health psychology
DESCRIPTION
health psychologyAn orview for the Rehabilitation ProfessinalTRANSCRIPT
Health Psychology: An Overview for the
Rehabilitation Professional
Ginseng Gray, SPTWayne State University
College of Pharmacy & Allied HealthDepartment of Physical Therapy
KNOWLEDGE IS POTENTIAL POWER. (Unknown)
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
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)
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
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
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)
3 Foundations of Health Psychology
Field is built on principles of:1) Behavioral learning: classical conditioning2) Behavioral learning: operant conditioning3) Social learning: observational
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.
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
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)
Four Parts to Self-Efficacy
1) Performance Accomplishment
2) Vicarious Accomplishment
3) Verbal Persuasion4) Physiological Status
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
Question??
What are the four aspects of self-efficacy?
1) Performance Accomplishment (mastery)2) Vicarious Accomplishment 3) Verbal Persuasion4) Physiological status
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
Positive vs Negative adjustment in LBP
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Negative Adjustment Positive Adjustment
Cognitive SuppressorsHelplessDiverting and praying
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)
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
Depression and Anxiety in SCI with the CET Intervention
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Intervention Control
PrePostFollow-up
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
Emotional Disclosure (Pennebaker, 1990)
In healthy populations it is associated with Better mood Increased grade point average Decreased absenteeism Enhanced immunity
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.
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
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
Question??
Name the three foundational principles of Health Psychology.
1) Operant Conditioning2) Classical Conditioning3) Social/Observational Learning
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
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
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
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
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)
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
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
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
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
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
Can the Health Belief Model Predict Compliance?
Chen & Neufield, Occupational Therapists, evaluated factors that would predict compliance in patients with UE Dysfunction
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
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.
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
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.
Question??
What is compliance considered? And what is a better term?
Passive Adherence Better term=Collaboration
STAGES OF MOTIVATION THEORY: a review
Also called the Transtheoretical ModelDelineates stages of readiness for change1) Precontemplation2) Contemplation3) Preparation4) Action5) Maintenance
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
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
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
Question??
Name some methods of increasing physical activity compliance1. Sign2. Balance Sheet/Pros & Cons3. Contests4. Phone calls/postcards
FINAL QUESTION
Complete the following statement:Knowledge is __________ _________
POTENTIAL POWER!!
Thanks for your Attention.