Health Psychology. Michael Murray
a cup of tea.There are no guarantees the end product will be fit for purpose. The final product is almost certainly inferior to the genuine article. The filtering process in EBP consists of seven levels: current knowledge, theory and paradigms taught in universities and schools; funding priorities of government, industry and charities; hypotheses considered important by the funders; methodology approved by funders; journal publication; systematic reviews; translated into EBP.
To be judged ‘sound’, evidence must pass through these seven filters, which are biased towards the preservation of existing practices, knowledge and myths. In confirming the ‘sound’ status of the techniques that have passed through the filters, the ‘unsoundness’ of the unfiltered techniques occurs by default. Undeniably, evidence filtering is systematic and biased towards the status quo. Evidence is considered ‘sound’ or ‘unsound’ according to established criteria.
However, EBP is contentious on a number of grounds. First, it is wasteful that so much evidence is ‘thrown away’. Many unfiltered techniques are quite possibly as effective as techniques that have been filtered. Second, the filtering process gives a high weighting to techniques that conform to beliefs and values of the knowledge establishment. For example, pharmacotherapy will be established ahead of psychological therapies (pharmaceutical industry sponsorship at filters 1–4), quantitative techniques will be preferred to qualitative techniques (filters 5–6), and patient treatment care will be about outputs and outcomes, rather than feeling they have been cared for as human beings (filters 7). Third, innovation may have difficulty breaking through.
In this book, we review the results of many studies using the approach of EBP, but many studies that have not been based on EBP are also reviewed. Many such studies have been in settings where EBP would be unethical, impractical or impossible. We also include qualitative studies because the findings illuminate the lived experience of health and illness.
Source: Marks (2005, 2009)
Future Research
1 Psychology requires a solution to the measurement problem (if there is one): there is no evidence that psychological attributes are continuous quantitative variables of the kind studied in the natural and physical sciences.
2 Trans-cultural studies of health, illness and health care are needed to facilitate communication and understanding of systems of healing among different cultural, ethnic and religious groups.
3 Evidence needs to be gathered to confirm that lifestyle changes cause positive changes to life expectancy and quality of life.
4 The limits of evidence-based practice require innovative evaluation methods of interventions.
Summary
1 Health is a state of well-being with physical, cultural, psychosocial, economic and spiritual attributes, not simply the absence of illness.
2 The fundamental sociality of individual behaviour demands a social orientation to health psychology, which must be studied in the context of society and culture.
3 To be healthy in body and mind a person’s needs to interconnect and to act autonomously as an agent must both be satisfied as well as his/her biological needs.
4 Subjective well-being is normally positive for the majority of individuals. It fluctuates around a set-point inside a range and is regulated by homeostasis.
5 Behavioural and environmental changes need to be given equal priority in interventions.
6 Health psychology has grown rapidly, with increasing evidence that much illness and mortality is caused by behaviour, and there is a growing awareness of the psychosocial aspects of health and illness.
7 The ‘Health Onion’ is a useful framework for the investigation of health and illness. The core of the onion is an individual’s current health status, including age, sex, genetic and epigenetic factors. Four layers of analysis surrounding this core are: (1) individual lifestyle, (2) social and community influences, (3) living and working conditions, and (4) general socio-economic, cultural and environmental conditions.
8 Concepts about health and disease are embedded in culturally diverse ways, with significant differences in experience and behaviour between cultures and places.
9 The organization of knowledge in health psychology is structured within frameworks, theories and models. It is helpful to notice the difference between these three types of structure and to treat them differently.
10 The nature of evidence and the methods by which evidence is gained are contentious issues in science. In health care, new knowledge about a theory, technique or intervention is the product of a series of evidence ‘gates’ or ‘filters’ that must be passed before it is deemed to be useful.
2 The Nervous, Endocrine and Immune Systems and the Principle of Homeostasis
‘… almost all aspects of behaviour can be fully understood in terms of the concept of homeostasis.’
Curt Richter (1967)
Outline
In this chapter, we outline three interacting biological systems with a primary role in the regulation of health and illness: the nervous system, endocrine system and immune system. These three systems together control and coordinate the body’s responses to changes in the internal and external environment. We outline each system in turn and examine interactions between the nervous system, endocrine system and immune system with examples of recent research on psychoneuroimmunology. We conclude with a description of two kinds of homeostasis, both physiological and psychological.
Biological Systems
Three biological systems of relevance to health psychology are the nervous system (NS), the endocrine system (ES) and the immune system (IS). These three systems communicate within the body using electrical and chemical signals. They activate and de-activate tissues, organs and muscles to control and regulate the body, the emotions and the mind. The principal objective of the three systems is to preserve homeostasis. The three systems and their relationships to the brain and behaviour are illustrated in Figure 2.1.
Figure 2.1 The nervous system (NS), endocrine system (ES) and immune system (IS) and their relationships to brain and behaviour
Constant reciprocated interaction between the three systems – the brain, organs and gut – is required to enable the control and coordination of behaviour. Endocrine substances directly affect the nervous and immune systems. The NS innervates every organ and tissue of the IS with reciprocal connections. The continuous interactions among the nervous, endocrine and immune systems was named ‘neuroimmunomodulation’ by Spector and Korneva (1981). Other related terms for these interactions include ‘psychoimmunology’, ‘psychoneuroimmunology’ (Kiecolt-Glaser and Glaser, 1992), ‘immunoendocrinology’, ‘behavioural immunology’ and ‘mind and immunology’. We review research on psychoneuroimmunology later in the chapter.
The three biological systems provide an essential foundation for the understanding of health and illness. Interest in the NS, however, is more than an academic one; it is also economic. The burden on health care and the economy from neurological disease is massive and rapidly increasing. For example, in the USA nearly 100 million people are ill with neurological disease. The combined annual costs of Alzheimer’s and other dementias, low back pain, stroke, traumatic brain injury, migraine, epilepsy, multiple sclerosis, spinal cord injury and Parkinson’s disease totals nearly $800 billion, and this figure is rapidly rising due to the ageing population (Gooch et al., 2017). This huge sum suggests a pressing need to expand knowledge and training in neuroscience. One necessary step is to begin with a basic grounding in the nature and function of the NS, a foundation stone for everything that follows.
The Nervous System
Neurones and microglial cells