According to WHO (1946), health is not simply the absence of illness but a state of complete physical, social and spiritual well-being. Importantly, Marks (2015) broadened this definition of health to include psychological, cultural and economic attributes.
While physical well-being is a rather straightforward concept, psychological health embraces the absence of mental illness and also mental/emotional well-being as indicated by positive states such as optimism, happiness, love and intimacy. Social health includes the ability to form satisfying interpersonal relationships, to easily adapt to and behave appropriately in different social situations and settings (Koshuta, 2017).
In turn, Health Psychology explores how biological (e.g. genetic predisposition, viruses, tumors, etc.), social (e.g., socioeconomic status, ethnicity, cultural influences, family relationships, social support), psychological (e.g., thoughts, beliefs) and behavioral (e.g., habits) factors affect health and illness (Ogden, 2012). From this biopsychosocial approach, health psychologists apply their research to promote wellness and healthy living, prevent illness, improve health care systems and the government's approach to health care policy (American Psychological Association, 2017).
According to “Division 38” of the American Psychological Association (APA) which is devoted to health psychology, health psychology has a unique contribution to our understanding of health and wellness, due to its emphasis on behavior and behavioral change.
Key areas of Health Psychology research concern: how behavior and experiences affect health and the effectiveness of health care; how health and disease affect psychological states; the promotion of healthy habits and the prevention or decrease of unhealthy habits (Cherry, 2016).
The approach and objectives of Health Psychologists
As already mentioned, the main approach used within health psychology is the Biopsychosocial model of health and illness introduced by George L. Engel (1977). Through this model, health psychologists are able to study how contextual factors and biology affect health. Some of the issues investigated include: how advertising may contribute to psychological addiction to tobacco; how unemployment may be linked to blood pressure elevations; how social class may relate to cardiovascular disease; what influences healthy eating; how stress relates to heart disease; ways to alter people’s health behavior to promote their health (Health careers, 2017).
Health psychologists may work with individual patients, whole families or groups of people or in large-scale public health programs. They may collaborate with other healthcare professionals (e.g., physicians, dentists, nurses, dietitians, social workers, pharmacists, physical and occupational therapists) in clinical assessments, treatment services or research programs. They may also be engaged in teaching, training, conducting research and improving the healthcare system (APA, 2017).
Health psychologists may focus on prevention and interventions promoting healthy lifestyles and encouraging people to improve their health. This would entail avoiding risky behaviors (e.g. unprotected sex), weight management, increasing internal control or self-belief and maintaining a positive perspective which is protective against stress, depression and anxiety (Cherry, 2016). Also, adopting health-promoting behaviors such as oral hygiene, hand washing, self-examination and preventative medical screenings (Health careers, 2017).
In this line, they develop and run population-based programs towards smoking cessation (e.g. anti-smoking campaigns), reduction of alcohol consumption, healthy eating and regular exercise. Such programs emphasize on educating people to recognize or minimize their risk of illness and to apply their knowledge of health practices in their lives.
Health psychologists may also implement psychological interventions to help patients cope with their illness and pain. Besides, they are interested in supporting the psychological well-being of terminal patients and the bereaved (Cherry, 2016). They also develop stress-reduction interventions at the workplace.
Health psychologists often go beyond the level of individual health to study how socioeconomic factors determine health inequalities and health policy at a community or national level.
Health psychologists may as well train other health professionals (e.g., physicians, nurses) to utilize health psychology knowledge in patient treatment and apply interventions about healthy eating, smoking cessation, weight loss, etc. Also, to improve their communication skills in terms of supporting patients’ adherence to treatment or delivering bad news (CareerProfiles, 2017).
Instead of doctor-centered consultations which are directed by the doctor, health psychologists promote patient-centered consultations which respect the patient's needs and their preferences in choosing treatment. In this respect, they may provide doctors with advise concerning effective doctor-patient communication (Health careers, 2017).
They are also concerned with improving patients’ adherence to medical treatment (APA, 2017), for example by tailoring treatment programs to their daily lives or providing modules of cognitive-behavioural therapy (CBT) which promote adherence to medical advice.
Another important area of interest is finding treatments for pain management and understanding irregularities of pain (e.g. episodic analgesia).
The Origins and establishment of Health psychology
The emergence of Health psychology as a distinct discipline occurred in the United States during the 1970s. In the 1960s, William Schofield was one of the few psychologists who studied the effect of psychology on physical health. Having identified that at his time mental health was generally considered as separate from physical health, in 1969 he send a report to APA concerning the “Role of Psychology in the Delivery of Health Services” with suggestions for the education and training for future psychologists (Psychology Research & Reference, 2017). In line with his proposals, the APA assigned a working group to study how psychologists might help people to manage their health-related behaviors and physical health problems, and train healthcare professionals in effective patient treatment.
These efforts led to the APA establishing the Health Psychology Division (38) in 1977 with Joseph Matarazzo in charge, who defined Health psychology as “the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of diagnostic and etiologic correlates of health, illness and related dysfunction, and the analysis and improvement of the healthcare system and health policy formation” (in Thielke, Thompson & Stuart, 2011).
In 1986 two more Professional bodies for health psychology were founded: the Division of Health Psychology of the British Psychological Society (BPS) and the European Health Psychology Society (EHPS). Other countries like Australia and Japan followed this lead.
The different branches in Health psychology
While Health psychology initially constituted a branch of clinical psychology, now it comprises the following four branches:
Clinical health psychology (ClHP) is one subspecialty of clinical psychology which focuses on education, techniques for modifying behavior and psychotherapy. It contributes to the fields of behavioral health and behavioral medicine which focus on prevention and treatment respectively. A clinical health psychologist with additional training, may in some countries become a medical psychologist with prescription privileges (CareerProfiles, 2017).
Public Health Psychology (PHP) explores the causal link between psychological factors and overall health of a population. Public health psychologists conduct research aimed at informing educators, healthcare providers and policy makers towards improving public health. PHP is closely related to other public health disciplines such as epidemiology, biostatistics, nutrition and genetics. Nowadays PHP may focus on at-risk populations (e.g. pregnant women who smoke) rather than the general population (e.g. all pregnant women) (CareerProfiles, 2017).
Community Health Psychology (CoHP) explores community factors that influence the health and well-being of individuals who live in a specific community. A central objective of CoHP is to develop community-level interventions aimed at fighting disease and improving physical and mental health.
Critical health psychology (CrHP) studies the effect of power differences on health, health behavior, health policy and health care systems. CrHP is particularly concerned with health inequalities, social justice and the universal right to health for people of any race, gender, age, socioeconomic status, with the intention to bring about change. International Society of Critical Health Psychology is a principal organization in this field (CareerProfiles, 2017).
Training Requirements and skills of Health Psychologists
In the UK, to become a health psychologist you have to complete the BPS Stage 1 and Stage 2 training in Health Psychology or have an equivalent qualification recognized by the Health & Care Professions Council (HCPC) (Lantz, 2011).
Qualified health psychologists are registered by the HCPC. They have received at least six years of training and have specialized in health psychology for at least three years, which makes them eligible for full membership of the Division of Health Psychology within the BPS (Chartered Status.) (The British Psychological Society, 2011).
Health psychologists in training (assistant health psychologists) need to have received BPS stage 1 training and be registered with the BPS Stage 2 training route or with a BPS-accredited university doctoral health psychology program.
The approved training routes are described below.
- Complete an accredited MSc in Health Psychology (equivalent to BPS Stage 1) and a BPS Stage 2 Qualification in Health Psychology (QHP).
- Complete an accredited Doctorate in Health Psychology, equivalent to Stage 1 and 2 BPS training which is approved by the HCPC.
Qualified health psychologists provide professional, research, consultancy, teaching and intervention skills. They are skillful in communication, teamwork, applying ethical and legal standards, in designing, implementing and analyzing psychological studies. Also, in designing, applying and assessing training programs and behavior change interventions (The British Psychological Society, 2011).
Besides, all qualified health psychologists are required to update and develop their knowledge and skills on an ongoing basis according to the continuing professional development (CPD) guideline of BPS (The British Psychological Society, 2017).
Career Opportunities for health psychologists
Qualified health psychologists may work in the National Health Service (NHS), in hospitals, clinics, public health departments, universities and medical schools, communities, research and charitable organizations or in private healthcare.
In the UK, health psychologists may hold one of the following positions (The British Psychological Society, 2011):
Consultant health psychologists can be in charge for health psychology concerning public health, directing tobacco control and smoking cessation services and leading the management of health trainers.
Principal health psychologists can lead the health psychology service in a prominent hospital, advising the members of the multidisciplinary team and offering clinical service to patients.
Health psychologists can provide health psychology expertise for example, to weight control centers, psychologically assessing the treatment, developing customized programs for weight control and providing advice on how to promote adherence to health advice and medical treatment.
Research health psychologists conduct research on health psychology, concerning, for instance, the most effective ways of providing psychological support for people with specific health problems or the psychological effects of being diagnosed with a particular disease or health promotion issues, such as the factors influencing healthy eating or physical activity.
Health psychologists in training may work as assistants in applied settings until fulfilling the HCPC criteria of registration and chartered status. They are supervised by a qualified health psychologist while getting experience in assessing patients, providing psychological interventions to alter health behaviors and doing research.
Potential problems in the profession of health psychology
The profession of health psychology encompasses various challenges. Firstly, it is a rather new science and people do not know much about its applications and usefulness. So, not many people would refer to a health psychologist for consultation. Information spreading is needed in order for the public to become aware of the effectiveness of health psychology in overall wellness.
In any case, research has not elucidated the extent to which health psychology has penetrated primary care treatment settings. For example, we do not know the prevalence of health psychologists or psychological interventions in primary care clinics (Thielke et al, 2011).
In integrated care programs, primary care practitioners collaborate with mental health practitioners in the treatment of common mental health conditions. However, in many such programs the psychological interventions involve primarily pharmaceutical treatment and health psychologists do not fulfill their traditional roles, such as receiving referrals and providing psychotherapy. Actually, they may never have direct contact with patients. Care managers who come from disciplines other than psychology (e.g. nurses and social workers) often conduct the evaluation and psychological treatments. So the involvement of health psychologists in such models can be limited (Thielke et al, 2011).
Besides, differences in education, training, clinical styles, reimbursement and patient preferences may limit the degree and quality of collaboration between health psychologists and primary care providers.
Moreover, health psychologists in primary care often have to justify to payers that providing psychotherapy is a significant supplement to primary care services.
Health Psychology in Greece
The field of Health Psychology has rapidly expanded in Greece, especially after 2004 when the first National Health Psychology Conference was held in Athens and the first post-graduate program in Health Psychology was launched at the University of Crete (European Health Psychology Society, 2017).
This expansion is witnessed by many textbooks and papers being published regularly in a local and international context, health psychology modules being provided in different Universities (e.g. in the post-graduate program in Clinical Psychology), in Medical Schools and Public Health Institutes and the establishment of respective research groups. Besides, more post-graduate programs in Health psychology are expected to be launched within the following years.
Several Health psychologists are employed in the Greek National Health System, Primary Care settings and Universities.
In the context of the Hellenic Psychological Society (HPS), Health Psychology is represented by the “Clinical and Health Psychology Division” (CHPD) which substituted the former “Division of Clinical Psychology” (established in 2005). The Division also represents Clinical Psychology ‒in which many Greek health psychologists were initially trained‒ however with respect to the differences between the two disciplines (European Health Psychology Society, 2017).
CHPD significantly contributes to the promotion of health psychology in Greece, having held three National Conferences (in Athens and Thessaloniki) up to date, which dealt with issues concerning theory-based research, evidence-based practice and the link between Community, Clinical, Health Psychology and Public Health.
Its members also have active participation in National and International Conferences and attend CHPD scientific meetings focusing on critical professional issues concerning, for instance, how the academic field of health psychology relates to the field of practice of the national health system. Other issues explored in CHPD scientific meetings include theory-based interventions, health promotion, professional supervision and post-graduate training (European Health Psychology Society, 2017).
Two European Health Psychology Society Conferences have been hosted in Greece ‒the 2003 “Gender, Culture and Health” in Kos and the 2011 “Engaging with Other Health Professions: Challenges and Perspectives” in Crete.
However, one of the most important challenges for the profession of Health Psychology in Greece is the lack of national law regulation specific to the title and practice of Health Psychologists, though this has been established for Psychologists in general. Since the tasks and responsibilities of health psychologists are not formally specified, their engagement in the Greek NHS relies on the needs and customs of specific settings. However, the Hellenic Association of Hospital Psychologists and the HPS Division of Clinical and Health Psychology are working together to specify conditions and procedures appropriate to training and supervising post-graduate students and professionals in Health and Clinical Psychology (European Health Psychology Society, 2017).
Another challenge concerns the limited funding of research groups in the Greek Universities which despite the financial and personnel shortage and the short history of health psychology in Greece, have produced remarkable work. For example, they have been involved in new Greek and English publications encompassing the work of Greek scientists. Also, more and more studies carried out in Greece are being published in national and international journals.
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Article Author: Panagiota Kypraiou MSc Health Psychology, MBPsS - Body & Gestalt Psychotherapist (ECP) - Body Psychotherapy Supervisor - Parents' Education Groups Coordinator https://www.psychotherapeia.net.gr
References
American Psychological Association, APA. (2017). Health Psychology Promotes Wellness. Retrieved 20 May, 2017, from http://www.apa.org/action/science/health/
CareerProfiles. (2017). Health Psychologist. Retrieved19 May, 2017, from http://www.careerprofiles.info/health-psychologist.html
Cherry, K. (2016). What Is Health Psychology?. Retrieved 16 May, 2017, from https://www.verywell.com/what-is-health-psychology-2794907
Health careers. (2017). Health psychologist. Retrieved18 May, 2017, from https://www.healthcareers.nhs.uk/explore-roles/psychological-therapies/health-psychologist
EHPS, European Health Psychology Society (2017). Greece. Retrieved 17 May, 2017, from https://www.ehps.net/content/greece
Koshuta, J. (2017). What Is Social Health? - Definition & Examples. Retrieved 16 May, 2017, from http://study.com/academy/lesson/what-is-social-health-definition-examples.html
Lantz, C. (2011). Psychology Student Employability Guide. The Higher Education Academy Psychology Network, University of York
Marks, D. F., Murray, M., Evans, B. & Estacio, E. V. (2015). Health Psychology: Theory, Research and Practice. Sage Publications
Ogden, J. (2012). Health Psychology: A Textbook (5th ed.). Maidenhead, UK: Open University Press.
Psychology Research & Reference. (2017). History of Health Psychology. Retrieved 20 May, 2017, from https://psychology.iresearchnet.com/social-psychology/health-psychology/history-of-health-psychology/
The British Psychological Society. (2011). Health psychology: A guide for employees.
The British Psychological Society. (2017). About CPD. Retrieved 21 May, 2017, from http://www.bps.org.uk/careers-education-training/professional-development-centre/cpd-resources/about-cpd/about-cpd
Thielke, S., Thompson, A. & Stuart, R. (2011). Health psychology in primary care: recent research and future directions. Psychology Research And Behavior Management, 4:59–68. doi: 10.2147/PRBM.S12996
