Health beliefs

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322 HEALTH PSYCHOLOGY
I The theory does not require patient expectations, but choice. This helps to explain
those reported instances where the individual does not appear to expect to get better.
I The theory suggests that the individual needs commitment to the medical procedure,
which explains why the individual may need to show some investment (e.g. pain,
time, money) in order to get better. This can explain some of the proposed effects of
treatment characteristics, individual characteristics and therapist characteristics.
Problems with cognitive dissonance theory
However, there are several problems with cognitive dissonance theory:
I Much of the research examining the effects of justification has involved giving money
to subjects to enable them to provide justification for their behaviour. It is possible
that providing subjects with money increases their anxiety and therefore increases
pain perception.
I It is also possible that the experimenter’s attempt to persuade the individual to
participate, itself also increases anxiety.
I Cognitive dissonance theory has mainly been tested using acute pain, which has been
elicited in a laboratory setting. Whether the results are transferable to ‘real life’ is
questionable.
I Totman argues that patient expectations are not necessary. However, an individual
must expect some changes following the intervention, otherwise they would not
make the original investment. It is also possible that paying subjects to participate
changes their expectations of a successful outcome.
I Totman does not explain what these unconscious regulating mechanisms may be.
THE ROLE OF PLACEBO EFFECTS IN
HEALTH PSYCHOLOGY
Placebos have implications for many areas of health psychology and illustrate how
these different areas may interact. These are outlined in terms of the areas of health
psychology described in this book, which provides additional insights into possible
mechanisms of the placebo effect. The interactions between these different areas are
illustrated in Figure 13.3.
Health beliefs
For a placebo to have an effect, the individual needs to have a belief that the intervention
will be effective. For example, a placebo in the form of a pill will work if the individual
subscribes to a medical model of health and illness and believes that traditional medical
interventions are effective. A placebo in the form of herbal tea may only be effective if
the individual believes in alternative medicines and is open to non-traditional forms of
intervention. Furthermore, the conditioning effects, reporting error and misattribution
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