2. Health Psychology

3. Mind-Body Relationship From earliest times – mind and body generally thought of as one unit Disease understood as resulting from some type of divine (supernatural) cause - possession, punishment from god(s), etc.

4. Mind-Body Relationship Greeks and Arabs were among the first to suggest natural causes of illness Ex – Hippocrates’ Humoral theory Galen – the first to attribute disease to a specific pathogen This emphasis on natural causation was lost with the fall of the Roman Empire and the subsequent rise in power of the Church.

5. Mind-Body Relationship In the Middle Ages the Church was the guardian of medical knowledge – the functions of the priest and physician merged. This began to change during the Renaissance, however, especially due to the influence of René Descartes

6. Cartesian Dualism Descartes proposed that mind and body be considered as two separate entities Body – works mechanistically – thus, can be understood scientifically Mind – also, the soul – to be studied by priests This “split” laid the foundation for study and experimentation that led to modern medicine

7. Mind-Body Relationship For the next 200 years, physicians looked exclusively at organic and cellular changes and pathology to understand and treat illness, until physical evidence became the only basis for diagnosis and treatment of disease Example – Krafft-Ebbing and General Paresis

8. Mind-Body Relationship This view became less tenable, however, with the contributions of Sigmund Freud – hysterical patients had obvious, profound physical symptoms, with no apparent organic cause Psychosomatic Medicine in the 1920’s  Led to an emphasis on the autonomic nervous system

9. Biomedical Model Still the dominant model in medicine Maintains that all illness can be explained on the basis of problems with bodily processes (biochemical imbalances, neurophysiological abnormalities, etc.) Is reductionistic Implicitly incorporates the assumption of mind/body dualism Emphasizes illness over health

10. Biopsychosocial Model Assumes biological, psychological and social factors are all important determinants of both illness and health Health and illness both caused by multiple factors and produce multiple effects Mind and body cannot be distinguished in matters of health and illness Emphasizes both health and illness – health is to be achieved, not taken for granted

11. Health Psychology Health psychology is a subfield that is concerned with the social and psychological factors that Influence health and illness.

12. Definition of 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 aetiologic and diagnostic correlates of health, illness, and related dysfunction, and to the analysis and improvement of the health care system and health policy formation.” (Matarazzo, 1982).

13. Why Health Psychology? 1. Changing Nature of Illness – traditional medicine has apparently been very successful treating acute illnesses – tuberculosis, pneumonia, influenza, etc. – * are short term * have identifiable causes * can be treated

14. Why Health Psychology? However, most of the major health problems today are chronic, not acute Cancer, heart disease, AIDS, accidents * cannot be cured, only managed * causes? * people must live with these diseases for years, leading to a number of issues of coping

15. Population Growth YearPopulation (millions) 1170 1000265 1500425 1650545 18501200 19302000 19502500 20005750 20226500-8000 (estimate)

16. What is causing this population growth? Two possible factors: Increasing birth rate. Decreasing death rate. (Growth=Birth rate-death rate)

17. The answer… Birth rate remained stable. Death rate has decreased substantially. But why?? What factors have led to the improvement in death rates?

18. Reducing mortality rates this century.

19. But when was the treatment introduced?

20. A nice quote… “Medical measures (both chemotherapeutic and prophylactic) appear to have contributed little to the overall decline in mortality in the United States since 1900…” McKinlay and McKinlay (1981)

21. Patterns of illness. Until the twentieth century, people typically died from nutritional deficiencies and infectious diseases. In developed countries, infectious diseases are largely controlled. Declining infant mortality led to increasing life expectancy. With increased life expectancy, chronic illnesses (diseases of ageing) are now more prevalent.

22. Major killers. Pneumonia TB Diarrhoea Heart disease Kidney Accidents Cancer Heart disease Cancer Liver disease Athersosclerosis Accidents Pneumonia Diabetes 1900 Now

23. How successful is modern medicine? Not very: major killers are still around. What factor do the major killer (heart disease, cancer, liver disease, accidents) have in common? PSYCHOLOGICAL FACTORS

24. Aim of the subject. To examine the range of psychosocial factors that influence people’s health behavior, their susceptibility and reactions to illness states and responses to medical treatment.

25. Why Health Psychology? Rapidly expanding cost of health care Increased medical acceptance Methodological and statistical contributions to research

26. Research Methods in Health Psychology Case Studies Correlational Studies  May be univariate or multivariate Note: example of MacDougall, Dembroski, Drusdale and Hackett (1985) Controlled Experimental Studies  To assess causality Problem – limited generalizability

27. Training for Health Psychology Careers Health psychologists typically hold a doctoral degree (Ph.D. or Psy.D.) in psychology. Applied health psychologists are licensed for the independent practice of psychology in areas such as clinical and counseling psychology, and board certification is available in health psychology through the American Board of Professional Psychology.

28. Training for Health Psychology Careers Undergraduate: Health psychology courses are available at about a third of North American colleges and universities. Because of the field's biopsychosocial orientation, students are also encouraged to take courses focusing on abnormal and social psychology, learning processes and behavior therapies, psychophysiology, anatomy and physiology, psychopharmacology, community psychology, and public health.

29. Training for Health Psychology Careers Graduate: Many doctoral programs in clinical, counseling, social, or experimental psychology have specialized tracks or preceptorships in health psychology. A number of programs now exist in the United States and other countries specifically for doctoral training in health psychology. These programs are quite diverse: some specialize in training students either for research careers or for direct clinical service to patients. Division 38 has a directory of doctoral programs offering training in health psychology, available from the Office of Division Services of the American Psychological Association.

30. Training for Health Psychology Careers Predoctoral Internships: Clinical and counseling psychologists are required to complete a one- year internship/residency before obtaining their doctorates. Many of these programs offer some training in health psychology. A number of internship programs provide specialized training in health psychology in which at least half of the trainee's time is spent in supervised health psychology activities. Division 38 distributes a directory of health psychology internships, which is linked to its web site, including programs offering major rotations (at least half time health psychology) and minor rotations (less than half time) in health psychology.

31. Training for Health Psychology Careers Postdoctoral Fellowships: Many university medical centers, universities, health centers, and health psychology programs offer specialized research and/or clinical training in different areas of health psychology. Division 38 has a directory of postdoctoral opportunities in health psychology, linked to its web site.

32. The Work Setting of a Health Psychologist Health psychologists participate in health care in a multitude of settings including primary care programs, inpatient medical units, and specialized health care programs such as pain management, rehabilitation, women's health, oncology, smoking cessation, headache management, and various other programs. They also work in colleges and universities, corporations, and for governmental agencies.

33. Clinical Activities Assessment approaches often include cognitive and behavioral assessment, psychophysiological assessment, clinical interviews, demographic surveys, objective and projective personality assessment, and various other clinical and research-oriented protocols. Interventions often include stress management, relaxation therapies, biofeedback, psychoeducation about normal and patho-physiological processes, ways to cope with disease, and cognitive-behavioral and other psychotherapeutic interventions. Healthy people are taught preventive health behaviors. Both individual and group interventions are utilized. Frequently, health psychology interventions focus upon buffering the effect of stress on health by promoting enhanced coping or improved social support utilization.

34. Research Health psychologists are on the leading edge of research focusing on the biopsychosocial model in areas such as HIV, oncology, psychosomatic illness, compliance with medical regimens, health promotion, and the effect of psychological, social, and cultural factors on numerous specific disease processes (e.g., diabetes, cancer, hypertension and coronary artery disease, chronic pain, and sleep disorders). Research in health psychology examines: the causes and development of illness, methods to help individuals develop healthy lifestyles to promote good health and prevent illness, the treatment people get for their medical problems, the effectiveness with which people cope with and reduce stress and pain, biopsychosocial connections with immune functioning, and factors in the recovery, rehabilitation, and psychosocial adjustment of patients with serious health problems.

35. Career Opportunities The opportunities for careers in health psychology in the United States are quite good. Medical settings, particularly medical centers, have greatly expanded their employment of psychologists. Aside from medical centers, health psychologists often work in colleges and universities, medical schools, health maintenance organizations, rehabilitation centers, pain management centers, public health agencies, hospitals, and private consultation/practice offices. In addition to the specific content skills which psychologists offer to patients and staff in the medical community, psychologists' unique training often makes the health psychologist an asset to the medical team with regard to quality assurance methods (making certain that health care is helpful and cost-effective), research, writing, grant-writing, statistical, communication, and team development skills.