Health psychology

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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. 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). [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]

Behavior or behaviour is the actions and mannerisms made by individuals, organisms, systems or artificial entities in conjunction with themselves or their environment, which includes the other systems or organisms around as well as the (inanimate) physical environment. It is the computed response of the system or organism to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or covert, and voluntary or involuntary.

Culture Social behavior and norms found in society

Culture is an umbrella term which encompasses the social behavior and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities and habits of the individuals in these groups.

Hypothalamic–pituitary–adrenal axis

The hypothalamic–pituitary–adrenal axis is a complex set of direct influences and feedback interactions among three components: the hypothalamus, the pituitary gland, and the adrenal glands.

Contents

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.

Public health preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.

Research systematic study undertaken to increase knowledge

Research is "creative and systematic work undertaken to increase the stock of knowledge, including knowledge of humans, culture and society, and the use of this stock of knowledge to devise new applications." It is used to establish or confirm facts, reaffirm the results of previous work, solve new or existing problems, support theorems, or develop new theories. A research project may also be an expansion on past work in the field. Research projects can be used to develop further knowledge on a topic, or in the example of a school research project, they can be used to further a student's research prowess to prepare them for future jobs or reports. To test the validity of instruments, procedures, or experiments, research may replicate elements of prior projects or the project as a whole. The primary purposes of basic research are documentation, discovery, interpretation, or the research and development (R&D) of methods and systems for the advancement of human knowledge. Approaches to research depend on epistemologies, which vary considerably both within and between humanities and sciences. There are several forms of research: scientific, humanities, artistic, economic, social, business, marketing, practitioner research, life, technological, etc. The scientific study of research practices is known as meta-research.

Although its early beginnings can be traced to the field of clinical psychology, [3] four different divisions within health psychology and one related field, occupational health psychology (OHP), [4] have developed over time. The four divisions include clinical health psychology, public health psychology, community health psychology, and critical health psychology. [5] Professional organizations for the field of health psychology include Division 38 of the American Psychological Association (APA), [6] the Division of Health Psychology of the British Psychological Society (BPS), [7] the European Health Psychology Society, [8] and the College of Health Psychologists of the Australian Psychological Society (APS). [9] Advanced credentialing in the US as a clinical health psychologist is provided through the American Board of Professional Psychology. [10]

Clinical psychology is an integration of science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers. OHP addresses a number of major topic areas including the impact of occupational stressors on physical and mental health, the impact of involuntary unemployment on physical and mental health, work-family balance, workplace violence and other forms of mistreatment, accidents and safety, and interventions designed to improve/protect worker health. OHP emerged from two distinct disciplines within applied psychology, namely, health psychology and industrial and organizational psychology, as well as occupational medicine. OHP has also been informed by other disciplines including industrial sociology, industrial engineering, and economics, as well as preventive medicine and public health. OHP is concerned with the relationship of psychosocial workplace factors to the development, maintenance, and promotion of workers' health and that of their families. Thus the field's focus is work-related factors that can lead to injury, disease, and distress.

American Psychological Association scientific and professional organization

The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 118,000 members including scientists, educators, clinicians, consultants, and students. The APA has an annual budget of around $115m. There are 54 divisions of the APA—interest groups covering different subspecialties of psychology or topical areas.

Overview

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).

The biopsychosocial model is an interdisciplinary model that looks at the interconnection between biology, psychology, and socio-environmental factors. The model specifically examines how these aspects play a role in topics ranging from health and disease models to human development. This model was developed by George L. Engel in 1977 and is the first of its kind to employ this type of multifaceted thinking. The Biopsychosocial Model has received criticism about its limitations, but continues to carry influence in the fields of psychology, health, medicine, and human development.

Social support support systems that provide assistance and encouragement to individuals

Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be emotional, informational, or companionship ; tangible or intangible.

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]

National Health Service publicly funded healthcare systems within the United Kingdom

The National Health Service in the United Kingdom includes NHS England, NHS Scotland, NHS Wales, and the affiliated Health and Social Care (HSC) in Northern Ireland. They were established together in 1948 as one of the major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery. Each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the United Kingdom, apart from dental treatment and optical care. The English NHS also requires patients to pay prescription charges with a range of exemptions from these charges.

Health Psychology is a monthly, peer-reviewed academic journal published by the American Psychological Association. The journal is "devoted to understanding the scientific relations among psychological factors, behavior and physical health and illness." The current editor-in-chief is Kenneth E. Friedland.

<i>Journal of Health Psychology</i> journal

The Journal of Health Psychology is a peer-reviewed academic journal covering all aspects of health psychology. The editor-in-chief is David Marks. The journal publishes reports of empirical studies, critical reviews of the literature, book reviews, contributions related to theory, commentaries related to theory, and editorials on what are deemed to be significant issues. The journal was established in 1996 and is published by Sage Publications.

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 health phenomena 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.

Experiment Scientific procedure performed to validate a hypothesis.

An experiment is a procedure carried out to support, refute, or validate a hypothesis. Experiments provide insight into cause-and-effect by demonstrating what outcome occurs when a particular factor is manipulated. Experiments vary greatly in goal and scale, but always rely on repeatable procedure and logical analysis of the results. There also exists natural experimental studies.

In psychology, qualitative research has come to be defined as research whose findings are not arrived at by statistical or other quantitative procedures. Qualitative research is often said to be naturalistic. Its goal is to understand behaviour in the natural setting. Two other goals attributed to qualitative research are understanding a phenomenon from the perspective of the research participant and understanding the meanings people give to their experience. It attempts to do this by using so-called naturalistic methods—interviewing, observation, ethnography, participant observation, and focus groups. Each of these methods seeks to understand the perspective of the research participant within the context of their everyday life. This means that the researcher is concerned with asking broad questions that allow the respondent to answer in their own words. These methods allow the researcher to try to qualify their understanding during the research process through further probing questions. In addition, a method such as observation allows the researcher to observe people within natural settings—particularly those in public places.

Action research is a philosophy and methodology of research generally applied in the social sciences. It seeks transformative change through the simultaneous process of taking action and doing research, which are linked together by critical reflection. Kurt Lewin, then a professor at MIT, first coined the term "action research" in 1944. In his 1946 paper "Action Research and Minority Problems" he described action research as "a comparative research on the conditions and effects of various forms of social action and research leading to social action" that uses "a spiral of steps, each of which is composed of a circle of planning, action and fact-finding about the result of the action".

Origins and development

Health psychology developed in different forms in different societies. [14] 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.

United States In 1969, William Schofield prepared a report for the APA entitled The Role of Psychology in the Delivery of Health Services. [15] 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. [16]

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. [17] In addition, psychologists and other scientists were discovering relationships between psychological processes and physiological ones. [18] These discoveries include a better understanding of the impact of psychosocial stress on the cardiovascular and immune systems, [18] and the early finding that the functioning of the immune system could be altered by learning. [19]

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." [20] 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. [21] 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 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. [22] The BPS's reconsideration of the role of the Medical Section prompted the emergence of health psychology as a distinct field. [23] 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. [24] 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. [25]

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. [24]

A number of relevant trends coincided with the emergence of health psychology, including:

The emergence of academic /professional bodies to promote research and practice in health psychology was followed by the publication of a series of textbooks which began to lay out the interests of the discipline. [27]

Objectives

Understanding behavioral and contextual factors

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. [28] Health psychologists have worked on developing ways to reduce smoking [29] and improve daily nutrition [30] 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. [31]

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, [32] although other research has found no relationship between media exposure and smoking in youth. [33] OHP research indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease. [34] [35] Other OHP research reveals a relation between unemployment and elevations in blood pressure. [36] [37] Epidemiologic research documents a relation between social class and cardiovascular disease. [38]

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

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. [39] 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. [40]

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. [41]

There is also evidence from OHP that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues [42] 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

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. [43]

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. [44] Health psychologists are also concerned with providing therapeutic services for the bereaved. [45]

Critical analysis of health policy

Critical health psychologists explore how health policy can influence inequities, inequalities and social injustice. [46] 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. [47]

Conducting research

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

Teaching and 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. [48]

Applications

Improving doctor–patient communication

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). [49] 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. [50]

Improving adherence to medical advice

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. [51] 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. [52]

Ways of measuring adherence

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. [53]

Managing pain

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 [54] 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 [55] ), biofeedback, and cognitive behavior therapy.

Health psychologist roles

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.

Training

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. [56] 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. [48] 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. [48] A health psychologist in training might be working within applied settings while working towards registration and chartered status. [48] A health psychologist will have demonstrated competencies in all of the following areas:

All qualified health psychologists must also engage in and record their continuing professional development (CPD) for psychology each year throughout their career. [56]

In Australia, health psychologists are registered by the Psychology Board of Australia. [57] The standard pathway to becoming an endorsed health psychologists involves a minimum of six years training and a two-year registrar program. [58] Health psychologists must also undertake continuing professional develop (CPD) each year. [59]

See also

Further reading

Related Research Articles

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Psychologist professional who evaluates, diagnoses, treats, and studies behavior and mental processes

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Tamara Sher psychologist

Tamara Goldman Sher, Ph.D. is a licensed clinical psychologist and professor at The Family Institute at Northwestern University. She is a leading researcher in the fields of Behavioral Medicine and Couples Therapy. Sher was awarded a $2.4 million grant from the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) which combined both of these fields in a study measuring the benefits of couples' involvement in cardiac treatment. This grant is part of Sher's work with the National Institute of Health's Behavior Change Consortium. Sher's research has been mentioned in the Chicago Tribune, Psychology Today, on Chicago Public Radio, and published in several leading psychology journals.

Susan Michie is professor of health psychology at University College London, United Kingdom.

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Psychology encompasses a vast domain, and includes many different approaches to the study of mental processes and behavior. Below are the major areas of inquiry that taken together constitute psychology. A comprehensive list of the sub-fields and areas within psychology can be found at the list of psychology topics and list of psychology disciplines.

Cardiac psychology is a specialization of health psychology that focuses on the primary and secondary prevention of heart disease by incorporating strategies to address the emotional and behavioral barriers to lifestyle changes, and that seeks to enhance recovery in cardiac patients by means of providing patients tools to cope with life and physical changes associated with their disease. Cardiac psychologists can help cardiac patients across the lifespan: prevention, pre-surgery, post-surgery, and rehabilitation of cardiac disease with a particular emphasis on achieving optimal quality of life outcomes. Cardiac psychology includes both research and clinical practice aspects.

Primary Care Behavioral Health Consultation model (PCBH) is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care. Primary Care practice has traditionally adopted a generalist approach whereby physicians are trained in the medical model and solutions to problems typically involve medications, procedures, and advice. Appointment times are short, with the goal of seeing a large number of patients in a day. Many patients present with mental health care needs whose symptomology may overlap with medical disorders and which may exacerbate, complicate, or masquerade as physical symptoms. In addition, many medical problems present with associated psychological sequelae, that are amenable to change, through behavioral intervention, that can improve outcomes for these health problems. Over 50% of medical visits to primary care clinics today are related to chronic medical conditions. As we learn more and more about the contributing factors to the development and maintenance of these medical problems, there is growing evidence that the PCBH model affords us the opportunity for early identification and behavioral/medical intervention that can prevent some acute problems from becoming chronic health care problems. Behavioral Health Consultants (BHCs) work side-by-side with all members of the clinical care team to enhance preventive and clinical care for mental health problems that have traditionally been treated solely by physicians. The role of the BHC is to facilitate systemic change within primary care that facilitates a multidisciplinary approach both from a treatment and reimbursement standpoint. BHCs typically collaborate with physicians to develop treatment plans, monitor patient progress, and flexibly provide care to meet patients’ changing needs In this review the terms Primary Care Behavioral Health Consultation and Behavioral Health Consultation will be used interchangeably.

Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.

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