Health psychology
Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare.[1] The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm (smoking or consuming excessive amounts of alcohol) or enhance (engaging in exercise) health.[2] Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes (e.g., a virus, tumor, etc.) but also of psychological (e.g., thoughts and beliefs), behavioral (e.g., habits), and social processes (e.g., socioeconomic status and ethnicity).[2]
By understanding psychological factors that influence health, and constructively applying that knowledge, health psychologists can improve health by working directly with individual patients or indirectly in large-scale public health programs. In addition, health psychologists can help train other healthcare professionals (e.g., physicians and nurses) to apply the knowledge the discipline has generated, when treating patients. Health psychologists work in a variety of settings: alongside other medical professionals in hospitals and clinics, in public health departments working on large-scale behavior change and health promotion programs, and in universities and medical schools where they teach and conduct research.
Although its early beginnings can be traced to the field of clinical psychology,[3] four different divisions within health psychology[4] and one related field, occupational health psychology (OHP),[5][6][7][8] have developed over time. The four divisions include clinical health psychology, public health psychology, community health psychology, and critical health psychology.[4] Professional organizations for the field of health psychology include Division 38 of the American Psychological Association (APA),[9] the Division of Health Psychology of the British Psychological Society (BPS),[10] the European Health Psychology Society,[11] and the College of Health Psychologists of the Australian Psychological Society (APS).[12] Advanced credentialing in the US as a clinical health psychologist is provided through the American Board of Professional Psychology.[13]
Objectives[edit]
Understanding behavioral and contextual factors[edit]
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 policy.[38] Health psychologists have worked on developing ways to reduce smoking[39] 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.[40]
Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. Physical addiction impedes smoking cessation. Some research suggests that seductive advertising also contributes to psychological dependency on tobacco,[41] although other research has found no relationship between media exposure and smoking in youth.[42] OHP research indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease.[43][44] Other research reveals a relation between unemployment and elevations in blood pressure.[45][46] Epidemiologic research documents a relation between social class and cardiovascular disease.[47]
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 psychologists employ cognitive behavioral therapy and applied behavior analysis (also see behavior modification) for that purpose.
Preventing illness[edit]
Health psychologists promote health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Health psychologists try to help people to lead a healthy life by developing and running programmes which can help people to make changes in their lives such as stopping smoking, reducing the amount of alcohol they consume, eating more healthily, and exercising regularly.[14] 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.[48] 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.[49]
Health psychologists help to promote health and well-being by preventing illness.[14] Some illnesses can be more effectively treated if caught early. Health psychologists have worked to understand why some people do not seek early screenings or immunizations, and have used that knowledge to develop ways to encourage people to have early health checks for illnesses such as cancer and heart disease.[14] Health psychologists are also finding ways to help people to avoid risky behaviors (e.g., engaging in unprotected sex) and encourage health-enhancing behaviors (e.g., regular tooth brushing or hand washing).[14]
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.[50]
There is also evidence from OHP that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues[51] have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.
Illness, disabilities and long-term conditions[edit]
Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. These stressors include problems meeting medical and other bills, problems obtaining proper care when home from the hospital, obstacles to caring for dependents, the experience of having one's sense of self-reliance compromised, gaining a new, unwanted identity as that of a sick person, and so on. These stressors can lead to depression, reduced self-esteem, etc.[52]
The use of medications can alter the microbiome and potentially impact overall health and the development of diseases. It has been discovered that the metabolites produced by intestinal microorganisms can influence one's health. For instance, antidepressants can modify the composition of the intestinal microbiota, which can then affect the course of the disease through changes in specific metabolites produced by certain intestinal microorganisms. This has significant implications, particularly in the context of depression, as it offers new insights into how to approach and treat the condition at hand.[53]
Health psychologists can support people living with long-term conditions to improve or maintain quality of life, self-manage their conditions, and adjust to life with an illness, disability or long-term condition.
Health psychology also concerns itself with bettering the lives of individuals with terminal illness. When there is little hope of recovery, health psychologist therapists can work within a multi-disciplinary palliative care team to improve the quality of life of the patient by helping the patient recover at least some of his or her psychological well-being.[54]
A form of therapy shown in recent studies is psychotherapy. It is used as a mode of intervention due to the inconsistency and issues that may arise from pharmacological interventions. It ensures the use of evidence-based practices and helps in facilitating adherence to medication regimens that may be impacted by psychiatric symptoms, such as low motivation or depressive symptoms. When using psychotherapeutic strategies, clinicians can choose from three modes: individual, family/couples, and group psychotherapy.[55]
Critical analysis of health policy[edit]
Critical health psychologists explore how health policy can influence inequities, inequalities and social injustice.[56] 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 qualitative methods that zero in on the health experience.[57]
Conducting research[edit]
Like psychologists in the other main psychology disciplines, health psychologists have advanced knowledge of research methods. Health psychologists apply this knowledge to conduct research on a variety of questions.[58] For example, health psychologists carry out research to answer questions such as:
Applications[edit]
Improving doctor–patient communication[edit]
Health psychologists 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).[59] One 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.[60]
Improving adherence to medical advice[edit]
Health psychologists engage in research and practice aimed at getting people to follow medical advice and adhere to their treatment regimens. Patients 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.[61] Additionally, traditional cognitive-behavioural therapies have been adapted for people with chronic illnesses and comorbid psychological distress to include modules that encourage, support and reinforce adherence to medical advice as part of the larger treatment approach.[62]
Below are some examples of the types of positions held by health psychologists within applied settings such as the UK's NHS and private practice.
Healthcare professionals who treat individuals with mental health conditions prefer medications that provide energy and have fewer side effects. When prescribing psychiatric drugs, it is essential to consider individual needs, safety, and anti-doping policies. Psychologists patients prefer specific medications like escitalopram for anxiety, melatonin for insomnia, lamotrigine for bipolar disorders, and aripiprazole for psychotic disorders. This emphasizes the importance of personalized prescribing individuals.[66]
Training[edit]
United States[edit]
Universities began to develop doctoral-level training programs in health psychology. In the US, post-doctoral level health psychology training programs were established for individuals who completed a doctoral degree in clinical psychology.
United Kingdom[edit]
The term "health psychologist" is a protected title, with health psychologists required to register with the Health Professions Council (HPC) and have trained to a level to be eligible for full membership of the Division of Health Psychology within the BPS.[67] Registered health psychologists who are chartered with the BPS will have undertaken a minimum of six years of training, with three of those years dedicated to health psychology training.[58] Following the completion of a BPS-accredited undergraduate degree in Psychology, aspiring health psychologists must first complete a BPS-accredited masters in health psychology (Stage 1 training). Once the trainee has completed Stage 1 training, they can either choose to complete the BPS' independent Stage 2 training route or sign up to an accredited health psychology doctorate program at a UK university (DHealthPsy). Both training routes require trainees to demonstrate they meet the core competencies of: