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Health Psychology Past, Present, and Potential

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Focus on prevention and health promotion as well as illness and rehabilitation ... The Surgeon General's Report on Health Promotion and Disease Prevention. ... – PowerPoint PPT presentation

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Title: Health Psychology Past, Present, and Potential


1
Health Psychology Past, Present, and Potential
  • Cynthia D. Belar, Ph.D., ABPP

2
  • Historical Perspectives
  • Growth of Education and Training
  • Growth of Research
  • Growth of Professional Practice/Applications
  • Potential (and preparation)

3
Health Psychology
  • 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
    etiologic and diagnostic correlates of health,
    illness and related dysfunctions and the
    improvement of the health care system and health
    policy formation.

(Matarazzo, 1980, 1982, 2001)
4
Key Features of Health Psychology
  • Breadth
  • Biopsychosocial model
  • Focus on prevention and health promotion as well
    as illness and rehabilitation
  • Focus on cost-effectiveness
  • Interdisciplinary collaboration

5
  • Clinical Health Psychology
  • professional practice of health psychology
  • Behavioral Medicine
  • interdisciplinary field to which health
    psychologists contribute

6
Historical Perspectives
  • Ancient Greece
  • Middle Ages
  • Renaissance

7
18th Century
  • the reason why a sound body becomes ill, or an
    ailing body recovers, very often lies in the
    mind (Gaub, cited in Lipowski, 1977)

8
19th Century
  • psychosomatic (Heinroth)
  • Benjamin Rush
  • Sigmund Freud
  • Walter B. Cannon
  • Ivan Pavlov

9
20th CenturyFormalization as a Field of Inquiry
  • Two major frameworks
  • psychodynamic and psychophysiologic
  • 1938 Psychosomatic Medicine
  • 1942 American Psychosomatic Society
  • Helen Flanders Dunbar
  • Franz Alexander
  • Harold G. Wolff
  • Edmund Jacobson
  • Hans Selye

10
20th Century
  • Comprehensive Medicine (Guze, Matarazzo,
    Saslow, 1953)
  • Biopsychosocial Model (Engel, 1977)
  • Neal Miller (1969)
  • Wilbert Fordyce (1976)
  • Robert Ader (1974)

11
Landmark Eventsin Organized Psychology
  • 1969 - The Role of Psychology in the
    Delivery of
    Health Services (Schofield)
  • 1975 - Section on Health Research in APA
    Division of Public Service
  • 1977 - Yale Conference on Behavioral Medicine

12
1978
13
Growth of Education and Training
  • Early 1980s opportunities for ET in HP
  • 42 doctoral (Belar, Wilson Hughes, 1982)
  • 48 internships (Gentry, Street, Masur Asken,
    1981)
  • 43 postdoctoral (Belar Siegel, 1983)
  • 1983 - Arden House Conference defines education
    and training in Health Psychology

14
Core Knowledge Domains
  • Biological bases of health, disease and behavior
    (basic anatomy and physiology, pathophysiology,
    pharmacology, psychoneuroimmunology,
    psychophysiology, neuroendocrinology)
  • Cognitive-affective bases of health, disease and
    behavior (how learning, memory, perception,
    cognition, thinking, motivation and emotions
    influence health behaviors, are affected by
    physical illness/injury/disability, and can
    affect response to illness/injury/disability)

15
Core Knowledge Domains
  • Social bases of health, disease and behavior
    (impact of relationships including
    physician-patient relationships, social support,
    culture, religion, workplace, health policy and
    organization of health care delivery systems on
    health and help-seeking)
  • Psychological bases of health,disease and
    behavior (behavioral risk factors for
    disease/injury/disability and nonadherence to
    medical regimens relationships among
    stress,coping and health outcomes developmental
    issues in health and illness impact of
    psychopathology on illness and treatment issues
    of diversity and health,e.g., gender, sexual
    orientation)

16
Core Domains of Knowledge Skill
  • Health research methods
  • Health assessment, consultation, and
    interventions
  • individual, families, groups, organizations,
    communities
  • primary, secondary and tertiary prevention
  • Program development and evaluation
  • Management and supervision
  • Ethical, legal and professional issues
  • Interdisciplinary collaboration

17
  • 1990 health psychology was the most frequently
    noted area of faculty research in APA accredited
    clinical psychology doctoral programs
  • 2004 3 APA accredited postdoctoral programs in
    clinical health psychology

18
Growth in Research
  • 1979 - U.S. Department of Health, Education and
    Welfare. Healthy People The Surgeon Generals
    Report on Health Promotion and Disease
    Prevention.
  • 1982 - Institute of Medicine. Health and
    Behavior Frontiers of Research in the
    Biobehavioral Sciences (50 of mortality from
    the 10 leading causes of death in the U. S. can
    be traced to behavior/lifestyle factors)

19
Establishment of Journals
  • 1978 Journal of Behavioral Medicine
  • 1982 Health Psychology
  • 1986 Journal of Psychology and Health

20
Behavior in Medical Journals (Suls and Rothman,
2004)
  • NEJM, Lancet, JAMA, Annals of Internal Medicine
  • behavior doubled from 1974-2001
  • (total of articles increased by 3)
  • BUT increase is from .002 of total articles to
    .004 (starting in 1986-89)

21
2001
22
Growth of Professional Practice
  • 1984 - American Board of Health Psychology
    incorporated (ABHP)
  • 1991 - Board certification recognized by American
    Board of Professional Psychology (ABPP)
  • 1997 - APA Council of Representatives recognizes
    Clinical Health Psychology as a specialty
  • 1998 - ABHP renamed as American Board of Clinical
    Health Psychology

23
Service Areas for Health Psychology
  • 1. Prevention of illness/injury
  • 2. Coping with illness
  • 3. Preparation for stressful medical
  • procedures
  • 4. Adherence to medical regimens
  • 5. Management of physical symptoms
  • 6. Management of psychophysiological
  • disorders
  • 7. Problems of health care providers and
  • health care systems.
  • 8. Mental health disorders

24
There are a variety of service areas for the
application of knowledge in health psychology.
Interventions can occur at a variety of levels.
  • Individual/Family
  • Health Care Provider
  • Health Care System
  • Population
  • Health Policy

25
1Prevention of illness/injury
26
Traumatic Injuries
  • Reckless driving
  • Poor body mechanics
  • Falls
  • Seatbelts/helmets
  • Toxic storage
  • Interpersonal violence

27
Behavioral Risk Factors
  • Tobacco use
  • Diet
  • Exercise
  • Unsafe sex
  • Alcohol and substance use

28
2Coping with illness
29
Social Support
  • Post MI survival (Berkman, 1995)
  • Hemodialysis survival (Christensen et al., 1994)

30
Myocardial Infarction
  • depression increases risk of mortality
    independent of cardiac disease severity
  • impact of depression is as great as previous MI
    and impaired left ventricular ejection fraction
  • anxiety and anger directed inward also increase
    risk

Frasure-Smith et al., 1995
31
Recovery from Illness Acute Myocardial Infarction
  • patients with high anxiety in the 48 hours after
    AMI had 4.9 times risk for developing
    complications
  • risk independent of clinical indicators

Moser Dracup, 1996
32
Interventions are more than health education.
  • Social support
  • Emotional support
  • Systematic behavior change
  • Increased self-efficacy

33
3Preparation for stressful medical procedures
34
Recovery from SurgeryMeta-analysis
  • N 191 studies, major and minor surgery
  • Interventions
  • information
  • skill-building
  • support
  • Outcome
  • 79-84 of studies reported beneficial effects
  • length of stay decreased by an average of 1.5 days

Devine, 1992
35
4Adherence to Medical Regimens
  • 1 out of 6 hospitalizations of seniors (GAO,
    1995)
  • 10 of all hospital admissions (DHHS, 1990)
  • 2/3 not taking therapeutic dose of BP medication
    (JAMA, 1989)
  • 50 of 1.6 billion prescriptions taken
    incorrectly

36
5Management of Physical Symptoms
  • Asthmatic episodes
  • Pain
  • Fecal incontinence
  • Anticipatory nausea
  • Vasospasms
  • Dyspnea
  • Headache
  • Muscle spasms
  • Insomnia
  • Cramping/diarrhea

37
COPD Rehabilitation Program
7
6
5
4
Pre
Post
3
2
1
0
Inpatient Days
Outpatient Visits
ER Visits
Talcott et al., 1996
38
Arthritis Self-Management
N 401
Physical Disability
9 Increase
Visits to Physicians
43 Decrease
Pain
20 Decrease
Sense of Self-efficacy
Significant Increase
Lorig et al., 1993
39
Fecal Incontinence
  • 1.2 over age 60
  • 2nd most common reason for institutionalizing the
    elderly
  • BF is treatment of choice when caused by nerve
    injuries resulting in weakness of external anal
    sphincter or impaired ability to detect rectal
    distention (est. 60-70 of adult patients)
  • 72 of patients obtain at least 90 reduction

Whitehead et al., 1996
40
6Psychophysiological Disorders
  • Irritable Bowel Syndrome
  • Migraine Headache
  • Tension Headache

41
7Problems of health care providers and health
care systems.
42
Medical Decision-Making
  • Surgery (pain, ICD)
  • Organ transplantation
  • Complex management (home dialysis, home
    ventilator)
  • Fertility treatments

43
Needs of Other Health Professionals
  • Education and Training
  • Physician-Patient Communication
  • Implementation of Practice Guidelines
  • Burnout Prevention

44
Needs of Health Care Organizations
  • Self-Help Programs
  • Program Development
  • disease management
  • staff development
  • community outreach
  • Infection control

45
Diabetes
  • n 11 studies, self-management training
  • FBS level improvement
  • Reduction in diabetes-related hospitalizations
  • Reduction in serious foot lesions
  • Reduction in diabetes-related health care costs
  • Need
  • extensive use of behavior change strategies
  • integrated team

Clement, 1995
46
8Mental health disorders
47
U.S. Surgeon General Reports 1999, 2000, 2001
  • 1 in 5 American adults experience a mental
    disorder in a given year
  • 1 in 10 children and adolescents
  • 1 in 5 older persons

48
Most Americans seek mental health care from their
family physician.
  • 50 of all individuals with a mental disorder go
    to primary care providers
  • 80 of psychotropic medication is prescribed by
    primary care providers
  • Patients have long-standing relationships with
    primary care providers

49
Problem
  • 50-66 of mental health problems are not
    detected by primary care providers
  • lack of knowledge
  • lack of training and experience
  • poor interviewing skills
  • lack of time

50
Need for Integration of Psychological Services in
Primary Care
  • Acknowledges the defeat of mind-body dualism
  • Facilitates dealing with high comorbidity of
    medical and psychological problems
  • pain-depression
  • COPD-anxiety
  • Reduction in overall health care costs

51
Barriers
  • Lack of Knowledge
  • Incomplete Data
  • Professional Islands
  • Attitudes
  • Mind-body Dualism
  • Lack of Vision/Leaders
  • Financial Mechanisms

52
Why has there been such growth in Health
Psychology?
53
  • Deficiencies in biomedical model
  • Increased maturity of behavioral science research
    and practice
  • Increased disease burden from chronic disease
  • HIV/AIDS epidemic
  • Focus on prevention
  • Increased concern with quality of life
  • Increased cost of health care

54
Why is there such potential for Health
Psychology?
55
  • Deficiencies in biomedical model
  • Increased maturity of behavioral science research
    and practice
  • Increased disease burden from chronic disease
  • HIV/AIDS epidemic
  • Focus on prevention
  • Increased concern with quality of life
  • Increased cost of health care

56
Healthy People 2010 10 Leading Health Indicators
  • responsible sexual behavior
  • tobacco use
  • injury and violence
  • physical activity
  • obesity
  • substance abuse
  • mental health
  • environmental quality
  • immunization
  • access to health care

57
Drivers of Health Policy
  • To Err is Human (IOM, 1999)
  • Crossing the Quality Chasm (IOM, 2001)
  • Health Professions Education Summit (IOM, 2002)
  • Improving Medical Education Enhancing the
    Behavioral and Social Science Content of Medial
    School Curriculum (IOM,2004)

58
Competencies for Quality Health Care2002 Health
Professions Education Summit
  • Informatics
  • Interdisciplinary Teams
  • Evidence-Based Care
  • Quality Improvement
  • Patient-Centered Care

59
Preparing to reach our potential
  • Changing demographics
  • Context Competence (e.g., culture,
    race/ethnicity, history, religion, politics,
    economics, community, discrimination)

60
Health Informatics
  • Communication (e.g., email)
  • Knowledge management (e.g.,
    evidence-based databases)
  • Decision support

61
Telehealth
62
Need more attention to
  • Clinical decision-making
  • Practice guidelines
  • Dissemination of guidelines

63
Need increased attention to
  • Genetics
  • Organ and tissue transplantation
  • Assisted reproductive technology
  • Primary care

64
Globalization
65
Environment
66
Advocacy
  • Graduate Education Training
  • Research
  • Health Policy

67
There is great potential for psychologists in
health research and care.
  • Psychological interventions
  • Program development
  • Administration
  • Team building
  • Supervision
  • Education and Training
  • Research
  • Health promotion and disease prevention
  • Assessment and triage
  • Consultation (case centered and systems centered)

68
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