ABS 200

3 Health Psychology By Gregory J. Privitera, St. Bonaventure University Fuse/Thinkstock Learning Objectives After reading this chapter, you should be able to• Define health psychology, and describe the different areas of interest of health psychologists.

• Identify the core models and psychological concepts used in health psychology.

• Evaluate the occupational and educational opportunities in the field of health \ psychology.

• Analyze current trends and opportunities in the field of health psychology.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 The Basics of Health Psychology From a general perspective, health can be thought of as the quality of life between birth and death. People often think of being “healthy” as the absence of illness. However, this is an over - simplification of what health is, and of how people live their lives. Consider the following phrases we may use on occasion:

“Let’s just relax and watch a movie; it’s been a stressful day.” “I take a multivitamin a day to stay healthy.” “Seeing my best friend always cheers me up.” “Exercising makes me feel healthy; I love that feeling.” “I need to take my medication each day; the doctor says it’s how I can get better.” Each of these five statements is related to the pursuit of feeling better or healthier, yet only the last statement relates to illness. It is important to understand that health is not relevant only when we are ill. We all have the potential to become ill, so naturally we may engage in health- related behaviors, such as purchasing a gym membership or dieting, even when we are not sick. We also may engage in unhealthy behaviors despite the consequences. According to the American Cancer Society and the World Lung Foundation, more than 55.8 million Americans still smoked cigarettes as of 2013, leading to a total cost in dollars spent treating tobacco- related illnesses of approximately $10–$11 billion annually (World Lung Foundation, 2015).

Understanding why people engage in health-related behaviors and ways to prevent unhealthy behaviors is important, not only to reduce the costs associated with unhealthy behaviors such as smoking, but also to enhance health and well-being.

This chapter will explore the diverse areas of research on which professionals in this sub- discipline focus, and how this understanding can promote a better understanding of health.

3.1 The Basics of Health Psychology Health psychology is the study of psychosocial and behavioral processes related to health, illness, wellness, and health care in order to understand how such processes contribute to the landscape of health across the lifespan. It is a relatively new field of psychology that has gained interest as the field of psychological medicine has grown. Increasingly, we are rec- ognizing that illness is not purely physical. Even when it is physical, like when a person has cancer, the psychology of how a person experiences that illness can play an important role in the progression of that illness. This is the psychosocial and behavioral component of health.

Health psychology focuses on how our interactions in a psychological, social, and behavioral context affect our health and the health of others. In order to make sense of the field of health psychology, let’s break this definition down into the fundamental components of the field.

Health According to the World Health Organization, in a statement last amended in 1948, health is “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity” (World Health Organization [WHO], 1948, p. 100). At the time, this was \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 The Basics of Health Psychology quite a progressive definition for health, although it is not comprehensive of what we now understand health to be. The definition misses key elements of health, such as psy - chological and social/cultural aspects, which together are commonly referred to as the psychosocial health factors.

To illustrate the everyday psychosocial fac- tors of health, consider that it is very likely that you do not eat the recommended five fruits and vegetables a day. Why? For many, these foods are too expensive (an economic reason). For others, fruits and vegetables may not be a staple food, and thus cultural or familial customs make it unlikely that these foods will be eaten five times a day. Similarly, health can be related to religious prac- tices (certain foods may be sacred), lifestyle factors (a busy work life leads to poorer dietary choices), bodily changes (pregnancy affects diet), or even personal experiences (divorce may lead to depression, which is related to weight gain). The interplay between psychology and society (or “the world we live in”) is a crucial part of the definition of health.

As stated earlier in this chapter, health psychology is a field with interests in the psychoso - cial and behavioral processes related to health, illness, wellness, and health care. When we consider illness, health, and wellness, the latter terms should not be used as synonyms. In practice, health, illness, and wellness are treated as part of a continuum. Figure 3.1 illustrates how such a continuum can reveal these aspects of health. The patient is often thought of as “healthy” when he or she has no apparent illness, which is a disease or sickness over any length of time that can affect the body, mind, or both. “Healthy” is the neutral point in the con- tinuum, although this is, of course, not correct with regards to how health is defined. Show - ing enhanced wellness is not typically regarded as a necessary condition for a patient to be labeled as “healthy.” Wellness involves caring for the physical self, while also attending to the psychosocial self. The treatment approach is a model that begins with illness, with the goal of eradicating the illness. The wellness approach is the other part of this continuum. In this approach, someone who is not necessarily ill makes efforts to promote wellness or become more than just “healthy” as a way to minimize the need for treatment.

The illness-wellness continuum varies across the lifespan; it is not a static model. Moving to the left in the continuum is a progressively worsening state of health. The treatment approach can help return the individual to the center of the continuum (Baker, McFall, & Shoham, 2009). An example of this is when doctors use drugs, surgery, or psychotherapy to treat patients. The treatment approach aims to alleviate symptoms of illness. To the right in the continuum is a progressively improving state of health or wellness. The wellness approach, which can be applied even during treatment, can help people achieve optimal wellness beyond simply not being ill, and it can help them cope with or manage an ongoing illness (Myers, 1992; Swarbrick, 2006). Regardless, throughout our lives we will vary along this continuum. Fuse/Thinkstock Culture, environment, and lifestyle all play a role in a person’s health.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 The Basics of Health Psychology Figure 3.1: The illness-wellness continuum Indicators below the star suggest illness, while indicators above the star suggest wellness. The wellness approach is typically applied on both ends of the continuum, whereas the treatment approach is typically applied only when indicators suggest illness.

Source: Adapted from The Wellness Workbook (3rd ed.), by J. W. Travis and R. S. Ryan, 2004, Berkeley, CA: Celestial Arts.

Notably, optimal wellness is more than just a physical state in this continuum. Even if an individual lacks physical symptoms of illness, the person may still experience psychological symptoms, often expressed as emotion (e.g., depression, anxiety, or even general dissatisfac- tion with life). Such emotional states can often affect mental and physical health. For example, excessive stress can weaken the immune system, leading to increased likelihood of diseases such as cancer (Corthay, 2014). Negative emotional states can also influence health behav - iors, leading to smoking, alcohol consumption, overeating, or even suicide. Death may be a natural part of life, and an individual’s place on the continuum often cannot be controlled.

However, people can control which direction they are facing in this continuum—and facing to the right of this continuum points to wellness.

Wellness is an increasingly important area of research and practice. Consider research from positive psychologists on flourishing and flow (Seligman & Csikszentmihalyi, 2000; Keyes & Haidt, 2003). Flow, which was coined by Mihaly Csikszentmihalyi, occurs when people become so engaged in an activity that they become engrossed, losing a sense of self and time as a result. Csikszentmihalyi’s work fundamentally focuses on what gives people enjoyment and happiness in their lives. He found that even those activities in which people experience physical discomfort, such as training for an athletic event, can be enjoyable and produce a strong sense of gratification if they contribute to feelings of happiness and well-being. Activi- ties that can induce flow can vary from reading a book to making friends to exercise and sports. Any activity that is rewarding and motivating can induce flow. Such research is lead- ing the way to help practitioners understand how people can flourish and find happiness, thereby enhancing their wellness (Centre for Confidence and Well-Being, 2006).

Keep in mind that health psychology, as a field, is interested in the processes that contribute to the full spectrum of health across the lifespan. To understand those processes, or what are also called the underlying mechanisms related to health outcomes, health psychologists use the scientific method to evaluate health outcomes. Health psychology is a scientific endeavor, and health psychologists, whether they are employed in a lab or in an applied setting, are scientists. \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 The Basics of Health Psychology Areas of Interest and Focus Among Health Psychologists Health psychologists often make significant contributions to the following key areas across the lifespan:

• The etiology or correlates of health, illness, and wellness • The prevention and treatment of illness • Health promotion and maintenance • The impact of the health care system and health policy Etiology The etiology , or cause of a disease or ill - ness, is more than just biological. Health psychologists are just as interested in health and wellness as they are in illness and view etiology from a broader perspec - tive by evaluating health, wellness, and illness from a “health onion” perspective (Dahlgren & Whitehead, 1991). The health onion is a multilayered framework for health psychology (Figure 3.2). From this perspective, to understand health, well - ness, and illness, the biological individual (e.g., age, sex, heredity) is at the center.

From a traditional clinical perspective, the biological individual is the primary focus for etiology. Health psychologists look beyond this layer and focus on the four lay - ers of etiology:

Indi vidual and lifestyle factors 2.

Social and community netw orks 3.

Li ving and working conditions 4.

Gener al socioeconomic, cultural, and environmental conditions Prevention A central focus in health psychology is on more than just treatment, which is an application of the left side of the illness-wellness continuum; it is on the prevention of disease as well, which is an application of the continuum from left to right. When applied to health, preven- tion means to avoid a disease entirely by taking actions that can stop a given disease from developing. Broadly, prevention services can be categorized into three types:

Primar y prevention is aimed at stopping disease before it occurs. An example of primary prevention is the immunization program, which has all but eradicated many diseases that were epidemic in the early 1900s. Figure 3.2: The health onion The “health onion” perspective views etiology in layers that when considered together can lead to improved quality care and health outcomes. A key feature of this perspective is that each layer is a contributing factor and that no one layer can be fully isolated when working to identify etiology, or causes of disease.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.1 The Basics of Health Psychology 2. Sec ondary prevention is aimed at the early diagnosis and detection of treatable dis- eases. This level of prevention aims to identify diseases early to make them easier to manage. An example of secondary prevention includes medical screening tests such as mammograms and colonoscopies.

T ertiary prevention is aimed at wellness for those with chronic irreversible diseases.

An example of tertiary prevention is physical therapy for those with arthritis. The goal is to help patients manage their diseases to improve their quality of life or wellness. Health Promotion While prevention of disease is an important step toward healthy living, health psychologists further focus on the promotion and maintenance of good health. Health promotion refers to enabling people to have greater control over and improve their health and well-being. Efforts to promote positive health go beyond individual behavior to include other factors. Examples of health promotion include building community parks to increase activity, opening grocery stores in “food deserts” to make fresh fruit and vegetables more available, and individual efforts such as lifestyle changes to increase exercise.

Health promotion is a key initiative today, thanks in part to the great work of health psycholo- gists who have developed effective strategies to promote health and wellness even among those who are not ill. For instance, the Centers for Disease Control (CDC) has made this a key initiative, particularly as it pertains to health equity. One of its key goals is to increase health promotion efforts targeting social determinants of health, such as increased access to affordable healthy food options in underserved communities through the development of community gardens, as well as tax - ing and zoning policies that encourage the development of full-service gro- cery stores in neighborhoods where they are lacking. (CDC, 2009, p. 12) Health Care and Policy Many of the concepts and strategies described in this chapter have implications for, and an impact on, the health care system and health policy. Keep in mind that the health care system is informed by health policy. As researchers gather data that affect the policies that health care providers must adhere to, the health care system—which includes any level of care from hospitals to physician office visits—thus fundamentally changes to adapt to new and chang- ing policies. Health psychology is an applied field rooted in evidence-based scientific think - ing to develop knowledge of illness, health, and wellness, and it certainly has an impact on health policy, particularly for behavioral health. For example, rates of depression and stress are rising among American war veterans, and the need to serve and treat this population has become increasingly important (Taylor, Parkes, Haw, & Jepson, 2012). The health psychol- ogy field is also a holistic approach to health that focuses on the entire person and not just the physical body. This has inspired efforts in health promotion and prevention that have led to fewer people getting sick and improved recovery from illness in many cases. For exam- ple, art therapy is a growing and cost-effective approach that has successfully been used to promote positive moods among those suffering from depression (Privitera, Misenheimer, & Doraiswamy, 2013a) and enhance communication among those with dementia (American Art \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 Core Models and Psychological Concepts in Health Psychology Therapy Association, 2015). Many of these prevention efforts often contribute to reducing costs associated with health care.

While health psychology’s impact on health care certainly relates to cost, it also relates to outcomes such as efficiency, accessibility, utility, and the potential ethical implications of pro- viding health care. Health care is a complex ecosystem in that it affects and is affected by the work of health psychologists, medical professionals, and even patients. It provides the essen - tial applied framework that guides the activities of medical and behavioral health profession- als. From a broad perspective, the role or structure of the health care ecosystem for providing care can be described by the 6 P’s (adapted from the website for the Center for Healthcare Innovation, 2012):

P atients are those whose health we are concerned for, such as you and me.

Pr oviders are systems that provide care, such as hospitals and clinics.

P ayers are those who pay for medicine, such as employers, government, and patients (out of pocket).

Pr escribers are those who prescribe medicine or health consultation, such as doc- tors, physicians, psychiatrists, and psychologists.

Pharmac euticals are companies that develop drugs that are utilized in the health care system, such as Johnson & Johnson and Pfizer.

P olicymakers are those who are responsible for making policies, rules, laws, or other regulations that affect the health care industry, such as members of the Food and Drug Administration (FDA).

3.2 C ore Models and Psychological Concepts in Health Psychology As a discipline, health psychology is a relatively new field of study compared to many other fields of psychology. Historically, health psychology was founded largely through the develop- ment of two key perspectives that have shaped the field. In this section, we will define health psychology and in the process introduce these two key perspectives that have shaped how health psychology is defined and how “health” is conceptualized in the discipline.

The Mind-Body Debate Health psychologists have varying perspectives on what health is and how to best understand it. These perspectives or models generally fit within the traditional debate of the mind-body relationship , which is the philosophical debate of whether the mind and body are one (part of the same system) or distinct (part of separate systems). The mind pertains to the mental processes, thoughts, and levels of consciousness of an individual. It is the conscious think - ing “self ” that experiences a person’s thoughts. The body is the physical “self,” including the actions of neurons and the structure of the brain, which is part of the body.

One of the central questions in psychology, and among philosophers, is whether the mind is part of the body, or vice versa. In other words, are the mind and body a synergistic whole, or are they distinct? And if they are distinct, which is in control? Humans are characterized as \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 Core Models and Psychological Concepts in Health Psychology having both a mind and a body, typically. F rom a dualism perspective, the mind and the body are distinct; the mind and the body thus constitute separate systems. From a monism perspective, the mind and the body are the same thing, that is, they are synergistic; the mind and the body are part of the same system. The Biopsychosocial Model The mind-body debate relates to the two predominant models within which health psychology is mainly studied.

The most widely adopted viewpoint among researchers and practitioners is the biopsychosocial model, which is the holistic perspective that illness, health, and wellness can be best explained in the interactions of biological, psychological, and social factors (Suls & Rothman, 2004).

It largely follows a monistic view that the mind and body are the same, or at the very least they are interconnected in such a way that they can be treated as if they are the same. Thus, any efforts to understand illness, health, and wellness should appeal to all aspects of the self—the mind (psychological, cognitive, mental) and the body (biological, physical).

According to the biopsychosocial model, the mind and the body collectively influence illness, health, and wellness, and this viewpoint has the key advantage of incorporating all aspects of health from the mind to the body. It provides a more complete view of factors known to affect health. It can help explain how emotions (the mind) can induce physical ailments (the body), known as psychosomatic symptoms (e.g., emotional stress can induce ulcers). It can even help explain how physical ailments, such as many types of cancers, are genetic or bio- logical in nature independent of psychosomatic symptoms. Thus, the biopsychosocial model is an understanding of illness, health, and wellness at a psychosocial level (e.g., the impact of social support, emotional well-being, or perceived anxiety on illness, health, and wellness) and at a physical level (e.g., the impact of cellular, chemical, or structural dysfunction on ill - ness, health, and wellness).

As an example of the biopsychosocial model in action, consider that the diagnosis and treat- ment of depression by clinicians is dynamic, meaning that treatment options can change or evolve over time (Motter et al., 2016; Privitera, 2008). Self-report tools often are used to ini- tially identify depression, using scales such as the Beck Depression Inventory (Beck, 1967), which includes many psychosocial items such as how a person feels, whether he or she is considering suicide, and even his or her diet. Family histories are also considered to identify potential biological bases of the disorder. Patients with a strong family history of depression are often identified as being genetically predisposed to the disorder, and this in turn informs treatment options. Treatment for depression is also dynamic. If there is little evidence of risk of suicide and family history, then therapy may be the best course of action, whereas with strong family histories or high likelihood of suicide, medication may be the prescribed treat- ment. In many cases, both treatment options are utilized depending on the types of risks and causes identified. In this way, the biopsychosocial model is often applied in clinical settings, with considerations made for psychological, social, and biological factors. Science Photo Library/Getty Images The mind-body dilemma is primarily split between two camps: dualists and monists.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 Core Models and Psychological Concepts in Health Psychology The Biomedical Model An alternative viewpoint comes from the more simplistic, reductionist biomedical model, which is the perspective that health and illness can be explained solely on the basis of biologi- cal factors. Thus, this model specifically excludes psychosocial factors to explain health and illness. It is a reductionist perspective in that it reduces the complexity of health to a single cause: the physical self. In this way, the biomedical model largely follows a dualistic view that the mind and body are separate—thereby allowing for a perspective in which we can under- stand health and illness by studying the body (physical, biological factors) separate from the mind (psychosocial factors).

The biomedical model has the advantage of simplicity, but this is also its key disadvantage.

It reduces illness and health to low-level processes, such as the actions of chemicals or neu- rophysiological processes in the body, while disregarding the role of psychological or social factors on disease. It also emphasizes an understanding of the causes of dysfunction or illness rather than the factors that promote health and well-being. Consider further that achieving wellness is largely a psychological endeavor—it is an attainment of health largely driven by the need to “feel” healthy—and therefore is an incomplete model in that it is not well adapted to explain the wellness approach in the absence of illness.

Key Psychological Concepts Health psychology is a diverse field where professionals are actively engaged in health care across the illness-wellness continuum. Many of the most important psychological concepts in this field broadly center on • the discrepancy between patient and provider beliefs and communication, and the impact of this on health behavior, and • the application of the illness-wellness continuum across the lifespan.

In this section, we will evaluate each broadly identified area and how these areas relate to many key psychological concepts that those who work in the field of health psychology must understand.

Health Belief Model The experiences we have in a medical setting, whether positive or negative, are partly shaped by the patient and provider expectations or beliefs in that setting. Health beliefs are the knowledge, attitudes, and expectations of patients or providers regarding their personal health and treatment. For example, patients’ beliefs about seeking help for depression vary by sex, and these beliefs may guide a patient’s experiences with health care. Women tend to be more likely to seek help for depression than men. One reason is that more nurturing norma- tive social factors exist for women compared to men (Piccinelli & Wilkinson, 2000). Similarly, providers may experience frustration when patients miss scheduled appointments or do not fully disclose their symptoms, maybe due to the symptoms being too embarrassing. These expectations or beliefs affect the health care experience as well as health behaviors.

Health behaviors are the actions people take to achieve and maintain good health, promote wellness, and prevent illness. Examples of good health behaviors are exercising regularly, \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 Core Models and Psychological Concepts in Health Psychology eating a balanced diet, and getting enough sleep each day, all of which are affected by the health beliefs of an individual. Many subtle factors influence our health behav - iors, including the following factors, adapted largely from the health belief model (Rosenstock, Strecher, & Becker, 1988; Ogden, 2007):

Locus of c ontrol (Marsh & Richards, 1987; Rotter, 1966). Our individual locus of control is the extent to which we perceive that we are in control over those things that we are capable of influencing. An internal locus of control is when we believe we control our health (“I’m sick because I stayed out in the rain too long”), whereas an external locus of control is when we believe our health is out of our control (“I’m sick because I’m unlucky”) or under the control of others (“I’m just doing what my doctor tells me to do”). As a general rule, a higher locus of control is associated with better health outcomes (Marsh & Richards, 1987).

Healt h motivation. Not everyone is equally concerned about health. The readiness or willingness of a person to be concerned about health matters is called health moti - vation . The more motivated a person is about health, the more likely that person is to engage in healthy behaviors (“I am concerned that my stress is damaging my health”). People who are concerned about their health are more likely to be moti- vated to take action or do something about it in a way that benefits their health.

P erception of risk and susceptibility. Those who perceive their risk to be low will be less likely to feel the need to see a doctor, even if, in fact, their risk is high (“I don’t feel well, but it will pass; I don’t need to see a doctor”). This leads to an important consideration with regard to perceived risk and susceptibility: It can be based on valid information (“I have a high risk due to a family history with the disorder”) or invalid information (“I can’t get lung cancer because I don’t smoke”). This perception is a driving force in determining whether a person sees a doctor.

Sev erity of illness or necessity of action . One important factor that contributes to health motivation and perceived risk/susceptibility is the severity of an illness. The more severe an illness, the more motivated someone will be to immediately take actions to ameliorate his or her symptoms. As an example, a young person who is obese and diabetic will likely be more motivated to make dietary changes than will a young person who is obese but otherwise healthy.

C ost-benefit analysis. Health aside, people also evaluate the costs and benefits of changing their behavior. This is related to a person’s openness to behavior change (“If I stop smoking I’ll save money, but I’ll probably gain weight”). Whether a per- son makes a behavior change is complex and is partly described in the transtheo- retical model , also called the stages of change model (Prochaska & DiClemente, 1982), where a patient may go back and forth through the following stages to decide whether to change his or her behavior: precontemplation (“I enjoy getting drunk”), contemplation (“Drinking is affecting my life; maybe I should think about stopping”), preparation (“I will stop going out to bars”), action (“I have stopped drinking”), and maintenance (“It has been 6 months since my last drink”). S847/iStock/Thinkstock What health behaviors do you engage in?

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.2 Core Models and Psychological Concepts in Health Psychology 6. C ues to action. A cue to action is an occurrence that triggers people to think about their health behaviors. This could be internal, such as a physical symptom (“I feel shortness of breath”) or external (“I read a pamphlet that said I may be at risk”).

Cues to action are important as they are relevant to the person in a way that makes him or her concerned—leading to greater health motivation to take action. Whether people take action can often depend on whether they believe their behavior can affect their health, a set of assumptions commonly referred to as self-efficacy beliefs (Bandura, 1992; Maddux, 1993; Wallston, 1994). Generally, self-efficacy refers to an individual’s belief in his or her ability to successfully complete the steps required for a given task or to achieve a certain goal. In terms of health behavior, high self- efficacy—a strong belief that one’s actions can make a difference in one’s health—is associated with a greater likelihood of taking action (Locke & Latham, 1990).

The nature of the relationship between the patient and the provider, however, is one of unequal power, in part because the provider has greater knowledge of the disease and the treatment options. A key concern, based on the health belief model, is that the information that the patient has will substantially drive health beliefs and subsequent health behaviors.

For this reason, many health care settings prefer more collaboration between the physician and the patient, in part to encourage positive patient health beliefs. This is known as a patient- centered communication model, as opposed to a physician-centered communication model. Communication Models In the physician-centered communica- tion model, the communication is directed from physician to patient. The physician does most of the talking, chooses the top- ics, and begins and ends the conversations.

This is a typical model applied in clinical settings when the physician gives a patient a diagnosis and treatment without really allowing the patient to provide feedback or ask questions. In a patient-centered com- munication model, the communication is largely collaborative. The physician and patient make mutually agreed-upon deci- sions based on a fair and honest exchange of information. The goal in this model shift is to empower patients with greater knowledge about their disease and the ways in which they can be part of the diagnostic solution.

A key feature of a patient-centered communication model is that the patient is part of the team of caregivers. Suppose, for example, a patient is evaluated for high blood pressure due to obesity. In a physician-centered communication model, the physician informs the patient of the diagnosis (high blood pressure) and the course of action to be followed. In a patient-cen - tered communication model, the physician guides the discussion of the diagnosis and works together with the patient to develop a course of action or treatment plan they can mutually agree upon. Monkeybusinessimages/iStock/Thinkstock Many are familiar with physician-centered communication within clinical environments, but patient-centered communication is less common, and more collaborative.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.3 Education and Careers in Health Psychology Often, just knowing what questions to ask can facilitate more positive experiences in a health care setting. The National Patient Safety Foundation (NPSF) started the “Ask Me 3” program to improve communication between patients and health care providers (NPSF, 2015). This program encourages patients to be active members of their health care team and to ask the following three questions to enhance patient-provider communications:

What is m y main problem?

What do I need t o do?

Wh y is it important for me to do this?

Health beliefs and behaviors are an important part of the psychology of health. The shift to a patient-centered communication model and the “Ask Me 3” program are two examples of how these concepts have been applied in medical health care settings to enhance patient experi- ences and to improve the quality of health care.

3.3 Education and Careers in Health Psychology According to Division 38 (Health Psychology) of the American Psychological Association (APA), Health psychologists participate in health care in a multitude of settings including primary care programs, inpatient medical units, and specialized health care programs such as pain management, rehabilitation, women’s health, oncology, smoking cessation, headache management, and various other programs. They also work in colleges and universities, corporations, and for governmental agencies. (APA, 2015, para. 2) There are many opportunities, from the applied to the academic, in the field of health psychol- ogy (for an example, see In Depth: The Mozart Effect). In Depth: The Mozart Effect The Mozart Effect is the theory that enhanced perfor- mance, intelligence, or cognitive ability can result from listening to Mozart’s music, and classical music in gen- eral. Coined by Alfred Tomatis in 1991, who played Mozart’s music in his attempts to cure a variety of dis- orders, the Mozart Effect was popularized in a book by Don Campbell and gained scientific recognition in 1993, following the publication of an experiment in Nature that showed that listening to Mozart tempo- rarily improved performance on an abstract/spatial reasoning test (Campbell, 1997; Rauscher, Shaw, & Ky, 1993). (continued) GODONG/BSIP/BSIP/SuperStock Music therapy continues to be evaluated as a way to promote positive health outcomes and wellness.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.3 Education and Careers in Health Psychology In Depth: The Mozart Effect (continued) The idea became so popular that in January 1998 the governor of Georgia, Zell Miller, proposed more than $100,000 in his state budget to ensure every child born in Georgia received a tape or CD of classical music. While original work showed strong evidence to support this effect, data have since been more balanced, and this theory today is largely regarded as controversial.

In 1999, a meta-analysis study was among the first to challenge the claims of the Mozart Effect on intelligence. From that work, the authors concluded that “any cognitive enhancement [due to music] is small and does not reflect any change in IQ or reasoning ability in general” (Cha - bris, 1999, p. 826).

While the relationship between sound and music, whether played or listened to, is complex and evidence to support the Mozart Effect is mixed, it has nonetheless become increasingly applied in clinical and mental health psychology settings, as is evident by the growing num- ber of music therapy programs in the United States (Landau, 2013). Studies have explored a variety of possible health benefits for music, including some looking at possible benefits for diet, mental health, and even the onset of seizures. Today, psychologists continue to explore possible benefits in health settings. From the lab to the growing applied field of music therapy, health psychologists today continue to evaluate evidence-based use of music interventions in a variety of clinical and nonclinical settings to treat illness and promote positive health out- comes and wellness. Education and Training Students can take many paths to studying health psychology. At the undergraduate level, health psychology courses are offered at many North American colleges and universities. Stu - dents are also encouraged to take courses that have a more biopsychosocial focus, such as those in abnormal, developmental, and social psychology; learning processes; clinical/behav - ioral therapies; biopsychology; anatomy and physiology; psychopharmacology; community psychology; and public health. These courses are closely related to the field of health psychol- ogy and prepare students for graduate work.

Health psychologists typically hold a doctoral degree, such as a doctor of philosophy (PhD) or a doctor of psychology (PsyD). There are master’s and doctoral programs in health psychol- ogy, and many other doctoral programs, such as those in clinical, counseling, social, or experi- mental psychology, have specialized tracks in health psychology. Programs in health psy - chology at the graduate level are quite diverse, with some focusing on training for careers in research and others emphasizing training for one of many possible applied careers in health psychology. A listing of health psychology training programs and doctoral degree tracks, as well as additional resources, can be found at the website for Division 38 of the APA: h t t p : // w w w.health-psych.org/LandingEducation.cfm .

There are also many other opportunities for students interested in pursuing education and a career in health psychology. Predoctoral internships allow students to gain the additional experience necessary to be competitive for graduate and doctoral programs in health psy - chology. This type of internship is required as part of the training prior to earning a doctorate degree for students in many clinical and counseling programs. The internship may be referred to as a residency, particularly if the internship is in a hospital or clinical setting. Typically, the \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.3 Education and Careers in Health Psychology internships provide opportunities for mentorship “in which at least half of the trainee’s time is spent in supervised health psychology activities” (APA, 2015, para. 10).

Other opportunities exist for continued professional development and education following a doctoral degree, such as postdoctoral fellowships , which are offered at many universities, and in medical, clinical, and other health center settings. Postdoctoral fellowships provide further education to recent doctoral graduates seeking to enhance their experience in their fields of study or for those who want to enhance their research skills. A listing of health psychology postdoctoral opportunities, as well as additional resources, can be found at the website for Division 38 of the APA, which is the same site as that for doctoral degree tracks: http://www .health-psych.org/LandingEducation.cfm .

Health psychologists in applied fields must often earn licensure or certification. In these applied fields, such as areas in clinical or counseling psychology, health psychologists are licensed for independent practice and may pursue board certification through the American Board of Professional Psychology (ABPP). More information regarding the requirements for board certification can be found at the ABPP website: ht tp://w w w.abpp.org .

Educational and training programs, including those directed toward licensure and certifica - tion, vary widely with regard to the focus and scope of the program—due in large part to the diversity of career options in this field of study. For this reason, it is always best to research these programs to ensure that they align with a student’s interests and goals. It may be ben- eficial to also contact programs that directly match interests and needs.

Career Focus and Settings Health psychologists are generally distinguished by (1) the setting in which they work and (2) the type of groups they work with. Health psychologists work in varied settings that gen- erally relate to four broad areas of work, three of which are applied settings and one of which is a largely academic or research setting.

Clinical Health Psychology This area of focus relates to the application of health psychology in clinical settings, such as hospitals or rehabilitation clinics, where patients are treated, diagnosed, or directly cared for. Clinical health psycholo- gists often work with individuals to help them change bad habits, such as drug use, or overcome lifestyle problems, such as poor diet or a lack of exercise, that may oth- erwise negatively affect health. Typically, clinical health psychologists work with clin- ical groups, meaning people who are sick or at serious risk of becoming sick, which can include mental health, such as depression or anxiety, and physical health, such as cop- ing with cancer or managing diabetes. Sergey02/iStock/Thinkstock Health psychologists in clinical settings treat everything from physical illness to mental illness.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.3 Education and Careers in Health Psychology Community/Public Health Psychology This area of focus relates to the application of health psychology in community or public health settings. Community health psychologists can work in government (CDC, FDA, or the Institute of Medicine), for professional organizations (APA or American Medical Association [AMA]), in private industry (pharmaceuticals with interests in policy), or even in clinical set- tings where community health is a key initiative. In community settings, health psychologists study the prevalence of disease, its possible causes, and how to reduce disease at a com- munity level (e.g., by initiating awareness campaigns) or at a policy level (e.g., by the pas- sage of laws requiring food manufacturers to place nutrition labels on food packaging). At a policy level, the health psychologist often fills an advisory role to guide lawmakers on public policy change.

Occupational/School Health Psychology This area of focus relates to the application of health psychology in workplace settings and in educational settings, such as with local schools. In the workplace, health psychologists partner with employers and employees to improve health outcomes, which can reduce costs associated with providing health care for the employer and improve the quality of life for the employee. Occupational health psychologists promote employee wellness to improve employee satisfaction and happiness in the workplace, which is often accomplished through workplace policy changes, such as developing programs to make the work environment less hostile, or the creation of new programs such as employee wellness programs or counseling.

In educational settings, health psychologists can serve parents as well as employees (faculty, administrators) and students.

Health Psychology Science An important area of focus in health psychology that affects all health psychologists is health psychology science. Health psychology scientists typically work in universities, but they can also be found in organizations (e.g., APA, AMA), in government (e.g., CDC, American Diabe- tes Association [ADA]), and in industry (e.g., pharmaceuticals). Health psychology scientists focus their work and research on the development of new knowledge creation. That is, they engage in scientific studies to discover new findings in the field of health psychology that are then shared with the general health psychology community. Research in this field can be com- pleted in a laboratory setting or in the field, such as in hospitals and clinics.

Consulting The four main areas of focus for health psychologists are more diverse than what is described here. For any of the areas of focus described in this section, for example, health psychologists can also work in a consulting role. A clinical health psychologist can provide consulting work as part of a government grant for local government agencies, such as local health depart- ments. Community health psychologists may be asked to provide consultation in a variety of settings, such as to provide consulting to local school districts on policies that affect child health. In workplace settings, companies often prefer to hire health psychologists to provide consultation on policies rather than hiring them as employees. Health psychology research- ers are often included as advisors or consultants on government or industry grants to oversee the methodologies used as part of the work described in those grants. In this way, there are \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.3 Education and Careers in Health Psychology opportunities for health psychologists to be self-employed and sought after for work relating to any number of initiatives or needs at all levels and in a variety of settings.

Related Fields As you evaluate the opportunities in health psychology, keep in mind that there are also many ways to contribute to the field without being a health psychologist. Fields in medicine, nurs- ing, social work, dietetics, and occupational or physical therapy are closely related or overlap with the work of health psychologists. One notable area of health psychology is health coach- ing. Many employers have recognized the benefits of employee wellness programs , which are employer-backed programs aimed at helping employees (and their families in many cases) make better and healthier choices that can increase their energy or excitement for healthy living and not only reduce health care costs, but also lead to better outcomes for the employer, such as lower employee absenteeism (Bray, 2015). Health coaches play an important role in that they provide personalized services to support employee wellness goals and information to support employees’ efforts to reach those goals.

Many students who pursue health psychology often find a closer fit within one of these or many other related fields in health and health care. Looking at these many paths in the health care industry can broaden the understanding of the diversity of careers available in health care.

Earning Potential Overall, there is a positive trend toward growth in the field according to the U.S. Bureau of Labor Statistics (BLS, 2015). Employment in the field of health psychology is expected to grow at about an 11% to 12% rate through 2022, which is an average growth rate expected for all occupations. Employment data show that this trend also varies substantially by the specific specialty in psychology. For those interested in pursuing health psychology, the great- est growth is generally seen in applied settings for professionals working in clinical and coun- seling fields, schools, hospitals, and mental health. Clinical and counseling fields in health psychology will continue to see growth particularly given the increased recognition of mental health as a disease. (Read more about advances in our understanding of depression in In Depth: In the Mood for Food.) Careers that focus on older populations and for veterans will also likely see continued growth and high demand.

To look up the salary and other statistical data for many related disciplines in psychology, refer to the U.S. Bureau of Labor Statistics website at ht tp://w w w.bls.gov. \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.4 Health Psychology in the 21st Century In Depth: In the Mood for Food It can sometimes be difficult to understand how research and applied fields come together.

As an example, consider that in recent decades there has been a profound shift in appetitive characteristics (i.e., how people respond to food) when experiencing depression. For early measures of depression, such as the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960), the key appetitive characteristic of depression was weight loss and loss of appetite.

No assessment for increased appetite, food intake, or weight gain was included in the HRSD.

In these early reports, people with depression who overate or gained weight were diagnosed with atypical depression and were generally treated differently from those with more typical depression, which is characterized by weight loss.

This understanding of depression has shifted due to current research and data, with weight gain and increased appetite being identified as a typical symptom of depression among those with the disorder today (Doraiswamy, 2013). Indeed, a recent representative U.S. national sur- vey of 43,093 adults found that the prevalence of major depression with atypical features was almost 40% higher than that of depression without atypical features (Blanco et al., 2012). In this survey, factors that predicted atypical depression appeared to mirror the growth of obe- sity and overeating in society as a whole.

Neurobiological evidence shows that neural reward pathways in the brain are activated by simply seeing high-calorie foods (Frank et al., 2010). Behavioral data show supporting evi- dence that mood is also positively enhanced among participants who view high-calorie and sweet-tasting foods (Privitera et al., 2013a) and participants who draw these foods in an art therapy setting (Privitera, Antonelli, & Creary, 2013b). Studies are thus showing positive effects on mood using food cues, without participants actually consuming those foods.

While the potential directions are certainly preliminary, there is no denying the weight of evi- dence for a shift in the appetitive symptoms that are characteristic of those with depression.

For this reason, current research efforts aim to explain this shift and to open new directions of research that can lead to potential strategies and therapies in applied settings to treat the now-typical depression associated with increased appetite and weight gain. 3.4 Health Psychology in the 21st Century It is certainly an exciting time to explore careers in health psychology. The field offers a prom- ising career path with the potential to make vital contributions to the health and quality of life of others. Health psychology as it is known today is very young. For example, Division 38 of the APA, the health psychology division, was founded in 1978, whereas the study of medi - cine can be traced back thousands of years. The Greek philosopher Hippocrates is regarded as the “father of medicine” (c. 460–c. 370 BCE). By comparison, Wilhelm Wundt (1832–1920) is regarded as the “father of psychology,” and the specific field of health psychology is much younger than that.

Our developing understanding of health has led to increased importance for the field of health psychology. Two central reasons for the broader growth of this field include changing pat - terns in chronic disease and changing costs of health care and services. \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.4 Health Psychology in the 21st Century Changing Patterns in Chronic Disease Over the last few decades, health psychology has evolved to address the changing landscape of medicine in the prevention and treatment of illness (Kaplan, 2009). To get a sense of why the rapid rate of growth in the health psychology field is important, consider obesity. Obesity is a public health, agricultural, and economic problem with significant costs to the health care system. Obesity predisposes individuals to a variety of health risks, including high blood pres- sure, high cholesterol, cardiovascular disease, type 2 diabetes, asthma, and sleep apnea (Freedman, Mei, Srinivasan, Berenson, & Dietz, 2007; Han, Lawlor, & Kimm, 2010; Whitlock, Williams, Gold, Smith, & Shipman, 2005). People who are overweight and obese are also more susceptible to psycho- social stress (school bullying, social stigma, and discrimination) and a concomitant ero- sion of mental health, the latter of which can manifest as diminished self-esteem, self- concept, or self-efficacy; emotional eating; or clinical depression (Swartz & Puhl, 2003; Privitera, 2008). In this way, obesity (a physical condition) is more than just a med- ical concern; it involves serious psychoso - cial concerns as well. To fight obesity, there is a need for psychologists and physicians to collaborate.

Understanding the growth of, and thus the need for, health psychology begins with under - standing the changing patterns in chronic illness such as obesity. In 1900, for example, heart disease was the fourth leading cause of death and cancer was sixth. That has changed, with heart disease, then cancer, being the current leading causes of death in the United States; chronic lower respiratory diseases, cerebrovascular diseases, Alzheimer’s disease, diabetes, influenza, pneumonia (the leading cause of death in 1900), and nephritis (inflammation of the kidneys) are also among the top 10 leading causes of death in the United States (CDC, 2015b). Chronic diseases are among the most prevalent, costly, and preventable of all health problems. Chronic diseases are responsible for about 7 of 10 deaths each year, and treatment for chronic diseases accounts for 86% of U.S. health care costs (CDC, 2015a). What this means is that the leading causes of death are chronic disorders that often require long-term care.

Moreover, these diseases often cause significant psychological challenges. According to the Institute of Medicine (IOM, 2008), people with a chronic illness need help to learn how to • cope with the intense, even debilitating, emotions related to their illness • change their behaviors to minimize the impact of their disease and maximize treat- ment protocol • manage day-to-day disruptions that their illness may cause to their work, school, and family life The role of health psychologists has become particularly important given that chronic illness has become increasingly prevalent. Suppose that a patient is diagnosed with cancer. In this Manuel-F-O/iStock/Thinkstock Health psychologists play an important role in addressing cultural issues that are related to health, such as epidemic obesity.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.4 Health Psychology in the 21st Century case, there is more than just a need to treat the cancer (a largely medical need). There is also a need for therapy and family involvement to help the patient cope with the disease; there is a need for the patient to change daily routines, such as taking off from work or changing his or her diet, particularly around the time of chemotherapy treatments. It is important to rec- ognize that all of these levels of care can contribute to the success of a treatment protocol— from medical care to psychosocial care, health psychology as a field is leading many efforts to improve overall patient care.

Another way that the field of health psychology is making important contributions is in understanding social and psychological risk factors of disease to promote health and well- being. Risk factors are variables that are correlated with a disease and therefore are associ - ated with the risks of having the disease. Keep in mind that risk factors are not the causes of disease, but instead are factors that co-occur or are correlated with disease. Thus, iden - tifying risk factors can help in the prevention of the disease. Poor diet and infrequent exer - cise are correlated with weight gain and thus are risk factors for obesity; alcohol abuse and increased stress are correlated with, and therefore risk factors for, depression; tobacco use and increased exposure to the sun are correlated with, and therefore risk factors for, certain types of cancer.

Over the past few decades, we have made significant progress in understanding risk factors associated with disease, and many of these risk factors are related more so to health behaviors than to preexisting medical conditions (CDC, 2009, 2015a). For example, people can change their diet or exercise more to reduce their risks of obesity (Privitera, 2008), or they can elimi- nate their tobacco use and use sunscreen to reduce their risks of certain types of cancer (IOM, 2008, 2012). These risk factors, if targeted, can significantly reduce the likelihood of disease, and each of them can be addressed by changing the way people behave. In this way, the field of health psychology plays a vital role by applying the biopsychosocial model to promote healthier behaviors not only once a person becomes ill, but also before sickness has devel- oped. From this view, health psychology complements the biomedical model of medicine by evaluating more closely the behavioral and social risk factors that substantively contribute to health outcomes and wellness.

Changing Costs and Services in Health Care The United States spends more money than any other country on health care. What may be surprising is just how much the United States outspends other nations. As shown in Figure 3.3, the United States spends nearly two thirds more on health care than the next highest- spending country. The health care costs of people with chronic illnesses represent 75% of health care spending in the United States (IOM, 2012). Consider further that end-of-life care among elderly patients is expensive, and that this group is growing in numbers as the baby boomers continue to retire. In 2011, Medicare spending constituted about 21% of the total dollars spent on health care in the United States, and about 28% of the Medicare dollars spent (or about $554 billion in 2011) was in the patients’ last 6 months of life. Certainly the costs of health care are concerning, particularly when you consider the trend that these costs are likely to continue to rise. \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Section 3.4 Health Psychology in the 21st Century Figure 3.3: A comparison of health care spending Annual dollars spent per person on public and private health care among the 10 highest-spending countries as of 2013.

Source: Data from “OECD Health Statistics 2015,” by Organisation for Economic Co-operation and Development, 2015 (http://www.oecd.org/els/health-systems/health-data.htm ).

One way in which health psychologists reduce costs is in how they are utilized in the illness- wellness continuum, which was illustrated in Figure 3.1. If the figure is split in half, then to the left is the biomedical model. It is largely a treatment approach, where expensive phar- maceuticals or surgeries may be needed to treat patients who have become ill. While these treatments may be effective, they are also expensive. They are much more costly than taking measures to avoid getting sick in the first place, or working to improve wellness while a per- son is sick in order to speed recovery time. These are the areas in which health psychologists can play a substantial role.

For this reason, health psychologists have largely adopted the biopsychosocial model, which represents the full scope of the continuum from left to right in the illness-wellness contin- uum, with the wellness approach being much less costly than treatment in many cases. For example, treating obesity-induced diabetes is much more expensive than changing your diet and joining a gym to exercise and lose weight, thereby reducing your risk of becoming dia- betic in the first place. Employers today recognize the benefits of wellness, and many have fully embraced the idea of wellness programs.

Trends in health care show that patient service options are increasing, in part, by shifting to an outpatient model in which patients are seen in outpatient clinics where they do not take up a hospital bed or require overnight stays. These patients can be more readily seen, and this results in an increased offering of services, from physical therapy to same-day surgeries.

Health psychologists play a significant role in the development of outpatient services aimed \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Summary and Resources at improving the overall likelihood of a successful recovery when sick (e.g., providing therapy or counseling) and services that can promote health and wellness in the prevention of sick- ness (e.g., by altering risky health behaviors before a person gets sick).

The health care system has a great economic impact, not only in the services provided, but also on the millions of professionals employed within this industry. Health psychologists play a vital role in evaluating the effectiveness of this system at a patient level. In this role, health psychologists have contributed important insights about improving patient care, such as showing that simple, cost-effective strategies such as reducing the time to see a patient and having the patient feel listened to can significantly improve patient satisfaction with health care. In this way, health psychologists do more than address the increasing costs of provid- ing health care; they help to bring about change needed to make the system as a whole more user-friendly for the patient.

Summary and Resources Chapter Summary Health psychology is the study of psychosocial and behavioral processes related to health, ill - ness, wellness, and health care with the goal of understanding how such processes contribute to health across the lifespan, from death and illness to optimal health and wellness. Health psychologists see health, illness, and wellness as being on a continuum and typically use both the treatment and wellness approaches to promote or enhance health. Areas of key interest for health psychologists are (1) the etiology or correlates of health, illness, and wellness; (2) the prevention and treatment of illness; (3) health promotion and maintenance; and (4) the impact of the health care system and health policy.

Health psychologists have varying perspectives on what health is and how to best understand it. These perspectives or models generally fit within the traditional debate of the mind-body relationship, which is the philosophical debate over whether the mind and the body are one (part of the same system) or distinct (part of separate systems). The mind pertains to the mental processes, thoughts, and consciousness of an individual. The body is the physical “self,” including the actions of neurons and the structure of the brain, which is part of the body. The mind-body debate relates to the two predominant models within which health psychology is mainly studied. The most widely adopted viewpoint among researchers and practitioners is the biopsychosocial model, which is the view that illness, health, and wellness can be best explained in the interactions of biological, psychological, and social factors. An alternative viewpoint comes from the more simplistic biomedical model, which is the perspective that health and illness can be explained solely on the basis of biological factors.

Health psychology offers career opportunities that range from the applied to the academic.

Health psychologists work in diverse academic or research settings that include clinics, com- munity/public health areas, occupational/school settings, and research-based opportuni- ties, both in the lab and in applied settings. Many levels of education are also available at the undergraduate and graduate/postgraduate level, in addition to opportunities for licensure and board certification. Predoctoral internships allow students to gain the additional expe- rience necessary to be competitive for graduate and doctoral programs in health psychol- ogy. Other opportunities for continued professional development and education following a \251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Summary and Resources doctoral degree include postdoctoral fellowships. In applied fields, practitioners often must earn licensure or certification in areas such as clinical or counseling psychology.

There is a positive trend toward growth in the field that varies substantially by the specific specialty in psychology, with the greatest growth generally seen in applied settings for pro- fessionals working in schools, hospitals, and mental health. Health psychology has evolved over the past few decades to address the changing landscape of medicine in the prevention and treatment of illness. Chronic diseases are among the most widespread, costly, and pre- ventable of all health problems, and the role of health psychologists has become particularly important as the incidences of chronic illnesses have increased. Additionally, the rising cost of providing health care has highlighted the importance of understanding the social and psycho- logical risk factors of disease. Promoting health and well-being has become an important way in which to reduce the costs or expenses of treatment. Health psychologists play an important role in evaluating the health care system.

Resources for Future Exploration American Board of Professional Psychology ht tp://w w w.abpp.org The American Board of Professional Psychology is the primary organization and landing site for specialty board certification in psychology.

Centers for Disease Control and Prevention ht tp://w w w.cdc.gov The Centers for Disease Control and Prevention is the national agency that aims to protect the United States from health, safety and security threats, both foreign and domestic.

Division 38 of the American Psychological Association ht tp://w w w.health-psych.org Division 38 of the American Psychological Association is the health psychology division for the American Psychological Association. It has members from across the world focusing on research and applied practice in the field of health psychology.

National Patient Safety Foundation ht tp://w w w.npsf.org The National Patient Safety Foundation is an independent, not-for-profit organization aimed at advancing patient safety and health care workplace safety.

Key Terms biomedical model The perspective that health and illness can be explained solely on the basis of biological dysfunction.

biopsychosocial model The holistic per- spective that illness, health, and wellness can be best explained in the interactions of biological, psychological, and social factors. cue to action An occurrence that triggers people to evaluate their health behaviors.

dualism The perspective that the mind and the body are distinct.

etiology The origin or cause of a disease or illness.

\251 2016 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Summary and Resources health A state of physical, mental, and social well-being that is also affected by various psychological and social/cultural factors.

health behaviors The actions people take to achieve and maintain good health, pro- mote wellness, and prevent illness.

health belief model A paradigm developed to predict many health-related behaviors based on a core set of beliefs of an indi- vidual’s perception of susceptibility, severity of illness, cost-benefit of behavior change, control, motivation, and cues to action.

health beliefs The cognitions of patients or providers regarding their personal health and how that health is cared for.

health motivation Readiness or willing- ness to be concerned with health matters.

health promotion Refers to enabling people to have greater control over, and to improve, their health and well-being.

health psychology The study of psycho- social and behavioral processes related to health, illness, wellness, and health care, including the goal of understanding how such processes contribute to the full spec- trum of health across the lifespan.

illness A disease or sickness over any length of time that can affect the body, the mind, or both.

locus of control The extent to which one perceives that one is in control over those things that one is capable of influencing.

mind-body relationship The historical and philosophical debate of whether the mind and the body are one (part of the same system) or distinct (part of separate systems).

monism The perspective that the mind and the body are the same. patient-centered communication model A model in which communication is col- laborative, where the physician and patient make mutually agreed-upon decisions based on a fair and honest exchange of information.

physician-centered communication model A model in which communica- tion is directive from physician to patient, where the physician mostly does the talking, chooses the topics, and begins and ends the conversations.

prevention Refers to avoiding a disease entirely by taking actions that can stop the disease from developing. There are three types of prevention: primary, secondary, and tertiary.

risk factors Variables that co-occur or are correlated with disease and therefore are associated with the risks of having the disease. self-efficacy Refers to an individual’s belief in his or her ability to successfully complete the steps required for a given task or to achieve a certain goal.

stages of change model A model for changing behavior that identifies the fol- lowing stages of change: precontemplation, contemplation, preparation, action, and maintenance. For each stage of change, dif- ferent intervention strategies are most often applied to move an individual to the next stage of change and subsequently through the model to maintenance, which is the ideal stage of behavior.

transtheoretical model See stages of change model.

wellness A physical state or condition to the right of the illness-wellness continuum that involves being in good physical and mental health, typically characterized by overt efforts aimed at maintaining this state or condition.