Health Psychology Chapter 1: Introduction to Health Psychology August 22-24, 2007 Classes #2-3

Health psychology: “A field which integrates psychological knowledge relevant to the maintenance of health, the prevention of illness, and the adjustment to illness.” (Wolfgang Stroebe, 2000)

Course Goals To encourage thinking about health and illness from a number of perspectives, including: scientist/researcher patient caregiver health professional

Course Goals Health psychology is an integrative field – you will be encouraged to synthesize ideas from a number of approaches and perspectives, through evaluation of theories, studies, and personal experience.

How would you describe your general overall health? I am in excellent health. I am in good health. I am in average health. I am in poor health. Take poll with class – ask how many would say that they are in excellent health. Then ask of those students, OK, (click to next slide) what is health, and how do you know that yours is excellent?

What is health? “The absence of disease, disorder and injury.” The Cornell Illustrated Encyclopedia of Health, 2002 "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organization Describe how this is a marked changed from medical definitions of health. Why are definitions important? Well, imagine that you’re a physician or a psychiatrist (hand some of you will be in a few years). If your definition of health is the absence of disease, will you consider it your job to help a patient create the most rewarding life possible? Or is it only your job to help a patient put together the pieces when everything falls apart?

Disease v. Illness Disease is a diagnosable biological dysfunction or infection. Illness is an individual’s unique experience of pain and suffering. Example: stomach pain What does recognizing illness buy us as a science that is applied in medical settings? Relate back to definitions of health.

Etiology 1 : CAUSE, ORIGIN; specifically : all of the causes of a disease or abnormal condition

Social pressures: Group think? Etiology Example: A Broken Bone Aggression? Social pressures: Group think? Sensation seeking? Alcohol abuse? Role models? Proximal cause What lead to the proximal cause? Psychological and social origins. Risk taking? Competition? Sleep deprivation?

Why do people get sick? Biomedical Model: Exposure to infectious agents or pathogens Immune response either sufficient or insufficient Introduce the biomedical model as an extension of the biomedical definition of health given earlier. Modern medicine has looked to two explanations for disease: exposure to infectious agents, i.e. tuberculosis, and changes in physical systems, such as the changes to blood vessels that increase risk for heart disease. Move into thought experiment…..(next slide)

Why else do people get sick? Previous exposure to virus Health behaviors (sleep, nutrition, etc.) Stress/emotions Social relationships (support, conflict) Imagine that I release a large quantity of cold virus into the ventilation system of the room, enough to guarantee that everyone in this room is exposed to the virus. Not everyone will develop symptoms – why not? Discuss each of these briefly, in terms of the their effects on the immune system in handling infections.

Biopsychosocial Model Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness This conceptualization, labeled the Biopsychosocial Model, 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).

The Biopsychosocial Model * The Biopsychosocial Model BIO PSYCHO HEALTH Use multiple languages in a room metaphor to compare biomedical and biopsychosocial models. SOCIAL

The Biopsychosocial Model: Why do college students get sick? health behaviors previous exposure to virus BIO PSYCHO immune reaction to virus personality HEALTH emotions SOCIAL social support social conflict

The Biopsychosocial Model: Understanding Pain Recall pain experience. Perhaps you recalled a time that you were injured, or a time when you were very sick, or perhaps a time when you felt a great deal of emotional pain. Did the pain influence other aspects of your life, such as your ability to fulfill role obligations (like studying for an exam, going to practice, or being a good friend)? A biopsychosocial approach to pain asks questions about how physical pain is related to psychological and social factors. For example….

Why does a broken heart hurt so much?!?!

Where is pain in the brain? The same part of the brain – the anterior cingulate cortex – responds to physical and emotional pain.                                                                                                Is this the pain part of the brain – or the suffering part of the brain? Does Rejection Hurt? An fMRI Study of Social Exclusion Naomi I. Eisenberger,1* Matthew D. Lieberman,1 Kipling D. Williams2 A neuroimaging study examined the neural correlates of social exclusion and tested the hypothesis that the brain bases of social pain are similar to those of physical pain. Participants were scanned while playing a virtual ball-tossing game in which they were ultimately excluded. Paralleling results from physical pain studies, the anterior cingulate cortex (ACC) was more active during exclusion than during inclusion and correlated positively with self-reported distress. Right ventral prefrontal cortex (RVPFC) was active during exclusion and correlated negatively with self-reported distress. ACC changes mediated the RVPFC-distress correlation, suggesting that RVPFC regulates the distress of social exclusion by disrupting ACC activity. Describe study: Eisenberger and her co-authors created a computer game in which test subjects were led to believe they were playing ball with two other players. At some point, the other players seemed to exclude the test subject from the game -- making it appear the test subject had been suddenly rejected and blocked from playing with the group. The shock and distress of this rejection registered in the same part of the brain, called the anterior cingulate cortex, that also responds to physical pain, Eisenberger said. "The ACC is the same part of the brain that has been found to be associated with the unpleasantness of physical pain, the part of pain that really bothers us," Eisenberger said. Transition: In a previous lecture, Prof. Gross described how psychological states can influence pain perception. This study gives us one yet another reason to suspect that pain is profoundly influenced by emotional and social events as well. In fact, researchers have found….

Studies of Chronic Pain People with chronic pain are more likely to have an anxious personality. People with chronic pain report low levels of social support. afflicts nearly 100 million people in the United States, more than a third of the population, according to the Society for Neuroscience. Chronic pain has been said to be the most costly health problem in America. Estimated annual costs, including direct medical expenses, lost income, lost productivity, compensation payments, and legal charges, are about $90 billion. Most patients with chronic pain report that biomedical approaches – I.e. prescription medication – do not adequately treat their pain. Individuals with chronic pain are at an increased risk for suicide. Mention how this information can help physicians understand chronic pain (except for the last one??) Chronic pain is one of the areas where biomedicine has really failed to make great progress, because pain is so strongly influenced by psychosocial factors.

Studies of Experimental Pain                                                    Anxiety and fear increase pain. Having a friend present reduces pain. Mention how this could be applied to medical contexts. Note that biomedical/disease models can tell us nothing about how individuals experience pain – because in disease models, pain is supposed to be caused by tissue damage or other biological dysfunction.

Psychological Consequences of Pain Chronic back pain patients showed atrophy in the prefrontal cortex. and….. impaired judgment in a risk-taking task.

Social Consequences of Pain Think back to your pain memory…. Did the pain influence your ability to fulfill social role obligations?

Social Consequences of Pain Think back to your pain memory…. Did the pain influence your ability to fulfill social role obligations? Being a good student?

Social Consequences of Pain Think back to your pain memory…. Did the pain influence your ability to fulfill social role obligations? Being a good team member?

Social Consequences of Pain Think back to your pain memory…. Did the pain influence your ability to fulfill social role obligations? Being a good friend?

The Biopsychosocial Model: Understanding Pain neurological changes risk-taking BIO PSYCHO brain activation anxiety, fear HEALTH SOCIAL attachment role obligations rejection social support

What do health psychologists do? Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. In contemporary research and medical settings, 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 assessment and treatment services Many health psychologists focus on prevention through research and clinical interventions designed to foster health and reduce the risk of disease While more than half of health psychologists provide clinical services as part of their duties, many health psychologists function in non-clinical roles primarily involving teaching and research.

The Work Setting of a Health Psychologist… Health psychologists participate in health care in a multitude of settings including: primary care programs inpatient medical units specialized health care programs such as pain management, rehabilitation, women's health, oncology, smoking cessation, headache management, and various other programs They also work in colleges and universities, corporations, and for governmental agencies

Clinical Activities… Assessment approaches often include cognitive and behavioral assessment, psychophysiological assessment, clinical interviews, demographic surveys, objective and projective personality assessment, and various other clinical and research-oriented protocols Interventions often include stress management, relaxation therapies, biofeedback, psychoeducation about normal and patho-physiological processes, ways to cope with disease, and cognitive-behavioral and other psychotherapeutic interventions Healthy people are taught preventive health behaviors. Both individual and group interventions are utilized

Research… Health psychologists are on the leading edge of research focusing on the biopsychosocial model in areas such as HIV, oncology, psychosomatic illness, compliance with medical regimens, health promotion, and the effect of psychological, social, and cultural factors on numerous specific disease processes (e.g., diabetes, cancer, hypertension and coronary artery disease, chronic pain, and sleep disorders) Research in health psychology examines: the causes and development of illness, methods to help individuals develop healthy lifestyles to promote good health and prevent illness, the treatment people get for their medical problems, the effectiveness with which people cope with and reduce stress and pain, biopsychosocial connections with immune functioning, and factors in the recovery, rehabilitation, and psychosocial adjustment of patients with serious health problems

Career Opportunities… The opportunities for careers in health psychology in the United States are quite good. Medical settings, particularly medical centers, have greatly expanded their employment of psychologists Aside from medical centers, health psychologists often work in colleges and universities, medical schools, health maintenance organizations, rehabilitation centers, pain management centers, public health agencies, hospitals, and private consultation/practice offices

Training for Health Psychology Careers… Health psychologists typically hold a doctoral degree (Ph.D. or Psy.D.) in psychology. Applied health psychologists are licensed for the independent practice of psychology in areas such as clinical and counseling psychology, and board certification is available in health psychology through the American Board of Professional Psychology Often, psychologists preparing for a career in health psychology obtain general psychology training at the undergraduate and doctoral levels, but then receive specialty training at the postdoctoral or internship level. Some programs have been developed which offer specialized training in health psychology at undergraduate and graduate levels

Undergraduate programs… Health psychology courses are available at about a third of North American colleges and universities Because of the field's biopsychosocial orientation, students are also encouraged to take courses focusing on abnormal and social psychology, learning processes and behavior therapies, psychophysiology, anatomy and physiology, psychopharmacology, community psychology, and public health

Graduate Programs Many doctoral programs in clinical, counseling, social, or experimental psychology have specialized tracks in health psychology A number of programs now exist in the United States and other countries specifically for doctoral training in health psychology These programs are diverse: some specialize in training students either for research careers or for direct clinical service to patients

Predoctoral Internships… Clinical and counseling psychologists are required to complete a one-year internship/residency before obtaining their doctorates Many of these programs offer some training in health psychology. A number of internship programs provide specialized training in health psychology in which at least half of the trainee's time is spent in supervised health psychology activities

Postdoctoral Fellowships… Many university medical centers, universities, health centers, and health psychology programs offer specialized research and/or clinical training in different areas of health psychology

Credits stanford.edu/~kmcg/portfolio/documents/finalwinterlP1healthpsych.ppt http://wwwpsych.stanford.edu/~kmcg/portfolio/documents/HealthPsychologyintrotopics.ppt#3