Introduction: Medical Psychology and Border Areas

Themes of Medical Psychology ► Psychological factors influencing the development or progression of disease Etiology ► Patient’s response to illness and disease Outcomes ► Communication with patients and colleagues - Relational issues

Medical Psychology and border areas PRIMARY PREVENTION Health education TREATMENT General practice Hospital care Rehabilitation Behavioural Health Medical Psychology (Behavioural Medicine) Medical doctors and other health professionals Individual behavior diet, exercise, etc. supperted by health professionals Health Psychology Clinical Psychology and Psychiatry Clinical psychologists and psychiatrists Health psychologists

Historical views of diseases ► Anatomical pathology Belief that disease was localized in anatomy (16th to 18th Centuries) ► Cellular pathology Belief that cells must be the place to look for disease (19th century) ► Germ theory Discovery that particles that could not seen (e.g., bacteria) could cause disease.

Biopsychosocial model Mind, body, and environment Contemporary view Biopsychosocial model (George Engel, 1977) Mind, body, and environment interact in causing disease.

The biopsychosocial model of disease Biology Genetics Anatomy Physiology Pathogens Germs Toxins Psychology Behavioural factors Diet, exercise, smoking, coping with illness Other psych. factors Stress, anxiety, depression, illness beliefs, etc. Social factors Family Society Friends, etc.

Psychological components of the biopsychosocial model ► Behaviour (actions in relation to the environment) ► Emotions (feelings, subjective states) ► Cognition (thoughts, beliefs, and attitudes) ► Personality (characteristic ways of thinking and feeling)

Clinical relevance of the biopsychosocial model The process of diagnosis must consider the interaction of biological, psychological, and social factors. Treatment recommendations must take these factors into account. The relationship between the patient and the health care practitioner has an impact on the effectiveness of care.

Examples for psychosocial factors influencing the onset of illness or injury ► Many patients diagnosed with cancer having had some significant loss 12-18 months prior to diagnosis. ► Individuals with high stress, low resources and poor coping have greater risk for injury (accidents, etc.).

Major life events, stress, and illness outcome 2000 people’s life events and periods of illness in the previous 10 years (Rahe et al, 1967). ► Approximately 50% of those who reported higher life stress scores indicated varying degrees of illness the following year. ► Life stress scores at the very top end were positively correlated with the number of reported periods of illness.

The practical relevance of medical psychology ► An interdisciplinary effort to open communication and collaboration. ► A common language can be created in which different disciplines can benefit each other.

The use of psychological interventions Short-term behavioral interventions have been effective in helping patients to: ►Manage pain ► Reduce anxiety prior and after surgery ► Improve communication with doctors ► Manage side effects and treatment effects when coping with chronic illness

Contributions of psychology to medical care ► Reliable and valid measures for assessing health-related factors. PSYCHOLOGICAL TESTS ► Techniques useful in changing behaviours that affect health and illness. BEHAVIOR MODIFICATON, SUPPORT AND PSYCHOTHERAPY

The clinical health psychologist ► A psychologist trained to work in collaboration with other health professionals ► Intervenes at the individual level to treat illness, slow or prevent disease progression, and reduce disability

The Practice of Medical Psychology

Pain management

Modification of illness beliefs

Communication with patients

Patient education