Health Psychology

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Health Psychology
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Mind-Body Relationship

• From earliest times mind and body generally
  thought of as one unit
• Disease understood as resulting from some type of
  divine (supernatural) cause -
• possession, punishment from god(s), etc.

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Mind-Body Relationship

• Greeks and Arabs were among the first to suggest
  natural causes of illness
• Ex Hippocrates Humoral theory
• Galen the first to attribute disease to a
  specific pathogen
• This emphasis on natural causation was lost with
  the fall of the Roman Empire and the subsequent
  rise in power of the Church.

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Mind-Body Relationship

• In the Middle Ages the Church was the guardian of
  medical knowledge the functions of the priest
  and physician merged.
• This began to change during the Renaissance,
  however, especially due to the influence of René
  Descartes

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Cartesian Dualism

• Descartes proposed that mind and body be
  considered as two separate entities
• Body works mechanistically thus, can be
  understood scientifically
• Mind also, the soul to be studied by priests
• This split laid the foundation for study and
  experimentation that led to modern medicine

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Mind-Body Relationship

• For the next 200 years, physicians looked
  exclusively at organic and cellular changes and
  pathology to understand and treat illness, until
  physical evidence became the only basis for
  diagnosis and treatment of disease
• Example Krafft-Ebbing and General Paresis

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Mind-Body Relationship

• This view became less tenable, however, with the
  contributions of Sigmund Freud hysterical
  patients had obvious, profound physical symptoms,
  with no apparent organic cause
• Psychosomatic Medicine in the 1920s
• Led to an emphasis on the autonomic nervous system

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Biomedical Model

• Still the dominant model in medicine
• Maintains that all illness can be explained on
  the basis of problems with bodily processes
  (biochemical imbalances, neurophysiological
  abnormalities, etc.)
• Is reductionistic
• Implicitly incorporates the assumption of
  mind/body dualism
• Emphasizes illness over health

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Biopsychosocial Model

• Assumes biological, psychological and social
  factors are all important determinants of both
  illness and health
• Health and illness both caused by multiple
  factors and produce multiple effects
• Mind and body cannot be distinguished in matters
  of health and illness
• Emphasizes both health and illness health is to
  be achieved, not taken for granted

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Health Psychology

• Health psychology is a subfield that is concerned
  with the social and psychological factors that
  Influence health and illness.

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Why Health Psychology?

• Changing Nature of Illness traditional medicine
  has been very successful treating acute illnesses
  tuberculosis, pneumonia, influenza, etc.
• are short term
• have identifiable causes
• can be treated

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Why Health Psychology?

• However, most of the major health problems today
  are chronic, not acute
• Cancer, heart disease, AIDS, accidents
• cannot be cured, only managed
• causes?
• people must live with these diseases for
  years, leading to a number of issues of coping

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Why Health Psychology?

• Rapidly expanding cost of health care
• Increased medical acceptance
• Methodological and statistical contributions to
  research

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Research Methods in Health Psychology

• Case Studies
• Correlational Studies
• May be univariate or multivariate
• Note example of MacDougall, Dembroski, Drusdale
  and Hackett (1985)
• Controlled Experimental Studies
• To assess causality
• Problem limited generalizability

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Training for Health Psychology Careers

• Health psychologists typically hold a doctoral
  degree (Ph.D. or Psy.D.) in psychology. Applied
  health psychologists are licensed for the
  independent practice of psychology in areas such
  as clinical and counseling psychology, and board
  certification is available in health psychology
  through the American Board of Professional
  Psychology.

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Training for Health Psychology Careers

• Undergraduate Health psychology courses are
  available at about a third of North American
  colleges and universities. Because of the field's
  biopsychosocial orientation, students are also
  encouraged to take courses focusing on abnormal
  and social psychology, learning processes and
  behavior therapies, psychophysiology, anatomy and
  physiology, psychopharmacology, community
  psychology, and public health.

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Training for Health Psychology Careers

• Graduate Many doctoral programs in clinical,
  counseling, social, or experimental psychology
  have specialized tracks or preceptorships in
  health psychology. A number of programs now exist
  in the United States and other countries
  specifically for doctoral training in health
  psychology. These programs are quite diverse
  some specialize in training students either for
  research careers or for direct clinical service
  to patients. Division 38 has a directory of
  doctoral programs offering training in health
  psychology, available from the Office of Division
  Services of the American Psychological
  Association.

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Training for Health Psychology Careers

• Predoctoral Internships Clinical and counseling
  psychologists are required to complete a one-year
  internship/residency before obtaining their
  doctorates. Many of these programs offer some
  training in health psychology. A number of
  internship programs provide specialized training
  in health psychology in which at least half of
  the trainee's time is spent in supervised health
  psychology activities. Division 38 distributes a
  directory of health psychology internships, which
  is linked to its web site, including programs
  offering major rotations (at least half time
  health psychology) and minor rotations (less than
  half time) in health psychology.

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Training for Health Psychology Careers

• Postdoctoral Fellowships Many university medical
  centers, universities, health centers, and health
  psychology programs offer specialized research
  and/or clinical training in different areas of
  health psychology. Division 38 has a directory of
  postdoctoral opportunities in health psychology,
  linked to its web site.

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The Work Setting of a Health Psychologist

• Health psychologists participate in health care
  in a multitude of settings including primary care
  programs, inpatient medical units, and
  specialized health care programs such as pain
  management, rehabilitation, women's health,
  oncology, smoking cessation, headache management,
  and various other programs. They also work in
  colleges and universities, corporations, and for
  governmental agencies.

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Clinical Activities

• Assessment approaches often include cognitive and
  behavioral assessment, psychophysiological
  assessment, clinical interviews, demographic
  surveys, objective and projective personality
  assessment, and various other clinical and
  research-oriented protocols. Interventions often
  include stress management, relaxation therapies,
  biofeedback, psychoeducation about normal and
  patho-physiological processes, ways to cope with
  disease, and cognitive-behavioral and other
  psychotherapeutic interventions. Healthy people
  are taught preventive health behaviors. Both
  individual and group interventions are utilized.
  Frequently, health psychology interventions focus
  upon buffering the effect of stress on health by
  promoting enhanced coping or improved social
  support utilization.

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Research

• Health psychologists are on the leading edge of
  research focusing on the biopsychosocial model in
  areas such as HIV, oncology, psychosomatic
  illness, compliance with medical regimens, health
  promotion, and the effect of psychological,
  social, and cultural factors on numerous specific
  disease processes (e.g., diabetes, cancer,
  hypertension and coronary artery disease, chronic
  pain, and sleep disorders). Research in health
  psychology examines the causes and development
  of illness, methods to help individuals develop
  healthy lifestyles to promote good health and
  prevent illness, the treatment people get for
  their medical problems, the effectiveness with
  which people cope with and reduce stress and
  pain, biopsychosocial connections with immune
  functioning, and factors in the recovery,
  rehabilitation, and psychosocial adjustment of
  patients with serious health problems.

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Career Opportunities

• The opportunities for careers in health
  psychology in the United States are quite good.
  Medical settings, particularly medical centers,
  have greatly expanded their employment of
  psychologists. Aside from medical centers, health
  psychologists often work in colleges and
  universities, medical schools, health maintenance
  organizations, rehabilitation centers, pain
  management centers, public health agencies,
  hospitals, and private consultation/practice
  offices. In addition to the specific content
  skills which psychologists offer to patients and
  staff in the medical community, psychologists'
  unique training often makes the health
  psychologist an asset to the medical team with
  regard to quality assurance methods (making
  certain that health care is helpful and
  cost-effective), research, writing,
  grant-writing, statistical, communication, and
  team development skills.