Download Clinical Health Psychology

BAHAR BAŞTUĞ
Assist. Prof. Dr.
Areas of Specialization:
Clinical Child Psychology & Health
Psychology
Lecture Preview
 Clinical Health Psychology
 Child Clinical Psychology
The principles and practices of clinical psychology can
be applied to many areas of research and clinical service.
Many psychologists maintain a general clinical practice,
some are focusing their skills in an area of specialization.
Clinical psychology has developed a number of specialty
areas.
Clinical psychology has a similar developmental process
to medicine.
Psychologists have been trained in a general manner and
have applied their skills to all patients and problems they
could be able to evaluate and treat. As the field has
become more sophisticated in specific problems,
specialties have come out.
Some specialty areas are health psychology, child
psychology, neuropsychology, and forensic psychology.
Subspecialty areas have also emerged, such as pediatric
neuropsychology and forensic health psychology.
Within each specialty area many psychologists focus on
a particular population or problem area. For example,
some professionals who specialize in clinical health
psychology work in the eating disorders, smoking
cessation, or alcohol abuse. Some who specialize in
neuropsychology focus their attention on elderly stroke.
Some of the specialty areas overlap. A pediatric
neuropsychologist might specialize in head injuries
suffered by children and be called on to begin a great
deal of forensic work. Such a psychologist may be said to
specialize in forensic pediatric neuropsychology.
Another psychologist may specialize in geriatric health
psychology working with AD.
There are some reasons to develop specialities:
1. As clinical psychology grows, more information has
become available through research and practice that can
be applied to specific problems and populations. Clinical
psychology is no longer limited to mental illness.
Medical problems such as cancer, head injury, heart
disease, and AIDS as well as legal problems such as child
custody decisions are within the domain of clinical
psychology.
2. Clinical psychology uses an interactive and evidencebased perspective. An integrated and evidence- based
biopsychosocial model allows for both growth and
overlap of specializations.
3. Specific postgraduate training programs have become
available in a number of specialty areas.
Areas of Specialization
 Clinical Health Psychology
 Child Clinical Psychology
 Clinical Neuropsychology
 Forensic Psychology
 Geropsychology
Clinical Health Psychology
is currently one of the most popular and fastest growing
specialties since 1980. Health psychology involves the
contribution of psychology to problems related to health
and illness.
Definition
“the total 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 etiologic and diagnostic correlates of
health, illness, and related dysfunction, and to the
analysis and improvement of the health care system and
health policy formation”
Clinical Health Psychology
Health psychology
involves the contribution
of psychology to problems
associated with health and
illness.
Clinical Health Psychology
Health psychologists work in many different settings
including hospitals, clinics, universities, businesses, and
private practices.
They use the principles of psychology and behavior
change to help people cope better with medical illnesses
as well as prevent potential illnesses from developing.
They conduct research on the relationships between
behavior and health and consult with organizations to
maximize health promoting behavior and policies.
Clinical Health Psychology
At the beginning of 20th century, influenza, measles,
tuberculosis, and other infectious diseases were the
cause of deaths. Today, lifestyle factors such as smoking,
high-fat diets, sedentary lifestyles, unsafe sexual
practices, accidents are the causes of death. Heart
disease, cancer, stroke, and other causes of death are
associated with lifestyle factors.
Therefore, most health problems are together behavioral
problems. The main reasons of illness are due to
emotions, cognition, social relations, and behavior.
Clinical Health Psychology
The principles of clinical psychology have been used to
help people live more healthy lifestyles to avoid
developing illnesses and to help treat illnesses once they
have developed.
Diabetes, cancer, heart disease, arthritis, asthma, AIDS,
autoimmune diseases such as lupus and multiple
sclerosis, chronic pain control, and other health
problems have been of interest to health psychologists.
Clinical Health Psychology
Intervention strategies used in health psychology are
complex and multidimensional.
Individual and group psychotherapy, education,
biofeedback, relaxation training, coping skills training
interventions have been used to treat these problems.
Clinical Health Psychology
Interventions integrate medical treatment with
education, psychotherapy, and social support
to maximize health and minimize illness.
Smoking, obesity, alcohol consumption, stress
management, AIDS, and chronic pain have
received attention from health psychology in
recent years.
Clinical Health Psychology
Diseases related to health psychology:
Irritable bowel syndrome, Panic disorders, Asthma,
Hypertension, Cardiovascular disease, Ulcers,
Headache, Diabetes , Cancer, Spinal injuries, Epilepsy,
Sleep disorders, Sexual disorders, Substance abuse
Clinical Health Psychology
 Smoking
 Obesity
 Alcohol Consumption
 Stress Management
 Acquired Immune Deficiency (AIDS)
 Chronic Pain
Smoking
Smoking is the largest preventable cause of premature death.
It has been associated with many illnesses such as cancer and
heart disease. Smokers are more likely to engage in
unhealthful behavior such as eating high-fat foods and
leading sedentary lifestyles.
Health psychology has been involved in
smoking quit
psychoeducational programs to prevent from
beginning the smoking habit.
Intervention programs and public policies have been
useful in decreasing the number of adult smokers.
People generally begin the smoking during teenage
years because of
peer pressure, cultural norms, modeling of family,
friends, and celebrities, as an act of rebellion, a
representation of independence.
The pleasurable effects of smoking occur after a number
of attempts at smoking and not during the first smoking.
Smoking may result in coughing, headache, nausea or
other aversive symptoms.
When habituation occured, the addictive qualities of
nicotine as well as the psychological dependence result
in a very difficult habit for most people to break. Anx,
depr, irritability, and anger are associated with nicotine
withdrawal. Therefore, smoking often is used to avoid
the negative consequences of withdrawal.
The majority of people who attempt to quit smoking are
unsuccessful.
Treatments include biological interventions such as the
nicotine patch and gum. They supply a constant dose of
nicotine without the harmful effects on lungs or other
organs. These treatments provide the drug effect
without the psychological and social support that
maintains the psychological dependence on smoking.
Other treatment approaches include psychological
interventions such as problem solving and coping skills
training, hypnotherapy, biofeedback, and behavior
modification approaches. Educational and social
interventions such as group support are also used. Social
engineering and public policy approaches such as
smoking bans in public places and large taxes for high
price discourage smokers from maintaining their habit.
Biopsychosocial approaches such as a nicotine patch
along with CBT coping strategies in the context of a
support group may work best.
Antidepresan (Bupropion)
Obesity
Overweight is defined as weighing 20% more than ideal,
a BMI of between 25–29.9 kg/m2.
Obesity
Obesity is defined as a body mass index of 30 kg/m2
or higher.
Obesity has been associated with coronary heart
disease, cancer, gall bladder disease, skeletal-joint
problems, diabetes, infections, and other illnesses.
Morbid obesity (i.e., weighing 100% above ideal
weight) is associated with premature death.
Obesity
Biopsychosocial factors contribute to the obesity:

Genetic factors and family history

Lifestyle factors such as sedentary behavior, high-fat
food consumption, and TV viewing

Psychological and social factors such as stress, depr,
access to highly attractive foods, and culture.
Obesity
Like smoking, the majority of those who try to lose
weight are not successful. Most people try to diet on
their own, many choose to join weight loss programs.
These programs use an integrative approach
combining medical intervention with social support,
education, and counseling. Others use medical
programs offered by medical centers and clinics.
Obesity
The majority of those who attempt to lose weight either on
their own or in an program do not maintain their weight loss.
In fact about 95% of those who lose weight regain weight lost
within 5 years.
Obesity
Treatments reflect the biopsychosocial
model.They include surgery, medication, and
very low calorie liquid diets for those who are
morbidly obese. To treat obesity:

behavioral modification,

problem-solving coping strategies,

hypnotherapy,

psychotherapy,

group support,

nutritional information programs, and

exercise programs are used.
 http://vimeo.com/29416289
Obesity
Multimodal approaches integrate medical
intervention with various forms of education and
counseling. In addition to individual treatment,
public health and informational approaches have
been used.
Alcohol Abuse
Alcohol Abuse
Alcohol abuse continues a major threat to the health. The
numerous physical, psychological, and social problems are
caused by alcohol. 50% of all traffic accidents are alcohol
related as well as most murders, suicides, rapes, and
violent crimes. Approximately 100,000 deaths in the USA
each year are due to alcohol consumption. Alcohol
disinhibits people’s control over their behavior and makes
them less concerned about the consequences of their
actions.
Alcohol Abuse
Like smoking and obesity, biopsychosocial factors
are associated with both the development of
alcohol-related problems and their treatment.
Alcohol problems are associated with genetic and
biological vulnerability. Many individuals seem to
have inborn tendency to developing an alcoholrelated problem. About 25% of Asian individuals
have a negative physiological reaction to alcohol. It
results in little alcohol abuse in Asian people.
Alcohol Abuse
Psychological factors:
anx, depr, stress
social factors:
peer influence,
low income, play an important role in the development
of alcohol problems.
Relationship of alcohol and stress
Alcohol is used as a way to buffer stress and becomes
a maladaptive coping strategy. Those who experience
many negative life events and little social support are
at risk for developing alcohol problems. Drinking
alcohol is temporarily beneficial since it can help
people to feel less stressed and distract them from
problems.
Alcohol Treatment
Treatment and prevention
programs for alcohol abuse
reflect the biopsychosocial
perspective.
Alcohol treatment might
include the use of Antabuse,
a medication that prevents
the metabolism of
acetaldehyde. It results in
severe nausea and vomiting
when alcohol is consumed.
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Alcohol Treatment
might include medical detoxification in an inpatient
hospital with individual, family, group, and
educational components. Psychotherapy and group
support such as Alcoholics Anonymous (AA) are
beneficial.
Relapse is extremely high. Only about 50% of those
treated for alcohol remain sober one year following
treatment. 75% of those who join AA drop out
within a year.
Stress Management
Stress has been related to the numerous physical and mental
health problems. Psychological and social stress impacts
many systems of the body.
Chronic psychosocial stress has been found to damage the
brain by hypercortical activity in the hippocampus. People
who lack a sense of control and self-efficacy in their lives are
vulnerable to stress-related problems. Environmental
stressors contribute to poor physical and mental health.
Stress Management
Stress management help people who have many
physical and mental health problems. Social support
help in the treatment of stress-related problems.
Social support and stress management provided in
group therapy assist in helping cancer patients live
longer.
Stress management
Stress management techniques such as:
relaxation training,
meditation,
biofeedback,
diaphragmatic breathing,
psychotherapy, and
visual imagery
have been found useful in reducing stress.
Acquired Immune Deficiency (AIDS)
AIDS
Since 1981, about 500,000 deaths have occurred due
to AIDS in the USA. It is estimated that 40 million
people are infected worldwide.
Changing problematic high-risk behavior is the best
way to prevent AIDS. Engaging in safer-sex and
avoidance of shared needles among IV drug users
are important.
Psychoeducational programs (informational and sexuality
training) and public policy approaches have been successful
in reducing high-risk behaviors. Self-management training
and social support have proved useful in behavioral change
among high-risk groups. Enhancing self-efficacy and
perceived control over sexual behavior has been found to
predict safe sex practices.
Chronic Pain Control
Some people cope well with severe pain while others
do not.
Pain perception is a subjective experience with
biopsychosocial factors .
Psychological factors such as anx, depr and
pessimism, low self-efficacy, and low sense of
control are related to pain experience. Those with
little social support cope less well with pain.
The treatment of chronic pain
 relaxation techniques,
 coping skills training,
 psychotherapy,
 biofeedback, and
 cognitive restructuring have been found to be useful
with medical interventions.
conclusion
Eating healthy low-fat foods,
minimizing alcohol consumption,
eliminating smoking and unsafe sexual practices,
wearing seat belts, and
better managing stress minimize the risk of premature
death and developing a long list of health problems.
Obtaining social support,
learning information about the illness,
finding strategies to cope with pain,
obeying the medical treatment rules, and
better understanding underlying causes of noncompliance to
medical treatments
are all of interest to health psychology.
Child Clinical Psychology
Child clinical psychologists specialize in working
with children and their families. They have
training in developmental psychology, child
assessment and treatment. They work in mental
health clinics, child guidance clinics, schools,
children’s hospitals, and private practices.
Some of the problem areas include physical and/or
sexual abuse, ADHD, conduct disorders, learning
disorders, autism, enuresis, depr, and school phobia.
These psychologists consult to school teachers,
school counselors, pediatricians, day care workers,
and parents.
They assist teachers in classroom behavior
management or assist parents in developing better
parenting skills.
Child Clinical Psychology
Child Clinical Psychology
They help the child and family cope with medical procedures,
anx and depr, or noncompliance with medical treatment.
They consult to various medical departments to assist
physicians, nurses, and other professionals in responding to
the emotional and behavioral harm of hard medical illnesses.
They assess neuropsychological functioning, level of
cognitive functioning, psychosis, and offer individual, group,
and family therapy.
ADHD
ADHD
Child clinical psychologists evaluate to diagnosis ADHD;
provide individual, family, and group treatment for ADHD
children; and consult with teachers, pediatricians, and parents
about social, behavioral, emotional, medical and educational
interventions with ADHD children.
ADHD effects 3 to 5 % of children, is found in boys. Symptoms
are
inability to maintain attention and concentration,
impulsivity,
overactivity, and
irritability.
ADHD
Children with ADHD are disruptive, very active,
oppositional , and often get in trouble at home and
in the classroom. Restlessness and impulsivity are
not tolerated by parents, peers, and teachers.
Attention and organizational problems are lifelong
problems. Adults who experienced ADHD are likely
to develop antisocial and criminal behavior and
underachievement.
ADHD
Biopsychosocial factors play a role in the etiology
and treatment of ADHD. Brain functioning in
certain regions of the cortex and heredity play roles
in its development. People with ADHD have less
brain activity in the frontal cortex and basal ganglia
area.
ADHD
Psychological and social factors such as child abuse have also
been associated with the development of ADHD. These
children receive negative attention from others. It results in
few friendships and frequent teasing. They often develop
depr and low self-esteem as a result of negative social
interactions.
ADHD
ADHD is not easy to diagnose. Marital conflicts,
physical and/or sexual abuse, depr, PTSD, poor
childrearing practices, learning disabilities, and
conduct disorders may result in ADHD-like
symptoms.
A careful diagnosis involves a thorough history, an
observation of the child’s behavior at home and at
school, and psychological, cognitive, and
educational testing (i.e. WCST, TMT, WAIS-R,
WMS).
Treatment of ADHD
reflects the biopsychosocial factors.
Ritalin is a stimulant medication and improves ADHD
symptoms.
Cognitive problem-solving strategies help children learn to
think before acting. Parent and teacher consultation is an
important contribution in treatment.
Learning disabilities
Learning disabilities
are diagnosed when a child experiences a cognitive
processing impairment (e.g., visual-motor, auditory),
which reduces academic achievement in relation to
ability measured by intellectual functioning. There is
a significant difference between ability and
achievement. Many children experience problems in
reading, writing, and mathematics as a result of
learning disability. Boys are much more vulnerable to
this problem than girls.
Learning disabilities
is a risk factor for dropping
out of school. Children with
learning disorders have
negative school experiences
and experience low selfesteem, depr, anx, and
disruptive behaviors. Learning
disorders escape detection by
parents and teachers.
Untimed tests are available at many schools and during
national examinations such as LYS and YGS in Turkey,
for students with ADHD and learning disabilities.
Learning disabilities
Like ADHD, learning disabilities are not easy to diagnose.
Many different problems such as marital conflict, poor
motivation, low ability, poor nutrition, large class sizes, poor
teaching stress, and illness can be associated with poor
school performance.
Many children with serious psychiatric or medical problems
such as ADHD, Pervasive Developmental Disorders,
Asperger’s syndrome, depr, PTSD, and cultural or language
differences appear to have trouble with school performance.
Learning disabilities
Intellectual, educational, and psychological testing with
interviews of teachers, family, and the child are used to
evaluate a learning-disabled child.
A classic example of a learning disability is dyslexia, a
reading disorder that involves letter reversals such as
confusing a “b” with a “d.”
Learning disabities
In learning disabilities, social skills are impaired
also.
Asperger’s syndrome is an example in which social
skills impaired. These children are unable to interact
with peers and teachers and have difficulty
interpreting and responding to social cues.
Asperger’s syndrome
Learning disabilities
Learning disorders involve genetic and neurological
factors. They are heritable. Early childhood or prenatal
brain damage cause learning disorders. These
biological influences interact with psychological,
social, and educational issues. Relationships with
parents and teachers as well as the child’s personality,
cultural expectations are all integral of learning
disorders.
Treatment of learning disabilities
Special tutoring
computer-assisted techniques,
psychotherapy,
parent education, and
teacher consultation
are incorporated into intervention programs.
Child Abuse and Neglect
Child Abuse and Neglect
Many children are physically, sexually, and/or
emotionally abused by parents, stepparents,
other family members, family friends, and
even strangers. Parents rather than strangers
are responsible for the majority of children
who are being abused, neglected, and even
murdered. Boys and girls appear to be at
about the same rate. Sexual abuse cases tend
to be more common among female than male.
Child Abuse and Neglect
Parents who abuse their children generally were
abused by their parents when they were children.
Alcohol and drug abuse, low SES, occupational and
marital stress, poor coping skills, and impulse
control problems contribute to abuse.
Child Abuse and Neglect
All professionals have to report suspected child
abuse to child protective services and the police. All
psychologists must be trained in the signs and
symptoms of child abuse.
Child clinical psychologists are involved in the
assessment of abuse, in child custody evaluations,
and in the treatment of both abused children and
their families. They offer psychoeducation to help
abusive parents learn better ways of interacting with
their children.
Child Abuse and Neglect
Abused children suffer from anx, depr, conduct disorders, and
eating disorders. Troubles with trust, chronic fear, bodily
vulnerability, self-esteem, and shame are common.
Perpetrators of abuse often suffer from alcohol abuse.
Treatment of both victims and the person responsible for abuse
can be very difficult. Usually the child, rather than the
victimizing parent, is taken from the home and she/he placed
in a new environment. ?????
Child Abuse and Neglect
A unique form of child abuse include factitious disorder
or Munchausen’s by proxy disorder. A factitious disorder
involves the “intentional production or feigning of
physical or psychological signs or symptoms”.
In Munchausen’s by proxy disorder, a parent (usually the
mother) obtains satisfaction from the attention and
support she receives from medical personnel when her
child is ill. She intentionally induces illnesses in her
child through poisoning or other methods in order to
seek treatment in the hospital setting.
Anorexia Nervosa
Anorexia Nervosa
affects about 1% of the adolescent female population. Age of
onset is around 17.
In anorexia, body weight falls to less than 85% of ideal with
an intense fear of becoming fat and amenorrhea.
All anorexics restrict food intake, some engage in episodes of
binge eating and purging. Purging might include selfinduced vomiting or laxative use. Hospitalization is needed
in severe cases.
Anorexia Nervosa
The etiology, symptoms, and treatment of AN reflect
the biopsychosocial nature. Anorexia and other eating
disorders may have a genetic component with a 4 - 5
times higher incidence in first-degree relatives.
Once an eating disorder begins, neurochemical factors
continue the problem. The functioning of the
hypothalamus via neurotransmitters such as DA, 5-HT,
and NE might be involved in AN.
Starvation leads to irrational and rigid thinking.
Anorexia Nervosa
Psychological factors:
a lack of perceived control in life,
poor self-esteem,
stress,
anxiety, and
depr and
social factors:
cultural ideals of thinness and beauty
play a role in the development and course of the illness.
Treatment of AN
Intervention approaches include intravenous (IV) feeding in
medical emergencies, high-calorie liquid diets, and
medication to assist with anx, depr, and compulsive
symptoms. Individual, family, and group psychotherapy are
usually provided.