remains in the therapist ’s hands (Schwartz & Higgins, 1979). One team of in-
vestigators looked at depression levels in patients with rheumatoid arthritis
(Reich & Zautra, 1997). The external patients became less depressed when
their spouses provided them with a lot of support and assistance. However,
internal patients showed an increase in depression when their spouse gave
this same amount of assistance. The researchers speculate that the spouse ’s
care was seen as helpful by the externals but as an indication of dependenceby the internals.
Locus of Control and Health
One of the most frustrating problems health care professionals face is lack ofpatient cooperation. Many patients discontinue their therapy programs or
simply stop taking their medicines. On the other hand, other patients do an
excellent job of watching their diets, taking medication, attending therapy,
and keeping appointments. Observations like these lead some psychologists
to suggest that locus of control might play a role in health behaviors
(Strickland, 1989; Wallston, 2005). Those who believe their health is largelyin their own hands will do what they can to get better. Those who attribute
poor health to bad genes or fate may see little reason to make the effort.
Research tends to support this analysis. One study followed 5,114
middle-aged men and women for an eight and half year period (Sturmer &Hasselbach, 2006). Locus of control scores taken at the beginning of the
study were strong predictors of which participants would suffer from heartattacks and cancer by the end of the study. As predicted, internals were less
likely than externals to experience these health problems. Another investiga-
tion measured locus of control in 10 year olds (Gale, Batty, & Deary, 2008).
When the researchers contacted these individuals again 20 years later, they
found the participants identified as internals two decades earlier were in sig-
nificantly better health than those identified as externals.
Psychologists explain these effects in terms of the way internals and exter-
nals approach their physical health. People who take an external orientationtoward their health believe there is little they can do to improve their physical
condition or avoid disease. Whether they become ill is out of their control,
and when they become ill they depend on health professionals to make them
well again. On the other hand, people with an internal locus of control be-
lieve they have a significant role in maintaining good health. Because they
see a relationship between what they do and how they feel, internals are
more likely than externals to eat well and participate in health-maintaining
exercise programs, such as aerobics or jogging.
Consistent with these descriptions, several studies find that internals prac-
tice better health habits and are generally healthier than externals (Johanssonet al., 2001; Klonowicz, 2001; Ng et al., 2006; O ’Hea, Grothe, Bodenlos,
Boudreaux, White, & Brantley, 2005; Perrig-Chiello, Perrig, & Staehelin,1999; Simoni & Ng, 2002). One investigation found college students whoheld an external locus of control toward their health were more likely to
smoke, drink alcohol, skip breakfast, eat fatty foods, and consume less fruit
and fiber than internals (Steptoe & Wardle, 2001). Internals also have more406 CHAPTER 14 The Behavioral/Social Learning Approach