Blair Johnson and Rebecca Acabchuk completed a review (2018) titled: What are the keys to a longer, happier life? Answers from five decades of health psychology research. They set out to share the field’s history, main themes and prominent findings, noting: “Health psychology emerged in recent decades as an important contributor to a broader effort aimed to ameliorate the most pressing health-related issues in the world today: health, medical care, stress and coping, and how best to prevent, treat, and/or manage chronic disease.”
What contributes to successful living and aging? Cultivate a sense of purpose, acceptance of life’s vagaries, close and positive relationships, healthy habits, including a nutritious diet, sufficient exercise and sleep, as well as a mindset of moderation and optimism.
Going back hundreds of years, the field of public health grew from “nasty, brutish, and short” life experiences in the 17th century; the eventual doubling of the lifespan from 35 to 70; the development of maternal care that reduced mother/infant mortality; and the introduction of antibiotics, vaccines, improved nutrition, and public sanitation.
Some improvements led to unanticipated health challenges. In particular, environmental factors have harmed public health - increases in assistive technologies leading to sedentary lifestyles, as well as the availability of fast and processed foods. Now we have a healthcare crisis related to health behaviors. In the US alone:
According to the WHO, morbidity and premature deaths from these diseases can be “significant reduced,” through lifestyle changes. The authors note: “Policy officials increasingly view behavior change on the population level as a key target to help reduce the immense burden of chronic disease.”
In the 1970s, the field of health psychology began to embrace a holistic “biopsychosocial” model that explores the “what and how” of biological, social, environmental, psychological and behavioral processes in health, illness, and healthcare. The biopsychosocial model is the basis of what would become lifestyle medicine, “an emerging effort to broaden the scope of mainstream medicine to include the use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole food, plant-based diet, exercise, sleep, stress management, alcohol moderation and tobacco cessation, and other non-drug modalities, to prevent, treat, and potentially reverse lifestyle-related, chronic diseases.”
One new area of study is whether social media addiction will translate into increased health issues and risk behaviors. So far, research suggests that repetitive stimulation of dopaminergic reward systems by social media can prime addiction pathways, especially during development.
Stress, which if continuous and chronic can lead to increased allostatic load or stress-induced wear and tear, is a central topic in health psychology. Stress impairs every bodily system indirectly or directly including the immune and inflammatory systems, metabolic system, cardiovascular and respiratory systems, the nervous and neuroendocrine systems, neuroplasticity and the microbiome. Biomarkers of stress have been developed for many of these systems.
Stress from a wide variety of life experiences, including adverse childhood experience, trauma, burnout, loneliness, depression, insufficient sleep, sense of inequality, discrimination, social stigma, poverty, unemployment, and low education, place people in the fast lane to chronic disease and premature death.
Note the authors: “Stressful life events may be inevitable, but how one perceives and interprets these events can greatly influence the magnitude of harm imparted upon one's health. Cognitive distortions, such as rumination, magnification and catastrophizing can cause additional stress beyond the initial stressor, contributing to prolonged, chronic stress, which can contribute to chronic disease. Thus, coping interventions (e.g., cognitive behavioral therapy, mindfulness-based interventions, goal setting, etc.) emphasize strategies such as emotion regulation, impulse control, and cognitive restructuring to improve mental health and health behavior.
A large part of current research focuses on investigating mechanisms of action, or “active ingredients” of interventions aimed to improve self-regulation and build resilience to stress in order to enable the translation of interventions into community-based programs.”
The authors highlight the importance of social support as a key driver of holistic health and health habits, as well as a key element of the solution to stress. Social networks can be both positive and promote health and negative and increase stress. At their best these networks “improve physical health and are probably the biggest contributor to positive mental health. Positive social networks improve productivity, healthy behavior, immune function, disease recovery, purpose, resilience and overall quality of life.”
Positive behavior change and maintenance don’t happen in a vacuum. Much research has highlighted the importance of close personal relationships in improving physical and mental health, the authors wrote, but “the challenge remains to translate such knowledge into interventions to improve social relationships.”
In healthcare, patient-provider interactions can function as social support, now that medical practice has moved toward a patient-centered approach in which patients are no longer simply passive recipients of medical care. Research has shown, for example, that patients can place the quality, humaneness, and competence of the provider above the health outcome.
However, even if the relationship is positive, there may still be challenges related to adherence to prescribed regimens. The WHO found that 50% of patients with chronic disease don’t adhere to their medical recommendations. In recent years, this lack of compliance has been viewed more productively as an issue of self-regulation which benefits from social support.
Health and wellness coaches can put the health behavior change findings of health psychology into action. For example, a taxonomy of 93 health behavior change techniques is a valuable menu for coaches. Note the authors: “Behavior change techniques such as goal setting and self-monitoring appear particularly useful in promoting the development of healthy behaviors, while factors related to internal motivation and autonomy appear more critical for maintaining those efforts.”
New forms of cognitive behavioral interventions can be readily integrated into coaching — such as those based on mindfulness, compassion, gratitude, and acceptance which are “geared towards empowering individuals to take greater control over their own thoughts, emotions, behaviors, and habits.”
The authors conclude: “To reduce the immense public health burden of chronic disease, health behavior change is necessary at the population level. Positive social networks along with efforts to improve self-regulation are critical to establishing and maintaining healthy attitudes and behavior. Public policy to address income inequality will help alleviate health disparities, but similar to the underlying biological mechanisms of stress, issues surrounding inequality are highly complex and often bidirectional. A wide opportunity for intervention lies in additional suffering that often goes beyond the initial stressor.”
Cultivate a sense of purpose, acceptance of life’s vagaries, positive and close social relationships, and healthy habits, including a nutritious diet, sufficient exercise and sleep, as well as a mindset of moderation and optimism.
Johnson, Blair T., and Acabchuk, Rebecca L. What Are the Keys to a Longer, Happier Life? Answers from Five Decades of Health Psychology Research. Social Science & Medicine. 2018 Jan; 196: 218–226. Published online 2017 Nov 4. doi: 10.1016/j.socscimed.2017.11.001.
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