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Health psychology is the study of psychological and behavioral processes in health, illness, and

healthcare.[1] It is concerned with understanding how psychological, behavioral, and cultural factors
contribute to physical health and illness. Psychological factors can affect health directly[2]. 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 health (engaging in exercise).[3] 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).[3]
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 take advantage of 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,[4] four different divisions
within health psychology and one related field, occupational health psychology (OHP),[5] have
developed over time. The four divisions include clinical health psychology, public health psychology,
community health psychology, and critical health psychology.[6] Professional organizations for the
field of health psychology include Division 38 of the American Psychological Association (APA),[7] the
Division of Health Psychology of the British Psychological Society (BPS),[8] and the European Health
Psychology Society.[9] Advanced credentialing in the US as a clinical health psychologist is provided
through the American Board of Professional Psychology.[10]

Contents

 1Overview
 2Origins and development
 3Objectives
o 3.1Understanding behavioral and contextual factors
o 3.2Preventing illness
o 3.3The effects of disease
o 3.4Critical analysis of health policy
o 3.5Conducting research
o 3.6Teaching and communication
 4Applications
o 4.1Improving doctor–patient communication
o 4.2Improving adherence to medical advice
 4.2.1Ways of measuring adherence
o 4.3Managing pain
o 4.4Health psychologist roles
 5Training
 6See also
 7Further reading
 8References
 9External links
o 9.1North America
o 9.2Europe

Overview[edit]
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, 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).
Psychologists who strive to understand how biological, behavioral, and social factors influence
health and illness are called health psychologists. Health psychologists use their knowledge of
psychology and health to promote general well-being and understand physical illness.[11] They are
specially trained to help people deal with the psychological and emotional aspects of health and
illness. 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 healthier lifestyles and try to find ways to encourage people to improve their
health. For example, they may help people to lose weight or stop smoking.[11] Health psychologists
also use their skills to try to improve the healthcare system. For example, they may advise doctors
about better ways to communicate with their patients.[11] Health psychologists work in many different
settings including the UK's National Health Service (NHS), private practice, universities,
communities, schools and organizations. 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, the Journal of Health Psychology, the British Journal of
Health Psychology,[12] and Applied Psychology: Health and Well-Being.[13] Health psychologists can
work with people on a one-to-one basis, in groups, as a family, or at a larger population level.[11]
Clinical health psychology (ClHP)
ClHP is 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 areas for clinical psychologists. It is also a major contributor to the
prevention-focused field of behavioral health and the treatment-oriented field of behavioral
medicine. Clinical practice includes education, the techniques of behavior change, 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)
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, nutrition, genetics and biostatistics. 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)
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)
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.
Health psychology, like other areas of applied psychology, is both a theoretical and
applied field. Health psychologists employ diverse research methods. These
methods include controlled randomized experiments, quasi-
experiments, longitudinal studies, time-series designs, cross-sectional
studies, case-control studies, qualitative research as well as action research. Health
psychologists study a broad range of variables including cardiovascular disease,
(cardiac psychology), smoking habits, the relation of religious beliefs to
health, alcohol use, social support, living conditions, emotional state, social class,
and 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.

Origins and development[edit]


Psychological factors in health had been studied since the early 20th century by
disciplines such as psychosomatic medicine and later behavioral medicine, but
these were primarily branches of medicine, not psychology. Health psychology
began to emerge as a distinct discipline of psychology in the United States in the
1970s. In the mid-20th century there was a growing understanding in medicine of
the effect of behavior on health. For example, the Alameda County Study, which
began in the 1960s, showed that people who ate regular meals (e.g., breakfast),
maintained a healthy weight, received adequate sleep, did not smoke, drank little
alcohol, and exercised regularly were in better health and lived longer.[14] In addition,
psychologists and other scientists were discovering relationships between
psychological processes and physiological ones.[15] These discoveries include a
better understanding of the impact of psychosocial stress on the cardiovascular and
immune systems,[15] and the early finding that the functioning of the immune system
could be altered by learning.[16]
Psychologists have been working in medical settings for many years (in the UK
sometimes the field was termed medical psychology). Medical psychology,
however, was a relatively small field, primarily aimed at helping patients adjust to
illness. In 1969, William Schofield prepared a report for the APA entitled The Role of
Psychology in the Delivery of Health Services.[17] While there were exceptions, he
found that the psychological research of the time frequently regarded mental health
and physical health as separate, and devoted very little attention to psychology's
impact upon physical health. One of the few psychologists working in this area at
the time, Schofield proposed new forms of education and training for future
psychologists. The APA, responding to his proposal, in 1973 established a task
force to consider how psychologists could (a) help people to manage their health-
related behaviors, (b) help patients manage their physical health problems, and (c)
train healthcare staff to work more effectively with patients.[18]
Led by Joseph Matarazzo, in 1977, APA added a division devoted to health
psychology. At the first divisional conference, Matarazzo delivered a speech that
played an important role in defining health psychology. He defined the new field in
this way, "Health psychology is the aggregate of the specific educational, scientific
and professional contributions of the discipline of psychology to the promotion and
maintenance of health, the prevention and treatment of illness, the identification of
diagnostic and etiologic correlates of health, illness and related dysfunction, and the
analysis and improvement of the healthcare system and health policy
formation."[19] In the 1980s, similar organizations were established elsewhere. In
1986, the BPS established a Division of Health Psychology. The European Health
Psychology Society was also established in 1986. Similar organizations were
established in other countries, including Australia and Japan.[20] 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.
A number of relevant trends coincided with the emergence of health psychology,
including:

 Epidemiological evidence linking behavior and health.[21]


 The addition of behavioral science to medical school curricula, with courses
often taught by psychologists.[21]
 The training of health professionals in communication skills, with the aim of
improving patient satisfaction and adherence to medical treatment.[21]
 Increasing numbers of interventions based on psychological theory
(e.g., behavior modification).[21]
 An increased understanding of the interaction between psychological and
physiological factors leading to the emergence
of psychophysiology and psychoneuroimmunology(PNI).[21]
 The health domain having become a target of research by social psychologists
interested in testing theoretical models linking beliefs, attitudes, and behavior.[22]
 The emergence of AIDS/HIV, and the increase in funding for behavioral
research the epidemic provoked.[21]
In the UK, the BPS’s reconsideration of the role of the Medical Section prompted the
emergence of health psychology as a distinct field. Marie Johnston and John
Weinman argued in a letter to the BPS Bulletin that there was a great need for a
Health Psychology Section. In December 1986 the section was established at the
BPS London Conference, with Marie Johnston as chair.[21] At the Annual BPS
Conference in 1993 a review of "Current Trends in Health Psychology" was
organized, and a definition of health psychology as "the study of psychological and
behavioural processes in health, illness and healthcare" was proposed.[23] The
Health Psychology Section became a Special Group in 1993 and was awarded
divisional status within the UK in 1997. The awarding of divisional status meant that
the individual training needs and professional practice of health psychologists were
recognized, and members were able to obtain chartered status with the BPS. The
BPS went on to regulate training and practice in health psychology until the
regulation of professional standards and qualifications was taken over by statutory
registration with the Health Professions Council in 2010.[21]

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.[24] Health psychologists
have worked on developing ways to reduce smoking[25] and improve daily
nutrition[26] 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.[27]
Health psychology is also concerned with contextual factors, including economic,
cultural, community, social, and lifestyle factors that influence health[2].
The biopsychosocial modelcan help in understanding the relation between
contextual factors and biology in affecting health[28]. Physical addiction impedes
smoking cessation. Some research suggests that seductive advertising also
contributes to psychological dependency on tobacco,[29] although other research has
found no relationship between media exposure and smoking in youth.[30] OHP
research indicates that people in jobs that combine little decision latitude with a high
psychological workload are at increased risk for cardiovascular disease.[31][32]Other
OHP research reveals a relation between unemployment and elevations in blood
pressure.[33][34] Epidemiologic research documents a relation between social class
and cardiovascular disease.[35]
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 behavior 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.[11] 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.[36] 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.[37]
Health psychologists help to promote health and well-being by preventing
illness.[11] 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.[11] 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).[11]
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.[38]
There is also evidence from OHP that stress-reduction interventions at the
workplace can be effective. For example, Kompier and his colleagues[39] 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[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.[40]
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 improve the quality of life of the patient by helping the patient recover
at least some of his or her psychological well-being.[41] Health psychologists are also
concerned with providing therapeutic services for the bereaved.[42]

Critical analysis of health policy[edit]


Critical health psychologists explore how health policy can influence inequities,
inequalities and social injustice [28]. 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.[6]

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.[43] For example, health
psychologists carry out research to answer questions such as:

 What influences healthy eating?


 How is stress linked to heart disease?
 What are the emotional effects of genetic testing?
 How can we change people’s health behavior to improve their health?[11]
Teaching and communication[edit]
Main article: Health communication
Health psychologists can also be responsible for training other health professionals
on how to deliver interventions to help promote healthy eating, stopping smoking,
weight loss, etc. Health psychologists also train other health professionals in
communication skills such as how to break bad news or support behavior change
for the purpose of improving adherence to treatment.[43]

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).[44] 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.[45]

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.[46] Additionally, traditional cognitive-behavioural therapies have been
adapted for people suffering from 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.[47]
Ways of measuring adherence[edit]
Health psychologists have identified a number of ways of measuring patients'
adherence to medical regimens:

 Counting the number of pills in the medicine bottle


 Using self-reports
 Using "Trackcap" bottles, which track the number of times the bottle is
opened.[48]
Managing pain[edit]
Health psychology attempts to find treatments to reduce or eliminate pain, as well
as understand pain anomalies such as episodic analgesia, causalgia, neuralgia,
and phantom limb pain. Although the task of measuring and describing pain has
been problematic, the development of the McGill Pain Questionnaire[49] has helped
make progress in this area. Treatments for pain involve patient-
administered analgesia, acupuncture (found to be effective in reducing pain
for osteoarthritis of the knee[50]), biofeedback, and cognitive behavior therapy.
Health psychologist roles[edit]
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.

 Consultant health psychologist: A consultant health psychologist will take a


lead for health psychology within public health, including managing tobacco
control and smoking cessation services and providing professional leadership in
the management of health trainers.[43]
 Principal health psychologist: A principal health psychologist could, for
example lead the health psychology service within one of the UK’s leading heart
and lung hospitals, providing a clinical service to patients and advising all
members of the multidisciplinary team.[43]
 Health psychologist: An example of a health psychologist's role would be to
provide health psychology input to a center for weight management.
Psychological assessment of treatment, development and delivery of a tailored
weight management program, and advising on approaches to improve
adherence to health advice and medical treatment.[43]
 Research psychologist: Research health psychologists carry out health
psychology research, for example, exploring the psychological impact of
receiving a diagnosis of dementia, or evaluating ways of providing psychological
support for people with burn injuries. Research can also be in the area of health
promotion, for example investigating the determinants of healthy eating or
physical activity or understanding why people misuse substances.[43]
 Health psychologist in training/assistant health psychologist: As an
assistant/in training, a health psychologist will gain experience assessing
patients, delivering psychological interventions to change health behaviors, and
conducting research, whilst being supervised by a qualified health
psychologist.[43]

Training[edit]
See also: List of universities with health psychology programs
In the UK, health psychologists are registered by 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.[51] Registered health psychologists
who are chartered with the BPS will have undertaken a minimum of six years of
training and will have specialized in health psychology for a minimum of three
years.[43] Health psychologists in training must have completed BPS stage 1 training
and be registered with the BPS Stage 2 training route or with a BPS-accredited
university doctoral health psychology program. Once qualified, health psychologists
can work in a range of settings, for example the NHS, universities, schools, private
healthcare, and research and charitable organizations.[43] A health psychologist in
training might be working within applied settings while working towards registration
and chartered status.[43] A health psychologist will have demonstrated competencies
in all of the following areas:

 professional skills (including implementing ethical and legal standards,


communication, and teamwork),
 research skills (including designing, conducting, and analyzing psychological
research in numerous areas),
 consultancy skills (including planning and evaluation),
 teaching and training skills (including knowledge of designing, delivering, and
evaluating large and small scale training program),
 intervention skills (including delivery and evaluation of behavior change
interventions).[43]
All qualified health psychologists must also engage in and record their continuing
professional development (CPD) for psychology each year throughout their
career.[51]

See also[edit]
 Applied psychology
 Behavioral medicine
 Bodymind
 Cardiac psychology
 Chronic stress
 Cognitive epidemiology
 European Academy of Occupational Health Psychology
 Healing environments
 Impact of health on intelligence
 Nutrition psychology
 Occupational health psychology
 Occupational Health Science
 Occupational safety and health
 Outline of psychology
 Pediatric psychology
 Self-concealment
 Society for Occupational Health Psychology
 Workplace stress
 Pain Psychology

Further reading[edit]
 Cohen, L.M.; McChargue, D.E.; & Collins, Jr. F.L. (Eds.). (2003). The Health
Psychology Handbook: Practical issues for the Behavioral Medicine
Specialist. Thousand Oaks, CA: Sage Publications.
 David F. Marks, Michael Murray, Brian Evans & Emee Vida Estacio
(2011) Health Psychology. Theory-Research-Practice (3rd Ed.) Sage
Publications. ISBN 1-84860-622-2(hbk) 978-1848606227 (pbk).
 Michie, S.; & Abraham, C. (Eds.). (2004). Health psychology in
practice. London. BPS Blackwells.
 Ogden, J. (2007). Health Psychology: A Textbook (4th ed.). Berkshire, England:
Open University Press.
 Quick, J.C.; & Tetrick, L.E. (Eds.). (2011). Handbook of Occupational Health
Psychology (2nd ed.). Washington, DC: American Psychological Association.
 Schonfeld, I.S., & Chang, C.-H. (2017). Occupational health psychology: Work,
stress, and health. New York, NY: Springer Publishing Company.
 Taylor, S.E. (1990). Health psychology. American Psychologist, 45, 40–50.
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External links[edit]
North America[edit]
 American Psychological Association, Division 38: Health Psychology.
Accessed: 15:52, 29 July 2014 (UTC).
 Division 38: Health Psychology at APA.org. Accessed: 15:52, 29 July 2014
(UTC).
 Society for Occupational Health Psychology. Accessed: 15:52, 29 July 2014
(UTC).
 Society of Behavioral Medicine. Accessed: 15:52, 29 July 2014 (UTC).
Europe[edit]
 European Health Psychology Society. Accessed: 15:06, 25 July 2017 (UTC).
 Division of Health Psychology of the British Psychological Society. Accessed:
15:52, 29 July 2014 (UTC).
 European Academy of Occupational Health Psychology. Accessed: 15:52, 29
July 2014 (UTC).

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