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USP112X Applied health and exercise psychology

Unit reference number: H/615/0938

Level: 3

Guided Learning (GL) hours: 60

Overview

This unit is about psychology applied in the context of exercise and health. Learners will develop knowledge of the psychological theories used to explain various factors that may influence exercise and health behaviours, including: motivation, personality, stress, anxiety and arousal. Learners will develop knowledge of the role of an exercise and health psychologist and the psychological assessments that may be used to collect information and the role of research. Learners will also develop knowledge of the different psychological interventions that may be used to engage and support exercise participation and healthy behaviour.

Learning outcomes

On completion of this unit, learners will: LO1 Know the psychological theories used to explain exercise and health behaviour

LO2 Know the role of an exercise or health psychologist

LO3 Know different psychological interventions that can be used to support exercise participation and healthy behaviours

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Assessment requirements

Learners must complete the assessment requirements related to this unit:

Learners must produce a portfolio of evidence which contains assessed evidence covering all the theory assessment criteria in the unit.

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Unit content

LO1 Know psychological theories used to explain exercise and health behaviour

Describe how different psychological theories explains exercise and health behaviour, personality and motivation:

Personality and motivation theories on exercise and health behaviour: - Personality – definitions of; related theories – trait theory, situation approach,

interactional approach, Marten’s schematic view, psychodynamic theory, type A and Type B

- Motivation – definitions of; related theories – achievement motivation, attribution theory, drive reduction theory, competence motivation theory, Maslow’s hierarchy of needs, intrinsic and extrinsic motivation and other factors that influence motivation

- Effects on engagement and participation in healthy behaviours – positive, negative, future expectations, how to develop a motivational environment to support exercise adherence

Other psychological theories that may be used to explain motivation, personality and behaviour:

- Behaviourist (Pavlov and Skinner) Classical conditioning – stimulus/response and association (1906),

Pavlov’s dogs experiment, behaviour modification achieved by pairing a neutral stimulus (e.g. bell) with another stimulus (presentation of food) to bring about a biological response (e.g. salivation of dogs). A memory of an experience that produces uncomfortable feelings is usually the result of classical conditioning, e.g. experience in PE at school may influence current exercise participation levels and successes

Operant conditioning – Skinner’s rats (press a lever to be fed pellets), behaviour shaped by consequences (1938)

Positive reinforcement (e.g. praise) – behaviour repetition – reinforces positive behaviour

Negative reinforcement (e.g. ignoring a behaviour) – behaviour avoidance – if the unwanted behaviour is ignored, no attention given, it is not repeated

Punishment (e.g. smacking) – behaviour presentation. Attention is being given to the unwanted behaviour and it represents reinforcement

- Psychodynamic (Freud, Jung, Adler) Unconscious motives, drive for pleasure/self-destruction – Eros and

Thanos

Iceberg analogy (conscious aspect of person that is presented is the tip of an iceberg, more exists beneath the surface)

Psychoanalysis to reach the unconscious, e.g. dream analysis, free association

Jung – personality structure and archetypes (anima, animus, self, shadow, persona) and typology (extrovert, introvert, sensation, thinking, feeling and intuitive), personality inventories, e.g. Myers-Briggs

Psychological (ego) defence mechanisms include:

Repression – uncomfortable memories moved to the unconscious mind, no longer in conscious awareness

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Displacement – emotional responses redirected, e.g. anger at boss directed to another person, animal or object, e.g. argue with spouse, kick the cat or throw household objects

Projection – motivations that are unacceptable to self are transferred to other, e.g. prejudice or blame of others

Regression – responding in the present in a way that represents an earlier regressed age/experience, e.g. sulking or temper tantrum

Humour – to minimise discomfort of an experience

- Cognitive behavioural (Beck and Ellis) Key concepts – levels of cognitive processing

Automatic thoughts – negative automatic thoughts (NATS)

Cognitive errors – selective abstraction, arbitrary inference, overgeneralisation, magnification and minimisation, personalisation, absolutistic (all or nothing) thinking

Schemas – core beliefs that affect how individuals process information

Cognitive behavioural therapy (CBT) to address thinking patterns, use of homework

- Humanistic (Rogers, Maslow) Self-worth, self-concept, growth, potential, actualisation

Rogers – person-centred approach – self-actualising tendency in presence of core conditions (empathy, congruence and unconditional positive regard)

Maslow’s hierarchy of needs (survival needs and growth needs) – lower (deficiency needs) have to be met before growth needs become a priority, e.g. need to satisfy hunger before esteem and belonging needs (relationships)

Health and exercise behaviour models/theories: - Health belief model (evolved from Kurt Lewins field theory) – expectancy–

value approach to motivation, e.g. what may or may not happen if they do or do not do something and the value they place on these outcomes

- Theory of reasoned action (Ajzen and Fishbein 1975/1980) – casual antecedents of volitional behaviour

- Theory of planned behaviour (Ajzen 1988) – casual antecedents of volitional behaviour with the addition of the variable ‘perceived behavioural control’

- Social learning theory (Bandura) – self-efficacy, the extent to which a person believes they can do something

- Cognitive dissonance (Festinger 1975) – holding two sets of contradictory beliefs which create discomfort, requiring a change in one of the beliefs, e.g. a sedentary person who knows the risks of inactivity may counter the dissonance by thinking they will not be affected

- Self-determination theory (SDT) Deci and Ryan – person centred roots, several sub-theories, basic psychological needs – autonomy, competence, relatedness

Trans-theoretical model (TTM) (Prochaska and Diclemente) to explain behaviour change processes:

- Stages of change and characteristics of each stage – pre-contemplation, contemplation, preparation, action, maintenance, termination, relapse

- Processes of change (cognitive and behavioural) – consciousness raising, dramatic relief, environmental re-evaluation, social liberation, self-revaluation,

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self-liberation, helping relationships/social support, counter-conditioning, stimulus control, contingency/reinforcement management

- Decisional balance – the reasons for making change and not making change that are weighed throughout the change process

- Self-efficacy – an individual’s belief in their ability to make a desired change

Motivational interviewing (Rollnick and Miller) helping approach used to facilitate behaviour change:

- Foundation in person-centred spirit – collaboration, compassion, acceptance, evocation but with some direction from the helper

- Steps – engaging, focusing, evoking, planning

- Skills – active listening

- Techniques – open ended questions, affirmations, reflective statements, summaries (OARS)

- Change and sustain talk and how to facilitate change talk

Biopsychosocial model in relation to exercise and health behaviours (inter-related factors that influence lifestyle choices and health outcomes)

- Biological factors – genetics and heredity and biochemical

- Behavioural factors – lifestyle, stress, health beliefs

- Psychological factors – self-worth, self-efficacy, self-esteem, perception mood and personality

- Social factors – culture, education, family relationships and socioeconomic, medical

Motivation and personality that may influence participation and engagement with different types of exercise (e.g. introvert/extrovert)

- Individual – gym, running, swimming, walking, cycling, weight lifting, body building

- Group – studio cycling, studio resistance, circuit training, exercise to music, dance, yoga, Pilates, kettlebells, step, Tai Chi

How theories can explain information that impacts exercise and health behaviour and lifestyle choices

- Barriers to exercise and health

- Motives for exercise and health, including reasons for engagement, participation and choice of activity

- Attitudes to exercise and health

- How barriers, motives and attitude change throughout life and factors that influence these changes

- Reasons for adherence and non-adherence to exercise or health behaviours

- Reasons for lapse and relapse

Recognise limitations of different models and theories - Historical timeline and shift in perspectives

- Criticisms from other psychological schools and theorists

Explain how stress, anxiety and arousal may affect exercise and health behaviour:

Stress – definitions of eustress and distress, positive and negative, types of stress, effects of stress

Anxiety – definitions of; state or trait, e.g. transitional (mood change in response to events) or permanent characteristic (personality characteristic)

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Arousal – definitions of; theories – drive theory, inverted U hypothesis, individual zones of optimal functioning, comfort zones, reversal theory

Causes of stress, anxiety and arousal – internal, external, personal, situational, occupational, levels of discomfort

Signs and symptoms of stress and anxiety - Physical – weight loss or gain, skin conditions

- Behavioural – fidgeting, twitching, use of drugs/alcohol, aggression, crying, self-harm

- Psychological – low self-esteem, negative thinking, fear, suicidal thoughts, depression, low mood, loss of enjoyment/pleasure

Effects on exercise behaviour – negative metal state, low self-efficacy and self-belief, fear of failure, loss of concentration or commitment

Describe the different psychological antecedents that may impact health behaviour

choices:

Major life events – positive and negative; marriage, divorce, bereavement, moving home, birth of a child, illness/injury

Personality – personality type (A/B), stress and anxiety, attitude to pain

Stress levels – causal factors and type of stress – life stress, coping strategies and their effectiveness (e.g. relaxation or use of alcohol)

Social factors; - Relationships and dynamics – power and rank, effects of bullying, inclusion,

exclusion, Drama triangle roles and patterns of behaving (Victim, Persecutor, Rescuer)

- Social group processes and dynamics – roles (formal and informal), stages of development (Tuckman – forming, storming, norming, performing), cohesion – what brings people together, factors effecting cohesion, types of cohesion (social or task), creating an effective climate; factors influencing group dynamics – situational characteristics, leader characteristics, individual and group characteristics, goal setting, role clarity and acceptance

- Leadership/management (work, school or family) and dynamics – differences, qualities and behaviours of effective leaders (including fitness instructors, personal trainers and health and lifestyle support advisors), prescribed versus emerging leaders, theories (traits versus behavioural approach), leadership styles (autocratic, democratic, laissez-faire, consultative, task orientated, relationship orientated), cohesion, role modelling

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LO2 Know the role of an exercise or health psychologist

Describe the role of an exercise or health psychologist:

Research and expansion of evidence base

Practice – work with individuals, families, groups

Qualifications – higher education degree, masters and doctorate programmes

Work settings – clinical, public health departments, community health settings

Ethical considerations – role boundaries, supervision

Skills: - Communication skills – active listening, empathy, reflective statements when

consulting with clients

- Awareness of client needs – influencing recommendations and advice provided for a holistic service – e.g. use of relaxation, meditation, positive affirmations to assist the client

Describe psychological assessments used in exercise and health:

Different psychological assessments – purpose, advantages and disadvantages, how and when used

Methods - Interview or consultation

Informal or formal

Motivational interviewing and levels of change or sustain talk

Professional intervention, e.g. health psychologist, clinical psychologist, psychotherapist, counsellor

- Observation – posture, body language, gait, technique, performance and alignment, facial expressions, gestures

- Questionnaires Social Readjustment Rating Scale – SRSS

State-Trait Anxiety Inventory – STAI

Eysenck Personality Questionnaire – EPQ

Cattell’s 16 Personality Factors Test

Type A and Type B questionnaires

Wellbeing – EQ-5D

Psychological readiness scales (e.g. 0-10 ranking to express motivation, fears, readiness to work towards goals)

Decisional balance to weight up readiness to change behaviour

- Locus of control questionnaires

Ethical and legal responsibilities when collecting psychological information - Privacy and confidentiality when collecting information and/or

transferring/storing information (the exception being if any risk of harm to self or others identified, this must be disclosed and the client should be aware this information needs to be disclosed prior to the sharing – e.g. clear role boundaries stated before consultation)

- Informed consent prior to collecting information

- Clarification of purpose of data collected

- Nature and procedure of assessment

- Effects and benefits of assessment

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- Risks of assessment

- Feedback of results to individual

- How data will be interpreted and used

Reliability and validity of the information gathered and factors that may influence this, e.g. level of honesty (responses to a questionnaire or information shared), level of understanding of what is being asked (misread or misinterpret question), rapport and relationship with an interviewer. Tester misinterpretation of results (e.g. responses to a questionnaire or responses to an interview question – ineffective listening)

Describe the role of research in exercise and health psychology:

Health psychology more established than exercise psychology

Research approaches and methods – longitudinal studies, qualitative, quantitative, random controlled trials, survey, interviews, observation, literature review

Research ethics – consent of study groups and individuals

Variables – socio-economic factors (class, culture), individual factors (gender, age, ethnicity), lifestyle and health factors (smoking, alcohol, chronic health conditions)

Evidence based practice – value and limitations

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LO3 Know different psychological interventions that can be used to support exercise participation and healthy behaviours

Explain psychological interventions used in exercise and health:

Purpose - Change thought patterns

- Control anxiety

- Promote positive action/change

- Help decision making

- Increase motivation, e.g. engagement and long term participation in activity/exercise

- Assist coping e.g. stress management, chronic health condition management, smoking cessation

- Control/remove self-doubt

- Social support and encouragement, e.g. group support to maintain motivation and help prevent lapse or relapse

Advantages and disadvantages of different interventions, e.g. time to make a difference and frequency of practice (some interventions), cost (e.g. professional service, meditation group, relaxation tape or one-to-one session), evidence-based effectiveness

Interventions:

- Motivation – praise and encouragement

- Goal setting – SMART (specific, measurable, achievable, realistic, timely), goal monitoring and reviews (outcome, process and performance goals), short, medium and long term

- Arousal management – relaxation (progressive muscular relaxation – active/passive), visualisation and imagery, breathing control, autogenic training, psyching techniques

- Self-talk – positive affirmations, concentration, positive thinking

- Meditation

- Imagery – concentration, emotion control, relaxation, mental rehearsal

- Stress Inoculation Training (SIT)

- Counselling and talking therapies – motivational interviewing, cognitive behavioural therapy (CBT)

Planning – current situation, aims and objectives, action planning to achieve aims and objectives, content of action plan (e.g. relapse management)

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Assessment criteria

In order to pass this unit, learners must at a minimum achieve all assessment criteria.

Learning outcome

The learner must:

Assessment Criteria

The learner can:

LO1 Know the psychological theories used to explain exercise and health behaviour

P1 Describe how different psychological theories explain exercise and health behaviour, personality and motivation

P2 Explain how stress, anxiety and arousal may affect exercise and health behaviour

P3 Describe the different psychological antecedents that may impact health behaviour choices

LO2 Know the role of an exercise or health psychologist

P4 Describe the role of an exercise or health psychologist

P5 Describe psychological assessments used in exercise and health

P6 Describe the role of research in exercise and health psychology

LO3 Know different psychological interventions that can be used to support exercise participation and healthy behaviours

P7 Explain psychological interventions used in exercise and health

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Resources

The special resources required for this unit are access to a real or realistic working environment which supports learners to develop their knowledge of exercise and health psychology. Best practice should be encouraged by giving learners the opportunity to access current research and resources that evidence the effects of psychology on exercise and health.

Recommended text books:

ACSM (2014). ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. American College of Sports Medicine. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia. USA

Berne E., (1964) Games People Play – The Basic Handbook of Transactional Analysis, Ballantyne books, New York

Biddle, S and Mutrie, N (2008) Psychology of Physical Activity. Determinants, well-being and interventions. 2nd Edition. Routledge. London

Bolitho, S, Lawrence, D and McNish, E (20112. The Complete Guide to Behavioural Change for Sport and Fitness Professionals. Bloomsbury Publishing. London. UK

Feltham, C & Horton, I. Eds.(2000) Handbook of Counselling & Psychotherapy. London. UK. Sage Publications Ltd

Gross, R (1996). Psychology. The Science of Mind and Behaviour. 3rd edition. Oxon. UK. Hodder and Stoughton

McLeod, J (2003) An Introduction to Counselling. 3rd edition. Buckingham. Open University Press

Michie, S., Atkins, L & West, R., (2014) The Behaviour Change Wheel A guide to designing interventions, Silverback publishing, UK

Michie, S., West, R., Campbell., Brown., Gainforth., (2014) ABC of behaviour change theories. Silverback publishing, UK

Prochaska, J. O., Velcier, W. F., (1997) The Transtheoretical Model of Health Behaviour Change, American Journal of Health Promotion, 12(1): 38-48

Rollnick, S, Miller, W and Butler, C (2008) Motivational Interviewing in Health Care. The Guilford Press. New York. USA

Rollnick, S, and Miller, W (1991) Motivational Interviewing. Preparing People to Change Addictive Behaviour. The Guilford Press. New York. USA

Steiner, C (1997) Achieving Emotional Literacy. London. Bloomsbury Publishing

NB: This list is not exhaustive. There are many other valuable text books.

Useful journals:

British Journal of Sports Medicine

British Medical Journal (BMJ)

Journal of Public Health

Medicine and Science in Sports and Exercise

Psychology of Sport and Exercise

Research Quarterly for Exercise and Sport

British Journal of Sports Medicine

British Medical Journal (BMJ)

Journal of Public Health

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Medicine and Science in Sports and Exercise

Psychology of Sport and Exercise

Research Quarterly for Exercise and Sport

Recommended Websites: Beck Institute (CBT): www.beckinstitute.org

British Association of Counselling and Psychotherapy: www.bacp.co.uk

Motivational interviewing (MINT): www.motivationalinterviewing.org

Mindfulness for mental wellbeing: www.nhs.uk/conditions/stress-anxiety-depression

British Association of Sport and Exercise Science: www.bases.org.uk

National Institute for Health and Care Excellence (NICE): www.nice.org.uk

American College of Sport Medicine (ACSM): www.acsm.org

Department of health: www.gov.uk/government/organisations/department-of-health

British Heart Foundation National Centre: www.bhfactive.org

NHS Choices: www.nhs.uk/Livewell/Goodfood?pages/water-drinks.aspx

Change4life: http://www.nhs.uk/Change4Life

Public Health England: http://healthengland.org/

Public Health Scotland: http://www.healthscotland.com/

Public Health Wales: http://www.publichealthwales.wales.nhs.uk/

Public Health Agency Northern Ireland: http://www.publichealth.hscni.net/

Self Determination Theory: http://www.selfdeterminationtheory.org/theory/

Delivery guidance

Teachers are encouraged to use innovative, practical and engaging delivery methods to enhance the learning experience. Learners may benefit from:

Meaningful employer engagement so they relate what they learn about psychology to the real world of exercise participation and health promotion

Presentations and interactive discussions to explore different psychological theories that link with health and exercise behaviour, personality, motivation and stress/anxiety

Guest speaker presentations and forums with exercise and health behaviour psychologists who can present specific evidence-based psychological approaches used to build motivation or manage arousal/anxiety; and/or share their experience of working with individuals engaging with exercise and health behaviour change

Exploration of ‘real’ or realistic case studies to discuss and share ideas of psychological factors that influence health and exercise behaviour participation

Opportunities to complete different psychological questionnaires and explore and discuss the results with peers

Opportunities to experience different psychological interventions, e.g. positive self-talk, relaxation, meditation and discuss how these approaches may be used to encourage exercise participation and promote health improvement

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Links with other units

This unit is closely linked with the following units:

USP97M Health and lifestyle

Learners will be required to apply their knowledge of health and lifestyle when learning about health and exercise psychology. The applied psychology unit will deepen learners’ understanding and awareness of psychological factors that impact lifestyle choices and health behaviours. The content of the health and lifestyle unit should be delivered before the applied psychology unit.

USP59M Behaviour change and adherence

Learners will be able to apply their knowledge and skills of behaviour change when learning about health and exercise psychology. The applied psychology unit will deepen learners’ understanding and awareness of psychological factors that impact behaviour change. The content of the behaviour change and adherence unit can be delivered before, or integrated with delivery of the applied psychology unit.

USP115X Exercise referral schemes and the management of chronic health conditions

Learners will be able to use their knowledge of exercise referral schemes and the management of chronic health conditions when learning about health and exercise psychology. The content of the exercise referral unit can be delivered before or integrated with the delivery of the applied psychology unit, if these units are selected as an optional study units.

USP114X Health promotion for community health and wellbeing

Learners will be able to apply their knowledge of health promotion for community health and wellbeing when learning about health and exercise psychology. The content of the health promotion for community health and wellbeing unit can be delivered before or integrated with the delivery of the applied psychology unit, if these units are selected as an optional study units.