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APPLICATIONS OF HEALTH PSYCHOLOGY:OBESITY, HEALTH CARE TRENDS

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Clinical Psychology­ (PSY401)
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Lecture 40
APPLICATIONS OF HEALTH PSYCHOLOGY
Nearly everyone agrees that a few simple behaviors, if widely practiced, would dramatically reduce the toll
of human misery and the torrents of dollars pouring into the health care system. These include reducing our
consumption of salt and fatty foods, driving carefully and using seat belts, exercising regularly, avoiding
cigarettes, and decreasing stress. But giving advice and having people take it are two very different things.
Therefore, psychologists, other behavioral specialists, and medical professionals have mounted research
programs to learn how to treat and also prevent a variety of potentially harmful human behaviors. health:
cigarette smoking, alcohol abuse, and weight control.
1. CIGARETTE SMOKING
Increased awareness of the dangers of cigarette smoking has led to a steady decline since the mid-1960s in
the percentage of Americans who are habitual smokers (Brannon & Feist, 2000). However, rates of
smoking differ according to
gender, level of education, and income. One disconcerting trend is that the rate of smoking for women has
shown much less of a decline than that for men (Centers for Disease Control and
Prevention, 1994). In
fact, among white-collar workers, the smoking rate for women now exceeds that for men.
Cigarette smoking has been linked to an increased creased risk of cardiovascular disease and cancer, the
two leading causes of death in the United States. Even though smoking increases one's e chances of
premature death from diseases such as coronary heart disease, cancers of the respiratory tract, emphysema,
and bronchitis, people still smoke. Why? Possible reasons include tension control, social pressure,
rebelliousness, the addictive nature of nicotine, and genetically influenced personality traits such as
extraversion. Tension control and social pressure are thought to be reasons for initiation of smoking,
whereas rebelliousness, addiction, and personality are seen primarily as maintaining factors.
A variety of techniques have been used to induce people to stop smoking, including educational programs,
aversion therapy (such as rapid smoking), behavioral contracts, acupuncture, cognitive therapy, and group
support (Brannon & Feist, 2000). Relapse rates are high (70-80%), however, and research findings about
which cessation approach is best are conflicting. Most smokers who do quit, do so on their own.
The best approach seems to be to prevent the habit from starting in the first place. Unfortunately, education
alone (such as warning messages on packages) does not appear to deter young people from smoking
(Brannon & Feist, 2000). What appears to be more effective is focusing on immediate rather than delayed
negative consequences, teaching coping skills, and increasing feelings of self-efficacy.
One of the early encouraging multiple-component prevention programs aimed at children and teenagers was
based on social learning principles and used peer role models (R. I. Evans, 1976). Videotaped presentations,
peer modeling, discussion groups, role playing, monitoring smoking, and checking repeatedly on attitudes
and knowledge about smoking were all used with elementary school children. Such an approach seems
superior to those used with adolescents that focus on long-term negative effects from smoking. The trick
seems to be to focus on immediate negative consequences (for example, from peers) rather than delayed
ones (such as emphysema).
2. ALCOHOL ABUSE AND DEPENDENCE
It is estimated that about 70% of men and 50% of women in the United States consume alcoholic beverages
(United States Department of Health and Human Services, 1993). Although some studies have suggested
positive health benefits from alcohol for light or moderate drinkers, consumption of alcohol has also been
associated with a number of negative outcomes. Heavy alcohol use has been associated with increased risk
for liver or neurological damage, certain forms of cancer, cardiovascular problems, fetal alcohol syndrome,
physical aggression, suicide, motor vehicle accidents, and violence (USDHHS, 1997). This extensive list of
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alcohol-related problems has made the treatment and prevention of alcohol abuse and alcohol dependence
(alcoholism) a high priority.
Over the years, many treatment approaches have been applied to problem drinkers; most of these treatments
preach total abstinence. These have ranged from medical treatments and medications such as disulfiram
(Antabuse) and naltrexone to traditional psychotherapy and group supportive strategies such as Alcoholics
Anonymous. However, alcoholism is a problem that has been extremely resistant to virtually all inter-
vention, and the relapse rate is high.
Another, more controversial, approach to the treatment of alcohol problems is controlled drinking (Sobell &
Sobell, 1978). As the name implies, this approach has as its goal light to moderate (but controlled) drinking.
Clients are taught to develop alternative coping responses (other than drinking) and to closely monitor
alcohol intake. The field is divided as to the merits of this approach, but research does suggest that
controlled drinking is a viable treatment option for some alcoholics (USDHHS, 1997).
Many alcohol treatment programs also incorporate relapse prevention training (Marlatt & Gordon, 1985).
The majority of clients treated for alcohol problems have a relapse episode soon after treatment is
terminated. Rather than see this as a failure (a sign that total relapse is imminent), clients are taught coping
skills and behaviors they can use in "high-risk" situations to make total relapse less likely.
Alcohol abuse and dependence are complex problems that will probably require multimodal treatment
strategies. Because of the difficulties with secondary and tertiary approaches to treatment or prevention,
more and more professionals have turned to primary prevention to forestall the development of problem
drinking. For both drinking and drug abuse, programs similar to those designed to prevent adolescents from
smoking are being developed.
Often these programs are implemented through health-education courses in high school or media
campaigns. School-based prevention programs typically involve one or more of the following components:
affective education (building self-esteem, increase decision-making skills); life skills (communication skills,
assertiveness training); resistance training (learn to resist pressures to drink alcohol); and correction of
erroneous perceptions about peer norms (USDHHS, 1997). Current research evidence suggests that
programs that incorporate peer resistance training and correction of misperceptions regarding peer norms
show the most promise (USDHHS, 1997).
3. OBESITY
Behavioral treatments for obesity have been more common than for any other condition. One reason for this
emphasis is that obesity is associated with such medical disorders as diabetes, hypertension, cardiovascular
disease, and certain cancers (Brannon & Feist, 2000). It is also a socially stigmatizing condition that impairs
the self-concept and inhibits functioning in a wide array of social settings. Often problems of weight can be
traced to childhood: 10-25% of all children are obese, and 80% of these individuals become obese adults
(Stunkard, 1979).
Although it is clear that obesity has a genetic component (Meyer & Stunkard, 1993), causes of obesity
undoubtedly represent complex interactions among biological, social, and behavioral factors, and exact
mechanisms are difficult to pin down. Traditional medical and dietary methods of treatment have not been
very effective; obese individuals lose weight but then quickly regain it. Furthermore, the dropout rate may
be high in traditional weight-control programs. Most behavior modification programs include components
aimed at restricting certain types of foods, teaching when and under what conditions to eat, encouraging
regular exercise, and maintaining modified eating patterns after the program has ended.
Again," however, early prevention may be the best and safest road to weight control. An excellent example
of such an approach is the Stanford Adolescent Obesity Project (Coates & Thoresen, 1981). A variety of
strategies were used with adolescents in the hope that control at this age would lead to prevention in
adulthood. The strategies used were self-observation, cue elimination, and social and family support.
These interventions were noticeably more effective when parents were involved. Many investigators are
also exploring the possibility of using peer group discussion. A recent ten-year outcome study of a family-
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based behavioral treatment for childhood obesity suggests that early intervention in childhood can effect
important and lasting changes in weight control (Epstein, Valoski, Wing, & McCurley, 1994).
OTHER APPLICATIONS:
Treatment and preventive initiatives must be supplemented with techniques that encourage patients to cope
with medical procedures and to follow medical advice.
A. COPING WITH MEDICAL PROCEDURES
The' prospect of facing surgery, a visit to the dentist, or a variety of medical examinations has been enough
to strike fear into the heart of even the strongest. Faced with such procedures, many patients delay their
visits or even forgo them entirely. Health psychologists specializing in behavioral medicine have developed
interventions to help patients deal with the stress surrounding such procedures.
B. PREPARATION FOR SURGERY:
A sizable amount of research has been done on Nays to improve psychological preparation for surgery.
Similar to those used to prepare patients for medical examinations and procedures, interventions include
(1) relaxation strategies,
(2) basic information about the procedures to be used.
(3)information concerning the bodily sensations experienced during the procedures, and
(4) cognitive coping skills (Brannon & Feist, 2000).
HEALTH PSYCHOLOGY: PROSPECTS FOR THE FUTURE
Health psychology is a growing field, and more psychologists are entering it every year. Therefore, it may
now be time for the field to take a look at itself and decide how best to train health psychologists and
structure programs to achieve training goals (Belar, 1997).Now we will discuss several health care trends,
training issues for future health psychologists, and important issues for the field of health psychology to
address in the future.
HEALTH CARE TRENDS
By the end of 1997, 85% of Americans belonged to some kind of managed health care plan (Winslow,
1998). In managed care systems, containing costs is a high priority. we know the great impact managed care
has had and will have on clinical psychologists. The impact on health psychologists will be even greater
because these specialists often work in medical centers or primary care settings. Health psychologists, by
virtue of their training, are well suited to provide interventions that will serve to cut the costs of medical
care (Belar, 1997; Friedman, Sobel, Myers, Caudill, & Benson, 1995). As business and industry realize the
costs they must absorb from employees whose habits and lifestyles create absenteeism, inefficiency, and
turnover, it is expected they will use the skills of health psychologists more often.
Although there appears to be an ever-increasing need for clinical psychologists specializing in health or
behavioral medicine, it should also be noted that currently there appears to be a surplus of mental health
professionals. For example, Frank and Ross (1995) estimate that there are approximately 32.8 social
workers, 22.8 psychologists, 13.1 psychiatrists, and 4.3 psychiatric nurses for every 100,000 Americans (a
total of 73 mental health professionals per 100,000). The problem lies in the overlapping definitions of each
discipline; all claim to assess and treat similar problems. As the economic stakes become higher, it is likely
that these disciplines self-definitions will incorporate concepts and issues once thought to be uniquely
characteristic of health psychology and behavioral medicine. Frank and Ross (1995) call for more
coordination of health workforce planning at the national level.
Clearly defining and establishing psychology's role in health care also requires efforts at delineating
psychology's unique contributions amid an increasing supply of other health-related professions ... efforts
to establish clear professional boundaries and identities among the various health care groups should be
based on dialogue, coordination, and cooperation to ensure that the health care needs of the population are
met by qualified, ethical, and competent professionals.
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TRAINING ISSUES IN HEALTH PSYCHOLOGY
A major source of health psychologists continues to be clinical psychology programs. The scientist-
practitioner and clinical scientist models adopted by most clinical psychology programsenable them to train
clinicians well suited for health psychology. Until recently, no other psychology specialty offered the
combination of academic, scientific, professional, and hospital experiences required for work in medical
settings. At the same time, Stroebe and Stroebe (1995) make a case for the background of social
psychologists, Again, the roles of methodology, quantitative analysis, and research design are emphasized.
Other psychology subspecialties are also well represented in health psychology. Many of the people cited in
this chapter are experimental or physiological psychologists-not just clinicians or social psychologists.
For the most part, health psychology is still a kind of ad hoc appendage to doctoral programs in
psychology. The student enters a clinical, social, or experimental program and then, in addition to the core
experience, does some specialized research or takes a practicum or two in a health-related topic. Perhaps
this is augmented by an internship at a health care site. But essentially, the health experiences are grafted
onto an already existing program in clinical psychology or some other related discipline.
Many people are now calling for health psychology to be a standard, core training component for all
professional psychologists for example, Frank & Ross, 1995). Because of the importance of health issues
and the broadening of the definition of clinical and professional psychology, training in areas such as
psychopharmacology, neuropsvchoiogy, and psychoneuroimmunology is considered essential. Further,
future health psychologists must be trained so that they can design and conduct studies to empirically
evaluate health outcomes. Currently, some clinical psychology graduate programs offer "tracks" in health
psychology or behavioral medicine, but this is the exception rather than the rule. In any case, curricular rec-
ommendations for health psychology training continue to be offered (Brannon & Feist, 2000).
OTHER CHALLENGES
Any newly emerging field has problems the defining roles of its members: health psychology is no
exception. Years ago. S. E. Taylor t 1984) identified several of these problems. One problem is simply role
ambiguity. No one is totally prepared to say just what a health psychologist should do-especially in a
practical work setting. Health psychologists may actually find themselves without psychology colleagues or
role models in the health setting, which only adds to their confusion.
Second. issues of status also arise. In health settings, the physician is clearly at the top of the heap.
Sometimes the psychologist enjoys much less status in a medical center setting than. for example, in an
academic settings.
Furthermore, the psychologist and the heath care professional may have competing goals. The latter may be
interested only in identifying immediate ways of helping the patient. The psychologist may be more
tentative and contemplative while thinking about research, theoretical models, and interventions.
As one way of establishing their identity and presence in settings traditionally dominated by physicians.
health psychologists need to document the cost-effectiveness of their interventions (Friedman et al., 1995).
In this era of health care reform, insurance companies and government agencies are scrupulously examining
ways to drive down the cost of health care.
Given the many successful and cost-efficient interventions performed by those specializing in health
psychology and behavioral medicine, ask Friedman et al. (1995), why haven't these interventions been
integrated to a greater extent into our health care system? They suggest several possible reasons:
1. Many of the data supporting the role of health psychology are unknown to physicians.
2. Biological origins of diseases and illnesses have been emphasized, causing many to overlook the
possible benefits of psychosocial explanations and behavioral interventions.
3. patients may be resistant to psychological interventions(and explanations).
4. Clinical health psychology and behavioral medicine are still confused with traditional, long-term
psychotherapy.
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Clearly, physicians, insurance companies, the 'federal government, and the general public need to be
educated regarding the role of health psychologists, as well as the potential financial and clinical benefits of
their interventions.
Another challenge for the field concerns ethnicity and health. The health profiles (such as life expectancy
and health status) of various ethnic minority populations in the United States appear to differ greatly from
one another, and more research is needed on health-promoting and health-damaging behaviors among
members of these groups (N. B. Anderson, 1995). Informative articles reporting on the health status of
African Americans, Asian Americans, and Hispanic Americans (Flack et al., 1995), behavioral risk factor
related to chronic diseases in ethnic minorities (Meyers, Kagawa-Singer, Kumanyika, Lex, & Marlddes,
1995), and the use of health care systems by ethnic minorities (Penn, Snehendu, Kramer, Skinner, &
Zambrana, 1995) have recently appeared in a special issue of Health Psychology. These reports and others
point out the need to further assess the relations between behavior and health in special populations.
It is easy to become carried away with the enthusiasm generated by an exciting new field. This has been
true in virtually every area of clinical psychology so far. However there is still a gap between the field's
promise and its accomplishment. as any experienced clinician will tell you, it is very hard to change human
behavior over the long haul.neverthe less, health psychology most assuredly deserves our enthusiasm as
well as our caution. Many people are optimistic about the future of health psychology, given the pressing
demands of improved health care. Infact Belar(1997)and others believe that health psychology is uniquely
suited to be the specialty for the professional practice psychology in twenty-first century.
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Table of Contents:
  1. MENTAL HEALTH TODAY: A QUICK LOOK OF THE PICTURE:PARA-PROFESSIONALS
  2. THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST:THE INTERNSHIP
  3. HOW A CLINICAL PSYCHOLOGIST THINKS:Brian’s Case; an example, PREDICTION
  4. HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY:THE GREEK PERIOD
  5. HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION
  6. HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT
  7. MODELS OF TRAINING IN CLINICAL PSYCHOLOGY:PROFESSIONAL SCHOOLS
  8. CURRENT ISSUES IN CLINICAL PSYCHOLOGY:CERTIFICATION, LICENSING
  9. ETHICAL STANDARDS FOR CLINICAL PSYCHOLOGISTS:PREAMBLE
  10. THE ROLE OF RESEARCH IN CLINICAL PSYCHOLOGY:LIMITATION
  11. THE RESEARCH PROCESS:GENERATING HYPOTHESES, RESEARCH METHODS
  12. THE CONCEPT OF ABNORMAL BEHAVIOR & MENTAL ILLNESS
  13. CAUSES OF MENTAL ILLNESOVERVIEW OF ETIOLOGY:PANDAS
  14. THE PROCESS OF DIAGNOSIS:ADVANTAGES OF DIAGNOSIS, DESCRIPTION
  15. THE CONCEPT OF PSYCHOLOGICAL ASSESSMENT IN CLINICAL PSYCHOLOGY
  16. THE CLINICAL INTERVIEW:The intake / admission interview, Structured interview
  17. THE ASSESSMENT OF INTELLIGENCE:RELIABILTY AND VALIDITY, CATTELL’S THEORY
  18. INTELLIGENCE TESTS:PURPOSE, COMMON PROCEDURES, PURPOSE
  19. THE USE AND ABUSE OF PSYCHOLOGICAL TESTING:PERSONALITY
  20. THE PROJECTIVE PERSONALITY TESTS:THE RORSCHACH
  21. THE OBSERVATIONAL ASSESSMENT AND ITS TYPES:Home Observation
  22. THE BEHAVIORAL ASSESSMENT THROUGH INTERVIEWS, INVENTORIES AND CHECK LISTS
  23. THE PROCESS AND ACCURACY OF CLINICAL JUDGEMENT:Comparison Studies
  24. METHODS OF IMPROVING INTERPRETATION AND JUDGMENT
  25. PSYCHOLOGICAL INTERVENTIONS AND THEIR GOALS:THE EXPERT ROLE
  26. IMPORTANCE OF PSYCHOTHERAPY:ETHICAL CONSIDERATIONS
  27. COURSE OF NEW CLINICAL INTERVENTIONS:IMPLEMENTING TREATMENT
  28. NATURE OF SPECIFIC THERAPEUTIC VARIABLES:CLIENT’S MOTIVATION
  29. THE BEGINNING OF PSYCHOANALYSIS:THE CASE OF ANNA, THE INSTINCTS
  30. PSYCHOANALYTIC ALTERNATIVES:EGO ANALYSIS, CURATIVE FACTORS
  31. CLIENT CENTERED THERAPY:PURPOSE, BACKGROUND, PROCESS
  32. GESTALT THERAPY METHODS AND PROCEDURES:SELF-DIALOGUE
  33. ORIGINS AND TRADITIONAL TECHNIQUES OF BEHAVIOR THERAPY
  34. COGNITIVE BEHAVIORAL THERAPY:MODELING, RATIONAL RESTRUCTURING
  35. GROUP THERAPY: METHODS AND PROCEDURES:CURATIVE FACTORS
  36. FAMILY AND COUPLES THERAPY:POSSIBLE RISKS
  37. INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY:THE ENVIRONMENT
  38. METHODS OF INTERVENTION AND CHANGE IN COMMUNITY PSYCHOLOGY
  39. INTRODUCTION AND HISTORY OF HEALTH PSYCHOLOGY
  40. APPLICATIONS OF HEALTH PSYCHOLOGY:OBESITY, HEALTH CARE TRENDS
  41. NEUROPSYCHOLOGY PERSPECTIVES AND HISTORY:STRUCTURE AND FUNCTION
  42. METHODS OF NEUROLOGICAL ASSESSMENT:Level Of Performance, Pattern Analysis
  43. FORENSIC PSYCHOLOGY:Qualification, Testifying, Cross Examination, Criminal Cases
  44. PEDIATRIC AND CHILD PSYCHOLOGY: HISTORY AND PERSPECTIVE
  45. INTERVENTIONS & TRAINING IN PEDIATRIC AND CLINICAL CHILD PSYCHOLOGY