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Health Psychology: An Overview for the Rehabilitation Professional Ginseng Gray, SPT Wayne State University College of Pharmacy & Allied Health Department of Physical Therapy

Health Psychology

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health psychologyAn orview for the Rehabilitation Professinal

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Page 1: Health Psychology

Health Psychology: An Overview for the

Rehabilitation Professional

Ginseng Gray, SPTWayne State University

College of Pharmacy & Allied HealthDepartment of Physical Therapy

Page 2: Health Psychology

KNOWLEDGE IS POTENTIAL POWER. (Unknown)

Page 3: Health Psychology

Presentation Objectives

Define Health PsychologyExamine Coping StrategiesDiscuss research relevant to rehabilitationIntroduce the biopsychosocial medical modelStudents will understand the role of mental health in physical functionProvide students with techniques to enhance complianceProvide students with objective assessment tools

Page 4: Health Psychology

What is Health Psychology?

The aggregate of specific educational, scientific and professional contributions of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness, and related dysfunction and the analysis and improvement of the healthcare system and health policy. (Matarazzo 1980)

Page 5: Health Psychology

Relevance to Physical TherapyDefinition of health psychology shares some common goals with the goals of physical therapyAs defined by the APTA in the guide to PT practice PTs seek to restore optimal physical function whereas psychology seeks optimal mental function

Page 6: Health Psychology

Relevance to Physical Therapy

PT’s teach encourage and motivate using principles borrowed from the field of psychologyThere is a need to understand how to successfully teach and affect health behaviors of compliance and motivation

Page 7: Health Psychology

Health Psychology:Historic Beginnings

In 1852, physician Henry Holland questioned the relationship between mind and body, between psychological and somatic processes. (Mental Physiology)Freud believed that unacceptable or disturbing thoughts and emotions, kept unconscious could create a physical disorder or the appearance of one. (Prokop)

Page 8: Health Psychology

3 Foundations of Health Psychology

Field is built on principles of:1) Behavioral learning: classical conditioning2) Behavioral learning: operant conditioning3) Social learning: observational

Page 9: Health Psychology

Psychology 101: Review

Classical conditioning was made famous by Pavlov and his dogs, which salivated at the presentation of foodBF Skinner tested the theory of operant conditioning, teaching animals to work for rewardsBandura was the first to develop the theory that thoughts influence the acquisition of behavior.Uncovering the underlying source of the behavior is important in preventing or altering the behavior.

Page 10: Health Psychology

COPINGCoping is the constantly changing cognitive and behavioral efforts to manage a stimulus that is appraised as stressful (Prokop, 1991)Differences in the ways people handle stress are learned

Page 11: Health Psychology

Self Efficacy: A coping strategy

An individual’s subjective perception of the ability to perform a taskA set of expectations, not skillsCan be applied to geriatric population at risk for falls (Tinetti & Powell, 1994)

“IT IS OUR PERCEPTION THAT BRINGS ABOUT A DESIRED EFFECT”

(Lehman & Roller, 1999)

Page 12: Health Psychology

Four Parts to Self-Efficacy

1) Performance Accomplishment

2) Vicarious Accomplishment

3) Verbal Persuasion4) Physiological Status

Page 13: Health Psychology

Self-Efficacy

Goreczny (1995), states that addressing self-efficacy improves and reduces disability and pain related behaviors in: Exercise compliance Workload Performance Motor Skills Pain tolerance

Page 14: Health Psychology

Question??

What are the four aspects of self-efficacy?

1) Performance Accomplishment (mastery)2) Vicarious Accomplishment 3) Verbal Persuasion4) Physiological status

Page 15: Health Psychology

Coping Strategies in Low Back Pain

Rosensteil & Keefe (1983) examined the use of coping strategies in chronic low back pain patientsThree types of coping strategies emerged most frequently 1) Cognitive coping & suppression 2) Helplessness 3) Diverting attention & prayer Found to be predictive of behavioral and emotional

adjustment =ABILITY TO CONTROL OR ADJUST PAIN

Page 16: Health Psychology

Positive vs Negative adjustment in LBP

02468

1012141618

Negative Adjustment Positive Adjustment

Cognitive SuppressorsHelplessDiverting and praying

Page 17: Health Psychology

Coping strategies in LBP: Results

Indicate an active approach to coping with painmore predictive than somatization scales, such as the McGill Pain questionnaire (Rosensteil & Keefe, 1983)

Page 18: Health Psychology

Effectiveness of Coping in Spinal Cord Injury (King, 1999)

The authors used the Coping Effectiveness Training (CET)programCET is a group based intervention that teaches appraisal skills, cognitive, behavioral coping, and how to obtain social support

Page 19: Health Psychology

Depression and Anxiety in SCI with the CET Intervention

02468

1012141618

Intervention Control

PrePostFollow-up

Page 20: Health Psychology

Emotional Disclosure

A cognitive behavioral intervention developed by PennebakerRequires subjects to write or talk privately about stressful life situations, 15 minutes per day for 3-5 days

Page 21: Health Psychology

Emotional Disclosure (Pennebaker, 1990)

In healthy populations it is associated with Better mood Increased grade point average Decreased absenteeism Enhanced immunity

Page 22: Health Psychology

Emotional Disclosure and Rheumatoid Arthritis

The onset of RA is associated with stressful life events when compared to controls (Baker, 1982)Emotional disclosure in RA has been shown to alter symptoms in the following ways.

Page 23: Health Psychology

Physical Dysfunction following Emotional Disclosure in RA (Kelley, Lumley & Leisen, 1997)

0

0.5

1

1.5

2

2.5

3

3.5

Baseline 2 weeks 3 months

DisclosureControl

Page 24: Health Psychology

Affective Disturbances in RA with Emotional Disclosure (Kelley, Lumley & Leisen, 1997)

00.5

11.5

22.5

33.5

44.5

Baseline 2 Weeks 3 Months

DisclosureControl

Page 25: Health Psychology

Question??

Name the three foundational principles of Health Psychology.

1) Operant Conditioning2) Classical Conditioning3) Social/Observational Learning

Page 26: Health Psychology

Body Mind Medicine

Hans Seyle is known as the great pioneer of body-mind medicine (Vogel, 1991)He was the first to discuss the role of stress in the fields of medicine and psychology

Page 27: Health Psychology

Body Mind Medicine

70% of visits to primary care physicians are for problems related to stress and lifestyle (Vogel, 1999) Methods of intervention 1. Educational2. Cognitive-Behavioral-skills training, pacing, distraction, imagery, and decreasing catastrophizing

Page 28: Health Psychology

Biopsychosocial Medicine:A New Medical Model

An alternative medical model which approaches patient management with a team of professionals at initial onset (Dea, 2000)

Adult Primary Care Team

Six MDs One LPN

One PT

Behavioral Med Health Educator

Page 29: Health Psychology

Personal Health Improvement Program (PHIP)

Meditation Based Program created by Matthew Budd of the Harvard Pilgrim PlanKaiser Permanente, a California HMO, tested the Personal Health Improvement Program in its CAD members

Page 30: Health Psychology

Bromwyn & Ford, 2000

Studied the effects of PHIP in Kaiser Permanente’s members with Coronary Artery DiseaseLifestyle Modification Program- Nutrition (vegetarian diet)-Exercise (yoga, group and home exercise)-Social (support group)

Page 31: Health Psychology

Results: Overall Disease Distress in CAD with PHIP

00.10.20.30.40.50.60.70.80.9

Before PHIP Post-PHIP 6 Month Follow-up

OverallDiseasesDistressPsychologicalDistress

Functional andHealth Status

Page 32: Health Psychology

Cost Comparison Before and After PHIP Referral in patients with CAD

1,650

1,270

1,010

1,709

1,119

760

0200400600800

1,0001,2001,4001,6001,800

Control PHIP Group

6 months prior6 months after12 months after

Page 33: Health Psychology

COMPLIANCE or should we say, COLLABORATION

Compliance to a medical protocol, is a form of passive adherence (Prokop, 1991)

An alternative term suggested is collaborationThis makes the activity a project for the healthcare professional and the client

Page 34: Health Psychology

How many patient’s comply?(Hoepful,1980)

25% to 64% of patients comply with medical advice or directionsWide range varies due to many populations

compliantnoncompliant

Page 35: Health Psychology

Health Belief and Compliance

The Health Belief Model is a theoretical framework to explain and predict health related behaviors.(Goreczny, 1995)According to the HBM, the following factors interact to produce behavior change Perceived vulnerability & severity Belief in effectiveness of prevention Perceived costs Presence of environmental cues

Page 36: Health Psychology

Can the Health Belief Model Predict Compliance?

Chen & Neufield, Occupational Therapists, evaluated factors that would predict compliance in patients with UE Dysfunction

Page 37: Health Psychology

Results

35% of the subjects were 100% compliantSelf-efficacy emerged as the most important factor in achieving compliance

Therefore encouraging self-efficacy should be the emphasis of collaborative home exercise programs and consultations

Page 38: Health Psychology

Compliance and Cardiac Rehabilitation (Lane, 2001)

Identified factors that would predict attendance to cardiac rehab76% attended all sessionsPrior exercise experience was a significant predictor of attendance.

Page 39: Health Psychology

Physical Capabilities Scale (Fitzgerald and Feuerstein(1992)

Eight item, self efficacy scale for rating expected performance in strength testing and enduranceAssessment tool to measure effectiveness of cognitive behavioral interventions

Page 40: Health Psychology

Can you identify non-compliers?

Salisbury (1996), has identified methods of assessing patient health beliefs, motivation and stress.Health beliefs are attained by asking the patient their perceived cause of illness.Provides the clinician with a start point and an idea of what behaviors can be changedOnly one behavior should be changed at a time.

Page 41: Health Psychology

Question??

What is compliance considered? And what is a better term?

Passive Adherence Better term=Collaboration

Page 42: Health Psychology

STAGES OF MOTIVATION THEORY: a review

Also called the Transtheoretical ModelDelineates stages of readiness for change1) Precontemplation2) Contemplation3) Preparation4) Action5) Maintenance

Page 43: Health Psychology

Interventions to Increase Physical Activity (ACSM, 2000)

Suggestions: Use of a sign/reminder

Balance Sheet: Write down pros/cons of anticipated participation and outcomes

Lottery or Contest: Provide prizes for behavioral changes or compliance levels

Phone Calls/Postcards

Page 44: Health Psychology

Conclusion

Economic pressures create a need for the most efficient and effective treatmentsThe cost reductions of Kaiser Permanente are not isolated to California

•Understanding mechanisms of behavioral change are vital to all rehab professionals

•More research is needed to standardize behavioral interventions

Page 45: Health Psychology

Summary

Self efficacy, perception of ability is a major factor in effective copingEmotional disclosure can positively mood and immunityBiopsychosocal medicine is a first contact team approach to careCompliance can be improved by teaching/encouraging self efficacy

Page 46: Health Psychology

Question??

Name some methods of increasing physical activity compliance1. Sign2. Balance Sheet/Pros & Cons3. Contests4. Phone calls/postcards

Page 47: Health Psychology

FINAL QUESTION

Complete the following statement:Knowledge is __________ _________

POTENTIAL POWER!!

Thanks for your Attention.