Handbook of Health Psychology

Tracey A. Revenson, Regan A. R. Gurung

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351683265
• Edition: 1
• Topic: Psychologie
• Subtopic: Angewandte Psychologie

This rich resource provides a thorough overview of current knowledge and new directions in the study of the biological, psychological, social, and cultural factors that affect health, health behavior, and illness. Chapters review the latest theories and research with an emphasis on how research is translated into behavioral medicine interventions. Featuring contributions from top researchers and rising stars in the field, authors provide a theoretical foundation; evaluate the empirical evidence; and make suggestions for future research, clinical practice, and policy.

The handbook reflects the latest approaches to health psychology today, including:

• Emphasis throughout on the socio-cultural aspects of health, including socioeconomic status, gender, race/ethnicity, sexual orientation, and age/developmental stage
• A new section on emerging areas in health psychology, including behavioral genomics, military veterans' health, and digital health
• Coverage of prevention, interventions, and treatment in the applications section
• An expansion of the biopsychosocial model across several levels of analysis, including cultural, macro-social, and cellular factors
• Sustained emphasis on translating research into practice and policy

The handbook considers the intersections of concepts (behavior change), populations (women's and sexual minority health), cultural groups (African American, Asian American, and Latino), risk and protective factors (obesity, coping), and diseases (cancer, diabetes, HIV), making it essential reading for scholars of health psychology, public health, epidemiology, and nursing. Novices to the field appreciate the accessibly written chapters, while seasoned professionals appreciate the book's deep, cutting-edge coverage.

Part I

The Foundations of Health Psychology

1
Health Psychology Rising

The Current Status and Future Directions of Health Psychology

Tracey A. Revenson and Regan A. R. Gurung

The publication of this Handbook could not come at a better time. Over a dozen journals focusing on health psychology or behavioral medicine exist in the U.S. and internationally, an indicator of the healthy interest among scholars. There are many more professional organizations catering to it as well (e.g., The British Psychological Society Division of Health Psychology, the Australian Psychological Society College of Health Psychologists, the European Health Psychology Society). The prominence of health psychologists in the field of psychology is growing as well. For example, Dr. Anne Kazak, the current editor of the American Psychological Association’s flagship journal American Psychologist, is a health psychologist. Nancy Adler, Neal Miller, Shelley Taylor, Robert Kaplan, Elisa Epel, and James Sallis are among the many health psychologists that have been elected to membership in the National Academy of Medicine. Health psychologists can be found in psychology departments, academic medicine, public health, nursing, government agencies, hospital clinics, and private practice.

Nearly 70% of U.S. psychology departments offer an undergraduate course in Health Psychology (Norcross et al., 2016), compared to only 26% in the 1990s (Panjwani, Gurung, & Revenson, 2017). Health psychology features prominently in many recent introductory psychology textbooks (Griggs, 2014) and is rated as one of the most important topics covered in introductory psychology (McCann, Immel, Kadah-Ammeter, & Adelson, 2016), a course taken by approximately 1.6 million students a year (Gurung et al., 2016). There are now numerous graduate programs in the U.S. and Europe that offer doctoral or master’s level training in health psychology and internships. The Variations in how health psychology is taught (Byrne, Gethin, & Swanson, 2017) have resulted in calls for standardization (Plass, Gruszcznska, Andersson, & Kassianos, 2018).

During the past four decades, health psychologists have worked to understand the biological, psychological, and social factors that affect health, health behavior, and illness. Researchers continue to grapple with probing questions that examine the bidirectional nature of mind and body interactions: How does depression contribute to the pathophysiology of cardiovascular disease? How can we convince more people to engage in regular cancer screening? How can we increase uptake and adherence rates for pre-exposure prophylaxis, or PrEP, the first biomedical prevention strategy for HIV, and how can we expand that research to underserved populations? How can we use the research evidence in health psychology to develop more effective and cost-effective behavioral interventions for those living with chronic illness? These questions (and others) are addressed in this volume, including the potential for the research evidence to be translated into clinical practice and health policy. In this chapter we look forward more than backward to present a new model of approaching health-behavior problems.

The Biopsychosocial Model

Health psychology encompasses educational, scientific, professional, and psychological contributions to promote and maintain (physical) health; to prevent and treat illness; and to identify the origins, determinants, and sequelae of health and illness (Matarazzo, 1982; Taylor, 1990). As a subfield of psychology, health psychology focuses on understanding the biological, psychological, and sociological relationship between health and illness, with a focus on physical health. Some argue that health psychology is one of the disciplines that comprise the multidisciplinary field of behavioral medicine, which, in turn, is part of a much larger universe that encompasses a vast array of medical and public health sciences and services (Freedland, 2017, p. 2).

Several excellent chapters describe the rich history of the first 40 years of the field and we refer the reader to them (Friedman & Adler, 2011; Pickren & Degni, 2011; Wallston, 1996). In its infancy the field of health psychology brought together psychologists from traditional areas of psychology who shared a common interest in problems of health and illness but who brought their own disciplinary paradigms and methodologies to the table. Not surprisingly, this smorgasbord of models, approaches, methods, and jargon appeared confusing at times. More recently, doctoral students are being trained specifically in health psychology, and the connections between physical health and individual cognitions, emotions, and behavior are exposed and at the forefront of the work.

The original paradigm adopted by health psychology was the biopsychosocial model (Engel, 1977; Schwartz, 1982), which posited that physiological, psychological, and social factors are braided together in health and illness processes and cannot be studied in isolation. Contrasting itself with traditional biomedical models, the biopsychosocial model did not give primacy to biological indices, stating that it was impossible to understand disease processes without understanding the psychological mechanisms propelling them or the social context surrounding them. The biopsychosocial model was inclusive enough to be applied to risk estimates for particular diseases as well as health-promoting behaviors and environments, to disease progression as well as psychosocial adaptation to illness, and to individually oriented therapeutic and behavior change interventions as well as broader community-based and media approaches. The biopsychosocial model stimulated theorizing, research designs, and methodologies (Wade & Halligan, 2017). Most important, the model suggested a multi-cause, multi-effect approach to health and illness, rather than the limiting single-cause, single-effect approach.

Within medicine, a biomedical approach on pathogens and cellular pathologies will likely continue to identify physiological and pharmaceutical interventions for many acute and chronic diseases. However, in the 40 years since the publication of the biopsychosocial model (Engel, 1977) and health psychology’s near universal adoption of this model, it has become clear that divorcing the study of health and disease from the broader context of the person and the individual’s social, cultural, and political contexts greatly limits our understanding (Revenson, 2012). As we contemplate the approaching third decade of the millennium, let’s take a look at the continued viability of the biopsychosocial model and where health psychology is going and needs to go.

Successes of Health Psychology in the 20th and Very Early 21st Century

Crossing Levels of Analysis

In a classic paper, Anderson (1998) described a framework for health sciences that involves the need to study multiple levels of analysis for any health problem (the social/environmental, behavioral/psychological, organ systems, cellular, and molecular levels). More importantly, he indicated that great advances would occur not with research that examines the association of variables within levels but with research that focuses on reciprocal and mutually causative processes between and across levels. At the time, much of health psychology research involved examining how a single variable, or multiple variables within a single level, affected health outcomes in an additive fashion. Anderson urged health psychologists to examine interactions among variables from at least two different levels of analysis to move the field of health psychology forward.

There are two ways in which new approaches, perhaps better described as paradigmatic worldviews, have come into health psychology. The first is a centripetal move inward toward the original “center” of biological and microanalytic processes (Gruenwald & Wang, Chapter 15, this volume; Robles et al., Chapter 5, this volume). Contemporary research examines the pathways through which stress perceptions affect infection on organ system, cellular, and molecular levels. As an exemplar of this research, Epel and her colleagues (2004) discovered that among women facing chronic stress as well as women facing “normal” stress, greater perceived stress was associated with the biological indicators of accelerated cellular aging (telomere length, telomerase, and oxidative stress). The study of telomeres has now become “routine” in health psychology to help us understand outcomes such as mental health and premature aging (Epel & Prather, 2018). Health psychologists are now looking to genomics to aid in predictions of behavioral change as well (Hay, Bowers, & Hamilton, Chapter 35, this volume). Another emerging focus is human studies examining the microbiota of the brain-gut axis for its apparent role in mental and physical health (Maier & al’Absi, 2017).

The second advance is a centrifugal force that moves health psychology outward toward the social, cultural, and political level of analysis. Health psychologists have taken the lead in examining the biological and psychological mechanisms by which socioeconomic status (SES) affects both individual and community health outcomes (Ruiz, Steffen, Doyle, Flores, & Price, Chapter 21, this volume). Others have focused on how the social world we live in can affect disease progress, adjustment to illness, and mortality (Holt-Lunstad, Smith, & Layton, 2010; Chapters 13, 20, 29, 30, this volume). Moving away from simplistic models of race differences, psychologists have examined how perceptions of racism can affect cardiovascular reactivity and heart disease, specifying mediating mechanisms at multiple levels, including everyday racism, coping, and community norms (Brondolo, Lackey, & Love, 2012; Edwards et al., Chapter 24, this volume).

Engaging in Interdisciplinary Research

In an editorial for Health Psychology, Kenneth Freedland (2017) recognized that in many large-scale intervention studies, multiple groups work in concert to improve health. In his view, health psychology is a critical part of a larger picture that includes behavioral medicine, medicine, health care, and public health. Today, the line between who is responsible for such interventions is blurring although traditional training models still ensure that individuals take a specific route (i.e., an MD or PhD), even if they are contributing towards the same goals. As exemplified by the chapters in this handbook, health psychological research has great relevance not only to theory in psychology but also to applications in clinical and public health. The relevance cannot be understated, especially in light of the changing landscape of access to health care in the U.S. and the need for integrated care and self-management (McDaniel et al., 2014).

A case in point is the greater existence of chronic conditions (vs. acute or infectious diseases), which now include heart disease, cancer, diabetes, and human immunodeficiency virus (HIV). To improve the quality of life among those living with chronic conditions, health psychologists collaborate across different domains, blending the expertise of various trained specialists. As we move forward, the need will only increase for “large, multicenter, randomized controlled trials (RCTs) … and large, multicenter RCTs require large, well-organized, multidisciplinary research teams and networks” (Freedland, 2017, p. 2).

One exemplar of this approach is the ORBIT model (obesity-related behavioral intervention trials; Czajkowski et al., 2015). Developed by an interdisciplinary consortium of scholars leading trials to develop and refine strategies to alter obesity-related health behaviors (e.g., dietary intake, physical activity) and to translate findings from basic research on human behavior into more effective clinical, community, and population interventions to reduce obesity. The ORBIT model focuses exclusively on the early, pre-efficacy phases of behavioral treatment development, but also makes it possible to integrate the ORBIT framework with other frameworks that outline steps beyond the pre-efficacy phase. The National Institutes of Health Office of Behavioral and Social Sciences Research (OBSSR) strategic plan for 2017–2021 also explicitly focuses on enhancing and promoting the research infrastructure, methods, and measures needed to support a more cumulative and integrated approach to behavioral and social sciences research (Riley, 2017, p. 5).

Emerging Areas in Health Psychology

The future of health psychology depends on our ability to foster rigorous intellectual growth and translate our research findings into viable interventions. To do so we must build on existing strengths and respond to emerging needs in the next decade. Throughout this Handbook we asked authors to provide a description of the state of the science in their area—the current research and pressing issues. For example, the chapter on nicotine and tobacco use (Mermelstein & Brikmanis, Chapter 9) deals with the current crisis on vaping and other nicotine delivery systems used by adolescents and young adults.

As shown in Part VI of this Handbook, several emerging areas within health psychology are developing at a rapid pace. Emergent research is honing in on critical health problem topics such as sleep (Zhou, Bakker, & Johnson, Chapter 36) and sexual health (McClelland, Chapter 37). Newer populations are being targeted for intervention, including veterans (Trivedi & Mori, Chapter 38). Innovative clinical techniques, such as mindfulness, are being used more and more for health conditions (Kristeller, Chapter 39). Methodologies have invigorated both research and its translation into practice, including delivery of health care through new channels, including digital media and common “electronics” (Yardley, Bradbury, Nadarzynski, & Hunter, Chapter 40). Techniques from neuroscience, coupled with social psychology and stress research have led to a new area, health neuroscience (Zoccola, Woody, & Bryant, Chapter 34), and a recent focus on epigenetics (Hay, Bowers, & Hamilton, Chapter 35), which has the potential to revolutionize the personalization of disease risk.

The field is now seeing a renewed emphasis on particular areas that have been the “meat and potatoes” of health psychology, such as obesity (Halliday, Epperson, & Song, Chapter 7), theories of behavior change (Michie, Marques, Norris, & Johnston, Chapter 6), and illness cognitions (Broadbent, Chapter 18). Also gaining increased attention are areas that have not occupied a central place in health psychology, such as aging (Emery, Landers, & Shoemake, Chapter 19) and religion and spirituality (Park & Carney, Chapter 17). It is now clearer than ever, as we have emphasized in this chapter, that the health of diverse popula...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of Contributors
• Preface
• Part I The Foundations of Health Psychology
• Part II Health Behaviors and Risk Factors
• Part III Psychological Determinants of Health
• Part IV Social Determinants of Health
• Part V Psychological Issues in Specific Conditions
• Part VI Emerging Areas in Health Psychology
• Name Index
• Subject Index