• Recent views of health place heavy emphasis on biopsychosocial functioning
• Health and disease are the products of interactions among psychosocial and biological factors
• Psychosocial factors affect biological systems and can impair functioning
• Medical care cannot substitute for healthy habits
• Biopsychosocial perspective underscores
• Health enhancement
• Disease prevention
• Orientation change from a disease model to a health model
• Stress
• Efficacy mediates stress which contributes to physical dysfunction
• Controllability is a key to explaining biological effects of stress
• Exposure to stressors w/control --> no adverse effects
• Exposure to stressors w/ no control
• Activates neuroendocrine
• Catecholamine
• Impairs functioning of immune system
• Stress is governed by perceived control over ones life
• Social cognitive theory views stress as low efficacy to exercise control over aversive threats and taxing environments

Biochemical effects of perceived self-efficacy in coping with stressors (262)

• If people believe that they can deal with environmental stressor they are not so perturbed by them
• If they believe they cannot, they distress themselves
• It is the perception of life events that becomes the stressful reality
• Exposure to uncomfortable stressors is correlated with illness
• Common cold
• Headaches
• Stress increases susceptibility ti viruses
• "Whereas stress can impair immune functioning, positive mood can enhance it"
• Antibodies are higher on a pleasant day, lower on an aversive day

Autonomic Activation (263)

• Phobics perceived efficacy was raised by modeling and mastery experiences
• Snake phobics were viscerally unperturbed by things they felt efficacious about
• Heart accelerated and blood pressure rose during intimidating activities
• Thus low efficacy actually affects biological functioning/processes

Catecholamine Activation (265)

• Catecholamine are neurotransmitters that play a crucial role in brain-body mechanisms and in stress related hormones that mobilize body systems to deal with perceived threats (p. 265).
• Self-doubts in coping efficacy produce increased catecholamines
• As efficacy weakened
• Epinephrine rose
• Horepinephrine rose
• Dopac rose

Opiate activation (266)

• Opioids are a type of endorphin (body's painkillers)
• Studies show that stress triggers opioids
• Opioid activation is determined not by pain, but by the psychological stress over its uncontrollability
• Thus, animals that cannot control shock treatments show no opioid production
• People submerged their hands in ice water
• efficacious people had no opioid activation
• non-efficacious people had stress and opioid production

Opioid and Cognitive Mechanisms in Pain Control (267)

• The same intensity of pain stimulation can give rise to different levels of conscious pain, depending on
• How attention is deployed
• How the experience is appraised cognitively
• Coping strategies used to modulate pain
• How others are observed to react to painful stimulation
• Pain control techniques
• Attention strategies
• Cognitive distractions
• Cognitive reconstrual
• There are several ways that coping efficacy can reduce pain
• People who believe that they can alleviate pain enlist ameliorative skills and persist to reduce discomfort
• Altering consciousness because if pain sensations are supplanted in consciousness they are felt less
• Engrossing activities that are attentionally demanding are better than trivial thoughts
• Perceived efficacy mediates analgesic potency of various psychological procedures
• Less pain in later cold-presser tests
• Higher pain threshold
• Higher pain tolerance (268)
• Self-efficacy and back pain
• Patients judged their efficacy for lifting, bending carrying pushing, and pulling
• Expectation of pain and harm are largely products of perceived inefficacy
• Gains in efficacy increased physical functioning and patients suffering from degenerative disk disease
• Helplessness theory and self-efficacy theory appear to be at odds
• Pain endurance
• Helplessness theory - deficient control over stressors
• Self-efficacy theory - control over stressors
• Increased pain endurance through non opiod cognitive mechanisms
• Differing consequences of control it types of coping situations

Pain Regulatory Efficacy in Placebo Analgesia (272)

• The purpose of placebo is to separate the contribution between
• Psychological action
• Pharmocological action
• People sometime begin to behave in ways that produce benefits (M*A*S*H*)
• Strength of placebo analgesic is predictable from placebos affect beliefs in efficacy to endure pain
• Placebos work because they are efficacious in their ability to withstand pain
• Efficacy beliefs to ameliorate pain are enlisted by placebo based on past experience with medicine to relieve pain

Combining Medications with psychosocial Treatment (273)

• A Perceived efficacy that rests entirely on medicinal aid will not survive withdrawal of medication
• Smokers and obese people who had placebo pills withdrawn lost their effect quickly and reverted to old habits
• Those told they succeeded though their own efforts achieved further reductions in wight loss and smoking
• Combining medicines and development of self-regulatory skills can enhance perceived efficacy
• Medication that enable people to develop self regulatory skills can enhance perceived efficacy
• Medication facilitates skill development and skill development enhances perceived efficacy
• Medication can undermine efficacy if coping successes are ascribed to medication rather than improved capability

Perceived Coping Self-efficacy and Immunocompetence (274)

• Psychosocial factors modulate the immune system in ways that can influence susceptibility to illness
• Immunoregulatory influence operates through
• Neuroanatomical
• Neurochemical
• Neuroendocrine . . . links of the central nervous system.
• Three way perceived self-efficacy can affect immune functioning
• Stress mediation
• Self efficacy to control stressors mediates their impact on immune functioning
• Immune cells have receptors for opiods
• When opioids are blocked the stress of coping inefficacy loses it immonosuppressive power
• Exposure to stressors is accompanied by impairment of the immune system
• Decreased lymphocyte proliferative response to mitogen stimulation
• Reduced number of helper T lymphocytic and natural killer cell activity
• Weaker immunological control over latent herpes viruses
• Depressed interferon production
• Poorer DNA repair in lymphocytes exposed to X-radiation
• Acquisition of perceived efficacy to control stressors produced changes in immunity
• Generally sustained changes over time
• Mastery of choice stressors instills strong sense of efficacy and leaves long lasting protective changes
• Efficacy gained commandingly often conveys more generalized sense of coping than efficacy gained laboriously
• Laborious achievement of efficacy can leave on "sensitive"
• Stress management skills
• Decrease immunological vulnerability in healthy individuals
• Increase immunofunctioning in metastic cancer patients
• Enhance cellular and humoral immune functioning is seropositive men in asymptomatic stages of HIV infection (Magic Johnson)
• Depression Mediation
• Depression has been shown to reduce immune functioning and heighten susceptibility to disease
• Increased incidence of infectious diseases
• Development and spread of malignant neoplasms
• Accelerated rate of tumor cell growth
• Efficacy to develop social relationships influences indirectly b/c supportive relationships lessen the impact of adverse life events
• Control Mediation (277)
• The central nervous system can exert regulatory influence on immune functioning
• Induced expectations affect physical reactions to allergens and antigens
• Expectancy learning can enhance immune functioning as well as impair it
• Prior experiences effectively to ineffectively managing environmental demands affect beliefs about coping efficacy
• Have physiological consequences when stressors are no loner present
• Mere thoughts about coping efficacy lower or heighten autonomous activation
• Situationally aroused beliefs may produce anticipatory immunosuppressive or immunoenhancing effects
• Example: Gastrointestinal disorders
• Stress produces stomach upset, which can cause abdominal pain, nausea, bloating, and diarrhea
• Uncontrollable stressors trigger chemicals that wreak gastrointestinal havoc
• Can be fixed two ways
• Pill that blocks brain chemicals activated by stressors
• Gain permanent mastery over stressors in life
• People ought to learn to exercise control in life habits rather than rely on drugs

PERCEIVED SELF-EFFICACY IN HEALTH-PROMOTING BEHAVIOR (279)

• Three basic processes of personal change
• Adoption of new behavior patterns
• Generalized use under differing circumstances
• Maintenance over time
• Efficacy beliefs affect all three
• Whether people consider changing their health habits
• Whether they can enlist the motivation and perseverance
• Success in restoring control after setbacks
• Maintenance of changes

Initiation of Personal Change (279)

• People see little point in even trying what they think they are incapable of
• Smokers who don't believe, don't try
• If they do they give up easily
• Phases of habit change
• Efficacy rises as people move from disregarding habit changes to contemplating it, to initiating it, to maintaining change
• The media plays a role in reporting health issues
• Scare tactics often backfire
• Fear without sense of personal control -> futility
• Efficacy in ability to stick to a hygiene routine is a better predictor for adopting preventive practices
• Fear arousal had little effect
• A shift in emphasis is required
• From scaring people into health
• To providing them with the tools needed to exercise personal control over their health habits
• Interventions
• Guided self-enablement programs/mastery experience
• Emotions
• Positive emotions increase the availability of thoughts about personal success
• Negative emotions male personal failure more salient
• Public health messages that elicit positive emotions make people feel more efficacious and optimistic
• Health communications should emphasize that success requires perseverant effort . . . so that people's sense of efficacy is not undermined by a few setbacks" (p. 281).

Conceptual Models of Health Behavior (282) (see chart)

• Health belief model
• Preventive health efforts are influenced by four factors
• Perceived threats - provide motivation
• Benefits - influence course of action to take
• Barriers - influence course of action to take
• Cues to action - experience and social prompts
• Protections motivation
• Includes physical threat, adds to efficacy component
• Response efficacy - whether a given course of action results in a given attainment
• "We are now in the age of cafeteria style theorizing in which constructs are plucked from divergent theories and strung together in various combinations as alternative conceptual schemes in the name of theoretical integration" (p. 285).

Achievement of Personal Change (286)

• Effective self-regulation is not achieved through an act of will. It requires the development of self-regulatory skills.
• Monitor behavior they want to change
• Set short range, achievable sub goals (motivate)
• Enlist positive incentives and social supports (sustain motivation)
• The stronger the efficacy beliefs the interventions instill, the more likely people are to enlist personal resources and sustain effort needed to maintain healthy behaviors
• Enhancement of pulmonary functioning
• Recovery of cardiovascular functioning
• Reduction of pain in arthritis patience
• Ameliorate tension headaches
• Control of labor pain during labor and childbirth
• Manage lower back pain
• Stress reduction
• Weight reduction
• Control over bulemic behavior
• Reduction of cholesterol through diet
• Maintaining diabetic self-care
• Coping with invasive medical procedures
• Contraceptive use
• Controlling sexual practices
• Addictive habits
• Alcohol abuse
• Smoking
• Opiate drugs

Maintenance of Personal Change (287) - Habits

• Habit changes are of little consequence unless they endure
• Habits embedded in interpersonal relationships are not easy to break
• Maintenance of habit change relies heavily on self-regulatory capabilities
• Experiences in exercising control serve as efficacy builders
• Each mode for enhancing perceived efficacy helps develop a resilient sense of efficacy
• Enactive mastery -- structured demonstrations trials exercising control over progressively more challenging tasks
• Modeling - patients demonstrate how to cope with and reinstate control; they make clear that success requires tenacious effort.
• Persuasion - verbal persuasions - construing a slip as an occasion for improvement supplants self-debilitating thoughts with constructive problem solving
• Long-term success in altering and maintaining health habits depends on self-regulatory skills.
• Perceived self-efficacy is a good predictor of how well people stick to healthful behavior
• Hypertension - the more firmly people believe in self-regulatory efficacy, the more they practice relaxation
• Efficacy beliefs predict adherence to habits that enhance cardiovascular functioning
• Predicts likelihood that organ transplant recipients will stick to immuno-suppressive medication
• Self-management of diabetics regiments

Relapse Prevention and Management (289)

• Relapse process is the same for
• Heroin addiction
• Alcoholism
• Smoking
• Common pre-cipients include inability to manage negative emotional states like
• Stress
• Loneliness and depression
• Boredom and restlessness
• Social pressures
• Personal conflict
• Mechanisms through which situational reminders prompt relapse
• Produce biological and cognitive change
• Familiar settings trigger biochemical reactions
• Familiar settings trigger positive or pleasurable outcome expectations
• Courses of behavioral change include
• Improvements
• Plateaus
• Setbacks
• Recoveries
• "People often must go through several cycles of mastery and relapse before they finally succeed" (p. 290).
• "Because serious attempts to quit are usually followed by lapses and relapses, the mastery process is better viewed in terms of relapse management rather than relapse prevention (p. 293).

Ecological Perspective on Efficacious Self-Regulation (p. 293).

• Each of the three classes of interactants - environmental factors, self-system, behavioral competencies - contribute to the long-term control of substance abuse. (Include little triangle here)
• Social support and guidance during difficult times bolster the maintenance of abstinence
• Environmental orientated approaches create social structures that enable people to exert satisfying proactive control over their family, occupational, and recreational lives.

Dynamics of Self-Regulation (p. 294)

• An efficacy belief system is not an immutable trait
• Understanding self-regulatory efficacy requires ongoing assessment of fluctuations of efficacy beliefs and behaviors they influence
• Proximal efficacy beliefs regulate behavior

Self-regulatory Model of Health Promotion and Risk Reduction (295)

• "Health care has thus become a major domestic problem" (p. 295)
• People who adopt healthful habits live not only longer but healthier lives, with less need for medical services
• Health promotion policies pay for themselves
• Physicians do not change high-risk behavior thus -> minimal prevention and costly remediation

Self Management and Chronic Disease (299)

• Rather than receive enabling guidance, most people suffering from chronic illness are heavily medicated or given guidelines that they ignore
• Treatment of chronic disease must focus on self-management of physical conditions over the lifetime rather than on care
• Pain amelioration
• Enhancement and maintenance of functioning with growing physical disabilities
• Development of self-regulatory compensatory skills
• Holman and Lorig Model of self-management of chronic diseases
• Cognitive pain control techniques
• Self-relaxation
• Proximal goal-setting
• Self-diagnosis skills
• Skills in locating community resources

Social Diffusion of Health Promoting Practices (302)

• An effective program of widespread change in health practices includes 4 major components
• Informational - build up people's awareness of health risk ans benefits
• Self-regulatory - development of social and self-regulatory needs
• Building robust sense of efficacy to support exercise of control in face of difficulties
• Enlisting and creating support for desired personal change
• Informational
• Mass media can be used more effectively
• Despite high levels of knowledge about health risks, many people continue health impairing practices
• People need reasons and means to change
• self-regulatory skills
• Motivation is not enough, skills must be developed
• Motivation without skills produces little change
• Self-regulation operates through 3 main subfunctions
• Self - monitoring
• Goal setting
• Enlistment of self-incentives for personal change
• Successful self-regulators enlist component subfactors of self-regulation
• Track their behavior
• Set proximal goals
• Draw from an array of coping strategies
• Create positive incentives for their efforts

Health Promotion in Childhood (303)

• It is easier to prevent detrimental health habits than to try to change then
• Prevention should be given priority but rarely is
• Rising health costs are likely to change all that
• School are natural settings for preventive programs
• Health promotion curriculum
• Healthy lunches
• New school based models (home community school)
• Current programs provide information but do little in the way of shaping and regulating habits (305)
• The programs that have proved most effective in substance abuse
• Strip the substance of its glamorous image
• Awarify students that substance abuse is not the norm
• Awarify students of health risks
• Model strategies for resisting social pressure

Social Supports for Personal Change (p. 307)

• Personal change occurs within a network of social influences
• Social influences can aid efforts at personal change
• Social influences can retard efforts at personal change
• Social influences can undermine efforts at personal change
• Subcommunity norms
• Taking drugs is a shared enterprise
• Kelly trained a group of well respected and popular students to lead the charge at a school and it worked well
• Social norms exert influence on behavior via 2 sanctions
• Social - community based models use both formal and informal networks
• Personal
• Community ownership is best achieved when a cadre of health educators is taught how to design, co-ordinate and implement programs for disease prevention and health

Health Enhancement Through Health Policy Initiation and Environmental Change (310)

• Health habits are not totally under personal control. They are the products of reciprocal interplay of personal and social influences
• Health of a nation is a social matter
• Personal beliefs in their collective efficacy to accomplish social change play a key role in health policy
• Health field has sound policies but lacks the collective efficacy to realize them
• Cigarette smoking is the single most preventable cause of death
• Kills more than 400,000 people a year
• More people die annually from smoking than from
• Alcohol
• Heroine
• Cocaine
• AIDS
• Suicide
• Homicide
• Auto accidents
• Fires
• Combined
• 3000 children take up smoking daily
• one-third will die of tobacco related disease
• Unless people take up habits as youngsters, they rarely become smokers during adulthood

Scope of Prognostic Schemas (313)

• Factors to include in prognosis schemes
• Biological factors
• Social factors and influences
• Self-beliefs of patents
• Psychological recovery from heart attack is a social rather than individual matter
• Spouses judgements have a strong impact
• Treadmill activities raised patients and spouses belief in patient ability to withstand cardiovascular strain
• Mode of conveying prognosis information (316)
• It is good to use verbal tasks, but add performance tasks as well

Self-Validating Potential of Prognostic Judgements (317)

• Diagnostics not only foretell the course of recovery but may partly influence it
• They form expectations about probable courses of a disease
• These beliefs are conveyed to patients
• People whose beliefs were raised by bogus information exhibited functional improvement in physical stamina and pain management