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Health psychology

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Health psychology is concerned with understanding how biological, psychological, environmental
Environment (biophysical)
The biophysical environment is the combined modeling of the physical environment and the biological life forms within the environment, and includes all variables, parameters as well as conditions and modes inside the Earth's biosphere. The biophysical environment can be divided into two categories:...

, and cultural factors are involved in physical health and illness. Health psychologists work alongside other medical professionals in clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...

al settings, work on behavior change in public health promotion, teach at universities, and conduct research
Research
Research can be defined as the scientific search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method...

. Although its early beginnings can be traced to the kindred field of clinical psychology
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...

, four different divisions within health psychology and one allied field have developed over time. The four divisions include clinical health psychology, public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...

 psychology, community health psychology, and critical health psychology. The allied field is occupational health psychology
Occupational health psychology
Occupational health psychology emerged out of two distinct applied disciplines within psychology, health psychology and industrial/organizational psychology, and occupational health. OHP is concerned with the psychosocial characteristics of workplaces that contribute to the development of...

. Organizations closely associated with the field of health psychology include Division 38 of the American Psychological Association and the Division of Health Psychology of the British Psychological Society.

Overview


Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model
Biopsychosocial model
The biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...

, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support
Social support
Social support can be defined and measured in many ways. It can loosely be defined as feeling that one is cared for by and has assistance available from other people and that one is part of a supportive social network...

).

Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. The term "health psychology" is often used synonymously with the terms "behavioral medicine
Behavioral medicine
Behavioral medicine is an interdisciplinary field of medicine concerned with the development and integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness...

" and "medical psychology
Medical psychology
Medical psychology is a very broad field and has been defined in various ways. The Academy of Medical Psychology's definition applies to both the practices of consultation and prescribing in Medical Psychology, when allowed by statutes...

". Health psychologists work with many different health care professionals (e.g., physicians, dentists, nurses, physician's assistants, dietitians, social workers, pharmacists, physical and occupational therapists, and chaplains) to conduct research and provide clinical assessments and treatment services. Many health psychologists focus on prevention research and interventions designed to promote health and reduce the risk of disease. While many health psychologists provide clinical services as part of their duties, others function in non-clinical roles, primarily involving teaching and research. Leading journals include Health Psychology
Health Psychology (journal)
Health Psychology is a bimonthly, peer-reviewed academic journal published by the American Psychological Association. The journal is "devoted to understanding the scientific relations among psychological factors, behavior and physical health and illness."...

, the Journal of Health Psychology
Journal of Health Psychology
The Journal of Health Psychology, first published in 1996, is a peer-reviewed psychology journal. The managing editor is David Marks. -Scope:...

, the British Journal of Health Psychology, and Applied Psychology: Health and Well-Being.
  • Clinical health psychology (ClHP) is a term that refers to the application of scientific knowledge, derived from the field of health psychology, to clinical questions that may arise across the spectrum of health care. ClHP is one of many specialty practice area for clinical psychologists. It is also a major contributor to the prevention focused field of behavioral health
    Behavioral health
    In psychology behavioral health, as a general concept, refers to the reciprocal relationship between human behavior, individually or socially, and the well-being of the body, mind, and spirit, whether the latter are considered individually or as an integrated whole...

     and the treatment oriented field of behavioral medicine
    Behavioral medicine
    Behavioral medicine is an interdisciplinary field of medicine concerned with the development and integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness...

    . Clinical practice includes education, the techniques of behavior change
    Behavior change
    Many health conditions are caused by risk behaviors, such as problem drinking, substance use, smoking, reckless driving, overeating, or unprotected sexual intercourse. The key question in health behavior research is how to predict and modify the adoption and maintenance of health behaviors....

    , and psychotherapy. In some countries, a clinical health psychologist, with additional training, can become a medical psychologist and, thereby, obtain prescription privileges.

  • Public health psychology (PHP) is population oriented. A major aim of PHP is to investigate potential causal links between psychosocial factors and health at the population level. Public health psychologists present research results to educators, policy makers, and health care providers in order to promote better public health. PHP is allied to other public health disciplines including epidemiology
    Epidemiology
    Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

    , nutrition
    Nutrition
    Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....

    , genetics
    Genetics
    Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....

     and biostatistics
    Biostatistics
    Biostatistics is the application of statistics to a wide range of topics in biology...

    . Some PHP interventions are targeted toward at-risk population groups (e.g., undereducated, single pregnant women who smoke) and not the population as a whole (e.g., all pregnant women).

  • Community health psychology (CoHP) investigates community factors that contribute to the health and well-being of individuals who live in communities. CoHP also develops community-level interventions that are designed to combat disease and promote physical and mental health. The community often serves as the level of analysis, and is frequently sought as a partner in health-related interventions.

  • 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. CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The critical health psychologist is an agent of change, not simply an analyst or cataloger. A leading organization in this area is the International Society of Critical Health Psychology
    International Society of Critical Health Psychology
    The International Society of Critical Health Psychology is a society devoted to debate about critical ideas within health psychology and developing new ways of health psychology practice....

    .


Health psychology is both a theoretical and applied field. Health psychologists employ diverse research methods. These methods include controlled randomized experiment
Experiment
An experiment is a methodical procedure carried out with the goal of verifying, falsifying, or establishing the validity of a hypothesis. Experiments vary greatly in their goal and scale, but always rely on repeatable procedure and logical analysis of the results...

s, quasi-experiments, longitudinal studies, time-series designs, cross-sectional studies, and case-control
Case-control
A case-control study is a type of study design in epidemiology. Case-control studies are used to identify factors that may contribute to a medical condition by comparing subjects who have that condition with patients who do not have the condition but are otherwise similar .Case-control studies are...

 studies as well as action research
Action research
Action research or participatory action research – is a reflective process of progressive problem solving led by individuals working with others in teams or as part of a "community of practice" to improve the way they address issues and solve problems. Action research is done simply by action,...

. Health psychologists study a broad range of variables including genotype, cardiovascular disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

 (cardiac psychology
Cardiac psychology
Cardiac psychology is a specialization of health psychology that focuses on the primary and secondary prevention of heart disease by incorporating strategies to address the emotional and behavioral barriers to lifestyle changes , and that seeks to enhance recovery in cardiac patients by means of...

), smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...

 habits, religious beliefs, alcohol
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...

 use, social support, living conditions, emotional state, social class, and much more. Some health psychologists treat individuals with sleep problems, headaches, alcohol problems, etc. Other health psychologists work to empower community members by helping community members gain control over their health and improve quality of life of entire communities.

Relationship to occupational health psychology


A separate but related discipline, occupational health psychology
Occupational health psychology
Occupational health psychology emerged out of two distinct applied disciplines within psychology, health psychology and industrial/organizational psychology, and occupational health. OHP is concerned with the psychosocial characteristics of workplaces that contribute to the development of...

 (OHP) is a relatively new field that emerged out of the confluence of health psychology, industrial/organizational psychology, and occupational health
Occupational safety and health
Occupational safety and health is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment. The goal of all occupational safety and health programs is to foster a safe work environment...

. The field is concerned with identifying psychosocial characteristics of workplaces that affect the health and well-being of people who work. OHP is also concerned with developing strategies to effect change at workplaces in order to improve the health of people who work. For more detail on OHP, see the entry on occupational health psychology
Occupational health psychology
Occupational health psychology emerged out of two distinct applied disciplines within psychology, health psychology and industrial/organizational psychology, and occupational health. OHP is concerned with the psychosocial characteristics of workplaces that contribute to the development of...

.

Understanding behavioral and contextual factors


Health psychologists conduct research to identify behaviors and experiences that promote health, give rise to illness, and influence the effectiveness of health care. They also recommend ways to improve health care and health-care policy. Health psychologists have worked on developing ways to reduce smoking and improve daily nutrition in order to promote health and prevent illness. They have also studied the association between illness and individual characteristics. For example, health psychology has found a relation between the personality characteristics of thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.

Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. The biopsychosocial model
Biopsychosocial model
The biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...

 can help in understanding the relation between contextual factors and biology in affecting health. Physical addiction plays an important role in smoking cessation. Some research suggests that seductive advertising also contributes to psychological dependency on tobacco, although other research has found no relationship between media and smoking in youth. Research in occupational health psychology indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...

. Other OHP research reveals a relation between unemployment and elevations in blood pressure. OHP research also documents a relation between social class and cardiovascular disease.

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 (also see Health Action Process Approach
Health Action Process Approach
Health behavior change refers to a replacement of health-compromising behaviors by health-enhancing behaviors . To describe, predict, and explain such processes, theories or models are being developed...

). Health psychologists employ cognitive behavior therapy and applied behavior analysis
Applied Behavior Analysis
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...

 (also see behavior modification
Behavior modification
Behavior modification is the use of empirically demonstrated behavior change techniques to increase or decrease the frequency of behaviors, such as altering an individual's behaviors and reactions to stimuli through positive and negative reinforcement of adaptive behavior and/or the reduction of...

) for that purpose.

Preventing illness


Health psychologists work towards promoting health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Campaigns informed by health psychology have targeted tobacco use. Those least able to afford tobacco products consume them most. Tobacco provides individuals with a way of controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals. Practitioners emphasize education and effective communication as a part of illness prevention because many people do not recognize, or minimize, the risk of illness present in their lives. Moreover, many individuals are often unable to apply their knowledge of health practices owing to everyday pressures and stresses. A common example of population-based attempts to motivate the smoking public to reduce its dependence on cigarettes is anti-smoking campaigns. Health psychologists also aim at educating health professionals, including physicians and nurses, in communicating effectively with patients in ways that overcome barriers to understanding, remembering, and implementing effective strategies for reducing exposures to risk factors and making health-enhancing behavior changes.

There is also evidence from occupational health psychology that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.

The effects of disease


Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. The stressors include problems meeting medical and other bills; problems obtaining proper care when home from the hospital; obstacles to caring for dependents; having one's sense of self-reliance compromised; gaining a new, unwanted identity as a sick person; and so on. These stressors can lead to depression, reduced self-esteem, etc.

Health psychology also concerns itself with bettering the lives of individuals with terminal illness
Terminal illness
Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as...

. When there is little hope of recovery, health psychologist therapists can improve the quality of life of the patient by helping the patient recover at least some of his or her psychological well-being. Health psychologists are also concerned with identifying the best ways for providing therapeutic services for the bereaved.

Critical analysis of health policy


Critical health psychologists explore how health policy can influence inequities, inequalities, and social injustice. These avenues of research expand the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists using newer qualitative methods and frameworks for investigating health experience and behavior.

Improving doctor–patient communication


Health psychologists attempt to aid the process of communication between physicians and patients during medical consultations. There are many problems in this process, with patients showing a considerable lack of understanding of many medical terms, particularly anatomical terms (e.g., intestines). 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 playing less of a role 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 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 follow medical advice and adhere to their treatment regimens is a difficult task for health psychologists. People often forget to take their pills or consciously opt not to take their prescribed medications because of side effects. Failing to take prescribed medication is costly and wastes millions of usable medicines that could otherwise help other people. Estimated adherence rates are difficult to measure (see below); there is, however, evidence that adherence could be improved by tailoring treatment programs to individuals' daily lives.

Ways of measuring adherence


Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens:
  • Counting the number of pills in the medicine bottle—although this has problems with privacy and/or could be deemed patronizing or showing lack of trust in patients
  • Using self-reports—although patients may fail to return the self-report or lie about their adherence
  • Asking a doctor or health worker—although this presents problems on doctor–patient confidentiality
  • Using "Trackcap" bottles, which track the number of times the bottle is opened; however, this either raises problems of informed consent
    Informed consent
    Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...

     or, if informed consent is obtained, influence through demand characteristics
    Demand characteristics
    In research, and particularly psychology, demand characteristics refers to an experimental artifact where participants form an interpretation of the experiment's purpose and unconsciously change their behavior accordingly. Pioneering research was conducted on demand characteristics by Martin Orne...

    .

Managing pain


Health psychology attempts to find treatments to reduce and eliminate pain, as well as understand pain anomalies such as episodic analgesia, causalgia, neuralgia
Neuralgia
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...

, and phantom limb pain. Although the task of measuring and describing pain has been problematic, the development of the McGill Pain Questionnaire
McGill Pain Questionnaire
The McGill Pain Questionnaire, also known as McGill pain index, is a scale of rating pain developed at McGill University by Melzack and Torgerson in 1971....

 has helped make progress in this area. Treatments for pain involve patient-administered analgesia, acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....

 (found by Berman to be effective in reducing pain for osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...

 of the knee), biofeedback
Biofeedback
Biofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...

, and cognitive behavior therapy.

Postgraduate programs in health psychology


Universities in the United Kingdom

Doctoral programs in health psychology


Universities in Australia

Universities in the United Kingdom
For more information on Universities in the United Kingdom with accredited Health Psychology courses, do visit the British Psychological Society website.

Universities in the United States

Universities in Canada

Universities in Asia

Doctoral programs in occupational health psychology


See also

  • Applied psychology
    Applied psychology
    The basic premise of applied psychology is the use of psychological principles and theories to overcome problems in other areas, such as mental health, business management, education, health, product design, ergonomics, and law...

  • Bodymind
  • Cardiac psychology
    Cardiac psychology
    Cardiac psychology is a specialization of health psychology that focuses on the primary and secondary prevention of heart disease by incorporating strategies to address the emotional and behavioral barriers to lifestyle changes , and that seeks to enhance recovery in cardiac patients by means of...

  • Chronic stress
    Chronic stress
    Chronic stress is the response to emotional pressure suffered for a prolonged period over which an individual perceives he or she has no control. It involves an endocrine system response in which occurs a release of corticosteroids...

  • Cognitive epidemiology
    Cognitive epidemiology
    Cognitive epidemiology is a field of research that examines the associations between intelligence test scores and health, more specifically morbidity and mortality. Typically, test scores are obtained at an early age, and compared to later morbidity and mortality...

  • Healing environments
    Healing environments
    Healing environment, for healthcare buildings describes a physical setting and organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, the process of healing, and sometimes, bereavement.The philosophy that guides this...

  • Impact of health on intelligence
  • Occupational safety and health
    Occupational safety and health
    Occupational safety and health is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment. The goal of all occupational safety and health programs is to foster a safe work environment...

  • Occupational health psychology
    Occupational health psychology
    Occupational health psychology emerged out of two distinct applied disciplines within psychology, health psychology and industrial/organizational psychology, and occupational health. OHP is concerned with the psychosocial characteristics of workplaces that contribute to the development of...

  • Outline of psychology
  • Workplace stress
    Workplace stress
    Workplace stress is the harmful physical and emotional response that occurs when there is a poor match between job demands and the capabilities, resources, or needs of the worker....


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