The term ‘health psychology’ is something that often gets misunderstood. Isn’t all psychology to do with mental health? How is this type of psychology any different?
The distinction with health psychology is that it isn’t dealing with psychological health per say (though that may come into it). Rather health psychology involves the psychology of health – and moreover the psychology of medical health.
In other words, this area of psychology looks at the impact that becoming ill has on someone’s mental state – and in turn how this can impact on their recovery. It also looks at why people will either take their medication or fail to and it looks at the best ways for doctors to approach patients in order to get the best outcomes.
Likewise, health psychology will also look at how psychological factors influence health to begin with. What makes someone likely to stick to a diet? What makes them likely to eat things they know are bad for them? How does one deal with addiction? Here we will look at some of the common themes in health psychology and how they can be used to try and improve the health of patients and the general public.
The Effects of Disease
One of the main areas that health psychology attempts to address is the way that disease affects us psychologically. Someone who becomes very ill will likely have to deal with a number of practical stressors as they become less mobile, as they have to deal with becoming dependent on others and as they have to alter their diet etc. As stress can have a very negative impact on health in general, this can lead to something of a vicious cycle.
Another issue to consider is how becoming ill might impact on a person’s sense of identity (1). In some cases they might take on the identity of being someone who is ‘ill’ and thus feel less independent. For those with terminal illnesses, the role of a health psychologist might be to help them to come to terms with this new identity and to accept their new position in life.
This is a big area of health psychology and something that generally deserves a lot of attention. The way that a doctor approaches dealing with a patient can have a huge impact on how that patient ultimately responds and how useful they find the interaction.
Two different approaches often exist here, with one being ‘doctor-centered’ communication and the other being ‘patient-centered communication’. In the former scenario, the emphasis is put on the doctor as the ‘expert’ who can guide the conversation and provide advice. In this situation the patient will play less of a role with regards to decision making and will mainly answer questions.
With ‘patient-centered communication’ however, the doctor will take slightly more of a back seat. Of course they do have more health knowledge than the patient but at the same time the patient will better know their own body, their symptoms and their history. Arguably, this puts the patient in a better position to ‘lead’ in some instances.
If I may interject with a personal account, I once dealt with a doctor who took a very ‘doctor-centered approach’ to a meeting we had at the expense of good treatment. In this case, I had been dealing with a rash that appeared every time I became ill or very cold – seemingly some kind of condition that my immune system was constantly fighting and which would rear its head whenever I was ‘low’ and my defenses were down. I spoke to the doctor about this and they suggested I changed my detergent. I then told them that I had had this problem for the past year – during which time I had used many detergents – and that the rash only appeared when I was ill or cold. The response? It’s probably my detergent…
In this scenario the doctor has looked at my symptom – a skin rash – but completely ignored everything I had to say and thereby provided me with completely unhelpful advice. This is an example of a doctor-centered approach gone wrong and it’s one of the things that health psychologists are trying to address.
Most health psychologists prefer a patient-centered approach and many believe that the patient should even have a role in choosing the best course of treatment/type of medication (2). Here it is the doctor’s role to explain the situation but then to allow the patient ultimately to come to a decision. After all, it’s their body!
There is a balance to be struck here however, as a very patient-centered approach could be more susceptible to abuse by those with addictions or hypochondria. Likewise, some patients actually prefer a more guided approach. Different patients and different conditions require a different balance and one of the roles of health psychologists is to help professionals to strike this balance in each case.
More broadly, health psychologists are also responsible for teaching doctors how to communicate with patients too. For instance, they might help GPs to more effectively break bad news, or explain the details of a situation. Again, this can actually have a big impact on the way that the patient views their situation and thus the way that they respond.
‘Adherence’ describes a patient’s commitment to the advice they have been given by their GP. This might mean their ability or inability to continue taking the medication they have been prescribed, or it might mean giving up cigarettes or eating a healthier diet.
In different cases patients will be more or less likely to do as they have been advised by their GPs and of course this can have a huge impact on their recovery.
Health psychologists look at ways to measure adherence so that they can track the success of different techniques and they also look at things that can be done to encourage more adherence. How do you get someone to keep taking their medication regularly? How do you measure whether or not they actually have taken that medication? Likewise, how can you get someone to quit smoking or give up certain foods? Is it better to ‘scare’ them into action, or is it better to simply outline the situation and let them come to their own conclusions?
Pain is very much a psychological phenomenon and this is something that health psychologists can therefore help with. One of the more interesting aspects of health psychology is devising ways to describe and measure pain. How effective are conventional scales in allowing a patient to communicate the level of discomfort they are experiencing? What would be a more effective solution?
Likewise, how can you help patients to not only deal with their pain but also overcome it if possible?
As well as helping to deal with existing illnesses and advising on treatments, health psychologists also play an important role in preventing illness and helping to encourage healthy behavior on a large scale. They may try to identify contextual factors for instance that lead to people becoming ill. For this they will often refer to the ‘biopsychosocial model’ which attempts to describe health in terms of not only biological, but also psychological and social factors.
They may also advise on such things as anti-smoking campaigns, campaigns against risky behavior and campaigns to promote positive behaviors (such as tooth brushing).
There are many more aspects to health psychology but generally they all look at the complex interplay between our psychology and the way this impacts on our prevention, management and response for illness.