introduction to clinical psychology: science, practice and ethics chapter 15 clinical health...

Introduction to

Clinical Psychology:Science, Practice and Ethics

Chapter 15

Clinical Health PsychologyThis multimedia product and its contents are protected under copyright law. The following are prohibited by law:•Any public performance or display, including transmission of any image over a network;•Preparation of any derivative work, including the extraction, in whole or in part, of any images;•Any rental, lease, or lending of the program

Copyright ©Allyn & Bacon 2005


Health Psychology: Definition

• “Health psychology is 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 dysfunction, and to the analysis and improvement of health care system and health policy formation” (Matarazzo, 1982).



Clinical Health Psychology• Subdiscipline of health psychology

and clinical psychology

• Approaches general health and illness with methods, models and assumptions of clinical psychology

• Aim “to translate research into practical applications that can help people lead healthier lives”


Biopsychosocial model• Health and illness a product of

biological, psychological and social factors


Health Psychology: Content Areas1. Health risk behaviour

2. Health protective and enhancing behaviours

3. Health-related cognitions

4. Processes influencing health-care delivery

5. Psychological aspects of illness


Health Risk Behaviour• Smoking

• Media more impact than education (Flynn, 1992)• Gender differences: Males nicotine

Females situational• Cravings: 8 – 15 minutes

• Alcohol Abuse• Tension-reduction theory• Social Learning Theory• Cognitive: Alcohol Myopia• Personality: harm avoidance control • Genetic


Health Risk Behaviour

• Obesity• Internal-External Hypothesis (Schacter,1968)• Mood regulation: more for females• Restraint Theory: dieter’s “Oh Well”• Lifestyle & Culture

• STD/HIV


Health Belief Model

Susceptibility

Severity

Benefits

Costs

Behaviour

Rosenstock, 1960

Who will undertake preventative action:


Reasoned Action/ Planned Behaviour

Perceived Behavioural

Control

IntentionsSubjective Norms

Attitudes

Behaviour

Ajzen, 1985


Social Cognitive Theory (Bandura)

• Direct Modeling

• Symbolic Modeling

• Self- efficacy

• Outcome Expectancies


Social cognitive theory (cont.)• What does it predict?

• smoking cessation• eating nutritious food• lowering cholesterol• brushing and flossing teeth• using condoms• exercising regularly


Prevention and Health Promotion• Stress and illness

• Managing stress

• Behaviour and Health• Promoting healthy behaviour• Decreasing negative health behaviours


Stress and Illness• Measurement:

• self-report• physiological

• Life Events vs Daily Hassles/Uplifts


Stress and Illness• Fight or Flight Response (Cannon)

• General Adaptation Syndrome (Selye)

• Cognitive Appraisal (Lazarus & Folkman)


General Adaptation Syndrome (Selye)StressorStressor

Alarm:

Initial mobilization to

fend off threat

Alarm:

Initial mobilization to

fend off threat

Resistance:

Continued fight against

stressor

Resistance:

Continued fight against

stressor

Exhaustion:

Depletion of bodily

resources

Exhaustion:

Depletion of bodily

resources

Illness & DiseaseIllness & Disease


General Adaptation Syndrome (Selye)

StressStress

Endocrine

System

Endocrine

System

HypothalamusHypothalamus

Sympathetic

Nervous System

Sympathetic

Nervous System

Adrenal gland releases

catecholamines

(epinephrine,

norepinephrine)


catecholamines

(epinephrine,

norepinephrine)

Increases in production of

energy, inhibition of

swelling

Increases in production of

energy, inhibition of

swelling

Pituitary gland releases

adrenalcorticotropic

hormone (ACTH)

Pituitary gland releases

adrenalcorticotropic

hormone (ACTH)


corticosteroids

(cortisol)


corticosteroids

(cortisol)

Increases in Heart rate,

blood pressure, &

breathing

Increases in Heart rate,

blood pressure, &

breathing


Cognitive Appraisal (Lazarus & Folkman)

EventEvent

Primary Appraisal:

“Am I in danger?”

Primary Appraisal:

“Am I in danger?”

Secondary Appraisal:

“What can I do about it?”

Secondary Appraisal:

“What can I do about it?”

StressStress


Negative Impact of Prolonged Stress Response

• Negative impact on body organs, mental functioning & Immune system

• Affect immune system so cannot destroy viruses, bacteria, tumors, & irregular cells

• Still not clear total impact of stress on immunosuppression –in any case it is important influence on health and illness


Illness

• Diabetes mellitus• Psychological Factors:

• Increase in depression & anxiety disorders• Stress impacts blood glucose levels

• Psychological Intervention• Blood Glucose Awareness Training (Cox, 1992)• Stress management: progressive muscle relaxation/

biofeedback


Illness

• Headache: Migraine & Tension • Psychological Factors: (Martin, 1998)

• Hassles vs Life-events• Headache sufferers tend to evaluate stressful events

more –v’ly• Perceive less social support• Type-A personality (Friedman & Rosenman, 1974)

• Psychological intervention• Biofeedback:

• Migraine – thermal

• Tension – EMG

• Relaxation Training


Illness

• Cancer• Psychological Factors:

• Depressed mood

• Psychological Intervention:• Treatment support: guided imagery• Palliative support


Self-Healing Personalities

• Control: in facing challenge feel power to influence outcome

• Commitment: to something important or meaningful-work, communities & family

• Challenge: energy & excitement for life change & innovation


Self-Healing Personalities

• Trust & Devotion:

• (Rotter, 1980) people who trust others are less likely to be unhappy, conflicted, or maladjusted-dependable & have more friends-healthier


Learned Optimism: Martin Seligman (1991)

• Adversity• Belief (personal control / explanatory

style)

• Consequence (depression, anger, embarrassment, hurt, worry . . .)

• Disputation (questioning & disputing your demoralizing thoughts )

• Energy


Training and Certification in Health Psychology

• Graduate School

• Pre-doctoral Internship

• Post-doctoral Training

• ABBP in Clinical Health Psychology

introduction to clinical psychology: science, practice and ethics chapter 15 clinical health...

Documents

general health

health protective

maintenance of health

definition health psychology

program copyright allyn

health promotion stress

biopsychosocial model

healthcare delivery