Applications of Health Psychology

[edit] Improving doctor-patient communication

Health psychologists attempt to 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).[19] One main 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.[20]

[edit] Improving adherence to medical advice

Getting people to follow medical advice and adhere to their treatment regimens is a
difficult task for health psychologists. People often forget to take their pills or are
inhibited by the side effects of their medicines. 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.[21]

[edit] 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 - although this has problems
with privacy and/or could be deemed patronizing or showing lack of trust in
patients
• Using self-reports - although patients may fail to return the self-report or lie about
their adherence
• Asking a doctor or health worker - although this presents problems on doctor-
patient confidentiality
• Using 'Trackcap' bottles, which track the number of times the bottle is opened;
however, this either raises problems of informed consent or, if informed consent
is obtained, influence through demand characteristics.[22]

[edit] Managing pain

Health psychology attempts to find treatments to reduce and 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[23] has helped make progress in this area.
Treatments for pain involve patient-administered analgesia, acupuncture (found by
Berman to be effective in reducing pain for osteoarthritis of the knee[24]), biofeedback,
and cognitive behavior therapy.

in philosophy, any theory that mind and body are distinct kinds of substances or natures.
This position implies that mind and body not only differ in meaning but refer to different
kinds of entities. Thus, a dualist would oppose any theory that identifies mind with the
brain, conceived as a physical mechanism.

The modern problem of the relationship of mind to body stems from the thought of René
Descartes, a 17th-century French philosopher and mathematician, who gave dualism its
classical formulation. Beginning from his famous Cogito, ergo sum (Latin: “I think,
therefore I am”), Descartes developed a theory of mind as an immaterial, nonextended
substance that engages in various activities such as rational thought, imagining, feeling,
and willing. Matter, or extended substance, conforms to the laws of physics in
mechanistic fashion, with the important exception of the human body, which Descartes
believed is causally affected by the human mind and which causally produces certain
mental events. For example, willing the arm to be raised causes it to be raised, whereas
being hit by a hammer on the finger causes the mind to feel pain. This part of Descartes’s
dualistic theory, known as interactionism, raises one of the chief problems faced by
Descartes: the question how this causal interaction is possible.

This problem gave rise to other varieties of dualism, such as occasionalism and some
forms of parallelism that do not require direct causal interaction. Occasionalism
maintains that apparent links between mental and physical events are the result of God’s
constant causal action. Parallelism also rejects causal interaction but without constant
divine intervention. Gottfried Wilhelm Leibniz, a 17th-century German rationalist and
mathematician, saw mind and body as two perfectly correlated series, synchronized like
two clocks at their origin by God in a preestablished harmony.

The Western concept of the Mind-Body Connection

went through five different stages:
1. Natural Philosophies always start with the Physical,
2. The birth of Holism,
3. Interest in the Stresses of Modern Life,
4. Development of the Wellness Movement, and
 5. Formulation of the complete Biopsychosocial
Model of Health, Wellness, and Illness.
in its historical development.

Contents of a History of the Mind-Body Connection

"For centuries and long before the first glimmerings of modern science,
physicians and non-physicians alike have acknowledged that the way
people felt in their minds could influence the way they responded in their
bodies. When prevailing medical theory denied the very possibility of such
interactions, common experience and sometimes quite startling clinical
encounters suggested otherwise."[32]

1. The Greek Period

2. The Greco-Roman Period
3. The 1500s--the Renaissance
4. Modern life begins between the 1870s and 1880s
5. Progressive Era of Health Care Reform (1890-1920)
6. The Next Millennium (2000-)
7. References

History of the Old World

"The close relationship of emotions to disease [has] been
... central to the long history of medical
practice."[33]

The Greek Period

Health could be maintained in the eyes of the ancient Greeks by adopting a

temperate lifestyle of moderation. Health, beauty and happiness were the most
important goals in life for the ancient Greeks. Physical fitness was seen by them as its
own reward.

• {Start with the Physical}"This story begins as did so many

other components of our culture, in Greek and Roman
 antiquity where medicine first emerged as a secular
activity independent of religion. There Hippocrates (ca. 460
B.C.Bca. 370 B.C.) and his followers combined naturalistic
craft knowledge with ancient science and philosophy to
produce the first systematic explanations of the behavior
of the human body in health and illness. ... They made the
first attempts to understand emotions as mental
phenomena which had surprising and complex
connections to physiological order and pathological
disorder."[34]
o "Emotional factors played only a minor role in the
subsequent development of classical medical
thought because authors after Hippocrates continued
to rely primarily on humoral-reductionism and did not
actively pursue emotional causal elements."[34]
• {Start with the Physical}Plato, throughout his writings,
emphasized the importance of bodily exercise for developing
the mind. His ideal was the harmonious perfection of the body,
mind, and psyche. Bodily exercise was one of the methods that
Plato advocated in his Republic.

The Greco-Roman Period

The Greco-Roman culture encouraged the development of physical perfection.

• {Start with the Physical}Roman motto: Mens sana in corpore

sano, A sane mind in a sound body.

The 1500s--the Renaissance

The humanistic revival of classical art, architecture, literature, and learning that
originated in Italy and later spreads throughout Europe. "Ideas about the 'balance of
the passions' were popular in the Renaissance and early modern
periods."[34]

• {Holism}Paracelsus (1493-1541), the father of modern

medicine, insisted on treating the whole being rather
than merely the part displaying disease. Of course little
else of Paracelsian medicine is desirable. His teaching
emphasized toxic pharmaceutical preparations of poisonous
metals like mercury, lead, arsenic and antimony. The human
 mind will eventually be viewed as being a part of the
whole person. The concept of holism will evolve,
beginning at the end of the 19th century, to include the
notion that stress, or our mental states, has an impact
upon our physical health.

History of the New World

The 1700s--the Colonies

The system of medicine prevailing in the Colonies in the years immediately preceding the
American Revolution, was that of the Dutch physician and teacher Hermann Boerhaave
(1668-1738). The Boerhaavian theory of disease explained it in terms of chemical and
physical qualities, such as acidity and alkalinity, or tension and relaxation. The
Boerhaavian system was increasingly being challenged in the second half of the 18th
century by the theories of William Cullen (1710-1790), a Scottish physician and teacher.
Cullen held that an excess or an insufficiency of nervous tension was the cause of all
disease. Too much tension was often characterized by a fever, to be treated by a
depleting regiment including bleeding, a restricted diet, purging, and rest and sedation. A
cold or chill, on the other hand, indicated too much relaxation and called for restorative
measures

Antebellum America--Age of Romanticism

"By the mid-nineteenth century, however, a place was secured for

emotions in connection with disease even as post mortem anatomy and
cellular pathology advanced. Already in the eighteenth century William
Cullen had noted that patients with certain major disorders -- 'insanity', for
example -- did not always show the expected organic lesions upon post
mortem dissection. ... Cullen and Robert Whytt were two of the many
physicians who turned to the nervous system to find a physiological
connection between emotions and disease. ... By the 1840s and 1850s,
functional disorders of the nervous system (also called "neuroses") and
the emotional causes that precipitated them had become a major area of
clinical study."[34]

• 1800s>{Medicine}"Intellectuals and lay people alike were

strongly committed to these ideas in the seventeenth and
eighteenth centuries. While certain philosophical fashions
within the medical community changed to reflect the
Scientific Revolution going on around it, much medical
 practice remained traditional and fundamentally unaltered.
Consideration of the role of the imagination and of strong
emotions in the onset and course of illnesses continued
into the nineteenth century."[34]
• 1840s-1850>{Medicine}"By the 1840s and 1850s hysteria
was a serious subject in medical textbooks and in
separate, often massively detailed studies."[35]

Americans who lived through the second half of the

nineteenth century experienced the most
fundamental changes in how people experienced
reality since the start of Western civilization.

Postbellum America

Health care is centered on the individual practitioner, rather than on the institution or in
science.

• 1859>{Science}Charles Darwin publishes his On the Origin of

Species, in London A growing loss of faith and an
acceptance of the authority of Science accompanied
Darwinism. "In this turbulent [American] society, which
stressed individualism over community, the psychologist
[would soon] replace the priest, as people sought respite
from their confusion and unhappiness."[17]
• 1865>{Medicine}The Civil War comes to an end. "In the post-
war period, physicians developed an interest in war-
induced stress, and soon identified similar syndromes in
the normal population."[17]

Modern life begins between the 1870s and 1880s.

The pace of life begins to speed up. People began to notice how the acceleration of the
perception of the duration of time and the apparent shortening of physical distances was
inducing stress in them. Americans who lived through the second half of the
nineteenth century experienced the greatest, most fundamental changes ever
experienced by mankind: electricity, telephone, telegraph, and the railroad.[1]
Western notions of stress was a direct consequence of theses technological accelerations
that began to really take off during the second half of the 19th century. People in our
modern times have to do more things, with less and less time to do them in.

• 1869>{Modern Stress}George Beard, MD, a neurologist, wrote:

Neurasthenia, or nervous exhaustion, an article published in a
medical journal. Neurasthenia, or Nervous Exhaustion, was
defined as a condition of general malaise, and was attributed by
Beard to the stresses of modern life. Beard completed his pre-
med studies at Yale in 1862, and received his medical degree
from New York's College of Physician's (now known as
Columbia University) in 1866. He became a member of the
College of Physicians and Surgeons of New York in 1886. Beard,
a real physician, was one of the most important American
electrotherapists of the 19th century. His contemporary critics
referred to him as the �P.T. Barnum of medicine.� Beard's
nervous exhaustion of neurasthenia would eventually
develop into the modern concepts of Chronic-Fatigue-
Syndrome, Fibromyalgia and Multiple Chemical
Sensitivities.[2],[13]
• 1876>{Faster is Better?}Alexander Graham Bell patents the
telephone.
• 1876>{Faster is Better?}Wind-up alarm clocks were first
introduced by Seth Thomas.
• 1881>{Modern Stress}George Beard, MD wrote American
Nervousness. Neurasthenia was first described as American
nervousness. Beard saw a significant correlation between
American social organization and nervous illness. Beard wrote:
"American nervousness is the product of American
civilization." Unlike other countries, America offered its
inhabitants the possibility of unlimited freedom which resulted
in unlimited ambition among the populace. Beard wrote: "It has
long seemed the especial province of Americans to abuse their
nerves from the cradle to the grave." A deficiency in nervous
energy was the price exacted by industrialized urban societies,
competitive business and social environments, and the luxuries,
vices, and excesses of modern life. "The chief and primary
cause of ... [the] very rapid increase of nervousness is
modern civilization, which is distinguished from the
ancient [civilizations] by these five characteristics:
steampower, the periodical press, the telegraph, the
 sciences, and the mental activity of women." American
nervousness was alarmingly frequent "among the well-to-do
and the intellectual, and especially among those in the
professions and in the higher walks of business life, who
are in deadly earnest in the race for place and power."[14]
• 1881>{Faster is Better?}Frederick Taylor (1856-1915)
introduces time-motion studies, where workers' movements are
dictated in order to maximize efficiency and boost speed.
• 1884>{Modern Stress}George Beard, MD, wrote: Practical
Treatise on Nervous Exhaustion (Neurasthenia). It was one of
the first books to express the concept that your mental
life can have a profound negative impact upon your
physical health.[15]
• 1884>{Wellness} Julia Anderson Root published the Healing
Power of the Mind.

Progressive Era of Health Care Reform (1890-1920)

"The late 19th century spawned the psychoanalytical enterprise, the shift
from priest to therapist, and the abnegation of personal responsibility in
the face of social turmoil. By medicalizing neurosis, the early
psychologists and physicians initiated a disturbing trend that has now
reached crisis proportions."[17] "By the turn of the 20th century,
neurasthenia had become a medical phenomenon on both sides of the
Atlantic and neurologists found themselves sharing authority over the
illness. Homeopaths, eclectics, general practitioners, and gynecologists in
Europe and America tried their hand at treating the condition, each putting
their discipline's own spin on the illness. ... Cases of neurasthenia reached
a peak near the turn of the 20th century, and by the 1930s fewer and fewer
physicians were diagnosing the disease. There are a number of
explanations for this decline, including modern medicine's abandonment
of the 'nervous energy' model of health and the rise of Freud's
psychoanalysis as a way of explaining and treating psychosomatic
disorders."[4]

• {Biomedicine} During the Progressive Era, medicine chose to

look to the biological roots of disease rather than to the illness
as experienced by the patient. The basic structures of
twentieth-century American medicine--its focus on
biomedical science, its reliance on technologically
based hospital care, and its systems for medical
education and training--were firmly in place by the end
of the Progressive Era.[5]
• 1890s>{Faster is Better?}The popularity of new sports
governed by the clock, like football and basketball, grows
dramatically.
• 1893>{Psychoanalysis}Sigmund Freud and Josef Breuer
publish their paper On the Psychical Mechanism of Hysterical
Phenomena in Europe, marking the beginning of the
psychoanalysis movement. Hysteria was thought to be caused
by undischarged emotional energy.
o "The next major stage in the unfolding of the
relationship between emotions and disease began
with the deeper exploration of one of the neuroses:
hysteria. This complex disorder was long known in
medicine but not until the seventeenth and
eighteenth centuries was it seriously associated with
the nervous system or emotional causation."[35]
• 1902>{Wellness} William James in his The Varieties of
Religious Experience wrote: "The Religion of Healthy-
Mindedness has recently poured over America and seems
to be gathering force every day."[8]
• 1909>{Mind-Body Connection}Richard Cabot, MD (1868-1939)
publishes his Social Service and the Art of Healing and wrote:
"I found myself constantly baffled and discouraged when it
came to treatment. Treatment in more than half of the
cases...involved an understanding of the patient's
economic situation and economic means, but still more of
his mentality, his character, his previous mental and
industrial history, all that brought him to his present
condition in which sickness, fear, worry, and poverty were
found inextricably mingled."[6]
• 1909>{Psychoanalysis}The psychoanalysis movement first
receives public recognition in the United States when Sigmund
Freud and Jung were invited to give a series of lectures at Clark
University in Worcester, Mass.
• 1920s-1930s>{Medicine}"In the 1920s and 1930s conversion
hysteria gained popularity as a general medical notion, as
psychoanalysts joined internists and other physicians in
exploring the meaning of hysterical symptoms."[35]
• 1920s>{Psychosomatic Medicine} Walter Bradford Cannon
coined the phrase fight or flight response when he discovered the
 relationship between the stress of perceived danger and
neuroendocrine responses in animals.[18]
• 1936s>{Psychosomatic Medicine}Hans Selye coined the phrase
General Adaptation Syndrome where stressors like cold and
heat produce a generalized response in biological organisms as
they respond with automatic somatic reactions.[23]
• 1937>{Mind-Body Connection}Joseph Pilates publishes his
Your Health where he writes about achieving a "balance of
mind and body" and "the natural development of
coordinated physical and mental (normal) health and the
prevention, rather than the cure of disease." In 1945 he
wrote Return to Life where Pilates wrote for the first time about
the the stresses of modern life. Pilates was ahead of his time in
his booklets on a number of different issues, such as the mind-
body connection, wellness, the benefits of mind-body exercise,
and functional exercise.[6]
• 1938>{Psychosomatic Medicine}Dr. E Jacobson in his
Progressive Relaxation book developed a relaxation technique
that claimed anxiety is caused by skeletal muscle contractions.
• 1940s>{Psychosomatic Medicine}"World War II accelerated
the growth of psychosomatic medicine even further."[35]
• 1940s>{Psychosomatic Medicine}Henry Beecher coined the
phrase placebo effect. He discovered during World War II that
pain experienced by wounded soldiers could be controlled with
saline injections. Subsequent research will soon show that up to
35 percent of a therapeutic response to any medical treatment
could be attributed to the power of belief.[19]
• 1940s>{Wellness}During the 1940s the self-help movement
became increasingly more psychologically oriented and was
devoid of religious overtones.[9]
• 1940s>{Psychosomatic Medicine} Harold G. Wolff moved from
Cannon's fight-or-flight self-defense disease model to a more
generalized notion of stress and disease where people respond
to stressful situations or events.[20]
• 1950s>{Psychosomatic Medicine} Medicine started to abandon
all ideas derived from psychoanalysis (i.e.., role of unconscious
emotions, early childhood experiences, etc.).[21] Psychotherapy
was replaced by stress reduction and increased reliance on the
drug therapy of biomedicine.[22] The public, however, sought
to fight off the effects of modern stress in two different basic
 ways. Either normal people sought out psychotherapy
for help or they turned to the wellness movement. One
famous example of the psychotherapy approach is the film
director Woody Allen
• 1950s>{Psychosomatic Medicine} Hans Selye became the best
known proponent of the role played by stress in psychosomatic
theory.[24] Selye published forty books and over 1,700
scientific papers in the course of his career. He wrote for the
public books like The Story of the Adaptive Syndrome (1952),
The Stress of Life (1956 and 1976), and Stress Without Distress
(1974).[25]
• 1950s>{Wellness}"However fashionable psychosomatic
medicine became, it was by no means the only way Americans
pursued their interest in the relationship between emotions and
disease. A long-standing tradition of mental self-help, not
directed by physicians and concentrating on overt and
positive rather than covert and negative feelings, began in
the late nineteenth century and was still strong in the
1950s and 1960s. This tradition had consistently focused
attention on proactive ways people could become more
positive and optimistic about life, master their moods, and
fix their physical ills without taking medications. People
could align their thoughts and constructively adjust their
attitudes. Because mind and body were assumed to be
closely interconnected ... it was taken for granted that
harmonizing one's emotions in a positive way would,
unquestionably, improve one's physical well-being."[36]
• 1950s>{Wellness}Halbert Dunn, a physician, began using the
phrase high level wellness in the fifties, based on a weekly
series of thirteen lectures at an Unitarian Universalist Church in
Arlington, Virginia, in the United States.[11]
• 1961>{Wellness}Halbert Dunn published High Level Wellness.
Wellness comes to mean a new concept of health where there is
more to health than a mere absence of disease. Wellness now
refers to a healthy balance of the mind-body and spirit
that results in an overall feeling of well-being. The
modern concern with wellness did not, however, become really
popular until the 1970's.[11],[12]
• 1969>{Psychosomatic Medicine}Neil E. Miller, a pioneer in
biofeedback research, showed that it was possible to apply the
 principles of operatant behavior shaping towards altering
internal bodily functions, like heart rate. Miller's Visceral
learning would later come to be known as biofeedback. Miller
established that man could learn to control his
involuntary or autonomic nervous system.[37]
• 1970s>{Modern Stress} It was becoming increasingly
clear to the public that the stresses of modern life, the
work place, and your home life could adversely affect
your health. More researchers were also starting to
introduced biofeedback as a practical method of managing
hypertension and a variety of other health conditions without
the use of drugs.[30]
• 1972>{Psychosomatic Medicine}George Engel coined the
phrase conservation-withdrawal as an alternative to the current
stress model. He conceptualized psychobiological threats to an
individual�s well-being in terms of losses and deprivations
that caused the organism to become withdrawn, depressed and
shut-down with depressed physiological functions that created
a pathway to illness and death.[26]
• 1974>{Mind-Body Connection} Meyer Friedman and Ray
Rosenman published Type A Behavior and Your Heart.[28]
• 1974>{Mind-Body Connection}Herbert Benson coined the
phrase relaxation response.[29] And publishes a book on it in
1975 which promoted it as a counter to modern stress. Benson
viewed the relaxation response as being opposite to the fight-or-
flight response. Both of these responses involved physiological
changes in the brain's hypothalamus. The fight-or-flight
response provokes feelings of anxiety and increased levels of
blood-lactate. While the relaxation response was presented
as a method, more practical than biofeedback, that
effectively counters inappropriate elicitation of the
fight-or-flight response.[31] Patients could elicit the
relaxation response through what he called "a non-cultic
psychological technique," which was a form of concentration
meditation. According to Benson, four basic
components were necessary to elicit the relaxation
response: 1)a quiet environment, 2)a mental device, 3)a
passive attitude, and 4)a comfortable position. And, he
offered a choice of 3 different mental devices:
 1)concentrating on breathing, and repeating 2)a
mantra or 3)an affirmation.[31]
• 1977>{Mind-Body Connection}George L. Engel, MD (1913-
1999) first proposed the biopsychosocial model of health,
wellness, and illness. The simplistic biomedical model
(mentioned above) assumes that all disease is caused by
structural anatomic or biochemical abnormality. The
physician's responsibility is limited to finding the abnormality
to be cured. But without an easily discovered abnormality, as in
the functional gastrointestinal disorders, the simplistic
biomedical model fails. In contrast, the complex
biopsychosocial model is concerned with illness, the subjective
sense of suffering or reduced capacity to function. The
biopsychosocial model is a much more complex, systems
theory approach to health, wellness, and illness. It does not
look for single, specific causes for illness, but sees
health, illness and healing as resulting from the
interacting effects of events of very different types,
including biological, psychological, and social factors.
All of these are seen as systems that affect on another and
interact with one another to affect individual health. In the past
decade, even as medical technology has advanced rapidly, there
has been an increased appreciation of the value of the mind-
body connection systems approach to managing both functional
disorders and chronic disease.

The Next Millennium (2000-)

• 2003>{Wellness} The economist Paul Pilzer in Wellness

Revolution writes that the wellness industry is already a 200
billion-dollar business, with most of its revenue coming from
vitamin sales and health club memberships.[16]