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Health psychology is concerned with understanding how biological, psychological, environmental, and cultural factors are involved in physical health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behavior change in public health promotion, teach at universities, and conduct research. Although its early beginnings can be traced to the kindred field of clinical psychology, four different divisions within health psychology and one allied field have developed over time. The four divisions include clinical health psychology, public health psychology, community health psychology, and critical health psychology.[1] The allied field is occupational health psychology. 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 Society.
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 many health psychologists provide clinical services as part of their duties, others function in non-clinical roles, primarily involving teaching and research. Leading journals include Health Psychology, the Journal of Health Psychology, the British Journal of Health Psychology, and Applied Psychology: Health and Well-Being.
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 (cardiac psychology), 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.
A separate but related discipline, occupational health psychology (OHP) is a relatively new field that emerged out of the confluence of health psychology, industrial/organizational psychology, and occupational health.[2] The field is concerned with identifying psychosocial characteristics of workplaces that affect the health and well-being of people who work. OHP is also concerned with developing strategies to effect change at workplaces in order to improve the health of people who work. For more detail on OHP, see the entry on occupational health psychology.
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.[3] Health psychologists have worked on developing ways to reduce smoking[4] and improve daily nutrition[5] 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 of thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.[6]
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. Some research suggests that seductive advertising also contributes to psychological dependency on tobacco,[7] although other research has found no relationship between media and smoking in youth.[8] 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.[9] Other OHP research reveals a relation between unemployment and elevations in blood pressure.[10] OHP research also documents a relation between social class and cardiovascular disease.[11]
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 (also see Health Action Process Approach). Health psychologists employ cognitive behavior therapy and applied behavior analysis (also see behavior modification) for that purpose.
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 of controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals.[12] 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.[13] 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.[14]
There is also evidence from occupational health psychology that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues[15] have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.
Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. The stressors 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.[16]
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 of his or her psychological well-being.[17] Health psychologists are also concerned with identifying the best ways for providing therapeutic services for the bereaved.[18]
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.[1]
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).[19] 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.[20]
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 consciously opt not to take their prescribed medications because of side effects. 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.[21]
Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens:
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[23] 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[24]), biofeedback, and cognitive behavior therapy.
For more information on Universities in the United Kingdom with accredited Health Psychology courses, do visit the British Psychological Society website.