title: The Place of Positive Psychology in Health Psychology type: Contributions from Practice language: English published: 07 Feb 2011 updated: 26 Mar 2018 category: Psychológia source: https://www.prohuman.sk/psychologia/miesto-pozitivnej-psychologie-v-psychologii-zdravia

Health psychology emerged at the end of the 1970s as a new paradigm in the view of health and disease at a time when, despite an expanding range of medications, an increasing number of diseases (particularly so-called lifestyle diseases) appeared, for which medicine alone was insufficient. It became evident that even the previously accepted biomedical approach, which exclusively preferred biological causal factors in the development of disease, began to fail in finding causal agents for diseases that were not caused by external factors or heredity (for more details see Pelcák, 2005). All of this gave rise to a new scientific discipline – health psychology – which deals with the role of psychological factors in maintaining health, disease prevention, the psychology of coping with various illnesses, questions of recovery, and coping with chronic diseases (e.g. Křivohlavý, 2001). It focuses on factors that promote health (a healthy lifestyle, psychohygiene, stress coping mechanisms – effective and ineffective coping strategies, stress moderators – social support, sense of life, faith), personality factors of health and disease (Type A personality, salutogenesis, hardiness, mental hygiene and lifestyle, self-regulation, quality of life (including its psychological aspects), life satisfaction), as well as risk factors threatening health (unhealthy lifestyle, obesity, stress, addictions – alcohol, drugs, smoking, risky sexual behavior) and the human psyche in illness (experiencing pain, psycho-oncology, psychoneuroimmunology (for more details see, e.g., Kondáš, 2002, and others).

More general definitions delineate health psychology as the systematic application of psychology to the fields of health, disease, and healthcare systems, whereby health psychology has from its inception consistently been based on a holistic approach that in theory and practice respects the bio-psycho-social model of health and disease, including the concept of multi-causal etiology of individual groups of diseases (Pelcák, 2005). Some authors consider it a borderline field primarily between psychology and behavioral medicine (Beamová, 2001, ibid.).

Kondáš (2002) emphasizes the preventive aspect – the fact that with the advent of health psychology, prevention came to the forefront, along with the use of new knowledge for the benefit of strengthening health and encouraging people to take responsibility for a healthy lifestyle. It is no coincidence that health psychology is also defined as a discipline that deals with questions of physical and mental hygiene, health and disease, whereby its subject of inquiry also includes the aforementioned issues of prevention, health promotion, and individual resilience. Kebza (2001, 2005) develops the social-psychological aspects of health within social health psychology.

From the above, the subject matter of health psychology can be understood as predominantly "positively oriented," which stimulates considerations of possible content overlaps with related psychological disciplines. We are referring primarily to positive psychology, whereby the aforementioned issues of health promotion, hardiness, prevention, and many others create an inspiring space for the application of positive psychology in health psychology.

The Relationship of Health Psychology to Other Scientific Disciplines

From the very definition of its subject matter, it can be inferred that health psychology is closely linked to other scientific disciplines. For illustration, Pelcák's (2005) schema is offered, which specifies which disciplines may be primarily involved:

  • mental hygiene, nursing, health education, health promotion, medicine, behavioral medicine, behavioral health, epidemiology, physiology
  • social psychology, personality psychology, developmental psychology, preventive psychology, counseling, psychotherapy, philosophy, sociology, cultural anthropology, human ethology, clinical psychology, medical psychology

HEALTH PSYCHOLOGY

Despite the nearly exhaustive schema of relationships between health psychology and related disciplines, the above overview does not include positive psychology as the study of conditions and processes that contribute to human, group, and institutional development or optimal functioning. Probably because it is a new discipline, which nevertheless is asserting itself very promisingly and assertively within the system of psychological sciences. Since we have not yet encountered in the professional literature an intention to link health psychology with positive psychology, we will attempt (also through presenting the historical context of the origin of positive psychology and its current orientation) to point out possible areas of contact between these two scientific disciplines, or to outline the place of positive psychology in health psychology.

Positive Psychology

The origin of positive psychology was primarily related to the fact that psychology had long and predominantly focused on negative phenomena associated with human mental life. At the same time, it became evident that psychological theories are strong in predicting failures, learned helplessness, despair, and the like, but are impotent when it comes to explaining happiness, love, compassion, perseverance, creativity, and other qualities that give value to human life (Gilham and Seligman according to Mareš, 2002). Psychologists' attention thus gradually began to shift from the pathogenetic perspective (negative paradigm) to positive qualities, and especially to the individual's internal psychological resources for resisting risks and dangers (salutogenetic perspective). At the end of the last century, this culminated in the formation of a scientific approach called positive psychology – or also the psychology of human strengths – which focuses on both the study of positive emotions (self-confidence, hope, joy) and the study of positive characteristics (altruism, resilience, wisdom, humility...), as well as human abilities (talent, intelligence, etc.). At a more general level, positive psychology declares itself as the science of positive individual traits, positive life experiences and experiences, and positively functioning communities and institutions, which, unlike the traditional pathologizing approach to humans (especially clinical psychology), seeks through rigorous empirical research ways to enable people to live a happier and more meaningful life (Mareš, 2002, Seligman, 2002a, 2002b).

Positive psychology therefore focuses on the positive sides and aspects of human functioning, emphasizing that alongside negative psychological (psychopathological) phenomena such as anxiety, fear, pain, depression, and the like, there are also positive, salutogenetic and provital factors that are health-promoting, maintaining, and strengthening. In addition to those already mentioned above, these include characteristics such as optimism, hope, faith, gratitude, courage, joy, and others, which function as "buffers" against feelings of unhappiness and mental disorders and can be key to building psychological resilience. Seligman (2002b) speaks of building the best qualities of life, whereby the so-called good life, success, and deepest emotional satisfaction, according to him, do not consist in maximizing positive emotions, but in the daily use and successful application of our characteristic strengths, from which positive experiences and positive emotions flow, which at the same time function as rapid "dissolvers" of negative emotions. This level of positive subjective experience, extending to the level of overall human health and emphasizing the role of individual strengths in developing and supporting health, we consider the basic intersection framework of positive psychology and health psychology.

Seligman presumes that in this century, positive psychology will succeed in discovering, understanding, and supporting those factors that will enable people and society as a whole to thrive and prosper. According to him, this will be sufficient simply by redirecting (refocusing) scientific energy. He believes that just as over half a century it was possible to build a science of mental illnesses with a taxonomy and reliable measures of such uncertain concepts as schizophrenia, depression, or anger (including understanding their causes), in the same laboratories two generations of scientists will succeed in understanding, measuring, and identifying factors and characteristics that make human life worth living.

Within the classification of the subject of positive psychology, its founders established, based on research into human personality strengths across various cultures, the existence of 6 basic so-called virtues, which encompass the basic positive characteristics (strengths) of humans that are supported by almost all religious and philosophical traditions, and together they create the concept of so-called good character. According to Seligman (2002b), these are wisdom and knowledge, courage, humanity, justice, temperance, and transcendence. For classification and measurement purposes, each basic virtue can be further subdivided into specific strengths, for example wisdom into love of learning, curiosity, judgment, originality, social intelligence, etc., which multiplies their number several times over (for more details see, e.g., Kordačová, 2007, 2009b, Mareš, 2008). Strengths are thus positive peculiarities of human personality that are more enduring characteristics (they are dispositions or even individual personality traits such as intelligence, optimism, perceived personal competence, etc.).

Personality Strengths – A Challenge for Health Psychology?

The examination of human strengths (positive traits) and virtues has since the origin of positive psychology been one of its key areas of interest. At the same time, they are an inspiration for the intersections of positive psychology and health psychology. This assumption can be supported by arguments from the main representatives of positive psychology Seligman, Peterson, Fredrickson, and others, as well as by research from some of our domestic authors. For example, Seligman (2002b) noted the increasing incidence of depression in all developed countries. He states that its incidence is 10 times more widespread than in 1960 and that depression is beginning at a much younger age (the average age of the first depressive episode was 29.5 years in 1960, currently it is 14.5 years). Paradoxically, this is the case despite the fact that every objective indicator of physical and mental well-being is rising (for example purchasing power, education level, nutrition), yet all indicators of subjective well-being are declining. He explains this by people's excessive reliance on shortcuts to happiness (TV, drugs, sex without love, chocolate consumption, etc.). Furthermore, it is shown that pessimists fall into depression up to 8 times more often than optimists, while pessimists have worse results in school, work, and sports than their talents would allow. Their physical health is worse and they live shorter lives, and they also have less harmonious interpersonal relationships. Also noteworthy is the finding that in presidential elections they are defeated by their more optimistic opponents.

The fact that optimism as a personality strength supports health has also been confirmed in our domestic research, showing that optimists experience fewer symptoms of illness, tend to have higher self-confidence and self-efficacy (for more details Kondáš, 2002). Hope as another of the strengths also increases resistance to depression, whereby even a good mood promotes generosity, tolerance, constructiveness, non-defensiveness, and creativity (Seligman, 2002b).

Regarding research on happiness, it has been shown that happy people have healthier habits, lower blood pressure, and a more efficient immune system, and are half as likely to die or become disabled, while at the same time being wiser in real decision-making (having different strategies). Positive emotions overall predict health and longevity, and also protect against the destructive effects of aging. However, according to Fredrickson (2000), positive emotions have a much deeper meaning than just inducing pleasant feelings – they expand our lasting intellectual, physical, and social resources and create reserves from which we can draw when some threat emerges.

Of personality traits, extraversion (bringing positive emotions) and neuroticism (negative emotions) are most commonly associated with life satisfaction, which was also confirmed in our research on personality strengths in the context of life well-being and happiness, where it was shown that strengths were most closely associated with extraversion and least with neuroticism (Kordačová, 2007). The most significant influence on reducing negative emotions was played by wisdom, courage, humanity, justice, and transcendence, and the strongest barrier to expressing strengths was negative expectations and irrational helplessness (Kordačová, 2008, 2009a, b). Research by Diener revealed that extraverts are happier than introverts, have a higher level of positive emotions, and feel more comfortable in social situations. Blatný and Osecká (1998) found that extraverts and stable persons are more satisfied and also have higher self-esteem.

Self-esteem as a personality strength was shown in Harter's (1999) research to be a fundamental indicator of individual subjective satisfaction, and it is used as an index of mental health, emotional adjustment, and general ability to cope with life.

There are also some domestic studies from the field of health psychology with a direct extension into positive psychology, which have yielded several interesting results. Selectively, for example, Šolcová and Kebza (2007) within research on predictors of hardiness found that with the exception of gender, positive predictors of hardiness included both age and education, as well as the person's social resources, physical activity, and subjective health.

In Selko's research (2007) on differences in psychological resilience between healthy individuals and patients diagnosed with CHD (coronary heart disease) in productive age, it was shown that reduced psychological resilience appears to be one of the most risk-associated cofactors in the development of CHD, whereby a very negatively experienced existential stress also played a significant negative role especially in women, which has serious consequences in reducing women's biological protection. This negatively manifests not only in worsening cardiovascular health, but also in oncological and overall health of our population, where women constitute 52%. It is therefore clear that several strengths are significant salutoprotective health factors, and their broader incorporation into health psychology research could substantially enrich the spectrum of current knowledge in this field of inquiry.

Positive Psychology and Health Psychology – Further Possibilities for Joint Intersections

Some further definitions of health psychology also support possible thematic connections between positive psychology and health psychology. For example, Pelcák (2009) states that health psychology prefers the positive pole of the "health – disease" continuum, and according to Taylor (1995), it is simultaneously the area of psychology that is devoted to understanding the psychological factors that influence whether a person remains healthy, why they do not get sick, and how they react when they are ill. Kondáš (2002) in his article on health psychology directly discusses several specific areas that, in our opinion, can be considered areas of contact between health psychology and positive psychology. These are primarily the following problem areas:

  • stress and its management – coping styles and strategies
  • psychological factors of cardiovascular diseases
  • psychoneuroimmunology and psycho-oncology
  • cognitive-emotional pathogenic and especially salutoprotective factors. Despite the thematic independence of these areas, we do not consider them isolated (quite the opposite), whereby salutoprotective factors and coping styles are apparently closest to positive psychology, which also indirectly affect the other two aforementioned areas. In the first area – stress and its management – positive psychology could be applied (with a focus on coping styles and strategies) by orienting toward those factors and strengths that promote effective stress management and thereby prevent the outbreak of so-called lifestyle diseases. It is known that resilience to stress depends on emotional stability, low levels of anxiety, the ability to control emotions, maintaining cool judgment even in exposed situations, etc.

Analogously, in the area of psychological factors of cardiovascular diseases, the focus could be on specific personality strengths that prevent the development of negative, namely extreme emotional experiencing and its adverse impact on the human cardiovascular system.

In the area of psychoneuroimmunology and psycho-oncology, it is evident that psychological factors are a significant factor in weakening/strengthening the human immune system, as well as vulnerability to oncological diseases. Through the CNS, together with biological and social factors, they influence immunological functions that protect the organism. Psychological stress, anxiety, learned helplessness, depression, and the like, for example, act as immunosuppressants, while positive emotions on the contrary support psychoimmunological reactions. For example, it has been shown that tumors are twice as common in depressed people. Negatively affected are also disappointments, irrational beliefs, social desirability, loss of sense of life, and prioritizing the needs of others (for more details Kondáš, 2002). This is therefore a direct challenge for research in this area with the application of positive psychology knowledge.

Regarding cognitive-emotional pathogenic and salutoprotective factors, it appears that these are the most psychologically elaborated, with their study beginning even before the official establishment of positive psychology. This includes, for example, the well-known personality characteristic of people who are able to survive even in extreme stress conditions, known as the sense of coherence (Antonovsky), which speaks to the fact that external stimuli make cognitive sense – they are not therefore chaotic or random, but are consistent and structured. Some authors call this trait indestructibility, or resilience and tenacity (resiliency). Kondáš, however, considers them a superordinate concept – hardiness, mental toughness, when stress is responded to as a challenge to personal growth rather than a threat. Resilient people also have a positive self-image, positive social relationships, tend to be cooperative, independent, and have minimal irrational beliefs.

Another significant salutoprotective factor is the aforementioned positive emotions, which are simultaneously one of the most frequently used concepts in contemporary positive psychology. From the perspective of health psychology, optimism is primarily interesting as a personality strength that supports health (optimists, as we have already mentioned, experience fewer symptoms of illness, tend to have higher self-confidence and perceived personal competence).

Health Psychology, Positive Psychology, and Prevention

One of the significant areas of contact between positive psychology and health psychology is the field of prevention. Valuable insights on this topic were provided, without conscious intention to enter the context of positive psychology, by Prof. Kondáš, who passed away shortly after its emergence, and who devoted considerable professional attention to issues of prevention. He mentions primarily three areas of specific goals of health psychology that are closely related to prevention and, in our opinion, also to positive psychology. These are health protection – which includes, for example, taking responsibility for one's own health and maintaining health-beneficial habits, reducing health-damaging habits, etc.; health promotion – managing stressors, social skills training, reducing social fear in favor of cooperativeness and independence, which increase resilience, etc.; and health enhancing – which includes not only motivation for a healthy lifestyle and its persistence, but also having health as one of the primary values and experiencing joy, life well-being, and happiness. He states that previous prevention theory relied mainly on pathogenic factors of the origin and spread of disorders, and that much more attention should be paid to early detection of precursors and persistent factors responsible for the continuation and relapses of disorders.

Following Seligman's (2002a) understanding, it would be possible to designate positive psychology directly as a preventive science, since he considers the greatest task of prevention in the new millennium to be the creation of a science of human strengths and to understand and discover how to support and develop them especially in young people. According to this author, the task of positive psychology is not merely to state that a person should be optimistic, spiritual, or kind, but rather to describe the consequences of these characteristics and traits (e.g., that optimistic thinking reduces the incidence of depression, improves physical health, and increases performance). His prediction about the science and practice of 21st-century psychology is based on a personal conviction that a psychology of positive human functioning will emerge, which will reveal effective interventions for forming thriving individuals, families, and society.

We are of the opinion that the development and support of human strengths at every age is one of the strongest weapons of positive psychology on the path to better health for both individuals and all of humanity. It would certainly be gratifying if positive psychology contributed to this goal also in cooperation with health psychology, which provides all the necessary conditions and prerequisites for it.

Conclusion

The aim of our contribution was to outline some areas of contact between two relatively new psychological disciplines – positive psychology and health psychology – and the possibilities of their theoretical, research, and applied intersections utilizing the knowledge of both disciplines for the support and strengthening of human health.

Although both psychologies originated independently of each other and with a certain time gap, from their content and orientation emerged several stimulating suggestions for mutual cooperation, also in a broader interdisciplinary understanding. From the concept of positive psychology, we focused primarily on those factors that have a clearly positive relationship not only to mental health and life satisfaction, but which overall positively affect health – the so-called personality and character strengths. Together with positive emotions, they are the areas of positive psychology that within its current orientation are developing most progressively.

Another prospective area of possible cooperation between health psychology and positive psychology is the field of prevention, where the use of strengths can play one of the key roles, especially in the overall reduction of the incidence of lifestyle diseases and their negative impact, as well as in strengthening health and life satisfaction for people of all age categories. Positive psychology and health psychology thus appear to be promising disciplines, possessing accessible psychological resources that can be utilized for the benefit of overall human recovery and the improvement of quality of life.

Author: Jana Kordačová, Institute of Experimental Psychology, Slovak Academy of Sciences, Bratislava

The contribution was published in the proceedings of the conference "Health Psychology – Health and Wisdom. Health Psychology and Burnout Syndrome. Gender Differences in Health." The conference was held in 2009. Editors: PhDr. Dušan Selko, CSc., MPH, Mgr. Róbert Ďurka, PhD. Proceedings published with financial support from the National Heart and Cardiovascular Diseases Institute, Bratislava Publisher: National Heart and Cardiovascular Diseases Institute, Bratislava, in MAURO Slovakia s.r.o. Publishing, Bratislava 2010, ISBN 978-80-968092-6-4

The entire proceedings in PDF is here: http://www.prohuman.sk/psychologia/psychologia-zdravia-2009