Health psychology

Health psychology concerns itself with understanding how biology, behavior, and social context influence health and illness. Health psychologists generally work alongside other medical professionals in clinical settings, although many also teach and conduct research. Although its early beginnings can be traced to the kindred field of clinical psychology, four different approaches to health psychology have been defined: clinical, public health, community and critical health psychology

Overview
Many researchers believe that physical health may be influenced by psychology through a variety of direct and indirect means. There is some evidence that certain negative mental states (such as clinical depression and anxiety) can directly affect physical immunity through production of stress hormones, such as the catecholamines and glucocorticoids. Although this research is widely debated, there is also some indication that negative psychological states may lead to faster disease progression in certain diseases (such as HIV and heart disease) through these direct biological mechanisms. Negative emotional states may also indirectly affect disease processes through their influence on health behaviors. For example, depression has been related to many risk factors for poor health including overeating, smoking, physical inactivity, and poor medication compliance. Health psychology is the “…use of psychological principles to promote health and to prevent illness" (Taylor 1990); it is also part of clinical treatment for established illness. This approach considers the biological, cognitive, behavioral, emotional, social, psychosomatic and environmental factors as they relate to health, illness and health care at the level of individuals. This approach has adopted what it calls the biopsychosocial model.


 * Clinical health psychology (ClHP) adopts a definition reflecting the fact that the field was originally a branch of clinical psychology; it is also a major contributor to the field of behavioral medicine within psychiatry. Clinical practice includes the techniques of education, behavioral change, and psychotherapy; with additional training, a clinical health psychologist can become a medical psychologist in certain countries and, consequently, prescribe medication.


 * Organizational health psychology (OHP) is the use of health psychology knowledge and techniques as applied to health and illness in the workplace, at the individual and group levels.


 * Public health psychology (PHP) tries to determine causation between psychological factors and health for the population as a whole, and present this information to educators, policy makers, and health care practitioners for the promotion of better public health. It gives prominence to population-level health outcomes and interventions. It is allied to other disciplines in the fields of global and public health including epidemiology, nutrition, genetics and statistics.   Interventions are determined and "targeted" using population health statistics which evaluate health needs of various population groups as perceived by health authorities and policy makers. These interventions are "top-down" and tend to have varying levels of effectiveness across diverse population groups.


 * Community health psychology (CoHP) approach tries to understand what is happening at a local level. Interventions are generated collaboratively with coalitions of stakeholders and are aimed to facilitate community empowerment to improve the physical and/or mental health of local people outside of any formal involvement of the health care system.


 * Critical health psychology (CrHP) is concerned with the distribution of power and the impact of power differentials on health experience and behavior, health care systems and health policy. It prioritizes social justice and the universal right to health of peoples of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The CrHPist is an agent of change, not simply an analyst or cataloger. The field was developed through the foundation of the Journal of Health Psychology and the International Society of Critical Health Psychology.

Health psychology is both a theoretical and applied field. Many different methods are employed including questionnaires, interviews, controlled studies, and actions designed to bring about change using "action research". Health psychologists conduct health interviews with clients that aim to construct a more holistic picture of each person’s health, one that includes their genes, religious beliefs, social supports, living conditions, emotional state, and beliefs of health, etc. They use this information to work alongside a person’s physicians and therapists to develop a treatment tailored for individual needs or to develop greater empowerment among the community's members so that the community is able to strengthen and sustain its own quality of life.

Understand behavioral factors
Health psychologists seek to identify the behaviors and experiences that promote health, lead to illness, influence the effectiveness of health care, and recommend improvements to health policy in their life. There are many examples of this. For instance, smoking, diet, and regular exercise are all factors in the contribution or prevention in physical and mental disease. There are some minor associations between illness and individual characteristics such as personality. For example, it is claimed that individuals with thrill seeking personalities are more likely to drive fast, making them more likely to injure themselves in car accidents. And also that people distrustful of physicians will not get regular checkups. However there are contextual factors in the form of political, economic, cultural, community, social and lifestyle factors that have a more major influence on the health of particular individuals, although they will not generally recognize these.

Factors that lead to the behaviors that cause illness are of interest because they help psychologists to predict who is most susceptible to illness and why. There are many contributing factors that help determine our behaviors, and all of the dimensions of the biopsychosocial model can be applied to understand these inter-connections. Biologically, physical addiction plays an important role in smoking cessation. As does the psychological dependency on tobacco brought about largely by seductive advertising and other forms of tobacco promotion. Psychologically, people with high stress jobs are more likely to develop cardiovascular disease. Socially, people with low incomes have less access to health resources and screening processes. They also are exposed to greater environmental toxins, lower levels of education, poorer housing, less healthy foods, higher smoking prevalence, and many other toxic socially determined living conditions.

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. Cognitive behavioral therapy and behavior modification are techniques often used for this purpose.

Prevent illness
Psychologists work towards promoting health through behavioral change, as mentioned above, but they prevent illness in other ways as well. Practitioners emphasize education as a large part of illness prevention, as many people do not recognize the risk to illness present in their lives. Or they are unable to implement the knowledge that they have owing to the pressures of their everyday existence. A common example of this is anti-smoking campaigns. Those least able to afford tobacco products consume them the most. It is a method for controlling emotional states, the daily experiences of stress that characterize the lives of deprived and vulnerable people. Health psychologists also aim at educating health professionals like physicians and nurses in communicating with patients in a way that highlights the psychosocial barriers to understanding, memorizing and implementing effective strategies for reducing risk factors and making behavior changes and that will help them to develop appropriate means for communicating information relevant to diagnosis, treatment and prognosis (Ogden, 2004).

Explore the effects of disease
There is much to know about how disease affects our mental well being. When illness or accidents befall a person, their entire life is affected. A psychologically healthy individual who gets severely injured, say, now has many different practical issues to contend with that will in turn affect their psychological wellbeing. Who will take care of them while they recover? If they can’t work, how will they pay for bills or care for dependents? If this person sees themselves as being self-reliant, how do they handle this new identity? What if they cannot pursue their usual hobbies and interests? All of these possibilities can affect a person’s relationships, self-esteem, stress level, happiness and belief system. Many of these issues are economic and social in nature rather than psychological but they have a direct impact on psychological wellbeing.

This important field of study considers how those with terminal illnesses can lead a better life. When there is little hope of recovery, health psychology therapists can improve the quality of life of the patient by helping them to recover their mental well-being.

Critical analysis of health policy
Critical health psychologists are exploring how health policy can impact on inequities, inequalities and social injustice. This expands the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health experience both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists and newer qualitative methods and frameworks for investigating health experience and behavior are advocated (Marks, Murray et al., 2005).

Improving doctor-patient communication
Health psychologists attempt to aid the process of communication between doctors and patients during medical consultations. There are many problems in this process, particularly the use of jargon by doctors (using long, complex, usually medicine-specific words often not understood by the patient). Researchers such as Boyle and McKinlay have investigated this process and discovered not only that patient understanding is low (40% of women on a maternity ward understood 13 medical terms that they were given), but that even doctors do not expect their patients to understand their jargon! 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 taking little part 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 the 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.

Improving adherence to medical advice
Getting people to obey medical advice and adhere to their treatment regimens is a difficult task for health psychologists. Mostly, people forget to take their pills or find their side effects too difficult to cope with (rational non-adherence), but failing to take prescribed medication costs the Health Service millions of pounds per year, as well as wasting millions of usable, viable medicines that could otherwise be used to help other people. Estimated adherence rates are very hard to measure due to the issues raised by the various techniques available (see below). Sarafino estimates adherence to be very low, however, he judges adherence to be following every part of the treatment program, whereas Taylor encourages the tailoring of the program to one's personal routine.

Ways of measuring adherence

 * Counting the number of pills in the medicine bottle - although this has problems with privacy and seems patronizing or showing lack of trust in patients
 * Using self report measures - although participants may fail to return the self report or lie about their adherence
 * Asking doctor or health worker - although this presents problems on doctor-patient confidentiality
 * Using 'Trackcap' bottles, which measure the number of times the bottle is opened - however, this either raises problems of informed consent or, if informed consent is gained, demand characteristics.

Managing Pain
Health psychology attempts to find treatments to reduce and eliminate pain, as well as understanding pain anomalies such as episodic analgesia, causalgia, neuralgia and phantom limb pain. Problems of measuring and describing pain are prominent, although have been reduced by the McGill Pain Questionnaire. Treatments for pain involve patient-administered analgesia, acupuncture (found by Berman to be effective in reducing pain for osteo-arthritis of the knee), biofeedback and cognitive behavioral therapy.

Managing stress
Stress is a common problem in modern life, but extreme levels of stress can cause fatigue, irritability, burnout and even illness. Health psychology attempts to define, measure and treat stress. One effective treatment is the Stress Inoculation program pioneered by Meichenbaum. Another empirically-supported treatment is the Mindfulness-Based Stress Reduction (MBSR)program by Kabat-Zinn.

Religiosity
The longitudinal Life Cycle Study began in 1921 with 1500 children of average age 11. Class ethnicity variables were removed by only using white children from middle-class families. The children had an IQ of 150+ and had been identified as "gifted" by their teachers. In 1950, the participants were asked to rate their religiosity on a scale of 1 to 4. In 1990, researchers compared this score with morality of the sample and concluded that religious people live longer. However, it is not clear why this is - it may be related to happiness and feelings of fulfillment.

Poverty
In a study by Fraser, it was found that affluent people were more likely to seek medical help earlier that the less affluent, who had less access to a car.

Personality
Freidman and Rosenman found that Type A personalities were twice as likely to develop coronary heart disease. They studied 2500 men over a period of 12 years.

Ethnicity
John Henryism