Psychology 9990

Chapter 8: Psychology and health

UAB Pain Behaviour Scale

Name:
Rater:

1 Vocal complaints: verbal MTWT F S SMTWT F S SMTWT F S S
None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Occasional ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

2 Vocal complaints: non-verbal Frequent 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(moans, groans, gasps, etc.) None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Occasional ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

3 Down-time Frequent 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(time spent lying down per day None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0–60 min ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

4 Facial grimaces >60 min 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Mild and/or infrequent ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

5 Standing posture Severe and/or infrequent 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 243
None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Mildly impaired ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

6 Mobility Distorted 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No visible impairment 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Mild limp and/or laboured walking ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

7 Body Language Marked limp and/or laboured walking 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(clutching, rubbing site of pain) None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Occasional ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½

8 Use of visible supportive equipment Frequent 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(braces, crutches, cane, leaning on None 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
furniture, TENS, etc). Do not score if
equipment prescribed. Occasional ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½
Dependent: constant use 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Stationary movement Sits or stands still 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

½½½½½½½½½½½½½½½½½½½½½

000000000000000000000

10 Medication None 111111111111111111111
½½½½½½½½½½½½½½½½½½½½½
Non-narcotic analgesic and/or psychogenic 000000000000000000000
medications as prescribed

Demands for increased dosage or frequency,
and/or narcotics, and/or medication abuse

TOTAL

8.15 The UAB Pain Behaviour Scale

Cambridge International AS and A Level Psychology

the parent and the doctor. It was created after the McGill

RESEARCH METHODS Pain Questionnaire and assesses the perceptions of

Why would it be important to have operational definitions the patient’s pain experience in a child-friendly format.
for the behaviours and the frequencies on the UAB? Specifically, this instrument measures pain intensity,
location and the sensory, evaluative and affective

qualities of the pain.

The UAB Pain Behaviour Scale can be used to track the

severity of chronic pain over time. This can help determine KEY TERM

the level of pain control and identify temporal associations affective: relating to mental disorders in which disturbance of
that can influence management. There are ten types of mood is the primary symptom.
question and each item is scored on a three-point scale

(0, 0.5, 1). The higher the score, the more marked the pain-

associated behaviour and the greater the level of impairment. The PPQ allows a comprehensive assessment of pain in
Therefore, a patient can get a score of between 0 and 10. children with chronic pain. The different forms use different

1 vocal complaints – verbal formats, such as using colours for younger children and
descriptive terms for adolescents.

2 vocal complaints – non-verbal (groans, moans Children are first asked to circle words that best describe
gasps, etc.) the pain that they are suffering and then must choose
the three that describe the pain they are in at the time of
3 down time (time spent lying down because of pain per
day from 8 a.m. to 8 p.m.) completing the questionnaire.

4 facial grimaces Circle the words that best describe your pain, or the way
5 standing posture you feel when you are in pain:

6 mobility
244
cutting pounding tingling tiring deep
7 body language (clutching/rubbing site)

8 use of visible support equipment (braces, crutches, squeezing throbbing horrible stabbing burning
cane, leaning on furniture, transcutaneous electrical
nerve stimulation (TENS), etc.) pulling sickening biting screaming scraping

9 stationary movement (ability to stay still) aching uncomfortable cold miserable stretching

10 medication use. pricking hot scared lonely jumping

Pain measures for children pinching unbearable sad itching grabbing

Paediatric Pain Questionnaire (Varni & Thompson, 1987) stinging sharp sore flashing pins and
needles
We already know that measuring pain in adults is very
difficult due to validity and reliability issues. Various pain The child is then asked to rate how they feel at the time on
assessment tools are available for children who are old a continuum as well as rating the worst pain they had this
enough to communicate. Pain scales have been developed week on the same scale.
using numbers, colours and facial expressions. In pre-
verbal children, several pain scales have been validated. Not hurting Hurting a whole lot
The CHEOPS (Children’s Hospital of Eastern Ontario Pain No discomfort Very uncomfortable
Scale) is a well-validated tool for the assessment of pain
in children. It was initially developed for post-surgical No pain Severe pain
patients, but has been used broadly since.
8.16 Asking children about how they perceive pain
Varni and Thompson’s Paediatric Pain Questionnaire
(PPQ) is a multidimensional questionnaire for assessing
childhood pain, with separate forms for the patient (child),

Chapter 8: Psychology and health

Finally, they are asked to pick four colouring pens and The child is told that each face is for a person who feels
happy because he has no pain (hurt) or sad because he has
colour in the picture of themselves, with one colour some or a lot of pain.

meaning no pain, another for mild pain, a third for moderate Face 0 is very happy because he doesn’t hurt at all.
pain and the final colour for severe pain (see Figure 8.17).
Face 2 hurts just a little bit.
Front Back
Face 4 hurts a little more.

Face 6 hurts even more.

Face 8 hurts a whole lot more.

Face 10 hurts as much as you can imagine, although you
do not have to be crying to feel this bad.

The child is asked to choose the face that best describes
how they are feeling.

This scale has been validated outside the emergency
department, mostly for chronic pain. Garra et al. (2010) were
able to demonstrate a significant difference in the visual
analogue scale for each of the Wong-Baker FACES Scale
ordinal categories. The visual analogue scale was found to
have an excellent correlation in older children with acute
pain and had a uniformly increasing relationship with the
Wong-Baker FACES Scale.

245

No pain No pain Moderate pain Severe pain Reflections: Is using faces a good way to ask children
No hurt A little hurt More hurt A lot of hurt how much pain they are in? Can you think of any other

ways that a doctor could use to gauge how much pain a
child was suffering?

8.17 Asking children about how they perceive pain ISSUES AND DEBATES

Wong-Baker Scale Although specificity theory contains features that have
The Wong-Baker FACES Rating Scale (Figure 8.18) was received research support, the theory cannot adequately
developed for young patients to communicate how much explain pain perception as it is reductionist and only
pain they are feeling. The scale shows a series of faces focuses on biological explanations of behaviour. One of the
ranging from a happy face at 0, ‘No hurt’, to a crying face problems with specificity theory is that the pain area of the
at 10, ‘Hurts worst’. The patient must choose the face that brain it proposes does not exist. Perhaps the most serious
best describes how they are feeling. The rating scale is problem with specificity theory (and other mechanistic
recommended for children aged three and older. theories of pain) is that it does not attempt to explain how
the experience of pain is affected by psychological factors.
Wong-Baker FACES® Pain Rating Scale Specificity theory uses a physiological approach and does
not recognise the psychological factors which influence
02 4 6 8 10 how we perceive pain.

No Hurts Hurts little Hurts even Hurts Hurts All of the theories of pain have useful applications
worst to everyday life as they help health practitioners
hurt little bit more more whole lot understand why individuals perceive pain and as a result
should be able to develop intervention strategies and

8.18 Wong-Baker FACES Rating Scale

Cambridge International AS and A Level Psychology

ISSUES AND DEBATES (continued) Reflections: If you were in pain, what would you turn
to first to reduce it? Drugs? Would you ever consider a
treatment programmes to help with this. For example, different method of pain relief?
theories, like the Gate Control Theory of pain, that
suggest that the brain can have a top-down influence Biochemical methods may be used to relieve pain. An
on pain perception, have led to practitioners developing analgesic or painkiller is any member of the group of drugs
techniques such as imagery and meditation to help used to achieve analgesia (relief from pain). Analgesic drugs
people control their pain perceptions. The improved act in various ways on the central nervous system. The type
understanding of pain through research into phantom of medicine that you need to treat your pain depends on
limb pain has also allowed researchers to develop what type of pain you have. The aim of taking medication is
treatments (such as the mirror box) for those individuals to improve your quality of life. All painkillers have potential
who have had amputations and experience phantom side effects, so you need to weigh up the advantages of
pain following this. taking them against the disadvantages.

SELF-ASSESSMENT QUESTIONS For pain associated with inflammation, such as back pain or
headaches, paracetamol and anti-inflammatory painkillers
8 What do intensity, duration and location refer to work best. Pain caused by sensitive or damaged nerves is
when discussing pain perception? usually treated with tablets that are also used for epilepsy
and depression. These tablets change the way the central
Managing and controlling pain nervous system works.

Psychologists have investigated the many different ways The most popular chemical treatment for pain is aspirin.
246 in which people can manage and control pain. A major Aspirin and other similar drugs such as ibuprofen have
three therapeutic actions: first, against pain; secondly,
distinction can be made between medical techniques against inflammation; and thirdly, against fever. They
used to manage pain, such as taking drugs or surgical appear to work on the damaged tissue that is causing the
treatment, and psychological ways of managing stress pain and inflammation, and they have no known effect on
such as cognitive training to cope with pain. We will also the nervous system. These drugs are heavily used today
discuss some alternative methods for controlling pain such and the only physical drawback is the number of side
as acupuncture and stimulation therapy. The Gate Control effects such as gastric irritation and bleeding and also
Theory of pain would suggest that we use a combination of (with large doses) deafness.
psychological and physical treatments.
Other drugs include paracetamol and opiates. Opiates
Medical techniques inhibit pain messages from travelling to the brain; in other
Surgical treatments are used when medication doesn’t words, they close the gate, preventing the pain signals
relieve pain. Such treatments can consist of cutting nerve getting to the brain. Morphine and morphine-like drugs
pathways or making lesions in special centres in the brain. (for example, oxycodone, fentanyl and buprenorphine)
Surgical treatment is usually only recommended for people are the strongest painkillers there are. Some come as a
with terminal illnesses. There are also several physical patch, but they all work in similar ways and should only
therapies that are used to ease and manage pain. These be used for severe pain. They will only be prescribed after
include manual therapies such as massage, mechanical consultation with a GP or a pain specialist and the dose
therapies such as ultrasound and traction and heat and response will be closely monitored.
treatments such as microwave diathermy, cold treatments
such as ice packs, and electrotherapy such as electrical Psychological techniques: cognitive strategies
nerve stimulation. Over the past few years there has been a growing acceptance
of the value of psychological interventions in the treatment

Chapter 8: Psychology and health

of pain. Included in these interventions are relaxation, • discussion on dealing with pain and relationship to pain 247
biofeedback, hypnosis, cognitive coping skills, operant
techniques, mental imaging, self-efficacy and counselling. and its chronic nature, discussion of all sessions and the
use of skills
Attention diversion, non-pain imagery and cognitive
redefinition • attention diversion and mindfulness: focus on the
Cognitive redefinition is where an individual attempts to
alter their thinking to replace thought of apprehension details of experience, mindfulness breathing exercises,
about the pain with other more positive thoughts. This integrating mindfulness in everyday activities, external,
cognitive approach is related to distraction therapies mental and somatic focus of attention
and involves the patient replacing thoughts such as “this
is really going to hurt” with “this is not the worst pain in • intense pain and flare-ups: identifying responses to pain
the world”. It is a top-down approach that suggests that
the brain can have a significant impact on the way that and vicious cycles in thoughts, images and behaviour,
pain is perceived. Further to this, it can involve therapists defusing catastrophising and breaking vicious cycles
attempting to ‘redefine’ the perception of pain as some
other feeling by encouraging a patient to consider the pain • pain transformation images: creating images to
sensation as a different sensation such as warmth.
transform pain.
Attention management is often included in cognitive In the first time period until the three month follow-
behavioural treatments (CBT). Patients vary in their up, pain intensity reduced significantly and this pain
response to attention diversion strategies and there are reduction was maintained at the six month follow-up,
individual differences in what diversion techniques are but to a lesser degree. Participants reported they used
effective as a method of pain relief. The core concept of brief relaxation, use of imagery and distraction towards
attention diversion is to divert attention from the pain by external objects most regularly, and reported benefits
refocusing or directing attention to something other than such as developing skills to deal with pain (n = 9), altered
the pain. According to the Gate Control Theory this will attitudes to pain (n = 10), improved sleep patterns (n = 8)
help close the gates and reduce the perception of pain. and stress reduction (n = 4).

Deliberately using imagery, attention diversion and Alternative techniques
mindfulness to cope with pain can take many forms as Acupuncture is a treatment derived from ancient Chinese
there are many ways to divert attention away from pain. medicine in which fine needles are inserted at certain
People who suffer chronic pain have reported that engaging sites in the body for therapeutic or preventative purposes
in an activity that is enjoyable is the most effective attention (Figure 8.19). It is often seen as a form of complementary
diversion. Interesting activities and mental distracters can or alternative medicine. Western medical acupuncture
become effective methods of attention diversion and pain is the use of acupuncture after a proper medical
relief. It is rare to offer a single form of coping strategy like diagnosis. It is based on scientific evidence that shows
attention management in isolation from other aspects of a the treatment can stimulate nerves under the skin and in
cognitive behavioural approach to pain management. muscle tissue.

Morley, Shapiro and Biggs (2004) developed a training 8.19 A patient undergoing acupuncture
programme in which they taught patients how to use
attention diversion strategies such as:

• use of imagery and mindfulness: creating vivid and

pleasant images to concentrate on

• basic attention management: brief relaxation, internal

and external attention focus

• pain coping strategies: coping self-statements, signal

breathing

Cambridge International AS and A Level Psychology

This results in the body producing pain-relieving ISSUES AND DEBATES (continued)
substances, such as endorphins. It is likely these
substances are responsible for any beneficial effects seen a more holistic approach to treat the entire individual,
with this form of acupuncture. Traditional acupuncture both physiologically and psychologically. The alternative
is based on the belief that an energy, or ‘life force’, flows techniques discussed often tend to focus heavily on
through the body in channels called meridians. This life psychological influences when treating pain, whereas the
force is known as Qi (pronounced ‘chee’). Acupuncturists cognitive methods of imagery also fail to recognise the
believe that when Qi can not flow freely through the body, biological factors in how we experience pain.
sickness can result. They also believe acupuncture can The most useful application that comes from our
restore the flow of Qi, and so restore health. understanding of pain is that the most effective pain
relief will probably come from combining the different
Transcutaneous electrical nerve stimulation (TENS) is a biological and psychological techniques. Further
method of pain relief involving the use of a mild electrical to this, it is important to note the improved quality
current. A TENS machine is a small, battery-operated of life that someone can experience when they are
device that has leads connected to sticky pads called not in pain, especially those who suffer from chronic
electrodes (Figure 8.20). When the machine is switched pain, and anything that can improve the quality of
on, small electric impulses are passed through the pads life for an individual is of significant importance to
to areas of the body where you are experiencing muscle psychology. Especially with techniques such as imagery
pain. These impulses can reduce the pain signals passing or cognitive behavioural therapy, it is a relatively simple
along nerves in the body and can help an individual relax. way of managing pain that can be learned by most
As well as the tingling sensation that you might get when people regardless of level of their age, sex or cultural
background.
using the machine,
it is suggested that SELF-ASSESSMENT QUESTIONS
the electric impulses
248 can also stimulate 9 Why might imagery or a cognitive therapy be the
endorphins which are most effective pain relief for all types of pain?
the body’s natural
opiates (painkillers).

8.20 A TENS machine

Health care professionals have reported that it seems to 8.4 Stress
help some people, although how well it works depends on
the individual and the condition being treated. The main Stress is caused by two things: levels of anxiety and
use of TENS is to help reduce the perception of deep muscle your body’s reactions to your thought processes. The
pain, or pain in muscles due to anxiety and stress. TENS is instinctive stress response to unexpected events is known
not a cure for pain and often only provides short-term relief as ‘fight or flight’. Stress happens when we feel that we
while the TENS machine is being used. are not in control of events in our lives and comes in many
forms, both positive and negative, and can have many
ISSUES AND DEBATES triggers and physiological responses.

When developing methods to control and manage Many of life’s demands can cause stress, particularly work,
pain, it is important to recognise that both biological relationships and money problems. When you feel stressed,
and psychological factors combine when we perceive the stress itself can get in the way of sorting out these
pain. Consequently, any method used to manage demands, and can affect everything you do.
pain effectively should not be reductionist, like the
biomedical approach, and attempt to explain and treat Stress is an inevitable part of life, but it is not a purely
the pain in a simplistic and narrow way, but instead take negative phenomenon. It can also result from intense joy
or pleasure as well as fear or anxiety. Researchers have

Chapter 8: Psychology and health

coined the term eustress, or beneficial stress, to reflect Physiology of stress and effects on health
the fact that positive experiences such as a promotion,
marriage, having children and many others are also The physiological model is primarily concerned with
stressful. what happens within the person, usually as a response to
stressors. Central to our understanding of the physiological
Reflections: What events in your life have caused you basis of stress is the concept of arousal. Arousal refers to
stress and anxiety? Is it the small things mounting up or a general physiological state in which the sympathetic
big life events that cause you the most worry? division of the autonomic nervous system is activated
(Figure 8.22). The function of the sympathetic division is
Sources of stress to rouse the body to action, and it does so by activating 249
a number of physiological mechanisms which produce or
There are many different ways of investigating the maintain alertness and energy.
causes or sources of stress. One way is to investigate
environmental changes which cause stress. Such changes KEY TERM
are called stressors. Modern life is full of frustrations,
deadlines and demands. For many people, stress is sympathetic division of the autonomic nervous system:
so commonplace that it has become a way of life. As the autonomic nervous system controls the internal organs
discussed above, stress isn’t always bad. Stress within of the body and plays an essential role in keeping the body’s
your comfort zone can help you perform under pressure, internal environment stable. It also plays a major part in our
motivate you to do your best, even keep you safe when emotional experience to external situations. The sympathetic
danger looms. But when stress becomes overwhelming, division is our emergency system. It prepares the body to
it can damage your health, mood, relationships and produce energy and to protect it from the effects of stress
quality of life. and injury: this is sometimes referred to as the ‘fight or flight’
response.
Top 5:
The GAS Model (Selye, 1936)
Sources of Stress Immediate responses to stressful or anxiety-provoking
events generate a high level of arousal. The human stress
What causes our stress? In an annual survey by the response involves many components, as Selye’s work
American Psychological Association, here are the top portrayed. He observed that long-term adaptation to
sources of stress, and the percentage of respondents who stress followed a three-stage pattern, which he named
identified each as a “very significant” source of stress. the General Adaptation Syndrome (GAS) (Figure 8.23).
GAS is a term describing the body’s short- and long-term
1 Money 76% reactions and adaptations to stress in order to restore
homeostasis.
2 Work 70%
KEY TERM
3 The economy 66%
homeostasis: the control of internal conditions, be it
4 Family responsibilities 59% temperature, specific blood conditions or other variables
within living organisms.
5 Relationships 55%
Selye suggested that there are three stages that lead to
Source: APA Stress in America survey, 2010 (most recent stats available) illness, linking stress and illness. He believed that stress

8.21 Sources of stress, as found by the American
Psychological Association in 2010

Cambridge International AS and A Level Psychology

Parasympathetic Sympathetic
nervous system nervous system

gHIPracts pupils Dilates pupils
Stimulates salivation
Inhibits salivation
Contracts bronchi
Relaxes bronchi
SlowQ Re—STUVWX
Accelerates heartbeat
ƒY`abcdtef
dhgipqrvs tuvwxy€ Inhibits digestive
activity
‚„…†‡ˆ‰‘’ “”•–˜™fhijk
Stimulates glucose
Contracts bladder release by liver

Relaxes bladder

8.22 Comparison of the parasympathetic and sympathetic nervous system

250 results in the depletion of physiological resources, lowering Homeostasis Alarm Stage Resistance Exhaustion
resistance to infection. The three stages of Selye’s GAS are: Stage Stage
alarm, resistance and exhaustion. Resistance

• Alarm: like the ‘fight or flight’ response, the stressor Time
8.23 Selye’s General Adaptation Syndrome
upsets the homeostasis of the body. The function of
this stage is to prepare the body’s resources. We might Selye suggested that early symptoms of almost any
respond to narrowly missing a serious car accident disease or trauma are virtually the same, that is, the
in the same way. Our bodies immediately release body responds identically to any stressor. In modern
hormones, including cortisol and adrenaline, to provide life, however, we rarely respond to perceived threat with
instant energy. actual action. Moreover, perceived threats do not have
to be present in a physical form and so they are difficult
• Resistance: the body adapts to the stressor and to quantify or avoid. They might also be continuous. This
means that the threat may be continuous and nebulous.
physiological arousal declines but is still above For example, the concern that financial problems might
normal. This is the body fighting back by adjusting to result in homelessness does not represent a direct
the stress. physical threat, but it may result in an acute and ongoing
perceived threat.
• Exhaustion: this occurs when long-term stress is

not removed. Eventually the body’s energy reserves
become depleted and the ability to resist declines. If
stress continues then disease, damage and death can
follow.

Chapter 8: Psychology and health

Causes of stress Pituitary gland Hypothalamus

Work (Chandola et al., 2008) Thyroid Immune
Workplace stress is the result of a conflict between the gland system
demands that a job might place on its employees and
the extent of the control an employee has to meet the Adrenal Mammary
demands. It can be a damaging physical and emotional gland glands
response. In general, the combination of high demands
in a job and a low amount of control over the situation Uterus Liver Ovaries
can lead to stress. Stress in the workplace might come
from one single event or many sources. It can impact on 8.24 Neuroendocrine mechanisms 251
both employees and employers alike. In 2001, the Higher
Education Funding Council of England conducted a three The Whitehall II study was established to explore the
year study of occupational stress. The main causes of stress relationship between socio-economic status, stress and
identified were: long hours, job security, particularly in cardiovascular disease. A sample of 10 308 participants
relation to terms of employment, work relationships, access aged 35–55, of whom 3413 were women and 6895 men,
to resources and communications. was recruited from the British Civil Service in 1985. Since
this first wave of data collection in 1985, self-report
Stress at work is associated with an increased risk of questionnaires and clinical data have been collected from
coronary heart disease (CHD) but the reasons underlying the cohort every two to five years with data collection
this association remain unclear. Chandola et al. (2008) intended to continue until 2030.
wanted to determine the biological and behavioural factors
linking work stress with CHD. Evidence from the Whitehall II study suggests that workers
who report work stress more often in their working
KEY TERM careers have increased risks of heart disease, obesity and
cardiovascular risk. A job strain questionnaire was used at
coronary heart disease (CHD): Coronary heart disease two points in the study to provide a measure of cumulative
(CHD) occurs where a waxy substance called plaque builds up work stress. Job strain was defined as a high job demand
inside the coronary arteries. These arteries supply oxygen-rich with low personal control over the job and decision making.
blood to your heart muscle. Hardened plaque narrows the People who have job strain and who are socially isolated
coronary arteries and reduces the flow of oxygen-rich blood to at work (without supportive co-workers) were said to have
the heart. work stress.

Chandola et al. analysed data collected from the Whitehall II Chandola et al. recorded the number of non-fatal heart
study to investigate the following three questions: attacks as well as deaths due to heart disease that occurred
during the study. They also collected information on
• Is the accumulation of work stress associated with biological risk factors for heart disease such as cholesterol,
blood pressure, blood sugar levels, waist circumference,
higher chances of developing CHD?

• Is this association stronger among the working-age

population?

• Does work stress affect CHD directly through

neuroendocrine mechanisms (Figure 8.24) or
indirectly through behavioural risk factors?

KEY TERM

neuroendocrine mechanisms: the system by which
the hypothalamus maintains homeostasis, regulating
reproduction, metabolism, eating and drinking behaviour,
energy utilisation and blood pressure.

Cambridge International AS and A Level Psychology

cortisol levels and heart rate variability; and behavioural were very much more likely to experience a prolonged
risk factors such as alcohol, smoking, diet and exercise. illness in the following year than people who had not.

The results suggest that cumulative work stress is a high Using medical case histories and interviews, Holmes and
risk factor for developing CHD, especially among the Rahe studied a large number of people who were suffering,
younger, working-age population. Around 32% of the or had suffered, from extreme stress. From this data, they
effect of work stress on CHD can be explained by the effect developed a social readjustment scale, which ranked life
of work stress on health behaviours such as low physical
activity and poor diet. Chronic work stress was associated events according to how much stress they appeared to
with CHD and this association was stronger among
participants under 50. give people. Not every life event was the same: for example,
going through a divorce or suffering bereavement was very
There were similar associations between work stress much more stressful than changing one’s eating or sleeping
and low physical activity, poor diet and lower heart rate
variability. Work stress was associated with a higher habits. Using a sample of 394 patients, Holmes and Rahe
morning rise in cortisol. Around 32% of the effect of work
stress on CHD was attributable to its effect on health were able to rank 43 life events on their scale, from those
behaviours and the metabolic syndrome.
that cause the most stress (death of a spouse) to those
Life events (Holmes & Rahe, 1967)
People use the word ‘stress’ to describe a wide variety that cause the least stress (minor violations in law and
of situations: from your mobile phone ringing while you
are busy on another task, to the feelings associated Christmas) as shown in Table 8.13.
with intense work overload, or the death of a loved one.
252 Perhaps the most useful and widely accepted definition Rank Life event Mean
of stress is: a condition or feeling experienced when a value
person perceives that demands exceed the personal and 1 Death of spouse 100
social resources they are able to make use of. In other 2 Divorce
words, we feel stressed when we feel that things are 3 Marital separation 73
out of control. 4 Jail term 65
5 Death of close family member 63
6 Personal injury or illness 63
7 Marriage 53
50

Life events are defined as experiences that disrupt an 8 Fired at work 47
individual’s usual activities, causing a substantial change 9 Marital reconciliation 45
and readjustment. Examples of life events include 10 Retirement 45
marriage, divorce, illness or injury, and changing or losing a 11 Change in health of family member 44
job. Lots of research into stress has focused on life events 12 Pregnancy 40
and these have been considered as an important type of 13 Sex difficulties 39
stressor. 14 Gain of new family member 39
15 Business readjustment 39
When investigating the causes and sources of stress, 16 Change in financial state 38
Holmes and Rahe (1967) looked at what makes a 17 Death of close friend 37
situation stressful. This is often called the stressful 18 Change to different line of work 36
life event approach or the engineering model. They 19 Change in number of arguments with 35
suggested that living through life events that were
stressful could cause serious damage to an individual’s spouse 31 ➔
health. One of their major findings was that stress 20 Mortgage over $10 000
generated by such events seemed to build up. Whether
a particularly stressful period produced illness later
on depended on just how much stress had been
accumulated and people who had experienced a very
high number of stressful life events in a certain period

Chapter 8: Psychology and health

Rank Life event Mean Type A characteristics Type B characteristics
value
Highly competitive Non-competitive
30
21 Foreclosure of mortgage or loan 29 Works fast Works more slowly
22 Change in responsibility at work 29
23 Son or daughter leaving home 29 Strong desire to succeed Lacking in desire to
24 Trouble with in-laws 28 succeed
25 Outstanding personal achievement 26
26 Wife begin or stop work 26 Likes control Does not enjoy control
27 Begin or end school 25
28 Change in living conditions 24 Prone to suffer stress Less prone to stress
29 Revision of personal habits 23
30 Trouble with boss 20 Table 8.14 Type A and Type B characteristics compared
31 Change in work hours or conditions 20
32 Change in residence 20 Friedman and Rosenman (1974) observed that the people 253
33 Change in schools 19 who seemed to be particularly susceptible to CHD also
34 Change in recreation 19 tended to have certain personality similarities (Table 8.14).
35 Change in church activities 18 These they argued formed the Type A pattern, which
36 Change in social activities 17 consists of three major facets.
37 Mortgage or loan less than $10 000 16
38 Change in sleeping habits 15 The first is a competitive achievement orientation, in
39 Change in number of family get- that these people are critical of themselves and set
15 goals without feeling any sense of happiness when they
togethers 13 accomplish them. The second personality characteristic is
40 Change in eating habits 12 time urgency. Type A individuals are very conscious of time,
41 Vacation 11 arranging a huge number of commitments, attempting
42 Christmas to complete more than one thing at once and expressing
43 Minor violations of the law impatience with delays. The third facet of Type A personality
Table 8.13 Social readjustment rating scale is a high level of anger and/or hostility, which may or may
not show outwardly. In contrast, type B individuals are less
competitive, show less time urgency and experience less
hostility.

Personality (Friedman & Rosenman, 1974) RESEARCH METHODS
Friedman and Rosenman (1974) believed that the causes This study used a very large sample. Why is a large
of stress come from the individual and that a person’s sample so important?
personality will determine whether they are susceptible to
stress or not. This approach to personality, known as Type In a longitudinal study, 3000 healthy men between ages
A and Type B personality, was originally developed as an 39 and 59 were assessed to determine their personality
attempt to explain why it was that some people seemed type, and then followed up throughout the following nine
to be particularly prone to CHD, while peers who also work years. The men were split into two roughly equal groups,
hard, were not.
KEY TERM

longitudinal study: a study that is conducted over a long
period of time. They are usually conducted to follow the
development of participants’ behaviour, illnesses or response
to interventions like treatment programmes.

Cambridge International AS and A Level Psychology

depending on whether they were assessed as Type A or how a large population of over 10 000 people respond
Type B. Over the course of the study, 70% of the 257 men to different life events, and the impact this had on their
who died were from the Type A group. People who are chances of developing coronary heart disease. This is far
of Type A are more susceptible to stress because of their more useful than a snapshot study that only shows how
behaviour traits, and are consequently more likely to suffer a sample of people are reacting at one point in time.
stress-related illness such as CHD.
Stress is a complicated concept, and it is unlikely that any
ISSUES AND DEBATES one explanation will be able to account for everyone’s
experience of stress following a life trigger. It is important
It is important to be able to identify what are the biggest that we consider how reductionist any explanation is when
sources of stress as this then allows individuals to trying to explain what sources of stress are. There are a
identify triggers in their life that may be impacting on variety of factors that could influence our stress response,
their health and implement appropriate interventions. from a depletion in physiological reserves (Selye) to life
This has applications to everyday life as correctly triggers like work, or even the type of personality that we
identifying stress triggers and the sources of stress in have and the impact this has on the way that we approach
one’s life could help with diagnosing stress early and stressful situations. It is likely to be a combination of these
preventing illnesses like coronary heart disease and other factors that will best explain how an individual experiences
illnesses relating to stress. and deals with stressful situations.

Measures of stress

There are cultural differences between different areas in Stress is not an illness itself, but it can cause serious

what might be a source of stress. These different cultural illness if it is not addressed. It is important to recognise

expectations and beliefs, and how they are internalised the symptoms of stress early since this will help a

by individuals within that culture, could have a significant patient work out ways of coping, and so save them from
254 impact on what they perceive as a trigger to stress. We must adopting unhealthy coping methods, such as drinking or

be aware of this and not be ethnocentric when discussing smoking.

sources of stress; what you consider a source of stress There are two main ways to measure stress: physiological
might be something of little significance to another culture.
and psychological. Physiological measures look at physical
Similarly, something that would not cause you stress could characteristics, such as blood flow and levels of chemicals
be the source of significant anxiety and stress to another and hormones in the body. Psychological measures tend

individual. to rely on self-report measures to gain feedback from the

When considering sources of stress, the nature versus person experiencing stress.

nurture debate would suggest that we need to consider

if an individual’s response to triggers and the impact this Physiological measures: recording devices and
has on stress is due to the environment or a biological sample tests (Wang et al., 2005; Evans & Wener,
predisposition. How we respond to stressful or anxiety 2007)
provoking events and our body’s physiological response One way to investigate the impact of stress on the brain
to these triggers could be a result of genes that we have
inherited from our parents or actually learned from our is to use brain imaging techniques. Functional magnetic
parents. Selye provides evidence to suggest that our
response to stress, and likelihood of suffering negative resonance imaging (fMRI) is a neuroimaging procedure
consequences following an anxiety provoking situation is
a combination of our physiology and how we choose to using MRI technology that measures brain activity by
respond to this. detecting changes associated with blood flow. In the
simplest fMRI study, a participant alternates between
periods of completing a specific task and a control or
rest state to measure baseline activity. The fMRI data

The use of longitudinal research allows researchers to is then analysed to identify brain areas in which the

see how different sources of stress impact individuals over signal changed between the activity and the rest state.

a period of time and how the stress response develops. It can be inferred that these areas were activated by the

The research by Chandola et al. gives an insight into stressful task.

Chapter 8: Psychology and health

Despite the prevalence of stress in everyday life and its scanner. Throughout, participants were prompted for faster
impact on happiness, health, and cognition, little is known performance and were required to restart the task if an
about the neural experience of stress in the brain. Wang error occurred. This high-stress condition was preceded
et al. (2005) used an fMRI scanner and a technique called by a low-stress condition, during which subjects counted
arterial spin-labelling perfusion MRI to measure aloud backward from 1000 (to control for activation of
cerebral blood flow. verbal and auditory centres). Self-report of stress and
anxiety levels (on a scale of 1 to 9) and saliva samples were
KEY TERM collected straight after each task (Table 8.15).
arterial spin-labelling perfusion MRI: arterial blood is
labelled or tagged and, after a delay, moves into the imaging Stress Effort Diffic ulty Frustration
plane or volume, during which time there is decay of the
label. Snapshot images are acquired in labelled and control Low-stress task 4.4 3.4 3.4
conditions and subtracted, producing an image that illustrates
cerebral blood flow to areas of the brain. High-stress task 7.0 6.6 6.1

8.25 An fMRI scan Table 8.15 Self-report of effort, difficulty and frustration
during low- and high-stress tasks (scale 1–9)
The data from fMRI scans are then used to generate
images that can illustrate how the brain is working during Regression analyses were carried out to search for 255
different tasks (Figure 8.25). They allow us to view active the specific brain regions associated with individual
brains without a neurosurgeon having to cut into the participants’ experience of stress. The hypothesis was
head of the patient. Patients are positioned in a large that the cerebral blood flow change induced by the high-
scanner that sends a strong magnetic field through their stress task compared with the low-stress task should be
head. The magnetic field causes the nuclei in hydrogen correlated with the change in perceived stress between
molecules in the brain to spin in a particular way, and these two conditions.
this is picked up by the scanner. Because hydrogen
concentrations vary in different parts of the brain, it is The results provide neuroimaging evidence that
possible for the scanner to produce a detailed picture of psychological stress induces negative emotion and that the
the brain based on the amount of hydrogen molecules it ventral right prefrontal cortex plays a key role in the central
identifies in different areas. stress response. It further suggests that it is possible to use
In Wang et al.’s research 32 participants were split into a physiological scan to measure the influence of stress on
a stress condition (25) and the control experiment (7). blood flow in the brain.
Participants were instructed to perform a mental
arithmetic task, responding verbally while in the fMRI Cortisol is released in response to fear or stress by the
adrenal glands as part of the ‘fight or flight’ mechanism.
Salivary cortisol is frequently used as a biomarker of
psychological stress and is a technique that has been
preferred by researchers as it is non-invasive. In addition,
as opposed to blood sampling, saliva collection does not
require the collaboration of skilled personnel, allowing
for an uncomplicated and trouble-free sample collection.
One issue to identify, though, is that stress mechanisms,
which trigger a physiological reaction, can only indirectly be
assessed by salivary cortisol measures.

Evans and Wener (2007) conducted research looking at how
easily and how frequently personal space may be intruded
upon and how this may be one of the key underlying
processes that underlie stressful experiences when
travelling. A total of 139 adult commuters (54% male) who
had been commuting to work by passenger train between
New Jersey into Manhattan, New York City, were recruited

Cambridge International AS and A Level Psychology

to the study. Each participant was provided a free monthly Psychological measures: self-report
rail pass for their participation. Participants had been on questionnaires (Holmes & Rahe, 1967; Rahe et al.,
the same commuting route for an average of 82 months, 1970; Friedman & Rosenman, 1974)

with a 12 month minimum and their average duration of the As mentioned above, Holmes and Rahe (1967) investigated

commute to work was 83 minutes. the causes and sources of stress and focused on life

Two measures of crowding were taken for each events as stressors. Through this they developed the
participant’s journey: car (carriage) density and seat Social Readjustment Rating Scale. The scale consisted
density. Car density was calculated by dividing the total of 43 different life events which each had a stress score.
number of passengers within the train car by the total Respondents would add up the stress scores of all of the
number of seats. Seat density was a more proximal events that they had experienced within the last 12 to 24
measure of crowding local to where the participant months to get their total score.

was sitting and was calculated by dividing the number An interesting observation suggested a relationship

of people sitting on the same row as them by the total between the Social Readjustment Scale and subsequent

number of seats on the row (five). health. A score of 300 or higher puts a person at risk of

Salivary cortisol was collected from each participant illness, 150–299 shows a moderate risk of illness, and a

through a chewable swab. The results showed that the score of less than 150 predicts only a slight risk of illness.

density of the train car was inconsequential for levels of The researchers suggested that this came from the physical

stress whereas the seating density near to the passenger drain on the body produced by the continual arousal and

significantly affected both self-reported stress and levels the general adaptation to long-term or repeated stress.

of cortisol in the participant’s saliva. Evans and Wener Rahe et al. (1970) tested the reliability of the scale again

concluded that the ease and how frequently personal space in 1970. He asked 2500 US military members (sailors) to
rank stressful events in their lives against the scale. He
is intruded upon may be one of the key processes that
tracked the sailors for six months, noting their visits to
256 underlie the experience of crowding.
the dispensary, to see if there was a correlation between

This study showed that it is possible to measure the impact their visits to the doctor and the stressful events they

of stressful experiences, such as a morning commute to had reported. The study once again proved the reliability

work, on an individual by using a physical measure such of the scale, with the exact same positive correlation

as taking a sample of saliva and measuring the levels of between reported stress and illness as found in the original
cortisol at different points. examination of medical record: 0.118 (Table 8.16).

1 Marriage ➔
2 Troubles with the boss
3 Detention in jail or other institution
4 Death of spouse
5 Major change in sleeping habits (a lot more or a lot less sleep, or change in part of day when asleep)
6 Death of a close family member
7 Major change in eating habits (a lot more or a lot less food intake, or very different meal hours or surroundings)
8 Foreclosure on a mortgage or loan
9 Revision of personal habits (dress, manners, association, etc.)
10 Death of a close friend
11 Minor violations of the law (e.g. traffic tickets, jay walking, disturbing the peace)
12 Outstanding personal achievement

Chapter 8: Psychology and health

13 Pregnancy 257
14 Major change in the health or behaviour of a family member
15 Sexual difficulties
16 In-law troubles
17 Major change in number of family get-togethers (e.g. a lot more or a lot less than usual)
18 Major change in financial state (e.g. a lot worse off or a lot better off than usual)
19 Gaining a new family member (through birth, adoption, oldster moving in, etc.)
20 Change in residence
21 Son or daughter leaving home (e.g. marriage, attending college)
22 Marital separation from mate
23 Major change in church activities (e.g. a lot more or a lot less than usual)
24 Marital reconciliation with mate
25 Being fired from work
26 Divorce
27 Changing to a different line of work
28 Major change in the number of arguments with spouse (e.g. either a lot more or a lot less than usual regarding

childrearing, personal habits, etc.)
29 Major change in responsibilities at work (e.g. promotion, demotion, lateral transfer)
30 Wife beginning or ceasing work outside the home
31 Major change in working hours or conditions
32 Major change in usual type and/or amount of recreation
33 Taking on a mortgage greater than $10 000 (e.g. purchasing a home, business)
34 Taking on a mortgage or loan less than $10 000 (e.g. purchasing a car, TV, freezer)
35 Major personal injury or illness
36 Major business readjustment (e.g. merger, reorganisation, bankruptcy)
37 Major change in social activities (e.g. clubs, dancing, movies, visiting)
38 Major change in living conditions (e.g. building a new home, remodelling, deterioration of home or neighbourhood)
39 Retirement from work
40 Vacation
41 Christmas
42 Changing to a new school
43 Beginning or ceasing formal schooling
Table 8.16 Social readjustment rating questionnaire

Cambridge International AS and A Level Psychology

As discussed above, it is possible to categorise individuals that a much more sophisticated model is needed to predict
as either Type A or Type B personality types (Friedman CHD than this simple Type A–Type B approach.
and Rosenman, 1974). Classifying behaviour into these
categories is usually done by interview or by questionnaire ISSUES AND DEBATES
(i.e. a psychometric test). Examples of questions are:

‘Has your partner or friend ever told you that you eat too Some of the methods used to measure stress are types
fast?’ of psychometric tests, that allow the practitioner to
better understand the feelings and perceptions of the
• Type As are likely to say, ‘Yes, often’. individual who is experiencing the anxiety. Psychometric
• Type Bs are likely to say, ‘Yes, once or twice’ or ‘no’. tests can be developed to help medical professionals
explore not only how much anxiety and stress is
‘How would your partner, or best friend, rate your general being experienced, but also possible personality and
level of activity?’ environmental criteria that could increase the experience
of the stress. On the other hand, physiological measures,
• Type As are likely to say, ‘Too active, need to slow such as measuring cortisol in saliva or using brain
imaging techniques are far more objective and not
down’. subject to the same biases increasing the reliability of
any data collected.
• Type Bs are likely to say, ‘Too slow, need to be more
All of the measures of stress provide useful applications
active’. to everyday life, both in a medical setting and at home.
If we can measure stress and identify when an individual
‘Do you ever set deadlines or quotas for yourself at work or is experiencing stress, it is possible that a medical
at home?’ professional could get involved early and prevent any
more dangerous illnesses.
• Type As are likely to say, ‘Yes once a week or more

often’.

• Type Bs are likely to say, ‘Only occasionally’.

258 ‘When you are in the middle of a job and someone (not your
boss) interrupts you, how do you feel inside?’

• Type As are likely to say, ‘I feel irritated because most Evaluation

interruptions are unnecessary’. Those stress measures that are reliant on self-report
mechanisms can be susceptible to social desirability
• Type Bs are likely to say, ‘I feel OK because I work better where patients answer in a way that they feel they should
answer, rather than giving the truth. Similarly, there are
after an occasional break’. issues of subject bias as stress perception is a unique
experience, and there are massive individual differences
The idea that people can be categorised is desirable to in stress thresholds. Two people could experience the
doctors as it allows practitioners to predict behaviour same trigger but react in very different ways to this
based on the results of a personality test. Such a anxiety.
simplistic approach can be criticised for trying to explain
human personality in such basic terms and it should Physiological measures are a more objective measure of
be recognised that there are more than two types of stress. This could be achieved by looking at brain activity,
personality. or levels of hormones produced by the body, however,
these are time consuming and expensive. Further to this,
The major problem with Type A and Type B theory is using physiological measures like fMRI (Wang et al.) require
actually determining which factors are influencing stress a technician to interpret the results of the scan; there is still
and CHD. Some research has concentrated on hostility, a lot that researchers do not know about areas of the brain
arguing that the Type A behaviour pattern is characterised and how activity links to the experience of emotion, so
by underlying hostility which is a major factor leading any inferences about stress and anxiety from these results
to CHD. Research by Friedman and Rosenman has should be treated with care.
demonstrated that it is the negative experience of stress
that those with Type A personalities are exposed to that is
the major factor leading to CHD. Therefore, it would seem

Chapter 8: Psychology and health

SELF-ASSESSMENT QUESTIONS individual. This information enables the person to gain
voluntary control over these processes through operant
10 If you were trying to conduct a study where conditioning. If, for instance, the person is trying to reduce
you needed to measure the amount of stress a neck muscle tension and the device reports that the
participant was under, what problems would you tension has just decreased, this information reinforces
face in collecting reliable data? whatever efforts the individual made to accomplish
this decrease.
Management of stress
Principles of biofeedback
Reflections: How do you manage your stress and The patient has electromyography (EMG) electrodes attached
anxiety? When you feel anxious about a situation, like a to the skin surface over a particular muscle.
college exam, how do you deal with the situation?
Subjects hear a tone with a pitch proportional to the
Medical techniques electromyographic activity in a given muscle group
Drugs can be used as a quick and relatively easy way of (Figure 8.26).
dealing with stress, especially in the short term. Stress is
often accompanied by anxiety and depression and so drugs As the patient gets better at this they have to maintain a
used to treat these disorders are often prescribed when a higher level relaxation in the muscle to hear a low tone.
person is experiencing many symptoms of stress.
Audiovisual Measurement 259
The antidepressants most widely prescribed for anxiety feedback of selected
are selective serotonin reuptake inhibiters (SSRIs) such physiological
as Prozac. These work by regulating serotonin levels in Personal computer parameters
the brain to elevate mood and have been used to treat or other device for
panic disorder, obsessive-compulsive disorder (OCD), and analysing the data
generalised anxiety disorders (GAD).
8.26 The principles of biofeedback
Anti-anxiety drugs decrease arousal and relax the body by
reducing tension in the muscles. Since the stress response Biofeedback has been used in stress management by
involves high arousal, tranquillisers may in some cases helping people learn to relax specific muscles. It has also
reduce stress. Benzodiazepines are drugs that can be used been employed to treat stress-related health problems,
to treat anxiety (which often results from stress) and work for example, in reducing chronic muscle-contradiction
by releasing inhibitory neurotransmitters, meaning that the headaches. Biofeedback is based on the principle of
brain is less aroused so the person is calmer and less anxious. operant conditioning and receiving reinforcement for
behaviour that reduces the stress response.
The effectiveness of benzodiazepines was researched by
Kahn et al. (1986) who gave a group of patients the drug, Most often, biofeedback helps people control their stress
while another was given a placebo (a substance that has no response, by realising when a stress response is happening
therapeutic effect, used as a control in testing new drugs). and employing relaxation techniques like deep breathing,
They followed 250 patients for eight weeks and found that visualisations and meditation to calm their physiological
benzodiazepines reduced stress significantly more than the arousal.
placebo.
Budzynski et al. (1969) wanted to assess the effect of
Psychological techniques: biofeedback and imagery biofeedback in reducing tension headaches. Tension
Biofeedback (Budzynski et al., 1969) headaches are associated with sustained contraction of
Biofeedback is a technique in which an electromechanical the scalp and neck muscles, therefore relaxing the frontalis
device monitors the status of a person’s physiological muscle (from the top of skull to the forehead) will have
processes, such as heart rate or muscle tension, and a positive impact on reducing the suffering of a patient
immediately reports that information back to the (Figure 8.27).

Cambridge International AS and A Level Psychology

The results were collected over five sessions and the mean
level of muscle tension was measured to operationalise
the dependent variable. It was evident that those
participants in the feedback condition saw a significant
reduction in their muscle tension over the course of the
five sessions, and this reduction was greater than the two
control groups.

The study showed that patients can be trained to voluntarily
lower their muscle through the use of biofeedback, see
Figure 8.29. This study suggests that operant conditioning
techniques and ‘shaping’ of behaviours could be applied
to a wide variety of physiological events in the body. The
practical implication of these results would seem apparent.
Biofeedback can have beneficial effects of profound muscle
relaxation in alleviating a number of anxiety and stress-
related disorders.

Imagery (Bridge, 1988)

8.27 The frontalis muscle (top of skull to forehead) Visualisation and imagery (sometimes referred to as
guided imagery) techniques offer yet another avenue for

stress reduction. These techniques involve the systematic

Each participant had electrodes attached to their head practice of creating a detailed mental image of an

one inch (25 cm) above the eye across the forehead. There attractive and peaceful setting or environment. There is
260 were three conditions in the experiment and each of the no single correct way to use visual imagery for stress relief.

15 participants was randomly allocated to one of these However, something similar to the following steps is often

conditions. The experimental group were told that the pitch recommended:

of the tone would vary with the level of muscle tension in • Find a private calm space and make yourself
the forehead. They were told to relax as deeply as possible

and to keep the tone low pitched. The other two conditions comfortable.
were control groups. The constant low tone irrelevant
• Take a few slow and deep breaths to centre your

feedback condition was told to relax deeply, especially the attention and calm yourself.

forehead muscle; they were also told that the constant tone • Close your eyes.
should help them relax. The final group was told to relax as • Imagine yourself in a beautiful location, where
deeply as possible and to do this in silence.
everything is as you would ideally have it. Some people

visualise a beach, a mountain or a forest, or being in a

Mean level of muscle action potential 16 favourite room sitting on a favourite chair.
(µv p-p)
14 • Imagine yourself becoming calm and relaxed.

12 Alternatively, imagine yourself smiling, feeling happy and

10 having a good time.

8 FF F • Focus on the different sensory attributes present in

6 Feedback your scene so as to make it more vivid in your mind. For
Silent
instance, if you are imagining the beach, spend some
4 Low tone
time vividly imagining the warmth of the sun on your

2 skin, the smell of the ocean, seaweed and salt spray, and

0 the sound of the waves, wind and seagulls. The more
012345
Session you can invoke your senses, the more vivid the entire

8.28 Patients can be trained to voluntarily lower their image will become.
muscle through the use of biofeedback
• Remain within your scene, touring its various sensory

aspects for five to ten minutes or until you feel relaxed.

Chapter 8: Psychology and health

• While relaxed, assure yourself that you can return to this of mood states differed significantly in the predicted way. 261
This indicated that relaxation positively affected mood state
place whenever you want or need to relax. and that this positive effect was further enhanced when
relaxation was combined with imagery.
• Open your eyes again and then re-join your world.
Relaxation plus imagery was more effective than relaxation
Guided imagery has many uses. You can use it to promote alone as the simplicity of the imagery, suggesting a
relaxation, which can lower blood pressure and reduce peaceful, pleasant scene of the patient’s choice, meant that
other problems related to stress. You can also use it to help it was within everyone’s grasp. Bridge reported that often
reach goals (such as losing weight or quitting smoking), the image made the patient smile, at a time when smiles
manage pain and promote healing. were perhaps few and far between. Therefore, this provides
support for the use of imagery techniques in reducing stress
A study on the impact of imagery is reported by Bridge in women undergoing cancer treatment.
(1988) who detailed an experiment looking at the effect of
relaxation and imagery on the stress levels of women who Preventing stress (Meichenbaum, 1985)
were undergoing treatment for cancer. Studies of patients Stress inoculation training (SIT) consists of three
with cancer showed that the systematic use of positive overlapping phases (Table 8.18). A key part of the training
thought and imagery when patients were in a relaxed frame is the idea that stressors are creative opportunities and
of mind helped prolong their lives. puzzles to be solved rather than obstacles. SIT is a form
of cognitive behavioural therapy in that it attempts
Bridge wanted to see whether stress could be alleviated in to get the patient to recognise the cognitions (thoughts)
patients being treated with radiotherapy for early breast that trigger a stressful experience and then skill them
cancer using a controlled randomised trial lasting six weeks. with intervention strategies to help relieve the stressful
All of the 139 women were outpatients having a six week experience.
course of radiotherapy at the Middlesex Hospital, London,
and were under the age of 70. KEY TERMS

The patients completed the Leeds General Scales Measure, cognitive therapy: a key influence on behaviour is how a
which gives the severity of depressive and anxiety person thinks about a situation, so cognitive therapy aims to
symptoms in patients who have not received a primary change maladaptive or unwanted thoughts and feelings.
diagnosis of affective illness, both before and after the six behavioural therapy: a key influence on behaviour is the
week trial. They also completed a mood scale: the profile of previous learning process, so behavioural therapy aims to
mood states uses 65 items to yield scores on subscales for produce a new set of more desirable behaviours.
tension, depression, vigour, fatigue, anger and confusion. cognitive behavioural therapy (CBT): a combination of
The women were fully aware of the experiment and were cognitive therapy and behavioural therapy.
randomly allocated to one of three conditions: relaxation,
relaxation plus imagery or a control condition (Table 8.17).

There were no significant differences on the Leeds General
Scales but the total mood disturbance score on the profile

Relaxation (n = 47) Relaxation plus imagery (n = 44) Controls (n = 48)

These patients were taught a relaxation technique which by a process of direct Women in the control group were
concentration focuses sensory awareness on a series of individual muscle encouraged simply to talk about
groups. They were also taught breathing techniques that induce a calmer state themselves and their interests.
and reduce tension.

These patients were given a tape recording of the instructions and told that they
should practise these techniques at home for 15 minutes each day.

Also taught to imagine a peaceful
scene of her own choice as a means of
enhancing the relaxation.

Table 8.17 Participant allocation

Cambridge International AS and A Level Psychology

Conceptualisation Education phase emphasising development ‘I realise that I’m most stressed in social
of a warm, collaborative relationship through situations and I always react by thinking “I can’t
which a careful assessment and problem handle this, I’m going to make a fool of myself”.’
reconceptualisation are completed. During this
stage, the patient is taught about the concept of
stressors and how these affect their body.

Skills acquisition New skills and coping strategies are acquired ‘Relax, I’m in control. I just need to focus on the
and rehearsal and rehearsed. These techniques will be chosen job. I must take slow, deep breaths and make
with the patient and specifically tailored to their sure my muscles are relaxed.’
cognitive strengths but could involve a variety
of emotion regulation skills, relaxation and
problem solving strategies. The development
of these skills, and the subsequent growth
in confidence about their effectiveness, will
empower the patient as they begin to realise
that they are able to control their stress
response.

Application and Focuses upon activities that transfer coping ‘I’ll try to chat to colleagues during the lunch
follow through skills to real life and prevent relapse. break. I’ll then move on to starting an evening
class and talking to new people there. If it
all goes wrong, I’ll talk it through with my
therapist.’

262 Table 8.18 The three overlapping phases of SIT

The goal of SIT is to equip the patient with a variety of (Table 8.19). Meichenbaum (1985) believed that people
coping strategies that they can implement when they could inoculate themselves against stress, in the same
identify that they are having negative, or stressful cognitions manner as being inoculated from disease.

Cool relaxed thoughts Just stay cool. Getting all anxious and upset won’t help.
It’s just not worth it. Who is going to know or care in a month anyway?
Just relax. That’s it, take those three deep breaths…
OK, if I need to, I will just switch on that calm relaxation image and calm myself down

Cognitive restructuring Is this an all-or-none situation? Things aren’t usually black and white.
of maladaptive
thoughts Don’t jump to conclusions. Check out the possibilities.
Don’t take it so personally. What’s my share of the responsibility pie anyway? Even if I am
responsible for this problem, it doesn’t mean I’m a bad person.

Put it into context. If you look at it the right way, it’s pretty funny.
One new snowflake doesn’t make a blizzard. Just stay with what’s going on.

It’s not going well, but that doesn’t mean that I’m worthless or it’s hopeless, just that it didn’t
work out for me this time.
I don’t ‘have to’ do it ‘perfectly’ or ‘right’. I am just going to do my best. That’s all I can ask of
myself or anyone else.

Don’t worry. Worrying doesn’t help.

Table 8.19 Examples of types of self-statements rehearsed in stress inoculation training

Chapter 8: Psychology and health

SIT proposes that stress occurs whenever the perceived SELF-ASSESSMENT QUESTIONS 263
demands of a situation exceed the perceived resources
that are available to the individual. The word ‘perception’ 11 How could you measure the effectiveness of a stress
is important here as it reflects the concept that stress is an management technique?
individual view of the situation and this can be modified
through interventions and coping strategies. 8.5 Health promotion

Evaluation Although the term health education is quite new, there
have been attempts made for centuries to persuade people
In Bridge, the sample was focused on women who were to change their behaviour to ensure good mental and
undergoing therapy for cancer. This biased sample means physical health. How best to encourage them to do so is
that any conclusions that are gained from the research a fundamental issue that hasn’t yet been resolved. There
cannot necessarily be generalised to men as well. This has been an increasing move among health professionals
limits the usefulness of the findings somewhat, but it is towards primary care: promoting behaviour that facilitates
important to note that the significant improvement when the avoidance of disease, ill health or injury.
using imagery could lead to further research to test the
reliability of the findings with a male sample. The use of Treating an illness once it has developed is the familiar
random allocation as a control is a strength of the research, and established medical model of ‘secondary care’. Health
however, as the patients were aware that they were in a psychologists are increasingly recognising that such a
study on the impact of pain management; this could have reactive stance is inadequate if we are one day to achieve
created demand characteristics. The use of a single-blind a healthy society and that a more proactive primary care
technique, where the patient is not aware of the condition approach of health promotion is needed.
that they are in, or the aim of the research could have been
used to avoid this. Strategies for promoting health

Budzynski’s research was focused on a small sample of This is a report of a study conducted by Cowpe (1989). At
15 participants which reduces the population validity the time this research was conducted, chip-pan fires were
of the research. A group of 15 people cannot represent a major cause of domestic fires in the UK. Approximately
the wide range of individuals within a population, so we one-third of all domestic fires were caused by chip-pans.
have to be careful in how we interpret the results and not In 1981, there were 21 deaths and 1372 injuries caused by
over-generalise the findings. There were many controls 15 000 chip-pan fires in the UK. Not only this but chip-pan
in the experiment, and each participant had to follow fires were a major cost to the taxpayer in terms of providing
a standardised procedure throughout the trials. This emergency rescue crews and police and the associated
standardised procedure allows the researchers to be costs to the National Health Service.
confident about the reliability of the results, however, the
researcher needs to be cautious about how long lasting any The aim of this study was to test the effectiveness of an
changes in behaviour would be as this is only a snapshot of advertising campaign warning people about chip-pan
behaviour over five weeks. fires. This can be understood as a quasi-experiment. The
advertisement was shown on television in ten UK regional
ISSUES AND DEBATES television areas. The findings revealed a net decline in each
area over the 12 month period from between 7% and 25%.
When developing methods to manage stress, it is The largest reduction was actually during the time that the
important to recognise that both biological and campaign was running. Questionnaires showed a significant
psychological factors combine in how our bodies react increase in awareness.
to anxiety. Any method developed should attempt
to combine as many techniques as possible, and The conclusion was that the advertising proved effective
not focus on one narrow approach. The most useful as shown by the reduction in chip-pan fires. However, as
application that comes from our understanding of time passes the effectiveness of the campaign passes away
stress management and prevention is that the most as well. Viewers are also less likely to be influenced by the
effective stress relief will probably come from combining campaign if overexposed.
the different biological and psychological techniques.

Cambridge International AS and A Level Psychology

Health professionals and health psychologists have After a week, questionnaires were administered asking

investigated many different methods of promoting health. how tooth-brushing behaviour had changed. They

Some psychologists have suggested that health can best be found 28% of the high-fear group reported that they

promoted by using health education campaigns and others had changed their habits, but 50% of the low-fear group

have suggested that it is done best by direct intervention. reported better habits. Clearly the low-fear group learned

There are several competing theories on what makes from their presentation, even if they found it boring.
an effective strategy for promoting a health behaviour. Students in the high-fear group had a quick emotional
Janis and Feshbach (1953) consider fear arousal the most reaction but less behaviour change. Something worth
effective way of changing behaviour, but recognise that it is noting about this study is that the low-fear group received
possible to scare people too much so that they do not take specific, practical instructions. Those instructions may
have been lost amid the 71 fear-arousing images in the
the message on board. The Yale Model of Communication high-fear presentation.
goes further by considering the different elements of a

health promotion and how each of these needs to be Janis and Feshbach found on one hand that the message

considered separately to be effective. arousing strong fear elicited the most favourable appraisals

of the communication by the audience and proved

Fear arousal (Janis & Feshbach, 1953) equally as effective as the other versions in teaching
Fear arousal is a key feature of many health promotion factual information. Different results were obtained, on
campaigns. It works by letting people know bad things
will happen to them unless they change their ways. One of the other hand, concerning acceptance of the message’s
the most studied variables affecting health promotion is
recommendation. The minimal fear appeal was far more
effective than the other two messages in encouraging

the degree of fear inspired by a message. An early study by students to adopt the recommended practices of oral
Janis and Feshbach (1953) compared high-fear, medium-
fear and low-fear presentations of information about hygiene, whereas the message that aroused strong fear was
264 dental hygiene, each presented to a group of the least effective. The same finding was demonstrated
when students subsequently were asked to react to a

50 high-school students (mean age 15 years). There was statement which contradicted the message’s emphasis
also a control group who received a presentation on on the use of the proper type of toothbrush. Minimal fear
human eye function. The aim was to test if level of fear elicited the most resistance to the counter-propaganda and
would have a behavioural consequence in relation to the strong fear, the least resistance.

participants’ brushing of teeth.

The greatest immediate impact was on the students in the Yale Model of Communication
high-fear group, of whom 76% said they were worried about
tooth decay (an increase of 42% after watching the film). The Yale Model of Communication (Figure 8.29) states
In contrast, of students seeing the low-fear presentation, that there are several factors that will affect how likely a
only 46% reported feeling worried about tooth decay (an person is to change their behaviour in response to a cue
increase of only 24%). in the environment. It takes into account the fact that
a person’s behaviour is unlikely to change unless their

Source Message Medium Target Situation

Are they credible? Is it one-sided or Is it one to Who is the Where will the
Do they have two-sided? one? message aimed message be
expertise? Is it clear and received?
Are they direct? Is it a personal at?
trustworthy? message? Is the audience Home,
Is it colourful and Is it on the sympathetic? cinema,
vivid? radio, TV or Is the audience doctor’s
print? knowledgeable? surgery?

8.29 Yale Model of Communication

Chapter 8: Psychology and health

thoughts or attitude towards the behaviour change first. Health Belief Model
The model focuses on three aspects of communication: According to the Health Belief Model people are likely to
the communicator (who says it), the communication (what practise healthy behaviour if they believe that by not doing
is said) and the audience (to whom it is said). so they are susceptible to serious health problems. In other
words, they are motivated by fear to protect their health.
• The communicator: it is crucial that the source of any
Leventhal (1967) demonstrated this with an experiment on
message has credibility. This can be achieved through cigarette smokers. Those who were exposed to a high-fear
use of academic advice, appropriately qualified appeal, involving watching a film of an operation to remove
people, relevant personal experience and those who a diseased lung, changed their attitudes and intentions
are trustworthy. For example, many group therapies for regarding smoking more than those shown a moderate-fear
drug users are led by an ex-drug user which gives them appeal.
credibility when empathising with their situations.
Also, many advertising campaigns will be sponsored by Providing information (Lewin, 1992)
government agencies to further add to the weight and Giving patients information to help them make informed
credibility of any message contained within. decisions could be a good way of promoting many health
behaviours. A home-based exercise programme has been
• The communication: the Health Belief Model suggests found to be as useful as a hospital-based one in improving
cardiovascular fitness after a heart attack.
that perceived threat is a prerequisite for positive
health behaviours. The Yerkes–Dodson Law of Arousal To find out whether a comprehensive home-based
(Figure 8.30) states that each individual has their own programme would reduce psychological distress, Lewin
optimal level of arousal and it is important for an (1992) randomly allocated 176 patients who had suffered
effective message to be strong enough to increase a heart attack to a self-help rehabilitation programme
attention, but not too unpleasant as to produce high based on a heart manual or to receive standard care plus a
levels of anxiety. placebo package of information and informal counselling.

Psychological adjustment, as assessed by the Hospital 265
Anxiety and Depression Scale, was better in the
Strong Optimal arousal rehabilitation group at one year. They also had significantly
Optimal performance less contact with their general practitioners during the
Increasing following year and significantly fewer were readmitted to
attention and hospital in the first six months.

interest The improvement was greatest among patients who were
Performance clinically anxious or depressed at discharge from hospital.
Impaired The cost-effectiveness of the home-based programme
performance has yet to be compared with that of a hospital-based
because of programme, but the findings of this study indicate that it
strong anxiety might be worth offering such a package to all patients who
have had a heart attack.
Weak Arousal High
Low ISSUES AND DEBATES

8.30 The Yerkes–Dodson Law of Arousal states that each When considering strategies for promoting health
individual has an optimal level of arousal. Over-arousal will behaviours it is important to look at both individual
reduce the effectiveness of any programme and situational explanations for their behaviour.
Some individuals may be more likely to follow a health
• The audience: when considering how the message is to promotion strategy if there are situational gains for them,
whereas others may be more affected by campaigns that
be conveyed it is important to consider the demographic
of the audience and the type of issue that is being
promoted. With complicated issues it is better to spell
out the conclusions whereas when there is a simple
message or it is addressing well-informed people, let
them make their own conclusions. Also, where possible,
the audience should be involved in some way by posing
questions or using point of view filming.

Cambridge International AS and A Level Psychology

ISSUES AND DEBATES (continued) the primary age range (4–11 years). The programme is
designed to be implemented entirely by school staff and
are directed towards them personally (by age, behaviour contains the following elements:
or sex for example). The interaction between these
needs to be considered so that theories do not become • a Food Dudes video containing six short adventure
too deterministic and promote the ideas that a person’s
health behaviour can be changed through the use of one episodes
simple strategy. It is not the case that if you do give a cue
to action to an individual they will follow it. • a set of Food Dudes rewards
• a set of letters from the Food Dudes that provide praise
The fear arousal model and the Yale Model of
Communication have useful applications to everyday and encouragement and remind children of the reward
life as they signpost strategies that can be employed contingencies
by marketing campaigns and those within the medical
profession to change patient’s health behaviours. • a Food Dudes home pack to encourage children to eat
Prevention of illness is a more effective way of dealing
with illness and if campaigns can be devised that fruit and vegetables in the home context as well as at
encourage people to live healthier lives then this helps school
not only the individual but the strains that are being put
on health services around the world. • a staff manual and staff briefing video to help teachers

Health promotion in schools, worksites and implement the programme correctly
communities
• a set of education support materials to help teachers
266 Schools - Tapper et al. (2003)
Often, healthy eating campaigns rely on educating meet curriculum targets using the Food Dudes theme.
individuals as to the negative consequences of continuing The main intervention phase of the programme lasts for
to eat unhealthy foods. Researchers at the Bangor a period of 16 days during which children watch the Food
Food Research Unit have approached the problem of Dudes video episodes and listen to their teacher read out
encouraging healthy eating from a different angle. Instead the Food Dudes letters. Children also receive rewards when
of attempting to change knowledge about healthy eating, they eat the fruit and vegetables that are presented to
or attitudes towards particular foods, they tackled food them. They receive a Food Dudes sticker for tasting a food,
consumption itself. Through their research they developed or a sticker and a small prize for eating a whole portion.
three different strategies to use with young children to The intervention phase is followed by a maintenance
change their eating behaviours: taste exposure, modelling
and rewards (Table 8.20). 8.31 The characters from the Food Dudes programme

Based on the these strategies, Tapper et al. (2003) recently
completed the development and evaluation of a whole-
school Food Dudes programme (Figure 8.31) for use across

Taste exposure Modelling Rewards

Increasing the exposure to a new food Research shows that certain factors Positive reinforcement for eating the
group over a period of weeks. make modelling (imitation and new food.
observational learning) more effective.
The more you taste a novel food the Rewards should imply the importance
more you learn to like it. A child is more likely to imitate another of the healthy eating behaviour rather
person if that person is liked by the than become a compensation for
child (Bandura, 1977). eating something unpleasant.

Table 8.20 Strategies developed by Tapper et al.

Chapter 8: Psychology and health

phase during which there are no videos and the letters and Millions of lost-time injuries per million person-hours40 Token economy
rewards become more intermittent.
20 Shirley Basin 267
Both teachers and parents evaluated the programme
positively. The children had engaged with the programme, 0
were enthusiastic about curriculum work using the Food
Dudes theme, had better attendance and previously lower 40
achieving children were more confident. After four months,
the children were still eating significantly more fruit and 20 Navajo
vegetables than they had been before the programme began.
0
Worksites (Fox et al., 1987) 1970 1975 1980 1985
Token economy programmes use the principles of Years
operant conditioning to modify behaviour; specifically,
reinforcement. Such programmes are used in prisons to 8.32 The yearly number of work-related injuries, per
encourage pro-social behaviour and involve giving tokens million person hours worked, requiring one or more days
to offenders if a desired behaviour is performed. The tokens lost from work
may then be swapped for certain rewards in the hope that
desired behaviour is repeated. disease (CVD) risk, morbidity and mortality. The FCP as
originally planned included six years of education (mid-1980
Fox et al. (1987) reported on a token economy system that to mid-1986), four independent (cross-sectional) population
used stamps as tokens that was instituted at two dangerous surveys, four surveys of a cohort, and continuous
open-pit mines. Employees earned stamps for working surveillance for cardiovascular disease events.
without lost-time injuries, for being in work groups in which
all other workers had no lost-time injuries, for not being The population surveys provide the major source of data
involved in equipment-damaging accidents, for making relating to CVD risk and risk factor reduction in the FCP.
adopted safety suggestions, and for unusual behaviour These surveys are designed to obtain information on
which prevented an injury or accident. The workers lost health attitudes, knowledge and behaviour, and selected
stamps if they or other workers in their group were injured, measures of CHD risk. They are conducted on randomly
caused equipment damage, or failed to report accidents or selected samples of young and older adults, ages 12–74,
injuries. The stamps could be exchanged for a selection of from four communities: Monterey, Salinas, Modesto and
thousands of items at shops on the site. San Luis Obispo.

Following the implementation of the token economy, large The two treatment cities were Salinas (1980 population
reductions in the number of days lost from work because 80 500) and Monterey (population 44 900), and the two
of injuries were recorded. The reductions in costs far control cities were Modesto (population 132 400) and
exceeded the costs of operating the token economy and San Luis Obispo (population 34 300). Santa Maria was
the improvements were maintained over several years. the third control city where only morbidity and mortality
events were monitored. People aged 12–74 who resided in
The tokens given to workers for periods without lost time randomly selected households in the four surveyed cities,
injuries or equipment damaging accidents apparently were eligible to participate with each survey comprising
benefitted all parties immediately involved. Both the approximately 1800–2500 participants.
number of days lost from work and the number of lost-time
injuries declined at both mines following the introduction of The major goals of the population surveys included the
the token economies. following:

Communities: Five City project (Farquhar et al., 1985) • to develop or adopt appropriate measurement
The Stanford Five City Multifactor Risk Reduction Project
(FCP) completed by Farquhar et al. (1985) is a long-term field instruments and procedures for the survey
study of the feasibility and effectiveness of community-
wide health education directed at lowering cardiovascular • to hire, train and supervise a staff to operate the centres

Cambridge International AS and A Level Psychology

• to establish survey centres in each of the four for systematic research and application of behavioural

communities science theory in developing interventions that are age-
appropriate, gender-specific and culturally relevant, as well
• to identify and recruit randomly selected samples
as research examining links between low socioeconomic
from each community with an objective of achieving a

response rate of at least 66% status and risk of disease.

• to conduct the surveys in a manner that provides
accurate and reliable data, and to maintain an effective
ISSUES AND DEBATES

relationship with the general public and medical/ The use of longitudinal research within this area
health care professionals in the community. provides lots of in-depth awareness of how health

As well as the surveys, physiological measures of some of promotion campaigns can impact on large communities.
the participants were taken. These included: Research such as Fox et al. identified the positive effects

that token economy systems can have in improving

• body height and weight safety in the workplace and how this can be sustained
• blood pressure by two methods (mercury manometer over a long period of time. This is also the case when
looking at the research conducted by Farquhar with the
and a semi-automated machine) Five City Project which was able to look at the long term
impact of mass media campaigns, the impact of which is
• resting heart rate still being measured in 2014.
• non-fasting blood sample analysed for plasma
The research in this are provide useful applications to
thiocyanate (as a measure of smoking rate) everyday life in the way it provides evidence to support
the implementation of health campaigns in a variety
• expired air carbon monoxide of different areas, and that these interventions can be
• urinary sodium potassium and creatinine (as an index of very successful at changing health behaviours. Knowing

prior sodium chloride intake)

• a low-level bicycle exercise test (as a measure of fitness).

268 The short-term impact of the project saw knowledge of that health promotion campaigns can be effective at
motivating people to change behaviours supports more
CVD risk factors steadily increase in both the treatment and research into why these are effective.

control groups, but improvement in the treatment group The use of children as participants is raised through
was significantly greater. There was a significant decline in the work by Tapper et al. who researched the impact
cholesterol over time. A significant net decrease in blood of a healthy eating campaigns within primary schools.
pressure occurred. Net decreases in the resting heart rate Researching the impact of these campaigns is important,
as developing healthy eating habits as a child will support
favoured intervention participants. In the 24 hour diet recall, the development of positive adult health behaviours too.
dietary saturated fat intake declined significantly in women, When using children as participants it is important that
but not in men.

The long-term impact found that both CHD and all-cause their parents are involved in the research and are aware

mortality risk scores were maintained or continued of the interventions that are being put into place.

to improve in intervention cities while levelling out or

rebounding in control cities.

During a follow-up in 2014, results suggest that frequent, Individual factors in changing health beliefs
regular, systematic contact with media professionals and
provision of materials influence newspaper coverage of Unrealistic optimism (Weinstein, 1980)
health-related topics, which has important implications for Weinstein (1980) investigated unrealistic optimism about
shaping public opinion and policy change. future life events. He classified unrealistic optimism as
an error in judgement where people tend to believe that
Future efforts should combine general mass media they are invulnerable and expect others to be victims of
education with programme development for special misfortune and illness, not themselves. There are several
populations and environmental changes that focus on factors that cause a person to be optimistically biased:
increasing the availability of lower-fat fast foods. Those their desired end state, their cognitive mechanisms, the
at the highest risk for CVD reported the lowest use of information they have about themselves versus others, and
preventive interventions. These findings indicate the need overall mood.

Chapter 8: Psychology and health

The research attempted to test six hypotheses: Positive life events Negative life events

• People believe that negative events are less likely to Like post graduation job Having a drinking problem 269

happen to them than to others, and they believe that Owning your own home Attempting suicide
positive events are more likely to happen to them than Divorced a few years after
to others. Starting salary > $10 000 married

• Among negative events, the more undesirable the event, Travelling to Europe Heart attack before
age 40
the stronger the tendency to believe that one’s own Starting salary > $15 000
chances are less than average; among positive events, Good job offer before Contracting venereal
the more desirable the event, the stronger the tendency graduation disease
to believe that one’s own chances are greater than Being fired from a job
average. Graduating in top third of
class Getting lung cancer
• The greater the perceived probability of an event, the
Home doubles in value in Being sterile
stronger the tendency for people to believe that their five years
own chances are greater than average. Dropping out of college
Your work recognised with
• Previous personal experience with an event increases award Having a heart attack
Not finding a job for
the likelihood that people will believe their own chances Living past 80 six months
are greater than average.
Your achievements in Decayed tooth extracted
• The greater the perceived controllability of a negative newspaper
No night in hospital for five Having gum problems
event, the greater the tendency for people to believe years
that their own chances are less than average; the greater Having a mentally gifted Having to take unattractive
the perceived controllability of a positive event, the child job
greater the tendency for people to believe that their own
chances are greater than average. State-wide recognition in Car turns out to be a
your profession lemon
• When a stereotype exists of a particular type of person
Weight constant for ten Deciding you chose wrong
to whom a negative event is likely to happen, people years career
will tend to believe that their own chances are less than
average. In ten years, earning > Tripping and breaking
$40 000 a year bone
In the first study, 258 college students estimated how
much their own chances of experiencing 42 events (given Not ill all winter Being sued by someone
in Table 8.21) differed from the chances of their peers. The
42 events were randomly split between two rating forms; Marrying someone wealthy Having your car stolen
positive and negative events were intermixed. Instructions
on the forms stated ‘Compared to other students – same Victim of mugging
sex as you – what do you think are the chances that the Developing cancer
following events will happen to you?’
In bed ill two or more days
Beneath the description of each event participants had a
15-point scale on which they had to choose their relative Victim of burglary
probability of this happening to them. The lowest choice
possible was 100% less than average, since this indicated Injured in auto accident
a probability of zero. At the other extreme, no probability
could exceed 100%, but this upper limit could be many Table 8.21 The 18 positive and 24 negative life events used
times the average probability. in Weinstein (1980)

Overall, the participants rated their own chances to be above Although all six hypotheses were supported, different
average for positive events and below average for negative factors appeared to govern responses to positive and
events. The present data provide evidence of unrealistic negative events. For negative events, optimism and
optimism for both positive and negative life events. perceived controllability had an impact on participants’
judgements. When an event was judged to be controllable,

Cambridge International AS and A Level Psychology

a stereotype existed in participants’ minds of the kind of Enter ance Pre-contemplation
person to whom the event generally occurred. We can
assume this person was seen to be at risk because he or The stages of
she did not take any action to control the risk. Participants change model
seemed to compare themselves with a stereotypical victim, Mainten
leading them to decide that their own risks were less than mination
average. For events perceived to be uncontrollable, there Contemplation Exit and re-enter
was no stereotype of the victim, and subjects did not show Relapse at any stage
any systematic bias.

Transtheoretical Model (Prochaska et al., 1997) Deter

Action

The Transtheoretical Model suggests that, as individuals 8.33 The Transtheoretical Model
start on the trajectory of a health behaviour, they

move through six stages of change: pre-contemplation, Processes of change are the actual activities that a person can
complete to move through the different intervention stages.
contemplation, preparation, action, maintenance You can consider these the methods of moving from one
and termination (Figure 8.33). At each stage different stage to another. There are ten processes that have received
intervention strategies are most effective to support an the most empirical support (Table 8.22). These can be used
individual to move from one state to the next and finally to during any of the stages to move from one to the next.
maintenance.
To help individuals progress through the stages, health
• Pre-contemplation: people do not intend to take action professionals need to understand the processes of change.
One of the fundamental principles for progress is that
in the foreseeable future (defined as within the next different processes of change need to be applied at different
six months) stages of change.

270 • Contemplation: In this stage, people are intending to Prochaska et al. (1992) believe that the future of health
promotion programmes lies with stage-matched, proactive
start the healthy behaviour in the foreseeable future and interactive interventions. Much greater impacts can
(defined as within the next six months). Even with this be generated by proactive programmes because of much
recognition, people may still feel ambivalent toward higher participation rates, even if efficacy rates are lower.

changing their behaviour.

• Preparation (determination): In this stage, people are

ready to take action within the next 30 days. People

start to take small steps toward the behaviour change,

and they believe changing their behaviour can lead to Health change in adolescents (Lau, 1990)
Lau (1990) conducted a longitudinal study to explore how
a healthier life. sources of stability and change in young adults might
affect their health beliefs for behaviours such as drinking,
• Action: In this stage, people have recently changed their diet, exercise and wearing seatbelts. The data for this
study were collected as part of a larger piece of research of
behaviour (defined as within the last six months) and students who were enrolled at Carnegie Mellon University
intend to keep moving forward with that behaviour for classes ending in 1983. Of 1106 students who were sent
questionnaires, 947 of these provided data which included
change. People may exhibit this by modifying their responses from both the student and the student’s parents.
These 947 parent-child pairs are the participants within the
problem behaviour or acquiring new healthy behaviours. study. The data collected via questionnaires from these
students over a period of three years were collated to
• Maintenance: In this stage, people have sustained their investigate six research questions:

behaviour change for a while (defined as more than six
months) and intend to maintain the behaviour change

going forward. People in this stage work to prevent

relapse to earlier stages.

• Termination: In this stage, people have no desire to

return to their unhealthy behaviours and are sure they

will not relapse. Since this is rarely reached, and people

tend to stay in the maintenance stage, this stage is 1 Is there a link between the health beliefs of parents
often not considered in health promotion programmes. and students when they initially leave home for college?

Chapter 8: Psychology and health

2 How do parents exert their influence on their children? health beliefs. Even though parental influence plays a large 271
part in the early years, once a child leaves home, they are
3 How much do young adults’ health beliefs change affected more by those that are around them.
during the first years of college life?
ISSUES AND DEBATES
4 How strong is the association between the health
beliefs of the young adults and their peers at this time? Understanding the individual factors in changing health
behaviours has useful applications to everyday life in
5 How do peers exert their influence over these young that they can be used to identify who is more likely to
adults? change their behaviours following a health promotion
campaign. This could help direct campaigns to specific
6 How strong is parental influence compared to peer groups of individuals or identify factors, such as
influence? unrealistic optimism, that can then be exploited to make
heath promotion campaigns more effective.
The results found that there was a substantial change
in the performance of health behaviours during the first There are cultural biases in the individual factors
three years of college and that peers have an increasing that may influence a person to change their health
influence on these. In total, parents’ influence on health behaviours. Different cultures could see health
beliefs is much more significant than that of peers. Lau behaviours as more central to their beliefs and
suggested that direct modelling of behaviour is the most expectations. Also, within cultures, social comparison
powerful influence on an individual’s health beliefs. is often a powerful factor when considering health
This provides support for the pattern of behaviour that behaviours; individuals will often compare themselves to
saw increasing parental influence over the child in the others in their community to make a judgement about
early years of development while they are at home. This their behaviour and if it is ‘normal’. If within a culture,
influence subsides as the child leaves for college as the obesity is more common, it is likely that the individual will
peers that they spend their time with have a greater see their own weight issues as less important.
influence over their behaviour. Therefore, this suggests that
proximity to individuals is a presiding factor over a person’s

Consciousness raising Process Intervention strategies
Dramatic relief Feedback, education, confrontation
Self re-evaluation Involves increased awareness about the
Environmental causes, consequences, and cures for a Role playing, grieving, personal testimonies
re-evaluation particular problem behaviour and media campaigns
Self-liberation
Social liberation Initially produces increased emotional Healthy role models and use of positive
experiences followed by reduced affect if imagery
appropriate action can be taken
Empathy training, documentaries, and family
Combines both cognitive and affective interventions
assessments of one’s self-image with and
without a particular unhealthy habit New Year’s resolutions, public testimonies, and
multiple rather than single choices
Both affective and cognitive assessments of
how the presence or absence of a personal Advocacy, empowerment procedures and ➔
habit affects one’s social environment are appropriate policies can produce increased
explored opportunities

The belief that one can change and the
commitment and recommitment to act on
that belief

This requires an increase in social
opportunities to demonstrate new, positive
behaviours

Cambridge International AS and A Level Psychology

Counter-conditioning Process Intervention strategies
Stimulus control
Requires the learning of healthier behaviours Relaxation techniques, and nicotine
that can become substitutes for problem replacement and fat-free foods can be safer
behaviours substitutes

This removes cues for unhealthy habits and Planning parking lots with a two minute
adds prompts for healthier alternatives walk to the office and putting art displays in
stairwells are examples of re-engineering that
Contingency Provides consequences for taking steps in a can encourage more exercise
management particular direction
Overt and covert reinforcements, positive
Helping relationships Develop relationships with caring, trust, self-statements and group recognition are
openness and acceptance as well as support procedures for increasing positive behaviours
for the healthy behaviour change
Rapport building, a therapeutic alliance,
counsellor calls and buddy systems can be
sources of social support

Table 8.22 The ten processes of change

Summary

From this chapter you will have gained an understanding techniques can be effective with adults, by using monetary

272 of how psychology helps us to understand aspects of incentives, and children, by making the process of adhering
health care, and to improve it, as well as providing an to the medical requests fun.

understanding of how aspects of health such as pain and The personal experience of pain was considered by looking
stress can impact on an individual. In terms of non-verbal at different theories of understanding how we perceive
communication, a doctor’s clothing can make a patient pain; from the biological theories suggesting pain is merely
more or less confident, with more formal clothing typically proportionally linked to the extent of the injury to more
inspiring trust. In verbal communication there are potential psychological theories, suggesting we are able to affect the
problems too. Although doctors tend to underestimate perception of pain by opening and closing ‘gates’. Measuring
patients’ understanding of medical terminology, they the experience of pain raises issues about relative self-
nevertheless continue to use medical terms. Studies of the reports and objectivity. Self-reports can be used with both
patient–practitioner relationship have shown that, although children and adults and are a quick and easy method of data
less often used by doctors, a patient-centred consultation collection, but are open to individual biases. We considered
style is beneficial, so psychology can both provide tools methods of managing pain from the use of drugs to medically
for measuring doctor effectiveness and suggest ways to influence our experience of pain, to the use of imagery and
improve practices. acupuncture.

We considered how and why patients might not adhere to Within the stress sub-topic, we considered another individual
medical requests even though they have been to see a doctor experience that has an impact on many millions of people
to gain their guidance. Rational choice and consideration worldwide. Initially, we considered a variety of causes of stress
of a cost–benefit analysis of following the advice seemed to such as work, life events and personality, and how our body
have a big impact on engagement with medical treatment. reacts to stress with the GAS model. As with the other areas,
Measuring adherence is problematic, with no single the measurement of stress was considered by considering
measure able to reliably and non-invasively report on both physiological and psychological measures and how these
patient adherence over a long period of time. Self-report could be used together to give an overview of a person’s level
measures can easily give feedback about adherence, but are of stress experience through the use of psychometric tests.
susceptible to response biases, whereas physical measures Both drug therapies and alternative treatments for stress such
can give an account of the number of pills that have been as biofeedback and imagery were considered, as well as more
removed from a container as a proxy for adherence. It seems proactive ways of preventing stress.
that to improve adherence to medical requests, behavioural
➔

Chapter 8: Psychology and health

Finally, we looked at how we can use psychology to promote worksite and within the general communities. Consideration
health behaviours using strategies such as fear arousal and was then given to the individual factors that change health
providing enough information for the general population to behaviours and how we can change health behaviours in
make informed decisions. Three health promotion campaigns adolescents.
were looked at as case studies in schools, on a mining

Exam-style questions 273

1 A marketing firm has approached you to develop a health promotion campaign to
encourage parents to get their children to have a yearly vaccination at their local clinic.
They have asked you to consider different approaches that could be taken to promote this
programme and the psychological research that would support the approach you would like
to take.
a Identify two named strategies for promoting health. [2 marks]
b For one of the strategies named in (a), give one strength and one weakness of using that
strategy to design a health promotion campaign. [4 marks]
c Describe one individual factor that could affect whether a person will change their health
beliefs. [4 marks]
d Discuss the strengths and weaknesses of using health promotion campaigns to change
an individual’s health behaviours. [5 marks]

2 a Design an experiment to test the effectiveness of a physical measure of adherence
compared to a self-report measure of adherence to medical requests. [10 marks]

b Explain the psychological and methodological evidence on which your experiment is
based. [8 marks]

274

Chapter 9
Psychology and organisations

Introduction ■ Organisational work conditions: including the famous
Hawthorne effect, bullying at work, the effect of
This chapter introduces you to five key topics within different office environments, the effect of shift work
organisational psychology: on health and accidents, the use of token economy in
improving safety
■ Motivation to work: including theories of motivation,
motivational techniques and the importance of ■ Satisfaction at work: the measurement of workplace
perceived equity satisfaction and the quality of working life,
employee sabotage, the effects of job involvement
■ Leadership and management: including ways of and organisational commitment on turnover and
measuring leadership, leadership styles and whether absenteeism, workplace commitment.
leadership can be learned

■ Group behaviour in organisations: including group
behaviours and team roles, the way that groups think
and make decisions, and conflict and the management
of conflict

Chapter 9: Psychology and organisations

What is organisational also theoretical models of decision making and other
psychology? cognitive processes are also crucial in understanding
how individuals make sense of their roles within
Formerly referred to as occupational psychology (with a organisations. Finally, although there is little biological
focus specifically on jobs or occupations), organisational research in this chapter, the study of motivation
psychology brings together theories and research from considers the ways in which work can satisfy our varying
across psychology and applies this to the study of physiological needs. Much of the current research into
organisations. This chapter will consider the world of work, working conditions looks at the effects of different work
and how individuals and groups within an organisation conditions such as office layouts or shift work patterns
function and influence each other and have an impact on on our physical and psychological health. We will also
the organisation itself. be considering psychometric approaches within this
chapter and these are attempts to measure personality
You may be able to think of some applications already and cognitive functioning in order to ensure that people
based on the psychology you learned in your AS and their organisational roles are well suited.
course. Social psychology may be relevant when
considering issues such as leadership and followership, Reflections: There are lots of ways in which
motivation, quality of working life, employee sabotage organisational psychologists may be able to benefit an
and group processes. The learning approach is vital organisation. Imagine you have been asked to help the
in considering whether personality characteristics
such as leadership can be explained from a nurture or management team of a large manufacturing organisation.
a nature perspective. This approach is also key when There is a very high turnover of staff and those staff
considering the role of reward and reinforcement not who remain are taking many days off as sick leave and
only in producing workplace satisfaction but also in reporting high levels of stress. Suggest some of the steps
training programmes such as those designed to make
sure that safety procedures are followed. Aspects of the you could take to begin to address the problem.
cognitive approach such as memory and attention, and
275

9.1 Motivation to work Self-actualisation
creativity,
Need theories
problem solving
Maslow’s hierarchy of needs authenticity, spontaneity
Maslow’s original hierarchy of needs (Maslow, 1943) is one
of the best known theories of motivation and proposes Esteem
that basic human needs need to be satisfied before we
can begin to satisfy higher needs. Maslow claimed that all achievement
needs of humans could be arranged in a hierarchy. A person Social needs
moves through the hierarchy by fulfilling each level, so friendship, family
that the basic physiological needs need to be met before
moving up. Some people may never move through the Safety and security
entire hierarchy. Maslow’s original hierarchy lists five levels
of needs as shown in Figure 9.1. Physiological needs (survival)
air, shelter, water, food, sleep, sex
Reflections: Is it possible for people in all parts of the
world to reach self-actualisation? Try to identify areas of 9.1 Maslow’s hierarchy of needs
the world where this may and may not be possible. It may
be important to consider the effects of recent conflicts Maslow continued to develop his theory through the 1960s
on this issue. and the 1970s.

The updated model now has eight stages which are
described below:

1 Biological and physiological needs: This stage is as it
was described in the original model and focuses on our
basic survival needs.

Cambridge International AS and A Level Psychology

2 Safety needs. This stage covers a range of safety and above the level of self-actualisation. This was called
security needs including those provided by a stable ‘transcendence needs’ and refers to our ability to

society with appropriate legal and justice systems. If help others to also achieve self-actualisation.

a country is in the middle of a civil war, or people are

living as refugees, they are unable to meet their safety Reflections: Can you think of anyone who might be
and security needs. considered to be at the transcendent level?

3 Love and belongingness needs: This was called ‘social

needs’ in the earlier model and focused primarily on

friendship and family. In this later model, this focus has Alderfer’s ERG Theory
been widened slightly to include all the groups that
we belong to: work, family, friends as well as romantic Alderfer’s ERG Theory (1972) is a revision of Maslow’s theory
relationships. and simplifies Maslow’s eight categories into just three.
These are the E, R and G of the title and refer to:

4 Esteem needs: This level is the same as in the original • Existence needs: the basic survival needs described
model and refers to achievements; skills, status,
independence, and so on. These esteem needs could in the first two levels of Maslow’s hierarchy; the
be met very differently in different people. Some may physiological and the safety needs.
feel a great sense of esteem through their family roles,
through their well-paid jobs, through voluntary work • Relatedness needs: the social and self-esteem needs.
that helps others or through the creation of something
that achieves critical acclaim. This is equivalent to the social needs identified by

Maslow. Alderfer proposes that self-esteem needs

can be divided into two: external and internal and

our need for relatedness satisfies the external

element of our self-esteem needs. If other people

276 Reflections: The internet did not exist when Maslow like us and want to spend time with us, we must be
proposed his theory. To what extent might social
likeable people.
media such as Facebook allow us to meet our ‘love and
belongingness’ (social) needs? • Growth needs: the needs related to self-development

and advancement. This refers to the internal element

of our self-esteem needs and allows us to meet needs

related to the self-esteem and self-actualisation needs in

Maslow inserted two new stages into his theory at this point. Maslow’s theory.

5 Cognitive needs: This relates to our need for Alderfer’s Theory is not a hierarchical approach and
information, knowledge and meaning. Once again it is people can be motivated by needs from more than
worth considering how the internet may have changed one level at the same time. We do not progress from
not only our ability to access information but also our satisfying needs at one level to satisfying needs at
need for it. the next level. Ideally paid work will provide for all
three of these needs and this is where the individual
6 Aesthetic needs: Maslow described this as our need experiences the greatest motivation. For example, your
and appreciation of beauty. job should provide at least for all your existence needs

7 Self-actualisation: These new stages are followed by but you will be more motivated if your job also provides
the original final stage; that of self-actualisation. This is for some of your relatedness and growth needs as
described in the way that Maslow originally described well. Alderfer’s theory also suggests that the relative
this; self-actualisation is reaching our personal importance of these needs may change throughout our
potential and becoming fulfilled. lives. Relatedness needs may be the most important in
adolescence and early adulthood, followed by growth
8 Transcendence needs: Maslow also made one needs as we establish a career and then relatedness
final amendment to his model and added a level needs again when we start a family.

Chapter 9: Psychology and organisations

Reflections: What is your ideal job? Would it provide for Reflections: What story do you think this picture in 277
all three of the needs? Figure 9.2 is telling? If someone else gives a very different
interpretation, do you agree that this tells us something
McClelland’s Theory of Achievement Motivation about them?
McClelland’s Theory of Achievement Motivation dates back
to 1965 but the concept of achievement motivation is still 9.2 What story is this picture telling you?
commonly referred to today. This theory proposes that
there are different needs that motivate people and that Evaluation
these differences are measurable. There are three types of
needs identified in this theory: ISSUES AND DEBATES

• Need for achievement: the need to get things done, It is important to begin any evaluation of theories of
motivation by recognising that it has been difficult
to achieve things, to be a success. People who have to support the notion that needs are organised in a
a high need for achievement (N-Ach) will be driven to hierarchical manner. This could be used to argue that
succeed and are highly motivated by challenges and Alderfer’s approach may be more accurate. Another
appraisals. criticism of Maslow’s work is that it has been difficult to test
the notion of self-actualisation and Maslow’s own work
• Need for affiliation: the need to be liked by others, to be was based on a small number of people that he thought
could be described as ‘self-actualised’. However, theories of
accepted as part of a group, to put effort into developing motivation can be usefully applied to the workplace in many
and maintaining social relationships. People who have ways: as well as working to earn enough money to satisfy
a high need for affiliation will tend to prefer working our physiological and safety needs (at least) organisations
with others to working alone and will be motivated by must ensure that they meet these needs while we are at
cooperative tasks. work. Workers should have breaks so that they can eat, drink
and go to the toilet regularly. Organisations must ensure
• Need for power: the need to have influence and control their workers’ safety – this might simply mean ensuring that
the building is safe but may also involve a complex set of
over others. People with a high need for power will be safety procedures and the need for appropriate clothing and
motivated by the chance to gain status or prestige or to equipment. Some organisations also attempt to provide
be looked up to by others. for workers’ social needs through the provision of social
clubs or events. They might also provide education and
Reflections: Can you think of people you know that fit training, rewards and bonus schemes to meet self-esteem
these categories? Which one of these do you think best needs. Similarly McClelland’s theory can be applied in the
describes you? Think about the study by Milgram that workplace to help understand personal characteristics and
you covered at AS Level (Section 5.1). Could any of these to ensure that people are given roles that suit their particular
three types explain the behaviour of the participants in need for achievement.
this study?

This theory is commonly applied in organisational settings
as these are measurable qualities of a person; one person
may have a higher need for power than another. It is likely
that someone who will make a good manager will have
a need for power but not a need for affiliation. We will be
looking at leadership later in this chapter.

Need for achievement (or N-Ach) can be measured with the
use of the Thematic Apperception Test or TAT. These are a
series of ambiguous images which the individual is asked
to interpret. For example they might be given the picture in
Figure 9.2 and asked to consider what is happening, what
has just happened, what is going to happen next and what
the people in the picture are thinking.

Cambridge International AS and A Level Psychology

Reflections: Consider how a workers’ social club might This may sound counter-intuitive but their book provides
improve workers’ lives. Make reference to theory in your evidence from many studies which support this claim.
answer.
Goal setting theory provides guidance on how to set goals and
RESEARCH METHODS these are based on five key principles which are referred to as
The work covered in this section is primarily theoretical 4C F standing for Clarity, Challenge, Complexity, Commitment
and you are not required to know details of any research and Feedback.
carried out by these theorists. However, research on
McClelland’s Theory of Achievement Motivation comes • Clarity: goals should be clear, specific, unambiguous and
under the heading of a projective test. Although these
tests are widely used (most frequently in a clinical context), measurable.
they are subjective and low in both reliability and validity.
• Challenge: goals should be relevant and linked to
KEY TERM
rewards.

• Complexity: Goals must be achievable within a specific

time period.

• Commitment: Goals must be understood and accepted

in order to be effective.

• Feedback: Goal setting must involve feedback on task

progress and achievement.

projective test: a personality test that uses ambiguous The importance of feedback in this model is crucial. If the
only assessment was whether the goal had been reached
stimuli such an ink blots or the Thematic Apperception Test or not, it is possible that many weaknesses in performance
may be missed. There may be easier, quicker or even more
images discussed here. The response given to the stimuli is effective ways of achieving the same goal. Feedback needs
thought to reveal hidden emotions and conflicts which the
individual projects onto the image.

to be positive and constructive and focus on the strategies
278 used. This process should also allow for reflection by the

RESEARCH METHODS individual rather than simply feedback from a superior.

McClelland used projective tests to measure the need The SMART method of goal setting developed from these
for achievement. Give one strength and one weakness five principles and is discussed in the Reflections box below.
of projective tests. A final method of goal setting is ‘Backward Goal Setting’ in

Cognitive theories which the individual is encouraged to work backwards from
the end goal in order to determine the most appropriate
Goal Setting Theory way of reaching this goal.

Goal setting theory opposes McClelland’s idea that internal

motives were largely unconscious and measurable only by Reflections: SMART targets are targets or goals which
are Specific, Measurable, Attainable, Relevant and have
projective tests. Locke and Latham based their work on the a Timescale. For example, a SMART target in business
claims made by Ryan (1970) who argued that ‘it seems a simple
fact that human behavour is affected by conscious purposes, would look like this:
Specific: I want to set up a business selling jewellery
plans, intentions, tasks and the like’ (page 18).

Locke (1981) suggested that goal setting was a key I have made myself.
Measurable: I will aim to sell five items on eBay to
motivator in getting people to work hard and improve begin with.
their performance. In their co-authored text ‘Goal setting: Attainable: I will start with an eBay store and then
research other options.
a motivational technique that works’, Locke and Latham Relevant: I will be turning my hobby into a money-making
(1984) suggest that setting specific goals produces higher enterprise.
Timescale: I will aim to list five items on eBay within one
levels of performance than setting vague goals. For example week and 20 items within two weeks.
stating as a goal ‘I want to earn more money’ is too vague SMART targets are used in many schools. Try and write
and is less likely to affect the way a person behaves whereas some SMART targets for your A Level Psychology course
someone who states ‘I want to earn $50 more each week’ and decide whether you think this is a useful strategy.
will be more likely to achieve this. Specific goals are harder

to achieve and present a greater challenge and goal-setting

theory claims that this will make the individual try harder.

Chapter 9: Psychology and organisations

Expectancy Theory Equity Theory was an application of this idea to the 279
Expectancy Theory (Vroom, 1964) proposes that workers workplace. It proposes simply that workers expect things to
are rational beings whose decision making is guided by be fair. They expect pay, status and recognition to equate to
logical thought processes in which potential costs and the amount of effort that they put in. The significant factor
rewards play a significant role. Vroom recognised that a in Equity Theory is comparison with others. If we perceive
worker’s performance would be influenced by a wide range others as being treated better than us, then the perceived
of factors, including knowledge, skills and experience as inequality will lead to decreased motivation.
well as individual characteristics such as personality and
different ambitions and goals. Despite this, he claims that This theory suggests that workers bring certain things to
all workers can be motivated if there is a clear relationship the job, such as skills, qualifications, energy, enthusiasm
between effort and performance, if the favourable and effort. These are referred to as INPUT (I) and may be
performance is rewarded, if the reward satisfies a need and perceived (Ip) or actual (Ia). Workers expect certain things
finally, if the desire to satisfy the need is strong enough to from their job, including pay, recognition, involvement and
make the effort worthwhile. Vroom proposes an equation many other benefits, all referred to as outcomes (O) and
which states that again these may be perceived (Op) or actual (Oa).

Motivation = expectancy × instrumentality × valence The key proposal of this theory is that workers compare
themselves with other workers in similar posts to check the
Expectancy is the perception of how much effort relates fairness or the equity of their own position. If they believe
to performance as well as a worker’s confidence in what that the situation they are in is one of inequity (unfairness),
they are capable of doing. Expectancy can be modified this can result in low motivation. Inequity can be of two
by the provision of additional resources or by training types: underpayment or overpayment. This is strongly
and supervision. Instrumentality is the perception of how related to the concept of organisational commitment which
much effort will be rewarded and whether workers actually will be considered later in this chapter (Section 9.5).
believe that they will be given the reward that has been
offered. Instrumentality will be positively affected if the Underpayment equity might be felt if you find out that
management makes sure that rewards are always given someone else in the same post as you is being paid
as promised. Valence is the perception of the strength or considerably more, despite being less experienced and
the size of the reward as well as the extent to which this less qualified. In order to bring the situation back to
reward is needed or wanted. It is likely that a small reward one of equity you have several options: you could try to
will produce low motivation regardless of the values of increase the outcomes from your job, perhaps by asking
expectancy and instrumentality, and similarly if the value of for a salary increase or you could try to decrease your
any one of the three is low, then overall motivation is likely input – after all if you are not being paid as much as
to be low. someone else, why would you work as hard as they do?
These are the most obvious outcomes from identifying
Equity Theory a state of inequity although there are other cognitive
Finally, Equity Theory was proposed by Adams (1963). This is strategies that also could be used. You could decide that
an application of social psychology, where Social Exchange you had made an inappropriate comparison and find
Theory predicts that people will weigh up what an action someone else to compare yourself to which will make
will cost them in terms of the benefits it will produce. you feel better about the situation, or find some other
way to distort the way that the inputs and outcomes
Reflections: Think about the study by Piliavin et al. (in are perceived. A final option might be to leave and find
your AS course, Section 5.2). Could equity theory be used another job.
to explain helping behaviour?
What if you experienced an overpayment equity? What
if you felt that you were being rewarded more than you
deserved or at least, more than the people you were
comparing yourself to? You might decide to work harder as
your input doesn’t match the outcomes. It is unlikely that

Cambridge International AS and A Level Psychology

you would look for options that decreased the outcomes RESEARCH METHODS
such as asking for a pay cut or asking for more work. You As with the previous section, much of this work is
could use the cognitive strategies described above, decide theoretical although clearly these ideas have been tested
that you need to compare yourself to different people in real-life situations. Whilst this will give the research high
or find some other way to distort either the input or the ecological validity, it is likely to be difficult to generalise
outcomes to reach a state of equity. to other different organisations due to the huge number of
variables involved. In other words, it will never be possible
Reflections: If you have a part-time job as well as being to conduct highly controlled research when dealing with
a student, how would you feel if a newly appointed real organisations and their employees and so conclusions
member of staff, doing the same job as you, was being need to be considered carefully.
paid more? What reasons might there be for this? What
if they were being paid less? What if you found out that Motivators at work
someone who had been working there longer than you,
doing the same job, was being paid less? Intrinsic and extrinsic motivation
‘People do work for money – but they work even
Evaluation harder for meaning in their lives. Companies
that ignore this fact are essentially bribing their
ISSUES AND DEBATES employees and will pay the price in a lack of loyalty
and commitment.’ (Pfeffer, 1998)
In this section we have been examining motivation from
the cognitive approach. All three of the theories outlined Reflections: Do you have a job? Why do you have one?
here focus on the way that the individual perceives the Write down all the reasons you can think of before
280 situation that they are in, rather than the situation itself. reading any further. Now think about the job that
As with the previous section, all three theories can be you would like to have when you have finished your
usefully and effectively applied to the workplace. If goals education. Write down all the reasons why you would like
are specific, measurable and achievable they will be to have this job.
more effective. Roberts (1994) points out that a manager
cannot simply say ‘do your best’ and expect this to Motivation can be internal or external. Internal (or
be effective. It is therefore crucial that we understand intrinsic) motivators come from within and include
exactly what types of goals and what type of feedback factors such as enjoyment or a sense of satisfaction or
will be most effective. Expectancy Theory can also be achievement as motivators. This means that motivation
applied in similar ways such as involving workers in comes from the actual performance of the task rather
the goal setting process and ensuring that rewards are than from the potential consequences of completing the
appropriate and will be valued by workers. tasks. These potential rewards would be called external
motivators. External (or extrinsic) motivators create a
Finally, Equity Theory demonstrates the importance sense of motivation because of an external reward such
of understanding the way that the individual makes as money, promotion and bonuses. Clearly different
sense of their role in comparison to others. A field organisations might offer different types of motivators.
study conducted by Martin and Peterson in 1987 and Someone who works in finance may experience high
reported by Hayward (1996) provides some support for levels of external motivators such as the amount they
Equity Theory. It showed that when new workers in a earn and the potential for additional bonuses, whereas
retail environment were taken on at a lower pay scale someone who chooses to work in some aspect of health
than existing workers, they perceived underpayment and social care is unlikely to experience the same level
inequity as they were being paid less than other workers of financial reward but may be rewarded and motivated
for doing the same job. However the existing workers by different things, such as a sense of helping others and
did not perceive overpayment inequity as they were making a difference.
not comparing themselves to the new workers and
maintained the comparisons they were making prior to
the introduction of the new scheme.

Chapter 9: Psychology and organisations

Reflections: Now look at the list you made earlier Non-monetary rewards 281
regarding a job you would like to have in the future. How Non-monetary rewards include praise, respect, recognition,
many of the reasons you wrote down would be internal empowerment and a sense of belonging.
motivators and how many would be external motivators?
Was there a difference between the job you have now Rewards and recognition are different. In an organisational
and the job that you would like to have in the future? context rewards are promised from the start. For most
employees there will be a clear understanding of how
Reward systems much they will be paid, for example. This may affect your
extrinsic motivation – you go to work in order to earn a
Reward systems vary from organisation to organisation and salary. Recognition is not promised from the start and
can include pay, bonuses, profit sharing and performance- is when a worker is recognised for their contributions or
related pay. Pay may be linked to performance such that the achievements. An example may make this clearer. Giving
harder someone works, or the faster they complete tasks, someone a medal for bravery is recognition for their
the more money they can earn. Bonuses are sometimes behaviour. It is not a reward as it was not promised from the
offered in addition to a salary and can be significant sums of start and as Hansen et al. (2002) explain; ‘we would never
money in some sectors, particularly in Finance. Profit sharing think of promising a cash reward for every act of courage
by an organisation means that a percentage of the company under fire. In fact, the thought of remuneration for such
profit is shared among all the workers. This gives workers deeds actually cheapens them. On the other hand, try to get
a stronger sense of belonging to the organisation and can a teenager to clean his room without some clear contract of
lead to increased motivation. These systems might not be “what is in it for him”’.
available in all organisations as not all organisations are set
up to make a profit. Most health and education organisations However, not everyone is motivated by money and not
for example do not have profit as their primary aim. all organisations are designed to make a profit. There
are several effective motivators which are not monetary.
It is hard to tell if monetary rewards are successful in Many of these you will understand as forms of positive
improving productivity and evidence exists on both side reinforcement.
of this debate. A paper by de Waal and Jansen (2011)
summarises a number of research findings in this area. Reflections: Which studies at AS Level involved the
They cite studies demonstrating that over half the growth concept of reinforcement?
in productivity in Chinese State industries could be
attributed to the use of bonuses (Yao, 1997) and studies Praise, respect and recognition come from other people
demonstrating the positive effects of performance-related and can be extremely motivating. Think about how
pay (Belfield & Marsden, 2005). Hollowell (2005) claimed you feel when you are praised for an achievement in
that those organisations paying their senior executives on the classroom. This is not quite an external reward like
high performance-related pay scales maintained strong money – this is reward that makes you feel good about
stock markets presences. yourself. Achievement of a difficult task or even simply the
completion of a task can lead to a feeling of empowerment.
However, de Waal and Jansen also include contradictory Empowerment makes you feel as though you can achieve
evidence. They cite studies which demonstrate that in anything!
organisations with very high inequalities (the difference
between the highest paid and the lowest paid member Recognition can take many forms. At its simplest,
of the organisation) there is also very high turnover of recognition may be the employer thanking an employee
staff. This is also true in baseball where the teams with the for a job well done. This might be made more formal by
highest pay inequalities lose more games (Bloom, 1999). the employee receiving a formal letter of thanks from
This would suggest that any gains in productivity shown their manager or even from someone more senior. More
by the high performers are outweighed by the costs to the public forms of recognition might be in the form of award
low performers. Finally research conducted in a number of ceremonies or ‘employee of the month’ schemes. Achieving
organisations in the UK (Fattorusso et al., 2007) and Holland a difficult task, or meeting a challenging goal, can produce
(Duffhues and Kabir, 2008) found no relationship between a sense of empowerment which is also motivating and
the size of bonus payments and performance.

Cambridge International AS and A Level Psychology

creates a sense of belonging, within a team or the whole ISSUES AND DEBATES (continued)
organisation.
that managers recognise the value of these rewards
Rose (1998) estimates that around 75% of organisations to ensure the motivation of their workers. This section
in the UK had some form of non-monetary recognition can be considered to take a behaviourist approach
scheme and also noted that these were even more to the topic of motivation as it considers the effect of
commonly found in organisations that rely heavily on certain outcomes (reinforcements) on behaviour rather
customer contact. than focusing on the cognitive aspects. However, we
can also consider individual differences here; what
There are many advantages to an organisation of having motivates one person may not motivate another – and
a non-monetary recognition scheme. Such a scheme can also the individual–situational debate as the situation
highlight desired behaviours and through recognition, create may well interact with the individual in determining
role models for other to imitate. The recognition may be the most effective motivators. Someone working in a
given immediately, strengthening the association between highly creative environment is likely to be motivated
the behaviour and the consequence, and these schemes are by praise and recognition for their creativity whereas
often very low-cost. Evidence suggests that staff turnover non-monetary rewards may not be as effective in the
can also be positively affected. Building positive affective competitive business world.
relationships between managers and workers and making
sure that workers know that they are appreciated and that RESEARCH METHODS
their efforts are valued makes people more likely to stay and The material covered in this section has not included
increases their satisfaction ratings (Brown and Armstrong, any empirical research although it is easy to see that all
1999). Reed (a large UK based recruitment company) found of these ideas could be tested experimentally. We could
that recognition was rated as the most important factor design a whole range of studies, in laboratory or field
in achieving job satisfaction, whereas salary was rated situations to test the effectiveness of different rewards.
sixth. The issues of staff turnover, absenteeism and job
282 satisfaction will be explored later in this chapter. Reflections: Design a laboratory-based study to test
whether praise or money would be a more effective
Reflections: How would you feel if you were nominated motivator for the completion of a boring, repetitive task.
as employee of the month? What strengths and weaknesses does your study have?

Evaluation SELF-ASSESSMENT QUESTIONS

ISSUES AND DEBATES 1 Describe what Maslow meant by ‘self-actualisation’.
2 McClelland used projective tests to measure the
This section has considered motivation in a more
practical sense. Rather than the theories that we met need for achievement. Give one strength and one
in the previous sections, here we have considered what weakness of projective tests.
factors may act as motivators in work. This is obviously 3 Equity theory proposes that workers expect things to
useful information in several ways. It may be useful for be fair. Suggest how somebody might respond if they
you to consider what motivates you and this may help discovered that someone doing the same job as them
you in deciding the type of job that you want to aim for was being paid more.
in the future. It may also be useful for managers of teams 4 Describe the difference between internal and external
and organisations when considering what motivates motivation.
their workers. For example, a monetary award is not
always possible and recognising that non-monetary
rewards such as praise and recognition can be equally
effective (in some organisations at least) may ensure

Chapter 9: Psychology and organisations

9.2 Leadership and management They will listen to workers more often than the other 283
category of leader and will try to improve performance
Traditional and modern theories of by boosting self-confidence.
leadership
A similar set of studies were conducted at the University
Universalist and behavioural theories of Michigan and this also produced two main types of
behaviours shown by leaders which were:
Reflections: Research the meanings of leadership and
management. Are they the same or different? • Task-oriented behaviours. Not surprisingly this refers

Universalist theories of leadership look at the personal to behaviours which focus specifically on the task to
qualities or characteristics which are shared by great be completed. Leaders focus on the structure (as in
leaders. One of the best known of these theories is the the ‘initiating structure’ leadership behaviour category
‘Great Man Theory’ first proposed by Woods in 1913 and described above) and will set targets and standards,
now more commonly referred to as the ‘Great Person supervise and monitor workers and progress.
Theory’. This theory argues that great leaders are born and
not made – in other words this can be understood as part of • Relationship-oriented behaviours. These have a focus on
the nature–nurture debate and this will be considered in the
evaluation section. the well-being of the workforce. Leaders would spend
time examining and understanding the interpersonal
Another way to look at this is to consider the notion of a relationships between workers and those between
charismatic or transformational leader – someone with the workers and managers and this has clear overlaps with
charisma and the interpersonal skills to inspire and lead the ‘consideration’ leadership behaviour described above.
others. Such people tend to have excellent public speaking
skills and high levels of confidence. They are sometimes Adaptive leadership
described as ‘visionaries’ and are often unconventional in
their approach. As organisations grow ever larger and more complex, it is
possible to argue that traditional forms of leadership may
Reflections: Can you think of anyone who might be be failing. If these traditional methods are not working,
described as a transformational leader? Ask a few people then there is a need to change or a need for adaptation.
of different ages and see what they say. Research anyone Working practices and organisational norms and values
whose name you do not recognise. that made an organisation successful in the past may
now be irrelevant and the organisation must confront the
Behavioural theories of leadership look at the specific need for change. This is where Heifetz et al.’s (1997, 2009)
behaviours shown by leaders as opposed to the personal concept of adaptive leadership comes in. They define
qualities of leaders. Researchers at Ohio State University leadership as the ‘art of mobilising people (in organisations
(R.M. Stogdill and A.E. Coons) have collated data from and communities) to tackle tough issues, adapt and thrive’
numerous studies of leaders and their workers and have (2009). They argue that leadership itself has to change; that
identified over 100 different behaviours shown by leaders. rather than leading by providing solutions, the leader of an
Through further analysis these behaviours were shown to organisation facing adaptive challenges must be able to
fall into two distinct categories: shift the responsibilty for change to the entire workforce.
This may be distressing for some people as employees
• Initiating structure: this includes allocating tasks to may have to take on new roles, learn new skills, align with
new values or even accept that there is no longer a place
people, creating groups and defining their goals, setting for them within the organisation. Employees are used to
deadlines and ensuring that they are met and making management solving problems for them and this will also
sure that workers are working to a set standard. have to change. This may mean that adaptive leaders
can no longer protect their workers from the problems
• Consideration: this is the category of behaviours which facing the organisation so that they understand the need
to change. The role of the adaptive leader is no longer
are shown by leaders who express a genuine concern to maintain and support the organisational norms and
for the feelings of workers. These leaders will establish values but to allow disorientation, conflict and challenge to
a rapport with workers and show trust and respect. create a new organisation that can survive. The differences
between traditional leadership and adaptive leadership are
summarised in Table 9.1.

Cambridge International AS and A Level Psychology

Traditional leadership Adaptive leadership
is about authority and the issuing of directions to others
is about maintaining organisational norms and traditions is about helping others to find their inner authority
(we have always done it like this) is about challenging these norms and traditions and
makes use of the skills and competencies available exploring new ways of working

is about tried and tested solutions or directions based on pushes boundaries and attempts to extend skills and
prior experiences competencies
is useful in times of certainty
Table 9.1 Leadership styles compared is about new solutions or new directions which have not
been tested and have unknown outcomes

is most useful in times of uncertainty

There are six key principles of adaptive leadership and these As an example of leadership styles, Heifetz and Linsky,

are as follows: in their book Leadership on the Line (2002), refer to Henry

1 ‘Get on the balcony’. An adaptive leader needs to see Fonda’s character in the film 12 Angry Men as an example
the whole picture and to view the organisation and the of the adaptive leader in action. Henry Fonda plays the
way it works as if they were observing from above. only jury member who initially votes ‘not guilty’ in a murder
trial. Through the film, his behaviour encourages the other
2 Identify the adaptive change. An adaptive leader needs jurors to explore their own prejudices and biases and to
to not only identify the need for change but be able look at the evidence from different perspectives. Heifetz
to determine the nature and extent of the change and Linksy claim that this is a powerful display of adaptive
required, be that to organisational structure, values,
working practices or working relationships. leadership.

284 3 Regulate distress. Adaptive change will both stress and The three levels of leadership

distress those who are experiencing it. This cannot be The idea of three levels of leadership was introduced
avoided but it can be managed. The pressure needs by James Scouller in a book published in 2011, which
to be enough to motivate people to change but not so explains how leadership presence can be developed and is
much that it overwhelms them. The adaptive leader sometimes referred to as the 3P model of leadership after
needs to be able to tolerate the uncertainty and the three key elements:
frustration and to communicate confidence.
• public leadership
4 Maintain disciplined attention. An adaptive leader • private leadership
must be open to contrasting points of view. Rather • personal leadership.
than avoiding or covering up issues that are difficult or

disturbing, they must confront the issues directly. The model is usually presented in diagram form as three

5 Give the work back to the people. An adaptive leader circles and four outwardly-directed arrows, with personal

must recognise that everyone in the organisation has leadership in the centre (Figure 9.3).

special access to information that comes only from

their experiences in their particular role. Adaptive Outer levels Public
leaders must step back from the traditional role of Private
telling people what to do and, by allowing them to use

their special knowledge, recognise that they are best

placed to identify the solutions to the problems.

6 Protect voices of leadership from below. Heifetz et al. Inner level Personal
argue that ‘giving a voice to all people is the foundation
of an organisation that is willing to experiment and 9.3 The three levels of leadership model
learn’. In many organisations, those who speak up are
silenced. An adaptive leader needs to listen to these
voices to learn of impending challenges. Ignoring them
can be be fatal for the organisation.

Chapter 9: Psychology and organisations

Public and private leadership are described as the ‘outer’ Evaluation 285
or ‘behavioural’ levels of the model. Public leadership
concerns the behaviours required to influence groups of ISSUES AND DEBATES
people and private leadership concerns the behaviours
involved in influencing individuals. Theories of leadership raise a number of crucial
evaluation issues. To begin with, we will consider the
Reflections: How do you think these might be different? nature versus nurture debate. Are leaders born or
What skills might you need to influence an individual? made? The Great Person Theory described above would
What skills might you need to influence a group? certainly be on the nature side of this debate while the
other theories may leave room for some development
The third level, shown in the centre of the diagram, is of leadership skills. Scouller in particular, whose theory
described as the ‘inner’ level and relates to the leadership brought together many of the older theories, including
qualities shown by the individual. This will include their trait theories, behaviour theories and theories of
skills and beliefs but also their emotions, subconscious leadership style, would argue that leadership presence
behaviours and their ‘presence’. Scouller argued that can be developed but the arguments proposed by Heifetz
leaders need to ‘grow their leadership presence, know-how et al. also suggest that leadership needs to able to adapt
and skill’ through developing their technical know-how and and change and that leadership skills can be learned.
skill, cultivating the right attitude towards other people and
working on psychological self-mastery. This final aspect The 3 Ps model and the Theory of Adaptive Leadership also
is the most crucial aspect of developing a leadership allow us to consider the individual–situational debate as it
presence. clearly shows that different skills will be required for different
situations, for example in trying to persuade an individual
‘At its heart is the leader’s self-awareness, his rather than trying to persuade a group. Heifetz et al. argue
progress toward self-mastery and technical strongly for the need for adaptive leadership particularly
competence, and his sense of connection with where the more traditional styles of leadership have failed
those around him. It’s the inner core, the source, or when the situation is one of great uncertainty. As with the
of a leader’s outer leadership effectiveness.’ earlier theories of leadership we can also consider whether
(Scouller, 2011) some individuals may be better able to provide adaptive
leadership as well as considering the extent to which
Scouller argues that personal leadership is the most personal leadership skills may be developed. Finally, it is
powerful of the three levels. He likened its effect to dropping important to consider the issue of usefulness or application
a pebble in a pond and seeing the ripples spreading out to everyday life. The theories that have been discussed here
from the centre (Figure 9.4) – hence the four arrows pointing have been applied in organisations all over the world and
outward in Figure 9.3. make a significant contribution to the success or otherwise
of a wide variety of organisations.

RESEARCH METHODS

The work conducted by Ohio State University and by the
University of Michigan brings together huge amounts
of data collected from a wide range of organisations
and individuals. This gives their findings a great deal of
support, and conclusions drawn from these findings can
be generalised easily. Heifetz et al. and Scouller present
largely theoretical models of leadership although this
is a good point to introduce the issue of psychometric
testing. In any study where leadership is being measured,
some form of psychometric test will be used. These have
a number of strengths and weaknesses which will be
discussed in the next evaluation section.

9.4 Personal leadership spreads like ripples

Cambridge International AS and A Level Psychology

Leadership style Untrustworthy 8 7 6 5 4 3 2 1 Trustworthy

Leadership effectiveness Considerate 8 7 6 5 4 3 2 1 Inconsiderate
There have been several attempts to explain different styles
Nasty 8 7 6 5 4 3 2 1 Nice
of leadership and this is what will be examined next. The
first is the Theory of Leadership Effectiveness proposed Agreeable 8 7 6 5 4 3 2 1 Disagreeable

by Fiedler (1967) which examines the interaction between Insincere 8 7 6 5 4 3 2 1 Sincere
the style of leadership and the situation. This identifies
Kind 8 7 6 5 4 3 2 1 Unkind

an important point that different leadership styles will be Table 9.2 Least preferred co-worker (LPC) scale
effective in different situations. This is not only because of

the goals of the organisation – a different leader would be

required to run a school, a prison, a charity and a financial The Situational Theory of Leadership

institution – but also because different organisations will The Situational Theory of Leadership was suggested by

give their leaders differing amounts of power and control Hersey and Blanchard (1988) and proposed that there is
and so different types of leader will fit better into different no single effective leadership style (Figure 9.5). Although

types of organisations. leaders may have their preferred style, it is not appropriate

for a leader to use the same style all the time. A truly

Reflections: Choose three of the following organisations: effective leader must be able to adapt their leadership style
a school, a prison, a bank, a hospital, a newspaper and a to suit the situation.

small convenience store. Identify what you think would

be the most appropriate way to lead each of your chosen High Situational leadership II model
organisations.

286 In order to measure leadership effectiveness, Fiedler Low directive Coaching High directive
and high and high
supportive
behaviour supportive
behaviour

developed the LPC or least preferred co-worker scale (see Supporting

Table 9.2). This 16-item questionnaire asks leaders about the

person with whom they work least well. Fiedler assumed Supportive behaviour

that everyone’s LPC is probably equally unpleasant and S3 S2
so the LPC is not about the least preferred co-worker but S4 S1
rather is about the person taking the test. The analysis of
Directing
the answers determines whether the individual has a low legating

LPC score and is task oriented (such that they would give

harsh ratings to their least preferred co-worker) or a high De Low directive High directive
LPC score and is relationship-oriented (such that they
would give positive ratings to even their LPC). and low and low
supportive supportive
behaviour behaviour

Pleasant 8 7 6 5 4 3 2 1 Unpleasant Low Directive behaviour High
Friendly 8 7 6 5 4 3 2 1 Unfriendly
Rejecting 8 7 6 5 4 3 2 1 Accepting D4 D3 D2 D1
Tense 8 7 6 5 4 3 2 1 Relaxed
Cold 8 7 6 5 4 3 2 1 Warm High Moderate to high Low to some Low
Supporting 8 7 6 5 4 3 2 1 Hostile competence competence competence competence
Boring 8 7 6 5 4 3 2 1 Interesting –––
Quarrelsome 8 7 6 5 4 3 2 1 Harmonious ––– Variable ––– –––
Gloomy 8 7 6 5 4 3 2 1 Cheerful High commitment Low High
Open 8 7 6 5 4 3 2 1 Closed commitment commitment commitment
Backbiting 8 7 6 5 4 3 2 1 Loyal
Developed Developing

9.5 Situational leadership model

The two key concepts in this model are the leadership style

of the leader and the individual’s or group’s maturity level.
An effective leadership style must be relevant to the task

Chapter 9: Psychology and organisations

and the most successful leaders are those who can adapt • M1 – the individual or group lacks the specific skills 287
their leadership style to the maturity level of the group they
are leading. required for the job in hand and is unable and unwilling
to do or to take responsibility for the task.
KEY TERM
• M2 – they are unable to take on responsibility for the
maturity: in this context is the capacity to set high but
attainable goals, willingness and ability to take responsibility task being done; however, they are willing to work at the
for the task, and relevant education and/or experience of an task. They are enthusiastic but need more training and
individual or a group for the task. support.

Reflections: Look at the list you made in response to • M3 – they are experienced and able to do the task
the previous reflection. Do you think that the maturity
level of the group you were leading was something you but lack the confidence or the willingness to take on
considered? responsibility.

Leadership style can be described in terms of task • M4 – they are experienced at the task, and comfortable
behaviour and relationship behaviour. This produces four
types of leader behaviour: with their own ability to do it well. They are able and
willing to not only do the task, but to take responsibility
• Style 1 (S1) telling. This is behaviour that is largely for the task.
Maturity levels are also task-specific rather than person-
directive, the leader will define the role for the members specific. A person might be generally skilled, confident and
of the group and will explain (or tell) the group members motivated in their job, but would still have maturity level M1
how, why, when and where to do the task. when asked to perform a task requiring skills they do not
possess.
• Style 2 (S2) selling. This behaviour type is still directive but
Reflections: Make a list of some tasks that you feel you
will involve more two-way communication and will also could complete at maturity level 4. Now make a list of
involve the use of relationship skills that will allow the some tasks where you think you might be at maturity
group members to ‘buy into’ or feel a part of the process. level 1. What sort of leader would you like to have for
each of these tasks?
• Style 3 (S3) participating. The leader provides less
Style of leader behaviour
direction and this style is characterised by shared Research conducted since the 1960s has tended to
decision making. A high use is made of relationship focus on the superiority of the democratic style of
skills. leadership. However, Muczyk and Reimann (1987) argue
that democratic leadership may not always be the most
• Style 4 (S4) delegating. The leader is still involved with effective and that it may not work at all in some situations.
They argue that ‘leadership is a two-way street, so a
the decision making process but the responsibility has democratic style will be effective only if followers are both
been delegated to the group. The leader is likely to take willing and able to participate actively in the decision
a monitoring rather than a directive role. making process. If they are not, the leader cannot be
democratic without also being “directive” and following
Reflections: Imagine you are a teacher of A Level up very closely to see that directives are being carried out
Psychology students and you have set your class a properly’ (page 301).
group activity to research some aspect of organisational
psychology. Which style of leader behaviour would you They argue that the importance of direction to successful
choose to use and why? leadership has neither been fully recognised nor properly
investigated and this, they claim, is due to the common
The right leadership style will depend on the person or failure to distinguish between participation and direction.
group being led. This is where the second important They further argue that some researchers appear to
concept, the maturity level of the individual or group comes understand direction as being the exact opposite of
in. The Hersey–Blanchard Situational Leadership Theory participation and that this has had the effect of making
identifies four levels of maturity: directive leadership appear anti-democratic.

Cambridge International AS and A Level Psychology

Their article is an argument for direction as a separate This means that there are two leadership factors which

dimension of leadership and one that is not necessarily need to be considered:

inconsistent with participation. Combining direction • Participation: low participation would be an autocratic
with participation produces four styles of leadership and
may help us understand the question of which style of leader and high participation would be a democratic or
leadership is best in which situation.
participative leader.
One of the key problems in previous research is that
researchers have tended to see decision making and the • Direction: low direction would be permissive with little
execution of this decision to be the same thing. This is a
or only general supervision and high would be directive,

close supervision, constant follow-up.

crucial point as clearly the process of making a decision An autocratic leader would assume that their role is to make

is quite separate from the process of ensuring that this decisions and that these decisions will be carried out by

decision is carried through. Deciding that something should others who are subordinate to them and have no role in

happen is not the same as ensuring that it does happen. the decision making process. A democratic leader on the

other hand will ensure that subordinates are involved in the

Reflections: Is deciding that something should happen decision making process even though they may retain the
all that an effective leader should have to do? right to make the final decision.

The directive behaviour refers to how the leader deals with

Although participation may well be the more effective style what happens after the decision has been made. A non-
in decision making, direction (or directive leadership) may directive leader (permissive) will leave their subordinates
be crucial to ensure correct implementation of this decision. free to decide how to reach the goal and will offer little if any
Research has tended to focus on the superiority of the direction. A directive leader on the other hand will specify
participative (or democratic) style of leadership during the
288 decision making process. It is important to realise that a how tasks are to be completed and will follow up progress

throughout the implementation stage.

leader may be participative during the decision making phase Classifying leaders as high or low on these two variables

and directive during the later stages, meaning that they follow produces four types of leader behaviour, as given in

progress carefully to ensure that the decision is fully achieved. Table 9.3.

Degree of participation in decision making

Low High

Amount of leader High Directive autocrat: Directive democrat:
Invites full participation in decisions
direction Makes unilateral decisions

Supervises workers closely monitors closely

Useful when there is a need for Useful when there is a need for
complex decisions involving many
quick decisions and supervision experts, needing an overall direction
of new staff or poor managers.

Low Permissive autocrat: Permissive democrat:

Makes decisions themselves Seen as ‘ideal’ leader in (primarily
American) literature
Allows staff to choose how to
implement these decisions Invites high degree of participation in
decisions
Useful where tasks are relatively
simple or where staff are highly Allows for autonomy of
skilled and need little supervision implementation

Good for highly skilled, trusted
employees

Table 9.3 Four types of leader behaviour

Chapter 9: Psychology and organisations

Evaluation Leaders and followers 289

ISSUES AND DEBATES Leader–member exchange model

The most obvious evaluation issue to begin with is the A number of different models have been proposed to
individual–situational debate. Fiedler examines the help explain the manager–worker relationship. One of
relationship between the individual (leader) and the situation these is the leader–member exchange model proposed
directly and makes the point that different leadership styles by Danserau et al. (1995). Originally Danserau et al.
will be effective in different situations. Hersey and Blanchard had proposed the Vertical Dyad Linkage Theory (1975)
take this further and state that the leader must be able to which suggested that leaders can treat their followers
fit their leadership style to the situation and that the mark in two different ways: they may treat some of them
of an effective leader is the extent to which they are able as trusted followers and others in more formal ways.
to do this. This has obvious applications to organisations, This theory has now become known as the leader-
and organisations that recognise the importance of the member exchange model (1994). A further model,
‘fit’ between the leader and the group or who can appoint the individualised leadership model, was developed
leaders with the skills required to adapt their behaviour will in 1995 and suggests that each follower should be
be the most successful organisations. understood as independent and each leader viewed
as unique.
Remaining with the theme of usefulness and applications,
the contribution made to this area by Muczyk and Reimann Vertical Dyad Linkage Theory claims that the
has been significant. Highlighting the difference between relationship between a manager and his or her
making a decision and ensuring that that decision is followers is developed through three stages. The
implemented (followed through to its completion) first of these is the role-taking stage. This is where
is extremely valuable and will allow organisations to individuals become team members and meet their
recognise that as with leadership in general, there are leader. Leaders need to make expectations clear and
many styles and these styles suit different situations and team members need to make their skills and abilities
groups. Ensuring that the right leader is in charge will evident to the leader so that he or she can determine
ensure the successful completion of the task. how each person may contribute to the team. In the
second stage, the role-making stage, members of the
RESEARCH METHODS team become integrated into the team and begin work.
As with previous sections, we have considered several This allows them the opportunity to further prove
theoretical models but again it would be possible to their skills as well as their ability to work with others.
test these models in real-life situations. We have also The leader may then determine who becomes part
considered the LPC scale and so we need to discuss the of the in-group and who belongs in the out-group.
strengths and weaknesses of this. Some critics argue that The final stage is described as the role routinisation
ratings of LPC tells us little about an individual’s leadership stage and this is where in-group members and the
style. Other criticisms of this scale are ones that could be leader engage in ‘mutual and high quality leader and
made about any psychometric test; individuals are prone subordinate exchanges’ which further develops their
to social desirability bias. It is difficult to construct a relationships. This can also lead to improvements within
culturally fair (unbiased) test and tests may reveal more the group. A study by Erdogan et al. (2015) showed that
about the assumptions of the test-maker than anything this is due to the out-group members attempting to
else. However tests like the LPC scale are relatively easy communicate well with the in-group members as they
to administer and to mark, produce quantitative data that are closely connected to the leader. This may allow
can be easily analysed and are relatively objective ways of them to achieve a move from the out-group to the
measuring personality characteristics. in-group. Danserau’s individualised leadership model
extends the theory described above by focusing on
KEY TERM the one-to-one relationship between a superior and
a specific subordinate, involving (1) the supervisor’s
social desirability bias: trying to present oneself in the best investments in and returns from the subordinate, and
light by determining what a test is asking. (2) the subordinate’s investments in and returns from
the superior.

Cambridge International AS and A Level Psychology

Followership yes-people will defend their leader when faced with
opposition from others.
Followership refers to a role held by certain individuals
in an organisation, team or group. Specifically, it is the • The pragmatics: these individuals are not trail-blazers;
way in which an individual actively follows a leader. It
is important to recognise that the role of leader can they will not stand behind controversial or unique
only be understood by also examining the reciprocal ideas until the majority of the group has expressed
role of follower: Kelley (1988) claims that the study of their support. These individuals often remain in the
‘followership’ will lead to a better understanding of background of the group.
leadership. The success or failure of a group may not be
solely down to the ability of a leader but may also be • The alienated: these individuals are negative and often
dependent on how well the followers can follow.
attempt to stall or bring the group down by constantly
Kelley described four main qualities of effective followers: questioning the decisions and actions of the leader.
These individuals often view themselves as the rightful
• Self-management: this refers to the ability to think leader of the organisation and are critical of the leader
and fellow group members.
critically, to be in control of one’s actions and to work
independently. It is important that followers manage • The star followers: these exemplary individuals are
themselves well as leaders are able to delegate tasks to
these individuals. positive, active and independent thinkers. Star followers
will not blindly accept the decisions or actions of a
• Commitment: this refers to an individual being leader until they have evaluated them completely.
Furthermore, these types of followers can succeed
committed to the goal, vision or cause of a group, team without the presence of a leader.
or organisation. This is an important quality of followers
as it helps keep one’s (and other member’s) morale and Measuring leadership
energy levels high.
Kouzes and Posner (1987) argue that leadership is a
290 • Competence: it is essential that individuals possess the ‘measurable, learnable and teachable set of behaviours’.
They developed the Leadership Practices Inventory (LPI) to
skills and aptitudes necessary to complete the goal or measure the extent to which an individual engages in each
task or the group, team or organisation. Individuals high of the five practices of exemplary leadership which they
in this quality often hold skills higher than their average established through their research with successful leaders.
co-worker (or team member). Further, these individuals These include modelling desired behaviours, inspiring
continue their pursuit of knowledge by upgrading their others, challenging the status quo, enabling others and
skills through classes and seminars. encouraging and rewarding others. The LPI consists of six
behavioural statements for each of these practices and
• Courage: effective followers hold true to their beliefs examples of these statements are given below.

and maintain and uphold ethical standards, even in the 1 Model the Way.
face of dishonest or corrupt superiors (leaders). These • ‘sets a personal example of what he/she expects of
individuals are loyal, honest and, importantly, candid others’
with their superiors. • ‘is clear about his/her personal philosophy of
leadership’.
Kelley also identified two characteristics (dimensions)
which help to identify the difference between followers and 2 Inspire a shared vision.
non-followers. The first of these is critical thinking and the • ‘describes a compelling image of what our future
second is whether the individual is active or passive. This could be like’
gives us five types of followers, described as follows: • ‘appeals to others to share an exciting dream of the
future’.
• The sheep: passive, lack commitment and require
3 Challenge the process.
external motivation and constant supervision from • ‘experiments and takes risks even when there is a
the leader. chance of failure’
• ‘challenges people to try out new and innovative
• The yes-people: these individuals are committed to ways to do their work’.

the leader and the goal (or task) of the organisation
(or group/team). These conformist individuals do not
question the decisions or actions of the leader. Further,

Chapter 9: Psychology and organisations

4 Enable others to act. ISSUES AND DEBATES (continued) 291
• ‘Treats others with dignity and respect’
• ‘Supports the decisions that people make on their own’. that the follower types are based on innate qualities of
an individual but it is likely that the follower qualities
5 Encourage the heart. discussed prior to the follower types are qualities that
• ‘Praises people for a job well done’. could be developed. As with many of the other theories
• ‘Makes it a point to let people know about his/her that we have examined in this chapter, Kelley’s work
confidence in their abilities’. highlights the importance of the relationship between
the leader and the situation; in this case the type of
The LPI consists of the individual’s self-ratings of the followers that the leader must lead. Increasing our
frequency with which they demonstrate these behaviours understanding of these relationships is clearly useful
as well as a number of observer ratings. These are for organisations and can be applied in a variety of
combined on the final profile. Kouzes and Posner strongly ways. The work of Danserau helps further by explaining
believe that leadership is learned rather than something the stages through which the leader–group member
one is born with. This means that the profile that is relationship follows.
produced after completion of the LPI does not simply
provide a picture of the behaviours that someone exhibits SELF-ASSESSMENT QUESTIONS
but can be used to identify areas for personal development.
They claim that there are many different ways in which 5 Explain the difference between a ‘task-oriented’
different types of people (for example introverts versus leader and a ‘relationship-oriented’ leader.
extroverts) can be developed into successful leaders.
6 In Scouller’s ‘Three levels of leadership model’ which
Reflections: Kouzes and Posner’s views would be on the level did he suggest was the most important and
‘nurture’ side of the nature-nurture debate as they believe why?
that leadership is something that is learned rather than
something that one is born with. What do you think? 7 Explain what a low score would indicate in Fiedler’s
Least Preferred Co-worker Scale?
Evaluation
8 Identify the four qualities of effective followers,
ISSUES AND DEBATES according to Kelley.

We will begin this evaluation by considering the nature 9.3 Group behaviour in
versus nurture debate. Kouzes and Posner argue that organisations
leadership is something that can be learned rather than
something which we are born with. By exploring the Group development and roles
personality characteristics of an individual they can
suggest different ways in which different types of people Group development
can be developed into successful leaders. If we add the
individual–situational debate to the discussion at this Reflection: How does a group form? Think about some
point, we could also argue that it should be possible to of the groups that you belong to. Were there stages of
develop someone into the most successful type of leader becoming a group?
based not only on their existing personality type and
attitudes but also on the situation (group) which they are Tuckman’s stages of group development (1965) are well
going to lead. Interestingly Kelley shifts the focus from known. His proposal of a five stage group formation process
leaders to followers although does not directly address (forming – storming – norming – performing – adjourning) has
the question of whether followership qualities are born been applied to countless groups since its original proposal
or made. We might assume that he would suggest in 1965.

Cambridge International AS and A Level Psychology

Forming Storming Norming Performing Adjourning

Team acquaints and Members start to People feel part of the The team works in The team conducts an
establishes ground communicate their team and realise that an open and trusting assessment of the year
rules. Formalities feelings but still they can achieve work atmosphere where and implements a plan
are preserved and view themselves as if they accept other flexibility is the key for transitioning roles and
members are treated individuals rather than viewpoints. and hierarchy is of recognising members’
as strangers. part of a team. They little importance. contributions.
resist control by group
leaders and show
hostility.

9.6 Tuckman’s stages of group development

He proposes that all groups go through the same five stages enjoy stimulating others, questioning established views

292 during their formation and these are described in Figure 9.6. and finding the best approaches for solving problems.

Shapers tend to see obstacles as exciting challenges,

Belbin’s Theory of Team Roles although they may also be argumentative and upset

Belbin’s Theory of Team Roles (1981) takes a slightly colleagues. Implementers are the people who get things
different approach to understanding group behaviour. done. They turn the team’s ideas and concepts into

Belbin proposes that an ideal team contains people who practical actions and plans. They tend to be people who
are prepared to take on different roles (see Table 9.4).
work systematically and efficiently and are very well
organised. However, they can be inflexible and resistant

Action-oriented roles to change. Completer-finishers are the people who see
that projects are completed thoroughly. They ensure
Shapers are people who challenge the team to improve. there have been no mistakes and they pay attention to
They are dynamic and usually extroverted people who

Action-oriented roles Shaper Challenges the team to improve

Implementer Puts ideas into action

Completer-finisher Ensures thorough, timely completion

People-oriented roles Coordinator Acts as a chairperson

Team worker Encourages cooperation

Resource investigator Explores outside opportunities

Thought- oriented Plant Presents new ideas and approaches
roles Monitor-evaluator Analyses the options

Specialist Provides specialised skills

Table 9.4 A summary of the team roles proposed by Belbin