Difficulty: Intermediate to Advanced | Prerequisites: Chapters 1–9 (the full course foundation)
These final chapters apply the biopsychosocial model to specific health challenges: pain management (Ch. 10), living with chronic illness (Ch. 11), confronting death and dying (Ch. 12), and the psychology of major chronic diseases (Ch. 13). This is where the course brings everything together.
Pain is both a sensory and psychological experience, and chronic pain requires a different management approach from acute pain. Living with chronic illness is as much a psychological challenge as a medical one, and quality of life matters alongside clinical outcomes. Terminal illness raises questions about how people cope with dying, how we talk about death, and how survivors grieve. Heart disease and diabetes illustrate how stress, social support, and psychological factors directly influence the course of major chronic diseases.
Acute pain
Short-term pain that typically results from injury or illness and resolves as the body heals. It serves a protective function by signalling tissue damage.
Chronic benign pain
Persistent pain that lasts beyond the normal healing period but is not associated with a progressive disease. The pain itself is the condition. Examples include chronic lower back pain.
Chronic progressive pain
Pain associated with a disease that worsens over time, such as cancer or rheumatoid arthritis. The pain intensifies as the underlying condition advances.
Recurrent acute pain
Episodic pain that comes and goes, such as migraines or flare-ups in conditions like irritable bowel syndrome. Between episodes, the person may be pain-free.
Quality of life
A broad concept encompassing physical functioning, psychological well-being, social relationships, and the degree to which a person can live as they wish. In chronic illness management, quality of life is often as important as clinical measures of disease progression.
Cognitive Behavioural Therapy (CBT)
A structured, evidence-based therapeutic approach that targets the relationship between thoughts, emotions, and behaviours. In chronic illness and pain management, CBT helps patients identify and modify unhelpful thought patterns (catastrophising, helplessness) and develop more adaptive coping strategies.
Infant mortality
The number of deaths of infants under one year of age per 1,000 live births in a given year. It is a key indicator of population health and health system quality.
Sudden Infant Death Syndrome (SIDS)
The unexplained death of an apparently healthy infant, usually during sleep. Safe sleep guidance (back sleeping, firm mattress, no loose bedding) is the primary prevention strategy.
Dual Process Model (DPM) of coping and bereavement
A model proposing that healthy grieving involves oscillation between loss-oriented coping (processing the loss, grief work) and restoration-oriented coping (attending to life changes, new roles, distractions). In simple terms, people do not grieve in a straight line; they move back and forth between confronting the loss and getting on with life.
Coronary Heart Disease (CHD)
A condition in which the coronary arteries narrow or become blocked, reducing blood flow to the heart muscle. Stress, hostility, and depression are psychological risk factors.
Type 2 diabetes
A metabolic disorder characterised by insulin resistance and high blood sugar. Psychological factors (stress, depression, health behaviours) play a role in both its development and its management.
This research examined pain perception and management. Key takeaway: pain is a subjective experience shaped by psychological, social, and cultural factors, not simply a direct readout of tissue damage. The research conclusions support a biopsychosocial approach to pain management.
Acute pain is time-limited and serves a biological warning function. Chronic pain persists beyond normal healing and becomes a condition in its own right. Three subtypes of chronic pain matter for the exam:
Chronic benign pain: persistent, not tied to a progressive disease (e.g. chronic lower back pain)
Chronic progressive pain: tied to a worsening disease (e.g. cancer pain)
Recurrent acute pain: comes and goes in episodes (e.g. migraines)
This distinction matters because each type calls for a different management approach.
Psychological interventions (CBT, relaxation training, biofeedback) are central to chronic pain management because the pain experience involves cognitive appraisal, emotional response, and behavioural patterns, not just nociception.
Porter & Jick (1980): Published a brief letter in the New England Journal of Medicine stating that addiction was rare among patients treated with opioids for pain. This letter was widely cited as evidence that opioids were safe for pain management, despite being based on a very small, specific sample of hospitalised patients.
Leung et al. (2017): Analysed how the Porter & Jick letter was cited over time and concluded that it was misrepresented as rigorous evidence for opioid safety, contributing to the overprescription of opioids and the subsequent opioid crisis. The significance: a single, brief, non-peer-reviewed letter was treated as definitive evidence, with catastrophic public health consequences.
Studying quality of life matters because clinical measures (blood tests, imaging) do not capture the full impact of chronic illness on a person's day-to-day experience. A treatment that extends life but makes it miserable is not a clear success. Quality of life measures give patients a voice in evaluating their own care.
Addington-Hall & Kalra (2002): Highlighted the importance of measuring quality of life in chronic and terminal illness. Key takeaway: self-reported quality of life often differs from what providers assume, and patient perspectives should guide treatment decisions.
CBT is the most widely studied psychological intervention for chronic illness management. It helps patients:
Identify and challenge catastrophic thinking about their condition
Develop realistic expectations and adaptive coping strategies
Improve adherence to treatment regimens
Manage the emotional burden (depression, anxiety) that often accompanies chronic illness
CBT does not cure the underlying disease. It changes how the patient relates to the disease, which in turn affects functional outcomes and quality of life.
Infant mortality is operationalised as the number of deaths before age one per 1,000 live births. The U.S. has a higher infant mortality rate than many comparable nations. There are stark disparities by race and ethnicity: Black infants have significantly higher mortality rates than white infants. Explanations include disparities in prenatal care access, maternal health, poverty, racism, and neighbourhood conditions.
SIDS guidance: Place infants on their backs to sleep on a firm, flat surface with no soft bedding, pillows, or stuffed animals. Room-sharing without bed-sharing is recommended.
Harrington et al. (2022): Identified a potential biological marker associated with SIDS risk. Takeaway: this research suggests a biological vulnerability may interact with environmental risk factors. However, critical review is warranted, as the findings are preliminary and do not eliminate the importance of safe sleep practices.
The right-to-die and death with dignity movement raises questions about patient autonomy, quality of life at end of life, and the role of psychological factors in end-of-life decision-making. Health psychologists contribute by studying how patients, families, and providers navigate these decisions.
Talking about death is difficult in many cultures, but open communication improves outcomes for patients, families, and providers. Avoidance of the topic can lead to inadequate end-of-life planning and greater distress.
The DPM (Stroebe & Schut) proposes that adaptive grieving involves oscillation between two orientations:
Loss-oriented coping: confronting and processing the loss, grief work, rumination
Restoration-oriented coping: attending to life changes necessitated by the loss, taking on new roles, seeking distraction
Healthy grieving is not a linear progression through stages but a dynamic process of moving back and forth between these two orientations. People who get stuck on one side (only grieving or only avoiding) tend to have poorer outcomes.
Stress and CHD: Chronic stress contributes to CHD through sustained sympathetic activation, elevated cortisol, inflammation, and health-compromising behaviours (poor diet, smoking, physical inactivity). The relationship between stress and CHD is one of the clearest examples of the biopsychosocial model in action.
Women and CHD: Heart disease is often perceived as a "man's disease," but it is the leading cause of death for women as well. Women may present with different symptoms (fatigue, shortness of breath rather than classic chest pain), leading to underdiagnosis and delayed treatment.
Stress management: Interventions that target stress (relaxation training, CBT, mindfulness) have been shown to improve outcomes in CHD patients. However, social support as a buffer is complicated: while social support generally protects health, its effects can be undermined by relationship conflict or by the burden of providing support.
Problems of social support: Social support is not uniformly helpful. It can create dependency, generate guilt, or become a source of stress if the supporter is overbearing or if the support offered does not match what the patient needs (receiving advice when emotional support is wanted, or vice versa).
Psychological factors in development: Depression, chronic stress, and health-compromising behaviours (sedentary lifestyle, poor diet) are risk factors for developing Type 2 diabetes. Stress affects diabetes both directly (through hormonal pathways that influence insulin resistance) and indirectly (through behaviour).
Stress and diabetes management: Stress complicates diabetes management by affecting blood sugar control, reducing adherence to dietary and medication regimens, and increasing the likelihood of health-compromising behaviours. Self-management of diabetes requires sustained behavioural effort, making it vulnerable to the same psychological factors that the course has been examining all term.
Students sometimes treat chronic benign pain and chronic progressive pain as the same thing. The key difference is whether the underlying condition is worsening over time.
Students may think the Porter & Jick (1980) letter was a rigorous clinical study. It was a brief letter to the editor based on a limited hospital sample. Its outsized influence on opioid prescribing is the cautionary lesson.
Students often assume bereavement follows neat stages (denial, anger, bargaining, depression, acceptance). The Dual Process Model argues grieving is an oscillation between loss-oriented and restoration-oriented coping, not a fixed sequence.
Students sometimes think social support is always beneficial. In practice, support that is mismatched, controlling, or poorly timed can make things worse.
The Porter & Jick / Leung et al. pair is a high-yield exam topic. Know the significance of the original letter, how it was misused, and what Leung et al. concluded.
Be able to distinguish the three types of chronic pain (benign, progressive, recurrent acute) and give an example of each.
The Dual Process Model is the bereavement framework to know. Expect a question asking you to explain it or to identify which orientation (loss or restoration) a person is engaging in.
For Ch. 13, know how stress contributes to CHD both directly and indirectly, and why women's heart disease is often underdiagnosed.
Quality of life as a construct: know why it matters, who measures it, and what Addington-Hall & Kalra found.
True or False: Porter & Jick (1980) was a large-scale randomised controlled trial. (False, it was a brief letter to the editor)
Fill in the blank: The three types of chronic pain are chronic ______ pain, chronic ______ pain, and ______ acute pain. (Benign, progressive, recurrent)
True or False: The Dual Process Model says healthy grieving follows a fixed sequence of stages. (False, it involves oscillation between loss-oriented and restoration-oriented coping)
Fill in the blank: Women with CHD may present with different symptoms such as ______ and ______ rather than classic chest pain. (Fatigue, shortness of breath)
True or False: Social support always improves health outcomes for chronically ill patients. (False)
Q: What is the significance of Porter & Jick (1980) in the context of the opioid crisis?
A: Porter & Jick published a brief letter stating that opioid addiction was rare in hospitalised patients. This was widely, and inaccurately, cited as evidence that opioids were safe for broader pain management. Leung et al. (2017) showed how this misrepresentation contributed to the overprescription of opioids.
Q: A bereaved person spends the morning crying and looking through old photographs, then in the afternoon attends a job interview and discusses practical plans for the future. According to the Dual Process Model, is this healthy grieving?
A: Yes. This illustrates the oscillation between loss-oriented coping (processing the loss, looking at photographs) and restoration-oriented coping (attending to life changes, the job interview). The DPM considers this back-and-forth to be adaptive.
Q: Explain how stress contributes to Type 2 diabetes through both direct and indirect pathways.
A: Directly, stress hormones (cortisol) affect glucose metabolism and insulin resistance. Indirectly, stress promotes health-compromising behaviours (poor diet, reduced exercise, smoking) that increase diabetes risk and complicate management.
Q: Why is quality of life an important outcome measure in chronic illness?
A: Clinical measures (lab values, imaging) capture disease status but not the patient's lived experience. A treatment might control the disease while making daily life miserable. Quality of life measures capture physical functioning, emotional well-being, and social participation, giving a fuller picture of how the patient is doing.
Pain management (Ch. 10) draws on the coping strategies from Chapter 7 and the CBT approach applied in Chapter 11. The Porter & Jick case study illustrates how research methods (Ch. 1) have real-world consequences when findings are misinterpreted. Bereavement (Ch. 12) connects to emotion-focused coping (Ch. 7). CHD and diabetes (Ch. 13) bring together stress (Ch. 6), social determinants (Ch. 2), behaviour change models (Ch. 3), and John Henryism (Ch. 8).
Related Terms / Search Tags
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