Questions of mind, body, and how they interact are at the core of the fascinating field of health psychology. More than just a collection of theories or esoteric research, there’s something for everyone in this rapidly-growing area of psychology to help you optimize your physical and mental functioning. Whether you experience chronic pain, allergies, high blood pressure, or just random bouts of indigestion or soreness, health psychology provides new ways for you to think about how to get relief. Just as importantly, it also offers ways to steer yourself onto the path of prevention.
In a recent publication of the journal Health Psychology, University College London psychologist Susan Michie and her associates (2013) describe where the field is headed and how recent advances translate into real-life strategies from which we can all benefit. It’s all part of the larger movement called translational research, in which health professionals put their heads together and figure out the real-world applications of what they study in the lab. Some of these ideas will have a familiar ring to you, especially if you have some background in basic psychology.
1. Your health decisions reflect what you’ve learned and how you make decisions.
Learning theory proposes that our behavior reflects the conditions to which we’re exposed which shape all of our habits, health and otherwise. Through operant conditioning, we come to acquire certain habits in response to particular cues. This type of conditioning accounts for the ways, for example, you continue be attracted to foods that you know are bad for your health. Throughout your life, you’ve come to associate pleasant feelings with high-salt, high-sugar, high-fat, and high-calorie food (French fries, donuts, cheese snacks, to name a few). These are hard habits to break because they come from such a long line of experiences involving positive rewards. The punishment of getting a bad bill of health from your physician is painful while it lasts, but it’s easily overcome by the far more prevalent lure of the Golden Arches.
Part of the reason this type of control over behavior exerts its effect is associative, or classical, conditioning. The Golden Arches trigger your brain’s pleasure centers, reminding you (even if only unconsciously) of the guilty thrills that await your palate. These are hard urges to resist.
How do you break these strong, ingrained habits? This is where decision theory comes into play. Economists study the cost-benefit analyses we all conduct when we are approached with choice points, small and large, as we try to maximize our expected utilities. It’s great to think that you’re a logical, rational person who sits down and puts “pro’s” in one column and “con’s” in another when you’re faced with health-related choices in your life. Unfortunately, when confronting a tempting option, the brain’s pleasure center screams “want” so loud that it drowns out “should.” As Michie and her team put it, “According to decision theory, this process may be incomplete, haphazard, subject to bias and misperception, and disrupted by emotion” (p. 582).
How can you overcome your brain’s own attempts to sabotage your best intentions? (or, as Freud would say, turn up your superego and turn down your id)? By recognizing that you have these cognitive biases, gained through emotional (“evaluative”) conditioning, you can catch them at work before they lead you into dangerous territory. You can form new links between pleasurable sensations and positive health behaviors, though at first this may seem impossible. The key is to identify your triggers and gradually replace the bad, unhealthy, associations (e.g. sugar=pleasure) with less obvious, but healthy, alternatives (e.g. controlling your sugar urge=pleasure). You can build your sense of self-efficacy as you show that you can turn away from the lures that previously trapped your automatic, reflexive cravings.
How about those faulty decision-making processes? Must you be a victim forever to your inability to choose the long-term benefits of health to the short-term benefits of pleasure? Unfortunately, the information from studies evaluating the impact of calorie counts in fast food restaurants on decision-making of consumers is not encouraging. People either ignore the charts completely or use them in unintended ways, such as not adding up all components of their meal or concluding that the calorie count isn’t as bad as they expected. You, though, can overcome these tendencies. Before you set foot into the restaurant, grocery store, or even your kitchen, decide on the plan of action you intend to follow. You’ll be less swayed by impulsive choices. Reward yourself, after you’ve stuck to your decision, with another activity you enjoy (5 minutes of a computer game). Most importantly, believe that you can control your health behaviors and when you do, step back and admire your work.
2. Context is everything when it comes to improving your health.
Your health-related decisions occur in a large variety of settings. In many of these settings, you don’t have control over the stimuli that pummel your senses. For example, you may conquer the urge to snack on high-fat foods in the isolation of your home, which is why health experts recommend purging your pantries of all those temptations. What happens when you set foot outside, though, especially in such danger zones as your local mall’s food court? Even worse, when you’re traveling, the rest stops on the highway practically grab you by the throat and force you into the pizza or ice cream and not the fresh fruit or salad lines. Your tendency to say all bets are off when you’re traveling only makes things worse.
I knew a book editor whose rationale for overeating on business trips (which, as an editor, were very frequent) was the “last meal theory.” He would say, "Well I’m on this airplane, it may crash, so I may as well enjoy my last chance to indulge." I lost touch with him when he changed jobs, but as far as I know, he was never involved in any travel-related calamities. It’s more likely that his last meal theory led him to the emergency room, where it became a self-fulfilling prophecy.
Health psychologists are trying new technologies to identify the cues that trigger our naughty pleasure centers. These researchers have gone way beyond the old and unreliable methods of diary studies (paper records completed at the end of the day), telephone messaging, and pagers. Mobile apps that participants agree to use when they sign up for studies allow researchers to monitor health choices as they’re being made. Not only can researchers track calorie intake, but they can use mobile devices to chart how much exercise people are getting, when they’re getting it, and how. Getting really sneaky, they can put sensors on public restroom sinks to see whether and how much people wash their hands. No need to ask people questions anymore, even about the most personal of habits!
The point for you is that in order to ensure the decisions you make will benefit your health, add in a few context points to allow for variation from place to place. Learn the settings that weaken your resolve the most (malls, movie theaters, coffee shops), and plan accordingly. You can even become your own researcher by bringing your objective powers of observation into focus to find out which contextual features might compromise your resolve.
3. Become a discerning consumer of health information.
Michie and her team, speaking to the research community, admonish their colleagues to adopt “rigorous criteria for demonstrating intervention effectiveness.” However, as a consumer, it’s perhaps even more important that you follow this advice. Don’t go chasing after every newest so-called advance, whether it’s a fad diet, an “exercise pill”, or a workout routine. Learn to look at the fine print yourself. Kick the wheels, metaphorically, of these new studies. You may feel that you lack the scientific expertise to evaluate the evidence, or that – despite what the ads say- you can’t “talk to your doctor.” However, you’d be surprised how quickly you can learn a few rules of thumbs and key words to look out for.
You want your health information to be evaluated by a scientific review process (though this can be subverted at times), to have words like “statistically significant” (not “trend”), and to have been shown that the diet or treatment works in more than one study (“replication”). The research should be done on people like you, not college undergrads if you're not one, men if you’re a woman and women if you’re a man, and they should match you in other characteristics such as age, social class, and ethnicity. If this is really important to you, write to the study’s author and ask for a copy of the paper. If there’s too much jargon there for you to understand, go to Google and start looking up the word meanings. Whatever strategy you adopt, make sure you don’t blindly follow every lead. As you’ve probably figured out already anyhow, what one researcher claims to find will only last so long until another will find the opposite. You can’t do a 180 on your health strategies based on each of the latest fads.
In sum, the field of translational research is heading in a positive direction. Something called “Team Science” is now catching hold in all of health-related research, particularly the translational arm that attempts to test how well new findings fill the needs of the target populations (consumers). Team Science has the advantage, so far, of playing unopposed. Researchers and even academic departments are looking at ways to cross over the disciplinary boundaries that used to keep economists, for instance, from talking to cardiologists. Canadians and Europeans are probably ahead of Americans in this process, but an American reshuffling seems to be in the works, particularly as granting agencies start to put translational research higher on their priority for funding.
The good news is that you can approach your own health in a positive, proactive manner to translate what you know you ought to be doing to what you actually do. By seeing how the benefits of taking charge outweigh the costs of poor health, your choices will become easier, more natural, and even pleasurable.
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Copyright Susan Krauss Whitbourne, Ph.D. 2013
Michie, S., West, R., & Spring, B. (2013). Moving from theory to practice and back in social and health psychology. Health Psychology, 32, 581-585. doi: 10.1037/a0030205