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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. disülfiram 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.