sem 5 health conv

MODULE-1
INTRODUCTION TO HEALTH
PSYCHOLOGY
HEALTH PSYCHOLOGY
● Health psychology is a specialty area that focuses on how biology,
psychology, behavior, and social factors influence health and illness.
● Health psychology aggregate of the specific educational, scientific and
professional contribution of the discipline of psychology to the promotion
and maintenance of health, the promotion and treatment of illness and
related dysfunction (Matarazzo, 1980).
● Health psychology examines the psychological underpinnings of illnesses to
understand how the mind and body are connected in terms of healing or
illness.”
● Health psychology emphasizes the role of psychological factors in the cause,
progression and consequences of health and illness.
Aims of Health Psychology

The aims of health psychology can be divided into two sections:
1) Understanding, explaining,developing and testing theory.

a) Evaluating the role of behavior in illness.Example-Coronary heart
disease is related to behaviours- smoking, food intake, lack of
exercise.
b) Predicting unhealthy behaviors. Example- Smoking, alcohol
consumption and high fat diets are related to beliefs.
c) Evaluating the interaction between psychology and
physiology.Example- The experience of stress relates to appraisal,
coping and social support.
d) Understanding the role of psychology in the experience of illness.
Example- Understanding the psychological consequences of illness
SUMITUP – SLIMMING PSYCHOLOGY 1

could help to alleviate symptoms such as pain, nausea, vomiting,
anxiety and depression.
e) Evaluating the role of psychology in the treatment of illness.Example-
Changing behavior and reducing stress could reduce the chances of a
further heart attack.
2) Aim of health psychology is to Put this theory into practice.
a) Promoting healthy behaviour.Example - Understanding the role of
behavior in illness can allow unhealthy behaviors to be targeted.
b) Preventing illness. Example 1. Behavioural interventions during
illness (e.g. stopping smoking after a heart attack) may prevent further
illness.
MIND BODY RELATIONSHIP

The relationship between the mind and body in the context of understanding illness
and disease has evolved significantly throughout history.
● Early Beliefs - Mind and Body as One: In ancient times, the mind
and body were generally perceived as a unified entity. Diseases were often
attributed to supernatural causes, such as possession by spirits or
punishments from deities. Healing was often performed through religious
rituals and interventions.
● Greek and Arab Contributions: The Greeks and Arabs made
significant advancements by suggesting natural causes for illnesses.
Hippocrates introduced the Humoral theory, which attributed diseases to
imbalances in bodily fluids. Galen took a step further by linking specific
diseases to identifiable pathogens.
● Church Dominance in the Middle Ages: During the Middle Ages,
the Church held significant power and served as the guardian of medical
knowledge. The roles of priests and physicians often merged, and medical
explanations frequently involved divine or spiritual elements.
● Renaissance and Descartes' Influence: The Renaissance period
brought about a shift in thinking, influenced in part by René Descartes.
Cartesian Dualism, proposed by Descartes, separated the mind and body into
two distinct entities. The body was seen as a mechanistic system that could

be studied scientifically, while the mind and soul remained the domain of
priests and theologians.
● Foundation for Modern Medicine: Descartes' separation of mind and
body laid the foundation for modern medical study and experimentation.
Physicians began focusing exclusively on organic and cellular changes and
pathology as the basis for understanding and treating diseases. Diagnosis and
treatment relied primarily on physical evidence.
● Psychosomatic Medicine and Freud: The exclusively physical view
of medicine faced challenges with the work of Sigmund Freud. Freud's
studies of hysteria revealed cases where patients exhibited profound physical
symptoms without apparent organic causes. This led to the development of
psychosomatic medicine in the 1920s, which emphasized the role of the
mind in influencing physical health.
● Emphasis on the Autonomic Nervous System: Psychosomatic
medicine contributed to a deeper understanding of the mind-body
connection. It highlighted the role of the autonomic nervous system in
mediating the influence of psychological factors on physical health. This
perspective recognized that mental and emotional states could impact bodily
functions and contribute to the onset or exacerbation of diseases.
The historical evolution of the mind-body relationship in medicine reflects a

transition from supernatural and religious explanations to a more scientific and
dualistic approach, and finally to an acknowledgment of the complex interplay
between psychological and physiological factors in health and illness. This
progression has shaped modern medicine's holistic understanding of the mind and
body as interconnected facets of human well-being.
NEED AND SIGNIFICANCE OF HEALTH

PSYCHOLOGY
Holistic Approach:
Health psychology takes a holistic approach to health by considering the interplay
between biological, psychological, and social factors. It recognizes that physical

health is influenced by psychological and social factors, such as stress, emotions,
beliefs, and social support.
Health Promotion and Prevention:

Health psychologists work to promote healthy behaviors and prevent illness. They
develop interventions and strategies to encourage individuals to adopt healthy
habits, such as exercise, healthy eating, and smoking cessation. By focusing on
prevention, health psychology aims to reduce the burden of disease and improve
overall well-being.
Chronic Disease Management: Health psychology plays a crucial role in

managing chronic diseases, such as diabetes, heart disease, and cancer. It helps
individuals cope with the psychological and emotional challenges associated with
these conditions, such as stress, anxiety, and depression. Health psychologists
provide support, education, and coping strategies to enhance patients' quality of life
and adherence to treatment plans.
Pain Management:
Health psychology is instrumental in managing and treating chronic pain. It helps
individuals understand the psychological factors that contribute to pain perception
and develop strategies to cope with pain effectively. Techniques such as cognitive-
behavioral therapy (CBT) are commonly used to address pain-related distress and
improve pain management.
Behavior Change:
Health psychology focuses on understanding and promoting behavior change. It
explores the factors that influence health-related behaviors, such as motivation,
self-efficacy, and social influences. By identifying barriers and facilitators to
behavior change, health psychologists can develop effective interventions to
promote healthy behaviors and reduce risky behaviors.
Healthcare System Improvement:

Health psychology contributes to improving the healthcare system by addressing
issues such as patient-provider communication, adherence to medical treatments,
and healthcare utilization. It helps healthcare professionals understand patients'
psychological needs, enhance communication skills, and develop patient-centered
care approaches.
Public Health and Policy:

Health psychology informs public health initiatives and policies. It provides
insights into the psychological determinants of health behaviors and helps design
effective health promotion campaigns. Health psychologists also contribute to
policy development by advocating for evidence-based interventions and addressing
health disparities.
BIOSPYCHOSOCIAL MODEL V/S BIOMEDICAL

MODEL
Bio psychosocial Model
● The biopsychosocial model posits that health and illness result from the
interplay of biological, psychological, and social factors. It was proposed by
George L. Engel and integrates these factors into the traditional biomedical
model.
● Bio Factors: Biological factors include genetics, viruses, bacteria, and
structural defects.
● Psycho Factors: Psychological factors encompass cognition (thoughts and
expectations), emotions (feelings and fears), and behaviors (lifestyle
choices).
● Social Factors: Social aspects relate to social norms, pressure to conform,
social values, social class, and ethnicity.
● This model rejects the dualist philosophy of the biomedical model,
emphasizing that the mind and body are interconnected and both influence
an individual's health.
Advantages of the Biopsychosocial Model:

● Guiding application of medical knowledge to the needs of each patient.
● Improved patient satisfaction, better adherence to prescriptions, more
maintained behavior change, better physical and psychological health and less
of a tendency to initiate malpractice litigations.
● Development and application of techniques to reduce health risk behaviour.
● Reduce multiple visits and admission into hospitals.
● Individuals with health challenges are acknowledged to be active participants in
the recovery process and good health, rather than mere passive victims.
● Increase efficiency of care by reducing unnecessary prescription of drugs (i.e.
diabetes and other chronic conditions).
● Development of psychological techniques in the strengthening of immune
reaction to illness.
● Biopsychosocial model can be used as a predictor of pain and other
psychosocial problems resulting into development appropriate prevention and
intervention strategies.
● Improvement of communication between health staff and the patients.
● Development and introduction of programmes of life quality improvement for
chronic patients, physically disabled individuals and the elderly patients.
● A significant influence on contemporary understanding of mental health
difficulties.
● Development and application of psychosocial support for the terminally ill
patients and their families.
Drawbacks of Biopsychosocial Model
● Time-consuming and expensive apply.

● It requires more information to be gathered during the assessment about an
individual's socioeconomic status, culture, religion, as well as psychological
factors that might affect the individual's condition.
● There is a lack of theoretical basis of the biopsychosocial model and
scientific evidence to support the model.

● The holistic nature of the biopsychosocial model makes it a luxury many
healthcare systems in resource-poor settings cannot afford.
● Insufficient training opportunities or financial resources available to support
the existence of multidisciplinary teams consisting of psychiatrists, clinical
psychologists, mental health nurses and social welfare workers to allow for a
full understanding of the biological, psychological and social factors
involved in an individual's condition.
● The model’s failure to provide straightforward guidelines for clinical treatment
or rules for prioritization in clinical practice.
● Medical students receive a very limited amount of content in psychosocial
subjects compared to biomedical-oriented courses.
Biomedical Model:
● Explanation of Illness: The biomedical model primarily explains illness by
looking at physical and biological factors. It attributes illnesses to
abnormalities in bodily processes, such as biochemical imbalances or
physiological malfunctions. It often views diseases as resulting from
external agents like pathogens or internal physical changes beyond an
individual's control.
● Responsibility for Illness: In this model, individuals are not held responsible
for their illnesses. They are seen as victims of external forces or internal
biological changes.
● Treatment Focus: Treatments within the biomedical model mainly revolve
around medical interventions like surgeries, medications, chemotherapy, and
radiation therapy. These treatments aim to modify the physical state of the
body to eliminate or manage diseases.
● Binary View of Health: Health and illness are seen as distinct categories;
you are either healthy or unhealthy, with no middle ground or continuum in
between.
● Mind-Body Separation: The biomedical model assumes that the mind and
body operate independently. The mind deals with thoughts and emotions,
while the body encompasses physical aspects like organs, muscles, and
bones.

Advantages of Biomedical Model
● It offers explanations of mental ill-health that many people who experience
mental health problems find reassuring as it can be the first stage towards
recovery.
● Diagnosing and naming conditions can help to reassure people that what
they experience is 'real' and shared by others.
● Relieves symptoms such as hallucinations, a rapid heartbeat or constant
worrying so that the individual starts to feel better.
● Provides access to help and support that can help to alleviate some of the
things that trouble the individual, such as not being able to go shopping.
Drawbacks of the Biomedical Model:

● Neglects Social and Psychological Factors: It tends to downplay the roles of
social and psychological factors in health and illness.
● Mechanistic View: The model can oversimplify complex health issues by
reducing them to mechanistic processes or biochemical imbalances.
● Mind-Body Dualism: It assumes a strict separation between the mind and
body, disregarding their intricate connections.
● Lack of Prevention Focus: The biomedical model emphasizes treating
existing diseases rather than promoting health and preventing illnesses.

MODULE- 2
HEALTH BEHAVIOR AND PRIMARY
PREVENTION
HEALTH BEHAVIOURS
● Health behaviors are actions that are taken by individuals that affect the
overall health of someone’s life. These behaviors range from simple daily
activities such as sleep and working out, to more complex ideas and
concepts such as coping mechanisms.
● Gochman (1997) defined health behavior as those personal attributes such as
beliefs, expectations, motives, values, perceptions and other cognitive
elements; personality characteristics, including affective and emotional
states and traits; and overt behavior patterns, actions and habits that relate to
health maintenance to health restoration and to health improvement.
● The benefits to having positive health behaviors can result in the prevention
of disease and chronic illnesses.
● Negative health behaviors can lead to the development of lifestyles focused
on drug abuse and high risk sexual activities.
● These behaviors can be considered intentional or unintentional and it is
important to note that behavior is easily shaped by the constructs and
environment that an individual is surrounded by. These factors are known as
social determinants, various and dynamic systems that continuously
manipulate the life of people.
Classification of Health Behaviour

Kasl and Cobb (1966) discuss three categories of health behavior. They are:
A. Preventive health behavior: Any activity undertaken by an individual

who believes himself (herself) to be healthy, for the purpose of preventing or
detecting an illness in an early state (example: a mother getting her daughter
immunized against cervical cancer as a preventive measure) or a simpler

example of vaccinating children against an array of diseases in childhood
(diphtheria, measles, whooping cough, Tuberculosis, encephalitis, smallpox,
etc.) In the present context of COVID 19, to prevent this disease, we are
directed to cover our face with a mask, maintain social distance and wash
hands frequently. This is an example of preventive health behavior.
B. Illness behavior: Any activity undertaken by an individual who perceives
himself/ herself to be ill, to define the state of health and discover a suitable
remedy (example :a person consulting a doctor with the fever taking it as a
symptom of tuberculosis and acting as per the instructions of the doctor to
undergo further diagnosis).
C. Sick role behavior: Any activity undertaken by an individual who
considers himself/ herself to be ill, for the purpose of getting well
(example:a doctor prescribing drugs and bed rest after being diagnosed with
viral fever and the patient follows it).
Characteristics of Health Behaviour

● Health Behaviour is complex in nature. This is because it is influenced by
beliefs, environment and emotional state/ traits. Further, health behaviour is
strongly influenced by psychological, cultural, social and environmental
factors.
● The second feature of health behavior is its dynamic nature. That means,
along with time, place, age, social-physical environment it undergoes
changes and alterations. For example, a person does not smoke when he or
she is in home where he or she will be judged, but smokes when he or she
moves out to the city for a job.
● Next, health behaviour is considered as a process, rather than discrete entity
or fixed trait. As time and circumstances changes it will evolve. For
example, a person does not become addicted to alcohol suddenly. But it is a
gradual process whereby he or she is introduced to alcohol, slowly increase
its consumption due to various reasons and gradually reaches the state of
addiction.
● Finally, any health behavior is motivated by a stimulus. This means, any
health behaviour, to occur needs a trigger and this trigger leads to its
manifestation or happening.

CHANGING HEALTH HABITS-ATTITUDE CHANGE
● Changing health habits and attitudes towards health is a crucial aspect of

promoting overall well-being. The relationship between our attitudes,
beliefs, and behaviors plays a significant role in our health outcomes.
● Changing health habits involves making changes to our daily routines and
behaviors that are necessary for maintaining good health. This might include
things like exercising regularly, eating a balanced diet, getting enough sleep,
and managing stress effectively.
● On the other hand, changing our attitudes towards health involves changing
the way we think and feel about health and wellness. This might include
things like developing a positive mindset towards health, viewing health as a
priority, and valuing self-care and preventative measures.
● Educational Appeals:Educational appeals make the assumption that people
will change their health habits if they have good information about their
habits. Early and continuing efforts to change health habits have focused
heavily on education and changing attitudes.
● Fear Appeals :Attitudinal approaches to changing health habits often make
use of fear appeals. This approach assumes that if people are afraid that a
particular habit is hurting their health, they will change their behavior to
reduce their fear.
● Message Framing:A health message can be phrased in positive or negative
terms. For example, a reminder card to get a flu immunization can stress the
benefits of being immunized or stress the discomfort of the flu itself
(Gallagher, Updegraff, Rothman, & Sims, 2011). Messages that emphasize
problems seem to work better for behaviors that have uncertain outcomes,
for health behaviors that needs practice only once. Such as vaccinations and
for issues about which people are fearful. Messages that stress benefits are
more persuasive for behaviors with certain outcomes.
COGNITIVE BEHVAIOURAL APPROACH
Cognitive-Behaviour Therapy (CBT)

● Cognitive-behavior approaches to health habit modification focus on the
target behavior itself, the conditions that elicit and maintain it, and the
factors that reinforce it (Dobson, 2010).
● The most effective approach to health habit modification often comes from
cognitive behavior therapy (CBT).
● CBT interventions use several complementary methods to intervene in the
modification of a target problem and its context. However, CBT may be
implemented individually, through therapy in a group setting, or even on the
Internet. It is a versatile as well as effective way of intervening to modify
poor health habits.
Self-Monitoring
● Many programs of cognitive-behavioral modification use self-monitoring as
the first step toward behavior change.
● The rationale is that a person must understand the dimensions of the poor
health habit before change can begin.
● Self-monitoring assesses the frequency of a target behavior and the
antecedents and consequences of that behavior.
Stimulus Control
● Once the circumstances surrounding the target behavior are well understood,
the factors in the environment that maintain poor health habits such as
smoking, drinking, and overeating, can be modified.
● Stimulus-control interventions involve ridding the environment of
discriminative stimuli. That stimuli evokes the problem behavior, and
creating new discriminative stimuli, signaling that a new response will be
reinforced.
The Self-Control of Behavior

● Cognitive-behavior therapy focuses heavily on the beliefs that people hold
about their health habits. People often generate internal monologues that
interfere with their ability to change their behavior.

● For example, a person who wishes to give up smoking may derail the
quitting process by generating self-doubts (.“I will never be able to give up
smoking”).
● Unless these internal monologues are modified, the person will be unlikely
to change a health habit and maintain that change over time.
Self-Reinforcement
● Self-reinforcement involves systematically rewarding oneself to increase or
decrease the occurrence of a target behavior.
● Positive self-reward involves rewarding oneself with something desirable
after successful modification of a target behavior. Such as going to a movie
following successful weight loss.
● Negative self-reward involves removing an aversive factor in the
environment after successful modification of the target behavior. An
example of negative self-reward is taking the Miss Piggy poster off the
refrigerator once she achieves the regular controlled eating.
Classical Conditioning
● Classical conditioning is the pairing of an unconditioned reflex with a new
stimulus, producing a conditioned reflex. It was one of the first methods for
health behavior change.
Operant Conditioning
● In contrast to classical conditioning, which pairs an automatic response with
a new stimulus, operant conditioning pairs a voluntary behavior with
systematic consequences.
● The key to operant conditioning is reinforcement. When a person performs a
behavior and that behavior is followed by positive reinforcement, the
behavior is more likely to occur again.
● Similarly, if an individual performs a behavior and reinforcement is
withdrawn or the behavior is punished, the behavior is less likely to be
repeated. Over time, these contingencies build up those behaviors paired

with positive reinforcement. Whereas punished or not rewarded behavior
decline.
Modeling
● Modeling is learning that occurs from witnessing another person perform a
behavior (Bandura, 1969).
● Observation and subsequent modeling can be effective approaches to
changing health habits. For example, in one study high school students who
observed others donating blood were more likely to do so themselves
(Sarason, Sarason, Pierce, Shearin, & Sayers, 1991).
Behavioral Assignments
● A technique for increasing client involvement is behavioral assignments,
home practice activities that support the goals of a therapeutic intervention.
● Behavioral assignments are designed to provide continuity in the treatment
of a behavior problem.
● For example, if an early session with an obese client involved training in
self-monitoring. The therapist encourage the client to keep a log of his eating
behavior, including the circumstances in which it occurred. Then the
therapist and the patient at the next session to plan future behavioral
interventions use this log.
Social Skills and Relaxation Training

● Some poor health habits develop in response to the anxiety people
experience in social situations. For example, adolescents often begin to
smoke to reduce their nervousness in social situations by trying to
communicate a cool, sophisticated image.
● Drinking and overeating may also be responses to social anxiety.
● Social anxiety can then act as a cue for the maladaptive habit, necessitating
an alternative way of coping with the anxiety.
Relaxation Training

● Stressful circumstances cause or maintain many poor health habits, and so
managing stress is important to successful behaviour change.
● A mainstay of stress reduction is relaxation training involving deep
breathing and progressive muscle relaxation. In deep breathing, a person
takes deep, controlled breaths, which decreases heart rate and blood pressure
and increases oxygenation of the blood.
● People typically engage in deep breathing spontaneously when they feel
relaxed. However, in progressive muscle relaxation, an individual learns to
relax all the muscles in the body progressively to discharge tension or stress.
Motivational interviewing
● Motivational interviewing (MI) is increasingly used in health promotion
interventions.
● Originally developed to treat addiction, the techniques have been adapted to
target smoking, dietary improvements, exercise, cancer screening, and
sexual behavior, among other habits (Miller & Rose, 2009).
● However, motivational interviewing is a client-centered counseling style
designed to get people to work through any ambivalence they experience
about changing their health behaviors.
● It may be especially effective for people who are initially wary about
whether to change their behavior.
Relapse Prevention
● One of the biggest problems faced in health habit modification is the
tendency for people to relapse. Following initial successful behavior change,
people often return to their old bad habits.
● Relapse is a particular problem with the addictive disorders of alcoholism,
smoking, drug addiction, and overeating (Brownell, Marlatt, Lichtenstein, &
Wilson, 1986), but it can be a problem for all behaviour change efforts.
Placebo Effect

● A placebo is “any medical procedure that produces an effect in a patient
because of its therapeutic intent and not its specific nature, whether chemical
or physical” (Liberman, 1962, p. 761).
● Any medical procedure, ranging from drugs to surgery to psychotherapy,
can have a placebo effect. Furthermore, Placebo effects extend well beyond
the beneficial results of ineffective substances.
● Much of the effectiveness of active treatments that produce real cures on
their own includes a placebo component.
● Placebo effects are enhanced when the physician shows faith in a treatment,
the patient is predisposed to believe it will work, these expectations are
successfully communicated and the trappings of medical treatment are in
place. Placebos are also a vital methodological tool in evaluating drugs and
other treatments.
The Health Belief Model

● The Health Belief Model (HBM) was developed in the early 1950s by social
scientists in the U.S. Public Health Service in order to understand the failure
of people to adopt disease prevention strategies or screening tests for the
early detection of disease. Later uses of HBM were for patients' responses to
symptoms and compliance with medical treatments.
● The HBM suggests that a person's belief in a personal threat of an illness or
disease together with a person's belief in the effectiveness of the
recommended health behavior or action will predict the likelihood the
person will adopt the behavior.
● The HBM derives from psychological and behavioral theory with the
foundation that the two components of health-related behavior are
○ 1) the desire to avoid illness, or conversely get well if already ill; and,
○ 2) the belief that a specific health action will prevent, or cure, illness.
● Ultimately, an individual's course of action often depends on the person's
perceptions of the benefits and barriers related to health behavior. There are
six constructs of the HBM. The first four constructs were developed as the
original tenets of the HBM. The last two were added as research about the
HBM evolved.

1. Perceived susceptibility - This refers to a person's subjective
perception of the risk of acquiring an illness or disease. There is wide
variation in a person's feelings of personal vulnerability to an illness
or disease.
2. Perceived severity - This refers to a person's feelings on the
seriousness of contracting an illness or disease (or leaving the illness
or disease untreated). There is wide variation in a person's feelings of
severity, and often a person considers the medical consequences (e.g.,
death, disability) and social consequences (e.g., family life, social
relationships) when evaluating the severity.
3. Perceived benefits - This refers to a person's perception of the
effectiveness of various actions available to reduce the threat of illness
or disease (or to cure illness or disease). The course of action a person
takes in preventing (or curing) illness or disease relies on
consideration and evaluation of both perceived susceptibility and
perceived benefit, such that the person would accept the
recommended health action if it was perceived as beneficial.
4. Perceived barriers - This refers to a person's feelings on the
obstacles to performing a recommended health action. There is wide
variation in a person's feelings of barriers, or impediments, which lead
to a cost/benefit analysis. The person weighs the effectiveness of the
actions against the perceptions that it may be expensive, dangerous
(e.g., side effects), unpleasant (e.g., painful), time-consuming, or
inconvenient.
5. Cue to action - This is the stimulus needed to trigger the decision-
making process to accept a recommended health action. These cues
can be internal (e.g., chest pains, wheezing, etc.) or external (e.g.,
advice from others, illness of family member, newspaper article, etc.).
6. Self-efficacy - This refers to the level of a person's confidence in his
or her ability to successfully perform a behavior. This construct was
added to the model most recently in mid-1980. Self-efficacy is a
construct in many behavioral theories as it directly relates to whether
a person performs the desired behavior.
Limitations of Health Belief Model

● It does not account for a person's attitudes, beliefs, or other individual
determinants that dictate a person's acceptance of a health behavior.
● It does not take into account behaviors that are habitual and thus may inform
the decision-making process to accept a recommended action (e.g.,
smoking).
● It does not take into account behaviors that are performed for non-health
related reasons such as social acceptability.
● It does not account for environmental or economic factors that may prohibit
or promote the recommended action.
● It assumes that everyone has access to equal amounts of information on the
illness or disease.
● It assumes that cues to action are widely prevalent in encouraging people to
act and that "health" actions are the main goal in the decision-making
process.
The Theory of Planned Behavior

● The Theory of Planned Behavior (TPB) started as the Theory of Reasoned
Action in 1980 to predict an individual's intention to engage in a behavior at
a specific time and place.
● The theory was intended to explain all behaviors over which people have the
ability to exert self-control.
● The key component to this model is behavioral intent; behavioral intentions
are influenced by the attitude about the likelihood that the behavior will have
the expected outcome and the subjective evaluation of the risks and benefits
of that outcome.
● The TPB has been used successfully to predict and explain a wide range of
health behaviors and intentions including smoking, drinking, health services
utilization, breastfeeding, and substance use, among others.
● The TPB states that behavioral achievement depends on both motivation
(intention) and ability (behavioral control). It distinguishes between three
types of beliefs - behavioral, normative, and control.
● The TPB is comprised of six constructs that collectively represent a person's
actual control over the behavior.

1. Attitudes - This refers to the degree to which a person has a favorable
or unfavorable evaluation of the behavior of interest. It entails a
consideration of the outcomes of performing the behavior.
2. Behavioral intention - This refers to the motivational factors that
influence a given behavior where the stronger the intention to perform
the behavior, the more likely the behavior will be performed.
3. Subjective norms - This refers to the belief about whether most
people approve or disapprove of the behavior. It relates to a person's
beliefs about whether peers and people of importance to the person
think he or she should engage in the behavior.
4. Social norms - This refers to the customary codes of behavior in a
group or people or larger cultural context. Social norms are
considered normative, or standard, in a group of people.
5. Perceived power - This refers to the perceived presence of factors
that may facilitate or impede performance of a behavior. Perceived
power contributes to a person's perceived behavioral control over each
of those factors.
6. Perceived behavioral control - This refers to a person's perception of
the ease or difficulty of performing the behavior of interest. Perceived
behavioral control varies across situations and actions, which results
in a person having varying perceptions of behavioral control
depending on the situation. This construct of the theory was added
later, and created the shift from the Theory of Reasoned Action to the
Theory of Planned Behavior.
Limitations of the Theory of Planned Behavior

● It assumes the person has acquired the opportunities and resources to be
successful in performing the desired behavior, regardless of the intention.
● It does not account for other variables that factor into behavioral intention
and motivation, such as fear, threat, mood, or past experience.
● While it does consider normative influences, it still does not take into
account environmental or economic factors that may influence a person's
intention to perform a behavior.

● It assumes that behavior is the result of a linear decision-making process,
and does not consider that it can change over time.
● While the added construct of perceived behavioral control was an important
addition to the theory, it doesn't say anything about actual control over
behavior.
● The time frame between "intent" and "behavioral action" is not addressed by
the theory.
The Transtheoretical Model (Stages of Change)

● The Transtheoretical Model (also called the Stages of Change Model),
developed by Prochaska and DiClemente in the late 1970s.
● This evolved through studies examining the experiences of smokers who
quit on their own with those requiring further treatment to understand why
some people were capable of quitting on their own.
● It was determined that people quit smoking if they were ready to do so.
Thus, the Transtheoretical Model (TTM) focuses on the decision-making of
the individual and is a model of intentional change.
● The TTM operates on the assumption that people do not change behaviors
quickly and decisively. Rather, change in behavior, especially habitual
behavior, occurs continuously through a cyclical process.
● The TTM is not a theory but a model; different behavioral theories and
constructs can be applied to various stages of the model where they may be
most effective.
● The TTM posits that individuals move through six stages of change. For
each stage of change, different intervention strategies are most effective at
moving the person to the next stage of change and subsequently through the
model to maintenance, the ideal stage of behavior.
1. Precontemplation - In this stage, people do not intend to take action
in the foreseeable future (defined as within the next 6 months). People
are often unaware that their behavior is problematic or produces
negative consequences. People in this stage often underestimate the
pros of changing behavior and place too much emphasis on the cons
of changing behavior.

2. Contemplation - In this stage, people are intending to start the
healthy behavior in the foreseeable future (defined as within the next
6 months). People recognize that their behavior may be problematic,
and a more thoughtful and practical consideration of the pros and cons
of changing the behavior takes place, with equal emphasis placed on
both. Even with this recognition, people may still feel ambivalent
toward changing their behavior.
3. Preparation (Determination) - In this stage, people are ready to take
action within the next 30 days. People start to take small steps toward
the behavior change, and they believe changing their behavior can
lead to a healthier life.
4. Action - In this stage, people have recently changed their behavior
(defined as within the last 6 months) and intend to keep moving
forward with that behavior change. People may exhibit this by
modifying their problem behavior or acquiring new healthy behaviors.
5. Maintenance - In this stage, people have sustained their behavior
change for a while (defined as more than 6 months) and intend to
maintain the behavior change going forward. People in this stage
work to prevent relapse to earlier stages.
6. Termination - In this stage, people have no desire to return to their
unhealthy behaviors and are sure they will not relapse. Since this is
rarely reached, and people tend to stay in the maintenance stage, this
stage is often not considered in health promotion programs.
To progress through the stages of change, people apply cognitive, affective, and
evaluative processes. Ten processes of change have been identified with some
processes being more relevant to a specific stage of change than other processes.
These processes result in strategies that help people make and maintain change.
1. Consciousness Raising - Increasing awareness about the healthy behavior.

2. Dramatic Relief - Emotional arousal about the health behavior, whether
positive or negative arousal.
3. Self-Revaluation - Self reappraisal to realize the healthy behavior is part of
who they want to be.

4. Environmental Reevaluation - Social reappraisal to realize how their
unhealthy behavior affects others.
5. Social Liberation - Environmental opportunities that exist to show society
is supportive of healthy behavior.
6. Self-Liberation - Commitment to change behavior based on the belief that
achievement of the healthy behavior is possible.
7. Helping Relationships - Finding supportive relationships that encourage the
desired change.
8. Counter-Conditioning - Substituting healthy behaviors and thoughts for
unhealthy behaviors and thoughts.
9. Reinforcement Management - Rewarding the positive behavior and
reducing the rewards that come from negative behavior.
10. Stimulus Control - Re-engineering the environment to have reminders and
cues that support and encourage the healthy behavior and remove those that
encourage the unhealthy behavior.
Limitations of the Transtheoretical Model

● The theory ignores the social context in which change occurs, such as SES
and income.
● The lines between the stages can be arbitrary with no set criteria of how to
determine a person's stage of change. The questionnaires that have been
developed to assign a person to a stage of change are not always
standardized or validated.
● There is no clear sense for how much time is needed for each stage, or how
long a person can remain in a stage.
● The model assumes that individuals make coherent and logical plans in their
decision-making process when this is not always true.
Protection Motivation Theory

● The Protection Motivation Theory (PMT) is a psychological framework
developed by Rogers in 1975, aimed at understanding how individuals
respond to threats and risks, and the factors that motivate them to engage in
protective behaviors.

● Protection Motivation Theory (PMT) is a widely recognized model that
explores how individuals assess threats and decide whether to engage in
protective behaviors.
● PMT suggests that people's motivation to protect themselves from harm is
determined by two main appraisal processes: threat appraisal and coping
appraisal.
1. Threat Appraisal:
● Perceived Severity: This is the individual's perception of how severe a threat
or risk is. The greater the perceived severity, the more motivated someone is
to protect themselves. For example, consider two individuals reacting to the
threat of a hurricane. Person A believes that hurricanes are not very severe
and do minimal damage, while Person B sees hurricanes as extremely
dangerous and destructive. Person B is more likely to take protective actions,
such as evacuating or reinforcing their home, because they perceive the
severity to be high.
● Perceived Susceptibility: This reflects the individual's belief about their
personal vulnerability to the threat. If someone believes they are highly
susceptible to a particular threat, they are more likely to take protective
measures. For instance, consider two people faced with the threat of skin
cancer from excessive sun exposure. Person X believes they have a low risk
of getting skin cancer due to their skin type, while Person Y believes they
are highly susceptible due to their fair skin. Person Y is more likely to take
precautions like using sunscreen, wearing protective clothing, and avoiding
direct sunlight.
2. Coping Appraisal:
● Perceived Response Efficacy: This relates to the individual's belief that the
recommended protective actions can effectively reduce the threat. If a person
believes that using a particular product or following a specific behavior will
effectively mitigate the threat, they are more likely to adopt that protective
measure. For example, if someone perceives that getting a COVID-19
vaccine is highly effective in preventing infection and transmission, they are
more motivated to get vaccinated.

● Perceived Self-Efficacy: This refers to the person's confidence in their
ability to carry out the recommended protective behaviors. If someone
believes they can successfully perform the required actions, they are more
likely to engage in protective behavior. For instance, if an individual has the
confidence to properly install a smoke detector in their home, they are more
likely to do so, enhancing their fire safety.
Limitations of Protection Motivation Theory

● Simplicity: PMT is a simplified model that doesn't account for the
complexity of human behavior, which can be influenced by emotions,
cultural factors, and individual differences.
● Rationality Assumption: It assumes individuals make rational decisions,
whereas emotions and cognitive biases often play significant roles in
decision-making.
● Emotional Factors: PMT doesn't thoroughly address the emotional aspects of
threat perception and response, which are critical in many situations.
● Social Influences: The theory doesn't adequately consider the impact of
social and peer pressure, which can strongly influence protective behaviors.
● Predictive Power: While useful for understanding motivations, PMT doesn't
always predict actual behaviors accurately because real-world decisions are
influenced by numerous factors.
The Social Cognitive Theory

● Social Cognitive Theory (SCT) started as the Social Learning Theory (SLT)
in the 1960s by Albert Bandura. It developed into the SCT in 1986 and
posits that learning occurs in a social context with a dynamic and reciprocal
interaction of the person, environment, and behavior.
● The unique feature of SCT is the emphasis on social influence and its
emphasis on external and internal social reinforcement.
● SCT considers the unique way in which individuals acquire and maintain
behavior, while also considering the social environment in which individuals
perform the behavior.

● The theory takes into account a person's past experiences, which factor into
whether behavioral action will occur. These past experiences influences
reinforcements, expectations, and expectancies, all of which shape whether a
person will engage in a specific behavior and the reasons why a person
engages in that behavior.
● Many theories of behavior used in health promotion do not consider
maintenance of behavior, but rather focus on initiating behavior. This is
unfortunate as maintenance of behavior, and not just initiation of behavior, is
the true goal in public health.
● The goal of SCT is to explain how people regulate their behavior through
control and reinforcement to achieve goal-directed behavior that can be
maintained over time.
● The first five constructs were developed as part of the SLT; the construct of
self-efficacy was added when the theory evolved into SCT.
1. Reciprocal Determinism - This is the central concept of SCT. This
refers to the dynamic and reciprocal interaction of person (individual
with a set of learned experiences), environment (external social
context), and behavior (responses to stimuli to achieve goals).
2. Behavioral Capability - This refers to a person's actual ability to
perform a behavior through essential knowledge and skills. In order to
successfully perform a behavior, a person must know what to do and
how to do it. People learn from the consequences of their behavior,
which also affects the environment in which they live.
3. Observational Learning - This asserts that people can witness and
observe a behavior conducted by others, and then reproduce those
actions. This is often exhibited through "modeling" of behaviors. If
individuals see successful demonstration of a behavior, they can also
complete the behavior successfully.
4. Reinforcements - This refers to the internal or external responses to a
person's behavior that affect the likelihood of continuing or
discontinuing the behavior. Reinforcements can be self-initiated or in
the environment, and reinforcements can be positive or negative. This
is the construct of SCT that most closely ties to the reciprocal
relationship between behavior and environment.

5. Expectations - This refers to the anticipated consequences of a
person's behavior. Outcome expectations can be health-related or not
health-related. People anticipate the consequences of their actions
before engaging in the behavior, and these anticipated consequences
can influence successful completion of the behavior. Expectations
derive largely from previous experience. While expectancies also
derive from previous experience, expectancies focus on the value that
is placed on the outcome and are subjective to the individual.
6. Self-efficacy - This refers to the level of a person's confidence in his
or her ability to successfully perform a behavior. Self-efficacy is
unique to SCT although other theories have added this construct at
later dates, such as the Theory of Planned Behavior. Self-efficacy is
influenced by a person's specific capabilities and other individual
factors, as well as by environmental factors (barriers and facilitators).
Limitation of Social Cognitive Theory

● The theory assumes that changes in the environment will automatically lead
to changes in the person, when this may not always be true.
● The theory is loosely organized, based solely on the dynamic interplay
between person, behavior, and environment. It is unclear the extent to which
each of these factors into actual behavior and if one is more influential than
another.
● The theory heavily focuses on processes of learning and in doing so
disregards biological and hormonal predispositions that may influence
behaviors, regardless of past experience and expectations.
● The theory does not focus on emotion or motivation, other than through
reference to past experience. There is minimal attention on these factors.
● The theory can be broad-reaching, so can be difficult to operationalize in
entirety.
Social Attribution theory

This theory was developed by Harold Kelley.

This theory focuses on how individuals make attributions about the causes of
behavior, considering both internal and external factors.
○ Covariation Model:
This is the central concept in Kelley's theory. It suggests that people

use multiple pieces of information to make attributions, taking into
account three dimensions:
■ Consensus: Refers to whether other people would react

similarly to the same situation. High consensus implies an
external attribution, while low consensus suggests an internal
attribution.
■ Distinctiveness: Relates to whether the person's behavior is
consistent across different situations. High distinctiveness
points to an external attribution, while low distinctiveness leans
toward an internal attribution.
■ Consistency: Focuses on whether the person's behavior is
consistent over time. High consistency leads to an internal
attribution, while low consistency implies an external
attribution.
Examples:

● Job Promotion:
■ Imagine a colleague gets promoted at work. You might use
Kelley's model to explain this:
■ Consensus: If most of your coworkers also think your colleague
deserved the promotion (high consensus), you might attribute
their success to their competence (internal).
■ Distinctiveness: If this colleague has a history of excelling in
various roles (high distinctiveness), you would again attribute
their promotion to their skills and qualifications (internal).
■ Consistency: If this colleague has consistently performed well
over time (high consistency), you are likely to attribute their
promotion to their personal attributes (internal).
● Restaurant Experience:
■ In a restaurant, if a waiter appears to be rude to you, you might
make attributions:
■ Consensus: If you notice the waiter is rude to everyone (high
consensus), you'd attribute their behavior to external factors like
poor training or a bad day.
■ Distinctiveness: If you see the waiter treating everyone
differently (low distinctiveness), you'd consider internal factors
such as their personality or mood.
■ Consistency: If you've seen this waiter act rudely on multiple
occasions (high consistency), you might attribute it to their
internal disposition.
Limitations of Social Attribution Theory

● Complexity of Attribution: While Kelley's model is more comprehensive
than the original attribution theory, real-life attributions can still be complex
and influenced by various factors not accounted for in the model.
● Availability of Information: Gathering information for all three dimensions
(consensus, distinctiveness, and consistency) can be challenging. People
often make quick, intuitive attributions without considering all aspects.
● Cultural Variations: Attribution patterns may vary across cultures, and this
model may not fully capture cultural differences in the attribution process.

● Underemphasizing Motivation: The model doesn't delve into the
motivational aspects of attribution, which can significantly impact how
attributions are made, especially in interpersonal relationships.
● Overemphasis on Situational Factors: The model might overemphasize the
role of situational factors and underplay the significance of personal traits,
which can lead to biased attributions.
MODELS OF PREVENTION
Prevention includes a wide range of activities known as “interventions” aimed at
reducing risks or threats to health. There are three categories of prevention:
primary, secondary and tertiary.
Primary prevention
Primary prevention aims to prevent disease or injury before it ever occurs. This is
done by preventing exposures to hazards that cause disease or injury, altering
unhealthy or unsafe behaviors that can lead to disease or injury, and increasing
resistance to disease or injury should exposure occur. Examples include:
● Legislation and enforcement to ban or control the use of hazardous
products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of
seatbelts and bike helmets)
● Education about healthy and safe habits (e.g. eating well,
exercising regularly, not smoking)
● Immunization against infectious diseases.
Secondary prevention
Secondary prevention aims to reduce the impact of a disease or injury that has
already occurred. This is done by detecting and treating disease or injury as soon as
possible to halt or slow its progress, encouraging personal strategies to prevent
reinjury or recurrence, and implementing programs to return people to their
original health and function to prevent long-term problems. Examples include:
● Regular exams and screening tests to detect disease in its earliest stages
(e.g. mammograms to detect breast cancer)

● Daily, low-dose aspirins and/or diet and exercise programs to prevent
further heart attacks or strokes
● Suitably modified work so injured or ill workers can return safely to
their jobs.
Tertiary prevention
Tertiary prevention aims to soften the impact of an ongoing illness or injury that
has lasting effects. This is done by helping people manage long-term, often-
complex health problems and injuries (e.g. chronic diseases, permanent
impairments) in order to improve as much as possible their ability to function, their
quality of life and their life expectancy. Examples include:
● Cardiac or stroke rehabilitation programs, chronic disease
management programs (e.g. for diabetes, arthritis, depression, etc.)
● Support groups that allow members to share strategies for living well
● Vocational rehabilitation programs to retrain workers for new jobs
when they have recovered as much as possible.

MODULE-3
STRESS AND COPING
STRESS
● Stress can be defined as any type of change that causes physical, emotional,
or psychological strain. Stress is your body's response to anything that
requires attention or action.
● Everyone experiences stress to some degree. The way you respond to stress,
however, makes a big difference to your overall well-being.
○ Eustress: the positive stress response, involving optimal levels of
stimulation: a type of stress that results from challenging but
attainable and enjoyable or worthwhile tasks (e.g., participating in an
athletic event, giving a speech). It has a beneficial effect by generating
a sense of fulfillment or achievement and facilitating growth,
development, mastery, and high levels of performance.
○ Distress: the negative stress response, often involving negative affect
and physiological reactivity: a type of stress that results from being
overwhelmed by demands, losses, or perceived threats. Distress
triggers physiological changes that can pose serious health risks,
especially if combined with maladaptive ways of coping.
Stressors
Stressors are life events or situations that trigger stress. They trigger your fight or
flight response, prompting the release of stress hormones throughout your body.
Examples:
● Work stressors. This includes having a long to-do list, a toxic boss, or a
high-pressure work environment.
● Financial stressors. Excessive debt, living paycheck to paycheck, or
expensive car repairs could stress you financially.

● Emotional stressors. Here we can include relationship troubles, lack of social
support, or being a primary caregiver.
We won't react to all stressors equally.Our response will vary based on our coping
abilities and how important the experience is to us. For example, if a student used
to giving presentations, one speech won't phase him. But if he never done it
before, he might feel more anxious.
➔ There are two types of stress

1. Acute Stress: Acute stress occurs during a particular time or event and is
isolated to that incident.You might experience acute stress when you have a
near-miss car accident, or you’re preparing for an important presentation at
work.
2. Chronic Stress: Chronic stress is ongoing. Similar to chronic pain or
chronic illness, chronic stress could increase or decrease in severity but is
relatively consistent in its presence. This could be due to any number of
things, from an unhealthy relationship where you’re constantly arguing to a
job that is burdensome and leaves you overworked daily.
THEORIES OF STRESS
Fight or Flight Response:
● This theory was developed by Walter Bradford Cannon in 1915.

● Cannon initially termed stress as the emergency response and further
elaborated that stress had its source in fighting emotions (Nelson and Quick,
2012).
● Cannon put forth the fight or flight response with regard to stress. According
to Cannon stress is an outcome of an environmental demand that was
external and that led to an imbalance in the natural steady state of an
individual.
● He further stated that the body encompasses natural defense mechanisms
that play a role in maintaining the homeostasis or the natural steady state of
an individual. Cannon was also interested in sympathetic nervous system
activation in an individual when in stressful situation.

● Thus, when an individual faces a situation that is threatening, he/ she will
either get ready to fight the threat or may flight or run away from the
situation.
● The individual will experience certain physiological changes that gets him/
her ready to fight or flight. These physiological changes include sweating,
dry mouth, tensed muscles and so on. There is also increase in blood
pressure and pulse rate. Besides the breathing may also become rapid and
pupils may widen.
● Basically, in this moment, the individual’s body will transfer the energy
from body systems that are not required to respond to the situation to the
body systems that are required to function in order to respond to the situation
at hand.
● The stimulation of the sympathetic nervous system and endocrine system
takes place.
● For instance, if a person suddenly comes across a snake, his/ her response
would be either of fight or flight and in this case his/ her body will prepare
the person for this situation.
● Thus, there is a disequilibrium that disturbs the homeostasis of the body.
Though, once the situation is over and there are no more challenges or
threats, the body will go back to normal and homeostasis will be restored.
● The flight and fight response is advantageous as it helps deal instantly with
the situation.
● In a long run, experiences of stress in this manner can have negative impact
on the bodily and affective functioning of a person (Ghosh, 2015).
Selye's General Adaptation Syndrome (GAS)
Hans Selye put forth three stages that are experienced by an individual when he/
she is in a situation that is stressful.
1. Alarm Stage
➢ The first stage is that of ‘alarm reaction’ that is denoted by a
decreased resistance to stress.
➢ This stage is similar to that of fight or flight response.

➢ During this stage, the autonomic nervous system and endocrine
system are activated by the hypothalamus. Further, the epinephrine
and norepinephrine are released by the adrenal glands. This can be
termed as a countershock, where the defense mechanisms of an
individual are activated.
➢ These defence mechanisms are activated as a result of enlargement of
adrenocortical cells that leads to discharge of adrenalin and thus
leading to increase in functions related to respiration and
cardiovascular activities.
➢ Thus, similar to fight or flight response, the body is prepared to face
the threatening situation.
➢ There is also an increase in energy production that is as a result of
cortisol produced by adrenal glands. Adrenal glands are stimulated by
Adrenocorticotropic hormone (ACTH) that is released by the pituitary
gland.
➢ Similar to fight or flight response, the individual’s body will transfer
the energy from body systems that are not required to respond to the
situation to the body systems that are required to function as a
response to the situation at hand.
➢ Thus, functions related to digestion, immune system and even
reproductive system do not receive any energy during this stage.
2. Resistance Stage :
➢ In the second stage, that is ‘resistance’, the adaptation is maximum
and the equilibrium is restored.
➢ During this stage, there is an adaptation on part of the individual and
he/ she resists the stimuli that create stress, though resistance to other
stimuli decreases.
➢ During this stage as well, a lot of energy is required, thus, the
nonessential functions related to digestion, immune system and even
reproductive system do not receive any energy.Thus, the individual
continues experiencing physiological changes such as increased pulse
rate and blood pressure, rapid breathing and so on.

➢ These activities are mainly directed towards restoration of equilibrium
or balance. Though, if the stress is still experienced and the defense
mechanisms are inactive then the individual will experience the third
and last stage.
➢ The duration of this stage will depend on the nature, degree and
intensity of the stressor that the individual is exposed to as well as the
condition of the individual when he/ she is exposed to the stressor.
3. Exhaustion Stage
➢ The last stage is that of ‘exhaustion’ where there is a collapse of
adaptive mechanisms (Cartwright and Cooper, 1997).
➢ Exhaustion occurs as a result of collapse in adaptation mechanisms
and due to decrease in the physiological resources.
➢ When an individual experiences stress for a long period of time, the
individual’s physiological resources deplete and this can have a
negative impact on the physical health of the individual and the
individual may become susceptible to various illnesses and health
related issues.
Tend-Befriend Theory
● The "Tend-and-Befriend" theory was developed by S.E. Taylor and her

colleagues.
● This theory offers a unique perspective on how individuals respond to stress.
● It suggests that, alongside the traditional "fight-or-flight" response, people
and animals have evolved to cope with stress through social affiliation and
nurturing behavior, particularly women.
● This theory sheds light on how our ancestors' survival roles and underlying
biological mechanisms have shaped our responses to stress.
● The theory posits that stress triggers not only the instinct to confront or flee
from a threat (fight or flight) but also a tendency to seek social connections
and engage in nurturing behaviors, especially when it comes to caring for
offspring.
● This response, researchers propose, may be particularly pronounced in
women.

Evolutionary Context:
● During the time when these stress responses evolved, men and women often
faced distinct adaptive challenges within their social groups. Men typically
assumed roles related to hunting and protection, while women were
responsible for gathering resources and tending to childcare.
● These roles were often segregated by sex. Consequently, women's responses
to stress appear to have evolved not only to protect themselves but also to
ensure the well-being and survival of their offspring.
● Importantly, these responses are not unique to humans. In fact, in most
species, offspring are born immature and unable to survive on their own.
Thus, the provision of care and attention, often by mothers, is critical for
their survival.
● This shared pattern of caregiving across species underscores the
evolutionary significance of these responses.
Biological Mechanism - Oxytocin:
● The Tend-and-Befriend responses are not solely behavioral; they also have
an underlying biological basis, particularly involving the hormone oxytocin.
● Oxytocin is sometimes referred to as the "love hormone" or "bonding
hormone" because it plays a key role in social bonding and attachment.
● When an individual faces a stressful event, the body rapidly releases
oxytocin, potentially motivating social behavior and caregiving actions.
● What makes this even more interesting is that the effects of oxytocin appear
to be particularly influenced by the hormone estrogen, which is more
prevalent in women.
● This suggests that oxytocin may play an especially vital role in how women
respond to stress.
The Tend-and-Befriend theory offers a comprehensive view of stress responses,

emphasizing social affiliation and nurturing behaviors alongside fight-or-flight.
This theory highlights the impact of evolutionary roles and the crucial role of
oxytocin, especially in women's responses to stress. It underscores the
interconnectedness of our biology and social behavior, providing valuable insights

into how we cope with life's challenges and the importance of social connections in
times of stress.
PSYCHOLOGICAL APPRAISAL AND STRESS

Psychological appraisal plays a significant role in how individuals experience and
respond to stress. This process involves evaluating and interpreting a situation,
determining its significance, and assessing one's ability to cope with it. Here's how
psychological appraisal relates to stress:
● Primary Appraisal: In the primary appraisal stage, individuals assess whether a

situation is a potential threat, challenge, or harm. This initial evaluation is
subjective and depends on personal beliefs, experiences, and emotions. For
example, receiving a challenging work assignment may be perceived as a threat to
one's job security by one person (leading to stress) and as an exciting challenge by
another (leading to motivation).
● Secondary Appraisal: After the primary appraisal, individuals assess their ability
to cope with the situation. This involves evaluating available resources, support,
and one's own skills and strengths. If a person believes they have the necessary
resources to manage the stressor, they may experience lower stress levels.
Conversely, if they perceive a lack of coping resources, stress may intensify.
● Reappraisal: As a situation evolves, ongoing appraisal is essential. Reappraisal
occurs as new information becomes available or as the individual's coping
resources change. Reevaluating the stressor's significance and one's ability to cope
can lead to adjustments in the stress response.
● Emotional Response: Psychological appraisal influences emotional responses to
stress. If an individual interprets a situation as highly threatening and believes they
lack the resources to cope, they are more likely to experience negative emotions
such as anxiety, fear, or anger. Conversely, if they perceive the stressor as
manageable, their emotional response may be less intense.
● Coping Strategies: Appraisal informs the choice of coping strategies. Based on
how a situation is assessed, individuals may employ problem-focused coping
(taking action to address the stressor) or emotion-focused coping (managing
emotional responses to the stressor). Effective coping strategies can reduce the
impact of stress.
● Long-Term Effects: Prolonged or chronic stress can lead to physical and mental
health issues. Psychological appraisal also influences how individuals adapt to

ongoing stressors. Those who continually perceive a situation as highly
threatening and feel powerless may be at greater risk of developing stress-related
disorders.
It's important to note that psychological appraisal is a complex, individualized process.

Two people facing the same stressor may appraise it differently, leading to distinct stress
responses. Factors such as personality, past experiences, and social support networks all
contribute to how individuals appraise and respond to stress. Recognizing the role of
psychological appraisal can be valuable in stress management and developing resilience
to life's challenges.
COPING
● According to APA, Coping is the use of cognitive and behavioral strategies
to manage the demands of a situation when these are appraised as taxing or
exceeding one’s resources or to reduce the negative emotions and conflict
caused by stress.
● Coping can be defined as the actual effort that is made in the attempt to
render a perceived stressor more tolerable and to minimize the distress
induced by the situation Folkman& Lazarus, (1985).
● According to Folkman and Lazarus there are two types of coping strategies.
They include problem focused and emotion focused coping.
1.PROBLEM FOCUSED COPING
● Problem-focused coping aims at problem solving or doing something to alter

the source of stress.
● Problem-focused coping tends to predominate when people feel that
something constructive can be done.
● According to Folkman& Lazarus,(1980) problem focused coping involves
active coping, social supports for instrumental reason, restraint coping,
acceptance, planning, suppression of competing activities and positive
reinterpretation and growth.

There are seven categories under problem focused coping and they are given
below.
A. Active coping- Active coping is the process of taking active steps to remove
the stressor. This involves taking additional or direct action to get rid of a
problem and concentrating on the task at hand. In the case of adolescents’
active coping would be removing the stressor by dropping a class.
B. Social supports for instrumental reason- Social supports for instrumental
reason is seeking advice, assistance or information. This is a problem
focused coping. Here the person talks to one’s advisor about how to deal
with the issues. Individuals who are high on using social supports for
instrumental reason use above mentioned methods when faced with crisis.
C. Restraint coping- This means waiting until an appropriate opportunity
comes, holding oneself back and not acting prematurely. Individuals who
use this method hold on doing things till the right time approach and they do
not engage in activities without giving a second thought. This is an active
coping strategy in the sense that the persons behavior focuses on dealing
effectively with the stressor.
D. Acceptance- Acceptance is a functional coping response, in that a person
who accepts the reality of a stressful situation would seem to be a person
who is engaged in the attempt to deal with the situation. Here the person
accepts the fact that something has happened and tries to get adjusted with
the present situations.
E. Planning- This involves coming up with active strategies, thinking about
what steps to take and how best to handle the problem. Individuals high on
using planning strategies make use of above mentioned strategies when
faced with problems.
F. Suppression of competing activities- This means putting other projects
aside, trying to avoid becoming distracted by other events, even letting other
things side, if necessary in order to deal with the stressor. Here the person
may suppress involvement in competing activities or may suppress the
processing of competing channels of information in order to concentrate
more fully on the challenge or threat at hand.
G. Positive Reinterpretation and Growth – This involves seeing things in a
positive manner and learning from experiences.

2. EMOTION FOCUSED COPING –
● Emotion focused coping tend to predominate when people feel that the
stressor is something that must be endured (Folkman& Lazarus, 1980).
● This includes social supports for emotional reasons, denial or avoidance,
venting of emotions, turning to religion, mental disengagement, behavioral
disengagement and alcohol disengagement.
Seven categories are identified under emotion focused coping and they are
discussed below.
A. Social supports for emotional reasons -Seeking social support for

emotional reasons is getting moral support, sympathy or understanding. This
involves venting about the problem to others. This is an aspect of emotion
focused coping.
B. Denial or avoidance – Denial here means refusal to believe that the stressor
exists or of trying to act as though the stressor is not real. This involves
simply not thinking about the problem.
C. Venting of emotions- Here the individual has the tendency to focus on
whatever distress or upset one is experiencing and to ventilate those feelings.
This is a means of emotion focused coping.
D. Turning to religion- One might turn to religion when under stress for
widely varying reasons: religion might serve as a source of emotional
support, as a vehicle for positive reinterpretation and growth, or as a tactic of
active coping with a stressor. Here individuals seek support of religion when
they face with stressors in life.
E. Mental disengagement- One of the dysfunctional coping which comes
under emotion focused coping is mental disengagement. This includes using
alternative activities to take one’s mind off a problem a tendency opposite to
suppression of competing activities), day dreaming, escaping through sleep
or escape by immersion in T.V etc.
F. Behavioral disengagement- Second dysfunctional coping means in many
circumstances is behavioral disengagement. This comes under emotion
focused coping. In behavioural disengagement one reduces one’s effort to

deal with the stressor even giving up the attempt to attain goals with in
which the stressor is interfering.
G. Alcohol disengagement – Here one reduces their effort to deal with a
stressor by using alcohol as a means to forget their stress element.
Individuals who use alcohol and drugs are high on using this strategy.
MODERATES OF COPING
Personality
● Coping personality refers to an individual's natural tendencies and
preferences for coping with stressors and challenges.
● Some people may have a tendency to rely more on problem-focused coping
strategies, while others may be more likely to use emotion-focused coping
strategies.
● The way that an individual's coping personality interacts with their social
support network can have an impact on their overall well-being.
● For example, an individual who has a tendency to rely on problem-focused
coping strategies may find that seeking social support from others can help
them to better manage stress and adversity. On the other hand, an individual
who has a tendency to rely on emotion-focused coping strategies may find
that social support can help them to better process and cope with their
emotions in a healthy way.
● Understanding the moderators of coping personality can help individuals and
mental health professionals to better understand how an individual's natural
tendencies for coping may impact their social support needs and vice versa.
Social Support
● Social support, on the other hand, refers to the emotional and practical
support that individuals receive from their social network, such as family,
friends, or colleagues.
● Social support can come in many forms, such as advice, encouragement, or
practical assistance.

● The way that social support is received and perceived can be influenced by a
variety of factors, such as the quality of the relationship, the type of support
provided, and the individual's own beliefs and attitudes.
● For example, an individual who receives social support from a close friend
may find that the support is more meaningful and helpful than social support
from a casual acquaintance. On the other hand, an individual who is used to
receiving a lot of social support may find that receiving less support can be
difficult to manage.
● Understanding the moderators of social support can help individuals and
mental health professionals to better understand how an individual's social
support needs may impact their overall well-being and how to best support
them in a way that is meaningful and helpful.
STRESS MANAGEMENT TECHNIQUES
1. Meditation
● A few minutes of practice per day can help ease anxiety. “Research suggests
that daily meditation may alter the brain’s neural pathways, making you
more resilient to stress,” says psychologist “Robbie Maller Hartman”
● The procedure for a short mediation is given below. Sit up straight with both
feet on the floor. Close your eyes. Focus attention on reciting out loud or
silently a positive mantra such as “I feel at peace” or “I love myself.” Place
one hand on belly to synch the mantra with breaths. Let any distracting
thoughts float by like clouds.
2. Breathe Deeply
● Second stress management technique is breathing exercise. For breathing

exercise we need to take a 5-minute break from whatever is bothering us and
should focus instead on our breathing.
● This exercise starts with sitting up straight by closing eyes with a hand on
belly. Slowly inhaling through nose, feeling the breath, starting from
abdomen, and feeling it to the top of our head.

● Reverse the process as you exhale through your mouth. “Deep breathing
counters the effects of stress by slowing the heart rate and lowering blood
pressure,” says psychologist Judith Tutin, PhD, a certified life coach in
Rome,
3. Be Present
● Usually people rush through dinner, hurry to our next appointment, and race
to finish one more thing on our agenda.
● An important things to reduce our pulse is to slow down. “Take 5 minutes
and focus on only one behavior with awareness,” says Tutin.
● Notice how the air feels on our face when we are walking and how our feet
feel hitting the ground.
● Enjoy the texture and taste of each bite of food as we slowly chew. When we
spend time in the moment and focus on our senses, we should feel the
tension leave our body.
4. Reach Out
● A good social support system is one of the most important resources for
dealing with stress.
● Talking to others preferably face-to-face or at least on the phone is a great
way to better manage whatever is stressing you out.
5. Tune In to Your Body
● Mentally scan our body to get a sense of how stress affects it each day.
● Lie on your back or sit with your feet on the floor. Start at your toes and
work your way up to your scalp, noticing how your body feels.
● “Simply be aware of places that we feel tight or loose without trying to
change anything,” says Tutin. For 1 to 2 minutes, imagine each deep breath
flowing to that body part.
● Repeat this process as we move focus up to body, paying close attention to
sensations you feel in each body part.

6. Relaxation Techniques
● Engaging in activities that promote relaxation, such as taking warm baths,

practicing yoga, or listening to calming music, can help individuals unwind
and reduce stress levels.

MODULE- 4
PSYCHOSOCIAL ISSUES AND

MANAGEMENT OF ADVANCING AND
TERMINAL ILLNESS
EMOTIONAL RESPONSE TO CHRONIC ILLNESS
Generally people facing the chronic illness will give following emotional
responses.
1. Denial
2. Anxiety
3. Depression
1. Denial
● Denial is a defense mechanism by which people avoid the implications of an

illness. It is a common early reaction to chronic illness (Krantz &
Deckel,1983; Meyerowitz, 1983).
● Patients may act as if the illness is not severe, it will shortly go away, or it
will have few long-term implications.
● Immediately after the diagnosis of illness, denial can serve a protective
function by keeping the patient from having to come to terms with problems
posed by the illness when he or she is least able to do so.
● Over time, however, any benefit of denial gives way to its costs. It can
interfere with taking in necessary treatment information and compromise
health.
2. Anxiety.
● Anxiety is also common. Many patients are overwhelmed by the potential

changes in their lives and, in some cases, by the prospect of death.

● According to Rabin, Ward, Leventhal, & Schmitz,(2001), Anxiety is
especially high when people are Waiting for test results,Receiving diagnoses
,Awaiting invasive medical procedures, and Anticipating or experiencing
adverse side effects of treatment.
● Anxiety is a problem not only because it is intrinsically distressing but also
because it interferes with treatment.
For example,
● Anxious patients cope more poorly with surgery (Mertens, Roukema,

Scholtes, & De Vries, 2010);
● Anxious diabetic patients have poor glucose control (Lustman, 1988);
3. Depression (Common reaction to chronic illness)
● Up to 33% of all medical inpatients with chronic disease report symptoms of

depression, and up to 1/4th suffer from severe depression (Moody,
McCormick, & Williams, 1990).
● Depression is especially common among stroke patients, cancer pa-tients,
and heart disease patients, as well as among people with more than one
chronic disorder
● At one time, depression was regarded only as an emotional disorder, but its
medical significance is increasingly recognized.
● However, people who have intermittent bouts of depression are more likely
to get heart disease, atherosclerosis, hyper-tension, stroke, dementia,
osteoporosis, and Type lI diabetes, and at younger ages.
● Moreover, depression exacerbates the course of several chronic dis-orders,
most notably coronary heart disease.
● Although, depression complicates treatment adherence and medical decision
making. As a result, It interferes with patients adopting a co-managerial role,
and it leads to enhanced risk of mortality from several chronic diseases
● Depression is sometimes a delayed reaction to chronic illness, because it
takes time for patients to understand the full implications of their condition.

PSYCHOSOCIAL ISSUES-CONTINUED TREATMENT
Continued treatment of terminally ill patients involves addressing a range of
psychosocial issues to ensure the best possible quality of life during the remaining
time. These issues extend beyond the medical aspects of care and encompass
emotional, social, and psychological dimensions. Here's an elaboration on the
psychosocial issues in the continued treatment of terminally ill patients:
1. Emotional Distress and Mental Health:

○ Ongoing emotional distress, such as anxiety, depression, and
existential distress, is common among terminally ill patients.
Continued treatment involves providing emotional support,
counseling, and access to mental health professionals to address these
concerns. Medications may also be prescribed when appropriate.
2. Pain and Symptom Management:
○ Pain and other physical symptoms are not just medical issues; they
have profound psychosocial implications. Effective symptom
management is vital to improve the patient's overall well-being and
comfort. This includes adjusting pain medications and other
interventions as the disease progresses.
3. Communication and Decision-Making:
○ Honest and compassionate communication remains essential.
Continued treatment involves ongoing discussions about the patient's
prognosis, treatment options, and their goals of care. Encouraging
patients to express their wishes and concerns ensures their preferences
are honored.
4. Family and Caregiver Support:
○ Family members and caregivers also face psychosocial challenges.
Providing support, education, and respite care for caregivers is
essential to prevent burnout. Family counseling can help address the
emotional strain and complex dynamics that may arise.
5. Spiritual and Existential Needs:

○ Addressing the spiritual and existential concerns of patients is crucial.
Continued treatment may involve spiritual counseling, connecting
patients with chaplains or religious leaders, or facilitating discussions
about life's meaning and legacy.
6. Social Support:
○ Maintaining a patient's social connections is important for their
emotional well-being. Continued treatment should encourage visits
from friends and family, facilitate support groups, and provide
opportunities for social interaction.
7. End-of-Life Planning:
○ Ongoing discussions about end-of-life planning, advance directives,
and palliative care options ensure that patients' preferences are
respected. This can help reduce anxiety about the dying process.
8. Grief and Bereavement Support:
○ Support for anticipatory grief and bereavement is essential for both
patients and their families. Continued treatment may involve
counseling and resources for coping with the impending loss and the
grieving process that follows.
9. Dignity and Autonomy:
○ Preserving the patient's sense of dignity and autonomy is paramount.
Continued treatment should focus on enabling patients to make
choices about their care and daily life, whenever possible.
10. Coping Strategies:
○ Encouraging the use of coping strategies, such as mindfulness,
relaxation techniques, and creative outlets, can help patients manage
their emotional distress effectively.
11. Quality of Life Enhancement:
○ The ultimate goal of continued treatment is to maximize the patient's
quality of life. This includes ensuring access to enjoyable activities,
improving comfort, and addressing any concerns related to daily
living.
12. Patient Advocacy:

○ Advocacy on behalf of the patient's psychosocial needs is essential.
The healthcare team should be proactive in identifying and addressing
these issues, collaborating with various specialists as needed.
Continued treatment for terminally ill patients involves a holistic approach that
recognizes and addresses psychosocial issues alongside medical care. This
approach aims to enhance the patient's overall well-being, provide emotional
support, and ensure that their values and preferences are respected throughout their
journey with a life-limiting illness.
ISSUES OF NON-TRADITIONAL TREATMENT

Non-traditional treatments, also often referred to as complementary and alternative
medicine (CAM), can present various issues when used in chronically ill patients.
While these treatments can sometimes be beneficial, they also come with potential
risks and concerns. Here are some of the key issues associated with non-traditional
treatments in chronically ill patients:
● Lack of Scientific Evidence: Many non-traditional treatments lack robust

scientific evidence to support their effectiveness and safety. This can lead to
uncertainty about their potential benefits, especially when compared to
evidence-based conventional treatments.
● Delayed or Rejected Conventional Treatment: Some patients may choose
non-traditional treatments over conventional therapies or delay seeking
medical treatment. This can be dangerous, particularly in cases where timely
medical intervention is crucial.
● Interactions and Side Effects: Non-traditional treatments can interact with
conventional medications and treatments, leading to adverse effects or
reduced treatment efficacy. Patients may not always disclose their use of
non-traditional therapies to healthcare providers, making it challenging to
manage interactions.
● Financial Burden: Pursuing non-traditional treatments can be expensive,
and insurance coverage may not extend to these therapies. This can place a
significant financial burden on patients and their families.

● False Hope: Some non-traditional treatments make exaggerated claims
about curing chronic illnesses, offering false hope to vulnerable patients.
This can lead to disappointment and emotional distress when the promised
results are not achieved.
● Safety Concerns: Non-traditional treatments may lack quality control,
leading to potential safety issues. Herbal supplements, for example, may
contain contaminants or incorrect dosages.
● Misinformation: Patients may rely on anecdotal information, testimonials,
or information from unverified sources when choosing non-traditional
treatments. This can result in misinformation and poor decision-making.
● Provider-Patient Communication: Effective communication between
patients and healthcare providers is essential. When patients do not disclose
their use of non-traditional treatments or providers dismiss these therapies
without open discussion, it can lead to a breakdown in trust and hinder
collaborative care.
It's important for patients and healthcare providers to have open and honest
discussions about non-traditional treatments. Patients should be encouraged to
share their choices and concerns, while providers should offer evidence-based
information and guidance on integrating complementary therapies safely into their
care plans. Ultimately, the goal is to ensure that patients receive the most
appropriate and effective treatment for their chronic conditions while considering
their holistic well-being.
STAGES TO ADJUSTMENT TO DYING

● There are five stages of grief: denial, anger, bargaining, depression, and
acceptance (DABDA). They apply when you are grieving for the death of a
loved one as well as when you are facing a terminal diagnosis.
● These stages help describe the emotional process when facing these life-
changing events. But keep in mind that most people do not experience
emotion in a linear pattern, and the responses are unique to each person
facing illness,death,or loss.
Stages of Grief

● The five stages of grief (DABDA) were first described in 1969 by Elisabeth
Kübler-Ross in her classic book, "On Death and Dying."
● DABDA is an acronym for the five stages identified by Kübler-Ross. The
letters stand for
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
1. Denial
● We all want to believe that nothing bad can happen to us. Subconsciously,
we might even believe we are immortal.
● When a person is given the diagnosis of a terminal illness, it's natural to
enter a stage of denial and isolation.
● They may flat-out disbelieve what the doctor is telling them and seek out
second and third opinions.
● They may demand a new set of tests, believing the results of the first ones to
be false. Some people may even isolate themselves from their doctors and
refuse to undergo any further medical treatment for a time.
● During denial, it is not uncommon to isolate oneself from family and friends
or to actively avoid discussing the trauma or event. It is a self-protective
mechanism by which a problem "ceases to exist" if you don't acknowledge
it.
● This stage of denial is usually short-lived. Soon after entering it, many begin
to accept their diagnosis as reality. The patient may come out of isolation
and resume medical treatment.
● Some people, however, will use denial as a coping mechanism long into
their illness and even to their death. Extended denial isn't always a bad thing;
it doesn't always bring increased distress.
● Sometimes, it's believed that people need to find a way to accept their death
to be able to die peacefully. However, this isn't always true.
2. Anger

● As a person accepts the reality of a terminal diagnosis, they may start to ask,
"Why me?"
● The realization that all of their hopes, dreams, and well-laid plans aren't
going to come about brings anger and frustration. Unfortunately, this anger
is often directed out at the world and at random people.
● Anger is the stage where the bottled-up feelings of the previous stages are
released in a huge outpouring of grief and directed at anyone who happens to
be in the way.
● Doctors and nurses are yelled at in the hospital; family members are greeted
with little enthusiasm and often face fits of rage. Even strangers aren't
immune to the brunt of this emotion.
● It is important to understand where this anger is coming from. A dying
person may watch TV and see people laughing and dancing—a cruel
reminder that he can't walk anymore, let alone dance.
● For some people, this stage of coping is short-lived. Again, however, some
people will continue in anger for much of the illness. Some will even die
angry.
3. Bargaining
● As denial and anger fail to offer any help and don't change the situation, the
grieving person may move on to bargaining. Most of us have already tried
bargaining at some point in our lives.
● This means trying to bargain with God. They may agree to live a good life,
help the needy, never lie again, or do any number of "good" things if this
higher power will only cure them of their illness.
● Some people may bargain with doctors or with the illness itself. They may
try to negotiate more time, saying things like, "If I can just live long enough
to see my daughter get married..." or "If only I could ride my motorcycle one
more time..."
● Bargaining is the stage where one clings to an irrational hope even when the
facts say otherwise.
● It may be expressed overtly as panic or manifest with an inner dialogue or
prayer unseen by others.

● The implied return favor is that they would not ask for anything more if only
their wish was granted.
● People who enter this stage quickly learn that bargaining doesn't work and
inevitably move on, usually to the depression stage
4. Depression
● When it becomes clear that the terminal illness is here to stay, many people
experience depression.
● The increased burden of surgeries, treatments, and physical symptoms of
illness, for example, make it difficult for some people to remain angry or to
force a stoic smile. Depression, in turn, may creep in.
● Kübler-Ross explains that there are really two types of depression in this
stage. The first depression, which she called "reactive depression," occurs as
a reaction to current and past losses.
➢ For example, a woman who is diagnosed with cervical cancer may
first lose her uterus to surgery and her hair to chemotherapy. Her
husband is left without help to care for their three children, while she
is ill and has to send the children to a family member out of
town.Because cancer treatment was so expensive, this woman and her
spouse can't afford their mortgage and need to sell their home. The
woman feels a deep sense of loss with each one of these events and
slips into depression.
● The second type of depression is dubbed "preparatory depression." This is
the stage where one has to deal with the impending future loss of everything
and everyone they love. Most people will spend this time of grieving in quiet
thought as they prepare themselves for such complete loss.
● Depression is considered the stage without which acceptance is unlikely.
With that being said, one can feel many different losses during the same
event. Weeding out those feelings may take time, during which a person
may rebound in and out of depression.
5. Acceptance

● The stage of acceptance is where most people would like to be when they
die.
● It is a stage of peaceful resolution that death will occur and quiet expectation
of its arrival.If a person is lucky enough to reach this stage, death is often
very peaceful.
● People who achieve acceptance have typically given themselves permission
to express grief, regret, anger, and depression. By doing so, they are able to
process their emotions and come to terms with a "new reality."
● They may have had time to make amends and say goodbye to loved ones.
● The person has also had time to grieve the loss of so many important people
and things that mean so much to them.
● Some people who are diagnosed late in their illness and don't have time to
work through these important stages may never experience true acceptance.
● Others who can't move on from another stage—the person who stays angry
at the world until death, for example—may also never experience the peace
of acceptance.
● For the lucky person who does come to acceptance, the final stage before
death is often spent in quiet contemplation as they turn inward to prepare for
their final departure.
PSYCHOLOGICAL MANAGEMENT OF THE

TERMINALLY ILL
● The psychological management of terminal illness is a critical aspect of
providing comprehensive care for individuals facing life-limiting conditions.
● It involves addressing the emotional, psychological, and spiritual needs of
patients and their families to enhance their quality of life and promote a
sense of well-being during this challenging time.
● Effective psychological management begins with a thorough assessment of
the patient's emotional state, coping mechanisms, and concerns.
● Open and honest communication about the prognosis, treatment options, and
end-of-life preferences is essential to establish trust and shared decision-
making.

● Patients often experience a range of intense emotions, including anxiety,
depression, fear, anger, and sadness. Psychologists and counselors can
provide emotional support through individual or group therapy sessions to
help patients express and process their feelings.
MEDICAL STAFF AND TERMINALLY ILL PATIENT
● Death in the institutional environment can be depersonalized and

fragmented.
● Wards may be under-staffed, with the staff unable to provide the kind of
emotional support a patient needs.
● Hospital regulations may restrict the number of visitors or the length of time
that they can stay, thereby reducing the availability of support from family
and friends.
● Pain is one of the chief symptoms in terminal illness, and in the busy
hospital setting, the ability of patients to get the amount of pair medication
they need may be compromised.
● Prejudices against drug treatments for pain still exist, and so termina patients
run the risk of being undermedicated for their pain
● Death in an institution can be a long, lonely, mechanized, painful, and
dehumanizing experience.
The Significance of Hospital Staff to the Patient
● The physical dependence on hospital staff is great because the patient may
need help for even the smallest activity, such as turning over in bed.
● Patients are entirely dependent on the medical staff for the reduction of their
pain.
● And staff may be the only people to see a dying patient on a regular basis if
he or she has no friends or family who visit regularly.
● Moreover, staff may be the only people who know the patient's actual
physical state; hence, they are the patient's only source of realistic
information.
● The patient may welcome communication with staff because he or she can
be fully candid with them.

Risks of Terminal Care for Staff
● Terminal care is hard on hospital staff.

● It is the least interesting physical care because it is often palliative care that
is, carefully designed to make the patient feel comfortable-rather than
curative care -that is, care designed to cure the patient's disease.
● Terminal care involves a lot of unpleasant custodial work, such as feeding,
changing, and bathing the patient, and sometimes symptoms go
undertreated.
● The staff may burn out from watching patient after patient die, despite their
best efforts.
● Staff may be tempted to withdraw into a crisply efficient manner rather than
a warm and supportive one so as to minimize their personal pain.
● Physicians, in particular, want to reserve their time for patients who can
most profit from it and, consequently, may spend little time with a
terminally ill patient.
● Unfortunately, Terminally ill patients may interpret such behavior as
abandonment and take it very hard.
● Accordingly, a continued role for the physician in the patient's terminal care
in the form of brief but frequent visits is desirable.
Achieving an Appropriate Death
● Psychiatrist Avery Weisman (1972, 1977), a distinguished clinician who

worked with dying patients for many years, outlined a useful set of goals for
medical staff in their work with the dying:
➢ Informed consent -Patients should be told the nature of their
condition and treatment and, to some extent, be involved in their own
treatment.
➢ Safe conduct -The physician and other staff should act as helpful
guides for the patient through this new and frightening stage of life.
➢ Significant survival -The physician and other medical staff should
help the patient use his or her remaining time as well as possible.

➢ Anticipatory grief -Both the patient and his or her family members
should be aided in working through their anticipatory sense of loss
and depression
➢ Timely and appropriate death -The patient should be allowed to die
when and how he or she wants to, as much as possible. The patient
should be allowed to achieve death with dignity.
● These guidelines, established many years ago, still provide the goals and
means for terminal care.
● Unfortunately, a "good death" is still not available to all.
● A survey of the survivors of 1,500 people who had died revealed that dying
patients often had not received enough medication to ease their pain and had
not experienced enough emotional support.
● Lack of open communication and lack of respect from medical staff aretwo
other common complaints
COUNSELING WITH THE TERMINALLY ILL
● Many dying patients need the chance to talk to a counselor.

● Therapy is typically short-term and the nature and timing of the visits
typically depend on the desires and energy level of the patient.
● Moreover, in working with the dying, patients typically set the agenda.
● Therapy with the dying is different from typical psychotherapy in several
respects.
● First, for obvious reasons, it is likely to be short term
● The format of therapy with the dying also varies from that of traditional
psychotherapy.
● The nature and timing of visits must depend on the inclination and energy
level of the patient, rather than on a fixed schedule of appointments.
● The agenda should be set at least partly by the patient.
● And if an issue arises that the patient clearly does not wish to discuss, this
wish should be respected.
● Terminally ill patients may also need help in resolving unfinished business.
Uncompleted activities may prey on the mind, and preparations may need to
be made for survivors, especially dependent children

● Through careful counseling, a therapist may help the patient come to terms
with the need for these arrangements, as well as with the need to recognize
that some things will remain undone.
● Some thanatologists -that is, those who study death and dying-have
suggested that behavioral and cognitive-behavioral therapies can be
constructively employed with dying patients (Sobel, 1981).
● For example, progressive muscle relaxation can reduce the discomfort and
instill a renewed sense of control.
● Positive self-talk, such as focusing on one's life achievements, can
undermine the depression that often accompanies dying.
● Family therapy can also be an appropriate way to deal with issues raised by
terminal illness, to help the family and patient recognize and plan for the
future.
FAMILY THERAPY
● Family therapy, often referred to as grief counseling, is a vital component of

comprehensive care for both the patient and their loved ones.
● This type of therapy focuses on addressing the emotional, psychological,
and relational challenges that family members face when a loved one is
diagnosed with a terminal illness.
● Family members often experience a wide range of intense emotions,
including grief, anxiety, sadness, anger, and fear, when dealing with a loved
one's terminal illness. Therapy provides a safe and supportive environment
for them to express and process these emotions.
● Therapists can provide families with information about the terminal illness,
its progression, and potential treatment options. Having a clear
understanding of the situation can help family members cope better and
make informed decisions.
● Terminal illnesses can strain communication within families. Therapy can
help improve family members' communication skills, ensuring that they can
express their thoughts and feelings effectively and listen to one another with
empathy.

● Therapists can teach family members coping strategies to manage stress,
anxiety, and grief. These strategies may include relaxation techniques,
mindfulness practices, and journaling.
● The emotional turmoil that often accompanies terminal illness can lead to
conflicts within families. Therapy can help mediate and resolve these
conflicts, fostering healthier relationships and reducing tension.
● Therapists can assist families in discussions about end-of-life planning,
advance directives, and decisions related to hospice or palliative care. These
conversations ensure that the patient's wishes are respected.
● Family therapy acknowledges the critical role of caregivers and provides
them with support, education, and resources to prevent caregiver burnout
and address their emotional needs.
● Anticipatory grief refers to the mourning process that family members may
experience before the loved one's passing. Therapy helps them navigate this
complex emotional journey and prepares them for the inevitable loss.
● Family therapy can extend into the bereavement period, offering support to
family members as they cope with the loss of their loved one. Grief
counseling helps individuals process their grief and adjust to life without the
deceased.
● Therapy aims to strengthen family resilience, helping them adapt to the
changes and challenges brought about by the terminal illness. This resilience
enables families to support one another during difficult times.
● Each family's situation is unique, and therapy is tailored to the specific needs
and dynamics of the family. Therapists work with families to create
personalized treatment plans.
● Family therapists often collaborate with medical teams and other healthcare
providers to ensure that the emotional and psychological aspects of care are
integrated into the patient's overall treatment plan.
● Therapy for the family of a terminally ill person provides a safe space for
family members to process their emotions, improve communication, and
find ways to support both the patient and one another effectively.
● It acknowledges that the entire family is affected by the terminal illness and
offers guidance and healing throughout the journey, from diagnosis to
bereavement.

THE MANAGEMENT OF TERMINAL ILLNESS IN
CHILDREN
● Working with terminally ill children can be incredibly challenging, as it is
often considered the most stressful aspect of providing end-of-life care.
● Many individuals, including family members, friends, and even medical
staff, may be hesitant to have open and honest conversations with a dying
child about their condition.
● However, it's important to recognize that terminally ill children often have a
deeper understanding of their situation than we might give them credit for.
● They pick up on cues from their treatments and the people around them,
which leads them to infer the severity of their condition.
● As their physical health deteriorates, they begin to form their own concept of
death and the realization that it may be approaching.
● Knowing how to communicate with a terminally ill child can be difficult.
Unlike adults, children may not directly express their knowledge, concerns,
or questions. Instead, they may indirectly convey their awareness, such as by
suggesting they want to celebrate Christmas early so they can be part of it.
They might also stop talking about their future plans altogether.
● Counseling with a terminally ill child is essential, and it often follows
similar guidelines as working with dying adults. However, therapists must
take their cues from the child, discussing only the topics the child is
comfortable addressing.
● Parents of terminally ill children also face immense emotional distress. They
may blame themselves for their child's illness or feel that they could have
done more.
● Other children in the family may sometimes have their needs overlooked due
to the focus on the dying child's situation. In such cases, a counselor
working with the family can help restore balance and address the unique
challenges each family member faces.
● The stress experienced by parents of dying children can be so overwhelming
that it may lead to symptoms resembling post-traumatic stress disorder
(PTSD). Consequently, parents may require supportive mental health
services, particularly in the first few months following the child's diagnosis.

● Working with terminally ill children involves recognizing their capacity to
understand their situation, communicating in a way that respects their
readiness to discuss it, and providing essential counseling and support not
only for the child but also for their parents and siblings, as they all navigate
this incredibly challenging journey.
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MODULE-1

Aims of Health Psychology

1) Understanding, explaining,developing and testing theory.

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MIND BODY RELATIONSHIP

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The historical evolution of the mind-body relationship in medicine reflects a

NEED AND SIGNIFICANCE OF HEALTH

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Health Promotion and Prevention:

Chronic Disease Management: Health psychology plays a crucial role in

Healthcare System Improvement:

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Public Health and Policy:

BIOSPYCHOSOCIAL MODEL V/S BIOMEDICAL

Advantages of the Biopsychosocial Model:

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Drawbacks of Biopsychosocial Model

● Time-consuming and expensive apply.

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Drawbacks of the Biomedical Model:

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Classification of Health Behaviour

A. Preventive health behavior: Any activity undertaken by an individual

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Characteristics of Health Behaviour

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● Changing health habits and attitudes towards health is a crucial aspect of

COGNITIVE BEHVAIOURAL APPROACH

Cognitive-Behaviour Therapy (CBT)

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The Self-Control of Behavior

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Social Skills and Relaxation Training

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The Health Belief Model

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Limitations of Health Belief Model

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The Theory of Planned Behavior

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Limitations of the Theory of Planned Behavior

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The Transtheoretical Model (Stages of Change)

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1. Consciousness Raising - Increasing awareness about the healthy behavior.

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Limitations of the Transtheoretical Model

Protection Motivation Theory

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Limitations of Protection Motivation Theory

The Social Cognitive Theory

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Limitation of Social Cognitive Theory

Social Attribution theory