“You, the individual, can do more for
your own health and well-being than
any doctor, any hospital, and drug,
any exotic medical service”
US Department of Health,
Education, and Welfare
Health Psychology
University of Toronto
Winter, 2005
Dr. Duane Hargreaves
Email: [email protected]
Phone: (905) 828-3957
Web: www.utm.utoronto.ca/~w3psy333/winter2005.htm
Lecture 1 - Outline
• Part 1
– Welcome and Introduction
– Topic Overview - Aims and Objectives
– Assessment
• Part 2
– What is Health Psychology?
• Part 3
– Scientist-Practitioner Model
Lecture 1 - Part 1
Welcome and Introduction
Course Handbook
Course Instructors
Learning Outcomes
Course Outline (readings)
General information (expectations, contact, assessment, text)
Lecture Outlines
Lecture 1 - Part 2
What is Health Psychology?
Question
What is most important in our lives?
Freedom
Enjoying life
Honesty
Reciprocation of favors
Social power
Broadminded
Successful
True friendship
Healthy
Accepting my portion in life
Self indulgent
Protecting the environment
Social order
Responsible
Social Justice
Pleasure
Equality
Self-respect
A varied life
Wealth
A spiritual life
Respect for tradition
Family security
Curiosity
Wisdom
Loyal
Question
What is most important in our lives?
Sample of 162 women and men
• Most important …
• 2nd most important …
• 3rd most important …
• 4th most important …
• Etc …
What is Health?
Health is popularly defined in terms of absence of
disease, but may be viewed as an illness/wellness
continuum
The World Health Organization (WHO) defines
health as “a complete state of physical, mental and
social well-being and not merely the absence of
disease or infirmity”.
Illness/Wellness Continuum
1900
1990
Changing patterns of illness
Summary
• 1900s - infectious diseases main cause of
death (acute conditions)
• 1960s - degenerative diseases main cause of
death (chronic conditions)
• 1990s - new infectious disease main cause
of premature death (chronic condition)
Death rates from infectious and parasitic disease, 1907 to 1998
Acute vs. Chronic Disorders
Summary
• acute conditions = short-lived, curable
– Etiology - Beyond individual control
• chronic conditions = long-lasting, no cure
– Etiology - Partly influenced by behavior
Reasons for changed causes of death
• Improved hygiene (water supply, etc)
• Penicillin (antibiotics)
• Aging population (risk factor for degenerative disease)
• Health Behaviors
– Activities to prevent or detect disease
Change 5 behaviors
According to the US
Public Health Service,
of the 10 leading
causes of death in the
US, at least 7 could be
reduced substantially
if people at risk would
change just 5
behaviors!
1. Adherence to medical
recommendations
(eg use of hypertensive
medication)
2. Diet
3. Smoking
4. Lack of exercise
5. Alcohol and drug use
Estimated contributions of behavior, medical care,
genetics, and other factors to health status.
Behavior 40%
Models of Health
• Biomedical Model
– Historically, dominant paradigm
– Suggests illness is a function of aberrant
somatic processes
– Main Focus = cure (biology and medicine)
Models of Health
• Biopsychosocial Model
– Current dominant paradigm
– All conditions of health and disease have
mental and social components
– Main focus = health (prevention not cure)
Models of Health
• Biopsychosocial Model
“health (wellness and illness) is a function
of biological, psychological, and social
factors in continual interaction”
A “factors” approach
A “systems” approach
The Biopsychosocial Model from Factors and Systems Perspectives
Health Psychology
• What is health psychology?
“the aggregate of the specific educational, scientific,
and professional contributions of the discipline of
psychology to …
– Promotion and maintenance of health (health habits)
– Prevention and treatment of illness (clinical)
– Identification of etiological and diagnostic correlates of
health and illness (research)
– Analysis of the health care system and health policy
formation (political)
(Matazarro, 1982)
Health Psychology
… vs. other health-related disciplines
• Medical psychology
• Psychosomatic medicine
• Behavioral medicine
• Behavioral health
• Medical sociology
Publications in Health Psyc.
Lecture 1 - Part 3
Scientist-Practitioner Model
Scientist-Practitioner Model
The essence of the S-P model is that students in clinical
psychology should be trained in research as well as
clinical skills.
Implications of the S-P model for clinical practice are a
little less clear!
S-P model in practice
3 different emphases:
• Practitioner uses research and basic principles to guide
treatment and assessment or to develop new approaches
(evidenced-based)
• Practitioner evaluates outcome (formal assessment of
outcome)
• Practitioner engages in research
Practitioners engage in 1, 2, or all 3 emphases
Importance of Psych. Theory
• Basis for effective techniques lies in the theoretical substrate
of the discipline of psychology
• Development of new therapies/interventions depends upon
this theoretical basis
• Application to complex or new problems requires a
theoretical basis
– Eg Walby (1970) … systematic desensitization for phobias
previously thought untreatable.
• Causal processes and mechanisms of change
Importance of Empiricism
• Evaluation of the efficacy of treatments
• Empirical justification for claims
• Delineation of limits of claims (rarely unequivocal)
– Success rates, breadth of response, long-term outcome
• Study of predictors of outcome
• Best practice protocols
Scientist-Practitioner Model
Hierarchical Knowledge Stores
• Empirically established relationships
• Scientific theories
• Clinical lore (shared beliefs and practices)
• Professional experience
• Personal experience
(James, 1991)
… acknowledges that we don’t know everything!
Scientist-Practitioner Model
Brief History…
• University clinics (foundation for US model of training)
–
–
–
–
1896 Pennsylvania Clinic
1908 Colorado
1909 Minnesota
1914 (26 University clinics in USA)
• Boulder Conference (1949)
– Research and clinical practice as joint training goal
• B F Skinner (1953) … Science and Human Behavior
• Hans Eysenck (1959) … Learning Theory and Behavior Therapy
• 1960s and 70s … treatment outcome evaluations
Scientist-Practitioner Model
Brief History…
• 1980s and 1990s
–
–
–
–
–
–
–
–
Large scale studies and follow-ups
Extensions to new areas
Refinement of techniques (eg anxiety disorders)
Relapse prevention (eg addictions)
Growth of behavioral medicine and health psychology
Use of the term “cognitive-behavior therapy”
Cost-effectiveness
Manual-based treatments derived from research
Scientist-Practitioner Model
Manual-Based Treatments
• Development of manuals as a “revolution”
• Evidence-based medicine
• Advantages
–
–
–
–
Consistency of application (replicability)
Quality assurance for customers
Ease of training
Division 12 (APA task force)
• Criticisms
– Appropriate renewal
Scientist-Practitioner Model
Scientific Achievements
•
•
•
•
•
Most effective treatment for anxiety
Very effective treatment for depression
Sexual problems
Eating disorders, addictions
Health psychology
–
–
–
–
Pain
Diabetes
Cardiovascular disorders
Tinnitus
Scientist-Practitioner Model
Professional Achievements
• Role of psychologist strengthened as providers of effective
interventions
• Empirical justification for psychological therapy - potential
cost effectiveness
• More effective therapy for clients for a wide range of
problems - extension to health
• Link between pure and applied psychology
Scientist-Practitioner Model
Implications for Health Psychology
• Adherence to the S-P model
• Active involvement of psychologists is transfer of psychological
knowledge to other health care professionals
– Nurses, doctors, pharmacists, OTs, speech therapists, physiotherapists, etc
– Psychologizing of health care
• “The promulgation of the scientific ethos in general, and the S-P model
in particular, among all the health professions.” (James, 1991)
Scientist-Practitioner Model
Invalid Criticisms
• Few clinicians engage in research
• Treatment-outcome literature is not useful
• What does the clinician do when a client fails to respond
• Clinicians need to be pragmatic, flexible, eclectic
• “human problems cannot be solved by science - therapy is
an art, not a science”
– Limited view of science
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