Health psychology

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Health psychology is the study of psychological and behavioral processes in health, illness and healthcare.[1] It is concerned with understanding how psychological, behavioral and cultural factors are involved in physical health and illness, in addition to the biological causes that are well understood by medical science. Psychological factors can affect health directly (such as stress causing the release of hormones such as cortisol which damage the body over time) and indirectly via a person's own behavior choices which can harm or protect health (such as smoking or taking exercise).[2] Health psychologists take a biopsychosocial approach - this means that they understand health to be the product not only of biological processes (e.g. a virus, tumour, etc.) but also of psychological processes (e.g. stress, thoughts and beliefs, behaviours such as smoking and exercise) and social processes (e.g. socioeconomic status, culture and ethnicity).[2]

By understanding and harnessing psychological factors, health psychologists can improve health by working directly with individual patients, indirectly in large-scale public health programs, and by training healthcare professionals (e.g. physicians and nurses) to take advantage of this knowledge when working with their patients. Health psychologists work in a variety of settings: alongside other medical professionals in hospitals and clinics, in public health departments working on large-scale behavior change and health promotion programs, and in universities and medical schools where they teach 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.[3] The allied field is occupational health psychology. Professional organizations for the field of health psychology include Division 38 of the American Psychological Association, the Division of Health Psychology of the British Psychological Society, and the European Health Psychology Society. Advanced credentialing in the U.S. as a Clinical Health Psychologist is provided through the American Board of Professional Psychology.

Overview[edit]

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.Health Psychologists use their knowledge of psychology and health to promote general well-being and understand physical illness.[4] They are specially trained to help people deal with the psychological and emotional aspects of health and illness. 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 healthier lifestyles and try to find ways to encourage people to improve their health. For example, they may help people to lose weight or stop smoking.[4] Health Psychologists also use their skills to try to improve the healthcare system. For example, they may advise doctors about better ways to communicate with their patients [4] Health Psychologists work in many different settings including the NHS, private practice, universities, communities, schools and organisations. 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 Psychologists can work with people on a one-to-one basis, in groups, as a family, or at a larger population level.[4]

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.

Origins and Development[edit]

Psychological factors in health had been studied since the early 20th century by disciplines such as psychosomatic medicine and later behavioral medicine, but these were primarily branches of medicine, not psychology. Health psychology began to emerge as a distinct discipline of psychology in the United States in the 1970s. In the mid-20th century there was a growing understanding in medicine of the effect of behavior on health. For example, the Alameda County Study which began in the 1960s showed that people who ate regular meals (e.g. breakfast), maintained a healthy weight, received adequate sleep, did not smoke, drank little alcohol and exercise regularly were in better health and lived longer.[5] At the same time, there was a growing realization of the importance of good communication skills in medical consultations. In addition, psychologists and other scientists were discovering relationships between psychological processes and physiological ones. These included the impact of stress on the cardiovascular and immune systems of the body, and the early finding that the functioning of the immune system could be altered by learning.[6]

Psychologists had been working in medical settings for some years previously in several countries such as the UK (sometimes termed medical psychology). However it was a small field, primarily working with adjustment to illness, with psychological factors usually as (often emotional) reactions to illness. In 1969, William Schofield prepared a report for the American Psychological Association entitled The Role of Psychology in the Delivery of Health Services.[7] While there were exceptions, he found that the psychological research of the time frequently saw mental health and physical health as entirely separate, and devoted very little attention to psychology's impact upon physical health. Of the psychologists working at the time, few were involved with this area, and he proposed that new forms of education and training for future psychologists would be needed. The APA reacted in 1973 by setting up a task force to consider how psychologists could help people to manage their health behaviours, as well as to better manage physical health problems and train healthcare staff to work most effectively with patients.[8]

This set in train a series of events that led in 1977 to the formation of a division of the APA dedicated to health psychology, led by Joseph Matarazzo. At its first conference, Matarazzo gave a speech often seen as a foundation of health psychology, in which he defined the new field as "Health psychology is the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of diagnostic and etiologic correlates of health, illness and related dysfunction, and the analysis and improvement of the healthcare system and health policy formation".[9] In the 1980s, similar organisations were set up in the UK as the British Psychological Society's Division of Health Psychology in 1986, and the European Health Psychology Society that same year. Similar organizations developed in other countries such as Australia and Japan.[10] Training programs were set up in these countries, usually training health psychologists at graduate level, and in the United States, at postdoctoral level after completing a doctoral degree in clinical psychology such as the PsyD or PhD. In addition, PhDs began to be awarded in health psychology. Today, health psychology is one of the most popular courses in undergraduate psychology degrees, as a choice for Masters degrees such as MSc, and as a career choice in psychology.

In hindsight, the emergence of Health Psychology could have been triggered by many different factors, such as the following:

In the United Kingdom, the British Psychological Society’s reconsideration of the role of the Medical Section, prompted the emergence of Health Psychology as a distinct field. It was argued by Marie Johnston and John Weinman in a letter to the 'BPS Bulletin' that there was a great need for a Health Psychology Section, and in December 1986 the section was established at the BPS London Conference, with Marie Johnston as chair.[11] At the Annual BPS Conference in 1993 a review of ‘Current Trends in Health Psychology’ was invited, and a definition of Health Psychology as ‘the study of psychological and behavioural processes in health, illness and healthcare’ was proposed.[13] The Health Psychology Section became a Special Group in 1993 and was awarded Divisional Status within the UK in 1997. This meant that the individual training needs and professional practice of Health Psychologists were recognised, and members were able to obtain chartered status with the BPS. The BPS went on to regulate training and practice in Health Psychology until the regulation of professional standards and qualifications was taken over by statutory registration with the Health Professions Council in 2010.[11]

Relationship to occupational health psychology[edit]

Occupational health psychology (OHP), a separate but related discipline, is a relatively new field that emerged out of the confluence of health psychology, industrial/organizational psychology, and occupational health.[14] 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.

Objectives of health psychology[edit]

Understanding behavioral and contextual factors[edit]

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.[15] Health psychologists have worked on developing ways to reduce smoking[16] and improve daily nutrition[17] 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.[18]

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,[19] although other research has found no relationship between media and smoking in youth.[20] 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.[21] Other OHP research reveals a relation between unemployment and elevations in blood pressure.[22] OHP research also documents a relation between social class and cardiovascular disease.[23]

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.

Preventing illness[edit]

Health psychologists work towards promoting health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Health Psychologists try to help people to lead a healthy life by developing and running programmes which can help people to make changes in their lives such as stopping smoking,reducing the amount of alcohol they drink, eating more healthily,and taking regular exercise.[4] 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.[24] 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.[25]

Health psychologists help to promote health and well-being by preventing illness.[4] Some illnesses can be treated better if they are caught early.Health Psychologists have worked to understand why some people do not go for screening or immunisations and are finding ways to encourage people to have health checks for illnesses such as cancer or heart disease.[4] Health Psychologists are also finding ways to try to help people to avoid risky behaviours that may affect their health and well-being, such as unprotected sex and can also help to encourage regular teeth brushing or hand washing to prevent future ill health.[4]

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.[26]

There is also evidence from occupational health psychology that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues[27] have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.

The effects of disease[edit]

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.[28]

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.[29] Health psychologists are also concerned with identifying the best ways for providing therapeutic services for the bereaved.[30]

Critical analysis of health policy[edit]

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.[3]

Conducting research[edit]

Health Psychologists have advanced skills in a variety of research methods, which enables them to conduct research, provide expert advice or collaborate on a study, for example studying the links between stress and health.[31] Health Psychologists carry out research to answer questions such as:

Teaching and communication[edit]

Health psychologists can also be responsible for training other health professionals, for example on how to deliver an intervention to help promote healthy eating or stopping smoking, or deliver training in communication skills such as how to break bad news, or support behaviour change. This can also enhance practitioner–patient relationships and adherence to treatment.[31]

Applications of health psychology[edit]

Improving doctor–patient communication[edit]

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).[32] 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.[33]

Improving adherence to medical advice[edit]

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.[34]

Ways of measuring adherence[edit]

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

Managing pain[edit]

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[36] 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[37]), biofeedback, and cognitive behavior therapy.

Health Psychologist roles[edit]

Below are some examples of the types of positions held by Health Psychologists within applied settings such as the NHS and privatepractice.

Training in Health Psychology[edit]

In the United Kingdom, Health Psychologists are registered by the Health Professions Council (HPC) and have trained to a level to be eligible for full membership of the Division of Health Psychology within the British Psychological Society (BPS).[38] Registered Health Psychologists who are chartered with the British Psychological Society (BPS) will have undertaken a minimum of six years of training and will have specialised in health psychology for a minimum of three years.[31] Health Psychologists in training must have completed BPS stage 1 training and be registered with the BPS Stage 2 training route or with a BPS-accredited university doctoral Health Psychology programme. Once qualified, Health Psychologists can work in a range of settings, for example the NHS, universities, schools, private healthcare, research and charitable organisations.[31] A Health Psychologist in training might be working within applied settings whilst working towards registration and chartered status.[31] A Health Psychologist will have demonstrated competencies in all of the following areas:

All qualified Health Psychologists must also engage in and record their continuing professional development (CPD) for psychology each year throughout their career.[38]

More Information[edit]

Find out more by visiting the Division of Health Psychology website

Postgraduate programs in health psychology[edit]

Universities in the United Kingdom

The following course are accredited by the British Psychological Society as Stage one training in Health Psychology:

For more information about accredited Health Psychology MSc courses in the United Kingdom, visit the British Psychological Society website.

The Following courses are also available:

Doctoral programs in health psychology[edit]

Universities in Australia
Universities in the United Kingdom

For more information on universities in the United Kingdom with accredited Health Psychology doctoral courses, visit the British Psychological Society website.

Universities in the United States

Doctoral Programs – Members of the Council of Clinical Health Psychology Training Programs (CCHPTP)

Concentrations and/or Master's Degrees

For more information on universities in the United States with accredited Health Psychology doctoral programs, visit the website of Division 38 of APA.

Universities in Canada
Universities in Asia

See also[edit]

References[edit]

  1. ^ Johnston, M. (1994). Current trends in Health Psychology. The Psychologist, 7, 114-118.
  2. ^ a b Ogden, J. (2012). Health Psychology: A Textbook (5th ed.). Maidenhead, UK: Open University Press.
  3. ^ a b David F. Marks, Michael Murray, Brian Evans & Emee Vida Estacio (2011) Health Psychology. Theory-Research-Practice (3rd Ed.) Sage Publications. ISBN 1-84860-622-2 (hbk) 978-1848606227 (pbk).
  4. ^ a b c d e f g h i The British Psychological Society (2011)What is Health Psychology? A guide for the public.07 March 2011.
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  20. ^ Ferguson C.J. & Meehan, D.C. (2011). With friends like these...: Peer delinquency influences across age cohorts on smoking, alcohol and illegal substance use. European Psychiatry, 26(1), 6–12.
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  22. ^ Kasl, S.V. & Cobb, S. (1970). Blood pressure changes in men undergoing job loss: A preliminary report. Psychosomatic Medicine, 32, 19–38.
  23. ^ Marmot, M.G. & Theorell, T. (1988). Social class and cardiovascular disease: The contribution of work. International Journal of Health Services, 18, 659–74.
  24. ^ 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.
  25. ^ 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.
  26. ^ 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, 479–83.
  27. ^ Kompier, M.A.J.; Aust, B.; van den Berg, A.-M. & Siegrist, J. (2000). Stress prevention in bus drivers: Evaluation of 13 natural experiments. Journal of Occupational Health Psychology, 5, 32–47.
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  29. ^ 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, 201–12.
  30. ^ 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, 317–28.
  31. ^ a b c d e f g h i j k The British Psychological Society (2011) Health Psychology: A guide for employees.07 March 2011.
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  33. ^ 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, 147–56.
  34. ^ 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.
  35. ^ Banyard, P. (2002). Psychology in practice: Health. London, England: Hodder & Stoughton Educational.
  36. ^ Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–99.
  37. ^ 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, 346–54.
  38. ^ a b The British Psychological Society (2011) Health Psychology in applied settings: A guide for employers.07 March 2011.

Bibliography[edit]

External links[edit]