roles of psychology in medical care

7/27/2019 Roles of Psychology in Medical Care

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DAVID GODOT, PSY.D.

Roles of Psychology in Medical Care


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How Psychology Operates in aMedical Context


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Involving the Patient in Treatment

Informed consentPsychologists emphasize informed consent in their ownpractice and can help to ensure that patients understand thenature, benefits, and risks of medical treatments

People are more likely to become active participantsin things they feel they understand and have chosenfreely


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Assessment & Intervention

Early experiences, nature/nurtureEnvironmental and social factorsThought Emotion Behavior


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The Roles of Psychology inMedical Care


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Health Psychology

Enhance patient communication with health careteam

Educate patient on the health effects of behavioralchoices

Enhancing patient motivation and compliance Monitor and improve patient understanding of

disease processes

Increase patient engagement in treatment Preventively address behavioral issues that may leadto or exacerbate medical conditions


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Behavioral Medicine

Focuses on direct manipulation of the mind-body relationship using tools such as:

Biobehavioral therapy for physical deficitsCognitive rehabilitation for organic brain damageBiofeedback Neurofeedback Hypnosis


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THE MIND-BODY RELATIONSHIP

Psychoneuroimmunology andthe HPA Axis


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The Hypothalamus

Links the nervous systemto the endocrine system viathe pituitary glandRoles in social andemotional functioning:

Mediates oxytocin responseResponds to externalchemosignals (food andsocial odors)Releases neurohormones

Its activity is regulated by the classic monoamineneurotransmitters


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The Pituitary Gland

Responds tohypothalamus by releasing hormones thatregulate: Homeostasis

Blood pressure Water balance Body temperature

Metabolism Growth Reproductive Function Pain Perception


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The Adrenal Glands

Respond to hormonalpituitary signals by releasing hormones

that exert direct controlover stress response,homeostasis, andreproductive

functioning


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The only way to separate the mind fromthe body is with a guillotine.

-Dabney Ewin, MD


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PRACTICAL APPLICATIONS

Psychological treatment of medical conditions


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Meditation

An 8-year NIH study of patients with heart diseasefound that practicing meditation 20 minutes a day reduced their risk of death, heart attack, and stroke by 48%Those who practiced twice a day reduced their risk

by 66%(Schneider et al, 2012)http://circoutcomes.ahajournals.org/content/early/2012/11/13/CIRCOUTCOMES.112.967406.abstract


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Biofeedback

Allows patients to gain conscious awarenessand control of automatic physiologicalprocesses, such as heart rate, vasodilation, andgalvanic skin responseEffective in the treatment of headache pain

Nestoriuc Y, Martin A, Rief W, Andrasik F (September 2008). "Biofeedback treatment forheadache disorders: a comprehensive efficacy review". Appl Psychophysiol Biofeedback 33(3): 12540. doi:10.1007/s10484-008-9060-3. PMID 18726688.

Effective in the treatment of adult urinary incontinenceBusby-Whitehead , Johnson T., Clarke M. K. (1996). "Biofeedback for the treatment of stress and urge incontinence". The Journal of Urology 156 (2): 483.


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Neurofeedback

Allows patients to gain direct conscious awareness of CNS activity by providing sensory representations of current and optimal brainwave patterns using EEGor fMRIProduces neuroplastic changes after as little as 30minutes of voluntary brainwave control

(Ros et al, 2010)http://www.sciencedaily.com/releases/2010/03/100310114936.htm

Still very new, but being applied effectively to rehabafter TBI or stroke, ADHD


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Psychotherapy

A large number of studies have shown increasedlongevity and survival among cancer patientsrandomly assigned to receive psychologicaltreatment. Immune functioning as mediated by HPA stress response is involved in cancer risk andprogression, as well as most other disease processes

(Spiegel et al, 2012)http://www.ncbi.nlm.nih.gov/pubmed/22438289


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Hypnosis

Can differentially modulate T-cell subsets by affecting HPA mediators

(Wood et al, 2003)http://www.ncbi.nlm.nih.gov/pubmed/12570090


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Example: Hypnosis and Warts

HPV Warts demonstrate the potential specificity of psychological intervention for physical ailment:

Controlled studies have shown an average 40% cure rateof warts using direct suggestion in hypnosis (DSIH)

33 out of 41 consecutive patients who did not respond toDSIH were cured using individualized hypnoanalytictechniques.

(Ewin, 1992)http://www.ncbi.nlm.nih.gov/pubmed/1442635

Hypnotic cure of warts results from activation of animmune response. New case evidence suggests that thisimmune response may be cellular, rather than systemic.

(Ewin, 2011)


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Modification of Congenital Conditions

A classic case published in the British MedicalJournal documents the use of hypnosis to cure asevere case of warts which turned out to becongenital ichtyosiform erythrodermia(Mason, 1952)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2021155/?page=2

This result has been replicated by several others(Schneck, 1954; Wink, 1961; Kidd, 1966)


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Alteration in Gene Expression

New studies using DNA microarrays have confirmedthat therapeutic interventions utilizing hypnosis arefollowed by characteristic changes in geneexpression, including: up-regulation of genes associated with stem cell growth Reduction in cellular oxidative stress Reduction in chronic inflammation

(Atkinson et al, 2010). http://www.ncbi.nlm.nih.gov/pubmed/20718241

M P i l A li i f P h h i


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More Practical Applications of Psychotherapy inMedicine

Cognitive conditionsSpinal cord and brain injuriesCardiac conditionsGI illnesses Acute and chronic pain control AsthmaComplementary treatment of all inflammatory disorders,including heart disease, arthritis, and autoimmune disordersThe adjunctive treatment of all side-effects associated withcancer and cancer treatment pain, nausea, fatigue, insomnia,anxiety, mood disturbances. Increases in quality of life andsurvival + potential for improving medication response and/ordirectly affecting disease progression (Godot, 2007)

http://davidgodot.com/hypno-oncology/

roles of psychology in medical care

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