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The Psychology of Health and Illness:
An Open Access Course
Jane Ogden
This course is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction
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*2019 – edited by University of the People Course Development, under the terms of the license, to correct
typos, grammar issues, and to convert British English spellings to American English. Removed For Discussion
Questions at the end of each chapter.
The Psychology of Health and Illness: Jane Ogden
Overview
For centuries health professionals have recognized that there are psychological
consequences of being ill. A diagnosis of cancer or diabetes can make people anxious or
depressed. This course will draw upon health psychology, public health, and community
psychology to emphasize how psychology can also contribute to the cause, progression,
experience, and outcomes of any physical illness. This course will highlight the many roles
that psychology plays in physical illness from i) being and staying well and the role of health
behaviors and behavior change; ii) becoming ill with a focus on illness beliefs, symptom
perception, help-seeking and communication with health professionals; iii) being ill in terms
of stress, pain, and chronic illnesses such as obesity, coronary heart disease, and cancer; iv)
the role of gender in health, and v) health outcomes in terms of Quality of Life and
longevity.
Learning objectives and outcomes
By the end of this course students will be able to:
1. Describe the key theoretical frameworks which underpin a psychological approach to
physical health
2. Understand the role of health behaviors in explaining health
3. Describe the psychological factors involved in the onset, maintenance, and change
of health behaviors
4. Describe the role of illness beliefs and symptom perception in help-seeking and
consultation
5. Describe the psychological factors involved in the stress/illness link and the
perception and treatment of pain
6. Describe the ways in which health behaviors, illness beliefs, symptom perception,
stress, and pain are key to chronic illnesses
7. Describe how health varies by gender
8. Understand the importance of psychological health outcomes including Quality of
Life and health status
About the author
Jane Ogden is a Professor in Health Psychology at the University of Surrey in the UK where
she teaches psychology, dietician, nutrition, medical and vet students to think more
psychologically about health and illness. Jane’s research interests focus on eating behavior
and obesity management, communication, and women’s health. She is the author of over 180
academic papers and 7 books including “Health Psychology: A Textbook” (published by
McGraw Hill), “The Psychology of Eating” (published by Blackwell), and “The Psychology
of Dieting” (published by Routledge). She is also a regular contributor to the media and has
been involved in many TV and radio programs and articles for a range of magazines and
newspapers.
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The Psychology of Health and Illness: Jane Ogden
Contents
1. Introduction to the Key Theoretical Frameworks of Psychology and Health
2. The Role of Behavior in Health
3. Behavior Change
4. Becoming Ill and the Role of Illness Beliefs, Help-Seeking, and Communication
5. Being Ill and the Experiences of Stress and Pain
6. The Role of Psychology in Chronic Illnesses such as Obesity, CHD, and Cancer
7. Gender and Health
8. Health Outcomes and Quality of Life (QoL)
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The Psychology of Health and Illness: Jane Ogden
Unit 1: An Introduction to the Key Theoretical Frameworks of
Psychology and Health
Overview
Health psychology is the study of physical illness and addresses problems such as obesity,
diabetes, cancer, and coronary heart disease (CHD) with a focus on health behaviors (eg.
diet, exercise, sleep, help-seeking, medication adherence), illness beliefs, behavior change,
and health outcomes. This first unit will describe the background to health psychology and
how it compares to a more traditional biomedical model. It will explore the 4 key
theoretical frameworks used in health psychology: the biopsychosocial model, health and
illness as a continuum, the direct and indirect pathways between health and illness, and the
focus on variability.
The Background of Health Psychology
Health psychology is the study of the role of psychology in any physical health problem
including coughs and colds, cancer, coronary heart disease, HIV, obesity, and diabetes. It is
best understood by comparing it to the more traditional biomedical model using 5 simple
questions as follows:
The Biomedical Model
The biomedical model can be understood in terms of its answers to the following 5 questions:
§ What causes illness? According to the biomedical model, diseases either come from
outside the body, invading the body and causing physical changes within the body, or
originate as internal physical changes. Such diseases may be caused by several factors
such as chemical imbalances, bacteria, viruses, and genetic predisposition.
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The psychology of health and illness: Jane Ogden
§ Who is responsible for illness? Because illness is seen as arising from biological
changes beyond their control, individuals are not seen as responsible for their
illness. They are regarded as victims of some external force causing internal
changes.
§ How should illness be treated? The biomedical model regards treatment in terms of
vaccination, medication, chemotherapy, and surgery, all of which aim to change
the physical state of the body.
§ Who is responsible for treatment? The responsibility for treatment rests with the
medical profession.
§ What is the role of psychology in health and illness? Within traditional biomedicine,
illness may have psychological consequences, but not psychological causes. For
example, cancer may cause unhappiness but mood is not seen as related to either
the onset or progression of cancer.
Health Psychology
Over the twentieth century thinking changed and it became obvious that the mind and body
were more connected than assumed by the biomedical model. In addition, the greatest risk to
health was no longer acute conditions such as TB or flu but chronic illnesses such as
coronary heart disease (CHD), cancer, obesity, and diabetes all of which have a clear
behavior role. As a result health psychology was developed, which can be understood in
terms of the same 5 questions that were asked of the biomedical model:
§ What causes illness? Health psychology suggests that human beings should be seen as
complex systems and that illness is caused by a multitude of factors and not by a
single causal factor. Health psychology, therefore, attempts to move away from a
simple linear model of health and claims that illness can be caused by a combination
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The psychology of health and illness: Jane Ogden
of biological (e.g. a virus), psychological (e.g. behaviors, beliefs) and social (e.g.
social support) factors.
§ Who is responsible for illness? Because illness is regarded as a result of a combination
of factors, the individual is no longer simply seen as a passive victim. For example,
the recognition of a role for behavior in the cause of illness means that the individual
may be held responsible for their health and illness.
§ How should illness be treated? According to health psychology, the whole person
should be treated, not just the physical illnesses that have taken place. This can take
the form of behavior change, encouraging changes in beliefs and coping strategies,
and compliance with medical recommendations.
§ Who is responsible for treatment? Because the whole person is treated, as compared
to just their physical illnesses, the patient is in part responsible for their treatment.
This may take the form of responsibility to take medication and responsibility to
change beliefs and behavior. They are not seen as a victim.
§ What is the role of psychology in health and illness? Health psychology regards
psychological factors not only as possible consequences of illness, but as
contributing to it at all stages along the continuum from healthy to ill.
Health psychology, therefore, focuses on the role of psychology at all stages of health and
illness. In particular, it draws upon the biopsychosocial model of health, health as a
continuum, the direct and indirect pathways between psychology and health, and a focus
on variability. These 4 key theoretical frameworks will now be considered.
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The psychology of health and illness: Jane Ogden
The Four Key Theoretical Frameworks
1.The Biopsychosocial Model
The biopsychosocial model was developed by Engel (1977) and represented an attempt to
integrate the psychological (the “psycho”) and the environmental (the “social”) into the
traditional biomedical (the “bio”) model of health as follows: (1) the bio contributing factors
include genetics, viruses, bacteria and structural defects; (2) the psycho aspects of health and
illness were described in terms of cognitions (e.g. expectations of health), emotions (e.g.
fear of treatment) and behaviors (e.g. smoking, diet, exercise or alcohol consumption); (3)
the social aspects of health were described in terms of social norms of behavior (e.g. the
social norm of smoking or not smoking), pressures to change behavior (e.g. peer group
expectations, parental pressure), social values on health (e.g. whether health was regarded as
a good or a bad thing), social class, the environment, and ethnicity.
Fig 1 The biopsychosocial model of health and illness (after Engel 1977, 1980)
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The psychology of health and illness: Jane Ogden
2. Health and Illness as a Continuum
Health Psychology emphasizes health and illness as being on a continuum and explores the
ways in which psychological factors impact health at all stages. Therefore psychology is
involved in illness onset (e.g. beliefs, behaviors (smoking, diet), stress), help-seeking (e.g.
symptom perception, illness cognitions, Dr./patient communication), illness adaptation
(e.g. coping, behavior change, social support, pain perception), illness progression (e.g.
stress, behavior change) and health outcomes (e.g. Quality of Life, longevity). This
perspective is illustrated in Figure 2.
Fig 2: Health and Illness as a Continuum
3. The Direct and Indirect Pathways between Psychology and Health
Health psychologists consider both a direct and indirect pathway between psychology and
health. The direct pathway is reflected in the physiological literature and from this
perspective, the way a person experiences their life (“I am feeling stressed”) has a direct
impact upon their body through changes in their physiology which can change their health
status. The indirect pathway is reflected more in the behavioral literature and from this
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The psychology of health and illness: Jane Ogden
perspective, the ways a person thinks (“I am feeling stressed”) influences their behavior (“I
will have a cigarette”) which in turn can impact upon their health. The direct and indirect
pathways are illustrated in Figure 3.
Fig. 3 The Direct and Indirect Pathways between Psychology and Health
3. A Focus on Variability
Biomedicine tends to focus on knowledge as a predictor of behavior (“I know smoking
kills”) and disease as a predictor of health outcomes (“I have cancer and therefore will die”).
Health psychology, however, argues that there is much more variability between people than
this and this variability is our focus. For example, two people might both know that smoking
is bad for them but only one stops smoking. Similarly, two people might find a lump in their
breast but only one goes to the doctor. Further, two people might both have a heart attack but
whilst one has another in 6 months time, the other is perfectly healthy and back to work
within a month. This variability indicates that health and illness cannot only be explained by
illness severity (type of cancer, severity of heart attack) or knowledge (smoking is
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The psychology of health and illness: Jane Ogden
harmful) but that other factors must have a key role to play. For a health psychologist, these
factors include a wide range of psychological variables such as cognitions, emotions,
expectations, learning, peer pressure, social norms, coping, and social support. These
constructs are the nuts and bolts of psychology and are covered in the units in this book. The
notion of variability is shown in Figure 4.
Fig 4: The focus on variability
Knowledge behavior
Variability
illness outcome
The 4 key theoretical frameworks form the basis of health psychology and reflect the
emphasis on psychology as having a role at all stages of being healthy and becoming ill.
These frameworks can be illustrated by the case example of Mr. A.
Mr. A: The example of lung cancer
Mr. A grew up in a poor area of India. Both of his parents smoked because it helped them
relax after a difficult day. Mr. A was given his first cigarette by his friend when he was 12
and they had great fun learning to smoke without coughing too much. If they were lucky,
they found half-smoked cigarettes lying around that they could smoke, but as they grew
older his parents would give him one of theirs. Sitting with his dad having a cigarette was
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The Six Dimensions of Wellness Model
OCCUPATIONAL
The occupational dimension recognizes personal
satisfaction and enrichment in one’s life through work.
At the center of occupational wellness is the premise
that occupational development is related to one’s attitude
about one’s work. Traveling a path toward your occupational
wellness, you’ll contribute your unique gifts, skills, and talents
to work that is both personally meaningful and rewarding.
You’ll convey your values through your involvement in activities
that are gratifying for you. The choice of profession, job
satisfaction, career ambitions, and personal performance are
all important components of your path’s terrain.
Occupational wellness follows these tenets:
• It is better to choose a career which is consistent with our
personal values, interests, and beliefs than to select one
that is unrewarding to us.
• It is better to develop functional, transferable skills
through structured involvement opportunities than
to remain inactive and uninvolved.
PHYSICAL
The physical dimension recognizes the need for regular
physical activity. Physical development encourages learning
about diet and nutrition while discouraging the use of tobacco,
drugs and excessive alcohol consumption. Optimal wellness
is met through the combination of good exercise and eating
habits. As you travel the wellness path, you’ll strive to spend
time building physical strength, flexibility and endurance
while also taking safety precautions so you may travel your
path successfully, including medical self-care and appropriate
use of a medical system. The physical dimension of wellness
entails personal responsibility and care for minor illnesses and
also knowing when professional medical attention is needed.
By traveling the wellness path, you’ll be able to monitor your
own vital signs and understand your body’s warning signs.
You’ll understand and appreciate the relationship between
sound nutrition and how your body performs. The physical
benefits of looking good and feeling terrific most often lead
to the psychological benefits of enhanced self-esteem, selfcontrol,
determination and a sense of direction.
Physical wellness follows these tenets:
• It is better to consume foods and beverages that enhance
good health rather than those which impair it.
• It is better to be physically fit than out of shape.
SOCIAL
The social dimension encourages contributing to
one’s environment and community. It emphasizes the
interdependence between others and nature. As you travel a
wellness path, you’ll become more aware of your importance
in society as well as the impact you have on multiple
environments. You’ll take an active part in improving our
world by encouraging healthier living and initiating better
communication with those around you. You’ll actively seek
ways to preserve the beauty and balance of nature along the
pathway as you discover the power to make willful choices to
enhance personal relationships and important friendships,
and build a better living space and community.
Social wellness follows these tenets:
• It is better to contribute to the common welfare of our
community than to think only of ourselves.
• It is better to live in harmony with others and our
environment than to live in conflict with them.
INTELLECTUAL
The intellectual dimension recognizes one’s creative,
stimulating mental activities. A well person expands his or
her knowledge and skills while discovering the potential for
sharing his or her gifts with others. Using intellectual and
cultural activities in the classroom and beyond the classroom
combined with the human resources and learning resources
available within the university community and the larger
community, a well person cherishes intellectual growth and
stimulation. Traveling a wellness path, you’ll explore issues
related to problem solving, creativity, and learning. You’ll
spend more time pursuing personal interests and reading
books, magazines, and newspapers, while keeping abreast
A Description of Each Dimension
Developed by Dr. Bill Hettler, co-founder of
the National Wellness Institute (NWI), this
interdependent model, commonly referred to
as the Six Dimensions of Wellness, provides
the categories from which NWI derives its
resources and services.
Six Dimensions of Wellness Model ©1976 by Bill Hettler, MD
© National Wellness Institute, Inc. | NationalWellness.org | 715.342.2969
Page 1 of 2
of current issues and ideas. As you develop your intellectual
curiosity, you’ll actively strive to expand and challenge your
mind with creative endeavors.
Intellectual wellness follows these tenets:
• It is better to stretch and challenge our minds with
intellectual and creative pursuits than to become selfsatisfied
and unproductive.
• It is better to identify potential problems and choose
appropriate courses of action based on available
information than to wait, worry, and contend with major
concerns later.
SPIRITUAL
The spiritual dimension recognizes our search for meaning
and purpose in human existence. It includes the development
of a deep appreciation for the depth and expanse of life
and natural forces that exist in the universe. Your search
will be characterized by a peaceful harmony between
internal personal feelings and emotions and the rough
and rugged stretches of your path. While traveling the
path, you may experience many feelings of doubt, despair,
fear, disappointment and dislocation, as well as feelings
of pleasure, joy, happiness and discovery. These are all
important experiences and components to your search and
will be displayed in the value system you will adapt to bring
meaning to your existence. You’ll know you’re becoming
spiritually well when your actions become more consistent
with your beliefs and values, resulting in a “world view.”
Spiritual wellness follows these tenets:
• It is better to ponder the meaning of life for ourselves
and to be tolerant of the beliefs of others than to close
our minds and become intolerant.
• It is better to live each day in a way that is consistent
with our values and beliefs than to do otherwise and feel
untrue to ourselves.
EMOTIONAL
The emotional dimension recognizes awareness and
acceptance of one’s feelings. Emotional wellness includes
the degree to which one feels positive and enthusiastic
about one’s self and life. It includes the capacity to manage
one’s feelings and related behaviors including the realistic
assessment of one’s limitations, development of autonomy,
and ability to cope effectively with stress. The well person
maintains satisfying relationships with others. Awareness of,
and accepting a wide range of feelings in yourself and others
is essential to wellness. On the wellness path, you’ll be able
to express feelings freely and manage feelings effectively.
You’ll be able to arrive at personal choices and decisions
based upon the synthesis of feelings, thoughts, philosophies,
and behavior. You’ll live and work independently while
realizing the importance of seeking and appreciating the
support and assistance of others. You’ll be able to form
interdependent relationships with others based upon a
foundation of mutual commitment, trust, and respect. You’ll
take on challenges, take risks, and recognize conflict as
being potentially healthy. Managing your life in personally
rewarding ways, and taking responsibility for your actions,
will help you see life as an exciting, hopeful adventure.
Emotional wellness follows these tenets:
• It is better to be aware of and accept our feelings than to
deny them.
• It is better to be optimistic in our approach to life than
pessimistic.
Applying the Six
Dimensions of
Wellness Model
By applying the model, a
person becomes aware of
the interconnectedness of
each dimension and how they
contribute to healthy living.
This holistic model explains:
• how a person contributes to his or her environment
and community, and how to build better living spaces
and social networks;
• the enrichment of life through work, and its
interconnectedness to living and playing;
• the development of belief systems, values, and
creating a world-view;
• the benefits of regular physical activity, healthy
eating habits, strength and vitality, as well as
personal responsibility, self-care and when to seek
medical attention;
• self-esteem, self-control, and determination as a
sense of direction;
• creative and stimulating mental activities, and
sharing your gifts with others.
Applying a wellness approach can be useful in nearly
every human endeavor. As a pathway to optimal living,
wellness is being applied to related fields, such as health
promotion and holistic health, and has seen a growth in
“helping professions” including counseling and medical
arts and practices. The National Wellness Institute
devised three questions that can help persons and
organizations assess the degree to which wellness is
incorporated into a particular approach or program:
• Does this help people achieve their full potential?
• Does this recognize and address the whole person
(multi-dimensional approach)?
• Does this affirm and mobilize people’s positive
qualities and strengths?
Six Dimensions of Wellness Model ©1976 by Bill Hettler, MD
© National Wellness Institute, Inc. | NationalWellness.org | 715.342.2969
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