Health Psychology:

An Overview for the

Rehabilitation Professional
Ginseng Gray, SPT
Wayne State University
College of Pharmacy & Allied Health
Department of Physical Therapy
KNOWLEDGE IS POTENTIAL POWER.
(Unknown)
Presentation Objectives
Define Health Psychology
Examine Coping Strategies
Discuss research relevant to rehabilitation
Introduce the biopsychosocial medical model
Students will understand the role of mental health
in physical function
Provide students with techniques to enhance
compliance
Provide students with objective assessment tools
 What is Health Psychology?
The aggregate of specific educational, scientific
and professional contributions 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 the analysis and
improvement of the healthcare system and health
policy. (Matarazzo 1980)
Relevance to Physical Therapy
Definition of health
psychology shares some
common goals with the
goals of physical therapy
As defined by the APTA
in the guide to PT practice
PTs seek to restore
optimal physical function
whereas psychology seeks
optimal mental function
Relevance to Physical Therapy
PT’s teach encourage and motivate using
principles borrowed from the field of
psychology
There is a need to understand how to
successfully teach and affect health
behaviors of compliance and motivation
Health Psychology:
Historic Beginnings
In 1852, physician Henry Holland
questioned the relationship between mind
and body, between psychological and
somatic processes. (Mental Physiology)
Freud believed that unacceptable or
disturbing thoughts and emotions, kept
unconscious could create a physical
disorder or the appearance of one. (Prokop)
3 Foundations of Health
Psychology
Field is built on principles of:
1) Behavioral learning: classical conditioning
2) Behavioral learning: operant conditioning
3) Social learning: observational
 Psychology 101: Review
Classical conditioning was made famous by Pavlov
and his dogs, which salivated at the presentation of
food
BF Skinner tested the theory of operant
conditioning, teaching animals to work for rewards
Bandura was the first to develop the theory that
thoughts influence the acquisition of behavior.
Uncovering the underlying source of the behavior
is important in preventing or altering the behavior.
 COPING
Coping is the
constantly changing
cognitive and
behavioral efforts to
manage a stimulus that
is appraised as
stressful (Prokop,
1991)
Differences in the
ways people handle
stress are learned
Self Efficacy: A coping strategy
An individual’s subjective perception of the
ability to perform a task
A set of expectations, not skills
Can be applied to geriatric population at risk for
falls (Tinetti & Powell, 1994)

“IT IS OUR PERCEPTION THAT BRINGS

ABOUT A DESIRED EFFECT”
(Lehman & Roller, 1999)
 Four Parts to Self-Efficacy
1) Performance
Accomplishment
2) Vicarious
Accomplishment
3) Verbal Persuasion
4) Physiological Status
Self-Efficacy
Goreczny (1995), states that addressing
self-efficacy improves and reduces
disability and pain related behaviors in:
 Exercise compliance
 Workload Performance

 Motor Skills

 Pain tolerance
 Question??
What are the four aspects of self-efficacy?

3) Performance Accomplishment (mastery)

4) Vicarious Accomplishment
5) Verbal Persuasion
6) Physiological status
 Coping Strategies in Low Back
Pain
Rosensteil & Keefe (1983) examined the use of
coping strategies in chronic low back pain patients
Three types of coping strategies emerged most
frequently
 1) Cognitive coping & suppression
 2) Helplessness
 3) Diverting attention & prayer
 Found to be predictive of behavioral and emotional
adjustment =ABILITY TO CONTROL OR ADJUST
PAIN
 Positive vs Negative adjustment
in LBP
18
16
14
12
10 Cognitive Suppressors
8 Helpless
Diverting and praying
6
4
2
0
Negative Adjustment Positive Adjustment
Coping strategies in LBP: Results
Indicate an active
approach to coping
with pain
more predictive than
somatization scales,
such as the McGill
Pain questionnaire
(Rosensteil & Keefe,
1983)
Effectiveness of Coping in Spinal
Cord Injury (King, 1999)
The authors used the Coping Effectiveness
Training (CET)program
CET is a group based intervention that
teaches appraisal skills, cognitive,
behavioral coping, and how to obtain social
support
Depression and Anxiety in SCI
with the CET Intervention
18
16
14
12
10 Pre
8 Post
Follow-up
6
4
2
0
Intervention Control
Emotional Disclosure
A cognitive behavioral
intervention developed
by Pennebaker
Requires subjects to
write or talk privately
about stressful life
situations, 15 minutes
per day for 3-5 days
Emotional Disclosure
(Pennebaker, 1990)

In healthy populations it is associated with

 Better mood
 Increased grade point average

 Decreased absenteeism

 Enhanced immunity
Emotional Disclosure and
Rheumatoid Arthritis
The onset of RA is
associated with
stressful life events
when compared to
controls (Baker, 1982)
Emotional disclosure
in RA has been shown
to alter symptoms in
the following ways.
 Physical Dysfunction following
Emotional Disclosure in RA
(Kelley, Lumley & Leisen, 1997)
3.5

2.5

2 Disclosure
1.5 Control

0.5

0
Baseline 2 weeks 3 months
 Affective Disturbances in RA
with Emotional Disclosure
(Kelley, Lumley & Leisen, 1997)
4.5
4
3.5
3
2.5 Disclosure
2 Control
1.5
1
0.5
0
Baseline 2 Weeks 3 Months
 Question??
Name the three foundational principles of
Health Psychology.

3) Operant Conditioning
4) Classical Conditioning
5) Social/Observational Learning
Body Mind Medicine
Hans Seyle is known
as the great pioneer of
body-mind medicine
(Vogel, 1991)
He was the first to
discuss the role of
stress in the fields of
medicine and
psychology
Body Mind Medicine
70% of visits to primary care physicians are for
problems related to stress and lifestyle (Vogel,
1999)
Methods of intervention
1. Educational
2. Cognitive-Behavioral
-skills training, pacing, distraction, imagery,
and decreasing catastrophizing
Biopsychosocial Medicine:
A New Medical Model
An alternative medical model which
approaches patient management with a team
of professionals at initial onset (Dea, 2000)
Adult Primary Care Team

Six MDs One LPN

Behavioral Med Health Educator

One PT
Personal Health Improvement
Program (PHIP)
Meditation Based
Program created by
Matthew Budd of the
Harvard Pilgrim Plan
Kaiser Permanente, a
California HMO,
tested the Personal
Health Improvement
Program in its CAD
members
Bromwyn & Ford, 2000
Studied the effects of PHIP in Kaiser
Permanente’s members with Coronary
Artery Disease
Lifestyle Modification Program
- Nutrition (vegetarian diet)
-Exercise (yoga, group and home exercise)
-Social (support group)
 Results: Overall Disease Distress
in CAD with PHIP

0.9 Overall
Diseases
0.8 Distress
0.7 Psychological
Distress
0.6
0.5 Functional and
0.4 Health Status
0.3
0.2
0.1
0
Before PHIP Post-PHIP 6 Month Follow-
up
 Cost Comparison Before and
After PHIP Referral in patients
with
1,800
CAD
1,709
1,650
1,600
1,400 1,270
1,200 1,119
1,010
1,000 6 months prior
800 760 6 months after
12 months after
600
400
200
0
Control PHIP Group
 COMPLIANCE or should we
say, COLLABORATION
Compliance to a medical protocol, is a form
of passive adherence (Prokop, 1991)

An alternative term suggested is

collaboration
This makes the activity a project for the
healthcare professional and the client
How many patient’s comply?
(Hoepful,1980)
25% to 64% of
patients comply with
medical advice or
directions compliant
noncompliant
Wide range varies due
to many populations
Health Belief and Compliance
The Health Belief Model is a theoretical
framework to explain and predict health related
behaviors.(Goreczny, 1995)
According to the HBM, the following factors
interact to produce behavior change
 Perceived vulnerability & severity
 Belief in effectiveness of prevention
 Perceived costs
 Presence of environmental cues
Can the Health Belief Model
Predict Compliance?
Chen & Neufield,
Occupational
Therapists, evaluated
factors that would
predict compliance in
patients with UE
Dysfunction
Results
35% of the subjects were 100% compliant
Self-efficacy emerged as the most important
factor in achieving compliance

Therefore encouraging self-efficacy should

be the emphasis of collaborative home
exercise programs and consultations
Compliance and Cardiac
Rehabilitation (Lane, 2001)
Identified factors that
would predict
attendance to cardiac
rehab
76% attended all
sessions
Prior exercise
experience was a
significant predictor of
attendance.
Physical Capabilities Scale
(Fitzgerald and Feuerstein(1992)

Eight item, self

efficacy scale for
rating expected
performance in
strength testing and
endurance
Assessment tool to
measure effectiveness
of cognitive
behavioral
interventions
Can you identify non-compliers?
Salisbury (1996), has identified methods of
assessing patient health beliefs, motivation and
stress.
Health beliefs are attained by asking the patient
their perceived cause of illness.
Provides the clinician with a start point and an
idea of what behaviors can be changed
Only one behavior should be changed at a time.
 Question??
What is compliance considered? And what
is a better term?

 Passive Adherence
 Better term=Collaboration
STAGES OF MOTIVATION
THEORY: a review
Also called the
Transtheoretical
Model
Delineates stages of
readiness for
change
1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
 Interventions to Increase Physical
Activity (ACSM, 2000)

Suggestions: Use of a sign/reminder

Balance Sheet: Write down pros/cons of anticipated
participation and outcomes
Lottery or Contest: Provide prizes for behavioral
changes or compliance levels
Phone Calls/Postcards
Conclusion
Economic pressures •Understanding
create a need for the mechanisms of
most efficient and behavioral change are
effective treatments
vital to all rehab
The cost reductions
professionals
of Kaiser
Permanente are not •More research is
isolated to California needed to standardize
behavioral
interventions
Summary

Self efficacy, perception of ability is a major

factor in effective coping
Emotional disclosure can positively mood and
immunity
Biopsychosocal medicine is a first contact team
approach to care
Compliance can be improved by
teaching/encouraging self efficacy
 Question??
Name some methods of increasing physical
activity compliance
1. Sign
2. Balance Sheet/Pros & Cons
3. Contests
4. Phone calls/postcards
FINAL QUESTION
Complete the following statement:
Knowledge is __________ _________

POTENTIAL POWER!!

Thanks for your Attention.