. This abuse will therefore occur earlier in the adolescents who fit the situation described above. The health-reducing behavior (problem behavior) is related to the larger social structure in which this behavior takes place. For example, health-damaging behaviors occur more in lower social classes. It may be that this problematic behavior is the reason that social class is so strongly related to diseases and death.

Obesity: a health risk?

Obesity is a surplus of body fat; fat accumulation in the body. Obesity is becoming a bigger and bigger problem. It is already beginning to replace almost malnutrition as the most important contributor to poor health worldwide. Causes of obesity are genetic predisposition, little physical activity and a large amount of fat and energy-rich food in developed countries.

What are the risks of obesity?

Obesity is a risk factor for many other disorders. This can be a direct risk factor, but also indirectly because obesity affects other risk factors such as high blood pressure. Disorders related to obesity are diabetes, arteriosclerosis, heart disease, hypertension, some forms of cancer, gallbladder disease and arthritis.

Other risk factors for obesity are social class and culture. For example, women with a low SES are often heavier than women with a high SES. This is true in rich countries, while in developing countries the opposite is true. There the prevalence of obesity is higher as people have a higher SES and have more prosperity.

The cultural factor has to do with the image of what is liked. In developed countries the focus is on being slim for women, so there is a great emphasis on physical exercise and dieting.

Someone who has obesity also has a greater risk of obesity. This is because these people have a high insulin content which makes them more hungry and therefore eat more. People with obesity can also easily store fat because they have very large fat cells.

Is diet a risk factor for obesity?

Diets are also a risk factor for obesity. Successive periods of diets and weight gain result in increased efficiency of the use of food in the body and lower metabolism. When people start eating normally after a diet, the metabolism is still low, which means they will gain weight sooner. This is the so-called jojo-effect.

Is there a link between food and stress?

There are people who eat more when they are under stress, but also people who eat less. In people who are not dieting or who are overweight, stress can suppress the physiological signs that cause hunger, so that less nutrition is taken. Someone who follows a diet, however, can lose control due to stress, causing the brake to stop on non-food. This leads to an increase in food intake. People who start eating when they are under stress often eat salty food and food that is low in calories. This while when they are not under stress they eat just high calorie foods.

What are interventions to prevent obesity?

Various interventions are possible to prevent obesity. Most weight loss programs start with diets. People then learn how they can control their food intake, what is in their food and how many calories they should eat per day. The results of diets are often small and not long-lasting in nature. Exercise is even more crucial, because exercising helps to reprogram genes. This affects the way fat is stored, so people are less likely to be overweight.

A radical way to deal with obesity is through operations. Especially stomach operations are popular. This is where the stomach is reduced so that it has a smaller capacity for food. As a result, the person who had surgery must start to limit his food intake. Because there are risks associated with surgery, this way is actually only used in people who are over 100% overweight, who have to lose weight because their health deteriorates and are unable to lose weight in a different way.

Another intervention is cognitive behavioral therapy (CBT). Researchers assume that compulsive eating is similar to a drug or alcohol problem.

Many current interventions in people with obesity use a multimodal approach. This may look like this: people with obesity are taught to do self-monitoring. They have to learn to keep track of what they eat, when they eat, how much they eat, where they eat and other dimensions of the food. This makes these obese patients more aware of their eating habits. Then the stimuli that contribute to eating behavior are analyzed. Patients must then learn to change these stimuli. For example, they can facilitate access to raw vegetables while reducing the presence of high-calorie food in the home. It appears to be important and successful that people who participate in such a program receive individual support and feedback.

The next step is self-control. Patients must gain control over their eating behavior. For example, by teaching people to eat slowly and put the cutlerty down after a certain number of bites, the intake of food decreases. People are also encouraged to enjoy their food, because the goal is to eat less and enjoy more. People also need to know the consequences of their eating behavior. In addition, they have to reward themselves if they have performed something successfully. Developing self-monitoring is very important for the treatment of the behavior of people with obesity.

Participants of the weight loss program are instructed to let go of their negative thoughts about weight loss and their weight and to focus on positive self-talk.

A factor that contributes to successful weight loss and maintaining this weight loss is the presence of social support. Because people with a lot of social support are more successful in weight loss, the participants are taught methods to get effective social support from family members and friends.

In the multimodal technique, elements of relapse prevention techniques are also present. Situations can then be practiced where the risk of relapse is high for which coping strategies are then developed. These relapse prevention techniques are important not only for controlling the diet, but also for people who are unsuccessful in losing weight and therefore want to stop. Women explain failure due to a lack of self-discipline, while men are more inclined to look for external reasons.

Do cognitive behavioral therapies work with weight loss?

The newer cognitive behavioral techniques work better than the older ones. They produce more weight loss in a shorter time. This could be because the new programs are longer and better because they emphasize self-direction and physical activity and contain relapse prevention techniques. Nevertheless, the results differ per individual. With one the weight goes off and remains off, while in others it comes as quickly as it goes off. Generally, the treatment of obesity is only successful to a certain extent. Constant diets can make the problem worse. Health psychologists encourage people to live as healthy as possible, with sensible eating and sufficient physical activity.

Does an approach work through public health?

Because obesity is a very big problem, a public health model has to be drawn up. Weight loss programs are not sufficient in the treatment of obesity and overweight. An important strategy is prevention in families who are at high risk of having children with obesity. Parents must then be taught that they teach healthy eating habits to their children. As a result, the incidence of obesity could decrease. Behavioral therapy in children can be very successful because children adopt to new habits more easily than adults. A lot of physical exercise is an important component of the programs in children. Because parents make food for children, the problem of self-control in children is not present.

Attention should also be paid to prevention of weight gain in normal adults who age. If adults have a healthy lifestyle, the weight gain as they get older will be better.

What causes eating disorders?

Some people continue to lose weight. This can be because they are influenced too much by the image of the 'perfect body' (slim and thin). Many people have the incorrect idea that if you are thin then you are healthy. Some people are so obsessed with weight and food that they have an eating disorder. In recent years there has been an increase in the number of people with eating disorders.

What is the clinical picture of Anorexia Nervosa?

Anorexia Nervosa is an obsessive disorder in which an individual starves himself, diets and sports a lot, to the point where the body weight is far below the optimum level. Most people with anorexia nervosa are female adolescents.

Several factors have been determined that contribute to the development of anorexia.

Physiological explanations are that stopping the menstrual cycle (amenorrhea) is a sign for weight loss. In girls with anorexia, the steroids that regulate the food in the body would be present to an increased extent. There seems to be a connection between Turner syndrome and having anorexia nervosa.

Women with eating disorders and women who tend to do so often have elevated blood pressure, increased heart rate, reactivity to stress and high urine cortisol. This indicates that these women are constantly overreactive to stress. Women with eating disorders quickly become depressed, anxious and have a weak self-confidence.

Anorexia would have a genetic component because it is common in certain families. Girls with anorexia would lack a sense of control coupled with needing confirmation. These girls show very perfectionistic behavior. There is a very wrong body image, of which one does not know whether this is the cause or the result of the anorexia.

Family factors also have a role. Girls with anorexia often come from problem families (for example, alcoholism) or from a very closed family that does not communicate well about emotions and quarrels. The mother-daughter relationship can affect the disorder.

Research now focuses on the conditions under which anorexia can develop in people with an increased risk of this.

How can anorexia be treated?

The first goal of treating an anorexic patient is to bring the weight back to the normal level. This can be done, for example, by means of operant conditioning that causes positive reinforcement of the behavior. If anorexic patients learn this in a hospital, the question is whether they can keep this up in the home situation.

If the weight is restored, other therapies can be given. An example of this is family therapy in which families learn to communicate better about conflicts and emotions. Psychotherapy may be necessary to improve self-esteem and self-confidence. Coping skills can also be learned with stress.

Because anorexia has major health consequences, attention is now focused on prevention. The most important thing is that the health risks of anorexia are clearly told. Women with symptoms of anorexia can also be encouraged to seek treatment.

What is Bulimia?

Bulimia is a syndrome characterized by alternating cycles of abnormal eating and removing food from the body, for example, by surrender. Eating large amounts of food usually happens when the individual is alone. This excessive eating can be caused by negative emotions. Someone then starts eating and can not stop. Although this food is unpleasant, the check is gone and the person can not stop it. Many people with anorexia are also bulimic.

People with bulimia usually have a normal weight, or even some obesity, especially on the hips. The phase in which these people eat is a phase in which the control is gone. The control must then be obtained by removing the food from the body by spitting. Food can become a constant thought. The normal control of food through internal sensations is no longer there, but has changed into decisions about what to eat when. This is cognitive based regulation system.

Families in which there is a lot of attention for appearance and being thin get children with bulimia faster. Bulimia patients often have low self-esteem and eat to control their negative emotions. Girls and women with bulimia are not only obsessed with food, but also with weight and body. There can be a history of depression, psychopathology, abuse of alcohol and drugs and difficulties with organizing work and social moments. Stress can induce an abnormal eating moment, especially when it comes to conflict with others. Physiological consequences of the disorder are hormonal disorders, disorders in the hypothalamus, food allergies, altered taste, neurological disorders and a disorder of the endogenous opioid system.

How can bulimia be treated?

A difficulty in the treatment of bulimia is that many women do not receive treatment. One of the first things that needs to be done is to convince these women of the health risks they and the importance of going into therapy.

A combination of medicinal and cognitive behavioral therapy is the most effective treatment for bulimia. Patients must have a diary in which they keep track of their eating habits. Self-monitoring can reduce the number of abnormal eating moments.

Other more specific techniques that are used are increasing the regularity of food, making a greater variety of food and delaying as far as possible the moment at which to be spit. Through these techniques, the patterns that the women have built up can be broken down. The treatment also includes relapse prevention techniques.

What is a binge eating disorder?

A binge eating disorder is an eating disorder in which people suffer from regularly recurring periods of binge eating. They then eat large quantities faster than that they would normally do without really being hungry.

What influence do alcoholism and problem drinking have on your health?

Alcoholism is the biggest cause of death in America after smoking, a poor diet and little physical activity. The consumption of alcohol is related to various conditions such as increased blood pressure, liver cirrhosis, strokes, some forms of cancer, developmental delayments and physiological abnormalities in the children of heavily drinking mothers. Excessive drinking can cause cognitive problems.

Alcohol consumption thus contributes to illnesses and accidents. In addition, it leads to a lot of economic costs and to higher health risks. An example of this is aggressiveness, whereby more murders and robberies are committed under the influence of alcohol. Alcohol consumption can also lead to unsafe sex.

What is the definition of substance dependence?

The problem is that people try to hide their addiction, they only use when they are alone. Yet they have become dependent on a certain substance. The individual then administered himself the same substance several times, which led to tolerance, withdrawal and compulsive (compulsive) behavior.

There are different forms of substance dependence. Someone can be physically dependent. Then the body is adapted to the presence of the substance and uses the fabric in the normal functions of the body. This also has to do with tolerance where a larger dose is always needed to achieve the same effect. Someone can also crave or crave the expression of certain behavior or the consumption of a certain substance. This can be the result of physical dependence or a conditioning process.

Someone is addicted when, as a result of the use of a substance, he has become physically or psychologically dependent on this substance over a certain period of time.

Withdrawal refers to the unpleasant symptoms that people experience when they stop using a substance to which they have been addicted. Examples of these symptoms are headaches, nausea, anxiety and hallucinations.

What is alcoholism and problem drinking?

Alcoholism and problem drinking include a number of specific patterns. An alcoholic is someone who is physically addicted to alcohol. Alcoholics have withdrawal symptoms when they try to stop drinking, they have a very high tolerance for alcohol and do not really have an opportunity to control their drinking habits.

A problem drinker does not have to have all these characteristics, but they usually have social, psychological and medical problems as a result of the alcohol. Behaviors that are associated with heavy alcohol use are: the daily need of alcohol, repeatedly trying to stop drinking without results, bursting out of drinking (suddenly drinking a lot), not being able to stop drinking, losing memory during intoxication, continuing to drink while health problems are known, and drinking non-alcoholic beverages.

The fact that some heavy alcohol users are physiologically dependent on alcohol is suggested because there are stereotype drinking patterns, through drinking the alcohol content in the blood remains the same, people can function at an alcohol level that is much higher than with less tolerant drinkers, there is a feeling that there is no control over the use of alcohol and there is a subjective urge for alcohol. Symptoms of alcohol abuse are: difficulties to perform daily work, inability to function socially normal without alcohol and difficulties encountered while drinking, such as convictions while driving under the influence.

What causes alcoholism and problem drinking?

The causes of alcoholism and problem drinking are very complex. There are genetic factors associated with it. Men also seem to have a greater risk than women. Socio-demographic factors, for example low income, can predict alcoholism. The development of alcoholism is a gradual process in which physiological behavior and socio-cultural variables play a role.

The use of alcohol is a way to buffer the effects of stress. People with many chronic stressors, many negative big events and little social support have a higher chance of becoming problem drinkers or alcoholics than people without these problems. If people have little autonomy in their work, are not allowed to make decisions or are unable to use their own qualities, these people will become heavy alcohol users sooner. In addition, financial tensions may play a role. People then drink to reduce their negative emotions and to increase their positive emotions.

Alcoholism also depends on the social and cultural environment of an individual. Parents and friends act as role models for adolescents and can thus influence attitudes towards adolescent alcohol. Many people who become alcoholics have associated alcohol consumption with pleasant events in their former lives.

When people marry and have children, their risk of alcohol abuse becomes smaller, because they will then go to pubs and parties where alcohol use is prominent. Risk ages for alcohol abuse are between 12-21 years and middle-age if it is a way to deal with stress.

How can alcohol abuse be treated?

Recent years have shown that alcohol abuse is a habit that can be changed. Some alcohol users can do this alone and others need help with this. Alcoholism can be successfully treated with cognitive behavioral change programs.

However, a large part of the participants can not leave the alcohol after following these programs and return to their old habit. This may be because those who participate in such programs are also those who have serious drinking problems. Otherwise they would not need help. The social class in which people find themselves is a factor that is important for the success with which alcoholics conclude treatment programs. People in a higher social class and with stable social environments (regular job, group of friends and an intact family) are more successful than people with a low SES and unstable social environment. Attention must be paid to these backgrounds during the treatment of alcoholics.

Which programs exist for the treatment of alcoholics?

One way that is widely used in the treatment of alcoholics is self-help groups. A known treatment is the AA (Alcoholics Anonymous). The treatment programs often use broad-spectrum cognitive behavioral therapy to address biological and environmental factors related to alcoholism. The goals of the treatment are to eliminate the strengthening effect of alcohol (so that patients must have more and more), to teach people new behaviors that do not encourage alcohol abuse and to change the environment so that stimuli are present here that lead to behavior other than alcohol abuse. Stress coping techniques can also be taught so that there is a greater chance of sustaining in the longer term.

The first phase with serious drinkers consists of detoxification. This must be done in a protected medical setting, because a lot of health problems can arise during this process. If the alcoholic is already partially detoxified and is dry for a while, the therapy can start. The alcoholic will then receive a short period of intensive and internal therapy that will later be followed by a period of external therapy.

The cognitive behavioral techniques that are used include self-monitoring. This often happens to allow the alcoholic or problem drinker to understand the situations in which drinking occurs and persists. Contingency contracting is also often used. This means that when something goes wrong in the future, this will result in psychological or financial costs.

Motivation techniques are used because the responsibility and possibility of change lie entirely with the patient / alcoholic. In some programs, the participants take medication to reduce the interactions in the brain with the alcohol that contribute to alcoholism.

In many programs participants are taught stress management techniques that can serve as a substitute for drinking, because alcoholics or problem drinkers often use drinking as a coping way of stress. It is also the case that these techniques ensure less waste in the programs. It has been proven that a stressful event within the first 90 days after treatment is a good predictor for relapse among apparently 'cured' alcoholics. Relaxation techniques can also help alcoholics to deal with situations in which they would otherwise go to drink. In some cases family therapy is given what makes the return to the family easier for the alcoholic.

The relapse after treatment is a major problem in the treatment of alcohol abuse. Prevention can be used by practicing coping skills and social skills in 'situations with a high risk of relapse'. A chance relapse can happen. This helps the problem drinker realize that an opportunity drop is not the end of the check and a sign of failure. People need to learn skills to reduce drinking. They can also choose risky social situations to drink non-alcoholic beverages.

Success of alcohol abuse treatment programs

Within alcohol abuse treatment programs, there are several factors that contribute to success. The drinker must be able to identify, change or develop ways of dealing with these factors from the environment that determine drinking. The participation in a program lasts an average of 6-8 weeks with aftercare afterwards with the patient back home. Other factors that contribute to success are the use of weather-therapy and the interference of family and employers in the program.

The question now is whether internal hospitalization of the patient is necessary to guarantee success. It appears that alcoholics with stable jobs, relationships and few other problems do just as well in treatment programs in which the patient does not have to work internally. This could save costs. Of all alcoholics out there, only a small percentage (about 15%) is treated.

Why is alcohol abuse prevention important?

Because alcoholism is a major problem, health psychologists have come up with the idea of ​​making young people realize early on that they can better keep their drinks off or that they should only drink controlled. Young people are taught techniques that allow them to refuse drinks or to handle risky situations in which the pressure to drink is high.

Because adolescents learn and apply these skills, they gain more self-awareness. Through the curricula, the social norms that makes young people drink, alcohol can be replaced by standards that emphasize the abstinence of drink or controlled drinking. Because these programs are not expensive to give, low-income groups can be reached. In these low-income groups there are people who are otherwise the most difficult to reach.

Prevention of alcohol abuse can also be achieved by increasing the taxes on alcohol, stricter rules on the advertising of alcoholic beverages, the attention of the authorities to the big drinking problem among the youth and the misleading health benefits of alcohol.

What are major problems that arise from alcohol abuse?

A major problem as a result of alcohol use is the accidents that occur due to drink-driving. The general public also considers this a matter that needs attention. The pressure on governments to carry out stricter alcohol control is increasing. Attention is also shifted to hosts and hostesses who let their guests drive under influence and to friends who do not recognize that their friends are getting drunk behind the wheel. However, this can be a difficult task. It can help if the driver is someone you know well, you think that the person really needs help and you can give him / her that help and if you have had conversations with the rider in the past about what to do in such situations.

The intervention of hosts and friends with drunken drivers goes against the principle of personal responsibility and individual freedom. As a result, many drunk people are still on the road.

Because nowadays more attention is paid to drunk drivers, many drinkers are developing self-regulating techniques that ensure that they avoid drunk driving, such as drinking less when driving, arranging a taxi or slowing down or stopping driving until the effect of the drink has dropped. Preventions are hard to get through, but because many people now regulate themselves to avoid drunk driving, some of them can come up with a solution to prevent accidents.

Modest drinking can be healthy because it reduces the risk of cardiovascular disease. This could be because alcohol increases the HDL content slightly. HDL removes cholesterol and helps to lower the LDL content. This reduces the chance.

Can alcohol be good for your health?

A small intake of alcohol (1 to 2 glasses per day, but less for women) reduces the risk of heart attack and stroke.

Why is smoking bad for your health?

Smoking is the cause of many preventable deaths. Smoking increases the risk of cardiovascular disease, chronic bronchitis, emphysema, respiratory diseases, damage due to accidents and burns, lower birth weight of the children and subordinate fetal development.

It appears that smokers are less aware of their health than non-smokers. Therefore, they will fall into other bad health habits earlier. Especially the combination of smoking and drinking is common. Smokers take more sick leave, have more accidents at work and make more use of health care than non-smokers.

The dangers of smoking are not limited to the smokers themselves, but also friends, family members and colleagues run a greater risk of different diseases.

Does smoking have a synergistic effect?

Smoking increases the influence of other risk factors on health. This is a synergistic effect. For example, the combination of smoking and cholesterol causes greater morbidity and mortality in cardiovascular diseases. Nicotine can namely reduce HDL content, because nicotine releases fatty acids, resulting in more triglycerides being synthesized. The latter ensures the decrease of HDL (HDL clears up cholesterol).

Smoking has a relationship with stress. For example, it has been proven that in men, nicotine increases the size of cardiac activity under stress. In women nicotine reduces heart rhythm, but blood pressure is increased. Because of the stimulating effects of nicotine, smokers have a greater risk of a sudden heart attack. There is a physiological relationship between smoking, hyperresponsiveness to stressful events that leads to a higher risk of cardiovascular disease. The combination of weight and smoking also leads to higher mortality. Very thin people who smoke have a higher mortality than smokers with a normal weight. Non-smokers who are thin do not have this increased mortality.

Smokers have less physical exercise if they continue to smoke. If they stop smoking, they will get a more active level of physical activity. Smoking therefore provides less physical exercise than normal. Too little exercise is a risk factor for many diseases and death.

People who are depressed and smoke have a greater risk of cancer than non-smokers who are depressed. This would be because natural killer cell activity increases due to the combination of smoking and depression. Nowadays people think that smoking could be a cause of depression. Smoking is related to anxiety in the period of adolescence. Whether fears and smoking have a synergistic effect on health is not known.

The synergistic health effects of smoking could be the cause of the deaths related to smoking. Although the direct health effects of smoking are known to the general public, the synergistic effects are less known. The risks on cardiovascular disease and lung disease decrease considerably if someone stops smoking.

What is the history of the problem of smoking?

Smoking was a normal habit for years. In the beginning this was especially true for men. In 1955, 53% of adult men smoked in the US. Women started smoking later than men. In 1964 the first official article was published with the message that smoking has harmful consequences.

A large public campaign followed in which the dangers of smoking were emphasized. Despite this campaign, women and young people started to smoke more. The number of smokers among men dropped to 39%. There were then alternatives for smoking, such as the 'healthy' cigarette. Many people switched from heavy cigarettes to light cigarettes with less strong nicotine. It was believed that they went in the direction of good health through that step. However, follow-up studies showed that these assumptions were wrong, because people started to smoke more of these lighter cigarettes to compensate for nicotine loss.

Since 1979, the number of adults who smoke has dropped by more than 25%. Nonetheless, smoking remains a big problem. The number of smokers is particularly high among groups of minorities and teenagers. Tobacco industries are shifting their markets to developing countries where smoking is an emerging problem. This is because in developed countries the pressure to reduce smoking among children and adolescents is very high. In China, smoking behavior is taking on epidemic proportions.

Why do people smoke?

Smoking is determined by various physiological, psychological and social factors. Family and twin studies have shown that genetic influences on smoking behavior are of influence. Due to genetic feedback, some smokers have difficulty stopping. It probably does not have much value to give this information to smokers. Many people who smoke do not depend on it. Some people become calmer because of the nicotine, others are stimulated and others become depressed.

Factors in adolescents play an important role in developing the habit of smoking. Smoking starts with a period of experimentation in which the adolescent feels pressure from his friends and tries out cigarettes. Then the adolescent develops his attitude in smoking. After the experimental phase, a small proportion of adolescents become heavy smokers.

The influence of friends is one of the most important factors that causes young people to start smoking. More than 70% of the cigarettes smoked by adolescents are smoked in the presence of a friend. Early smoking behavior is often part of a syndrome of problem behavior, including alcohol consumption, drug use and irresponsible sex. Smoking can be an attempt to reduce a negative mood. It can also be associated with an increased testosterone function.

Adolescents will smoke earlier if their parents smoke, if they come from a low social class or if they feel environmental pressure to smoke.

The image of a smoker can also be a factor in which adolescents start smoking. Adolescents may have the image of a smoker that is tough, mature and rebellious. Insecure young people can then smoke, because they then radiate this image. Other young people can of themselves have the image that fits a picture of smoker. These will therefore be more inclined to smoke. Other factors that contribute to a greater chance of smoking are little self-confidence, dependence, powerlessness and social isolation. Male students are less likely to smoke than female students.

Why is smoking addictive?

Smoking is addictive. Only a small group of smokers is able to do it occasionally and not build up an addiction. Nicotine is a strong addictive drug. However, the mechanisms by which nicotine has an addictive effect are unknown.

The theory that the role of nicotine in not being able to stop smoking assumes that by smoking someone keeps their nicotine blood levels up and prevents withdrawal symptoms. These withdrawal symptoms occur when someone stops smoking.

It comes down to the fact that the nicotine levels in the blood change when someone starts to smoke. However, there are studies that have changed the nicotine level in the blood in humans, to which these people did not show any other smoking behavior. Another argument against this theory is that smoking strongly depends on situations in the environment and therefore can not change the nicotine level in the blood so quickly. Even if smokers are stopped and their nicotine content is zero, many smokers cease to fall back into their old habit. According to nicotine theory, there would be no reason for this.

Another theory is the theory of Pomerleau. He assumes that smoking works as a neuroregulator. Nicotine would then be a means by which reactions and attitudes are regulated. Nicotine changes the levels of normal neuro-regulators, such as norepinephrine, acetylcholine, dopamine, vasopressin and endogenous opioids. Smoking would then provide a temporary improvement of reactions. Thus, acetylcholine, norepinephrine and vasopressin can improve the memory. Acetylcholine and beta endorphins reduce anxiety and tension. The changes in these neurotransmitters can also improve the mood.

Smoking therefore increases concentration, alertness, responsiveness and the ability to eliminate irrelevant stimuli. When smokers stop smoking their concentration decreases, they have trouble remembering things and they experience more fears, tensions and mood swings. Because nicotine solves these problems, many smokers return to their old habit. As people smoke longer, they adjust their nicotine intake in such a way that they increase the beneficial effects of nicotine. This could be a reason that smoking is so good for coping with stress.

Other theories assume that smoking is maintained by social learning. Smoking is linked to rewarding experiences. For example, a young, insecure adolescent smokes because he is insecure. As soon as the cigarette is out, he / she becomes insecure again so he only lights up a cigarette again to lower his fears. Because smoking is very addictive, it is difficult to treat.

What can be done to reduce smoking?

One way to reduce the number of smokers is to try and change attitudes to smoking. Because many risks of smoking are emphasized via the media, people's attitudes to smoking change. The media can be very effective in providing information about health habits. The media also creates anti-smoking attitudes and other social norms with regard to smoking within society. These attitudes also ensure that adults start smoking less quickly and are persuaded to remain non-smokers. The anti-smoking messages from the media make people want to quit smoking.

Which interventions exist to stop smoking?

It turns out that people who, for example, look for psychotherapy to treat smoking do not do better than people who look for other therapies. If doctors give advice, this can lead to greater success. Especially if these recommendations contain an intervention or a reference to a specific stop program, they are successful.

It could be useful to set up stop programs via work. There is then great social support. However, it has been shown that stop programs do not work better than other programs through work. Continuing to stop smoking also does not work better in the workplace.

There are commercial programs that promise people that they can help with fighting smoking. The real statistics usually show a different success result than the advertisers want smokers to believe in.

The commercial programs are also available in the form of self-help. These are then nicotine patches or television programs that the smoker can follow and instructions on how he / she can stop smoking. It appears that this self-help allows fewer people to stop smoking in the beginning, but the people who quit keep this up as well as with more intensive programs.

Public health activities can also be carried out that can encourage people to stop. For example, there have been campaigns aimed at risk groups, for example people with a higher risk of cardiovascular disease. Such interventions are usually expensive and the long-term effects are limited.

Evans has developed a program that prevents young people from smoking. He starts from the fact that young people smoke more quickly when their parents or friends do that. Starting smoking is therefore influenced by modeling others. His program through social influence must therefore include the possibility of modeling. He then wants young people to model themselves on a non-smoker with a high status.

Another element of the intervention via social influence is behavioral vaccination. This is equivalent to a regular vaccination. Someone is exposed to seductive message, to which counter-arguments. This allows this person to better withstand this message.

The program of intervention through social influence consists of the following three elements:

The information about the negative effects is given in such a way that it appeals to young people. Although many young people know that smoking is bad for their health, they continue to do so. Therefore, suitable anti-smoking materials must be developed for this specific group. The campaigns should not, for example, emphasize the health problems in 20-30 years, but rather the problems that could currently occur. Attention should also be paid to the financial costs and the negative social consequences of smoking.

Are these interventions successful?

Whether these prevention programs are successful is difficult to estimate. They often only postpone the smoking behavior. Research has shown that intervention through social influence can reduce the number of smokers for about four years. Experimental smoking is probably more affected by these programs than regular smoking. The experimental smokers will stop by themselves more quickly through these programs.

What is the impact of stress on health? - Chapter 6

What is stress?

Stress is a negative emotional experience, accompanied by biochemical, psychological, cognitive and behavioral changes.

People experience things as stressful when they believe that their own resources will not be enough to beat a challenge or threat (eg no money to pay the rent). Stress therefore has to do with the way people assess a situation. Mainly things that are uncontrollable, negative and unpredictable and stand in the way of normal life are seen as stressful.

Research into stress, important?

The first contribution to the stress study came from Walter Cannon. His fight-or-flight concept introduced the idea that an organism is preparing to fight or flee in a threatening situation. With fighting, an aggressive response to stress is meant (anger), while flights mean seclusion of social activities or distractions.

Another important early contribution to stress research came from Hans Seyle. His General Adaptation Syndrome assumed that three phases can be identified in response to stress: the alarm phase, the resistance phase and the depletion phase.

There was a lot of criticism for the GAS. For example, criticisms say that not enough attention is paid to psychological aspects and this theory assumes that everyone reacts the same to stress. There is therefore no attention for differences in emotions, personalities and biological factors between people.

New studies (Taylor) assume that there is not only a flight or combat reaction and a depletion phase, but that people and animals can also respond to stress by tending to caring for offspring and promoting social ties. The research assumes that mainly women will respond in the latter way.

What is the effect of stress on health?

Stress leads to changes in the body. Think, for example, of an increased blood pressure or a lesser functioning of the immune system. People with chronic stress also have more bad habits in terms of health such as smoking, poor sleep, little exercise, etc. Stress can also prevent social contacts, including health care when they need it.

Which systems have to do with the response to stress?

When situations are experienced as stressful, the brain is put to work. This results in the production of the substances epinephrine and norepinephrine (catecholamines). These substances provide an accelerated heartbeat and sweating, etc. The hypothalamic-pituitary-adrenal axis is also activated in response to stress. It ensures the production of cortisol. It helps the body return to its normal state in a stressful situation.

When stress is experienced for a longer time, this has an effect on the immune system, sleep, blood pressure, cardiac arrhythmia and the development of psychiatric disorders. It is important to know that not every person is equally sensitive to stress and its effects.

What makes things stressful?

Events are experienced as stressful when it has a number of characteristics. For example, negative events will be perceived as more stressful than positive events. Uncontrollable and unforeseeable events also generate a lot of stress, just like when it is not sure if events are negative or positive. Another characteristic of a stressful event is that it concerns overload. Finally, events that are experienced as very important in a person's life are more stressful than minor events.

Most people can adapt to a moderate stressor. In principle, a situation can cause stress, but if the stressor stays on longer (chronically), less and less stress reactions will be shown. However, it is much more difficult and often impossible for people to adapt in this way in very stressful situations. A consequence of this is that it can have consequences for health. For vulnerable population groups it is much more difficult to adapt to a stressor. Adverse effects of stress can last until long after the stressful event.

In what ways is research done on stress?

Researchers conduct research into stress in a laboratory, through experiments in which test subjects are exposed to pathogens (eg viruses). Research into stressful life events shows that in a situation where people have to change, a higher degree of stress occurs, creating an increased risk of illness. Also daily stressful events (eg standing in a traffic jam every day) can affect physical and psychological health in the long term.

What causes chronic stress?

Difficulties during a person's childhood or puberty not only have an effect on health as a child / adolescent, but also work through in adulthood. For example, maltreatment during childhood causes greater health risks later in life and it causes problems with recognizing emotions in others and a lack of social skills. Children who have grown up in 'hard' families also experience difficulty building relationships with others.

Stress at work can also be a factor for chronic stress. Work stress is caused by, among other things: high work pressure, the lack of satisfactory work relations, overload and role conflicts and lack of clarity. Unemployment counts as a major stressor, as does combining work with private life. The different roles that one has at home and at work can lead to role conflicts or role overload. This causes stress, which can lead to a deteriorated health. The extent to which stress occurs depends in this case on sources such as time, money and social network.

What is the influence of coping styles and social support on health? - Chapter 7

What is coping?

Coping is the way someone deals with problems and events that are seen as stressful. A person's personality has a big influence on this. A negative approach to stress can also have a negative effect on health, or give people the idea that they are in bad health. A positive attitude to life, on the other hand, provides better mental and physical health. Optimism (believing that you can deal with a stressful situation), personal control (learning to think about stress) and self-confidence (the higher the self-confidence the less stress) are coping strategies that have a positive effect on how people with daily stress handle. Good coping strategies ensure, among other things, better health, fewer emotional problems and a higher quality of life.

There are different ways in which people can cope with stress (coping styles). Firstly, there is a difference between an avoiding and active approach. In an avoiding coping style one tries to ignore the stress. This often works in the short term, but with long-term stress it is wiser to opt for an active style to really solve the problem.

Another way to deal with stress is through problem-oriented coping. This means that a solution to a problem is sought by changing the situation that causes stress or setbacks. One can also choose to regulate the emotions that are created by a stressful situation (emotion-oriented coping). Which coping style you choose depends on, among other things, the type of stressor. However, it is certain that people who can change coping styles can best deal with stress.

Proactive coping often works best. Here one tries to anticipate a stressful situation even before this situation arises. This can avoid the emergence of a stressful situation or reduce its impact.

Coping styles are not only determined by internal factors, but also by external factors. Examples include the presence of time, money, education, work and social support (friends and family). People where many of these factors are present can often deal with stress better.

How do we know if the coping is successful?

Whether coping is successful is due to physiological indicators and whether these are reduced (body returned to pre-stressful conditions). Coping is successful when people can continue with activities that they performed before for the stressful situation and feel free of fear about situations where they get stress. Negative events are accepted more and they adapt to them. In addition, a more positive self-image is created.

What are interventions for dealing with stress?

Not everyone finds a correct way to cope with stress, which is why interventions for stress have been developed.

Effectiveness training for dealing with stress is used to learn ways to deal with stress more easily. Expressing emotions and expressive writing about stressful situations are used as methods. Expressing emotions by writing about it or talking about it is seen as a good way of coping. It provides support from third parties, changing from negative to positive thoughts and a better self-image.

For people who find it difficult to deal with stress, stress management programs are available. These kinds of programs help people develop good coping styles and skills. People are encouraged to talk about their stressful situations and are helped with dealing with these problems.

Why is social support so important in stress?

Social support ensures that people have the idea that others want to help them and that they are cared for, this ensures that people feel better. Social support reduces psychological anxiety and has various health benefits. Of course it is important to be with the right people. Suppose, for example, that the peer group of a person smokes, then that person is more inclined to smoke himself. In general, however, it is assumed that people with a social safety net are more likely to change unhealthy habits, they also cured more quickly or become ill less quickly.

How effective social support is depends on how the support is used by the individual. For example, someone with good social skills will receive a large degree of social support. Social support in a stressful period is most effective when this support comes from the right person and when it gives the right things. After all, every stressful event produces its own need for a kind of support. In childhood, for example, social support from parents is seen as the most important. Social support from the wrong person is ineffective. People tend to isolate themselves from a social network (and thus social support) in successful situations. Increasing the quantity and quality of social support is therefore an important goal of health psychological interventions.

Why do people use health care? - Chapter 8

It is assumed that only people who are ill use the health care system. However, this immediately raises a question: When and how does a person determine that he or she is ill? When are symptoms seen so serious that a doctor must be seen?

How difficult is it to recognize and interpret symptoms?

Recognizing symptoms and their interpretation is strongly influenced by psychological processes. The personality of people plays a major role in this. People who have more neurotic features or who are hypochondriac will have the quicker idea of ​​recognizing symptoms and thereby making more frequent use of health care. The same applies to people who are more focused on themselves.

The situation in which someone is present also influences the recognition of symptoms. For example, boring situations make people more aware of symptoms than interesting situations. Stress can exacerbate the experience of symptoms. People who have a lot of stress often believe that they are more vulnerable to contracting diseases. As a result, they pay more attention to looking and listening to their own body. People who are positive in life see themselves as healthier and have less fear of becoming ill.

Interpreting symptoms is also a psychological process. Previous experiences with illness, expectation of symptoms and how seriously the symptoms are taken play a major role in this.

The 'common sense model of illness' assumes that people have implicit ideas about symptoms and illness. These ideas are arranged in disease schemes. Through personal experiences, family and friends people have views about illness. The common sense model contains basic information about a disease. It indicates the type, causes, consequences, time span and treatment of the illness.

Most people can have three types of disease models:

• Acute illness: short time span, few consequences, caused by, for example, a virus (think of the flu);
• Chronic illness: caused by multiple factors, long time span, major consequences for health (eg heart disease);
• Cyclic disease: periods with many symptoms alternate with periods with few symptoms (think of herpes).

The opinions of people about illness are variable and affect behaviors related to the disease. It is therefore logical that people all deal differently with illness and that they also seek help in other ways and to different degrees.

What is the influence of the social network and the internet?

The informal social network of a person often already provides an interpretation of symptoms and thus serves as an intermediate step between a person and healthcare. Because people talk about their symptoms with friends and family, this is often seen as the first form of treatment. When a wise old woman, for example, says that the symptom can not be serious, then it is assumed that this is correct. Often for this reason no help is sought with health institutions, but first a solution is sought at home.

On the internet, people often search for their symptoms and other issues related to their health. Four in five people have already searched for information about health care.

Who uses the health care?

Healthcare is used disproportionately. Most often, young children, the elderly, women and the middle and upper class use the medical system. Social psychological factors also play a role in whether people seek help or not.

Can health care be taken advantage of?

Health care is misused when people want treatment for things that are not medically significant. This causes the system to be overloaded. Conversely, abuse occurs when people who need treatment do not use the system.

How does health care work, and what problems can people encounter? - Chapter 9

Health care: What problems can arise between doctors and patients?

In most cases there is good communication between doctors and patients. Information is exchanged and a treatment plan is drawn up. However, it is also possible that something goes wrong during a doctor's visit. Consider, for example, issues such as long queues, incorrect diagnoses and treatments that have no effect. This ensures that many people have an ambiguous attitude towards health care.

In the past, the authority of a doctor was accepted without a struggle. Nowadays it is not that simple. Patients often get the choice to opt for a certain treatment and patients are increasingly involved in the treatment. The cooperation of a patient and embracing the treatment plan is therefore very important. Patients see themselves more and more as care consumers instead of passive recipients of care.

In what ways do doctors communicate with patients?

Patients tend to value the care they receive based on interactions with doctors. People often do not have enough knowledge about medication or treatments themselves to know if they are good. They must then trust that their doctor makes a good estimate. A friendly, empathic doctor gives the idea of ​​being competent in what he does. This ensures that health care is increasingly focused on the patient.

Nevertheless, doctors often criticize their communication, they do not make stories personal enough and talk too much in terms that are not understood by patients. It should be noted that an appointment with a doctor is not the best setting for effective communication. Talks lasts for a maximum of fifteen minutes and there is little chance for patient comments.The doctor has the problem that he has to find out what the patient's problem is as soon as possible.

Which behavior contributes to incorrect communication?

Doctors often make the mistake that they do not seem to be listening. Patients do not have the chance to finish their story because the doctor is already making a diagnosis. In addition, doctors use too much jargon, or they switch to 'baby talk'. Although the use of jargon is often too complicated for the patient, what patients know may also be underestimated by the doctor.

Another common mistake by doctors is depersonalizing patients (pretending the patient is not there). Often this is used as a method to keep the patient quiet, allowing the doctor to perform better. Another mistake is that doctors often assume stereotypes of patients. Often this is not even done consciously, but research has shown, for example, that doctors give less educated people less information than to highly educated people. In addition, older people are considered less full and there is often sexism. Patients who seem to meet certain stereotypes are therefore often suspicious and are therefore less satisfied with the care given to them.

Patients also make mistakes when it comes to dealing with doctors. For example, they do not always give doctors the right information. Patients often only look for symptoms that interfere with their own activities, so they do not understand that a doctor looks at the underlying causes of illness. When the doctor does not prescribe treatment, but for example only medication that can be bought in the store, patients often feel ignored and doubt the diagnosis. Patients sometimes feel that they are not allowed to give feedback or comment on the diagnosis or treatment and remain distant. In the case of doctors, it also causes frustration that patients do not seem to (want to) listen to a diagnosis.

What are the consequences of poor communication?

Poor communication between doctor and patient leads in most cases to non-compliance with treatments or treatment regimes by the patient. Patients' chances of adherence to treatment become smaller when those physician's recommendations do not appear to be medical or when people feel that they have to adjust their lives through treatment. In addition, conflicts arise when patients themselves already have an idea about their illness and treatment, but this idea does not match the treatment prescribed by the doctor.

When patients feel that a doctor cares about them, understand what they need to do and get written instructions, they are much more likely to follow the treatment.

How can communication between doctors and patients be improved?

There are several things that doctors and patients can do to improve mutual communication. First, the physician can use communication training, because communication that focuses on the patient ensures that patients will sooner follow a treatment. Face-to-face communication is very important here.

There are also interventions to improve patient communication. Within these interventions, attention is paid to the way in which patients can receive information from doctors.

How does a hospital work?

The functioning of a hospital is focused on three key points: healing, caring for and the core / functioning. Curing is the responsibility of physicians, they have to treat patients in such a way that the good health of the patient returns. The care for patients is arranged by nurses, it is more about the humane side of medicine. The administration of the hospital deals with the functioning of the system and the supply and removal of goods. The objectives of these key points do not always correspond, so friction can arise.

What is the role of health psychologists?

Health psychologists participate in the diagnosis of patients and assess the functioning of the patient. This could lead to interventions. In addition, psychologists are involved in the process before and after surgery, interventions to increase medication (pain control) and monitoring compliance with the treatment. In addition, they diagnose and treat patients with psychological problems.

What is the impact of hospitalization on the patient?

Patients are often scared and uncomfortable when they arrive at the hospital. They have to rely on a stranger in unknown territory. The lack of communication between staff and patient also causes problems sometimes.

How is the provision of the right information promoted?

Many hospitals nowadays provide programs that should give patients more insight into their hospitalization and the procedures involved. It appears that this has good effects, both for the patients and for the hospital. Patients who are well informed and prepared experience less stress and often recover more quickly, allowing them to go home sooner.

What is the effect of hospitalization on children?

A hospital admission has a big impact on children. It is difficult for the child to be separated from their parents and their homes. Sometimes they do not understand why they can not be with their parents, the child can then feel alone and isolated.

How can a child be best prepared for hospitalization?

Just like adults, children benefit from good preparation. Children can be taught good copings style, to deal with surgeries or how to relax. Children can often be prepared by the parents. For example, parents can explain why a hospital admission is necessary, who is involved in their process and how often the parents will come to visit.

If parents are present in a stressful medical procedure, this can have benefits, but it can also give the child more stress. In most cases, however, one assumes a positive effect. The support of the parents is therefore important in any case, so most hospitals ensure that parents are allowed to visit 24 hours a day.

What are complementary and alternative medicines?

In addition to traditional medicine, many people also use traditional and complementary medicine. This involves a diverse group of therapies, products and treatments, for example acupuncture, specific nutrition and meditation. The disadvantage is that this is often not covered by insurance and that medicines are not always tested as well. It is therefore difficult to estimate whether all these alternatives work well, but especially when it comes to pain control it shows that good results are achieved.

People are inclined to use alternative medicines when they feel that traditional medicine has not worked. Examples of this alternative medicine are traditonal Chinese medicine, naturopathy and homeopathy.

What is the placebo effect?

What is the history of the placebo effect?

During the first years of medicine, few drugs and treatments had a real effect on health. As a result, people were treated with increasingly strangely ineffective therapies. It is therefore strange that people often responded well to these alternative treatments. It is obvious that it was a placebo effect.

What is a placebo?

A placebo is a medicine prescribed as a medicine that contains no active ingredients. It causes an effect in a patient due to its therapeutic nature. The placebo response is a complex psychologically mediated series of events that often have physiological effects.

How effective is a placebo?

How effective a placebo is depends on how a therapist treats a patient and whether the therapist seems to believe in the treatment. Respirators who radiate heat, competence and self-confidence provide stronger placebo effects than formal therapists.

Not every patient exhibits the same degree of placebo effects. People who need a lot of confirmation and who have to deal with low self-esteem show a strong degree of placebo effects. In addition, it appears that a high degree of medical formality (machines, people in uniform, etc.) causes more placebo effects. The shape, size, color, taste and quantity of the placebo also influence its effect. 'Medical' looking placebos provide the best results.

Can the placebo be used as a methodical tool?

The placebo response is so powerful that every drug in the United States is first evaluated by putting it next to a placebo. Often, a double-blind experiment is used. A group then receives the actual medication, while the other group receives a placebo. Both the researcher and the subject do not know whether he is receiving the real drug or the placebo. The effectiveness of the placebo in relation to the actual medicine must determine whether the drug is effective enough to market.

How to deal with pain? - Chapter 10

Why is it so difficult to deal with pain?

Pain can be so emphatically present that it stands in the way of normal life and thus the basic needs. Pain, however, is crucial to survival, it gives us signals about how it is done with our body, so we make adjustments in our actions. It is a symptom that most often causes people to seek help.

Why is the cause of pain elusive?

Pain is one of the most immobile aspects of illness and its treatment. It is primarily a psychological experience, how it is felt and the extent to which it causes discomfort largely depends on the way in which the pain is interpreted. Pain is also heavily influenced by the context in which it is experienced. In addition, it appears that women are more susceptible to pain than men.

How can pain be measured?

It is difficult to treat pain well because people often find it hard to describe what kind of pain they have. Pain has no objective references.

The psychology of pain

Pain has psychological, behavioral and sensory components. It is a protective mechanism in which tissue damage is brought to light. Pain often coincides with a certain (emotional) behavior, such as crying or retiring. All these factors are an important part of the pain experience, which is why they are important for diagnosis and treatment.

What is the 'Gate Control Theory of Pain'?

The gate theory assumes that the painful stimulus that comes in first goes through nerves to the spinal cord. This can be done via A-delta nerve fibers (fast, sharp, local pain) C-nerve fibers (slow, prolonged and burning). The spinal cord then passes the stimulus to the brain. When the stimulus reaches the brain, then the pain is felt. Other incoming stimuli can then alter the pain stimuli, so that the pain is not felt or felt less.

What are opioids and opiates?

Opiates (such as morphine) are painkillers made from plants. Opioids are opiate-like substances that are produced in the body, which provide for internal pain regulation. They form the natural system for pain suppression. This system does need a trigger, for example, stress.

What are clinical problems with pain management?

There are two main groups of clinical pain: acute and chronic pain. Acute pain often comes from specific injuries that cause tissue damage. This pain disappears when the injury is healed and therefore often only lasts for a short time. Chronic pain often starts acute, but does not pull away like acute pain.

There are different types of chronic pain:

1. Chronic benign pain, often lasts more than 6 months and is not very sensitive to treatments. The pain is variable in strength and can affect all muscle groups;
2. Recurrent acute pain, involving interrupted episodes of pain, which have an acute character but last for more than six months;
3. Chronic progressive pain lasts longer than six months and is becoming increasingly severe. Often it is about degenerative disorders.

Chronic pain can stand in the way of normal daily activities. It often results in these patients withdrawing from social life, no longer being able to work or not able to do anything in their free time. Because the income goes down, the standard of living falls. Chronic pain also has a big effect on relationships with others.

Patients with chronic pain score high on neurotic disorders such as depression and hysteria. In addition, treatments are often given more attention to anger management.

Which types of pain control exist?

Pain management can be focused on different things. It can be about not feeling pain, but also about how to deal with pain.

The most traditional way of controlling pain is taking medication. Every drug that affects the neural transmission is a candidate to fight pain. The problem here is that not every painkiller is equally effective and there is a chance of addiction.

Pain can also be fought through surgeries. By creating lesions or cutting the pain fibers, pain sensations can no longer be felt. Unfortunately, the effects are often limited and it can make the pain worse over time.

Other ways of combating pain are counterirritation (irritating another part of the body so that pain is no longer noticeable), biofeedback (gaining control of the body and adjusting processes), relaxation training and distraction, so that the pain is not felt. In addition, patients can be taught coping styles that they can use to deal with pain. The effects and results of all these pain management techniques vary.

Which pain management programs are available?

Chronic pain can be treated by means of pain management programs that focus on pain management, stopping changing behavior through pain and having a profitable lifestyle. Patients are approached with respect for their behavior and the pain they feel, a qualitative and quantitative assessment of the pain is important.

The programs are aimed at the individual, with concrete goals and rules. Often the goal is to reduce the intensity of the pain and to stop the dependence on medication. Group therapy is used to restore control over emotional responses. In addition, relapse prevention is also important. Pain management programs are often successful.

How can people (learn to) deal with chronic health problems? - Chapter 11

Why is research into quality of life important for research into chronic diseases?

About 50% of people have to deal with a chronic condition that requires medical treatment. The quality of life is getting more and more attention in the research into chronic diseases. These include physical functioning, psychological status, social functioning and disease and treatment symptoms. In other words, it is about how having a chronic illness and a normal life go together.

Research into the quality of life of people with chronic illness can lead to interventions that improve this quality of life. It shows the impact of treatments and can compare therapies with each other. This gives therapists insight into the treatments that ensure a high quality of life. This quality of life can then ensure that people experience symptoms as less and that a disease develops less quickly.

What are common emotional reactions to chronic conditions?

When a patient is diagnosed with a chronic illness, this can cause a physical, social and psychological imbalance for the patient. The coping styles that a person would normally use then have no effect, which can lead to an exaggeration of symptoms and their significance, a negative attitude and therefore a poorer health.

The first defense mechanism that people use to dodge the implications of a disorder is denial. Patients then pretend that the disease will last for a while and is not important. The problem here is that this can impede good communication and thus treatment.

Other reactions are anxiety and depression. Patients may be afraid of what is to come, results of testing or for treatment. This can stand in the way of a good treatment if this fear is wrongly seen as a symptom. Depressions are so common as a response to a diagnosis that doctors pay extra attention to this during doctor visits. This is difficult because many symptoms associated with depression can also be related to the disease. The risk of depression increases as the illness or condition is more serious.

Which personal problems arise for people with chronic health conditions?

A chronic illness can lead to major changes in self-esteem and self-confidence. Often these changes are temporary, but they can also be permanent. The body image people have is the perception and evaluation of a person's physical functioning and appearance. When people get sick, this self-image is affected in a negative way.

How can people best deal with chronic health conditions?

Most people with chronic conditions who experience psychological problems do not seek professional help. They focus more on their own personal coping styles or social network to solve problems. It is certain that active and flexible coping styles are the most successful.

What other issues are involved when dealing with a chronic illness?

People can first use physical rehabilitation, although this is not always necessary. Physical rehabilitation has a number of objectives. The point is that people can use their bodies as much as possible. People learn to make adjustments, both to the environment and to what they ask of the body.

Continuing sexual relations, adjusting to treatments, changing work / taking a job coach are other matters that contribute to a better treatment with a chronic condition.

Some people with a chronic condition find it difficult to interfere in social life. They are afraid of negative reactions or have the idea that people in the social circle have certain prejudices. In addition, a chronic illness often takes a big toll on families. However, this does not always mean that this is negative, often families become even closer to it. Women with a chronic health condition experience more social problems than men.

Are there also positive changes in response to a chronic condition?

People are very resilient. This ensures that there are not only negative aspects to a chronic illness. For example, people can feel positive emotions and be optimistic because they give meaning to daily life. People value life more and find inspiration to do things sooner, they put more energy into relationships and feel more empathy towards others. These positive feelings contribute to a better way of dealing with illness.

Why are chronic disorders in children more problematic?

Chronic health problems are especially problematic for children. Children often do not understand the diagnosis immediately and therefore have trouble dealing with the disease. Family must help with a treatment plan and follow the treatment because the child can not do this himself. This can cause tension between parents and child. Children with chronic problems can then also experience mood swings and low self-esteem.

What are psychological interventions for chronic conditions?

The effects that chronic disorders and their treatment may have have led to special psychological interventions being set up. Examples include pharmacological interventions (in case of depression), individual therapies (in psychosocial complications), training in dealing with stress, relaxation therapy and physical activity.

Social support is very important for people with chronic health problems. Mainly support from the family and the family plays a major role in this. It ensures that a patient can function better physically and emotionally and ensures that patients better comply with a treatment plan. It is therefore wise that families are taught how to deal with the patient.

How does death play a role in health psychology? - Chapter 12

How does death play a role during the course of life?

What are the main causes of child mortality in the Western world?

In America there is a high mortality rate among children and babies. This number is higher than in other Western countries. This has to do with the fact that there is no national medical program in the United States where free or cheap care is offered during pregnancy.

During the first year of life, the main cause of death is cot death (sudden infant death syndrome). It is about the death of a baby without a real cause for this. After the first year of life, accidents are the most important cause of death in children under the age of 15, followed by cancer (leukemia).

What do children know about death?

Children only get a sense of awareness between the ages of five and nine that death is definitive. This does not mean, however, that they have a biological knowledge about death. Death then has a supernatural character for children. The fact that death is inevitable arises only later, around the age of 10, when children get a better view of all processes that belong to death (for example a funeral and that the dead person does not return).

What are the main causes of mortality among adolescents and young adults in the western world?

The mortality rate among adolescents is low. The main cause of death in this population group (15 to 19 years) are accidental accidents, often with cars. A second leading cause of death is murder (America, mainly black men), a third cause is suicide and the fourth is cancer.

How is reacted to mortality among young people?

The death of children and young people is always experienced as tragic. Young people diagnosed with terminal illness will therefore be shocked and have a feeling of powerlessness. It is therefore often difficult for hospital staff to work with these patients. Often it takes a long time for these patients to die because the body is otherwise in good condition, causing anger.

What are the main causes of mortality among middle-aged people in the Western world?

For middle-aged people, death becomes a more realistic image. People already develop chronic problems that eventually lead to death. People at this age often take new steps to postpone the image of an approaching death.

The main reason for early death among middle-aged people (dying before the age of 79) is a heart attack or stroke. Most adults, if they could, would opt for a sudden death. This is to avoid a long illness.

Why is it slightly easier to die in old age?

Dying is difficult at any time in life, but older people (over 65 years old) are often better prepared for death. This is because they themselves have already come into contact with death and often have thought about it. Most elderly people die of degenerative diseases such as cancer or heart failure.

What are psychological problems with terminal illnesses?

People who are terminally ill know that they are dying, in addition, the treatments they have to follow often have many unpleasant side effects. It is therefore important that these people are well supervised. Partly for these reasons, the question of whether there is a right to die (euthanasia) has become increasingly important in recent years.

Which social and psychological problems can terminally ill people have?

Diseases change the self-image that people have. When a disease gets worse, it is increasingly difficult for people to present themselves in the way they would like to. In addition, it can occur that they display behaviors that are unpleasant for themselves and for others, such as drooling or uncontrollable surrender. All these problems ensure that people try to avoid social contacts, while they may want or need this themselves. Family and friends are often used to reduce this process.

In the beginning, as long as the prognosis is favorable, there is often open communication. Only when the prognosis worsens and the treatment becomes more drastic can this communication change. For example, doctors give less information. Talking about death is usually avoided at this stage.

What problems arise with non-traditional treatments?

When health deteriorates and open communication does not seem to be possible anymore, different patients opt for non-traditional treatments. These treatments are not only expensive and uncomfortable, but also have little effect.

What is the five-phase model of Kübler-Ross?

The five-phase model of Kübler-Ross assumes that people go through five phases when they know they are going to die.

• Denial: This is a defense mechanism whereby a person protects himself by completely rejecting the truth. All facts relating to the disease are ignored as much as possible;
• Anger: The person protests against the diagnosis, questions like "Why me?" be asked. The patient can hold a grudge against healthy people, or try to blame others. The anger is therefore often directed against others;
• Negotiation: The patient notices that anger does not help and will try to purchase good health with good behavior;
• Depression: In this phase the patient feels helpless and tries to accept that he has no control over the situation. Here the patient starts to say goodbye to relationships and activities, he mourns, as it were, for his own death;
• Acceptance: A patient at this stage is often too weak to be angry and too accustomed to the idea of ​​being depressed.

Criticism of this model is that there is too little attention for fear, which is one of the most common reactions in addition to depression. Patients are most afraid of uncontrollable pain.

What psychological problems can arise for terminally ill patients in hospitals?

About a third of all people who die, die in a hospital. This institutional environment can ensure that patients can not count on the help they expect. Think of strict visiting hours or de-personalized help. The patient is dependent on the hospital staff, because they often need help with the smallest things. In addition, they are the only realistic source of information for the patient.

Terminal care is difficult for the caring staff. It is no longer about curing a patient, but only about palliative care. The staff tries to repress the pain they experience by repeatedly seeing the death of patients by withdrawing and working formally. This can then make the patient feel as if he is being abandoned.

Are there alternatives outside the hospital?

First, terminally ill patients can go to a hospice. Here is a focus on palliative care and emotional support for the patient and their families. They are allowed to organize their rooms at home and make them more personal. In addition, there are few restrictions regarding visits and visiting hours.

In addition, more and more people are interested in home care. This is often easier for the patient himself, but places a high burden on the family.

What happens to the next of kin?

For stragglers it is often very difficult to deal with the loss of a loved one. The weeks before someone dies are often very hectic for the family. When the person then dies, not only this person leaves, but also all the hectic that have caused his illness. This leads to that next of kin often experience the feeling of falling into a hole.

What are the four most common chronic conditions? - Chapter 13

This chapter focuses on the four most common chronic conditions, namely coronary heart diseases, hypertension (high blood pressure), stroke, diabetes.

What are coronary heart diseases (CHD)?

CHD is the leading cause of death in the United States. It is a collective term for all diseases caused by atherosclerosis, the silting up of the veins. Risk factors for CHD include high cholesterol, high blood pressure, obesity and little physical activity. Also biological reactions to stress do not benefit the risk of CHD. These risk factors are already beginning to accumulate from the 14th year of life.

Women are more likely to die from CHD than men. In women CHD often only occurs later in life, making it even more dangerous immediately. Mainly after the menopause, the chance of a heart condition is greater. Yet there are still many unanswered issues regarding CHD in women, which ensures that there is also less information available about the risks for women.

What is the influence of a person's personality on CHD?

Negative emotions such as anger and hostility increase the risk on CHD. This hostility can be determined at an early age. This is often the result of low self-esteem and negative feelings about others. Often this is the case with people who come from families that offer no support, in which there is little acceptance and where there are many conflicts.

Expressing all these negative feelings increases the chances of CHD. In addition, they often have a smaller social network and with that less social support, which can also be a risk.

Depressions, hostile coping and fear also influence the development and progression of CHD. Positive emotions, emotional vitality and optimism and cheerfulness, however, lead to a lower risk of heart disease.

What to do in case of a heart attack?

An important reason for the high death rates for heart attacks is that patients often do not immediately seek help. This often only happens after a few weeks or days. It is therefore important to know how help-seeking behavior can be promoted and accelerated.

The diagnosis CHD can be dealt with in different ways. First, by surgeries. Consider, for example, a bypass surgery, in which the blocked veins are opened again. A rehabilitation program is then set in motion after the operation.

Another way is through medicines called beta blockers. The disadvantage of these drugs is that they often have unpleasant side effects. In addition, aspirins are prescribed in the first month after the attack.

Most people who are recovering from a heart attack must stick to diet rules and certaing moving rules. In addition, a lot of attention is paid to stress management during rehabilitation. Depressions and problems within people's social network are also addressed here because a heart attack can cause problems in social relationships.

How can a heart attack be prevented?

By addressing the risk factors, a heart attack can be prevented. For example, screening can be done for too much cholesterol or high blood pressure. Changes in people's diet and physical activity are encouraged. In addition, stress management is also a good factor to prevent a heart attack.

What is hypertension and what are the causes?

Hypertension (high blood pressure) is a common condition. High blood pressure occurs when the supply of blood through the blood vessels is excessive. It is a serious medical problem, but there are no real symptoms. Because of this, most people do not know that they have high blood pressure. A high blood pressure is considered a risk factor for many other diseases and disorders.

Ninety percent of all causes for elevated blood pressure are unknown. We do know that genetic factors play a role, just like emotional factors. A family in which there is chronic anger can also be a risk, just like a high level of stress. Black people seem to suffer faster from high blood pressure.

How can hypertension be treated?

Because an increased blood pressure is easy to detect, many people are early to prevent worse. However, because so many people do not know that they have high blood pressure, it would be wise to make more use of screening people. Like this a treatment can be used more quickly.

Goals such as weight loss, a better diet and more exercise are used to lower blood pressure. When the high blood pressure is already at a more advanced stage, drugs will have to be taken. Here too, a healthy lifestyle, no caffeine and weight loss are important.

Cognitive behavioral treatments are also used to treat patients with high blood pressure. Think of hypnosis, relaxation therapy and meditation. With all these therapies, the intention is to bring the body into a state of rest that lowers the blood pressure. The advantage of this is that it is often cheap and has few side effects and that it is very effective.

How does a stroke develop and what are the consequences?

In a stroke there is a disturbance of the blood supply to the brain. Such a disturbance can occur due to a blood clot or bleeding. The biggest problem with a stroke is that such a stroke is often followed by other strokes, which can lead to someone becoming disabled or dying. Aspirin can reduce the risk of such recurrent stroke.

The risks of a stroke largely resemble the risks of a heart attack. Think of high blood pressure, a heart disease or a high number of red blood cells. The risk of a stroke increases as you get older and it happens more often in men than in women. Acute triggers for stroke include stress, negative emotions, depression and anxiety.

A stroke has an effect on all aspects of life. Immediately after a stroke, patients experience motor problems. This makes that they need a lot of help, which leads to changes in their relationship with others. Whether a patient also experiences cognitive problems depends where he is affected by the stroke. People affected on the left hemisphere can experience communication problems and problems with short-term memory. People who are affected on the right hemisphere have trouble understanding visual feedback.

How can people with a stroke be treated?

Treatments for people who have had a stroke have five key points: medication, psychotherapy, cognitive training, exercise therapy and the use of a stimulating and structured environment.

What is Diabetes Type II and what are the consequences?

Until recently, it was thought that Type II diabetes was a disease of old age, but due to the emergence of high-sugar foods that contribute to diabetes, more and more young people are also getting the disease. Diabetes type II is therefore a growing health problem.

In diabetes type II, the body has too little insulin. Moreover, it does not respond well anymore, there is an insensitivity to insulin. Symptoms include: frequent urination, dry mouth, irregular menstruation, infected gums or skin, pain or cramps in the legs, fingers or feet and long-term healing of wounds.

Patients with diabetes have a greater risk of cardiovascular disease. It can lead to blindness, pain and symptoms of disruption. It is also an increased risk for developing depression and cognitive problems. People with diabetes are more sensitive to stressful situations.

How can diabetes be treated and how can it be prevented?

The successful treatment of diabetes has to do with an active, independent attitude. When people change their lifestyle and they start to exercise and eat healthy, diabetes can be prevented. Yet it is often difficult to implement these changes in normal life, because people often do not see the severity of their diagnosis.

What is Psychoneuroimmunology and what other Immune-related disorders exist? - Chapter 14

What effect does stress have on the immune system?

The immune system is the body's security system. It protects the body from outside invaders. There are several stressors that affect this system. Different types of stressors all need different types of treatments from the immune system. In addition, not all parts of the immune system work equally hard at all times to ward off a threat.

Stress has a big influence on the immune system. Both children and adults who have to deal with stress are prone to infections and therefore become ill more quickly. People who are ill can become even more sick due to stress.

Part of the reason why stress causes problems with the immune system is because stress increases negative emotions such as anxiety and depression, which has a negative effect on the immune system. In addition, the lack of personal relationships, marital problems, stress by caring for others and the use of wrong coping styles have a negative effect on the immune system.

Stress management interventions can reduce the impact of stress on the immune system.

What are HIV and AIDS and in what ways can these diseases be treated?

AIDS or Acquired Immune Deficiency Syndrome has spread from Africa to Europe and the United States. Approximately 37 million people worldwide are affected by this disease.

AIDS is caused by the retrovirus HIV. This virus is transmitted through the exchange of body fluid that is rich in cells. Think of blood and semen, for example. The period between receiving the virus and developing symptoms of Aids can take a long time. The HIV virus spreads throughout the body and slowly affects the immune system.

What is the psychological impact of HIV?

An HIV diagnosis often coincides with depression. This is especially true for people with a low level of social support and people who feel stigmatized by their sexuality or race. This depression can lead to people using self-medication, which leads to drinking, medicine and drug use. This can lead to risky sexual behavior. Interventions that combat depression are therefore very useful in the fight against Aids.

Yet people generally seem to be able to deal with HIV in the long term. Most people with HIV change their lives in a positive way, such as following a good diet and more physical activity. Many of these changes ensure that people also progress psychologically.

The fact that many people do not make public that they have HIV, or lie about the symptoms, makes it very difficult to check the spread of HIV. Interventions to prevent the spread of HIV are therefore required. Most interventions focus on education and information about the infection, but also on preventing it. Here it is emphasized again how important having safe sex is. Prevention programs are used in schools.

How do people deal with the diagnosis Aids?

Dealing with a life-threatening illness is always a challenge. HIV is a chronic condition, which causes psychological problems associated with a chronic illness. Often this ensures that people can not / do not want to work anymore. Interventions are then used to get people back to work. The image that society has of people with HIV or Aids also ensures that these patients experience a lot of stress.

Training for the effective use of coping styles can ensure that people with HIV are better able to deal with issues that cause stress around their illness. Social support is another effective way to reduce stress.

Psychological problems in people with HIV can speed up the disease process. Optimism, an active coping style, being extraverted and spiritual can ensure that the disease develops less quickly.

What is cancer?

Cancer is a collective term for more than 100 diseases that have the same common factors. With every type of cancer it is a dysfunction in the DNA. The DNA then causes an enormous growth of cells that are harmful to the body.

Cancer is difficult to investigate because every type of cancer has its own symptoms, causes and treatments. In addition, many types of cancer have a long and irregular growth period.

Many types of cancer are partly genetic, but there are also types of cancer that are more ethically determined. Other types of cancer are seen more as culturally determined, because they are the cause of a certain lifestyle. In addition, there are risk factors for cancer, for example excessive drinking and a bad diet.

Can stress cause cancer?

Stress in the form of losing social support can cause the onset of cancer and affect its course of disease. It can also affect symptoms associated with cancer.

Psychological factors can also influence the course and development of cancer. Not being able to face and ignore the disease often lead to a faster progress. The same applies to depression and the use of evasive, passive coping styles.

What are problems in the treatment of cancer?

The treatment of cancer can cause psychological problems. The treatments often have side effects. Especially chemotherapies are both physically and mentally heavy.

Cancer has become a chronic disease nowadays. There are people who heal from cancer, but also people where the cancer always returns or can not be cured. The fact that people often have to deal with the disease for a very long time can also lead to long-term depression.

Cancer patients have the same problems with stress as other people. What can give extra stress to cancer patients is the knowledge that the cancer can come back. Social support is very important for cancer patients.

Before the treatment starts, it is important that information is given about the ways in which cancer patients can deal with their treatment and the symptoms that go with it, which should improve the quality of life of these patients. After the treatment, attention is also paid to interventions that improve the quality of life of patients.

What is arteritis?

As is known, there are a number of autoimmune diseases. This means that the body does not recognize its own tissues and attacks them. The most common autoimmune disease is arteritis. It is a collective name for more than 100 diseases that affect the joints.

Rheumatoid arthritis (RA) is a progressive autoimmune disease characterized by inflammation of the mucous membrane in joints. It can occur in people of all age groups, but is more common in women. The consequences of RA include pain, less / not being able to undertake activities and always being dependent on others. Older people or people who already have a chronic illness are more affected by unpleasant symptoms. Depressions often occur as a reaction to the disease.

Can stress cause arteritis?

Stress could play a role in the development and course of Rheumatoid arthritis. Mainly socially related stress could lead to the development of this disease.

How can RA be treated?

Treatments that reduce the problems with Rheumatoid arthritis are aspirin, rest and exercise under supervision. Unfortunately, the affection to actually do these things is low among many people. Support from a partner can ensure that people still comply with their treatment.

What is Diabetes type I?

Diabetes Type I is an autoimmune disease that results from a shortage of insulin. The disease can occur after a virus, but is mainly genetically determined. Type I diabetes is a life-threatening disease. Its treatment is in the administration of insulin, by means of insulin syringes. An high blood sugar level is life-threatening for a Diabetes Type I patients. Stress can make the symptoms of diabetes worse, mainly because it causes mental problems.

Unfortunately, it appears that compliance with the entire treatments is often difficult. But about 15 percent of all patients comply with all recommendations regarding their treatment. This is because people often do not suffer from symptoms. The use of good coping strategies contributes to compliance with the treatment. Especially in adolescents, the treatment of diabetes causes problems.

Health psychologists can develop ways of education that help people to follow their treatment plan.

Health psychology: What are the challenges for the future? - Chapter 15

When it comes to health-related problems, it is often forgotten that a lot of progress has already been made. Consider, for example, the life expectancy that continues to rise, the fact that fewer and fewer people start smoking and the falling mortality figures. Health psychology has played a major role in this, as are changes in the health care system and technological changes. Yet there are always issues that need improvement.

What else can be done in the field of promotion?

More and more people see that bad health behaviors have an impact on their health. For this reason, people stop smoking or people try to follow a healthier diet. For health psychology it is a challenge to also address the people who do not see this themselves. This must be done in a (cost) effective way that reaches many people. The development of interventions against mass consumption is therefore necessary.

What to do in the field of prevention and risk patients?

People who are at risk of becoming chronically ill must learn to deal with their risk status and learn ways to change risky behaviors. Health psychologists can play an important role here.

Preventing bad health habits is an important objective. Adolescents are most inclined to switch to these bad habits. Prevention programs can therefore best target this target group. This is possible, for example, by giving lectures at schools. Because people are getting older, there must also be interventions for the elderly, who learn how to function in a good way for as long as possible.

The focus of promoting good health should be more on reducing morbidity and increasing quality of life. More attention needs to be paid to positive issues that reduce or delay morbidity. In order to be able to implement the promotion really well, this should actually also be part of the medical world and the care system.

What to do in the field of prevention and risk patients?

In recent years, more and more attention has been paid to the influence of stress on the general health of people. In addition, research has shown how important social support is in this whole. It is important that they continue their line and that more research is done. Social support must be promoted and more attention must be paid to the ways in which people can care for each other.

What to do in the field of healthcare?

At the moment, health care (in America) is struggling with three major problems. First, it is very expensive, but the system is also used incorrectly and in an unfair manner. Research has shown that people who are really ill and those who are treated for disease are often not the same people. This is often due to financial and cultural reasons. It is therefore a major challenge to reduce misuse of healthcare. In addition, it is a challenge to ensure that people comply with treatment plans, (self) medication and changes in lifestyles.

What can be done in the area of ​​dealing with the sick and elderly?

The treatment of patients who are chronically and / or terminally ill should be focused more on ways that increase the quality of life of these people. Health psychologists can play an important role in major issues such as termination of life and family participation when it comes to the death of a patient.

Because people are getting older, new problems will arise with regard to health and lifestyle of people. It is therefore important that research is done on medical conditions that may arise. Like this, interventions can be deployed.

What are important trends in health and health psychology?

Health psychology must be able to respond to changes and trends in medical practice including demographic changes. The changes of medicines and changes in technology can be challenges for health psychologists. They are the ones who have to prepare patients for what is to come.

For health psychology it must therefore be an important objective to record the effectiveness of treatments and interventions. In doing so the costs and ways of reducing these costs should be taken into account.

Are you a health psychologist?

Health psychology can be a rewarding career for anyone who is prepared to gain the necessary training, but also to gain experience in research and field situations.

Health Psychology - Taylor - BulletPoints (English)

What does health psychology involve? - BulletPoints 1

• Health psychologists examine psychological influences with regard to how people stay healthy, why people get sick and how people respond when they become ill. For example, they examine which behavioral and social factors contribute to health or illness. The focus is on the prevention and treatment of diseases. Promoting a healthy lifestyle plays a role in this. It is important to keep an eye on the definition of health. Rather than defining health as the absence of illness, health is recognized to be an achievement involving balance among physical, mental and social well-being..

• The biopsychosocial model assumes that health and illness are the result of an continual interaction between biological, psychological and social factors. This involves both macrolevel processes (for example the lack of support) and microlevel processes (deviations in cells).

• There are several factors that have contributed to the rise of health psychology. Examples are the growth of lifestyle-related and chronic diseases such as cancer and cardiovascular diseases, the expansion of health care services and the the increasing acceptance of health psychologists within the medical community.

• Health psychologists have different tasks. They develop theories and study the interaction between biological, psychological and social factors that contribute to health and/or disease. To study these interactions they use experiments, prospective research and search for links.The results of their studies can be used to prevent and treat diseases among the population such as epidemies.

How does the human body work? - BulletPoints 2

• The cerebral cortex consists of:

1. The frontal lobe, involved in movement;

2. The temporal lobe, auditory information;

3. The parietal lobe, processes information from the skin (pain, touch, etc.);

4. The occipital lobe, visual information.

• The nervous system functions on the basis of neurotransmitters. Stimulation of the sympathetic nervous system causes two neurotransmitters to be released: epinephrine and norepinephrine. These substances are also referred to as catecholamines. The release of catecholamine ensures that the body prepares for a stressful situation: the heartrate becomes faster, blood pressure increases and hunger is reduced. Parasympathetic functions then ensure that the body returns to its normal, homeostatic, state.

• Breathing has three important functions: regulating the absorption of oxygen, discharging carbon dioxide and regulating the composition of the blood.

• Before food can be used as energy it must be converted into substances that can be absorbed by the body. This conversion process is called digestion. The digestive system is responsible for producing energy and heat needed to restore and grow cells.

• Microbes can enter the body in different ways:

1. Direct transmission, physical contact is required;

2. Indirect transmission via particles in the air, dust, food or water;

3. Biological transfer: A vector (transmission of diseases) ensures that the pathogenic microbe is transmitted;

4. By mechanical transmission, the microbe is transferred by a carrier that is not directly involved in the disease process, think of dirty hands or bad water.

• Infections may be localized, focal or systemic.

What is the influence of behavior on health? - BulletPoints 3

• Good health is a personal and collective goal. That is why good health should be promoted. This can be done through media, through doctors and through the government who makes policy plans. It turns out that promotion of health costs less and is more successful than disease prevention, which used to happen more often. People will experience less illnesses having good health habits.

• Primary prevention has the task to develop good health habits and to change bad ones. This primary prevention is aimed at changing / removing the risk factors of a disease before the disease develops. This can be done by: behavioral change methods to change problematic health behaviors, and by preventing people from developing bad health habits.

• There are several factors that influence healthy behavior and health habits:

1. Demographic factors: people with little stress, highly educated, young and with many sources of social support generally have better health habits than people with a lot of stress, little social support and people with fewer sources such as people with a lower SES.

2. Age: health habits are good in childhood, become worse during adolescence and young adulthood. The health habits improve as people get older.

3. Values: the value society attaches to certain health habits influences the exercise of these health habits. An example of this is the value that is attached to the physical exercise of women who differ from different cultures.

4. Personal control: people who see their health as something under their personal control will have better health habits than people who relate their health to chance factors.

5. Social influence: friends, family, colleagues and other social contacts can influence health behavior, both negative and positive.

6. Personal goals: the goals that a person has set up influence the exercise of healthy behavior. If the goal is 'being fit', then someone will have more physical activity.

7. Symptoms received: certain symptoms may induce people to engage in health behaviors.

8. Access to healthcare: if people have poor access to health care, they will have fewer regular checks (a mammogram), which may result in fewer healthy habits. This group of people will also receive fewer lifestyle advice from doctors, as a result of which poor health habits will change less quickly.

9. Cognitive factors: people can believe that certain behavior is beneficial and if they do not comply with certain health behaviors they are more vulnerable to disease.

• Unhealthy habits can be enjoyable so that people are not motivated to change them. Unhealthy habits are not related to each other. It is therefore important to tackle the bad habits separately.

• The development of good health habits also depends on the moment the habit is learned. A good educational moment must be chosen, because one moment is more suitable to learn a certain healthy behavior or to prevent a bad development than another.

• Health promotion among the elderly was first seen as a waste, but now more and more policymakers are acknowledging that a healthy elderly population brings fewer health costs. The promotion of health in older people has therefore become increasingly important. Attention is focused on maintaining a healthy and balanced diet, taking steps to prevent accidents, exercise regularly, smoking cessation, controlled use of alcohol and reducing the misuse of medication.

• Changing attitude towards healthy behavior can be achieved by means of education. This assumes that people will change their health habits if they have the right information. Education as a way to change health behaviors works best when the following conditions are met:

1. Communication must be lively and colorful. Cases from the past should be used as examples.

2. The speaker must be an expert who is reliable, friendly and equal to the public.

3. The message must be short, clear and direct.

4. Strong arguments must be reported in the beginning and at the end of the story, so not in the middle.

5. Conclusions must be drawn explicitly. It must be clear what the public must do to change his / her situation.

The health belief model assumes that there are two factors that determine whether someone has certain health habits:

• The extent to which someone experiences a certain health threat. This is again influenced by general values ​​about health, certain ideas about the vulnerability to a particular disease and certain ideas about the consequences of a disease.

• The extent to which someone believes that adopting certain health behavior will be effective to reduce the threat and that the benefits of acting on health habits exceed the disadvantages.

• People can not only change bad health habits through interventions, they can also change themselves. People are responsible for their own actions, emotions and thoughts (self-regulation). This can happen unconsciously, but also consciously.

• The consequences of a relapse are negative emotional effects, such as disappointment, frustration, anger and unhappiness. People get a reduced sense of self-motivation due to a relapse. If people make a new attempt to change their behavior after a relapse, this can cause problems. People will start less quickly with a new attempt. A paradoxical effect of a relapse can also occur. People become more convinced of their own control. It then seems as if several attempts are needed to finally reach the goal, for example to quit smoking.

• The possibility that relapse occurs can be reduced by, for example, giving a few 'spur' sessions a week before the end of the treatment. A few months after stopping the treatment some 'clearing' sessions can be given. A better way than these sessions is to add more behavior-changing elements, such as the relaxation exercises or training of assertiveness.

• A third way to reduce relapse is to let the therapy go on for their entire life. Disadvantages of this are that people keep feeling that they are very vulnerable to relapse. This also suggests that people can not exercise control over their habit. A better option is to rebalance the client's lifestyle. Like this, people keep control and there is also a positive behavioral change.

• The change in unhealthy behavior does not happen at once. There are several steps that can be displayed in the Transtheoretical model. The stages of change are:

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

What is the influence of physical activity, sleep and nutrition on health? - BulletPoints 4

• Women are physically more inactive than men. White people get more exercise than black people and spanish people, older people are less active than young people. People with high incomes are also more active than people with lower incomes. Physical activity is the most important form of health behavior for the elderly.

• During exercise, the same hormones (epinephrine) are released as when experiencing stress. Nevertheless, physical exercise does have a beneficial effect on health and stress does not. This may be because epinephrine has a beneficial effect if it is released intermittently and a negative effect if it is permanently present in the blood, such as during stress. It is also possible that epinephrine is metabolized differently during exercise than during stress. A final possibility is that the activation of the Hypothalamic-Pituitary-Adrenocortical system (HPA-axis) is responsible for the harmful effects of stress and not the activation of the sympathetic nervous system such as during physical exercise and also during stress.

• Because physical exercise improves well-being, it can be a way to deal with stress. A study has shown that the negative effects of stressful events on health decrease as physical activity increases.

• Many deaths could be prevented by the prevention of accidents. This concerns traffic accidents, but also poisonings and accidents at work. The biggest cause of death and cause of accidents among children younger than 5 years are accidents in the house. Parents usually take measures to prevent this as well as possible; after all, they have control over the environment in which the child is. Many general practictioners teach parents skills in taking these measures. Parents can be informed about the most common toxic substances through parent classes. Nevertheless, older people in particular are at greater risk of an accident. In addition, about 25% of the elderly remain dependent on hospital care for at least a year after an accident.

• When communicating this to adolescents and young adults, it is important that the gains (free of skin cancers) and the direct risks are emphasized. In the development of knowledge about cancer, more types of self-examination and prevention measures will be discovered.

• Eating healthy should be a goal for everyone. Eating is a risk factor for many causes of death and also for the development of many diseases. A healthy diet is therefore very important. Dietary factors are related to the cholesterol level and especially to the LDL content.

• If people have to change their diet, this is usually an adjustment that must be sustained throughout life. This is often a difficult adjustment. People tend to eat healthier more often because they want a better appearance than they do for their health.

• Sleeping is an essential health habit. It ensures that depression, infections and the progression of chronic diseases are less likely. There are two types of sleep: NREM and REM. NREM sleep consists of four phases:

1. Sleep phase 1: Light sleep: the consciousness is reduced, but it is still easy to wake up;

2. Sleep phase 2: You lose consciousness completely, brain and heart go into 'rest mode', body temperature drops;

3. Sleeping phase 3 and 4: Deep sleep: difficult to wake up, but during the REM sleep that occurs, the brain is just as active as in an awake state. The eyes show rapid movements.

Which behavior is harmful to health? - BulletPoints 5

• Health-damaging behaviors are behaviors which reduce or damage current or future health. Because many of these behaviors are habits and also addictive, they are difficult to change. However, if the right attitude, motivation and help are available, every habit can be changed. If someone has changed one health habit, such as quitting smoking, there will often be other lifestyle changes, for example eating healthy.

• The cultural factor has to do with the image of what is liked. In developed countries the focus is on being slim for women, so there is a great emphasis on physical exercise and dieting.

• Someone who has obesity also has a greater risk of obesity. This is because these people have a high insulin content which makes them more hungry and therefore eat more. People with obesity can also easily store fat because they have very large fat cells.

• Another intervention is cognitive behavioral therapy (CBT). Researchers assume that compulsive eating is similar to a drug or alcohol problem.

• Anorexia would have a genetic component because it is common in certain families. Girls with anorexia would lack a sense of control coupled with needing confirmation. These girls show very perfectionistic behavior. There is a very wrong body image, of which one does not know whether this is the cause or the result of the anorexia.

• Family factors also have a role. Girls with anorexia often come from problem families (for example, alcoholism) or from a very closed family that does not communicate well about emotions and quarrels. The mother-daughter relationship can affect the disorder.

• The first goal of treating an anorexic patient is to bring the weight back to the normal level. This can be done, for example, by means of operant conditioning that causes positive reinforcement of the behavior. If anorexic patients learn this in a hospital, the question is whether they can keep this up in the home situation.

• People with bulimia usually have a normal weight, or even some obesity, especially on the hips. The phase in which these people eat is a phase in which the control is gone. The control must then be obtained by removing the food from the body by spitting. Food can become a constant thought. The normal control of food through internal sensations is no longer there, but has changed into decisions about what to eat when. This is cognitive based regulation system.

• Alcoholism and problem drinking include a number of specific patterns. An alcoholic is someone who is physically addicted to alcohol. Alcoholics have withdrawal symptoms when they try to stop drinking, they have a very high tolerance for alcohol and do not really have an opportunity to control their drinking habits.

• The causes of alcoholism and problem drinking are very complex. There are genetic factors associated with it. Men also seem to have a greater risk than women. Socio-demographic factors, for example low income, can predict alcoholism. The development of alcoholism is a gradual process in which physiological behavior and socio-cultural variables play a role.

• However, a large part of the participants can not leave the alcohol after following these programs and return to their old habit. This may be because those who participate in such programs are also those who have serious drinking problems. Otherwise they would not need help. The social class in which people find themselves is a factor that is important for the success with which alcoholics conclude treatment programs. People in a higher social class and with stable social environments (regular job, group of friends and an intact family) are more successful than people with a low SES and unstable social environment. Attention must be paid to these backgrounds during the treatment of alcoholics.

• The cognitive behavioral techniques that are used include self-monitoring. This often happens to allow the alcoholic or problem drinker to understand the situations in which drinking occurs and persists. Contingency contracting is also often used. This means that when something goes wrong in the future, this will result in psychological or financial costs.

• Motivation techniques are used because the responsibility and possibility of change lie entirely with the patient / alcoholic. In some programs, the participants take medication to reduce the interactions in the brain with the alcohol that contribute to alcoholism.

• Within alcohol abuse treatment programs, there are several factors that contribute to success. The drinker must be able to identify, change or develop ways of dealing with these factors from the environment that determine drinking. The participation in a program lasts an average of 6-8 weeks with aftercare afterwards with the patient back home. Other factors that contribute to success are the use of weather-therapy and the interference of family and employers in the program

• Smoking increases the influence of other risk factors on health. This is a synergistic effect. For example, the combination of smoking and cholesterol causes greater morbidity and mortality in cardiovascular diseases. Nicotine can namely reduce the HDL content, because nicotine releases fatty acids, resulting in more triglycerides being synthesized. The latter ensures the decrease of HDL (HDL clears up cholesterol).

• Smoking is determined by various physiological, psychological and social factors. Family and twin studies have shown that genetic influences on smoking behavior are of influence. Due to genetic feedback, some smokers have difficulty stopping. It probably does not have much value to give this information to smokers. Many people who smoke do not depend on it. Some people become calmer because of the nicotine, others are stimulated and others become depressed.

What is the impact of stress on health? - BulletPoints 6

• People experience things as stressful when they believe that their own resources will not be enough to beat a challenge or threat (eg no money to pay the rent). Stress therefore has to do with the way people assess a situation. Mainly things that are uncontrollable, negative and unpredictable and stand in the way of normal life are seen as stressful

• Another important early contribution to stress research came from Hans Seyle. His General Adaptation Syndrome assumed that three phases can be identified in response to stress: the alarm phase, the resistance phase and the depletion phase.

• There was a lot of criticism for the GAS. For example, criticisms say that not enough attention is paid to psychological aspects and this theory assumes that everyone reacts the same to stress. There is therefore no attention for differences in emotions, personalities and biological factors between people.

• When situations are experienced as stressful, the brain is put to work. This results in the production of the substances epinephrine and norepinephrine (catecholamines). These substances provide an accelerated heartbeat and sweating, etc. The hypothalamic-pituitary-adrenal axis is also activated in response to stress. It ensures the production of cortisol. It helps the body return to its normal state in a stressful situation.

• When stress is experienced for a longer time, this has an effect on the immune system, sleep, blood pressure, cardiac arrhythmia and the development of psychiatric disorders. It is important to know that not every person is equally sensitive to stress and its effects.

What is the influence of coping styles and social support on health? - BulletPoints 7

• There are different ways in which people can cope with stress (coping styles). Firstly, there is a difference between an avoiding and active approach. In an avoiding coping style one tries to ignore the stress. This often works in the short term, but with long-term stress it is wiser to opt for an active style to really solve the problem.

• Another way to deal with stress is through problem-oriented coping. This means that a solution to a problem is sought by changing the situation that causes stress or setbacks. One can also choose to regulate the emotions that are created by a stressful situation (emotion-oriented coping). Which coping style you choose depends on, among other things, the type of stressor. However, it is certain that people who can change coping styles can best deal with stress.

• Coping styles are not only determined by internal factors, but also by external factors. Examples include the presence of time, money, education, work and social support (friends and family). People where many of these factors are present can often deal with stress better.

Why do people use health care? - BulletPoints 8

• Recognizing symptoms and their interpretation is strongly influenced by psychological processes. The personality of people plays a major role in this. People who have more neurotic features or who are hypochondriac will have the quicker idea of ​​recognizing symptoms and thereby making more frequent use of health care. The same applies to people who are more focused on themselves.

• Most people can have three types of disease models:

1. Acute illness: short time span, few consequences, caused by, for example, a virus (think of the flu);

2. Chronic illness: caused by multiple factors, long time span, major consequences for health (eg heart disease);

3. Cyclic disease: periods with many symptoms alternate with periods with few symptoms (think of herpes).

• The informal social network of a person often already provides an interpretation of symptoms and thus serves as an intermediate step between a person and healthcare. Because people talk about their symptoms with friends and family, this is often seen as the first form of treatment. When a wise old woman, for example, says that the symptom can not be serious, then it is assumed that this is correct. Often for this reason no help is sought with health institutions, but first a solution is sought at home.

• On the internet, people often search for their symptoms and other issues related to their health. Four in five people have already searched for information about health care.

How does health care work, and what problems can people encounter? - BulletPoints 9

• Nevertheless, doctors often criticize their communication, they do not make stories personal enough and talk too much in terms that are not understood by patients. It should be noted that an appointment with a doctor is not the best setting for effective communication. Talks lasts for a maximum of fifteen minutes and there is little chance for patient comments.The doctor has the problem that he has to find out what the patient's problem is as soon as possible.

• Doctors often make the mistake that they do not seem to be listening. Patients do not have the chance to finish their story because the doctor is already making a diagnosis. In addition, doctors use too much jargon, or they switch to 'baby talk'. Although the use of jargon is often too complicated for the patient, what patients know may also be underestimated by the doctor.

• When patients feel that a doctor cares about them, understand what they need to do and get written instructions, they are much more likely to follow the treatment.

• Health psychologists participate in the diagnosis of patients and assess the functioning of the patient. This could lead to interventions. In addition, psychologists are involved in the process before and after surgery, interventions to increase medication (pain control) and monitoring compliance with the treatment. In addition, they diagnose and treat patients with psychological problems.

• Just like adults, children benefit from good preparation. Children can be taught good copings style, to deal with surgeries or how to relax. Children can often be prepared by the parents. For example, parents can explain why a hospital admission is necessary, who is involved in their process and how often the parents will come to visit.

• If parents are present in a stressful medical procedure, this can have benefits, but it can also give the child more stress. In most cases, however, one assumes a positive effect. The support of the parents is therefore important in any case, so most hospitals ensure that parents are allowed to visit 24 hours a day.

• A placebo is a medicine prescribed as a medicine that contains no active ingredients. It causes an effect in a patient due to its therapeutic nature. The placebo response is a complex psychologically mediated series of events that often have physiological effects.

• How effective a placebo is depends on how a therapist treats a patient and whether the therapist seems to believe in the treatment. Respirators who radiate heat, competence and self-confidence provide stronger placebo effects than formal therapists.

How to deal with pain? - BulletPoints 10

• Pain is one of the most immobile aspects of illness and its treatment. It is primarily a psychological experience, how it is felt and the extent to which it causes discomfort largely depends on the way in which the pain is interpreted. Pain is also heavily influenced by the context in which it is experienced. In addition, it appears that women are more susceptible to pain than men.

• The gate theory assumes that the painful stimulus that comes in first goes through nerves to the spinal cord. This can be done via A-delta nerve fibers (fast, sharp, local pain) C-nerve fibers (slow, prolonged and burning). The spinal cord then passes the stimulus to the brain. When the stimulus reaches the brain, then the pain is felt. Other incoming stimuli can then alter the pain stimuli, so that the pain is not felt or felt less.

• There are two main groups of clinical pain: acute and chronic pain. Acute pain often comes from specific injuries that cause tissue damage. This pain disappears when the injury is healed and therefore often only lasts for a short time. Chronic pain often starts acute, but does not pull away like acute pain.

1. Chronic benign pain, often lasts more than 6 months and is not very sensitive to treatments. The pain is variable in strength and can affect all muscle groups;

2. Recurrent acute pain, involving interrupted episodes of pain, which have an acute character but last for more than six months;

3. Chronic progressive pain lasts longer than six months and is becoming increasingly severe. Often it is about degenerative disorders.

• Pain management can be focused on different things. It can be about not feeling pain, but also about how to deal with pain.

• Other ways of combating pain are counterirritation (irritating another part of the body so that pain is no longer noticeable), biofeedback (gaining control of the body and adjusting processes), relaxation training and distraction, so that the pain is not felt. In addition, patients can be taught coping styles that they can use to deal with pain. The effects and results of all these pain management techniques vary.

How can people (learn to) deal with chronic health problems? - BulletPoints 11

• When a patient is diagnosed with a chronic illness, this can cause a physical, social and psychological imbalance for the patient. The coping styles that a person would normally use then have no effect, which can lead to an exaggeration of symptoms and their significance, a negative attitude and therefore a poorer health.

• The first defense mechanism that people use to dodge the implications of a disorder is denial. Patients then pretend that the disease will last for a while and is not important. The problem here is that this can impede good communication and thus treatment.

• Continuing sexual relations, adjusting to treatments, changing work / taking a job coach are other matters that contribute to a better treatment with a chronic condition.

• People are very resilient. This ensures that there are not only negative aspects to a chronic illness. For example, people can feel positive emotions and be optimistic because they give meaning to daily life. People value life more and find inspiration to do things sooner, they put more energy into relationships and feel more empathy towards others. These positive feelings contribute to a better way of dealing with illness.

How does death play a role in health psychology? - BulletPoints 12

• Children only get a sense of awareness between the ages of five and nine that death is definitive. This does not mean, however, that they have a biological knowledge about death. Death then has a supernatural character for children. The fact that death is inevitable arises only later, around the age of 10, when children get a better view of all processes that belong to death (for example a funeral and that the dead person does not return).

• Dying is difficult at any time in life, but older people (over 65 years old) are often better prepared for death. This is because they themselves have already come into contact with death and often have thought about it. Most elderly people die of degenerative diseases such as cancer or heart failure.

• The five-phase model of Kübler-Ross assumes that people go through five phases when they know they are going to die.

1. Denial: This is a defense mechanism whereby a person protects himself by completely rejecting the truth. All facts relating to the disease are ignored as much as possible;

2. Anger: The person protests against the diagnosis, questions like "Why me?" be asked. The patient can hold a grudge against healthy people, or try to blame others. The anger is therefore often directed against others;

3. Negotiation: The patient notices that anger does not help and will try to purchase good health with good behavior;

4. Depression: In this phase the patient feels helpless and tries to accept that he has no control over the situation. Here the patient starts to say goodbye to relationships and activities, he mourns, as it were, for his own death;

5. Acceptance: A patient at this stage is often too weak to be angry and too accustomed to the idea of ​​being depressed.

• In addition, more and more people are interested in home care. This is often easier for the patient himself, but places a high burden on the family.

What are the four most common chronic conditions? - BulletPoints 13

• This chapter focuses on the four most common chronic conditions, namely coronary heart diseases, hypertension (high blood pressure), stroke, diabetes.

• Negative emotions such as anger and hostility increase the risk on CHD. This hostility can be determined at an early age. This is often the result of low self-esteem and negative feelings about others. Often this is the case with people who come from families that offer no support, in which there is little acceptance and where there are many conflicts.

• By addressing the risk factors, a heart attack can be prevented. For example, screening can be done for too much cholesterol or high blood pressure. Changes in people's diet and physical activity are encouraged. In addition, stress management is also a good factor to prevent a heart attack.

• In a stroke there is a disturbance of the blood supply to the brain. Such a disturbance can occur due to a blood clot or bleeding. The biggest problem with a stroke is that such a stroke is often followed by other strokes, which can lead to someone becoming disabled or dying. Aspirin can reduce the risk of such recurrent stroke.

• Treatments for people who have had a stroke have five key points: medication, psychotherapy, cognitive training, exercise therapy and the use of a stimulating and structured environment.

• Until recently, it was thought that Type II diabetes was a disease of old age, but due to the emergence of high-sugar foods that contribute to diabetes, more and more young people are also getting the disease. Diabetes type II is therefore a growing health problem.

What is Psychoneuroimmunology and what other Immune-related disorders exist? - BulletPoints 14

• The immune system is the body's security system. It protects the body from outside invaders. There are several stressors that affect this system. Different types of stressors all need different types of treatments from the immune system. In addition, not all parts of the immune system work equally hard at all times to ward off a threat.

• Stress has a big influence on the immune system. Both children and adults who have to deal with stress are prone to infections and therefore become ill more quickly. People who are ill can become even more sick due to stress.

• The fact that many people do not make public that they have HIV, or lie about the symptoms, makes it very difficult to check the spread of HIV. Interventions to prevent the spread of HIV are therefore required. Most interventions focus on education and information about the infection, but also on preventing it. Here it is emphasized again how important having safe sex is. Prevention programs are used in schools.

• Psychological problems in people with HIV can speed up the disease process. Optimism, an active coping style, being extraverted and spiritual can ensure that the disease develops less quickly.

• Cancer is difficult to investigate because every type of cancer has its own symptoms, causes and treatments. In addition, many types of cancer have a long and irregular growth period.

• Stress in the form of losing social support can cause the onset of cancer and affect its course of disease. It can also affect symptoms associated with cancer.

• The treatment of cancer can cause psychological problems. The treatments often have side effects. Especially chemotherapies are both physically and mentally heavy.

• Unfortunately, it appears that compliance with the entire treatments is often difficult. But about 15 percent of all patients comply with all recommendations regarding their treatment. This is because people often do not suffer from symptoms. The use of good coping strategies contributes to compliance with the treatment. Especially in adolescents, the treatment of diabetes causes problems.

• Health psychologists can develop ways of education that help people to follow their treatment plan.

Health psychology: what are the challenges for the future? - BulletPoints 15

• When it comes to health-related problems, it is often forgotten that a lot of progress has already been made. Consider, for example, the life expectancy that continues to rise, the fact that fewer and fewer people start smoking and the falling mortality figures. Health psychology has played a major role in this, as are changes in the health care system and technological changes. Yet there are always issues that need improvement.

• Preventing bad health habits is an important objective. Adolescents are most inclined to switch to these bad habits. Prevention programs can therefore best target this target group. This is possible, for example, by giving lectures at schools. Because people are getting older, there must also be interventions for the elderly, who learn how to function in a good way for as long as possible.

• The treatment of patients who are chronically and / or terminally ill should be focused more on ways that increase the quality of life of these people. Health psychologists can play an important role in major issues such as termination of life and family participation when it comes to the death of a patient.

• Health psychology can be a rewarding career for anyone who is prepared to gain the necessary training, but also to gain experience in research and field situations.

Health Psychology - Taylor - ExamTickets

What does health psychology involve? - ExamTickets 1

• Keep the definition of health psychology in mind.
• It is easy to remember the definition of biomedical: everything is explained out of biology.

How does the human body work? - ExamTickets 2

• Para means against, so parasympathetic means it works against the body’s stress creating processes.

What is the influence of behavior on health? - ExamTickets 3

• By looking at what is needed with education, it comes in handy to think of examples. Try to understand what you read. When someone wants you to believe something he or she tells you, what should he or she do? What should he or she say?
• Remember that cognitive behavior therapy is used a lot and is regarded as the best therapy.

What is the influence of physical activity, sleep and nutrition on health? - ExamTickets 4

• Make sure you know the different phases of sleep.
• What is really important for change? What is the influence of social support on change?

Which behavior is harmful to health? - ExamTickets 5

• What is the influence of culture on people their eating habits?
• Keep in mind that boulimic patients often have a normal body weight and that anorexic patients sometimes also use boulimic ways to lose weight such as barfing.
• Remember the two theories about smoking.

What is the impact of stress on health? - ExamTickets 6

• Know the three phases of GAS from Seyle. Also pay attention to the critics.
• Remember the HPA-axis. You will see it come back often.
• Make sure you know the difference between chronic stress and acute stress. Which one can have advantages and which one has negative consequences?

What is the influence of coping styles and social support on health? - ExamTickets 7

• Why is coping important? In what situations is it determining? Make sure you can think of examples.
• Which type of people have the biggest chance on chaning their habits? There are two factors that play a role.

Why do people use health care? - ExamTickets 8

• Remember the three types of disease.
• Why is the use of internet bad? What can be done to prevent his bad effect?

How does health care work, and what problems can people encounter? - ExamTickets 9

• Remember the influence of doctors. Sometimes patients don’t get taken seriously or use too much jargon.
• What are the kinds of mistakes patients make?
• When is a placebo the most effective?

How to deal with pain? - ExamTickets 10

• Why is it so hard to treat pain?
• With the Gate Control Theory of Pain, remember that the spine acts as a gate to the brain.
• Remember the three types of chronic pain.

How can people (learn to) deal with chronic health problems? - ExamTickets 11

• Study the different defense mechanisms that people have.
• What happens with people their self-esteem when they get ill? Why is this?

How does death play a role in health psychology? - ExamTickets 12

• Why is there a higher death rate in America? Make sure you know this.
• When do children know what death means?
• What is the biggest cause of death with adolescents?
• Why is it easier to die for older people?
• Make sure you know the five phase model of Kübler-Ross. There is a big chance that one of these phases will be asked on the test.

What are the four most common chronic conditions? - ExamTickets 13

• Make sure you know the four most occurring chronic conditions.
• What is the reason for that increasingly more people have diabetes type II?

What is Psychoneuroimmunology and what other Immune-related disorders exist? - ExamTickets 14

• Why is cancer hard to research?
• Make sure you understand and can explain what the troubles are with treating cancer.

Health psychology: What are the challenges for the future? - ExamTickets 15

• What is the reason for new problems with regards to health?
• Why are changes in medicines sometimes difficult for health psychologists?