You, the individual, can do more for your own health and wellbeing than any doctor, any hospital, an

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• 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
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Health Psychology

• University of Toronto
• Winter, 2005

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Dr. Duane Hargreaves

• Email dhargrea_at_utm.utoronto.ca
• Phone [phone]
• Web www.utm.utoronto.ca/w3psy333/winter2005.htm

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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

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Lecture 1 - Part 1

Welcome and Introduction
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Course Handbook

Course Instructors Learning Outcomes Course
Outline (readings) General information
(expectations, contact, assessment, text) Lecture
Outlines
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Lecture 1 - Part 2

What is Health Psychology?
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Question

• What is most important in our lives?

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• Freedom Responsible
• Enjoying life Social Justice
• Honesty Pleasure
• Reciprocation of favors Equality
• Social power Self-respect
• Broadminded A varied life
• Successful Wealth
• True friendship A spiritual life
• Healthy Respect for tradition
• Accepting my portion in life Family security
• Self indulgent Curiosity
• Protecting the environment Wisdom
• Social order Loyal

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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

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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.

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Illness/Wellness Continuum
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(No Transcript)
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1900
1990
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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)

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Death rates from infectious and parasitic
disease, 1907 to 1998
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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

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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

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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!

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Estimated contributions of behavior, medical
care, genetics, and other factors to health
status.
Behavior 40
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Models of Health

• Biomedical Model
• Historically, dominant paradigm
• Suggests illness is a function of aberrant
  somatic processes
• Main Focus cure (biology and medicine)

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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)

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Models of Health

• Biopsychosocial Model
• health (wellness and illness) is a function of
  biological, psychological, and social factors in
  continual interaction

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A factors approach
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A systems approach
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The Biopsychosocial Model from Factors and
Systems Perspectives
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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)
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Health Psychology

• vs. other health-related disciplines
• Medical psychology
• Psychosomatic medicine
• Behavioral medicine
• Behavioral health
• Medical sociology

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Publications in Health Psyc.
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Lecture 1 - Part 3

Scientist-Practitioner Model
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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!
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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
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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

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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

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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 dont know everything!
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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

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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

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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

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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

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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

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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)

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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