1. “You, the individual, can do more for your own health and well-being than any doctor, any hospital, and drug, any exotic medical service”
US Department of Health, Education, and Welfare

2. University of Toronto Winter, 2005
Health Psychology
University of Toronto
Winter, 2005

3. Dr. Duane Hargreaves
Phone: (905)
Web:

4. Lecture 1 - Outline Part 1 Part 2 Part 3 Welcome and Introduction
Topic Overview - Aims and Objectives
Assessment
Part 2
What is Health Psychology?
Part 3
Scientist-Practitioner Model

5. Lecture 1 - Part 1
Welcome and Introduction

6. Course Handbook Course Instructors Learning Outcomes
Course Outline (readings)
General information (expectations, contact, assessment, text)
Lecture Outlines

7. Lecture 1 - Part 2
What is Health Psychology?

8. Question
What is most important in our lives?

9. Freedom Responsible
Enjoying life Social Justice
Honesty Pleasure
Reciprocation of favors Equality
Social power Self-respect
Broadminded A varied life
Successful Wealth
True friendship A spiritual life
Healthy Respect for tradition
Accepting my portion in life Family security
Self indulgent Curiosity
Protecting the environment Wisdom
Social order Loyal

10. Question What is most important in our lives?
Sample of 162 women and men
Most important …
2nd most important …
3rd most important …
4th most important …
Etc …

11. What is Health?
Health is popularly defined in terms of absence of disease, but may be viewed as an illness/wellness continuum
The World Health Organization (WHO) defines health as “a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity”.

12. Illness/Wellness Continuum

14. 1900
1990

15. Changing patterns of illness
Summary
1900s - infectious diseases main cause of death (acute conditions)
1960s - degenerative diseases main cause of death (chronic conditions)
1990s - new infectious disease main cause of premature death (chronic condition)

16. Death rates from infectious and parasitic disease, 1907 to 1998

17. Acute vs. Chronic Disorders
Summary
acute conditions = short-lived, curable
Etiology - Beyond individual control
chronic conditions = long-lasting, no cure
Etiology - Partly influenced by behavior

18. Reasons for changed causes of death
Improved hygiene (water supply, etc)
Penicillin (antibiotics)
Aging population (risk factor for degenerative disease)
Health Behaviors
Activities to prevent or detect disease

19. Change 5 behaviors
According to the US Public Health Service, of the 10 leading causes of death in the US, at least 7 could be reduced substantially if people at risk would change just 5 behaviors!
Adherence to medical recommendations (eg use of hypertensive medication)
Diet
Smoking
Lack of exercise
Alcohol and drug use

20. Estimated contributions of behavior, medical care, genetics, and other factors to health status.

21. Models of Health Biomedical Model Historically, dominant paradigm
Suggests illness is a function of aberrant somatic processes
Main Focus = cure (biology and medicine)

22. Models of Health Biopsychosocial Model Current dominant paradigm
All conditions of health and disease have mental and social components
Main focus = health (prevention not cure)

23. Models of Health Biopsychosocial Model
“health (wellness and illness) is a function of biological, psychological, and social factors in continual interaction”

24. A “factors” approach

25. A “systems” approach

26. The Biopsychosocial Model from Factors and Systems Perspectives

27. Health Psychology What is health psychology?
“the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to …
Promotion and maintenance of health (health habits)
Prevention and treatment of illness (clinical)
Identification of etiological and diagnostic correlates of health and illness (research)
Analysis of the health care system and health policy formation (political)
(Matazarro, 1982)

28. Health Psychology … vs. other health-related disciplines
Medical psychology
Psychosomatic medicine
Behavioral medicine
Behavioral health
Medical sociology

29. Publications in Health Psyc.

30. Lecture 1 - Part 3
Scientist-Practitioner Model

31. Scientist-Practitioner Model
The essence of the S-P model is that students in clinical psychology should be trained in research as well as clinical skills.
Implications of the S-P model for clinical practice are a little less clear!

32. Practitioners engage in 1, 2, or all 3 emphases
S-P model in practice
3 different emphases:
Practitioner uses research and basic principles to guide treatment and assessment or to develop new approaches (evidenced-based)
Practitioner evaluates outcome (formal assessment of outcome)
Practitioner engages in research
Practitioners engage in 1, 2, or all 3 emphases

33. Importance of Psych. Theory
Basis for effective techniques lies in the theoretical substrate of the discipline of psychology
Development of new therapies/interventions depends upon this theoretical basis
Application to complex or new problems requires a theoretical basis
Eg Walby (1970) … systematic desensitization for phobias previously thought untreatable.
Causal processes and mechanisms of change

34. Importance of Empiricism
Evaluation of the efficacy of treatments
Empirical justification for claims
Delineation of limits of claims (rarely unequivocal)
Success rates, breadth of response, long-term outcome
Study of predictors of outcome
Best practice protocols

35. Scientist-Practitioner Model
Hierarchical Knowledge Stores
Empirically established relationships
Scientific theories
Clinical lore (shared beliefs and practices)
Professional experience
Personal experience
(James, 1991)
… acknowledges that we don’t know everything!

36. Scientist-Practitioner Model
Brief History…
University clinics (foundation for US model of training)
1896 Pennsylvania Clinic
1908 Colorado
1909 Minnesota
1914 (26 University clinics in USA)
Boulder Conference (1949)
Research and clinical practice as joint training goal
B F Skinner (1953) … Science and Human Behavior
Hans Eysenck (1959) … Learning Theory and Behavior Therapy
1960s and 70s … treatment outcome evaluations

37. Scientist-Practitioner Model
Brief History…
1980s and 1990s
Large scale studies and follow-ups
Extensions to new areas
Refinement of techniques (eg anxiety disorders)
Relapse prevention (eg addictions)
Growth of behavioral medicine and health psychology
Use of the term “cognitive-behavior therapy”
Cost-effectiveness
Manual-based treatments derived from research

38. Scientist-Practitioner Model
Manual-Based Treatments
Development of manuals as a “revolution”
Evidence-based medicine
Advantages
Consistency of application (replicability)
Quality assurance for customers
Ease of training
Division 12 (APA task force)
Criticisms
Appropriate renewal

39. Scientist-Practitioner Model
Scientific Achievements
Most effective treatment for anxiety
Very effective treatment for depression
Sexual problems
Eating disorders, addictions
Health psychology
Pain
Diabetes
Cardiovascular disorders
Tinnitus

40. Scientist-Practitioner Model
Professional Achievements
Role of psychologist strengthened as providers of effective interventions
Empirical justification for psychological therapy - potential cost effectiveness
More effective therapy for clients for a wide range of problems - extension to health
Link between pure and applied psychology

41. Scientist-Practitioner Model
Implications for Health Psychology
Adherence to the S-P model
Active involvement of psychologists is transfer of psychological knowledge to other health care professionals
Nurses, doctors, pharmacists, OTs, speech therapists, physiotherapists, etc
Psychologizing of health care
“The promulgation of the scientific ethos in general, and the S-P model in particular, among all the health professions.” (James, 1991)

42. Scientist-Practitioner Model
Invalid Criticisms
Few clinicians engage in research
Treatment-outcome literature is not useful
What does the clinician do when a client fails to respond
Clinicians need to be pragmatic, flexible, eclectic
“human problems cannot be solved by science - therapy is an art, not a science”
Limited view of science