Introduction to personality, clinical and health psychology

Chapter 1. What is abnormality?
 

• The study of abnormal psychology is the study of people who suffer from mental, emotional and often physical pain. This is often called psychopathology.
   
• Cultural relativism states that behavior can only be abnormal according to current cultural norms and not through universal standards.
   
• The distress-criterium states that behavior can be viewed as abnormal when a person experiences distress as a consequence of that behavior.
   
• Modern judgments of abnormality are not based on a single criteria, but are influenced by an interplay of the four D’s: dysfunction, distress, deviance and dangerousness.
   
• There are three types of theories that try to describe the causes of abnormal behavior: biological, supernatural and psychosocial theories.
   
• A psychological epidemic is a phenomenon in which a large number of people show abnormal behavior that seems to have a psychological cause.
   
• Franz Anton Mesmer developed mesmerism. This is a method based on animal magnetism. His treatments took patients into a state of trance that later would be called hypnosis.
   
• Classical conditioning refers to connecting a conditioned response to a stimulus that before caused another response. Operant conditioning states that behavior that is followed by positive consequences is more likely to be repeated than behavior that is followed by negative consequences.

Chapter 2. What are the theories of and treatments for abnormality?
 

• A theory is a set of ideas that offers a framework upon which questions can be asked about a certain phenomenon and upon which information can be gathered and interpreted about that phenomenon.
   
• A therapy is a treatment, often based on a theory about a disorder, that deals with the factors that according to that theory cause the disorder.
   
• There are several approaches for explaining psychological complaints: the biological, psychological and sociocultural approach.  Besides these there is also the biopsychosocial approach, which acknowledges that a disorder often cannot be explained by only one approach and which combines the three approaches.
   
• Three possible biological causes of abnormality are brain dysfunction (damage to a part of the brain), biochemical imbalance (imbalance in the neurotransmitters) and genetic abnormality (abnormalities caused by genes, such as Down syndrome). Treatment of biological abnormality consists of medication or psychosurgery.
   
• Treatments in psychosocial approaches are based on conditioning, behavioral therapies and cognitive therapies, and sometimes psychotherapy.
   
• Psychoanalysis (by Freud) is a theory of personality and psychopathology. It is a method to investigate the mind as a form of treatment of psychopathology.
   
• According to Freud there are psychosexual phases through which each child has to go. These are the oral phase, the anal phase, the phallic phase, the latent phase and the genital phase.
   
• Primary prevention tries to combat disorders before they start. Secondary prevention tries to slow down and stop disorders while they are in an early stage. Tertiary prevention tries to prevent relapse for people who already have a disorder.
   

Chapter 3. How can you assess and diagnose abnormality?
 

• An assessment is the process of collecting symptoms and looking at what the possible causes of those symptoms may be. A diagnosis is a label for a group of symptoms that often occur at the same time.
   
• The validity is the correctness of a test: the test needs to measure what it is designed to measure. There are several types of validity: face validity, content validity, concurrent validity, predictive validity and construct validity.
   
• The reliability is the certainty that the result of a measurement stays the same. There are several types of reliability: test-retest reliability, alternate form reliability, internal reliability and inter-rater/interjudge reliability.
   
• A diagnosis can take place by using several techniques: symptom questionnaires, personality inventories, behavior observation, intelligence tests, neurological tests, brain imaging techniques and projective tests.
   
• Language problems between cultures can cause someone to be under- or over-diagnosed. Cultural bias can also cause problems (because symptoms can differ between cultures).
   
• A diagnosis is a label that we give to symptoms that often occur together. A set of symptoms is called a syndrome. This is the observable manifestation of the underlying biological disorder.
   
• The DSM-IV has five axes: 1) Clinical disorders, 2) Personality disorders and mental retardation, 3) General medical conditions, 4) Psychological stressors and problems with the surroundings, and 5) Global assessment of functioning. The DSM-V uses a non-axial assessment. The axis-system is thus no longer used. The DSM-V only uses three axes: the first axis describes clinical syndromes and other medical conditions. The second axis describes psychosocial and environmental stressors. The third axis describes the level of functioning of a person.
   

Chapter 4. Which anxiety disorders are there?
 

• During the fight- or flightresponse the autonomic nervous system and the adrenal cortical system are activated. As a response to danger, psychological changes are caused. Also cortisol, an indicator of stress, is released.
   
• An anxiety disorder is when someone continuously lives with anxiety and it is limiting the normal functioning. Anxiety consists of somatic, emotional, cognitive and behavioral symptoms.
   
• Posttraumatic stress disorder and acute stress disorder are both caused by an experience of extreme stress. Trauma’s that often lead to PTSD are natural disasters, war, terrorist attacks, torture and abuse.
   
• An important element of the cognitive behavioral therapy is systematic desensitization. In systematic desensitization a client identifies the thoughts and situations that cause anxiety and learns to confront these and to deal with them.
   
• Medications for anxiety often include selective serotonin reuptake inhibitors (SSRI’s) and benzodiazepine. These are especially effective for sleeping problems, nightmares, etc.. People who take SSRI’s often show no more symptoms after five months.
   
• Panic attacks are short, intense episodes of anxiety during which the person experiences many different symptoms of anxiety. A panic disorder is when these panic attacks happen more frequently in the same kind of situation and when the person due to these attacks starts worrying and starts changing his or her behavior.
   
• Specific phobias are fears that relate to specific objects or situations. There are four types of specific phobias: animal type, natural environment type, situational type and blood-injection-injury type. A social phobia is not categorized as a specific phobia.
   
• Examples of treatments for phobias are systematic desensitization, modeling and flooding. Cognitive behavioral therapies often use these methods in combination with techniques to identify and change dysfunctional thoughtmechanisms.
   
• People with general anxiety disorder are very worried about many things in their life, such as their health, their children or being late for an appointment. The worrying is accompanied by physical symptoms such as fatigue and muscle tension.
   
• Separation anxiety often starts in childhood. It is normal that children get upset when they are being left by their primary caregivers, but when children become extremely anxious and tense it is a sign of separation anxiety. This disorder is often treated with cognitive behavioral therapy.
   
• Obsessive compulsive disorder: obsessions are persistent, reoccurring thoughts or images that a person cannot get rid of. These thoughts or images create anxiety and stress within the person. Compulsive acts are compulsions that a person has to act upon because the person feels that otherwise something terrible will happen.

Chapter 5. Which somatic symptom disorders and dissociative disorders exist?
 

• People with a somatic symptom disorder have physical complaints, without an organic cause. Often these people also suffer from depression or an anxiety disorder. People with a dissociative disorder develop several independent personalities, which cause them to suffer memory loss. People with a psychosomatic disorder have a physical disease that is worsening through their psychological state.
   
• In a factitious disorder by proxy parents act as if their child is ill, or they create an illness in their child, in order to get attention.
   
• Five somatic symptom disorders can be distinguished: somatic symptom disorder, illness anxiety disorder, conversion disorder and factitious disorder. The last diagnosis consists of psychological factors that affect other medical conditions (sometimes called psychosomatic disorder).
   
• A dissociative disorder can cause a person to have several different personalities (alters): child alter, persecutor personality and/or helper personality. Because the alters often don’t communicate with each other there is often memory loss.
   
• Someone with a dissociative fugue can suddenly move to another city and start a new life, without remembering ever having had another life.
   
• Organic amnesia is amnesia caused by brain damage as a consequence of, for example, a disease, drug use or an accident. Usually this is anterograde amnesia. Psychogenic amnesia has a psychological cause. Anterograde amnesia is hardly ever seen with psychological causes.
   
• Depersonalization disorder is a state in which people have the idea they are disconnected from their thoughts and body.
   

Chapter 6. What is the relationship between mood disorders and suicide?
 

• A bipolar disorder is a disorder with periods of mania and periods of depressions. Someone with a unipolar disorder only suffers depression (and not mania). Symptoms of depression can be anhedonia, changes in movement, eating, sleeping and activities, cognitive symptoms such as thoughts about hopelessness, shame and suicide. A persistent depressive disorder is a form of depression which is less intense but stays longer.
   
• There are different subtypes of depression: depression with anxiety and stress, depression with combined symptoms, depression with melancholic symptoms, depression with psychotic symptoms, depression with catatonic symptoms and depression with atypical symptoms. Besides these exist as well seasonal affective disorder, depression with peripartum onset and premenstrual dysphoric disorder. Symptoms of mania are feelings of grandiosity, sleep reduction, talking more, having the feeling that thoughts and ideas are flying or racing, being easily distracted and exhibiting more goal-directed and reckless behavior. People with a cyclothyme disorder have alternatively hypomane and moderate depressive episodes for at least two years.
   
• There are indications that genetic factors play a role in the development of depression and mania, but genes play a bigger role in the bipolar disorder than in depressions. Neurotransmitters that possibly play a role in mood disorders are especially the monoamines: norepinephrine, serotonin and dopamine. Parts of the brain that are important are the prefrontal cortex, anterior cingulate, hippocampus and amygdale.
   
• The theory of learned helplessness states that depression often comes from experiences that the person cannot influence. This causes people to believe that they cannot influence any important experience.
   
• SSRI’s are often used to treat depressive symptoms. They are no more effective than available antidepressants, but have less severe side-effects and are safer in case of an overdose. Besides these there are also bupropion, tricyclic antidepressant, monoamine oxidase inhibitors and lithium.
   
• Behavioral and cognitive techniques are combined in cognitive behavioral therapy to teach a patient new skills. The two goals are: breaking negative thinking patterns, and helping to solve the problems of the patient so that the patient has less reason to be depressed. Besides these there are also psychodynamic therapy and interpersonal therapy. For the treatment of a bipolar disorder there are two different therapies: interpersonal and social rhythm therapy and family-focused therapy.
   
• Suicide is the act of consciously taking the own life by damaging the body, or by poisoning or suffocating. There can also be non-suicidal self damage in which the person does not have the goal to die.
   

Chapter 7. What does the schizophrenic spectrum look like and what do we know about related psychotic disorders?
 

• Someone suffers from a psychosis when he has hallucinations and delusions and cannot be certain if the observations are real or not.
   
• Two categories of symptoms can be distinguished in schizophrenia, namely positive and negative symptoms. Positive symptoms are delusions, hallucinations, unorganized speech and thoughts, and unorganized or catatonic behavior. Negative symptoms refer to the absence of normal behavior, such as a lack of emotions or interest.
   
• Other psychotic disorders are schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder and schizotypical personality disorder.
   
• Genes have an influence on getting schizophrenia. People with schizophrenia often show differences in the brain. Often they have enlarged ventricles. The prefrontal cortex is often smaller and shows less activity. Also they show differences in the hippocampus.
   
• Also it seems people with schizophrenia have too much dopamine in the brain, especially in the frontal lobe and the limbic system. A new hypothesis is that too much dopamine in the mesolimbic system leads to positive symptoms of schizophrenia, whereas too little dopamine in the frontal lobe leads to negative symptoms of schizophrenia.
   
• Treatment nowadays often consists of atypical antipsychotics. An example is clozapine. This drug effects the dopamine receptor D3. Atypical antipsychotics also influence the negative symptoms, while earlier medications only influenced the positive symptoms.
   
• Psychological interventions are often used in combination with medications. They are aimed at teaching people social skills and to get them out of their isolation.
   

Chapter 8. Which personalitydisorders are there?
 

• Personality is the collection of traits that a person has or shows that differentiates that person from the rest. It is the way we behave, think, believe and feel.
   
• The ‘big five’ theory states that there are five different factors of personality traits that everyone more or less has. These are negative emotionality, extraversion, openness to new experiences, conformity and conscientiousness.
   
• A personality disorder is a long-term pattern off unadjusted behavior, thoughts and feelings. There are three personality clusters: A) odd or eccentric behaviors and thinking (paranoid, schizoid and schizotypical personality disorder), B) dramatic, erratic and emotional behavior and interpersonal relationships (antisocial, borderline, histrionic and narcissistic personality disorder), and C) anxious and fearful emotions and chronic self-doubt (dependent, avoidant and obsessive-compulsive personality disorder).
   
• The difference between obsessive-compulsive personality disorder and obsessive-compulsive disorder is that the personality disorder is broader whereas the OCD is more specific.
   
• There is a lot of layover between the personality disorders. Probably there are more disorders than are currently in the DSM.
   
• A continuum model has been added to the DSM-IV, because many personality disorders are extreme forms of character traits. Also, personality disorders are no longer disorders of the second axis, but belong to the first axis.

Chapter 9. Which eating disorders are there?
 

• People with an eating disorder often develop another disorder, such as major depression or anxiety disorder.
   
• People with anorexia nervosa starve themselves, even though they are far under a healthy weight. They do this by not eating or eating very little for a long time. Because of the weight loss the menstruation in girls stops as well, this is called amenorrhea. 5 to 8 percent of people with anorexia will die from it.
   
• There are two types of anorexia nervosa. People with the restricting type refuse to eat, or eat only a little bit, to prevent gaining weight. People with binge/purge type of anorexia have binges followed by activities to prevent gaining weight (purge). This last types resembles bulimia, except that the weight with anorexia is under the healthy weight, whereas that does not have to be the case with bulimia. A person with bulimia can even be slightly overweight.
   
• Important characteristics of bulimia nervosa are uncontrolled binges, followed by actions to prevent weightgain. People who try to lose weight through vomiting or inappropriate use of laxatives fall under the purging type of bulimia. People who try to lose weight through excessive exercise or fasting fall under the non-purging type of bulimia.
   
• People with a binge-eating disorder seem behaviorally similar to people with bulimia, but they do not engage in activities to compensate for their binge-eating and don’t try to prevent weightgain.
   
• Partial-syndrome eating disorder is an eating disorder that is behaviorally similar to anorexia and bulimia, but does not fulfill all the criteria to be diagnosed as one of those disorders. Another disorder is the other specified feeding or eating disorder (previously called eating disorder not otherwise specified). People with that disorder show serious symptoms of anorexia or bulimia, but don’t fulfill all the criteria to be diagnosed as one of those disorders. However, the disorder is just as serious and persistent as anorexia and bulimia.
   
• Obesity is defined as having a BMI of 30 or more (weight/length²). It is not an eating disorder in the DSM, but it is still a health risk.
   
• Proof has been found that anorexia and bulimia are genetically influenced, with 33%-84% being genetically caused. The problem is mostly in the hypothalamus, that regulates eating behavior.
   
• Cognitive behavioral therapy seems the most effective for treating bulimia nervosa. Wrong cognitions can be mapped out and the patient will be confronted with them. Also new and healthy eating patterns will be taught to the patient through behavioral therapeutic methods.

Chapter 10. What is health psychology?
 

• Health psychology focuses on investigating how biological, psychological and social factors interact with physical health.
   
• Factors that determine if a person is resilient or sensitive with regards to stress are: appraisal, pessimism and coping. Also gender, culture, psychological disorders and physical health play a role.
   
• Chronic stress reduces functioning, because the immune system as part of the fight- or flight response is being suppressed. This is why in times of stress people often get colds for example.
   
• Stress also influences the onset and development of certain types of cancer, HIV/AIDS and heart diseases and high blood pressure.
   
• The personality factor that seems to be the most related to heart diseases is the type A behavior pattern. These people often feel strongly pressured by time, are easily hostile and often competitive. They create unnecessary deadlines for themselves and try to do several things at once.
   
• Guided mastery techniques give people explicit information about how to execute positive health-related behaviors.
   
• The death percentage of people who sleep less than six hours per night is 70% higher than that of people who sleep at least seven or eight hours per night. Sleep is essential for health.
   
• Dyssomnias are primary sleep disorders in which people do not get enough sleep, or when the sleep is not of a good quality, or not in the right moment. Insomnia is the most prevalent. There is also hypersomnia, narcolepsy, sleep apnea, sleep disorder in the circadian rhythm, arousal disorders, REM-disorders, nightmare disorders and the restless leg syndrome.
   

Chapter 11. Which theories exist about personality traits?
 

• Inner motives or inner wishes can lead to certain behaviors. A character trait is an important cause of behavior. A character trait is however not the only factor that determines behavior, also motivation and situation play a role.
   
• The act frequency approach assumes that  a trait exists of certain acts and follows three steps: act nomination, prototypicality judgement and recording of act performance.
   
• There are three ways in which important traits can be identified, namely through the lexical, statistical and theoretical approach.
   
• According to Eysenck there are three main characteristics under which personality traits can be placed: extraversion-introversion, neuroticism and psychoticism.
   
• The relationship between traits in a circumplexmodel can be described in three ways. Proximity refers to traits that are next to each other and positively related, bipolarity refers to traits that are across from each other and negatively related, and orthogonality refers to unrelated traits that are in a corner of ninety degrees from each other.
   
• The most accepted personality model is the Big Five. It contains the following five traits: extraversion, kindness, conscientiousness, emotional stability and openness and intellect.
   

Chapter 12. What is the relationship between personality and genetics?
 

• The human genome refers to the complete set of genes of an organism. Humans have between 30.000 and 40.000 genes, that are on 23 chromosome pairs.
   
• In 2000 scientists managed to map out the whole human genome. Now they are finding out what the functions of the different genes are.
   
• Researchers are trying to determine in what way changes in the personality are caused by either differences in the genes or by the environment. They are also researching how genes and the environment interact.
   
• Hereditary is the proportion phenotypic variation that can be appointed to genotypic variation in a human.
   
• The nature-nurture debate is the discussion about what is more important in determining personality: the genetic influences (nature) or the environmental influences (nurture). This can be investigated through selective breeding, family studies, twin studies and adoption studies.
   
• Every person is unique in his attitudes and preferences, but these are often stable over long periods of time. There are some attitudes, like traditionalism, career choice and religiosity during adulthood, that are hereditary up to a certain point.
   
• The genotype-environment interaction refers to the different reactions of individuals with different genotypes on the same environment. The genotype-environment correlation refers to the different exposure of individuals with different genotypes on different environments. These can be positive or negative, and active, reactive or passive.
   

Chapter 13. What is the relationship between physiology and personality?
 

• Brain damage can lead to personality changes. The most common change is a decrease in impulse control and self-control. This is most likely caused by damage to the frontal lobe.
   
• The most common biological measure methods are electro dermal activity, cardiovascular activity, EEG and fMRI.
   
• Eysenck claimed that introvert people have more activity in the ascending reticular activating system (ARAS: controls the cortical arousal) of the brain than extravert people.
   
• The reinforcement sensitivity theory states that the human personality is based on two biological systems in the brain, namely the behavioral inhibition system (BIS) and the behavioral activation system (BAS).
   
• Sensation seeking refers to the drive that people have to find a certain amount of sensation, like taking risks, avoiding boredom and engaging in exciting activities. When there is too much arousal, people want to decrease it and when there is not enough, people want more.
   
• Some researchers say that neurotransmitters are responsible for certain individual differences. People can also have different amounts of dopamine and/or serotonin and therefore have different personalities.
   
• People can be morning or evening people. This is a stable trait in which mainly the circadian rhythms and endocrine secretion levels are important.
   
• The left frontal hemisphere is more active than the right when a person experiences pleasurable emotions, whereas the right is more active during unpleasant emotions. Asymmetry is a stable individual trait.

Chapter 14. What are the psychoanalytical approaches of personality?
 

• Freud believed that the amount of psychological energy a person has stays constant during his or her life. He considered a change of personality to be caused by a redistribution of psychological energy.
   
• Libido referred to the need-satisfying, life-supporting and pleasure-oriented drives. Thanatos was used for drives that were associated with doing harm, destructing and aggression.
   
• According to Freud the human mind consists of three components: the conscious mind, the preconscious mind and the unconscious mind. According to Freud, the last one forms the largest part of the mind.
   
• According to Freud all acts have a subconscious cause. A slip of the tongue is not a coincidence or an accident, but an expression of the subconscious.
   
• Subconscious information processing helps with making complex decisions. This is called deliberation-without-awareness.
   
• The psychoanalytic personality theory describes how people handle their urges within the limits of civilized society. A part of the mind creates these urges (the id), another part contains knowledge about the expectations of society (the superego) and another part tries to satisfy these urges within the limits of society (the ego).
   
• Freud differentiated three types of fear: objective anxiety, neurotic anxiety and moral anxiety.
   
• Defense mechanisms against fear according to Freud are: repression, denial, displacement, rationalization, reaction formation, projection and sublimation.
   
• Freud believed that everyone goes through stages of development: oral phase, anal phase, phallic phase, latent phase and genital phase.
   
• The Oedipus conflict consists of the subconscious wish of a little boy to possess his mother, wherein the father is perceived as the rival. The father should therefore be eliminated and following these thoughts emerges a conflict.
   
• Psychoanalysis is a psychotherapeutic method that could help people with a mental disorder. The goal of psychoanalysis is to make people aware of their subconscious. Techniques that were used were free association, dream analysis and projective techniques.

Chapter 15. What is the relationship between emotions and personality?

• An emotion can be defined by three aspects: association with subjective feelings, several action tendencies and physical changes in the nervous system.
   
• An emotional state is temporary and has more to do with the situation in which a person currently is than with the person himself. An emotional trait is a consistent pattern of emotional reactions that a person expresses in different situations.
   
• Emotional content is an emotional experience of a person. Emotional content can be divided in pleasurable and unpleasant emotions. The emotional style of a person depends on how that person experiences those emotions.
   
• The causal relationship between happiness and certain life outcomes goes both ways. This is called reciprocal causality.
   
• Extraversion and neuroticism predict positive and negative emotions in life. Feeling good is mostly subjective.
   
• According to Eysenck, neuroticism arises when the limbic system in the brain is activated fast. The limbic system is responsible for emotions and the fight- or flight response.
   
• Matthews developed the attentional theory which states that people with a high level of neuroticism give more attention to unpleasant information in the environment than people with a low level of neuroticism.

• Hostility is associated with a high level of neuroticism and a low score of friendliness. Aggressive and hostile people often have more deviations in the brain.

Chapter 16. How to deal with stress and health?
 

• Health psychology focuses on the influence of psychological and behavioral factors  on health, often in combination with the environment. The subject of stress is central.
   
• Stress is a subjective feeling that is the consequence of uncontrollable and threatening events (stressors). These are often extreme situations with bad consequences that cannot be influenced. However, also positive things can be stressful.
   
• There are different kinds of stress: acute stress, traumatic stress, episodic acute stress and chronic stress.
   
• The General Adaptation Syndrome (GAS) contains the following phases: alarm phase, resistance and exhaustion.
   
• The interactional model suggests that personality factors determine the impact of events, because they determine how someone deals with a certain situation. Personality influences how someone copes.
   
• According to the transactional model personality affects three factors: coping, interpretation of the event and the event itself.
   
• Positive emotions can relieve stress, give people time to fix social relationships and support coping. 
   
• Coping strategies can be: positive reevaluation, problem-focus coping and creating positive events.
   
• With regards to coping there are three important dimensions of attribution styles: internal versus external, global versus specific and stable versus instable. These attribution styles determine how someone views his role and amount of control in a certain situation and therefore also how much stress that situation causes.
   
• Telling a secret or talking about a stress-related topic is healthy, because it leads to relief and positive reinterpretations of an event.
   
• Type-A-behavior can be described in terms of performance drive (competitive), a constant sense of urgency, hostility and frustration. Hostility seems to be a good predictor for heart- and vascular disease.

Chapter 17. What is the influence of behavior on health?
 

• Health promotion is a philosophy that centers around the idea that good health or wellbeing is a personal and collective achievement.
   
• Health behavior is behavior that is being acted upon to improve or maintain health. Health habits consist of health-related behaviors that are a part of daily life and are often executed without even thinking about them.
   
• Because unhealthy behaviors are often pleasurable, automatic or addictive, people are often not very motivated to change them.
   
• Because health behaviors are often not related to each other, they need to be handled one by one. Also, health behaviors are often not stable over time.
   
• An educational appeal assumes that people will change their health habits when they have the right information.
   
• Fear appeals assume that if people fear a certain habit will damage their health, they will change that habit to reduce their fear.
   
• Message framing means that a message can be framed in a positive or a negative way. It can either focus on the positive aspects of taking a certain action, or on the negative aspects of not taking that action.
   
• The perception of a health threat is determined by interest in health, convictions about the sensitivity for a certain disorder and convictions about the consequences of that disorder.
   
• Cognitive behavioral therapy (CBT) changes the focus of the goalbehavior – the conditions in which this behavior takes place and is reinforced and the factors that reinforce that behavior. Techniques that are used are among others self monitoring, classic and operant conditioning, modeling and stimulus control. There is also attention for self control and self punishment and self reward.
   
• Relapse is one of the biggest problems with behavioral changes and is most common for addictive behaviors. Abstinence violation effect emerges when someone for example smokes one cigarette and then feels a loss of control.
   
• The stages of change according to the transtheoretical model of behavioral change are pre-contemplation, contemplation, preparation, action and maintenance.
   
• Social engineering refers to the adaptation of the environment, in ways that influence how well someone can execute a behavioral change.

Chapter 18. Health-improving behavior

• Exercising for only thirty minutes a day reduces the risk for several chronic diseases, among which heart diseases and certain types of cancer. Movement in combination with a healthy diet reduce the risk for diabetes type II.
   
• Exercising regularly improves the mood and the feeling of wellbeing directly after the workout, as well as in general.
   
• Personal characteristics among other factors determine which people exercise the most. People who have learnt to exercise or who have a lot of self-efficacy for exercise, or who receive social support or enjoy exercising, naturally enjoy exercising more.
   
• Because accidents are one of the most common causes of deaths, health psychology is focusing more and more on reducing accidents through interventions.
   
• The most common consequence of diet is the level of cholesterol in the blood. Diet is also an important predictor of several types of cancer, especially in combination with stress or negative emotions. Diet can also offer protection against obesity and heart- and vascular disease by lowering insulinlevels.
   

Chapter 19. Which behavior deteriorates health?
 

• Many unhealthy behaviors share important characteristics. Like a period during adolescence in which adolescents are sensitive to the development of behaviors such as drinking, smoking, drug use, unsafe sex, etc.. This is often caused by peer-influence.
   
• Obesity is an excess of body fat and is becoming a bigger problem across the world. Obesity is a risk factor for developing several conditions, directly as well as indirectly. Eventually, obesity can lead to early death.
   
• Stress can lead to eating too little or too much (unhealthy eating patterns). The hunger signals of the body can be suppressed or reinforced by stress.
   
• Programs to lose weight are often diet programs. Other ways to lose weight are fasting, surgery and/or hunger-diminishing medications. Now there are also multimodal approaches. Awareness and changes in wrong cognitions are part of that. Also self monitoring, self control and exercise are part of the multimodal approach.
   
• Newer forms of cognitive behavioral therapy are more effective in treating obesity than older forms. The results however differ per person.
   
• Obesity can be seen everywhere, which reinforces the importance of public health programs. Part of these programs are prevention for risk families and behavioral therapy for children.
   
• A person with anorexia starves them self, diets and exercises, for as long as it takes the weight to reach the below optimum. Treatment is aimed at returning weight to its normal level. When that weight has been reached, extra therapies can be started.
   
• Bulimia is characterized by periods of excessive eating and then removing the food from the body (for example by throwing up). Excessive eating is usually done by the individual alone. Often the individual does not have a below average weight, but a normal or even above average weight. Many patients with anorexia also suffer from bulimia. The most effective treatment for bulimia is a combination of cognitive behavioral therapy and medications.
   
• Craving is a strong desire to consume a product, as a result of physical dependence and conditioning. Addiction arises when a person is physically or mentally dependent on the product. Withdrawal refers to the symptoms, physically and psychologically, that arise when a person stops using the product.
   
• A real alcoholic is often physically addicted to alcohol and will show symptoms of withdrawal when drinking is stopped. Problem drinkers may not show these symptoms, but they do have other social, psychological and medical problems caused by the alcohol.
   
• Cognitive behavioral therapy is also used in the treatment for alcoholism. Besides that, medication can be given to block alcohol-braininteractions (the rewarding effect) that contribute to the alcoholism.
   
• Prevention programs are often aimed at teaching techniques to fight the drinking and to deal with risk situations.
   
• Smoking enforces negative effects of other health problems. Smoking for example interacts with cholesterol, stress, depression and being underweight.
   
• Because smoking is very resistant to intervention, the focus is now more on prevention. This is more effective and cheaper.
   
• The  life-skills-training approach does not focus much on smoking. It is focused more on developing coping skills, self esteem and more common social skills.