Key Concepts in Health Psychology

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Ian P. Albery & Marcus Munafò

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    Dedication

    For Mioara, And also for Henry, Beth and Will. And in memory of Rowland, the last of the Starkeys.

    Ian P. Albery, June 2007

    List of Figures

    • Figure 1.1 The biopsychosocial model of health and illness 3
    • Figure 1.2 Where health psychology sits in relation to related areas of study 5
    • Figure 1.3 Mortality rates for males and females for two socio-economic groups 10
    • Figure 1.4 Rutter and Quine's (1996) model of social inputs, social psychological processes and health outcomes 11
    • Figure 1.5 The effects of employment status and perceived social support on reported physical symptoms 13
    • Figure 2.1 Study design 21
    • Figure 2.2 Experimental study design 30
    • Figure 2.3 Cross-over study design 31
    • Figure 3.1 Theory of planned behaviour 47
    • Figure 3.2 The health belief model 51
    • Figure 3.3 Protection motivation theory 55
    • Figure 3.4 Percentage of TSE for experimental and control groups 61
    • Figure 3.5 The health action process approach 64
    • Figure 3.6 Precaution adoption process model 68
    • Figure 3.7 Percentage of participants progressing one or more stages in the PAPM towards using home radon testing by pre-intervention stage and matched/mismatched intervention condition 70
    • Figure 3.8 Stages of change in the transtheoretical model 73
    • Figure 4.1 Heritability 84
    • Figure 4.2 The General Adaptation Syndrome 91
    • Figure 5.1 Reaction times to modified Stroop stimuli in women with (FH+) and without (FH-) a history of familial breast cancer 117
    • Figure 5.2 Reaction times to verify the verb ‘drinking’ by habit strength and goal activation type 118
    • Figure 5.3 Alcohol voucher uptake by habit strength and goal activation type 119
    • Figure 6.1 Self-regulatory model of illness behaviour 127
    • Figure 8.1 The Gate Control Theory of pain 163
    • Figure 9.1 The Stages of Change in Smoking Cessation 193
    • Figure 10.1 Examples of health promotion leaflets 200
    • Figure 10.2 The Yale model of persuasive communication 206
    • Figure 10.3 The elaboration likelihood model of persuasion 208
    • Figure 10.4 Quine et al.'s (2002) communication to persuade young cyclists to wear cycle helmets 210
    • Figure 10.5 Two fear appeals 213
    • Figure 10.6 McGuire's inverted U curve hypothesis for describing the relationship between levels of fear and attitude change 215
    • Figure 10.7 Terror management theory in practice: the effects of mortality salience and driving self-esteem on risky driving intention 218
    • Figure 10.8 The cognitive model hypothesis of compliance 221

    List of Tables

    • Table 2.1 Differences between quantitative and qualitative research 34
    • Table 2.2 Strengths and weaknesses of qualitative research 34
    • Table 2.3 Different research questions and methods in quantitative and qualitative research 35
    • Table 2.4 Lay beliefs about hypertension 36
    • Table 3.1 Manipulating key factors in social cognitive theory: the percentage of participants making forward change stage transitions in a stage of change matched intervention study among smokers 45
    • Table 5.1 Mean responses for perceived comparative skill, safety, future accident likelihood and intended driving speed (on the motorway) for groups of accident and non-accident involved drivers 105
    • Table 6.1 Leventhal and colleagues’ component beliefs of illness representations 128
    • Table 9.1 Criteria for a diagnosis of pathological gambling 195

    List of Boxes

    Preface

    Background

    Health psychology is one of the fastest growing disciplines in psychology but remains in its early years. Very few textbooks or journals, let alone societies devoted to the study of health psychology, existed prior to the late 1970s to early 1980s. By the twenty-first century, and our putting pen to paper for the production of this book, health psychology had matured significantly into its adolescence. Psychological societies and associations around the world have their own divisions or sections devoted to the discipline. For instance, in the UK the British Psychological Society established the Division of Health Psychology in 1997 from the Special Group in Health Psychology (see http://www.health-psychology.org.uk and http://www.bps.org.uk/dhp/dhp.home.cfm), and in the USA health psychology is represented as Division 38 of the American Psychological Association (see http://www.health-psych.org). There is also a burgeoning and active European Health Psychology Society (see http://www.ehps.net/1024/index.html) with membership and representation derived from across the whole of eastern and western Europe. Each of these societies have the general aim to study psychological processes of health, illness and well being in order to understand and implement the promotion and maintenance of health, to prevent illness and augment outcomes for those affected by illness, as well as to provide evidence that can be used to improve local and international healthcare systems and as such inform healthcare policy.

    Major international journals have also been established to report specifically research related to the psychology of health (e.g. Health Psychology and Psychology and Health), many international and national conferences are organized so that researchers from around the world can converse about new and interesting findings and ideas, and it seems virtually infeasible to think that these days there are many universities around the world that do not offer courses or modules in health psychology.

    From all this it would seem that academic health psychology is alive and kicking!

    Health Psychology as a Profession

    In parallel with the development of health psychology as an academic discipline providing applied empirical evidence for understanding psychological processes in health, there have also been significant moves in the maturity of health psychology as a profession. This has resulted in the development of health psychology competencies and professional skills to present the boundaries within which health psychologists should be expected to work and to which they should adhere. These include research competencies (e.g. familiarity with various research methods and research tools, and so on), teaching and training competencies (e.g. designing and delivering training about factors involved in the psychology of health to various consumer groups, and so on), consultancy (e.g. communication skills in the management of clients, and so on), as well as more general professional competencies (e.g. understanding and managing legal and ethical frameworks relevant to the professional environment).

    An example of these competency requirements has been developed by the Division of Health Psychology within the British Psychological Society (BPS) and can been viewed at http://www.health-psychology.org.uk (see also Michie, 2004). Once a person has demonstrated these competencies to a governing body they can be approved as a professional health psychologist. In the UK achieving these competencies takes places via what is known as Stage 1 and Stage 2 training. Stage 1 training involves the postgraduate study of the core theories, models, methods and evidence in health psychology and as such provides core knowledge. This stage can be undertaken by successfully completing a BPS approved postgraduate qualification at a university. Stage 2 comprises supervised practice in which the individual is expected to show evidence of the core competencies (e.g. through written reports, assignments, supervisor's reports, and so on). Once a person has completed Stage 1 and Stage 2 training they can apply to become a full member of the Division of Health Psychology of the BPS and also a Chartered Health Psychologist.

    But the story does not end there. Being an effective, competent, professional health psychologist, or indeed any other professional, means that you have to keep abreast of new information, new intervention techniques, contemporary legislation, and the like, in order to maintain the highest standards of professional practice. This means that registered health psychologists are expected to undertake and demonstrate what is called ‘continuing professional development activities’.

    So, I'm a chartered health psychologist but what kind of jobs can I do? Among many other examples health psychologists work as part of a multidisciplinary team in clinical and research practice. It is not uncommon to find a health psychologist in healthcare services such as in medical departments. They work in health promotion departments providing expert knowledge in the identification of core psychological factors that, for instance, lead people to behave in unhealthy ways, as well as having an important input into the design and evaluation of health promotion activities. You will also find them in university departments training aspiring health psychologists and undertaking health-related research which can be disseminated to the wider audience – just like us. Some even write books! A number of specific examples of the types of jobs chartered health psychologists undertake can be found at http://www.health-psychology.org.uk/menuItems/what_is_health_psychology.php.

    Aims of the Book

    Concepts are mental tools that we use when we are thinking about a subject. Conceptual thinking enables us to organize, catalogue, evaluate, interpret and explain the issue or topic we are interested in. While current textbooks in health psychology offer the reader some conceptual reasoning about different aspects of a discipline, there is no single source which provides a detailed conceptual analysis of current issues and debates, and theories and models, in health psychology. This book aims to provide the reader with a ‘one stop’, comprehensive and conceptual analysis of key issues in contemporary health psychology. This type of conceptual analysis also allows the learner to create meaningful relations among many related facts and ideas, which is essential for a full and critically discerning appreciation of an area of study.

    In addition, health psychology concerns evidence and concepts drawn from a multitude of perspectives including those based on biological systems, cognitive or thinking systems, emotional systems and social systems. As such this book aims to offer the reader the opportunity to engage with a full range of approaches and methods in contemporary health psychology, and importantly, to be able to appreciate the relationships between each. We are trying to build ‘a contemporary picture’ of health psychology comprising many different interacting themes and concepts. Only when a person is able to appreciate the discipline in this way are they able to view the discipline of health psychology in its entirety.

    Structure of the Book

    To achieve these aims we have included chapters in the book which can be thought of as cataloguing an overarching theme or unit of description in health psychology. In the first part of the book we have included chapters that detail concepts relevant for the understanding of how health psychology can be defined (Chapter 1) and also what sorts of research methods and measurement techniques are used to study psychology and health (Chapter 2). The next part of the book introduces key explanatory approaches in health psychology by examining social cognitive models and theories (Chapter 3), biologically based factors and models (Chapter 4) and approaches that have detailed factors that describe individual differences between people in their health behaviour and experience (Chapter 5). Chapter 6 identifies key concepts and approaches that have been used to study thinking processes and beliefs among people who are actually experiencing illness, whilst the following three chapters consider the psychology of long-term and short-term experience for a number of illnesses, and the health outcomes associated with those illnesses (Chapter 7 – acute and chronic illnesses; Chapter 8 – pain; Chapter 9 – addictive behaviours). In the final chapter we turn our attention to key concepts in health promotion interventions for people who are or who are not ill. We consider health promotion activities, adherence and persuasion processes, as well as the role of communication between the patient and care provider as fundamental concepts.

    Within each of these chapters we have then identified a number of key concepts that have been the focus of debate, research and enquiry among those interested in the psychology of health. Each concept is presented and explored according to four key components. We first detail the contemporary meaning of a concept and then place it in its historical and applied position in the discipline by discussing the origin of the term. In effect we are asking the question what does the concept mean and where did it come from? Then we detail how the concept is currently used and understood by providing the reader with an analysis of current debates and empirical evidence in relation to the concept. Finally we examine how relevant the concept is in the discipline per se by examining its significance to health psychology. In designing the structure of the book and in the identification and selection of the key concepts used we have made every attempt to be as inclusive as possible in the generation of themes and concepts relevant for contemporary health psychology.

    Cross-referencing among concepts and a few examples of further reading for each concept is also provided so that the interested reader is able to identify and refer to related concepts and approaches, and explore the ideas presented in greater detail if they want to. In addition, we have included various figures, tables, images and text boxes which include further information designed to reinforce and make even clearer the meaning, development, current usage and significance of the concept to health psychology. The inclusion of a glossary of terms to provide a brief meaning of terms used in the text, and a complete reference section detailing all the published evidence cited for advanced study of primary reading material, completes the volume.

    Happy reading!

    Ian P. Albery and Marcus Munafò, June 2007

    Acknowledgements

    We would like to thank the staff at Sage Publications, London, for their extremely well organized and thorough approach to the production of this book. Our thanks go in particular to Michael Carmichael at Sage for his enthusiasm for the project which, we must say, rubbed off on us, ‘the writers’, at times when the book started to take second place to the many other things we have to deal with in our working lives. Thanks for the sustained encouragement and for motivating us by buying us lovely lunches. Also thanks to Emily Jenner at Sage for answering publication questions that, on the face of it, are obvious but perplexing for confused academics such as ourselves. Your patience is appreciated.

    Publisher's Acknowledgements

    The authors and publishers wish to thank the following for permission to use copyright material:

    Department for Transport, United Kingdom, Think! Leaflet TINF/911a – ‘Watch Out Even On Roads You Know’.

    Australian Government, Department of Health and Ageing, for reproduction of a leaflet from Grim Reaper campaign 1987

    Cancer Research UK for permission to reproduce ‘The Great Indoors’ leaflet.

    We thank Wiley-Blackwell Publishing for granting us permission to use extracts from the following articles:

    Appendix A from Verplanken, B. & Orbell, S. (2003) “Reflections on past behaviour: a self-report index of habit strength” Journal of Applied Social Psychology, 33 (6), 1313–1330, Wiley-Blackwell

    McKenna, F.P. & Albery I.P (2001) “Does unrealistic optimism change following a negative experience,” Journal of Applied Social Psychology, 31 (6), 1146–1157, Wiley-Blackwell

    We thank Science AAAS for granting us permission to use extracts from the following articles:

    Figure 2 from Caspi A et al, SCIENCE 301: 386–389 (2003) Reprinted with permission from Science AAAS

    We thank The Open University Press Publishing Company for granting us permission to use extracts from the following articles:

    Rutter, D. & Quine, L. (2002) (Eds.) Changing Health BehaviourChapter 10, p 179, Figure 10.1 Persuasive Communication for the intervention condition. The Open University Press Publishing Company

    Conner & Norman: Predicting Health Behaviour 2e (2005) p. 311, The Open University Press Publishing Company

    We thank McGraw Hill Publishers for granting us permission to use the following material:

    Rutter, D. & Quine, L. (2002) (Eds.) Changing Health Behaviour.

    Chapter 10, p 179, Figure 10.1 Persuasive Communication for the intervention condition.

    While every effort has been made to trace the owners of copyright material, in a few cases this has proved difficult and we take this opportunity to offer our apologies to any copyright holder whose rights we have unwittingly infringed.

  • Glossary

    ACE models Genetic models which indicate the proportion of additive genetic (A), common environmental (C) and unique environmental (E) variance which accounts for observed phenotypic variance.

    Acquired Immunodeficiency Syndrome A serious (often fatal) disease of the immune system transmitted through bodily fluids, and in particular blood products, especially by sexual contact or contaminated needles in intravenous drug users.

    Acute A condition having a short or rapid onset and lasting for a distinct and typically short period. As distinct from chronic.

    Acute pain Pain which is short-lasting and clearly related to an underlying physical pathology (e.g., tissue damage), and which resolves relatively quickly as the injury causing it heals.

    Addiction A chronic, relapsing condition characterized by compulsive drug-seeking and drug-taking, possibly related to long-term changes in the brain.

    Adherence The active process whereby the behaviour of an individual reflects that recommended action or advice proposed by a health practitioner or through information derived from some other information source.

    Alcohol A colourless, volatile, flammable liquid produced by the fermentation of sugars or starches. Generally taken to mean ethanol, when consumed by humans, which produces psychoactive and intoxicating effects.

    Alcohol abuse The excessive consumption of alcohol in a manner which may cause physical, psychological or social harm, and which may be related to alcohol dependence.

    Alcohol dependence Reliance on alcohol, typically as a result of the withdrawal symptoms that arise when alcohol consumption ceases in those who have used alcohol to excess over an extended period. Resumption of alcohol consumption removes withdrawal symptoms, thereby leading to further alcohol use through negative reinforcement processes.

    Alcoholism Increasingly rarely used term (alcohol abuse and alcohol dependence are now preferred, as they refer to distinct components of the syndrome) which refers to the addiction to alcohol.

    Allele Alternative form of a genetic locus; a single allele for each locus is inherited separately from each parent.

    Alzheimer's disease A progressive form of dementia that is similar to senile dementia except that it usually starts earlier in life; first symptoms are impaired memory which is followed by impaired thought and speech and finally complete helplessness.

    Anchoring The classification and naming of unfamiliar objects by comparing that which is experienced against the collection of familiar classes of event or protoypes.

    Appraisal A judgment, in psychology typically referring to another person or external events, and made in terms of the impact of oneself, potential threat, etc.

    Association In molecular genetics, a technique for identifying whether or not variation in a specific gene is related to a behaviour or disease, by determining whether a specific variant occurs in a given population at a greater than chance frequency.

    Attentional bias Refers to the selective attention to, or processing of, material of specific personal relevance. For example, heavy drinkers appear to demonstrate attentional bias towards alcohol-related cues compared to neutral cues.

    Attitude A general feeling or evaluation, in a positive (favour) or a negative (disfavour) direction, about a person, object or issue.

    Attrition The loss of participants in a study. If this in non-random (for example, attrition is higher in a treatment group compared to the control group), this may lead to bias.

    Automaticity A process or behaviour that operates outside of conscious awareness, is very difficult to control, is unintentional (not consciously planned) and is mentally efficient such that it can operate when cognitive resources are also being used to do other tasks.

    Aversion therapy The pairing of a behaviour (e.g., drug taking) with an unpleasant or aversive consequence, in an attempt to reduce the specific behaviour through learning processes.

    Behaviour change approach A health promotion perspective that argues that the alteration of thinking processes should be the central focus in the development of health promotion activities.

    Behaviour genetics The study of the relative contribution of genetic and environmental influences on various outcomes such as behaviours and risk of disease. Typically involves the study of twins or other related family members.

    Behavioural addiction An addictive-like behaviour which occurs in the absence of a substance of pharmacological agent (e.g., gambling addiction). There is some debate regarding whether such behaviours genuinely constitute an addiction.

    Behavioural intention Prior to behaviour enactment people form a cognitively based intention to behave in that way. Intention is formed from attitudes, beliefs, normative values and perceived control over doing the behaviour. From the theory of planned behaviour.

    Behavioural models Models which emphasize the relationship between behaviours and their consequences in sustaining these behaviours, usually through learning processes such as operant conditioning. Have been widely used in attempting to understand the maintenance of pain behaviours in chronic pain.

    Behavioural support In therapeutic interventions, the use of motivational counselling, group therapy and other therapies which do not include a pharmacological component.

    Benign In cancer, tumours which are not malignant – an abnormal growth that is not cancerous and does not spread to other areas of the body.

    Bias In research, a statistical sampling or testing error, either intentional or unintentional, caused by systematically favouring some outcomes over others. This can limit the interpretability of generalizability of research findings.

    Binge Excessive consumption of alcohol in a single episode, although there is no clear consensus regarding what constitutes a binge. Some have argued that five drinks or more in a single episode constitutes a binge, but other definitions place higher or lower limits on the amount of alcohol which must be consumed to be regarded as a binge.

    Biofeedback The use of biological information (e.g., heart rate or blood pressure) to teach patients how to relax and exert volitional control of the body's systems.

    Bio-medical model A model of health, disease and illness which emphasizes the role of biological agents, and a mechanistic view of the body, so that disease and illness reflect interruptions on the normal functioning of the body.

    Biopsychosocial model A model of health, disease and illness which extends the bio-medical model and places importance on the role of social and psychological factors, and their interaction with biological factors (e.g., the relationship between stress and health).

    Blinding In a research study, the process of keeping participants and researchers uninformed about the specific aim of a study which they are in, in order to minimize the potential effects of bias which may arise if the treatment which is being received is known.

    Cancer Any malignant growth or tumour caused by abnormal and uncontrolled cell division; it may spread to other parts of the body through the lymphatic system or the blood stream.

    Candidate gene A specific gene which is of a priori interest in relation to the phenotype which is being studied, for example because it is involved in a neurobiological pathway known to be important in regulating the phenotype.

    Carbon monoxide A colourless, odourless, poisonous gas, produced by incomplete burning of carbon-based organic products. When carbon monoxide gets into the body, for example through inhalation, the carbon monoxide combines with chemicals in the blood and prevents the blood from bringing oxygen to cells, tissues, and organs.

    Case-control A research study design, used widely in epidemiology, which matches groups of individuals on the basis of the presence or absence of a certain characteristic (e.g., a specific disease), in order to identify other factors (e.g., exposure to an environmental factor) associated with the specific characteristic.

    Causation The act or mechanism by which an effect or outcome is produced. In research, this refers to factors which cause an outcome (e.g., a disease state) to occur. Certain study designs (e.g., experimental designs) are better able to provide evidence of causation than others.

    Central nervous system The brain and spinal cord, which receives signals from the peripheral nervous system and exerts control over the body.

    Central neural plasticity The capacity of the central nervous system to be modified, for example through learning processes, giving rise to functional and structural changes which may be permanent or semi-permanent.

    Chippers Smokers who do not appear to be dependent on nicotine, and smoke socially and at irregular intervals, compared with nicotine dependence smokers who consume cigarettes at regular intervals to maintain circulating levels of nicotine.

    Chronic A condition having a slow, progressive onset and lasting for an extended period, sometimes (although not necessarily) in the absence of any identifiable physical pathology. Cure is sometimes not possible and treatment may be focused on the amelioration of symptoms. As distinct from acute.

    Chronic obstructive pulmonary disease A progressive lung disease process characterized by difficulty breathing, wheezing and a chronic cough. Complications include bronchitis, pneumonia and lung cancer.

    Chronic pain Pain which is long lasting, may not be related to any identifiable physical pathology or tissue damage, and which does not resolve over time. Often resistant to pain-relieving medication.

    Chronic pain syndrome A behavioural syndrome consisting of high levels of reported pain, as well as chronic anxiety and depression, anger and changed lifestyle. Often occurs in the absence of identifiable physical pathology or tissue damage, and may be maintained in part by learning processes related to gain.

    Cigarettes Finely ground or cut tobacco, rolled in paper, for smoking. Usually manufactured but may be hand-rolled using loose tobacco. Provides very rapid delivery of nicotine to the central nervous system, and therefore have high addiction potential.

    Classical conditioning A learning process whereby an initially neutral stimulus is repeatedly paired with a natural reinforcer so that, over time, the initially neutral stimulus comes to elicit the same reaction as the natural reinforcer.

    Cohort A research study design which follows a group of participants over an extended period (i.e., longitudinally) in order to identify factors which predict change in status or some outcome (e.g., disease onset).

    Collective action/community development approach A health promotion perspective that argues that individual health status is dependent upon environmental causes of illness and that people should act collectively to change their physical and social environment.

    Comparative optimism, optimistic bias or unrealistic optimism The processes characterized by the observation that people consider themselves to be less likely to experience negative events and more likely to experience positive events in the future when comparing themselves to others.

    Compliance The passive processes whereby the individual follows the advice of a prescriber with little engagement and possession of treatment by the patient.

    Conditioned response In classical conditioning, the learned response to the initially neutral stimulus.

    Conditioned stimulus In classical conditioning, the name given to an initially neutral stimulus which has acquired the capacity to elicit a conditioned response.

    Constructivism Qualitative research perspective which argues that ‘reality’ is constructed from the interactions of individuals and the meaning placed on events and phenomena by individuals and society.

    Control In research study design, the use of a comparison group (e.g., in a case-control study, or a randomized controlled trial) to determine factors which are associated with an outcome of interest (e.g., disease status, or response to treatment).

    Coping appraisal A component of protection motivation theory that proposes that coping efficiently with a perceived threat and altering the likelihood of an adaptive response is dependent upon response efficacy, self-efficacy and response costs, or barriers to behaviour.

    Coping strategy A set of actions or a plan related to ways of addressing issues relating to overcoming difficulties or/and securing well being. May be internal (e.g., changing the way in which one perceives or appraises specific situations) or external (e.g., involving specific activities or behavioural responses).

    Coronary heart disease Damage to the heart that occurs because its blood supply is reduced. Fatty deposits build up on the linings of the blood vessels that supply the heart muscles with blood, causing them to narrow. The narrowing reduces the blood supply to the heart muscles and causes pain known as angina.

    Cross-over In research study design, the allocation of participants in an experimental study to both treatment conditions, given sequentially so that each participant crosses over from one treatment condition to the other, usually with a wash out period in between.

    Cross-sectional In research study design, the study of a group of participants at a single point in time (as distinct from a cohort study, where a group of individuals is followed-up and investigated repeatedly over time).

    Cue exposure In addiction research, the use of a set of techniques which involve presenting drug users with stimuli (cues) which are typically present when the drug is consumed. Because of the learned associations between the drug and these cues, the cues alone can elicit marked subjective and physiological responses in the user.

    Cues to action Factors, or triggers, that are likely to stimulate the activation of health behaviour when certain belief sets are held. From the health belief model.

    Decisional balance The weighing up of the pros and cons of behaviour change as conceptualized in the transtheoretical model.

    Deoxyribonucleic acid (DNA) The material inside the nucleus of cells that carries genetic information.

    Depression A mental state characterized by chronic low mood, a pessimistic sense of inadequacy and a lack of activity.

    Design In research, the methods which will be used to address a specific research question (e.g., case-control versus experimental). Certain research designs are better suited to answering specific research questions than others.

    Disability The absence or impairment of specific physical or mental functions, usually permanently.

    Discourse analysis An analytical technique in which the researcher seeks to undertake a ‘reading’ or ‘interpretative account’ of a text or conversation by isolating a number of strategies used by participants in their language to describe an event or experience.

    Discursive psychology The approach that proposes that experience is predominantly social in nature and is concerned not with inferred, unobservable and static beliefs (as in social cognitive approaches), but with how language and discourse is used to describe experience. This approach emphasizes that what people say should be interpreted in terms of both current and historical context.

    Disease An impairment of health or a condition associated with abnormal functioning of a bodily system.

    Disease model A conception of addiction which emphasizes the biological effects of substance use, and assumes that addictive behaviours can be best understood as a disease state resulting from chronic substance use.

    Dispositional optimism A generalized expectancy that good things will happen in the future and bad things will not irrespective of how these outcomes occurred.

    Dizygotic In genetics, the non-identical twins which result from the separate fertilization of two separate eggs, and who shared 50% of their genotype as a result.

    Doctor-patient communication Those factors that both the patient and doctor bring to the interpersonal communication in the consultation setting and which may predict satisfaction with the consultation, understanding and adherence to advice for recommended health behaviour.

    Documentary analysis In qualitative research, the analysis of documentary and other written records.

    Dopamine A monoamine neurotransmitter, or chemical, that transmits signals between nerve cells, which has been suggested to play a role in a number of psychiatric conditions, including addictive behaviours.

    Double blind In research study design, the condition whereby both the research participant and the researcher are blind to the specific experimental condition to which the participant has been allocated.

    Elaboration likelihood model Petty and Cacioppo's model of attitude change in which when people attend carefully to the persuasive message they engage in central processing, otherwise they engage in peripheral processing.

    Electrodermal activity The electrical conductivity of the skin, resulting from sweat gland activity. Changes in this conductivity reflect changes in sweat gland activity.

    Electroencephalogram The recording of electrical activity of the brain by positioning electrodes on the scalp.

    Endorphins Any of a group of peptide hormones (endogenous opioids) that bind to opiate receptors and are found mainly in the brain. They play a role in the regulation of the pain response to injury.

    Environmental tobacco smoke Also known as secondhand smoke or passive smoking. The ambient tobacco smoke which results from cigarette smoking and which can be inhaled by those not smoking cigarettes themselves but in the close vicinity of those who are.

    Epidemiology The study of the patterns, causes and control of disease in groups of people or populations.

    Equivalence In research study design, the attempt to demonstrate that the effects of a medication are at least as beneficial as those of an established, proven treatment for the same disease or condition.

    Error In research, the uncertainty associated with any measurement, due to imperfections in the measurement instrument or the methods used. Error may be unsystematic (i.e., random) or systematic (i.e., non-random).

    Event-related potentials Electroencephalogram activity, produced in response to some environmental sensory stimulus (e.g., a noise), and obtained by averaging data recorded after presentation of the stimulus.

    Expectancy-value The idea that people hold expectancies about what outcomes they should get if they behave in a particular way and at the same time their beliefs about the value of that outcome for themselves which is related to decision making and behaviour choice.

    Experimental In research study design, the manipulation of a condition in order to determine the effects of that condition on the outcome of interest. For example, a new treatment may be compared with a placebo to determine the efficacy of that treatment. This study design offers the strongest evidence regarding causation.

    Explanatory style The dispositional manner in which an individual attributes particular causes to observed events.

    Fear appeals Types of persuasive communications that try to motivate people to change their attitudes or behaviour by inducing fear in the recipient.

    Fight or flight response An instinctual response when the organism perceives that its survival is threatened, characterized by increased sympathetic nervous system activation.

    Figuration The use of metaphorical images in language to give an abstract notion a more concrete flavour (e.g. butter mountains for overproduction of foodstuffs).

    Focus Groups A group or team formed for the purpose of either resolving a given problem within a larger group or (more often) simply identifying the spread of opinions and feeling on the issue.

    Functional magnetic resonance imaging A non-invasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow or both.

    Gain In disability, the advantages which may be achieved by certain behaviours, such as sympathy, reassurance, financial benefit, in addition to the immediate benefits of those behaviours such as reducing pain and promoting healing.

    Galvanic skin response A change in the ability of the skin to conduct electricity (i.e., skin conductance response), caused by an environmental stimulus (typically an emotional stimulus, such as fright).

    Gambling addiction Excessive gambling which appears to share many of the characteristics of archetypal chemical addictions. Often cited as an example of a behavioural addiction which can occur in the absence of a psychoactive substance.

    Gate Control Theory Theory of pain perception which hypothesizes that a neural structure at the base of the spinal cord governs the transmission of pain information from the peripheral nervous system to the central nervous system, and which can be influenced by descending signals from the central nervous system that may ‘close’ the gate (rendering the individual less sensitive to pain).

    Gene A hereditary unit consisting of a sequence of DNA that occupies a specific location on a chromosome and determines production of a particular protein. Two copies of each gene are inherited, one from the father and one from the mother.

    Gene x environment interaction An effect of the environment which serves to modify the effects of a genetic variant on an outcome. For example, life stress may influence the impact of a specific gene on the risk of developing major depression. Most genetic effects are likely to be modified in some way by the environment.

    General Adaptation Syndrome A general description of the body's short-term and long-term response to environmental stress, which assumes that the response is broadly similar irrespective of the nature of the environmental stress.

    Genetic marker A gene or DNA sequence having a known location on a chromosome.

    Genetics The study of the inherited basis of human characteristics, traits, behaviours, diseases and so on.

    Genome The entire genetic sequence, comprising the entirety of genetic information about an individual.

    Genotype The specific combination of genetic variants (alleles) possessed by an individual, which give rise to genetic variation between individuals.

    Grounded Theory In qualitative research, a method of data collection and analysis which involves the recursive use of themes that emerge through the course of the research to refine the research question and methods of investigation.

    Group therapy Any therapeutic intervention which involves an interaction between individuals in a group setting, where the group setting itself is considered to be an integral part of the therapeutic component (e.g., because of the support offered by other group members).

    Habit The process characterized by learning through the repetition of a behaviour under the same environmental conditions such that over time exposure to a particular cue or stimulus will activate an automatic cognitive process which guides behaviour. Negative and positive reinforcement processes may serve to maintain habitual behaviours.

    Hardiness A personality type characterized by commitment (a sense of purpose in life events and activities), control (the belief of personal influence over situations) and challenge (seeing adaptation and change as a ‘normal’ and positive experience).

    Health action process approach A stage based model specifying that both a motivational phase and a volition phase have to be passed through in order for a person to adopt, initiate and maintain health protective behaviour.

    Health belief model Focuses on threat perception and health-related behavioural evaluation as the primary aspects concerned with understanding how a person represents health action. Behavioural decisions are based on beliefs about susceptibility to and severity of an illness threat (i.e. threat perception) and the benefits of change and barriers to undertaking a recommended behaviour (i.e. behavioural evaluation).

    Health locus of control The perception that one's health is either under the control of the individual themselves, controlled by powerful others, or by external factors such as chance.

    Health promotion Any activity, event or process that facilitates the improvement of the health status of individuals and groups or which stimulates behavioural change to protect against harm associated with maladaptive health behaviour.

    Health psychology The scientific study of psychologically based factors and processes that are involved in the health, illness and healthcare.

    Heritability The proportion of variability in a trait (phenotype) that is due to additive genetic influences.

    Heuristic systematic model Chaiken's model of attitude change in which when people attend carefully to the persuasive message they engage in systematic processing, otherwise they process the information using heuristics or cognitive short-cuts.

    Hospitalization The act of placing a person in a hospital as a patient. The condition of being hospitalized.

    Hostility A pattern of behaviour characterized by thoughts and behaviours based on the expression of anger, cynical views of the world, and negative expectations of others.

    Human Immunodeficiency Virus The retrovirus that causes AIDS – the acquired immunodeficiency syndrome.

    Illness representations Mental models that operate in long-term memory and comprise a number of beliefs associated with the identity, onset, progression, cause, expectancies and outcome of illness.

    Implementation intentions The processes by which formed behavioural intentions are likely to manifest themselves in actual behaviour and the striving for goal intentions based on recognition that a response that will lead to the successful completion of a goal, and also the situation in which that response would be possible.

    Infertility A diminished or absent ability to produce offspring. Diminished ability is sometimes referred to as subfertility.

    Inpatients An individual who is admitted to hospital overnight, usually for a period not less than 24 hours, in order to receive treatment or services.

    Interpretative phenomenological analysis An analytical approach that is concerned with personal perception or account of an event and does not attempt to produce an objective statement of the object or event itself. It assumes that there is an association between what people say and how they think and feel about an object in their social worlds.

    Interpretative repertoires The types of metaphors and images used in everyday talk to ‘construct’ an object. They are used in contradictory ways by the same person in differing contexts such as the goals that people bring to their interactions.

    Interviews In qualitative research, the technique of conducting a research interview in person in the field by a trained individual in order to ask a series of structured or semi-structured questions related to the research question of interest.

    Korsakoff's syndrome A syndrome of severe mental impairment characterized by confusion, disorientation and amnesia, often resulting from excessive and chronic alcohol abuse.

    Linkage In molecular genetics, a technique for identifying a region of a chromosome which may contain a genetic variant related to the phenotype of interest. Due to the tendency for genetic markers to be inherited together because of their location near one another.

    Locus of control A personality based factor that emphasizes the distinction between the internal control of an event and the external attribution of an event.

    Longitudinal In research study design, the measurement of outcomes at repeated intervals over time in a cohort of individuals. Allows the identification of factors related to outcomes of interest before those outcomes have become apparent or have developed.

    Lung cancer The uncontrolled growth of abnormal cells in lung tissue. The disease tends to progress extremely rapidly, and life expectancy following diagnosis is typically short.

    Malignant In cancer, a progressive and uncontrolled growth, caused by abnormal cell division, which spreads to other body parts.

    Meta-analyses The combination, review and re-analysis of existing datasets that provides a large sample size and high statistical power for analysis.

    Molecular genetics The study of the relationship between specific genetic variants, using either association or linkage techniques, with any phenotype of interest, including behavioural traits, risk of disease, and so on.

    Monozygotic In genetics, the identical twins which result from the simultaneous fertilization of a single egg by two sperms, and who shared 100% of their genotype as a result.

    Moral model In addiction, the perspective that addictive behaviours are a matter of choice, deserving of punishment rather than treatment. This view was widely held in the past but is not in current conceptions of addictive behaviour.

    Morbidity rates The numbers of cases of people in a population who suffer costs associated with a particular illness or disease such as disability or injury.

    Mortality rates The numbers of cases of people in a population who die from a particular illness or disease.

    Mortality salience hypothesis Derived from terror management theory. Identifies that two types of distal defence strategies are used to reduce the state of ‘terror’ caused by the saliency of mortality by making cognitive and behavioural efforts to protect their cultural worldview (views shared among individuals about the nature of reality) or to maintain or increase personal self-esteem by reinforcing the values sanctioned by their cultural worldviews.

    Motivational phase A pre-intentional stage proposed by the health action process approach which proposes that behavioural intention is predicted by perceived self-efficacy outcome expectancies and risk perception processes.

    Myocardial infarction A heart attack, which occurs when the blood supply to part of the heart is cut off. If the blood flow to the heart is not restored, that part of the heart will die, causing disability or death.

    Narrative In qualitative research, the analysis of (usually textual) accounts of individuals who are the focus of research, and the detailed description of the findings of this research (as distinct from the numerical findings of quantitative research).

    Natural reinforcer In learning theory, a reinforcer which occurs naturally (e.g., food, water) and has reinforcing properties that do not arise from association with other reinforcers. Can act as an unconditioned stimulus, giving rise to an unconditioned response, in classical conditioning, for example.

    Negative affectivity A tendency to experience persistent and pervasive negative mood and negative self-concept. As distinct from positive affect.

    Negative reinforcement In learning theory, the increase in the frequency of a response or behaviour resulting from the removal of an aversive event immediately after the response or behaviour is performed. As distinct from positive reinforcement.

    Neoplasms New growth or tumour which may be benign or malignant.

    Neuroadaptation A permament or semi-permanent structural or functional change in the central nervous system, for example as a result of learning processes.

    Neurobiological model In addiction, the view that addictive behaviours have a biological basis, with learning processes and the resulting changes in the central nervous system thought to play a central role in the maintenance of these behaviours.

    Neuroimmune system Comprised of the immune system and those components of the central and peripheral nervous system that modulate immune response.

    Neurological models In pain, the view that subjective experiences of pain can be understood in terms of activity in the central and peripheral nervous system.

    Neuropathic pain Pain that originates from damage to a nerve or the nervous system.

    Nicotine replacement therapy Pharmaceutical products used in smoking cessation which work by replacing the nicotine usually consumed in cigarette smoke, via patches, gum, lozenges, or other delivery devices. These roughly double the chances of successfully stopping smoking.

    Nociception Activity in specific nerve pathways resulting from tissue damage which is felt subjectively as pain.

    Objectification The mechanism by which unfamiliar (or abstract) events are changed into concrete realities and may result in the use of metaphor in everyday language to explain and understand abstract concepts.

    Objectivity The extent to which a measurement is impartial and impervious to influence by the participant or experimenter in a research study.

    Observational In research study design, a method of collecting data which does not involve an experimental manipulation. Case-control and cohort studies may both be observational in nature.

    Ontologizing The processes in which physical characteristics are attributed to some concept or idea or how the immaterial becomes materialized.

    Operant conditioning The learning process by which behaviours that result in positive outcomes (or the removal of negative outcomes) increase in frequency, and those that result in negative outcomes decrease in frequency.

    Opioid Narcotic drugs that resemble naturally occurring opiates and are used to treat moderate to severe pain. Opioids are similar to opiates such as morphine and codeine.

    Outcome expectancies Beliefs that undertaking a particular behaviour will result in an anticipated outcome.

    Outpatients A patient who visits a healthcare facility for diagnosis or treatment without spending the night. Sometimes called a day patient.

    Pain An unpleasant sensation, either related to tissue damage or defined in terms of such damage, that can range from mild, localized discomfort to agony. Pain has both physical and emotional components.

    Parkinson's disease A progressive nervous disease occurring in later life, associated with the destruction of brain cells that produce dopamine, and characterized by muscular tremours, slowing of movement, partial facial paralysis, distortions of gait and posture, and physical weakness.

    Passive smoking The inhalation of tobacco smoke produced by someone else – a consequence of exposure to environmental tobacco smoke.

    Pathological gambling An impulse control disorder associated with gambling. It is a chronic and progressive mental illness similar in many respects to substance use disorders. Often cited as an example of a behavioural addiction.

    Patient controlled analgesia A system that allows people to control the amount of pain medication that they receive. The person pushes a button and a machine delivers a dose of pain medicine into the bloodstream through a vein.

    Perceived barriers Beliefs related to the likely barriers to undertaking a recommended course of action in response to a health threat. From the health belief model.

    Perceived behavioural control Beliefs that relate to how much control a person thinks they have over a certain behaviour. From the theory of planned behaviour.

    Perceived benefits Beliefs related to the likely positive consequences associated with undertaking a healthy behaviour. From the health belief model.

    Perceived severity Beliefs about the severity of the consequences of becoming ill or not undertaking a behaviour on one's health. From the health belief model.

    Perceived susceptibility Beliefs about how likely one is to suffer a negative (or positive) health outcome. From the health belief model.

    Personality An area of psychology that is about individual differences and what makes us unique as human beings by emphasizing how psychological systems (i.e. traits) are organized within an individual and how this causes behaviours and ways of thinking that are characteristic of the individual.

    Personification The perceived connection between a concept and some person or group (e.g. Skinner and behaviourism) in order to provide for the concept a concrete existence.

    Persuasion processes Attitude formation or change process. Occurs usually after exposure to arguments or other information about the attitude object.

    Phantom limb pain Pain or discomfort felt by an amputee in the area of the missing limb.

    Phenotype The observable physical or behavioural characteristics of an organism, as determined by both genetic and environmental influences.

    Physical dependence An adaptive physiological state that occurs over time with regular drug use and results in a withdrawal syndrome when drug use is stopped; usually occurs with tolerance. As distinct from psychological dependence.

    Placebo effect The beneficial effect in a patient following a particular treatment that arises from the patient's expectations concerning the treatment, rather than any active properties of the treatment itself.

    Polymorphic Occurring in multiple forms. In genetics, refers to the fact that certain genes may exist in multiple forms, sometimes resulting in differences in function.

    Positive affect Broad term describing elevated mood, happiness and other positive emotional states. As distinct from negative affect.

    Positive imagery A therapeutic intervention which involves the maintenance of positive thoughts and mental images.

    Positive reinforcement In learning theory, the increase in the frequency of a response or behaviour resulting from the acquisition of a positive event or outcome immediately after the response or behaviour is performed. As distinct from negative reinforcement.

    Positron emission tomography A neuroimaging technique that uses signals emitted by radioactive tracers to construct images of the distribution of the tracers in the human body (usually the brain).

    Precaution adoption process model Weinstein's model that identifies seven stages that people progress through in a defined sequence from being unaware of a potential health threat to the maintenance of behaviour designed to remove this threat, and processes that are influential for transition from one stage to the next.

    Prevalence The proportion of individuals in a population having a disease.

    Primary gain The relief of emotional conflict and distress by the patient which can be achieved by ascribing emotional conflict (e.g., resulting from job loss) to an organic illness as a coping mechanism. As distinct from secondary gain and tertiary gain.

    Problem drinking Pattern of drinking that is potentially harmful and association with lifestyle factors, but has not yet resulted in a diagnosis of alcohol dependence.

    Problem gambling Participation in any form of gambling to the extent that it creates any negative consequences to the gambler, their family, place of employment, or others. Related to pathological gambling.

    Prohibition A law forbidding the sale of alcoholic beverages, established in 1920 in the USA and later repealed.

    Prospective In research study design, where one or more groups (cohorts) of individuals who have not yet had the outcome of interest are monitored for the number of such events which occur over time.

    Protection motivation theory Rogers’ approach for the understanding of mechanisms by which a person reduces the threat of an event and stimulates the motivation to protect oneself from potential negative outcomes associated with the threat based on the degree of perceived severity of an event, the perceived likelihood of an event or outcome occurring if no adaptive response is made to the threat event, and how efficacious the response made to the threat is perceived to be.

    Prototypes Those cases of an event which are used to compare an unfamiliar event against. If the unfamiliar object is similar to the prototype it is assigned the characteristics of the prototype. If the unfamiliar is dissimilar to the prototype it is adjusted so as to fit the characteristics of the prototype.

    Pseudo-longitudinal In research study design, the cross-sectional collection of data on groups of individuals of, for example, different ages, to allow the (imperfect) study of changes over time (e.g., related to age).

    Psychological dependence A compulsion to use a drug for its pleasurable effects (see positive reinforcement) or for its removal of unpleasant effects or moods (see negative reinforcement). As distinct from physical dependence.

    Psychometric The design, administration and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude and personality traits.

    Psychoneuroimmunology The branch of psychology concerned with the study of the interaction of psychological, behavioural, neural and endocrine factors and the functioning of the immune system.

    Psychophysiology The branch of psychology that is concerned with the biological and physiological bases of psychological processes.

    Psychosocial risk factors Those psychological and social factors (such as belief sets and behaviours) that put an individual at an increased risk of experience of suffering a negative health outcome.

    Psychosomatic medicine A view that considers that psychological causes can not only be the consequences of an illness but may also be the cause of physical illness.

    Public health The approach to medicine that is concerned with the health of the community as a whole (as opposed to individual patient health).

    Quality of life The overall enjoyment of life, including an individual's sense of well being and ability to perform various tasks, as well as simple longevity.

    Randomization A method based on chance by which study participants are assigned to a treatment group. Randomization minimizes the differences among groups by equally distributing people with particular characteristics among all the trial arms.

    Randomized clinical trial A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using randomization to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively.

    Relapse The return of signs and symptoms of a disease after a patient has enjoyed a remission. This can include behavioural symptoms, such as an abstinent smoker relapsing to regular cigarette consumption.

    Relative risk ratio The calculation of the likelihood of a certain event occurring equally for two population groups. A relative risk ratio of 1 means that the event is equally likely in both groups; a ratio of above one that the event is more likely in the first group; and a risk ratio below 1 that the event is less likely in the first group.

    Relaxation A therapeutic intervention using simple relaxation and breathing exercises to enable an individual to relax.

    Reliability The extent to which a measurement instrument yields consistent, stable and uniform results over repeated observations or measurements under the same conditions each time. Freedom from measurement error.

    Replacement therapy In addiction, the use of pharmaceutical grade drugs (e.g., nicotine for smoking cessation) or alternatives (e.g., methadone for heroin dependence) to ameliorate withdrawal symptoms in abstinent drug users while minimizing the harmful effects of the drug.

    Response efficacy A component of protection motivation theory that refers to personal beliefs that self-protective action will decrease the arousal experienced as a result of a health threat.

    Retrospective A study looking back in time, so the outcomes have occurred to the participants before the study commences. Case-control studies are always retrospective, cohort studies can be, and randomized clinical trials are never retrospective.

    Risk factor A characteristic of personal behaviour, lifestyle or inherited factor that is associated with the experience of health-related outcomes.

    Schizophrenia A mental illness in which the person suffers from distorted thinking, hallucinations and a reduced ability to feel normal emotions.

    Secondary gain The acquisition of (often unanticipated) positive outcomes by the patient, such as personal attention and service, monetary gains, disability benefits, and release from unpleasant responsibilities, resulting from an organic illness. As distinct from primary gain and tertiary gain.

    Self-efficacy Beliefs about the perceived degree to which people have control over outcomes associated with doing a particular behaviour, or how confident a person is in their ability to perform a certain action and attain anticipated outcomes.

    Self-empowerment approach A health promotion perspective that argues for the emphasis in activities to be on self-empowerment derived by engagement and involvement with health-related activities at an individual or community based level.

    Self-monitoring The process of maintaining an awareness of one's own actions and intentions. Can be applied broadly to describe personality traits (some people are high ‘self-monitors’) or therapeutic interventions (where greater awareness is encouraged for some therapeutic benefit).

    Self-regulation The process by which an individual monitors their behaviour, emotions and thoughts to maintain an equilibrium in psychological and physical functioning.

    Self-regulation model of illness cognition and behaviour Outline of the process by which people monitor and respond to changes in experience behaviour, thinking and emotion by utilising the illness representations and emotional representations derived from an illness experience to generate coping responses aimed at re-establishing healthy equilibrium. The system involves appraisal of the effectiveness of the coping responses applied for re-establishing equilibrium.

    Sexually transmitted disease Any disease (e.g., gonorrhoea, syphilis, herpes, Chlamydia) that is transmitted through sexual contact.

    Sexually transmitted infection An infection that can be transferred from one person to another through sexual contact.

    Single blind In research study design, the condition whereby either the research participant or the researcher are blind to the specific experimental condition to which the participant has been allocated.

    Single photon emission computed tomography A type of neuroimaging using nuclear imaging that shows how blood flows to tissues and organs.

    Smokeless tobacco Tobacco that is not burned or smoked but used in another form such as chewing tobacco or snuff.

    Social cognition models Models which emphasize the way in which our cognitions, thoughts and emotions are affected by the immediate social context, and in turn how these affect social behaviour through learning processes.

    Social Cognitive Theory A widely used approach that emphasizes the role social modelling, or vicarious learning, on human motivation, thinking and behaviour. Motivation and behaviour are regulated through reasoned pre-actional thinking and behavioural change is determined by a sense of personal control over the environment.

    Social comparison theory The argument that individuals are motivated to seek self understanding and self knowledge by evaluating themselves in their social worlds, and attempting to understand whether the beliefs and opinions they hold are correct by ‘looking’ at others and how others’ behaviour or belief sets differs from their own.

    Social constructionism An approach that argues that as social experiences are forever changing, we can only examine how the world appears at the time at which we are looking at it, and that knowledge and experience of the social world is created (or constructed) by language, culture and history. Reality is argued to be socially constructed through interactions in the social world.

    Social context The social context or social environment is the set of social positions and social roles which an individual participates in and interacts with.

    Social inequalities The observation that there are real differences in the health status of individuals according to socio-demographic characteristics.

    Social learning theory The argument that social behaviour is learned by observing and imitating the behaviours of others and also by receiving reinforcement for their own social behaviours. Behaviour is shaped by perceived outcome expectancies and self-efficacy beliefs related to an event.

    Social model In disability, the argument that barriers, prejudice and exclusion by society (purposely or inadvertently) are the ultimate factors defining disability, rather than any inherent characteristics of the individual.

    Social representations The values, thoughts, knowledge and images that a collective share in which a person's own identity is found in the collectivity of others and own experience.

    Social support The availability and use of emotional and instrumental advice in coping with currently experienced environmental stressors.

    Socio-economic status A broad term that is used to describe factors about a person's lifestyle including occupation, income and education.

    Spinothalamic tract The sensory pathway in the body that transmits pain, temperature, itch and touch information from the peripheral nervous system to the central nervous system.

    Stages of change model see transtheoretical model

    Stress-health relationship The effects of subjective stress and the resulting stress reaction on psychological and physical health, in particular as a consequence on long-term exposure to stressors.

    Stress management Interventions designed to reduce the impact of stressors in the workplace and environment more generally. These can have an individual focus, aimed at increasing an individual's ability to cope with stressors.

    Stress reaction Any physiological or psychological reaction to physical, mental or emotional stress that disturbs the organism's homeostasis.

    Stressor Internal or external factors or stimuli that produce stress. These can be physical, biological, environmental or psychological. They share the capacity to elicit a common stress reaction.

    Subfertility A state of reduced fertility, resulting in a less than normal capacity for reproduction.

    Subjective norm Beliefs we have about how other people we perceive as being important to us would like us to behave (normative beliefs) and the value we hold about behaving that way in line with other's wishes (motivation to comply). From the theory of planned behaviour.

    Substance In addiction, any agent with psychoactive properties which has the potential to be abused because of physical dependence or psychological dependence liability.

    Superiority In research study design, the attempt to demonstrate that the effects of a medication are superior to a placebo medication. As distinct from equivalence trials.

    Tar The term used to describe the particular (as opposed to gaseous) chemicals (mostly toxic) found in cigarette smoke produced by the burning of tobacco.

    Tension-reduction hypothesis In addiction, the hypothesis that substance use is maintained in part by negative reinforcement processes related to the ability of the substance to reduce subjective tension and stress.

    Tertiary gain The acquisition of (often unanticipated) positive outcomes by the caregiver, such as gratitude, monetary gains, disability benefits, resulting from an organic illness in the patient for whom he or she is caring. As distinct from primary gain and secondary gain.

    Textual accounts In qualitative research, written or transcripted interview material used as the object of study for analysis.

    Thematic methods In qualitative research, the identification of themes (for examples in interview exchanges), which may be used to guide the development of theoretical perspectives and, in some cases, subsequent data collection (see Grounded Theory).

    Theory of planned behaviour Ajzen's extension of the theory of reasoned action. States that the immediate antecedent of actual behaviour is behavioural intention. Behavioural intention is predicted by perceived behavioural control, attitude and subjective norm.

    Theory of reasoned action Fishbein and Ajzen's theory that proposes that the immediate antecedent of actual behaviour is behavioural intention. Behavioural intention is predicted by attitude and subjective norm.

    Terror management theory An approach to the study of the effects of fear appeals. When people are reminded of their own mortality they use proximal defensive strategies like denial or distancing. After delay when thoughts of one's own mortality are accessible but not in focal attention, distal defence strategies such as bolstering self-esteem will be used.

    Threat appraisal A component of protection motivation theory that proposes that the inhibition of maladaptive responses is dependent upon the perceived severity of a threat and perceived vulnerability to the threat.

    Tobacco Leaves of the tobacco plant, of the genus Nicotiana, dried and prepared for smoking or oral ingestion.

    Tolerance In addiction, the condition that occurs over time when the body gets used to a substance so that increasing doses are required to achieve the same effect.

    Transtheoretical model Prochaska and DiClemente's model that proposes five stages through which a person progresses in sequence from not thinking about undertaking a behaviour change, through the decision to change to maintenance of the change. Developed from an amalgamation of a number of key psychological and psychotherapeutic theories of processes in change.

    Triple blind In research study design, the condition whereby the research participant, the researcher and a third-party (e.g., the statistician analysing the resulting data) are blind to the specific experimental condition to which the participant has been allocated.

    Tumour A mass of abnormally growing cells that serve no useful bodily function. Tumours can be either benign or malignant.

    Type A behaviour A constellation of factors including competitiveness, achievement-orientated behaviour, impatience, being easily annoyed, hostility and anger, trying to achieve too much in too little time and a vigorous speech pattern that has been used to study the aetiology of various health outcomes (e.g. coronary heart disease). It was first described as an important risk factor in coronary disease in the 1950s by Friedman.

    Type C personality A personality type characterized by the personal attributes of cooperation, appeasement, compliance, passivity, stoicism, unassertiveness, being self-sacrificing and the inhibition of negative emotions. Suggested as a risk factor in cancer.

    Type D personality type A personality type characterized by inhibition of expression of negative emotions and avoidance of social interaction so as to avoid feelings of disapproval.

    Unconditioned response In classical conditioning, the unconditioned response is the unlearned (i.e., innate) response that occurs naturally in response to the unconditioned stimulus.

    Unconditioned stimulus In classical conditioning, a stimulus that evokes an unconditioned response.

    Validity The ability of a test to measure what it was designed to measure, and the degree to which the results of a experimental method lead to robust and clear conclusions (see Psychometrics).

    Volition phase A post-intentional stage proposed by the health action process approach which describes factors that are important for translating intention into action such as specific types of efficacy beliefs and planning processes.

    Withdrawal symptoms Abnormal physical or psychological symptoms that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence.

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