Health psychology

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Health psychology is concerned with understanding how biology, behavior, and social context influence health and illness. Health psychologists work alongside other medical professionals in clinical settings, teach in universities, and conduct research. Although its early beginnings can be traced to the kindred field of clinical psychology, five different divisions within health psychology have developed over time: clinical health psychology, public health psychology, occupational health psychology, community health psychology, and critical health psychology.[1] Organizations closely associated with the field of health psychology include Division 38 of the American Psychological Association and the Division of Health Psychology of the British Psychological Association.

Contents

[edit] Overview

Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support).

Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. The term "health psychology" is often used synonymously with the terms "behavioral medicine" and "medical psychology". Health psychologists work with many different health care professionals (e.g., physicians, dentists, nurses, physician's assistants, dietitians, social workers, pharmacists, physical and occupational therapists, and chaplains) to conduct research and provide clinical assessments and treatment services. Many health psychologists focus on prevention research and interventions designed to promote health and reduce the risk of disease. While more than half of health psychologists provide clinical services as part of their duties, many health psychologists function in non-clinical roles, primarily involving teaching and research. Leading journals include the Journal of Health Psychology and the British Journal of Health Psychology.

  • Clinical health psychology (ClHP) is a term for a division of health psychology that reflects the fact that the field was originally a branch of clinical psychology. ClHP is also a major contributor to the field of behavioral medicine within psychiatry. Clinical practice includes education, the techniques of behavior change, and psychotherapy. In some countries, a clinical health psychologist, with additional training, can become a medical psychologist and, thereby, obtain prescription privileges.
  • Occupational health psychology (OHP) is a relatively new discipline within health psychology. OHP is concerned with identifying psychosocial characteristics of workplaces that give rise to health-related problems in people who work. These problems can involve physical health (e.g., cardiovascular disease[2]) or mental health (e.g., depression[3]). Examples of psychosocial characteristics of workplaces that OHP has investigated include amount of decision latitude a worker can exercise and the supportiveness of supervisors. OHP is also concerned with the development and implementation of interventions that can prevent or ameliorate work-related health problems.[4] In addition, OHP research has important implications for the economic success of organizations.[5] Other research areas of concern to OHP include workplace incivility[6] and violence,[7] work-home spillover,[8] unemployment[9] and downsizing,[10] and workplace safety[11] and accident prevention.[12] Two important OHP journals are the Journal of Occupational Health Psychology and Work & Stress. Organizations closely associated with OHP include the Society for Occupational Health Psychology and the European Academy of Occupational Health Psychology.
  • Public health psychology (PHP) is population oriented. A major aim of PHP is to investigate potential causal links between psychosocial factors and health at the population level. PH psychologists present research results to educators, policy makers, and health care providers in order to promote better public health. PHP is allied to other public health disciplines including epidemiology, nutrition, genetics and biostatistics. Some PHP interventions are targeted toward at-risk population groups (e.g., undereducated, single pregnant women who smoke) and not the population as a whole (e.g., all pregnant women).
  • Community health psychology (CoHP) investigates community factors that contribute to the health and well-being of individuals who live in communities. CoHP also develops community-level interventions that are designed to combat disease and promote physical and mental health. The community often serves as the level of analysis, and is frequently sought as a partner in health-related interventions.
  • Critical health psychology (CrHP) is concerned with the distribution of power and the impact of power differentials on health experience and behavior, health care systems, and health policy. CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The CrH psychologist is an agent of change, not simply an analyst or cataloger. A leading organization in this area is the International Society of Critical Health Psychology.

Health psychology is both a theoretical and applied field. Health psychologists employ diverse research methods. These methods include controlled randomized experiments, quasi-experiments, longitudinal studies, time-series designs, cross-sectional studies, and case-control studies as well as action research. Health psychologists study a broad range of variables including genotype, cardiovascular disease, smoking habits, religious beliefs, alcohol use, social support, living conditions, emotional state, social class, and much more. Some health psychologists treat individuals with sleep problems, headaches, alcohol problems, etc. Other health psychologists work to empower community members by helping community members gain control over their health and improve quality of life of entire communities.

[edit] Objectives of health psychology

[edit] Understanding behavioral and contextual factors

Health psychologists conduct research to identify behaviors and experiences that promote health, give rise to illness, and influence the effectiveness of health care. They also recommend ways to improve health care and health-care policy.[13] Health psychologists have worked on developing ways to reduce smoking[14] and improve daily nutrition[15] in order to promote health and prevent illness. They have also studied the association between illness and individual characteristics. For example, health psychology has found a relation between the personality characteristics thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.[16]

Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. The biopsychosocial model can help in understanding the relation between contextual factors and biology in affecting health. Physical addiction plays an important role in smoking cessation. However, seductive advertising also contributes to psychological dependency on tobacco.[17] Research in occupational health psychology indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease.[18] Other OHP research reveals a relation between unemployment and elevations in blood pressure.[19] OHP research documents a relation between social class and cardiovascular disease.[20]

Health psychologists also aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens. Health psychologists employ cognitive behavior therapy and applied behavior analysis (also see behavior modification) for that purpose.

[edit] Preventing illness

Health psychologists work towards promoting health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Campaigns informed by health psychology have targeted tobacco use. Those least able to afford tobacco products consume them most. Tobacco provides individuals with a way controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals.[21] Practitioners emphasize education and effective communication as a part of illness prevention because many people do not recognize, or minimize, the risk of illness present in their lives. Moreover, many individuals are often unable to apply their knowledge of health practices owing to everyday pressures and stresses. A common example of population-based attempts to motivate the smoking public to reduce its dependence on cigarettes is anti-smoking campaigns.[22] Health psychologists also aim at educating health professionals, including physicians and nurses, in communicating effectively with patients in ways that overcome barriers to understanding, remembering, and implementing effective strategies for reducing exposures to risk factors and making health-enhancing behavior changes.[23]

[edit] The effects of disease

Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. The stresssors include problems meeting medical and other bills; problems obtaining proper care when home from the hospital; obstacles to caring for dependents; having one's sense of self-reliance compromised; gaining a new, unwanted identity as a sick person; and so on. These stressors can lead to depression, reduced self-esteem, etc.[24]

Health psychology also concerns itself with bettering the lives of individuals with terminal illness. When there is little hope of recovery, health psychologist therapists can improve the quality of life of the patient by helping the patient recover at least some his or her psychological well-being.[25] Health psychologists are also concerned with identifying the best ways for providing therapeutic services for the bereaved.[26]

[edit] Critical analysis of health policy

Critical health psychologists explore how health policy can influence inequities, inequalities, and social injustice. These avenues of research expand the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists using newer qualitative methods and frameworks for investigating health experience and behavior.[27]

[edit] Applications of Health Psychology

[edit] Improving doctor-patient communication

Health psychologists attempt to aid the process of communication between physicians and patients during medical consultations. There are many problems in this process, with patients showing a considerable lack of understanding of many medical terms, particularly anatomical terms (e.g., intestines).[28] One main area of research on this topic involves 'doctor-centered' or 'patient-centered' consultations. Doctor-centered consultations are generally directive, with the patient answering questions and playing less of a role in decision-making. Although this style is preferred by elderly people and others, many people dislike the sense of hierarchy or ignorance that it inspires. They prefer patient-centered consultations, which focus on the patient's needs, involve the doctor listening to the patient completely before making a decision, and involving the patient in the process of choosing treatment and finding a diagnosis.[29]

[edit] Improving adherence to medical advice

Getting people to follow medical advice and adhere to their treatment regimens is a difficult task for health psychologists. People often forget to take their pills or are inhibited by the side effects of their medicines. Failing to take prescribed medication is costly and wastes millions of usable medicines that could otherwise help other people. Estimated adherence rates are difficult to measure (see below); there is, however, evidence that adherence could be improved by tailoring treatment programs to individuals' daily lives.[30]

[edit] Ways of measuring adherence

Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens.

  • Counting the number of pills in the medicine bottle - although this has problems with privacy and/or could be deemed patronizing or showing lack of trust in patients
  • Using self-reports - although patients may fail to return the self-report or lie about their adherence
  • Asking a doctor or health worker - although this presents problems on doctor-patient confidentiality
  • Using 'Trackcap' bottles, which track the number of times the bottle is opened; however, this either raises problems of informed consent or, if informed consent is obtained, influence through demand characteristics.[31]

[edit] Managing pain

Health psychology attempts to find treatments to reduce and eliminate pain, as well as understand pain anomalies such as episodic analgesia, causalgia, neuralgia, and phantom limb pain. Although the task of measuring and describing pain has been problematic, the development of the McGill Pain Questionnaire[32] has helped make progress in this area. Treatments for pain involve patient-administered analgesia, acupuncture (found by Berman to be effective in reducing pain for osteoarthritis of the knee[33]), biofeedback, and cognitive behavior therapy.

[edit] References

  1. ^ Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, & C., Sykes, C. (2005). Health psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage.
  2. ^ Bosma, H., Marmot, M. G., Hemingway, H., Nicholson, A. C., Brunner, E., & Stansfeld, S. A. (1997). Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. British Medical Journal, 314, 558C565.
  3. ^ Tucker, J. S., Sinclair, R. R., & Thomas, J. L. (2005). The multilevel effects of occupational stressors on soldiers' well-being: Organizational attachment, and readiness. Journal of Occupational Health Psychology, 10, 276-299.
  4. ^ Schmitt, L. (2007). OHP interventions: Wellness programs. Newsletter of the Society for Occupational Health Psychology, 1, 4-5. [[1]]
  5. ^ Adkins, J. A. (1999). Promoting organizational health: The evolving practice of occupational health psychology. Professional Psychology: Research and Practice, 30, 129 137.
  6. ^ Cortina, L. M., Magley, V. J., Williams, J. H., & Langhout, R. D. (2001). Incivility in the workplace: Incidence and impact. Journal of Occupational Health Psychology, 6, 64-80.
  7. ^ Kelloway, E. K., Barling, J., & Hurrell, J. J. (Eds). Handbook of workplace violence. Thousand Oaks, CA: Sage Publications.
  8. ^ Haines, V. Y. III, Marchand, A., & Harvey, S. (2006). Crossover of workplace aggression experiences in dual-earner couples. Journal of Occupational Health Psychology, 11, 305-314.
  9. ^ Feldt, T., Leskinen, E., & Kinnunen, U. (2005). Structural invariance and stability of sense of coherence: A longitudinal analysis of two groups with different employment experiences. Work & Stress, 19, 68-83.
  10. ^ Moore, S., Grunberg, L., & Greenberg, E.. (2004). Repeated downsizing contact: The effects of similar and dissimilar layoff experiences on work and well-being outcomes. Journal of Occupational Health Psychology, 9, 247-257.
  11. ^ Kidd, P., Scharf, T., & Veazie, M. (1996) Linking stress and injury in the farming environment: A secondary analysis. Health Education Quarterly, 23, 224-237.
  12. ^ Williamson, A. M., & Feyer, A.-M.(1995). Causes of accidents and the time of day. Work & Stress, 9, 158-164.
  13. ^ Sharman, S. J., Garry, M., Jacobsen, J. A., Loftus, E. F., & Ditto, P. H. (2008). False memories for end-of-life decisions. Health Psychology, 27, 291-296.
  14. ^ Dusseldorp, E., van Elderen, T., & Maes, S. (1999). A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychology, 18, 506-519.
  15. ^ Resnicow, K., Jackson, A., Blissett, D., Wang, T., McCarty, F., Rahotep, S., & Periasamy, S. (2005). Results of the Healthy Body Healthy Spirit Trial. Health Psychology, 24, 339-348.
  16. ^ Beirness, D. J. (1993). Do we really drive as we live? The role of personality factors in road crashes. Alcohol, Drugs & Driving, 9, 129-143.
  17. ^ Pierce, J. P.. & Gilpin, E. A. (1995). A historical analysis of tobacco marketing and the uptake of smoking by youth in the United States: 1890-1977. Health Psychology, 14, 500-508.
  18. ^ Johnson, J. V., Stewart, W., Hall, E. M., Fredlund, P. & Theorell, T. (1996). Long-term psychosocial work environment and cardiovascular mortality among Swedish men. American Journal of Public Health, 86, 324-331
  19. ^ Kasl, S. V., & Cobb, S. (1970). Blood pressure changes in men undergoing job loss: A preliminary report. Psychosomatic Medicine, 32, 19-38.
  20. ^ Marmot, M. G., & Theorell, T. (1988). Social class and cardiovascular disease: The contribution of work. International Journal of Health Services, 18, 659-674.
  21. ^ Whalen, C. K, Jamner, L. D., Henker, B., & Delfino, R. J. (2001). Smoking and moods in adolescents with depressive and aggressive dispositions: Evidence from surveys and electronic diaries. Health Psychology, 20, 99-111.
  22. ^ Hershey, J. C., Niederdeppe, J., & Evans, W. D. (2005). The theory of 'truth': How counterindustry campaigns affect smoking behavior among teens. Health Psychology, 24, 22-31.
  23. ^ Ogden, J., Bavalia, K., Bull, M., Frankum, S., Goldie, C., Gosslau, M., et al. (2004) 'I want more time with my doctor': A quantitative study of time and the consultation. Family Practice, 21, 479-483.
  24. ^ Cassileth, B. R., Lusk, E. J., Strouse, T. B., Miller, D. S., Brown, L. L., Cross, P. A., & Tenaglia, A. N. (1984). Psychosocial status in chronic illness. New England Journal of Medicine, 311, 506-511.
  25. ^ Lander, D. A., & Graham-Pole, J. R. (2008). Love medicine for the dying and their caregivers: The body of evidence. Journal of Health Psychology, 13, 201-212.
  26. ^ O'Brien, J. M., Forrest, L. M., & Austin, A. E. (2002). Death of a partner: Perspectives of heterosexual and gay men. Journal of Health Psychology, 7, 317-328.
  27. ^ Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, & C., Sykes, C. (2005). Health psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage.
  28. ^ Boyle, C. M. (1970). Difference between patients' and doctors' interpretation of some common medical terms. British Medical Journal, 2, 286-289.
  29. ^ Dowsett, S. M., Saul, J. L., Butow, P. N., Dunn, S. M., Boyer, M. J., Findlow, R., & Dunsmore, J. (2000). Communication styles in the cancer consultation: Preferences for a patient-centred approach. Psycho-Oncology, 9, 147-156.
  30. ^ Clark, M., Hampson, S. E., Avery, L., & Simpson, R. (2004). Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes. British Journal Of Health Psychology, 9 (Pt 3), 365-79.
  31. ^ Banyard, P. (2002). Psychology in practice: Health. London, England: Hodder & Stoughton Educational.
  32. ^ Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277-299.
  33. ^ Berman, B., Singh B.B., Lao, L., Langenberg, P. , Li, H., Hadhazy, V., Bareta, J., & Hochberg, M. (1999). A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology, 38, 346-354.

[edit] Bibliography

  • Michie, S. and Abraham, C. (Eds.). (2004). Health psychology in practice. London. BPS Blackwells.
  • Cohen, L.M., McChargue, D.E., Collins, Jr. F.L. (Eds.). (2003). The health psychology handbook: Practical issues for the behavioral medicine specialist. Thousand Oaks, CA: Sage Publications,.
  • Ogden, J. (2007). Health psychology: A textbook (4th ed.). Berkshire, England: Open University Press.
  • Quick, J. C., & Tetrick, L. E. (Eds.). (2003). Handbook of occupational health psychology. Washington, DC: American Psychological Association.
  • Taylor, S. E. (1990). Health psychology. American Psychologist, 45, 40-50.

[edit] See also

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