current research in health psychology

Health Psychology Journal

An analytical framework for the embodiment of structural inequities.

Maria M. Llabre & Zachary T. Goodman

We describe a data analysis framework that allocates the sources of health inequities such as the stress from structural racism to two levels: a community level where the stress occurs and the person’s perception of the stress. Such allocation will help in designing interventions at the appropriate level.

Racial differences in physical activity engagement, barriers, and enjoyment during weight loss.

Francesca M. Knudsen, Charlotte J. Hagerman, Reena S. Chabria, Hannah C. McCausland, Marny M. Ehmann, Leah M. Schumacher, & Meghan L. Butryn

The current study contributes to knowledge that could work toward reducing health disparities and enhance the effectiveness of behavioral weight loss interventions for racial minority groups. This study does so by investigating racial differences in known predictors of physical activity to elucidate potential discrepancies in physical activity engagement outcomes between Black and White participants enrolled in behavioral weight loss programs.

The utility of coping through emotional approach: A meta-analysis.

Michael A. Hoyt, Karen Llave, Ashley Wei-Ting Wang, Katie Darabos, Karina G. Diaz, Megan Hoch, James J.  MacDonald, & Annette L. Stanton

This meta-analytic study synthesizes our knowledge of how coping via emotional expression or emotional processing is associated with mental and physical health. Results are useful in establishing and strengthening health psychology interventions across a variety of populations and contexts.

Most cited papers

Optimism, coping, and health: Assessment and implications of generalized outcome expectancies.

Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy, White women.

Stages of change and decisional balance for 12 problem behaviors.

A taxonomy of behavior change techniques used in interventions.

Psychosocial models of the role of social support in the etiology of physical disease.

Most downloaded papers

The relationships of change in physical activity with change in depression, anxiety, and burnout: A longitudinal study of Swedish healthcare workers.

Family disruption increases functional somatic symptoms in late adolescence: The TRAILS Study.

Does theory influence the effectiveness of health behavior interventions? Meta-analysis.

Exercise improves executive function and achievement and alters brain activation in overweight children: A randomized, controlled trial.

Priming effects of television food advertising on eating behavior.

Special Issues

December 2023: Advancing Adolescent Health through the Adolescent Brain Cognitive Development (ABCD) Study

August 2023: Vaccine Hesitancy and Refusal

October 2022: Cardiovascular Behavioral Medicine

April 2022: Developing Resilience in Response to Stress and Trauma

December 2021: From Ideas to Efficacy in Health Psychology

Meet the Editor

Dr. John M. Ruiz discusses the new editorial team, their vision for the journal, and emerging opportunities for engagement.

Editorial Team Bios

Spanish abstracts (resúmenes científicos en español).

Crises impact youth mental health

Declining youth mental health has been labelled a global crisis. Although raging wars are most emotionally salient, ecological crises such as climate change are more costly for the psychological health of young people.

• Emma L. Lawrance

Online misinformation warning labels work despite distrust of fact-checkers

Could online warning labels from fact-checkers be ineffective — or perhaps even backfire — for individuals who distrust fact-checkers? Across 21 experiments, we found that the answer is no: warning labels reduce belief in, and sharing of, posts labelled as false both on average and for participants who strongly distrust fact-checkers.

Deconstructing the compounds of altruism

A computational model is proposed to provide a better understanding of human altruism, highlighting the role of multiple motives that influence altruistic behaviors.

Related Subjects

• Human behaviour

Latest Research and Reviews

11-month-olds recognize the teacher–student relationship

• Ruolan Ling
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Egalitarian preferences in young children depend on the genders of the interacting partners

Gender-related differences in resource distribution depend on both the gender of the Allocator and of the Recipient. Girls tried to reduce advantageous inequality more than boys but tolerated disadvantageous inequity more if it favoured another girl whereas boys were more competitive with other boys.

• Marijn van Wingerden
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Claims about scientific rigour require rigour

• Joseph Bak-Coleman
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The role of facial cues in signalling cooperativeness is limited and nuanced

• Johannes Lohse
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Consonant lengthening marks the beginning of words across a diverse sample of languages

Blum et al. report evidence of lengthening of word-initial consonants across a diverse sample of 51 languages. On average, these consonants are 13 ms longer than word-medial ones, helping mark word boundaries in continuous speech, which is crucial for understanding speech.

• Frederic Blum
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Older adults are relatively more susceptible to impulsive social influence than young adults

Older adults were more influenced by impulsive economic decisions made by others in comparison to young adults. More empathetic and emotionally motivated older adults were the most influenced by others’ impulsive economic choices.

• Mona M. Garvert
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News and Comment

Commentary on: can ai chatbots accurately answer patient questions regarding vasectomies.

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Psychology needs philosophy

Philosophy — in particular feminist philosophy — can help psychology meet its standards of rigor, objectivity, validity and reliability.

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Cognitive neuroscience: the brain’s symphony in hearing speech and music

New research shows that the brain employs similar anatomical regions but specific neural oscillatory patterns during speech and music perception.

• Troby Ka-Yan Lui

From the lab to a career in defence research

Nature Reviews Psychology is interviewing individuals with doctoral degrees in psychology who pursued non-academic careers. We spoke with Mike Tombu about his journey from a postdoctoral fellow to a defence scientist.

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Health Psychology

In subject area: Social Sciences

Health psychology is a field of applied psychological research that focuses on studying the factors that influence physical health and the impact of health-related behaviors.

AI generated definition based on: International Encyclopedia of the Social & Behavioral Sciences (Second Edition) , 2015

Chapters and Articles

You might find these chapters and articles relevant to this topic.

Denise de Ridder , in International Encyclopedia of the Social & Behavioral Sciences (Second Edition) , 2015

Health psychology is an area of applied psychological research and a profession. Health psychology research examines the determinants and consequences of physical health, showing that health behaviors are critical to health. Four core topics in health psychology are discussed in this article: (1) the promotion and maintenance of health, (2) prevention and treatment of (chronic) illness, (3) the etiologic and diagnostic correlates of health and illness, and (4) patient behavior in the health care system.

Social Science Contributions to Public Health: Overview

J. Coreil , in International Encyclopedia of Public Health , 2008

Health psychology

In 1977 George Engel published a seminal article titled “The Need for a New Medical Model,” in which he advocated for a multidisciplinary biopsychosocial model of health that incorporates psychological and social dimensions of well-being. This signaled the emergence of health psychology as a subdiscipline; the following year, the Health Psychology section of the American Psychological Association was established. Like other social and behavioral sciences, the field of health psychology developed partly in response to the rise of chronic disease and to the role of personal health habits in the etiology and management of conditions such as cancer, heart disease, and diabetes. In addition, new models for understanding the complexity of contextual factors in the illness process enlarged the scope of analysis and intervention. The biopsychosocial model emphasizes the interplay of biological, psychological, and social factors in illness, and gives importance to multiple determinants and macro-level processes ( Taylor, 2006 ). For example, stress and social support have been increasingly recognized as contributing factors in health. This broad view is compatible with the ecological perspective of public health.

Important contributions from health psychology include the study of health behaviors such as smoking and exercise; research on stress, social support, and immune function; interventions for addictions; the relationship between mental illness and physical illness; and practical approaches to the management of chronic illness. Some particular areas of note include studies of Type A behavior, hostility, and heart disease; health promotion strategies such as smoking cessation and weight management; methods for enhancing sexual health such as safer sex practices to reduce sexually transmitted infections; and psychosocial factors in the progression of cancer. As noted previously, social psychological models of health behavior change have dominated the public health field of health promotion and education.

Concluding Remarks

Health psychology research can reveal psychological processes underpinning health and illness and thereby suggest changes in health care practices designed to optimize effectiveness. Central to health psychology is the concept of health behavior, which plays a major role in health promotion, prevention of illness, illness onset, and patient behavior in a treatment setting via physiological and psychological pathways. New models of health behavior and health behavior change are being developed, moving beyond the traditional models emphasizing rational deliberate decision making about engaging in health behavior, raising several new important questions about its impulsive and automatic nature that need to be answered in future research. One particular issue deserving attention from this novel perspective is how people maintain their initial changes for health behavior and how environmental changes can be implemented that support individuals in behaving healthily. In addition, societal changes pose new questions about health behavior change, such as health behavior in the elderly and cultural issues related to health behavior in an ethnically diverse population. Answers to these questions should be informed by rigorous scientific evidence and academic debate among health psychologists working in a variety of health care practices.

Susan Michie , in Comprehensive Clinical Psychology , 1998

8.06.1.1 Clinical Health Psychology

Health psychologists have much to contribute to the prevention and management of problems within organizations, and have the skills to function in a variety of settings ( Altman & Cahn, 1983 ). The essence of training in psychology is learning about the factors that affect the causes, maintenance, and changes of human functioning at the individual, group, and organizational levels. Human functioning is considered in its component parts (behavior, thinking, and emotion) and an analysis is made of the relationships between these components, and of the relationships between these components and situational factors. Health psychology is a broad discipline: for convenience, content areas have been summarized into five broad areas ( Johnston & Weinman, 1995 ).

(i) Health risk behaviours

The nature, causes, and health effects of such behaviors as smoking, substance abuse, unsafe sexual behavior, and harmful dietary choice; the role of stress and dispositional factors in the etiology and exacerbation of disease; psychological theories and interventions for primary prevention and health-related behavior change in community and workplace settings.

(ii) Health protective or enhancing behaviors

The uptake and maintenance of such behaviors as exercise, healthy dietary choice, teethbrushing, health checks/self-examination, and attendance for preventive medical screening; psychological approaches to health promotion.

(iii) Health-related cognitions

Cognitive processes that mediate and determine health and illness behaviors. These include general health beliefs/attitudes; attributions, control, and self-efficacy beliefs; symptom perception; and illness representations in children and adults. There are a range of theoretical models and frame-works that can be used, not only for explanation and prediction, but also for developing interventions (e.g. to modify health beliefs, increase internal control, or self-efficacy beliefs).

(iv) Processes influencing health care delivery

The nature and effects of communication between health care practitioners and patients; patient satisfaction and adherence to treatment and advice; the uptake and response to preventive services such as screening; stressful medical investigations and treatment; hospitalization; health care staff attitudes; decision-making,work stress; quality assurance; measurement issues in audit and outcome evaluation; psychological interventions to improve communication, facilitate adherence, and prepare for stressful medical procedures.

(v) Psychological aspects of illness

The psychological impact of acute and chronic illness on individuals and their families and carers across the lifespan; pain behavior and rehabilitation and health-related behavior change; dying, death, and bereavement. Psychological intervention to promote self-management, facilitate coping with pain or illness, to improve quality of life, and to reduce disability and handicap.

In all these areas, a wide range of skills is used, including assessment, evaluation, communication, teaching, and intervention. The work of a health psychologist is targeted at the problems of public health, the provision of health care and the response to illness. The problems may be identified by health care agencies, health professions, and organizations and employers outside the health care system. Psychologists can bring a systems approach to problems and locate them and the health care system within their wider contexts. By putting these skills together, psychologists are able to address “what if” questions by developing theoretical and quantitative causal models of behavioral predictors.

Health psychology is a new discipline. The first book including the term “health psychology” in its name was published in 1979 ( Stone, Cohen, & Adler, 1979 ). Health psychology is defined as the study of psychological and behavioral processes in health, illness and health care ( Johnston, 1994 ). Clinical health psychology has been used to refer to clinical, organizational, or health psychology in a health-service setting. There are two primary reasons for interest in the contribution of clinical health psychology to other health professionals and to health service managers ( Jansen, Methorst, & Kerkhof, 1991 ). The first is the increasing recognition that solutions to health problems may be found by seeking behavioral solutions (e.g., risk-factor management in the case of heart disease). The second is the escalating cost of health care, which fosters a welcoming of prevention and of interventions that reduce reliance on the medical system (e.g., psychological interventions for chronic pain management).

Clinical health psychology aims to translate research into practical applications that can help people lead healthier lives. This may take several routes: teaching and training health professionals and patients; working with patients to adopt healthier lifestyles or to manage problems such as pain or stress; and consulting with professionals about patient, staff, or organizational issues. Many research findings are not applied and do not influence clinical practice or policy, a situation that is itself the subject of analysis and study by health psychologists ( Marteau, Sowden, & Armstrong, submitted ).

The knowledge bases required for a successful health psychology consultancy role are theoretical models, (see Chapter 8.01, this volume) measurement techniques (see Chapter 8.04, this volume) successful interventions, factors that influence behavior and behavior change (a portfolio of examples that is currently being collected by the British Psychology Society Special Group is cited here), and specific health psychology knowledge (e.g., psychophysiological processes, health behavior, stress, communication and decision-making in health care, consequences of and coping with illness) (see Chapters 8.02 and 8.07, this volume).

Clinical Psychology in Europe, History of

I. Lunt , in International Encyclopedia of the Social & Behavioral Sciences (Second Edition) , 2001

As new fields of practice in the health field evolve, in particular health psychology , there are pressures on clinical psychology. For example, in some countries it has been said that there may no longer be a field of clinical psychology, since there are strong moves toward a broader field of health psychology and a greater focus on preventive work. These newer areas, such as health psychology, neuropsychology, and forensic psychology, are leading to greater specialization within and outside clinical psychology. Although European countries differ in the extent and nature of their specialisms within the health field, there is an increasing trend for specialization and demands for higher qualifications. In one respect, psychologists working within the health system could be said to be becoming more generic, while on the other hand there are increasing specializations within this field of work.

Social and Cultural Perspectives on Eco-Health

G. Albrecht , ... S. Freeman , in International Encyclopedia of Public Health , 2008

Health Psychology and Conservation Psychology

A new transdisciplinary synthesis of health psychology and conservation psychology has emerged to foster people's engagement in the construction and maintenance of ecosystem health. This new field in psychology explores self–place relationships, environmental perception, experiential issues, and caring, nurturing, and environmentally sensitive behaviors (see Saunders and Myers, 2006 ). It is important when examining complex adaptive systems, and the adaptive management techniques needed to achieve sustainability, that attention is paid to understanding the meanings that emerge from people's experience of their localities ( Bott et al ., 2003 ). Sense of place and place attachment ( Horwitz et al ., 2001 ) are powerful concepts that connect human and environmental health. For example, ‘solastalgia’ ( Albrecht, 2005 ) describes the melancholia or lack of solace in one's home environment caused by the effects of negative environmental change such as mining and drought. Human action and reaction to environmental change cannot be understood without consideration of concepts derived from the psychological end of the transdisciplinary ecosystem health spectrum.

T.W. Smith , in International Encyclopedia of the Social & Behavioral Sciences , 2001

1 History, Foundations, and Related Disciplines

The emergence of health psychology was made possible by a variety of developments at the interface of behavioral and biomedical science. The work of Walter Cannon, Hans Selye, and other physiologists working in the 1930s, 1940s, and 1950s described physiological changes induced by environmental stressors and negative emotions (e.g., the ‘fight or flight’ response). This identified a pathway through which psychological factors could impact physical health. Shortly thereafter, epidemiologists determined that several behaviors—notably smoking, excessive intake of fat and calories, and low levels of physical activity—were risk factors for the subsequent development of cancer and cardiovascular disease. Elsewhere, psychologists were beginning to explore the application of learning principles to the treatment of physical conditions, as in the seminal work by Neal Miller on the operant conditioning of physiological responses and the work of William Fordyce on the use of behavioral contingencies in the management of pain and disability. At the same time, clinical psychologists—led primarily in the United States by Joseph Matarazzo—were beginning to establish research and clinical roles within academic medicine through appointments to medical school faculties and the establishment of related academic medical departments and services.

In response to a variety of government and organizational initiatives, health psychology became a recognized subdiscipline in the late 1970s. For example, it was established as a formal division within the American Psychological Association in 1978, and the first health psychology handbook was published in 1979 (Stone et al. 1979 ). At the same time, an interdisciplinary field—behavioral medicine—was established, sharing the focus on behavior in the development, prevention, and management of medical conditions (Schwartz and Weiss 1978 ). Although most health psychologists view themselves as engaging in behavioral medicine, that field includes concepts, methods, and professionals from medicine, public health, and other disciplines. Hence, health psychology is a component of this broader field. Because health psychology addresses the impact of behavior on health beyond its role in established disease and disability, its emergence represented a departure from older fields such as medical and rehabilitation psychology. The former refers traditional clinical psychological services (e.g., assessment, consultation, and psychotherapy) within medical settings, whereas the latter refers to similar services and research in the context of physical disabilities (e.g., spinal cord or brain injuries).

The biopsychosocial model is a conceptual cornerstone in health psychology and behavioral medicine. In the traditional biomedical model which underlies much of modern medical research and practice, disease is seen as stemming from disordered biological systems. Aberrations in biochemistry or physiology cause disease, alter its course, and are intervention targets. Psychological or social factors are seen as largely irrelevant. In a landmark paper, Engel ( 1977 ) articulated the biopsychosocial model as an alternative. Here biological, psychological, and social processes are seen as inter-related influences on and effects of health and illness. The onset, course, and treatment of illness is best understood as involving each of these interacting, reciprocally determined levels of analysis.

Current research in health psychology consists of three general topics. The first—health behavior and prevention—focuses on the determinants of behaviors that influence disease (e.g., diet, exercise, smoking), and the effectiveness of interventions to reduce these risks. The second—stress and illness—focuses on direct connections between psychological processes and the development of illness. Rather than the intervening effects of habits and lifestyle factors, this research examines the impact of environmental stress and related personality and social processes on psychobiological mechanisms and the pathophysiology of disease. The third research area—the psychosocial impact and management of illness—focuses on the emotional and social consequences of illness and psychological interventions intended to improve adjustment and supplement traditional medical care.

Helen R. Winefield , in Comprehensive Clinical Psychology , 1998

8.07.3 Major Goals of Health Psychology Teaching

The health psychology input for health profession students does not need to be uniform in format or content across courses. Indeed health psychology courses need to be geared sensitively to the practice modes, traditions, and expectations of practitioners of each discipline. For example other professions vary in whether they see their discipline as a science or a craft, how independently they expect to practice, and where practice usually occurs, as well as in the academic achievement levels and backgrounds of incoming students. In this section of the chapter, however we will canvass some broad goals which could apply to all health psychology input. Section 8.07.6 will address the controversial issue of what the consequences for health psychology might be, of “giving psychology away” to other disciplines.

8.07.3.1 Improved Healthcare

Most teachers, trainers, and curriculum committees would probably agree that the main purpose of including health psychology is to improve the quality of healthcare which students are later able to deliver. In Section 8.07.3.3 , I shall try to distinguish some super-ordinate skills of the well-taught and well-trained health professional, to which health psychology has contributed.

A secondary goal of course organizers might be for health psychology itself to gain recognition and respect amongst other health professions, and for health psychologists to develop useful professional networks and access to research opportunities by being visible and successful within the training institutions.

A large practical and conceptual obstacle to devising a successful health psychology course, in terms of knowing that it is contributing to improved healthcare, has been the lack of markers or indicators for quality of health care practice. When no data are available about how successful various practice interventions are, either in improving patients' quality of life or in reducing their symptoms and death rate, the role of health psychology knowledge and skills (as with every other component of the students' learning experiences) becomes difficult to judge. Presently there is increasing awareness of the need for health professions to develop appropriate outcome measures, to validate them, and to begin the process of exploring their antecedents ( Kaplan, 1994a ).

8.07.3.1.1 Measurement of quality of care

Life expectancy has improved in developed countries following the great public health reforms of clean water, sanitation, public education about hygiene, nutrition, and prevention; and accessibility of antenatal care, child health screening, and emergency services. However, mortality rates are insufficiently sensitive as outcome measures of many health care interventions, particularly given the chronic nature of much illness in developed countries. Ongoing measures of health are needed which will reflect changes over time in both physical and psychological dimensions. Health-related quality of life (QOL), a concept which embraces affective and social well-being, functional capacities, and lack of symptoms, is an outcome measure well-suited to the evaluation of the effectiveness and cost-effectiveness of health care ( Kaplan, 1994a, 1994b; Ware, 1995 ). An example of the latter analysis is that some preventive and educational interventions have much greater payoff in terms of “cost per well year,” than more specialized surgical treatments. Specifically, costs per well year in 1991 US dollars of seat belt laws = 0, of smoking cessation counseling = 6463, and of coronary artery bypass graft for heart disease = 662 835 ( Kaplan, 1994a ). The development and standardization of QOL measures is widely agreed to be a top priority project for health psychology ( Sarafino, 1994; Weinman, 1990 ).

Patients are often forced to rely at least in the short term, on interpersonal features of the care-delivery interaction to assess its value. Some of these “process” features have been shown to correlate with beneficial health outcomes although the relationship is not straightforward ( Kaplan, Greenfield, & Ware, 1989; Stewart, 1995 ).

“The patient is now … to some degree an adjudicator of service quality … [which] means that the doctor's perspective on what is valuable in this interaction … is marginalized” ( Fairhurst & May, 1995 , pp. 389-390). Patient satisfaction with care is a proximal measure of quality of care but cannot be accepted as adequate by itself. Apart from the likely response-biases when seeking feedback from people who may need help again soon, there are problems in accepting patients' definitions of what they need. Some patients may have unrealistic expectations of what can be achieved, or of how much time the health worker can devote to their case. Others may feel most secure only after numbers of extra diagnostic tests, investigations, and treatments which are regarded as unnecessary and excessive by their health carers, and/or by the insurers and administrators who oversee health care costs ( Aharony & Strasser, 1993; Pickering, 1993; Williams, 1994 ). Another difficulty is that patients' satisfaction with an episode of healthcare may change over time, and not be validly captured by a questionnaire after a single consultation ( Avis, Bond, & Arthur, 1997 ).

Nonetheless, there are compelling arguments for seeking evaluative information from users of health care services. In industrialized countries the individual consultation between a patient and a general practitioner, for example, only rarely results in dramatic improvements in the health of the person concerned ( Winefield, Murrell, & Clifford, 1995 ). Often, patient satisfaction with the experience of being cared for may be the only measurable outcome of a health care interaction, but this sense of being cared for and valued by credible experts can have powerful nonspecific benefits ( Shepherd & Sartorius, 1989 ). An example is the finding by Fitzpatrick, Hopkins, and Harvard-Watts (1983) that headache sufferers were more likely to report fewer and less severe headaches one year after referral to a neurology clinic, regardless of what, if any, medication was prescribed, if they had felt satisfied immediately after the consultation. The popularity of alternative healthcare practitioners with the public has been attributed to their willingness to spend time, show interest, and develop a caring personal relationship with the “client"; these factors plus the shared rationale for illness and the confident prescription of healing activities are also common to nonmedical healers in other cultures ( Frank, 1989 ).

8.07.3.2 Health and Well-being of the Health Workers

A secondary goal of including health psychology in courses for other professions might be seen as preparing them not only to deliver health care to patients/clients, but to maintain their own health and well-being while doing so. The high turnover in some health professions, particulary nursing where there are many back injuries, and the reports of high job stress, career dissatisfaction, burnout, and associated problems of alcoholism, drug abuse, and marital strains ( Allen, 1994; Howell & Schroeder, 1984 ), provoke consideration of the need for some preventive educational preparation.

Students often enter health courses when quite young (many are teenagers direct from secondary school, in Australia and Britain), and with relatively little life experience. The higher the academic qualifications for entry, it seems the less opportunity students have had to mix with people outside their own peer group, people of different ages, social class and cultural background, and to explore their own talents and interests beyond study. It is not surprising therefore that the demands of tertiary study— often combined with financial pressures and personal development issues around independence, sexuality, and vocation—in combination with the exposure to illness, suffering, and death, can be stressful for students ( Ashton & Kamali, 1995; Firth-Cozens, 1987; Simpson & Budd, 1996 ).

The role models available to students in clinical settings may or may not be positive examples of healthy coping. There is a delicate balance between maintaining a degree of professional detachment which facilitates action but still expresses care and respect for the patient, and an emotional distance which patients and professionals alike find unsatisfying and depersonalizing. Getting this balance right is possibly the hardest task in professional training, or certainly the most psychologically challenging aspect, and clinical health psychologists may have valuable roles as both teachers and therapists.

After graduation, other work-related pressures are added. Autonomy, a traditional reason for job satisfaction in medicine for example, is perceived as being eroded through the intrusion of third parties such as insurers, administrators, and managers ( Allen, 1994; Burke, 1996; Siegler, 1993 ). An awareness of the psychological hazards of healthcare is the first requirement for prevention, so that affected individuals do not castigate themselves as weak and inadequate. This awareness can be raised during undergraduate years and may subsequently need reinforcement with stress management interventions ( Bunce & West, 1996; Midence, Gregory, & Stanley, 1996; Quick et al., 1992 ).

8.07.3.3 Knowledge and Skills from Health Psychology Input

In this section I shall review some general categories of health psychology knowledge and skills which, in the context of the restrictions described above on how to recognize quality care, could be expected to equip students for their future work in health professions.

First it is relevant to draw the distinction between “knowledge” which is acquired through teaching, and “skills” which are acquired through training. While the distinction cannot be rigidly applied, it usefully indicates different types of learning and the activities meant to promote them. Traditionally, health students have acquired knowledge in an abstract way through lectures and readings, assessed through exams, then proceeded to acquire clinical skills though supervised “hands on” practice, assessed to competency standards by experienced practitioners. The knowledge acts as a foundation for the skills but also goes further to give students a general appreciation of the theoretical and conceptual roots of their discipline and its methods of accumulating further knowledge. It is also meant to equip students to read critically, to continue their education life-long, and possibly to contribute to the knowledge base of the discipline themselves by engaging in research.

Skills have the more immediate practical value of equipping students to deal effectively with their work tasks. As well as being capable of giving injections, bandaging, and a host of other physical procedures, health professionals have to develop cognitive skills of clinical decision-making and time management. They must learn to respond calmly and automatically in distressing or life-threatening situations and to cope with behaviors, injuries, or disfigurements which untrained members of the public would find overwhelming. Skills can also become obsolete, and re-training or revision of them is then needed.

While each health profession has a more or less specific knowledge base and distinctive skills, health psychology can contribute important general elements which are identified below. Each of them could usefully become a strand of instruction, taking different forms with progression through the course (see Section 8.07.4 ), but with continuity throughout it. More specific topics are listed in Section 8.07.5 .

8.07.3.3.1 Communication skills

Every health practitioner needs to develop effective communication skills. These include being able to access information from the patient which is relevant to diagnosis and treatment, to explain matters using comprehensible terms (including written materials) and to check patient understanding, to encourage patient questions, to listen attentively, to communicate respect and care, and to persuade service-recipients to follow recommended patterns of self-care after the consultation ends (whether taking medications, changing health habits, making a follow-up appointment, etc.). These skills were identified largely through research into the outcomes of psychotherapy ( Greenberg & Pinsof, 1986; Stiles, Shapiro, & Elliott, 1986; Strong & Claiborn, 1982 ) and acquiring them is a clear case of behavioral training via graded steps. A great deal is now known about teaching such skills ( Cushing, 1996; Byrne & Byrne, 1996; Dickson, 1989; Egan, 1994; Evans, Stanley, Mestrovic, & Rose, 1991; Froelich, Bishop, & Dworkin, 1976; Kimberlin, 1989; Winefield, 1992 ).

To be most effective, the communication process will often need to take into account how patients' responses and needs are affected by their psychosocial development, age, education, level of anxiety and cultural background. Thus flexible communication skills need sound psychological foundations.

Skilled communication increases patient satisfaction and compliance, reduces the rates of malpractice litigation, and achieves nonspecific (placebo) benefits, all of which may additionally contribute to the health worker's job satisfaction. Public health benefits can follow from targeted communications or information campaigns with health-promoting or educational messages. These require rather different sets of skills from the one-to-one interactions which are the present focus.

Health workers also need skills in communicating with their colleagues, superiors (clinicians, managers, and administrators), members of related disciplines, and often with the relatives or friends of the designated patient. Less commonly but just as critically, health professionals may need to communicate effectively with politicians, accountants, and other decision-makers. So far none of these skills has received as much attention as the skills for communicating with patients, yet they may prove vital in securing community support and resources for effective health care to proceed.

8.07.3.3.2 Understanding of and respect for scientific enquiry

It does not need a high-flying mathematical background (though some health students have that) to comprehend the basic concepts of experimental design such as matched control groups, random allocation to treatment or control groups, standardized outcome measures, and credible lengths of follow-up. Also practitioners of every discipline need to be aware of the nonspecific or placebo influences on healing which are independent of discipline-specific treatment techniques, whether pharmacotherapy, spinal manipulation, or craft activities. The psychological and therefore physical benefits of trust, hope, a sense of control and a sense of self-worth are relevant both to “feeling better” after contact with health professionals and also to the whole range of self-care (compliance) and preventive activities by the patient.

If students do not learn about the need for untreated and placebo control groups and about how to evaluate claims of treatment efficacy, there is a risk of inflated beliefs about the impact of their own discipline's specific effectiveness (an example perhaps being claims for the rehabilitation of torture victims by physiotherapy ( Bloch & Moller, 1990 ). Evidence-based healthcare, which means using the best techniques available according to pooled high-quality information, will increasingly be demanded by health-management organizations as well as by health professionals concerned to offer the best care ( Friedman, Sobel, Myers, Caudill, & Benson, 1995; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996 ). The access to information offered by the electronic revolution in information technology will help, but the attitude of curiosity and willingness to learn remain vital. Confidence in one's own capacity to evaluate claims and remain an active self-educator, as well as to work with collaborators from a variety of disciplinary backgrounds, depends on this basic ability to assess the evidence—an ability which is not specific to health psychology but which psychologists have great experience and expertise in imparting ( MacLeod & McCullough, 1994 ).

The psychologist's skills in research design and methodology, standardized measurement, and statistical analysis are increasingly valued by other health disciplines, as the sophistication of their research rises. Even where health students cannot become expert in these matters themselves, they can acquire a respect for the scientific approach to understanding human behavior, and the cognitive tools to ask critical questions of their own research literature and other sources of claims about new treatments. There is a permanent gain from having learned how to appraise the flood of information to which students are likely to be exposed during their working lives, and to develop tools for assessing its value and meaning.

Once data have been collected and analyzed, and even after a scientific paper has appeared in a prestigious journal, much remains to be done to translate the findings to improve community health and to ensure the sustainability of interventions after the researchers leave ( Altman, 1995 ). Action research principles ( Greene, 1988; Hart & Bond, 1995; Whyte, 1991 ) take seriously the obligation of researchers to ensure visibility of their work to decision-makers. Often this involves collaborating actively with key stakeholders from the community in order to gain access to subjects and measurements, as well as help in publicizing the results and ensuring their conversion to policy ( Altman, 1995 ).

Another development within health psychology research which owes some impetus to health professions other than psychology, is the relatively recent interest in qualitative research methods ( Patton, 1990; Waitzkin, 1990 ). Triangulation, the combination of quantitative and qualitative approaches in the same investigation can be extremely fruitful, as shown for example in recent studies of occupational stress and health in a factory by Baker, Israel, and Schurman (1996) , and of the complex determinants and consequences of patient participation in consultations by O'Brien and Petrie (1996) .

8.07.3.3.3 Appropriate patterns of practice

The ability to monitor one's own professional performance increases recognition of the limits of one's own disciplinary expertise, while failure to know one's limits is probably responsible for some of the worst cases of mismanaged health care efforts.

With the typically crowded curriculum of health disciplines, the health psychologist teacher will be able to give practical training in communication skills but not in performing psychological diagnosis or managing behavior change. Gaining an understanding of the principles of the latter two areas will allow nonpsychologist professionals to make effective referrals to specialist services including from clinical health psychologists ( Belar, Deardorff & Kelly, 1987; Winefield, 1996 ).

The psychological awareness and the rejection of a narrow biomedical perspective which are the desirable outcomes of health psychology teaching, can be usefully applied by other professions not only to their interactions with patients but also to reflections on their own work practices. Health professionals need a sensitivity to the causes and effects of job stress in themselves and their colleagues, as the unproductiveness and danger inherent in dissatisfied, stressed, and impaired professionals is considerable ( Jones et al., 1988; Keltner & Leung, 1995; Nuffield Provincial Hospitals Trust, 1996 ). All health workers should receive some educational preparation about the psychological as well as physical hazards to their safety and well-being, be capable of detecting signs of emotional exhaustion and other signs of strain in themselves and colleagues, and know how to proceed next.

Occupational health psychologists may be valuable to develop job stress management interventions for health workers and more broadly, to help health professions to select, train and monitor their members to prevent occupational stress and its damaging consequences for both practitioners and patients ( Landy, Quick, & Kasl, 1994 ). Governments may not welcome such initiatives if they lead to calls for shorter working hours (e.g., for junior, salaried doctors in training), better working conditions (e.g., not being forcibly sent to rural locations), more support from psychologists, and policies to reduce environmental and social causes of illness such as air and water pollution, unsafe workplaces, poverty, racism, unemployment, and unequal access to education and health care.

8.07.6.2 Needs of Health Psychologists who Teach Other Professions

Information about the other professions' traditions, expectations, practice patterns, and needs should be readily available from teaching colleagues and associated practitioners. This will give a vital flavor of reality to the teaching examples and assignments used.

Health psychologists who teach nonpsychology students may also need peer support. Recognition and feedback from nonpsychologist teaching colleagues would be very welcome, but it may be valuable to use professional societies and their journals or newsletters and conferences to develop networks of people with similar jobs, in order to share information, practical advice, and understanding. Groups with a focus on health psychology within the professional societies include Division 38 in the American Psychological Association, a special group within the British Psychological Society, a section in the Canadian Psychological Association, a college within the Australian Psychological Society, and a division in the International Association of Applied Psychology. In addition there is an Association of Medical School Professors of Psychology, a European Health Psychology Society, an International Society for Health Psychology, and doubtless other national and international organizations. As noted above, the Internet, and the national societies for health informatics (information technologies applied to health-related knowledge) with their conferences, newsletters, and e-mail discussion groups, greatly increase the opportunities for connection with health psychology teachers around the world.

Joan C. Chrisler , in The Psychology of Gender and Health , 2017

Research, practice, and public policy are the core of health psychology , but they are not the only aspects of health psychologists’ work that would benefit from the integration of information about sex and gender. I urge readers not to forget about the vital importance of education. Health education for the general public would surely be more effective if gender issues were routinely taken into account and messages were designed with the gender (also culture and socioeconomic class) of the target audience in mind. The teaching of health psychology at the university level is also key to the integration of gender and health psychology. If undergraduate students can be interested in the ways that gender influences health, illness, and treatment, and if graduate students can be trained to think about gender as they design research projects and clinical interventions, then the next generation of health psychologists will produce and practice health psychology in the way the authors and editors of this book envision. Here I will focus on some ways to integrate gender into the standard health psychology course for undergraduate university students.

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Studying Health Psychology and Illness

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Health psychology is a specialty area that focuses on how biology, psychology, behavior, and social factors influence health and illness. Other terms such as medical psychology and behavioral medicine are sometimes used interchangeably with the term health psychology.

Health and illness are influenced by a wide variety of factors. While contagious and hereditary illnesses are common, many behavioral and psychological factors can impact overall physical well-being and various medical conditions.

An Overview of Health Psychology

Health psychology is a field of psychology focused on promoting health as well as the prevention and treatment of disease and illness. Health psychologists also focus on understanding how people react to, cope with, and recover from illness. Some health psychologists work to improve the health care system and the government's approach to health care policy.

Division 38 of the American Psychological Association is devoted to health psychology. According to the division, their focus is on a better understanding of health and illness, studying the psychological factors that impact health, and contributing to the health care system and health policy.

The field of health psychology emerged in the 1970s to address the rapidly changing field of healthcare. Today, life expectancy in the U.S. is around 80 years, and the leading causes of mortality are chronic diseases often linked to lifestyle.  Health psychology helps address these changes in health.

By looking at the patterns of behavior that underlie disease and death, health psychologists hope to help people live better, and healthier, lives.

How Is Health Psychology Unique?

Because health psychology emphasizes how behavior influences health, it is well-positioned to help people change the behaviors that contribute to health and well-being. Examples of health psychology in action would be researchers conducting applied research on how to prevent unhealthy behaviors such as smoking or to find new ways to encourage healthy actions such as exercising.

For example, while most people realize that eating a diet high in sugar is not good for their health, many people continue to engage in such behaviors regardless of the possible short-term and long-term consequences. Health psychologists look at the psychological factors that influence these health choices and explore ways to motivate people to make better health choices.

Importance of Health Psychology

The U.S. Centers for Disease Control's National Center for Health Statistics compiles data regarding death in the nation and its causes. Congruent with data trends throughout this century, nearly half of all deaths in the United States can be linked to behaviors or other risk factors that are mostly preventable.

In the CDC's 2012 report, the rate of death had declined for all leading causes except suicide. Life expectancy was also at an all-time high (78.8 years), yet about 83 Americans die from heart disease and stroke every hour. And more than a quarter of those deaths are preventable.

Cancer deaths were second, followed by chronic lower respiratory diseases—primarily chronic obstructive pulmonary diseases (COPD) such as emphysema and chronic bronchitis. COPD was followed by drug poisonings, including overdoses , then fatal falls among an increasingly elder population.

Current Issues in Health Psychology

Health psychologists work with individuals, groups, and communities to decrease risk factors, improve overall health, and reduce illness. They conduct research and provide services in areas including:

• Stress reduction
• Weight management
• Smoking cessation
• Improving daily nutrition
• Reducing risky sexual behaviors
• Hospice care and grief counseling
• Preventing illness
• Understanding the effects of illness
• Improving recovery
• Teaching coping skills

The Biosocial Model in Health Psychology

Today, the main approach used in health psychology is known as the biosocial model. According to this view, illness and health are the results of a combination of biological, psychological, and social factors.

• Biological factors include inherited personality traits and genetic conditions.
• Psychological factors involve lifestyle, personality characteristics, and stress levels.
• Social factors include such things as social support systems , family relationships, and cultural beliefs.

Health Psychology in Practice

Health psychology is a rapidly growing field. As increasing numbers of people seek to take control of their own health, more and more people are seeking health-related information and resources. Health psychologists are focused on educating people about their own health and well-being, so they are perfectly suited to fill this rising demand.

Many health psychologists work specifically in the area of prevention, focusing on helping people stop health problems before they start.

This may include helping people maintain a healthy weight, avoid unhealthy or risky behaviors , and maintain a positive outlook that can combat stress, depression, and anxiety.

Another way that health psychologists can help is by educating and training other health professionals. By incorporating knowledge from health psychology, physicians, nurses, nutritionists, and other health practitioners can better incorporate psychological approaches into how they treat patients.

Branches of Health Psychology

Individuals who are interested in a health psychology career can choose to work in a specific branch of this field. Four main branches of health psychology are:

• Clinical health psychology : This health psychology branch involves working with individuals, helping them make lifestyle changes for better health.
• Community health psychology : Health psychology workers can also work with entire communities, such as studying diseases that are common in certain communities and the causes behind them.
• Occupational health psychology : This branch of health psychology focuses on how a person's job can affect their health, in addition to finding ways to promote employee health within work environments.
• Public health psychology : Another option for health psychology professionals is to work in a position that studies and/or is able to influence policies and programs designed to promote the health of the public as a whole.

A Word From Verywell

If you are struggling to make healthy changes in your life , dealing with the onset of illness, or facing some other type of health problem, seeing a health psychologist is one way to help start you off on the right foot. By consulting with one of these professionals, you can gain access to support and resources designed to help you cope with your illness and achieve your health goals.

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Influencing factors of the work engagement of healthcare workers in maternal and child health institutions: an online cross-sectional study

• Published: 23 September 2024

Cite this article

• Hongjin Zhu 1 ,
• Limei Cao 1 &
• Yanqiu Chen   ORCID: orcid.org/0009-0000-4128-3164 1  

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Work engagement has a positive effect on individuals and organizations. However, data on the work engagement of healthcare employees in maternal and child health institutions are limited. To explore the level of work engagement and its influencing factors on healthcare employees in maternal and child health institutions. In January 2023, an online cross-sectional survey was conducted among 411 healthcare employees working in maternal and child health institutions in Chongqing, China. Data were collected using the Utrecht Work Engagement Scale (UWES), the Perceived Social Support Scale (PSSS), the Pittsburgh Sleep Quality Index (PSQI), and sociodemographic information. Descriptive statistics, t-tests, one-way analyses of variance (ANOVAs), Pearson’s correlation analysis, and multiple linear regression analysis were used to analyze the relationship between variables. Healthcare employees’ overall work engagement is at a medium level, with a score of 3.51 ± 1.49. The dedication subscale showed the highest mean score (3.76 ± 1.56), followed by the vigor (3.50 ± 1.54) and absorption (3.33 ± 1.53). Gender was associated with absorption. Employment form was associated with work engagement, and its two dimensions (vigor and absorption). Hospital preparedness and perceived social support were positively associated with work engagement and its three dimensions. Healthcare managers should provide a supportive work environment to increase employees’ work engagement, and formulate strategies and measures by considering influencing factors. Further research is needed to design effective intervention programs and implement them.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

• Maternal and child health

The Utrecht work engagement scale

The perceived social support scale

The Pittsburgh sleep quality index

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Acknowledgements

We would like to thank the healthcare employees in maternal and child health institutions very much for having given us their valuable time and data.

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Hongjin Zhu, Limei Cao & Yanqiu Chen

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All authors contributed to the study conception and design. Material preparation and data collection were performed by [Chen Yanqiu] and [Cao Limei]. Data analysis was performed by [Zhu Hongjin]. The first draft of the manuscript was written by [Zhu Hongjin] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Zhu, H., Cao, L. & Chen, Y. Influencing factors of the work engagement of healthcare workers in maternal and child health institutions: an online cross-sectional study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06712-z

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Positive Psychology and Physical Health

Positive psychology is the scientific study of a healthy and flourishing life. The goal of positive psychology is to complement and extend the traditional problem-focused psychology that has proliferated in recent decades. Positive psychology is concerned with positive psychological states (eg, happiness), positive psychological traits (eg, talents, interests, strengths of character), positive relationships, and positive institutions. We describe evidences of how topics of positive psychology apply to physical health. Research has shown that psychological health assets (eg, positive emotions, life satisfaction, optimism, life purpose, social support) are prospectively associated with good health measured in a variety of ways. Not yet known is whether positive psychology interventions improve physical health. Future directions for the application of positive psychology to health are discussed. We conclude that the application of positive psychology to health is promising, although much work remains to be done.

‘. . . a happy, engaged, and fulfilling psychological and social life is not just a consequence of good health, it is what leads people to live a healthy and long life.’

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. —World Health Organization 1

Most would agree with this statement, but over the years, it has been largely a slogan. More recently, theory, research, and applications from the perspective of positive psychology have helped articulate the meaning of health and well-being. Positive psychology is an umbrella term for the scientific study of the various contributors to a healthy and thriving life for the self and others (eg, positive emotions, life meaning, engaging work, and close relationships). 2 It is the study of strengths, assets, and positive attributes. The topics of concern to positive psychology are broad indicators of psychological, social, and societal well-being.

Research has shown that not only are physical, mental, and social well-beings important components for complete health, but they are also interconnected. Evidence is accumulating that a happy, engaged, and fulfilling psychological and social life is not just a consequence of good health, it is what leads people to live a healthy and long life.

This article provides a brief overview of what positive psychology is and addresses how theories, findings, and especially applications from positive psychology might pertain to physical health.

What Is Positive Psychology?

Positive psychology is a perspective within psychology that studies optimal experience, people being and doing their best. 2 - 4 It challenges the assumptions of the disease model. Positive psychology assumes that life entails more than avoiding or undoing problems and that explanations of the good life must do more than reverse accounts of problems. Someone without symptoms or disorders may or may not be living well. Positive psychology urges attention to what is taking place on the other side of the zero point of being problem-free. It calls for as much focus on strength as on weakness, as much interest in building the best things in life as in repairing the worst, and as much attention to fulfilling the lives of healthy people as to healing the wounds of the distressed. Research findings from positive psychology are intended to contribute to a more complete and balanced scientific understanding of human experiences and ways to foster thriving in individuals, communities, and societies.

One of the triggers for the introduction of positive psychology was the realization that since World War II, psychology as a field had devoted much of its effort to identifying, treating, and—occasionally—preventing problems such as anxiety and depression. 3 The yield of these problem-focused efforts has been impressive, but a myopic view of the human condition has resulted. It is as if psychology has viewed people as only fragile and flawed.

The goal of positive psychology is to complement and extend the problem-focused psychology, and an important idea from positive psychology is that one way to solve problems is by identifying and leveraging individual and societal strengths and assets. 5

The topics of concern to positive psychology can be divided into 4 related topics 2 , 3 :

• Positive subjective experiences (happiness, gratification, fulfillment, flow)
• Positive individual traits (strengths of character, talents, interests, values)
• Positive interpersonal relationships (friendship, marriage, colleagueship)
• Positive institutions (families, schools, businesses, communities)

The value of positive psychology is to use the scientific method to sort through various claims and hypotheses about what it means to live well or poorly and to identify the relevant circumstances in each case.

Positive Psychology and Health

Can physical health be clarified by a positive perspective in the same way that psychological well-being has been clarified? To return to the definition of health by the World Health Organization with which this article began, 1 a positive perspective urges us to look beyond the mere absence of disease and infirmity to define what it means to be healthy in positive terms. 6 - 8 Positive health can be characterized not only as a long and disease-free life but additionally in terms of

• Less frequent and briefer ailments
• Greater recuperative ability
• Rapid wound healing
• More physiological reserves
• Chronic but nondebilitating diseases

Familiar within the field of epidemiology are the population-level concepts of DALYs (disability adjusted life years), HALYs (health-adjusted life years), and QALYs (quality-adjusted life years), which combine measures of morbidity and mortality into the same index. 9 Along these lines, HLEs (happiness-adjusted life expectancies) measure the quality of life in a nation by forming the product of the average life expectancy and the average happiness (aka subjective well-being, life satisfaction) in that nation. 10 Positive health concerns itself with the individual-level analogues of these constructs.

The field of positive health as we envision it overlaps with allied approaches concerned with disease prevention, health promotion , and wellness. The value of positive health as an approach in its own right is that it makes explicit the need to consider good health as opposed to the absence of poor health. Studies of “wellness” often end up being studies of illness, much as studies of mental “health” are often studies of mental illness.

Concern with positive health leads to an examination of health assets , individual-level factors that produce positive health in one or more of the ways that it might be defined, over-and-above the frequently studied risk factors for poor health, like high cholesterol, obesity, smoking, excessive alcohol use, and a sedentary lifestyle. 8 Among the psychosocial risk factors frequently examined with respect to poor health are anger, anxiety, depression, and social isolation. By the logic of a positive perspective, the mere absence of these negative states and traits is not all that matters for physical health. Important as well are positive states and traits, and the contribution of these in their own right needs to be studied, controlling for negative states and traits as well as other usual-suspect risk factors.

There have been extensive studies on negative psychological factors such as stress, depression, hostility, and their effects on increased risk of various health problems. 11 However, less known is whether certain positive psychological factors play a protective role against health risks. Research has shown that positive and negative emotions are not opposite and are only modestly correlated. 12 , 13 Experiencing each of those emotions is also involved in the activation of different brain regions. 14

For the past several years, researchers have examined the contributions of health assets, especially psychological ones, to good health, while they have controlled for established risk factors. Researchers need to examine both risk factors and health assets to understand relationships between both positive and negative psychological factors as they together contribute to health outcomes.

Carefully conducted research shows that positive health assets indeed predict good health assessed in a variety of ways. 15 Among the positive psychology health assets foreshadowing good health are

• Positive emotions 16 , 17
• Life satisfaction 17 , 18
• Optimism 19 - 22
• Forgiveness 23
• Self-regulation 24
• Vitality and zest 25
• Life meaning and purpose 26 - 29
• Helping others and volunteering 30 - 32
• Good social relationships 33 - 35
• Spirituality and religiosity 36 , 37

There has been growing evidence that positive psychological characteristics affect health and longevity using various research methods including longitudinal prospective and experimental designs.

Perhaps, among the most well-known long-term studies that showed the possible link between positive psychological assets and health outcomes is The Nun Study. 38 A group of American nuns who were members of the School Sisters of Notre Dame wrote autobiographical essays in their early 20s when they joined the Sisterhood. Six decades later, researchers who had accessed the convent archive scored the emotional content of 180 essays in terms of positivity, and investigated whether they were related to the mortality of nuns. Indeed, positive emotional content was significantly related to longevity. The nuns who expressed more positive emotions (those in the upper 25%) in their essays, strikingly, lived on average 10 years longer than those expressing fewer positive emotions (those in the bottom 25%). In other words, happier nuns lived longer than less happy (but not depressed) nuns. Putting this in context, unhealthy behavior like smoking costs on average 7 years of one’s life. 2

In another experimental study, Cohen and his colleagues examined the relationships between positive emotions and the vulnerability of catching the common cold. 39 With 334 healthy adult volunteers in the community, they first measured both positive emotional experience, such as happy, pleased, lively, and relaxed, and negative emotional experiences, such as depressed, anxious, and hostile, over a few weeks using self-reports. Afterward, participants were invited to the study lab and exposed to rhinoviruses through nasal drops and monitored in quarantine for the development of the common cold. The researchers found that higher positive emotional experiences were related to lower risk of developing a cold and fewer reports of symptoms, while negative emotional experiences were not significantly related to catching a cold, but associated with reports of more symptoms. In short, this study showed that experiencing positive emotions was linked to greater resistance to developing the common cold.

The health benefits of positive psychological assets have been documented in different cultural settings as well. For instance, in Japanese culture, the most commonly used indicator of subjective well-being is the sense of “life worth living” ( ikigai ). 29 In a population-based prospective cohort study with 43, 391 adults in Ohsaki, Japan, lack of the sense of “life worth living” ( ikigai ) was significantly associated with higher risk of all-cause mortality over time. Those who reported having an ikigai in their life in a survey were more likely to be alive at a 7-year follow-up compared to their counterparts who did not find a sense of ikigai . Interestingly, the increase in mortality risk was due to an increase in mortality from cardiovascular disease and external causes such as suicide, but not to morality from cancer. Having a sense of “life worth living” ( ikigai ) often means having a purpose in life and realizing the value of being alive which could serve as a motivation for living.

In our own study with US adults, having life purpose played a protective role for heart health. 27 At a 2-year follow-up, the higher level of life purpose was prospectively related to lower risks of incidence of myocardial infarction among people with coronary heart disease at the baseline.

One of the ways to achieve a sense of life meaning and purpose is through helping others and doing regular volunteer work in communities. Research has shown that among elders, people who volunteer regularly are healthier and live longer. 30 , 31 In a longitudinal study with a nationally representative sample of community-dwelling older US adults, a study found that volunteerism predicted a lower risk of hypertension 4 years later. 31 That is, those who had volunteered at least 200 hours in the previous 12 months were less likely to develop hypertension risk compared to those who did not volunteer. However, lower levels of volunteering did not decrease the health risk of hypertension. It seems that dosage and intentions of volunteering matters for its health benefits. In another study, people who regularly volunteered for self-oriented motives did not exhibit lower risk for mortality 4 years later, while those who regularly and frequently volunteered for other-oriented motives showed lower risk of subsequent mortality. 32 In conclusion, it is good to be good!

One of the well-studied health-related positive psychology topics is optimism. Optimism is sometimes seen as pollyannaism, a naively rosy view of the world coupled with a “don’t worry, be happy” attitude. However, optimism the way researchers study it is a disposition to an expectation that the future will entail more positive events than negative ones. 40 Optimists are neither in denial nor naive about challenges and difficulties in life. They simply attend to and acknowledge the positive.

Empirical research shows that optimism—usually assessed with self-report surveys—relates to good health and a long life. According to research, among asymptomatic men with HIV, optimism slowed the onset of AIDS over an 18-month follow-up. 41 , 42 Over an 8-year follow-up, optimism predicted better pulmonary function among older men, even when smoking was controlled. 43 In a longitudinal study of older men and women, optimism predicted not only better health but also lower levels of pain. 44 Our own research group recently reported a study of a large nationally representative sample of older adults (aged >50 years) in the United States showing that over a 2-year period, optimism predicted a lower likelihood of stroke, even after controlling for chronic illnesses, self-rated health, and relevant sociodemographic, biological, and psychological factors. 45

In addition, the importance of social support and positive relationships on good health and well-being has long been documented. Supportive social relationships were associated with longevity, less cognitive decline with aging, greater resistance to infectious disease, and better management of chronic illnesses. 33 - 35

Enough well-designed studies exist in support of the premise that health assets predict good health to warrant further investigation. Research so far provides compelling evidence that positive psychological health assets predict or are associated with various health outcomes and longevity among healthy populations. However, what is relatively unknown are the effects of positive health assets for recovery and long-term health outcomes among those with serious health problems such as cancer.

Furthermore, before we consider interventions that deliberately encourage these assets in order to reduce morbidity and mortality and to increase physical well-being, there are issues that need to be addressed. 46

First, assuming that health assets do play a causal role, what are the mechanisms? Research to date has often been stark, usually demonstrating an association over time but not clarifying how it happens. We assume the pathways are multiple, from biological to emotional to cognitive to behavioral to social. For example, in the case of optimism, biologically, it has been linked to better immune system functioning, and behaviorally, people who are optimistic engage in healthier behaviors. They eat healthy, exercise, do not smoke or drink, and seek medical care when they need. Socially, optimists have better and more frequent social contacts. All of these are associated with health benefits.

It is unknown which pathway bears the most traffic or whether the mechanisms vary as a function of the specific health outcome (eg, cardiovascular disease vs the common cold) or as a function of the individual’s age, gender, or lifestyle. Again, the best a researcher can do is to identify plausible mechanisms in a given study and explicitly investigate their role as mediators.

Second, are health assets a cause of good health or merely a correlated marker of its real causes? Indeed, the array of positive health assets is challenging for researchers, who cannot study or control all possible assets in the same investigation. No single study relying on correlational data can be definitive, so it is the overall body of research investigating health assets that must be examined to draw causal conclusions. 17

Third, do the apparent benefits of health assets generalize to all kinds of health outcomes? Much of the relevant research has ascertained general health and all-cause mortality, and some of this work has relied only on self-reported information about health status. When researchers look at specific health outcomes assessed in more objective ways, psychological health assets seem to be more predictive of cardiovascular health than they are of freedom from cancer. So the benefits of health assets may be disease specific. A wider variety of diseases needs to be investigated from the positive health perspective. Moreover, research is not clear about the relative contribution of health assets to disease onset, to disease progression, and/or to recovery.

Positive Psychology Interventions for Physical Health

Researchers and practitioners have begun to develop intervention strategies based on positive psychology to increase positive psychological assets such as positive emotions or life satisfaction to bolster physical health. Whether increasing positive psychological assets will turn to better health outcomes is inconclusive. These intervention efforts targeting health assets in order to lead to better health not only have practical significance but also theoretical importance because appropriately done intervention studies would strengthen the claim that health assets actually cause good health.

We refer to interventions informed by positive psychology as positive psychology interventions. Sometimes positive psychology interventions entail a specific technique, like counting one’s blessings at the end of the day or using one’s signature strengths of character in novels ways. 47 At other times, the intervention uses a more-elaborated therapy package that combines different techniques, such as “Well-Being Therapy,” 48 and Quality of Life Therapy , 49 among others.

Intervention studies allow us to conclude that interventions informed by positive psychology can indeed change positive psychological states and traits, sometimes in lasting ways. 47 , 48 An important qualification is that long-term benefits do not result from one-shot interventions unless these lead to a change in how someone habitually lives. 18 Perhaps, what is required is a sustained lifestyle change.

On the face of it, intervening to increase a health asset should also have benefits for physical health, given the association between health assets and health outcomes. However, this argument does not embody a syllogism. Health assets may not be direct causes of good health, and even if they are, changing them may not result in better health. Said another way, we do not yet know if the health benefits of deliberately cultivated happiness or optimism or life meaning have the same benefits as their naturally occurring counterparts. 50

Needed is intervention research that incudes physical health as an explicitly measured outcome. While it is interesting and important to show that a positive psychology intervention increases the psychological well-being of medial patients, the more exciting issue is whether the intervention also affects their physical health. If so, how quickly would health benefits be evident? And what is the mechanism by which the intervention has an effect?

In studying the mechanisms by which a positive psychology intervention influences physical health, the role played by mundane behavior should not be neglected. 46 There are well-documented “healthy” ways of behaving, 51 including sleeping 8 hours a night, eating balanced meals, not smoking, not drinking to excess, and exercising regularly.

We suspect that positive psychology interventions, when successful, lead people not only to think and feel in more positive ways but also to behave in more healthy ways. 40 , 46 For example, optimistic people are more actively engaged with the world and are better problem solvers than their pessimistic counterparts. They have more frequent and higher quality social contacts as well as more social support. All of these factors may lead to healthier behaviors and habits and eventually to better health.

Positive psychology intervention studies for better health outcomes are in their infancy. So far, nearly all positive psychology interventions primarily targeted changing health-related behaviors such as physical activity, not the health outcome directly. Researchers have shown that positive psychology interventions influence some of the biological and behavioral processes implicated in good health. For example, inducing positive emotions speeds cardiovascular recovery following a stressful event. 52 Training in mindfulness meditation can boost immune function. 53 Psychosocial resilience training targeting positive emotions, cognitive flexibility, social support, life meaning, and active coping reduces total cholesterol among middle-aged adults. 54 Researchers have begun to investigate how positive affect and affirmation influence physical activity and medication adherence among patients with coronary artery disease, 55 asthma, 56 and hypertension. 57 The next step in each case is to show that such interventions also increase good health as opposed to its possible precursors.

Using a randomized controlled clinical trial, a group of researchers recently developed an intervention strategy that enhances positive affect and self-affirmation (PA/SA) and applied it to 3 different high-risk clinical populations (eg, hypertension, asthma, coronary artery disease) to change their health-related behaviors. 55 - 57

In each clinical trial, patients were randomly assigned to either the patient education (PE) control group or the positive-affect/self-affirmation (PA/SA) intervention group. For the control group, each patient received an educational workbook, a pedometer, and a behavior contract for a physical activity goal. For the intervention group, each received PE control components and additionally, a PA/SA workbook chapter, bimonthly induction of PA/SA by telephone, and small mailed gifts. Patients in the PA intervention group were taught how to self-induce positive affect and self-affirmation using a workbook chapter, received bimonthly inducement of PA/SA by telephone, and unexpected small gifts (PA) mailed bimonthly several weeks before follow-up calls. During PA/SA induction phone calls, patients were told to “think about things that make you feel good” and take a moment each day to enjoy positive thoughts (PA), and to think about “proud moments” in their personal lives if they have a difficult time exercising (SA). For both groups, data were collected through a standardized bimonthly telephone follow-up for 12 months.

Using this research design, researchers conducted 3 parallel studies. In study 1, 55 patients were recruited right after percutaneous coronary intervention to increase physical activity among people with coronary artery disease. Compared to the control group, patients in the intervention group engaged in significantly more physical activities. In study 2, 56 physical activity among asthma patients who participated in the study was improved without differences between control and intervention groups. There was no significant effectiveness of intervention. In study 3, 57 the intervention effect on enhancing medication adherence among hypertensive African Americans was examined. Patients in both control and intervention groups received a culturally appropriate hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls to help them better handle barriers to medication adherence. In addition, patients in the PA/SA intervention group received small gifts and bimonthly telephone calls to help them utilize positive thoughts into their daily routine and foster self-affirmation. At the 12-month follow-up, the intervention group showed a significantly higher level of medication adherence compared to the control group (42% vs 36%). The reduction of blood pressure was found among participants without significant differences across groups.

Mixed results from these intervention studies leave questions that need to be clarified with more studies to better understand the effectiveness of a positive psychology intervention on the different health outcomes before they are implemented in health practices.

Another line of positive psychology intervention research that attracted significant attention in recent years is applications of mindfulness meditation. It is assumed that meditations induce positive affect and lead to good health. A study led by a neuroscientist, Richard Davidson, demonstrated that mindfulness meditation produces changes in brain and immune function in a positive way. 53 In this study, 25 healthy employees at a work site received an 8-week intensive clinical training in mindfulness meditation. A weekly training class met for about 3 hours, and a silent 7-hour retreat was held during week 6 of the training. In addition, participants were instructed to perform home meditation practices for 1 hour each day, 6 days a week with the guided audiotapes. Brain electrical activity was measured at the baseline, the end of training, and 4 months after training. Also at the end of training, participants were vaccinated with influenza vaccine. Results from the meditation group were compared to those of the wait-list control group. Among the meditation group, brain activity in the left-sided anterior, associated with positive affect, was significantly increased. They also found significant increases in antibody concentrations to influenza vaccine in the meditation group. Interestingly, the size of increase in left-sided activation predicted the size of antibody concentration rise to the vaccine.

In sum, the effects of positive psychology interventions on health outcomes are inconclusive. As stated before, positive psychology interventions seem to be more effective on reducing health risks among healthy individuals in the short term. However, its long-term health effects, especially, on a population with different health problems, is not clear.

Conclusions

Positive psychology is a perspective that urges scientific attention to strengths and assets that contribute to health and a flourishing life. We have described what positive psychologists have learned about the relationships between positive psychological assets and physical health in the past decade.

To date, the application of positive psychology to health is promising, although much work remains to be done. On the positive side, research shows that what we call positive psychological health assets (eg, positive emotions, life satisfaction, optimism, positive relationships, life purpose) are prospectively associated with good health measured in a variety of ways. Also on the positive side, interventions have been developed that increase these assets; lasting effects require a lifestyle change.

Not yet known is whether positive psychology interventions improve physical health, reducing morbidity and mortality, speeding recovery from illness, and so on. Investigators are beginning to study the health effects of such interventions. Studies to date suggest that positive psychology interventions reduce some of the biological and behavioral processes that affect health, but the next step is to study good health per se.

We urge an open mind about the eventual success of such interventions. It is important not to get too far ahead of the data. Perhaps these interventions will work as intended, perhaps not. For example, the lesson from studies of psychological interventions targeting negative states and traits such as anger and depression in the hope of reducing cardiovascular disease, with which they are associated, is instructive. The success of these interventions is checkered at best. 46 Whether the deliberate cultivation of positive health assets such as positive emotions or life purpose will be more successful in promoting good health than the reduction of psychological risk factors is not known, but is a question worth addressing.

In conclusion, growing evidence suggests that positive psychological assets are linked to health and longevity. However, more studies are necessary to learn more about when, why, how, and for whom positive psychological assets plays a role in good health and whether interventions that enhance these assets will yield health benefits. We urge a skeptical yet fair-minded attitude on the part of researchers and practitioners and that they pay particular attention to underlying mechanisms. Meanwhile, freedom from disease and longevity are not the only goals of life. Quality of life matters in addition to quantity of life. It is clear from research that experiencing frequent positive emotions, having sense of life purpose, paying attention to what is positive in life, and living a more socially integrated life is linked to one’s quality of life across the lifespan. Thus, helping people cultivate positive psychological and social assets in life has potential for leading to happier, more meaningful, and healthier lives.

Acknowledgments

Christopher Peterson unexpectedly died on October 9, 2012, during the revision of this article. We are deeply indebted to his scholarly contributions and mentorship not only to this work but also to the foundation of positive psychology and its applications to various fields. His intellectual and personal contributions will continue to inspire and guide the positive psychology and positive health community.

Support for the preparation of this article was provided by the Robert Wood Johnson Foundation’s Pioneer Portfolio, which supports innovative ideas that may lead to breakthroughs in the future of health and health care. The Pioneer Portfolio funding was administered through a Positive Health grant to the Positive Psychology Center at the University of Pennsylvania, Martin Seligman, Director.

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Health Psychology Promotes Wellness

Understanding Health Psychology

For years, we’ve known about the dangers of smoking, and that we should eat less and move more. But in the end, what motivates us to put down the doughnut and hit the running trail or carefully follow a doctor’s instructions about medications and follow-up visits?

Health psychology explores those motivations in the pursuit of getting people to embrace health promotion and illness prevention. This specialty area examines how biological, social and psychological factors influence the choices we make about our health.

Health psychologists study the factors that allow people to be healthy, recover from an illness or cope with a chronic condition. They are experts in the intersection of health and behavior and are in demand as a part of integrated health care delivery teams — working with other doctors to provide whole-person health care.

Health Psychology Applied

The path to wellness is complex, and health psychologists know this. That is why they consider all the factors in a person’s life to get at what’s really driving certain behaviors.

Ever heard of emotional eating? Or psychosomatic illnesses? Linking people’s emotions to their behavior and its consequences is a key component of their work.

Health psychologists apply their expertise in many settings, including private practices, hospitals and primary care programs, universities, corporations, government agencies and specialty practices, such as oncology, pain management, rehabilitation and smoking cessation.

Helping people make choices that have a positive impact on their health — and the well-being of their families, the workforce and their communities is at the heart of this dynamic field.

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