Behavioral medicine and clinical health psychology: introduction to the special issue, a view from the decade of behavior

Integrating Behavioral Healthcare and Primary Care, Appropriate Balance on What Model is Driving Care, and, the Whole Spectrum of Individuals are Coming Through the Door…

With the integration of behavioral health services into primary care and other medical specialties, the community of providers and the public must address a number of questions, including: What models of care are there for these services? What kinds of providers supply these services? Are these providers trained behavioral health providers or extenders in some form? And, as these systems of care are constructed, who makes use of them? The purpose of this study is to address these questions as well as to consider some of the challenges of attending to the spectrum of needs that will arise as integrated healthcare services expand. Consideration of these questions may serve to clarify the impact that these models of healthcare will have in ways that may be readily apparent and, at the same time, in ways that may be subtler and less comprehensible. Addressing these questions is also intended to facilitate discussions within healthcare systems and among providers concerning which models of care best respond to specific populations. In turn, proactively answering these questions will, for the foreseeable future, shape not only behavioral healthcare, in perhaps small or large ways, but also healthcare in general.

Reaction Time Explains IQ's Association with Death

Lower IQ is associated with earlier death, but the cause of the relationship is unknown. In the present study, psychometric intelligence and reaction times were both significantly related to all-cause mortality in a representative sample of 898 people aged 56 years who were followed up with respect to survival until age 70. The association between IQ and mortality remained significant after adjusting for education, occupational social class, and smoking, all of which have been hypothesized as confounding variables. The effect of IQ on mortality was not significant after adjusting for reaction time, suggesting that reduced efficiency of information processing might link lower mental ability and earlier death. This new field of cognitive epidemiology provides arguably the strongest evidence for the importance of psychological factors in physical health and human survival. Finding the mechanisms that relate psychometric intelligence to mortality might help in formulating effective interventions to reduce inequalities in health.

Psychological consultation in a paediatric setting: A qualitative analysis of staff experiences of a psychosocial forum

The use of psychosocial forums in paediatric settings has been recommended as a means of providing psychological consultancy. However, no research has explored staff perceptions of these meetings or whether they have a positive impact on patient care. In this study, six members of a paediatric gastroenterology multidisciplinary team were interviewed about their experience of a weekly psychosocial forum using a qualitative approach. The data revealed that staff regarded the forum as an essential and useful part of the service. Staff reported a number of benefits to their clinical work as a result of attending the forum, in addition to the general benefits of having a clinical psychologist available to see patients. However, staff also made recommendations for improving the forum. The results suggest that psychosocial forums may provide an efficient means of delivering specialist psychological consultation for patients with psychological difficulties, in line with Department of Health recommendations for paediatric services. Future research should aim to investigate the effectiveness of psychosocial forums in different settings and to establish the cost-effectiveness of these meetings.

Modification of Coronary-Prone Behaviors in Coronary Patients of Low Socio-Economic Status

The purpose of this study is to determine the effectiveness of a group cognitive-behavioral treatment to modify coronary-prone behaviors in patients from a fairly low social and educational level. Participants were 98 male coronary patients randomly allocated to one experimental and two control groups. All groups received standard medical treatment. The experimental group received an additional psychological treatment and one of the two control groups received a health education treatment. Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up. The results are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.

Long-Term Adherence to Health Behavior Change

The utility of lifestyle-based health promotion interventions is directly impacted by participant adherence to prescribed behavior changes. Unfortunately, poor adherence to behaviors recommended in lifestyle interventions is widespread, particularly over the long-term; thus, the "adherence problem" represents a significant challenge to the effectiveness of these interventions. The current review provides an overview of the adherence problem and describes a theoretical framework through which the factors that impact adherence can be understood. To further understand the difficulties individuals face when adhering to health behavior changes, we focus our discussion on challenges associated with adherence to lifestyle behaviors recommended for weight loss and healthy weight management (i.e., reductions in dietary intake and increases in physical activity). We describe strategies that improve long-term adherence to health behaviors related to healthy weight management, including the provision of extended care, skills training, improving social support, and strategies specific to maintaining changes in dietary intake and physical activity. Finally, we discuss difficulties involved in implementing long-term weight management programs and suggest practical solutions for providers.

A motivational interviewing course for pharmacy students

OBJECTIVE

To create, implement, and evaluate a pharmacy course on motivational interviewing.

DESIGN

A 3-hour elective course was created to train doctor of pharmacy (PharmD) students in brief patient-centered motivational interviewing counseling strategies that have proven effective with the types of health issues most commonly addressed in pharmacy settings. Students were assisted in developing their skills through required readings, interactive lectures, in-class demonstrations and practice sessions, out of class skills practice, one-on-one supervision provided by doctoral level clinical health psychology students, and written reflections on each class session.

ASSESSMENT

Students demonstrated significant improvement in motivational interviewing skills and a high level of motivation for and confidence in using these skills in their future practice. Students overall assessment of the course and supervision process was highly positive.

CONCLUSION

This patient-centered counseling skills course was feasible and produced improvements in PharmD students' counseling skills and increased their motivation and confidence to use motivational interviewing skills in their future communications with patients.

Addressing the workforce crisis in integrated primary care

Training and education in integrated primary care is limited. We see a need for addressing the looming workforce shortage as behavioral health services in primary care become more widely implemented. Bringing mental health clinicians straight from specialty mental health settings into primary care often results in program failure due to poor skills fit, assumptions about services needed, and routines of practice these clinicians bring from their specialty settings. Health psychology graduate programs tend to prepare graduates for specialty research and practice in medical settings rather than preparing them for the pace, culture and broad spectrum of needs in primary care. Family medicine residency programs provide an underutilized resource for training primary care psychologists and family physicians together. Even if comprehensive graduate training programs in integrated primary care were developed, they could not begin to meet the need for behavioral health clinicians in primary care that the present expansion will require. In response to the demand for mental health providers in primary care, new initiatives have emerged which attempt to provide training for the preexisting mental health workforce to enable their successful integration into primary care settings.

Psicologia pediátrica: a atenção à criança e ao adolescente com problemas de saúde

O presente trabalho examina algumas questões referentes ao modelo psicossocial, à Psicologia da saúde e à Psicologia pediátrica. A Psicologia pediátrica é o campo que aplica os conhecimentos da Psicologia da saúde às crianças e adolescentes com problemas de saúde e tem como objetivo prevenir, compreender e tratar os problemas psicológicos causados pelos transtornos físicos. A autora discute as origens da Psicologia pediátrica, os conhecimentos básicos para trabalhar nesse campo e questões referentes à atuação prática e à pesquisa com crianças e adolescentes com problemas de saúde e suas famílias.

Work disability in adults with cystic fibrosis and its relationship to quality of life

With increasing numbers of cystic fibrosis (CF) patients surviving to adulthood, issues related to vocation inevitably arise and warrant specific attention. We examined the percentage of participants with CF currently working and explored risk factors for work disability among adults with CF.

METHOD

We recruited 50 consecutive patients from an adult cystic fibrosis service. Demographic, employment history, illness severity indicators and CF-attributed work disability factors were evaluated. Demographic risk factors for work disability using the illness severity measures of FEV(1), S-K score, CRDQ, and recent hospitalisation as independent variables were determined.

RESULTS

Factorial analysis of a disability index (DI) indicated no dependency on FEV(1) or S-K score, but dependency on quality of life indices (p<0.05), age (p<0.05) and hospital admission rate (p<0.05). Hours worked per week were dependent on quality of life (p<0.01) (mastery of disease domain), fewer hospital admissions (p<0.01) and age (p<0.05). Sixty-eight percent of the sample reported that CF resulted in significant impediments to employment. However, few had sought vocational guidance (6%).

CONCLUSION

Determinants of workforce participation shows that hours worked and perceived disability are more dependent on mastery of disease, age, and time in hospital, than on clinical severity scores. Health professionals may assist productivity through career counselling or tailored programs.

Evolution of the biopsychosocial model: prospects and challenges for health psychology

Although advances have been made in specifying connections between biological, psychological, and social processes, the full potential of the biopsychosocial model for health psychology remains untapped. In this article, 4 areas that need to be addressed to ensure the continued evolution of the biopsychosocial model are identified and a series of recommendations concerning initiatives directed at research, training, practice and intervention, and policy are delineated. These recommendations emphasize the need to better understand and utilize linkages among biological, psychological, social, and macrocultural variables. Activities that facilitate the adoption of a multisystem, multilevel, and multivariate orientation among scientists, practitioners, and policymakers will most effectively lead to the kinds of transdisciplinary contributions envisioned by the biopsychosocial perspective.

Health services and health care economics: the health psychology marketplace

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed.

Current status of psychotherapy for mental disorders in the elderly

Research on psychotherapy for older adults with psychiatric disorders has demonstrated its effectiveness, although the majority of research has been conducted on major depression. Recent advances in extending this research to additional diagnostic categories and treatment settings are reviewed. Psychotherapy appears promising in the treatment of minor depression, dysthymia, anxiety disorders, depression with comorbid personality disorders, depression with comorbid cognitive impairment, and as an adjunctive treatment in psychotic disorders. Psychotherapy also has been successfully transported to the primary care setting, and shows potential in long-term care and in-home settings. Many of these studies are preliminary, however; additional research is needed with larger, more diverse samples across a variety of psychiatric diagnoses and treatment settings.

Introduction to the Special Section on the Future of Health Psychology

Following 25 years of landmark progress, health psychology faces even greater change in the foreseeable future. Evolving patterns of health and illness and developments in medicine and related fields will shape the future of health psychology. The articles in this special section discuss these future issues in several areas: the biopsychosocial model, changes in demographics, prevention, clinical health psychology interventions, health care financing, and new technologies. In every case, the future holds a variety of important challenges and opportunities in research, practice, training, and policy.

Behavioral medicine: 2002 and beyond

This article highlights future directions for research and practice in behavioral medicine. Topics addressed include social and environmental issues, the role of technology, translational research, improving and developing interventions, and professional training and retraining.