Health psychology

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https://en.wikipedia.org/wiki/Health_psychology

Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm (smoking or consuming excessive amounts of alcohol) or enhance (engaging in exercise) health. Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes (e.g., a virus, tumor, etc.) but also of psychological (e.g., thoughts and beliefs), behavioral (e.g., habits), and social processes (e.g., socioeconomic status and ethnicity).

By understanding psychological factors that influence health, and constructively applying that knowledge, health psychologists can improve health by working directly with individual patients or indirectly in large-scale public health programs. In addition, health psychologists can help train other healthcare professionals (e.g., physicians and nurses) to apply the knowledge the discipline has generated, when treating patients. Health psychologists work in a variety of settings: alongside other medical professionals in hospitals and clinics, in public health departments working on large-scale behavior change and health promotion programs, and in universities and medical schools where they teach and conduct research.

Although its early beginnings can be traced to the field of clinical psychology, four different divisions within health psychology and one related field, occupational health psychology (OHP), have developed over time. The four divisions include clinical health psychology, public health psychology, community health psychology, and critical health psychology. Professional organizations for the field of health psychology include Division 38 of the American Psychological Association (APA), the Division of Health Psychology of the British Psychological Society (BPS),^[10] the European Health Psychology Society (EHPS), and the College of Health Psychologists of the Australian Psychological Society (APS). Advanced credentialing in the US as a clinical health psychologist is provided through the American Board of Professional Psychology.

Overview

Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support).

Psychologists who strive to understand how biological, behavioral, and social factors influence health and illness are called health psychologists. Health psychologists use their knowledge of psychology and health to promote general well-being and understand physical illness. They are specially trained to help people deal with the psychological and emotional aspects of health and illness. Health psychologists work with many different health care professionals (e.g., physicians, dentists, nurses, physician's assistants, dietitians, social workers, pharmacists, physical and occupational therapists, and chaplains) to conduct research and provide clinical assessments and treatment services. Many health psychologists focus on prevention research and interventions designed to promote healthier lifestyles and try to find ways to encourage people to improve their health. For example, they may help people to lose weight or stop smoking. Health psychologists also use their skills to try to improve the healthcare system. For example, they may advise doctors about better ways to communicate with their patients. Health psychologists work in many different settings including the UK's National Health Service (NHS), private practice, universities, communities, schools and organizations. While many health psychologists provide clinical services as part of their duties, others function in non-clinical roles, primarily involving teaching and research. Leading journals include Health Psychology, the Journal of Health Psychology, the British Journal of Health Psychology, and Applied Psychology: Health and Well-Being. Health psychologists can work with people on a one-to-one basis, in groups, as a family, or at a larger population level.

Health psychology, like other areas of applied psychology, is both a theoretical and applied field. Health psychologists employ diverse research methods. These methods include controlled randomized experiments, quasi-experiments, longitudinal studies, time-series designs, cross-sectional studies, case-control studies, qualitative research as well as action research. Health psychologists study a broad range of health phenomena including cardiovascular disease (cardiac psychology), smoking habits, the relation of religious beliefs to health, alcohol use, social support, living conditions, emotional state, social class, and more. Some health psychologists treat individuals with sleep problems, headaches, alcohol problems, etc. Other health psychologists work to empower community members by helping community members gain control over their health and improve quality of life of entire communities.

Clinical health psychology (ClHP)

ClHP is the application of scientific knowledge, derived from the field of health psychology, to clinical questions that may arise across the spectrum of health care. ClHP is one of the specialty practice areas for clinical and health psychologists. It is also a major contributor to the prevention-focused field of behavioral health and the treatment-oriented field of behavioral medicine. Clinical practice includes education, the techniques of behavior change, and psychotherapy. In some countries, a clinical health psychologist, with additional training, can become a medical psychologist and, thereby, obtain prescription privileges.

Public health psychology (PHP)

PHP is population-oriented. A major aim of PHP is to investigate potential causal links between psychosocial factors and health at the population level. Public health psychologists present research results to educators, policy makers, and health care providers in order to promote better public health. PHP is allied to other public health disciplines including epidemiology, nutrition, genetics and biostatistics. Some PHP interventions are targeted toward at-risk population groups (e.g., undereducated, single pregnant women who smoke) and not the population as a whole (e.g., all pregnant women).^{[citation needed]}

Community health psychology (CoHP)

CoHP investigates community factors that contribute to the health and well-being of individuals who live in communities. CoHP also develops community-level interventions that are designed to combat disease and promote physical and mental health. The community often serves as the level of analysis, and is frequently sought as a partner in health-related interventions. A prominent focus of community health psychology is how to promote and strengthen health systems in communities. By doing so, community health psychologists hope to improve health across generations in a family. This comes with a strong focus in maternal and child care to do so.

Critical health psychology (CrHP)

CrHP is concerned with the distribution of power and the impact of power differentials on health experience and behavior, health care systems, and health policy. CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages, and socioeconomic positions. A major concern is health inequalities. The critical health psychologist is an agent of change, not simply an analyst or cataloger. A leading organization in this area is the International Society of Critical Health Psychology.

Occupational health psychology

Occupational health psychology brings together aspects of health psychology and industrial/organizational psychology to protect and improve health and workalike balance. Two of the main focuses are on occupational stress and workplace interventions. Pickren and Degni and Sanderson observed that in Europe and North America, occupational health psychology (OHP) emerged as a specialty with its own organizations. The authors noted that OHP owes some of that emergence to health psychology as well as other disciplines (e.g., i/o psychology, occupational medicine). Sanderson underlined examples in which OHP aligns with health psychology, including Adkins's research. Adkins documented the application of behavioral principles to improve working conditions, mitigate job stress, and improve worker health in a complex organization.

Current occupational health psychology research focuses on different job fields to more effectively determine how to improve organizational health. A job field that has received a lot of focus are nurses. Among nurses, there were two methods to reduce occupational stress. One method was implementing cognitive-behavioral skills training. This type of training focuses on emotional regulation, emotional intelligence, assertiveness, and time management. Another method to reduce occupational stress among nurses was mindfulness based intervention. Mindfulness-based intervention were taught to nurses as a way to stay present and was encourage to use before shifts or during busy shifts when it was chaotic.

Origins and development

Health psychology developed in different forms in different societies. Psychological factors in health had been studied since the early 20th century by disciplines such as psychosomatic medicine and later behavioral medicine, but these were primarily branches of medicine, not psychology.

United States

In 1969, William Schofield prepared a report for the APA entitled The Role of Psychology in the Delivery of Health Services. While there were exceptions, he found that the psychological research of the time frequently regarded mental health and physical health as separate, and devoted very little attention to psychology's impact upon physical health. One of the few psychologists working in this area at the time, Schofield proposed new forms of education and training for future psychologists. The APA, responding to his proposal, in 1973 established a task force to consider how psychologists could (a) help people to manage their health-related behaviors, (b) help patients manage their physical health problems, and (c) train healthcare staff to work more effectively with patients.

Health psychology began to emerge as a distinct discipline of psychology in the United States in the 1970s. In the mid-20th century there was a growing understanding in medicine of the effect of behavior on health. For example, the Alameda County Study, which began in the 1960s, showed that people who ate regular meals (e.g., breakfast), maintained a healthy weight, received adequate sleep, did not smoke, drank little alcohol, and exercised regularly were in better health and lived longer. In addition, psychologists and other scientists were discovering relationships between psychological processes and physiological ones. These discoveries include a better understanding of the impact of psychosocial stress on the cardiovascular and immune systems, and the early finding that the functioning of the immune system could be altered by learning.

Led by Joseph Matarazzo, in 1977, APA added a division devoted to health psychology. At the first divisional conference, Matarazzo delivered a speech that played an important role in defining health psychology. He defined the new field in this way, "Health psychology is the aggregate 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 diagnostic and etiologic correlates of health, illness and related dysfunction, and the analysis and improvement of the healthcare system and health policy formation." Similar organizations were established in other countries, including Australia and Japan.

Europe

In the 1980s there was increasing interest in many European countries in researching psychological aspects of health and illness. In 1986, Stan Maes (1947–2018) of Tilburg University convened a meeting of researchers from Finland, Switzerland, Poland, Czechoslovakia, Italy, Germany, Belgium, Spain, the UK and the Netherlands. Out of this meeting emerged the European Health Psychology Society which began to organise regular conferences (e.g. Trier, 1988; Utrecht, 1989; Oxford, 1990; Lausanne, 1991; and Leipzig, 1992) and published proceedings from these meetings. This society also began to develop its own publications.

United Kingdom

Psychologists have been working in medical settings for many years (in the UK sometimes the field was termed medical psychology). Medical psychology, however, was a relatively small field, primarily aimed at helping patients adjust to illness. The BPS's reconsideration of the role of the Medical Section prompted the emergence of health psychology as a distinct field. Marie Johnston and John Weinman argued in a letter to the BPS Bulletin that there was a great need for a Health Psychology Section. In December 1986 the section was established at the BPS London Conference, with Marie Johnston as chair. Annual conferences began to be held and began to map out the areas of interest. At the Annual BPS Conference in 1993 a review of "Current Trends in Health Psychology" was organized, and a definition of health psychology as "the study of psychological and behavioural processes in health, illness and healthcare" was proposed.

The Health Psychology Section became a Special Group in 1993 and was awarded divisional status within the UK in 1997. The awarding of divisional status meant that the individual training needs and professional practice of health psychologists were recognized, and members were able to obtain chartered status with the BPS. The BPS went on to regulate training and practice in health psychology until the regulation of professional standards and qualifications was taken over by statutory registration with the Health Professions Council in 2010.

Development

A number of relevant trends coincided with the emergence of health psychology. One of those trends being the addition of behavioral science to medical school curricula, with courses often taught by psychologists. Another trend of the increased knowledge in health psychology is the training of health professionals in communication skills, with the aim of improving patient satisfaction and adherence to medical treatment. Another impact of the emergence and focus on health psychology are the increasing numbers of interventions based on psychological theory (e.g., behavior modification) and an increased understanding of the interaction between psychological and physiological factors leading to the emergence of psychophysiology and psychoneuroimmunology (PNI). The health domain has also become a target of research by social psychologists interested in testing theoretical models linking beliefs, attitudes, and behavior. Another important impact of the focus on health psychology and its research is the increase of and funding of research in the emergence of AIDS/HIV. The emergence of academic /professional bodies to promote research and practice in health psychology was followed by the publication of a series of textbooks which began to lay out the interests of the discipline.

Objectives

Understanding behavioral and contextual factors

Health psychologists conduct research to identify behaviors and experiences that promote health, give rise to illness, and influence the effectiveness of health care. They also recommend ways to improve health care policy. Health psychologists have worked on developing ways to reduce smoking in order to promote health and prevent illness. They have also studied the association between illness and individual characteristics. For example, health psychology has found a relation between the personality characteristics of thrill seeking, impulsiveness, hostility/anger, emotional instability, and depression, on one hand, and high-risk driving, on the other.

Health psychology is also concerned with contextual factors, including economic, cultural, community, social, and lifestyle factors that influence health. Physical addiction impedes smoking cessation. Some research suggests that seductive advertising also contributes to psychological dependency on tobacco, although other research has found no relationship between media exposure and smoking in youth. OHP research indicates that people in jobs that combine little decision latitude with a high psychological workload are at increased risk for cardiovascular disease. Other research reveals a relation between unemployment and elevations in blood pressure. Epidemiologic research documents a relation between social class and cardiovascular disease.

Health psychologists also aim to change health behaviors for the dual purpose of helping people stay healthy and helping patients adhere to disease treatment regimens (also see health action process approach). Health psychologists employ cognitive behavioral therapy and applied behavior analysis (also see behavior modification) for that purpose.

Preventing illness

Health psychologists promote health through behavioral change, as mentioned above; however, they attempt to prevent illness in other ways as well. Health psychologists try to help people to lead a healthy life by developing and running programmes which can help people to make changes in their lives such as stopping smoking, reducing the amount of alcohol they consume, eating more healthily, and exercising regularly. Campaigns informed by health psychology have targeted tobacco use. Those least able to afford tobacco products consume them most. Tobacco provides individuals with a way of controlling aversive emotional states accompanying daily experiences of stress that characterize the lives of deprived and vulnerable individuals. Practitioners emphasize education and effective communication as a part of illness prevention because many people do not recognize, or minimize, the risk of illness present in their lives. Moreover, many individuals are often unable to apply their knowledge of health practices owing to everyday pressures and stresses. A common example of population-based attempts to motivate the smoking public to reduce its dependence on cigarettes is anti-smoking campaigns.

Health psychologists help to promote health and well-being by preventing illness. Some illnesses can be more effectively treated if caught early. Health psychologists have worked to understand why some people do not seek early screenings or immunizations, and have used that knowledge to develop ways to encourage people to have early health checks for illnesses such as cancer and heart disease. Health psychologists are also finding ways to help people to avoid risky behaviors (e.g., engaging in unprotected sex) and encourage health-enhancing behaviors (e.g., regular tooth brushing or hand washing).

Health psychologists also aim at educating health professionals, including physicians and nurses, in communicating effectively with patients in ways that overcome barriers to understanding, remembering, and implementing effective strategies for reducing exposures to risk factors and making health-enhancing behavior changes.

There is also evidence from OHP that stress-reduction interventions at the workplace can be effective. For example, Kompier and his colleagues have shown that a number of interventions aimed at reducing stress in bus drivers has had beneficial effects for employees and bus companies.

Illness, disabilities and long-term conditions

Health psychologists investigate how disease affects individuals' psychological well-being. An individual who becomes seriously ill or injured faces many different practical stressors. These stressors include problems meeting medical and other bills, problems obtaining proper care when home from the hospital, obstacles to caring for dependents, the experience of having one's sense of self-reliance compromised, gaining a new, unwanted identity as that of a sick person, and so on. These stressors can lead to depression, reduced self-esteem, etc.

The use of medications can alter the microbiome and potentially impact overall health and the development of diseases. It has been discovered that the metabolites produced by intestinal microorganisms can influence one's health. For instance, antidepressants can modify the composition of the intestinal microbiota, which can then affect the course of the disease through changes in specific metabolites produced by certain intestinal microorganisms. This has significant implications, particularly in the context of depression, as it offers new insights into how to approach and treat the condition at hand.

Health psychologists can support people living with long-term conditions to improve or maintain quality of life, self-manage their conditions, and adjust to life with an illness, disability or long-term condition.

Health psychology also concerns itself with bettering the lives of individuals with terminal illness. When there is little hope of recovery, health psychologist therapists can work within a multi-disciplinary palliative care team to improve the quality of life of the patient by helping the patient recover at least some of his or her psychological well-being.

A form of therapy shown in recent studies is psychotherapy. It is used as a mode of intervention due to the inconsistency and issues that may arise from pharmacological interventions. It ensures the use of evidence-based practices and helps in facilitating adherence to medication regimens that may be impacted by psychiatric symptoms, such as low motivation or depressive symptoms. When using psychotherapeutic strategies, clinicians can choose from three modes: individual, family/couples, and group psychotherapy.

Critical analysis of health policy

Critical health psychologists explore how health policy can influence inequities, inequalities and social injustice. These avenues of research expand the scope of health psychology beyond the level of individual health to an examination of the social and economic determinants of health both within and between regions and nations. The individualism of mainstream health psychology has been critiqued and deconstructed by critical health psychologists using qualitative methods that zero in on the health experience.

Conducting research

Like psychologists in the other main psychology disciplines, health psychologists have advanced knowledge of research methods. Health psychologists apply this knowledge to conduct research on a variety of questions. For example, health psychologists carry out research to answer questions such as:

• What influences healthy eating?
• How is stress linked to heart disease?
• What are the emotional effects of genetic testing?
• How can we change people's health behavior to improve their health?

Teaching and communication

Main article: Health communication

Health psychologists can also be responsible for training other health professionals on how to deliver interventions to help promote healthy eating, stopping smoking, weight loss, etc. Health psychologists also train other health professionals in communication skills such as how to break bad news or support behavior change for the purpose of improving adherence to treatment.

Applications

Improving doctor–patient communication

Health psychologists aid the process of communication between physicians and patients during medical consultations. There are many problems in this process, with patients showing a considerable lack of understanding of many medical terms, particularly anatomical terms (e.g., intestines). One area of research on this topic involves "doctor-centered" or "patient-centered" consultations. Doctor-centered consultations are generally directive, with the patient answering questions and playing less of a role in decision-making. Although this style is preferred by elderly people and others, many people dislike the sense of hierarchy or ignorance that it inspires. They prefer patient-centered consultations, which focus on the patient's needs, involve the doctor listening to the patient completely before making a decision, and involving the patient in the process of choosing treatment and finding a diagnosis.

Improving adherence to medical advice

Health psychologists engage in research and practice aimed at getting people to follow medical advice and adhere to their treatment regimens. Patients often forget to take their pills or consciously opt not to take their prescribed medications because of side effects. Failing to take prescribed medication is costly and wastes millions of usable medicines that could otherwise help other people. Estimated adherence rates are difficult to measure (see below); there is, however, evidence that adherence could be improved by tailoring treatment programs to individuals' daily lives. Additionally, traditional cognitive-behavioural therapies have been adapted for people with chronic illnesses and comorbid psychological distress to include modules that encourage, support and reinforce adherence to medical advice as part of the larger treatment approach.

Ways of measuring adherence

Health psychologists have identified a number of ways of measuring patients' adherence to medical regimens:

• Counting the number of pills in the medicine bottle
• Using self-reports
• Using "Trackcap" bottles, which track the number of times the bottle is opened.

Managing pain

Health psychology attempts to find treatments to reduce or eliminate pain, as well as understand pain anomalies such as episodic analgesia, causalgia, neuralgia, and phantom limb pain. Although the task of measuring and describing pain has been problematic, the development of the McGill Pain Questionnaire has helped make progress in this area. Treatments for pain involve patient-administered analgesia, acupuncture (found to be effective in reducing pain for osteoarthritis of the knee), biofeedback, and cognitive behavior therapy.

Current research

MIDUS

Midlife in the United States, also known as MIDUS, has sent out numerous surveys since its start in 1995. The goal of MIDUS was to collect data on the role of behavioral, social, and psychological factors on age-related outcomes on health and well-being. Since its start, MIDUS has sent out a variety of surveys and done an extensive amount of research pertaining to health psychology. Many researchers often refer back to MIDUS data for their own research as the MIDUS data is extensive and longitudinal.

MIDUS 1: National Survey of Midlife Development in the United States.

Done in 1995 to 1996, the MIDUS 1 project surveyed 7,108 individuals ages 25 to 75 years old. This sample also included the national sample of twins and siblings as a large sample of their participants. This survey was done through self-administered questionnaires and phone interviews. Participants were asked to provide information on their physical and mental health as well as insight on their lifestyle choices, demands of their career, substance use, sense of control over their health, and what their decision making process is.

MIDUS 2

MIDUS 2 was completed in 2009 and was a longitudinal follow-up on all of the participants in the MIDUS 1 survey. Within MIDUS 2, there were five projects. Project 1 was a follow up on all of the questions asked in MIDUS 1 pertaining to psychosocial, sociodemographic, and health variables. Project 2 was a follow up of the daily diary in MIDUS 1. Project 3 was a new assessment of cognition in this sample and also included a follow up for the previous cognitive subsample from MIDUS 1. Project 4 was a biomarkers assessment on the participants. Project 5 was a neuroscience assessment on a subsample of those who participated in the biomarker study.

MIDUS Refresher

The MIDUS Refresher study was done in 2011 through 2014. This study recruited a new sample of 3,577 adults between the ages of 25-74 and was designed to replenish the original MIDUS 1 sample in order to parallel the original survey. The MIDUS Refresher survey had the same assessments that were done with the existing MIDUS sample, but included additional questions about the effects of the economic recession that took place in 2008 through 2009. The MIDUS Refresher survey also included five projects. Project 1 was a 30 minute phone interview as well as a two 50 page self-administered questionnaires that were mailed to each participant. This was done to analyze the mental and physical effects related to the economic recession. Projects two through five followed the same pattern as the MIDUS 2 survey with daily diary, cognitive, biomarker, and neuroscience assessments respectively.

MIDUS 3

A third wave of surveys were sent in 2013 to collect longitudinal data on the MIDUS Refresher participants. This survey followed the same structure as the MIDUS Refresher survey with the addition of questions about optimism and coping, stressful life events, and caregiving.

MIDJA: Midlife in Japan

MIDJA looks at 1,027 adults ages 30 to 79 in Japan, specifically the Tokyo metropolitan area, in 2008. This survey collected baseline data on sociodemographic characteristics, psychosocial characteristics, and mental and physical health. In 2009, biomarker data was taken from these cases. This survey and the collection of biomarker data mirrored the longitudinal studies of MIDUS to analyze differences between the United States and Japan. In 2012, a longitudinal follow up was completed on MIDJA participants. This repeated the baseline assessments to further look at the differences between MIDUS and MIDJA data.

Uses of MIDUS Data

One study used MIDUS 1 through 3 data to complete a longitudinal study. This study was looking at cognitive reappraisal, affective reactivity, and health. From the MIDUS data, they used the cognitive reappraisal, sociodemographics, daily stressors, daily negative affect, mental health scales, reported chronic conditions, and physical health data throughout these studies. What they found was that cognitive reappraisal was significantly associated with future health and well-being outcomes.

Another study looked at daily stressors, positive events, and depression, specifically the difference in affect between groups with and without major depressive disorder. This study used MIDUS 1 and 2 data as well as the National Study of Daily Experiences (NSDE) which is a subset of the MIDUS data also knows and the daily diary project. The data taken from these surveys were reports of daily affect, daily stressors, daily positive events, and major depressive disorder. What was found was that those who had major depressive disorder and experiences at least one positive event that day reported a greater decrease of positive affect and greater increase of negative affect compared to groups without major depressive disorder.

Another study looked at affective reactivity, heart rate, and marital quality. This study looked at the NSDE, Biomarker Project, and MIDUS 2 and 3 data. Within this, the variables of interest were daily stressors, affective reactivity, marital quality, and resting heart rate. What was found were greater affective reactivity to daily stressors predicted lower marital satisfaction and higher marital risk. In addition to that, resting heart rate moderated these associations. High levels of resting heart rate offset the negative relationship between affective reactivity and marital quality.

MIDUS data is very important to and applicable in health psychology research. Since it looks at such a wide variety of variables, there are many different ways for researchers to analyze the data. It allows for a variety of different combinations of variables to compare, a large amount of longitudinal data, and so much research to build off of. The different variables allow for an intersection of data to present in health psychology because of the variety in physical health and mental health variables.

Health psychologist roles

Below are some examples of the types of positions held by health psychologists within applied settings such as the UK's NHS and private practice.

Healthcare professionals who treat individuals with mental health conditions prefer medications that provide energy and have fewer side effects. When prescribing psychiatric drugs, it is essential to consider individual needs, safety, and anti-doping policies. Psychologists patients prefer specific medications like escitalopram for anxiety, melatonin for insomnia, lamotrigine for bipolar disorders, and aripiprazole for psychotic disorders. This emphasizes the importance of personalized prescribing individuals.

• Consultant health psychologist: A consultant health psychologist will take a lead for health psychology within public health, including managing tobacco control and smoking cessation services and providing professional leadership in the management of health trainers.
• Principal health psychologist: A principal health psychologist could, for example lead the health psychology service within one of the leading heart and lung hospitals, providing a clinical service to patients and advising all members of the multidisciplinary team.
• Health psychologist: An example of a health psychologist's role would be to provide health psychology input to a center for weight management. Psychological assessment of treatment, development and delivery of a tailored weight management program, and advising on approaches to improve adherence to health advice and medical treatment.
• Research psychologist: Research health psychologists carry out health psychology research, for example, exploring the psychological impact of receiving a diagnosis of dementia, or evaluating ways of providing psychological support for people with burn injuries. Research can also be in the area of health promotion, for example investigating the determinants of healthy eating or physical activity or understanding why people misuse substances.
• Health psychologist in training/assistant health psychologist: As an assistant/in training, a health psychologist will gain experience assessing patients, delivering psychological interventions to change health behaviors, and conducting research, whilst being supervised by a qualified health psychologist.

Training

United States

Universities began to develop doctoral-level training programs in health psychology. In the US, post-doctoral level health psychology training programs were established for individuals who completed a doctoral degree in clinical psychology.

United Kingdom

The term "health psychologist" is a protected title, with health psychologists required to register with the Health Professions Council (HPC) and have trained to a level to be eligible for full membership of the Division of Health Psychology within the BPS. Registered health psychologists who are chartered with the BPS will have undertaken a minimum of six years of training, with three of those years dedicated to health psychology training. Following the completion of a BPS-accredited undergraduate degree in Psychology, aspiring health psychologists must first complete a BPS-accredited masters in health psychology (Stage 1 training). Once the trainee has completed Stage 1 training, they can either choose to complete the BPS' independent Stage 2 training route or sign up to an accredited health psychology doctorate program at a UK university (DHealthPsy). Both training routes require trainees to demonstrate they meet the core competencies of:

• professional skills (including implementing ethical and legal standards, communication, and teamwork),
• research skills (including designing, conducting, and analyzing psychological research in numerous areas),
• consultancy skills (including planning and evaluation),
• teaching and training skills (including knowledge of designing, delivering, and evaluating large and small scale training program),
• intervention skills (including delivery and evaluation of behavior change interventions).

At present, there are limited opportunities for trainees to receive fully funded training. The NHS Education Scotland (NES) Stage 2 program funds several trainee health psychologists each year, providing trainees with fixed-term posts within NHS Boards across Scotland. In 2022, a pilot scheme was launched by Health Education England (HEE) to provide similar opportunities to aspiring health psychologists across England.

Once qualified, health psychologists can work in a range of settings, for example the NHS, universities, schools, private healthcare, and research and charitable organizations. A health psychologist in training might be working within applied settings while working towards registration and chartered status. All qualified health psychologists must also engage in and record their continuing professional development (CPD) for psychology each year throughout their career.

Australia

Health psychologists are registered by the Psychology Board of Australia. The standard pathway to becoming an endorsed health psychologists involves a minimum of six years training and a two-year registrar program. Health psychologists must also undertake continuing professional development (CPD) each year.

New Zealand

Health psychologists are registered by the New Zealand Psychologists Board within the psychologist scope of practice. The training pathway to becoming a registered health psychologist requires a Masters in Health Psychology and a two-year registration Postgraduate Diploma in Health Psychology at the University of Auckland. Outside of clinical work in primary, secondary and tertiary healthcare settings, graduates may choose careers in research and health promotion in universities and private settings. Health psychologists are able to join the Institute of Health Psychology (IHP), an institute of the New Zealand Psychological Society, as a practitioner, academic or student affiliate.

 

Nocebo

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Nocebo

A nocebo effect is said to occur when a patient's expectations for a treatment cause the treatment to have a worse effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication, they can experience that effect even if the "medication" is actually an inert substance. The complementary concept, the placebo effect, is said to occur when expectations improve an outcome.

More generally, the nocebo effect is falling ill simply by consciously or subconsciously anticipating a harmful event. This definition includes anticipated events other than medical treatment. It has been applied to Havana syndrome, where purported victims were anticipating attacks by foreign adversaries. This definition also applies to cases of electromagnetic hypersensitivity.

Both placebo and nocebo effects are presumably psychogenic but can induce measurable changes in the body. One article that reviewed 31 studies on nocebo effects reported a wide range of symptoms that could manifest as nocebo effects, including nausea, stomach pains, itching, bloating, depression, sleep problems, loss of appetite, sexual dysfunction, and severe hypotension.

Etymology and usage

Walter Kennedy coined the term nocebo (Latin nocēbō, "I shall harm", from noceō, "I harm") in 1961 to denote the counterpart of placebo (Latin placēbō, "I shall please", from placeō, "I please"), a substance that may produce a beneficial, healthful, pleasant, or desirable effect. Kennedy emphasized that his use of the term nocebo refers strictly to a subject-centered response, a quality "inherent in the patient rather than in the remedy". That is, he rejected the use of the term for pharmacologically induced negative side effects such as the ringing in the ears caused by quinine. That is not to say that the patient's psychologically induced response may not include physiological effects. For example, an expectation of pain may induce anxiety, which in turn causes the release of cholecystokinin, which facilitates pain transmission.

Response

In the narrowest sense, a nocebo response occurs when a drug-trial subject's symptoms are worsened by the administration of an inert, sham, or dummy (simulator) treatment, called a placebo. Placebos contain no chemicals (or any other agents) that could cause any of the observed worsening in the subject's symptoms, so any change for the worse must be due to some subjective factor. Adverse expectations can also cause anesthetic medications' analgesic effects to disappear.

The worsening of the subject's symptoms or reduction of beneficial effects is a direct consequence of their exposure to the placebo, but the placebo has not chemically generated those symptoms. Because this generation of symptoms entails a complex of "subject-internal" activities, we can never speak in the strictest sense in terms of simulator-centered "nocebo effects", but only in terms of subject-centered "nocebo responses". Some observers attribute nocebo responses (or placebo responses) to a subject's gullibility, but there is no evidence that someone who manifests a nocebo/placebo response to one treatment will manifest a nocebo/placebo response to any other treatment; i.e., there is no fixed nocebo/placebo-responding trait or propensity.

Based on a biosemiotic model (2022), Goli explains how harm and/or healing expectations lead to a multimodal image and form transient allostatic or homeostatic interoceptive feelings, demonstrating how repetitive experiences of a potential body induce epigenetic changes and form new attractors, such as nocebos and placeboes, in the actual body.

Effects

Side effects of drugs

It has been shown that, due to the nocebo effect, warning patients about drugs' side effects can contribute to the causation of such effects, whether the drug is real or not. This effect has been observed in clinical trials: according to a 2013 review, the dropout rate among placebo-treated patients in a meta-analysis of 41 clinical trials of Parkinson's disease treatments was 8.8%. A 2013 review found that nearly 1 out of 20 patients receiving a placebo in clinical trials for depression dropped out due to adverse events, which were believed to have been caused by the nocebo effect.

In January 2022, a systematic review and meta-analysis concluded that nocebo responses accounted for 72% of adverse effects after the first COVID-19 vaccine dose and 52% after the second dose.

Many studies show that the formation of nocebo responses are influenced by inappropriate health education, media work, and other discourse makers who induce health anxiety and negative expectations.

Researchers studying the side effects of statins in UK determined that a large proportion of reported side effects were related not to any pharmacological cause but to the nocebo effect. In the UK, publicity in 2013 about the apparent side effects caused hundreds of thousands of patients to stop taking statins, leading to an estimated 2,000 additional cardiovascular events in the subsequent years.

Electromagnetic hypersensitivity

Evidence suggests that the symptoms of electromagnetic hypersensitivity are caused by the nocebo effect.

Pain

Verbal suggestion can cause hyperalgesia (increased sensitivity to pain) and allodynia (perception of a tactile stimulus as painful) as a result of the nocebo effect. Nocebo hyperalgesia is believed to involve the activation of cholecystokinin receptors.

Ambiguity of medical usage

Stewart-Williams and Podd argue that using the contrasting terms "placebo" and "nocebo" for inert agents that produce pleasant, health-improving, or desirable outcomes and unpleasant, health-diminishing, or undesirable outcomes (respectively) is extremely counterproductive. For example, precisely the same inert agents can produce analgesia and hyperalgesia, the first of which, on this definition, would be a placebo, and the second a nocebo.

A second problem is that the same effect, such as immunosuppression, may be desirable for a subject with an autoimmune disorder, but undesirable for most other subjects. Thus, in the first case, the effect would be a placebo, and in the second a nocebo. A third problem is that the prescriber does not know whether the relevant subjects consider the effects they experience desirable or undesirable until some time after the drugs have been administered. A fourth is that the same phenomena are generated in all the subjects, and generated by the same drug, which is acting in all of the subjects through the same mechanism. Yet because the phenomena in question have been subjectively considered desirable to one group but not the other, the phenomena are now being labeled in two mutually exclusive ways (i.e., placebo and nocebo), giving the false impression that the drug in question has produced two different phenomena.

Ambiguity of anthropological usage

Some people maintain that belief can kill (e.g., voodoo death: Cannon in 1942 describes a number of instances from a variety of different cultures) and or heal (e.g., faith healing). A self-willed death (due to voodoo hex, evil eye, pointing the bone procedure, etc.) is an extreme form of a culture-specific syndrome or mass psychogenic illness that produces a particular form of psychosomatic or psychophysiological disorder resulting in psychogenic death. Rubel in 1964 spoke of "culture-bound" syndromes, those "from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventive measures, and regimens of healing".

Certain anthropologists, such as Robert Hahn and Arthur Kleinman, have extended the placebo/nocebo distinction into this realm to allow a distinction to be made between rituals, such as faith healing, performed to heal, cure, or bring benefit (placebo rituals) and others, such as "pointing the bone", performed to kill, injure or bring harm (nocebo rituals). As the meaning of the two interrelated and opposing terms has extended, we now find anthropologists speaking, in various contexts, of nocebo or placebo (harmful or helpful) rituals:

• that might entail nocebo or placebo (unpleasant or pleasant) procedures;
• about which subjects might have nocebo or placebo (harmful or beneficial) beliefs;
• that are delivered by operators that might have nocebo or placebo (pathogenic, disease-generating or salutogenic, health-promoting) expectations;
• that are delivered to subjects that might have nocebo or placebo (negative, fearful, despairing or positive, hopeful, confident) expectations about the ritual;
• that are delivered by operators who might have nocebo or placebo (malevolent or benevolent) intentions, in the hope that the rituals will generate nocebo or placebo (lethal, injurious, harmful or restorative, curative, healthy) outcomes; and, that all of this depends upon the operator's overall beliefs in the nocebo ritual's harmful nature or the placebo ritual's beneficial nature.

Yet it may become even more terminologically complex, for as Hahn and Kleinman indicate, there can also be cases of paradoxical nocebo outcomes from placebo rituals and placebo outcomes from nocebo rituals (see also unintended consequences). In 1973, writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, gave up hope and died a premature death: "there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')".

Ethics

Some researchers have pointed out that the harm caused by communicating with patients about potential treatment adverse events raises an ethical issue. To respect their autonomy, one must inform a patient about harms a treatment may cause. Yet the way in which potential harms are communicated could cause additional harm, which may violate the ethical principle of non-maleficence. It is possible that nocebo effects can be reduced while respecting autonomy using different models of informed consent, including the use of a framing effect and the authorized concealment.

Behavioral medicine

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Behavioral_medicine

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

Behavioral medicine is especially relevant in recent days, where many of the health problems are primarily viewed as behavioral in nature, as opposed to medical. For example, smoking, leading a sedentary lifestyle, and alcohol use disorder or other substance use disorder are all factors in the leading causes of death in the modern society. Practitioners of behavioral medicine include appropriately qualified nurses, social workers, psychologists, and physicians (including medical students and residents), and these professionals often act as behavioral change agents, even in their medical roles.

Behavioral medicine uses the biopsychosocial model of illness instead of the medical model. This model incorporates biological, psychological, and social elements into its approach to disease instead of relying only on a biological deviation from the standard or normal functioning.

Origins and history

Writings from the earliest civilizations have alluded to the relationship between mind and body, the fundamental concept underlying behavioral medicine. The field of psychosomatic medicine is among its academic forebears, albeit, it is now obsolete as an psychological discipline.

In the form in which it is generally understood today, the field dates back to the 1970s. The earliest uses of the term were in the title of a book by Lee Birk (Biofeedback: Behavioral Medicine), published in 1973; and in the names of two clinical research units, the Center for Behavioral Medicine, founded by Ovide F. Pomerleau and John Paul Brady at the University of Pennsylvania in 1973, and the Laboratory for the Study of Behavioral Medicine, founded by William Stewart Agras at Stanford University in 1974. Subsequently, the field burgeoned, and inquiry into behavioral, physiological, and biochemical interactions with health and illness gained prominence under the rubric of behavioral medicine. In 1976, in recognition of this trend, the National Institutes of Health created the Behavioral Medicine Study Section to encourage and facilitate collaborative research across disciplines.

The 1977 Yale Conference on Behavioral Medicine and a meeting of the National Academy of Sciences were explicitly aimed at defining and delineating the field in the hopes of helping to guide future research. Based on deliberations at the Yale conference, Schwartz and Weiss proposed the biopsychosocial model, emphasizing the new field's interdisciplinary roots and calling for the integration of knowledge and techniques broadly derived from behavioral and biomedical science. Shortly after, Pomerleau and Brady published a book entitled Behavioral Medicine: Theory and Practice, in which they offered an alternative definition focusing more closely on the particular contribution of the experimental analysis of behavior in shaping the field.

Additional developments during this period of growth and ferment included the establishment of learned societies (the Society of Behavioral Medicine and the Academy of Behavioral Medicine Research, both in 1978) and of journals (the Journal of Behavioral Medicine in 1977 and the Annals of Behavioral Medicine in 1979). In 1990, at the International Congress of Behavioral Medicine in Sweden, the International Society of Behavioral Medicine was founded to provide, through its many daughter societies and through its own peer-reviewed journal (the International Journal of Behavioral Medicine), an international focus for professional and academic development.

Areas of study

Behavior-related illnesses

Many chronic diseases have a behavioral component, but the following illnesses can be significantly and directly modified by behavior, as opposed to using pharmacological treatment alone:

• Substance use: many studies demonstrate that medication is most effective when combined with behavioral intervention
  
• Hypertension: deliberate attempts to reduce stress can also reduce high blood pressure
• Insomnia: cognitive and behavioural interventions are recommended as a first line treatment for insomnia
• Diabetes: Research suggests diet and exercise as one of the main treatments for diabetes
  

Treatment adherence and compliance

Medications work best for controlling chronic illness when the patients use them as prescribed and do not deviate from the physician's instructions. This is true for both physiological and mental illnesses. However, in order for the patient to adhere to a treatment regimen, the physician must provide accurate information about the regimen, an adequate explanation of what the patient must do, and should also offer more frequent reinforcement of appropriate compliance. Patients with strong social support systems, particularly through marriages and families, typically exhibit better compliance with their treatment regimen.

Examples:

• telemonitoring through telephone or video conference with the patient
• case management by using a range of medical professionals to consistently follow up with the patient

Doctor-patient relationship

It is important for doctors to make meaningful connections and relationships with their patients, instead of simply having interactions with them, which often occurs in a system that relies heavily on specialist care. For this reason, behavioral medicine emphasizes honest and clear communication between the doctor and the patient in the successful treatment of any illness, and also in the maintenance of an optimal level of physical and mental health. Obstacles to effective communication include power dynamics, vulnerability, and feelings of helplessness or fear. Doctors and other healthcare providers also struggle with interviewing difficult or uncooperative patients, as well as giving undesirable medical news to patients and their families.

The field has placed increasing emphasis on working towards sharing the power in the relationship, as well as training the doctor to empower the patient to make their own behavioral changes. More recently, behavioral medicine has expanded its area of practice to interventions with providers of medical services, in recognition of the fact that the behavior of providers can have a determinative effect on patient outcomes. Objectives include maintaining professional conduct, productivity, and altruism, in addition to preventing burnout, depression, and job dissatisfaction among practitioners.

Learning principles, models and theories

Behavioral medicine includes understanding the clinical applications of learning principles such as reinforcement, avoidance, generalisation, and discrimination, and of cognitive-social learning models as well, such as the cognitive-social learning model of relapse prevention by Marlatt.

Learning theory

Learning can be defined as a relatively permanent change in a behavioral tendency occurring as a result of reinforced practice. A behavior is significantly more likely to occur again in the future as a result of learning, making learning important in acquiring maladaptive physiological responses that can lead to psychosomatic disease. This also implies that patients can change their unhealthy behaviors in order to improve their diagnoses or health, especially in treating addictions and phobias.

The three primary theories of learning are:

• classical conditioning
• operant conditioning
• modeling

Other areas include correcting perceptual bias in diagnostic behavior; remediating clinicians' attitudes that impinge negatively upon patient treatment; and addressing clinicians' behaviors that promote disease development and illness maintenance in patients, whether within a malpractice framework or not.

Our modern-day culture involves many acute, microstressors that add up to a large amount of chronic stress over time, leading to disease and illness. According to Hans Selye, the body's stress response is designed to heal and involves three phases of his General Adaptation Syndrome: alarm, resistance, and exhaustion.

Applications

An example of how to apply the biopsychosocial model that behavioral medicine utilizes is through chronic pain management. Before this model was adopted, physicians were unable to explain why certain patients did not experience pain despite experiencing significant tissue damage, which led them to see the purely biomedical model of disease as inadequate. However, increasing damage to body parts and tissues is generally associated with increasing levels of pain. Doctors started including a cognitive component to pain, leading to the gate control theory and the discovery of the placebo effect. Psychological factors that affect pain include self-efficacy, anxiety, fear, abuse, life stressors, and pain catastrophizing, which is particularly responsive to behavioral interventions. In addition, one's genetic predisposition to psychological distress and pain sensitivity will affect pain management. Finally, social factors such as socioeconomic status, race, and ethnicity also play a role in the experience of pain.^{[citation needed]}

Behavioral medicine involves examining all of the many factors associated with illness, instead of just the biomedical aspect, and heals disease by including a component of behavioral change on the part of the patient.

In a review published 2011 Fisher et al. illustrates how a behavior medical approach can be applied on a number of common diseases and risk factors such as cardiovascular disease/diabetes, cancer, HIV/AIDS and tobacco use, poor diet, physical inactivity and excessive alcohol consumption. Evidence indicates that behavioral interventions are cost effectiveness and add in terms of quality of life. Importantly behavioral interventions can have broad effects and benefits on prevention, disease management, and well-being across the life span.

Journals

• Annals of Behavioral Medicine
• International Journal of Behavioral Medicine
• Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine
• Journal of Behavioral Health and Medicine
• Journal of Behavioral Medicine

Organizations

• Association for Behavior Analysis International's Behavioral Medicine Special Interest Group
• Society of Behavioral Medicine
• International Society of Behavioral Medicine
• The Lifestyle Change and Behavioral Health (LCBH) Study Section

Psychosomatic medicine

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Psychosomatic_medicine

Psychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, behavioral factors on bodily processes and quality of life in humans and animals.

The academic forebearer of the modern field of behavioral medicine and a part of the practice of consultation-liaison psychiatry, psychosomatic medicine integrates interdisciplinary evaluation and management involving diverse specialties including psychiatry, psychology, neurology, psychoanalysis, internal medicine, pediatrics, surgery, allergy, dermatology, and psychoneuroimmunology. Clinical situations where mental processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence.

Psychosomatic disorders

Main article: Somatic symptom disorder

Some physical diseases are believed to have a mental component derived from stresses and strains of everyday living. Some researchers have suggested, for example, that lower back pain and high blood pressure may be related to stresses in everyday life. The psychosomatic framework additionally sees mental and emotional states as capable of significantly influencing the course of any physical illness. Psychiatry traditionally distinguishes between psychosomatic disorders, disorders in which mental factors play a significant role in the development, expression, or resolution of a physical illness, and somatoform disorders, disorders in which mental factors are the sole cause of a physical illness.

It is difficult to establish for certain whether an illness has a psychosomatic component. A psychosomatic component is often inferred when there are some aspects of the patient's presentation that are unaccounted for by biological factors, or some cases where there is no biological explanation at all. For instance, Helicobacter pylori causes 80% of peptic ulcers. However, most people living with Helicobacter pylori do not develop ulcers, and 20% of patients with ulcers have no H. pylori infection. Therefore, in these cases, psychological factors could still play some role. Similarly, in irritable bowel syndrome (IBS), there are abnormalities in the behavior of the gut. However, there are no actual structural changes in the gut, so stress and emotions might still play a role.

The strongest perspective on psychosomatic disorders is that attempting to distinguish between purely physical and mixed psychosomatic disorders is obsolete as almost all physical illness have mental factors that determine their onset, presentation, maintenance, susceptibility to treatment, and resolution. According to this view, even the course of serious illnesses, such as cancer, can potentially be influenced by a person's thoughts, feelings and general state of mental health.

Addressing such factors is the remit of the applied field of behavioral medicine. In modern society, psychosomatic aspects of illness are often attributed to stress making the remediation of stress one important factor in the development, treatment, and prevention of psychosomatic illness.

Connotations of the term "psychosomatic illness"

The term psychosomatic disease was most likely first used by Paul D. MacLean in his 1949 seminal paper ‘Psychosomatic disease and the “visceral brain”; recent developments bearing on the Papez theory of emotions.’ In the field of psychosomatic medicine, the phrase "psychosomatic illness" is used more narrowly than it is within the general population. For example, in lay language, the term often encompasses illnesses with no physical basis at all, and even illnesses that are faked (malingering). In contrast, in contemporary psychosomatic medicine, the term is normally restricted to those illnesses that do have a clear physical basis, but where it is believed that psychological and mental factors also play a role. Some researchers within the field believe that this overly broad interpretation of the term may have caused the discipline to fall into disrepute clinically. For this reason, among others, the field of behavioral medicine has taken over much of the remit of psychosomatic medicine in practice and there exist large areas of overlap in the scientific research.

Criticism

Studies have yielded mixed evidence regarding the impact of psychosomatic factors in illnesses. Early evidence suggested that patients with advanced-stage cancer may be able to survive longer if provided with psychotherapy to improve their social support and outlook. However, a major review published in 2007, which evaluated the evidence for these benefits, concluded that no studies meeting the minimum quality standards required in this field have demonstrated such a benefit. The review further argues that unsubstantiated claims that "positive outlook" or "fighting spirit" can help slow cancer may be harmful to the patients themselves if they come to believe that their poor progress results from "not having the right attitude".

Treatment

While in the U.S., psychosomatic medicine is considered a subspecialty of the fields of psychiatry and neurology, in Germany and other European countries it is considered a subspecialty of internal medicine. Thure von Uexküll and contemporary physicians following his thoughts regard the psychosomatic approach as a core attitude of medical doctors, thereby declaring it not as a subspecialty, but rather an integrated part of every specialty. Medical treatments and psychotherapy are used to treat illnesses believed to have a psychosomatic component.

History

In the medieval Islamic world the Persian psychologist-physicians Ahmed ibn Sahl al-Balkhi (d. 934) and Haly Abbas (d. 994) developed an early model of illness that emphasized the interaction of the mind and the body. He proposed that a patient's physiology and psychology can influence one another.

Contrary to Hippocrates and Galen, Ahmed ibn Sahl al-Balkhi did not believe that mere regulation and modulation of the body tempers and medication would remedy mental disorders because words play a vital and necessary role in emotional regulation. To change such behaviors, he used techniques, such as belief altering, regular musing, rehearsals of experiences, and imagination.

In the beginnings of the 20th century, there was a renewed interest in psychosomatic concepts. Psychoanalyst Franz Alexander had a deep interest in understanding the dynamic interrelation between mind and body. Sigmund Freud pursued a deep interest in psychosomatic illnesses following his correspondence with Georg Groddeck who was, at the time, researching the possibility of treating physical disorders through psychological processes. Hélène Michel-Wolfromm applied psychosomatic medicine to the field of gynecology and sexual problems experienced by women.

In the 1970s, Thure von Uexküll and his colleagues in Germany and elsewhere proposed a biosemiotic theory (the umwelt concept) that was widely influential as a theoretical framework for conceptualizing mind-body relations. This model shows that life is a meaning or functional system. Farzad Goli further explains in Biosemiotic Medicine (2016), how signs in the form of matter (e.g., atoms, molecules, cells), energy (e.g., electrical signals in nervous system), symbols (e.g., words, images, machine codes), and reflections (e.g., mindful moments, metacognition) can be interpreted and translated into each other.

Henri Laborit, one of the founders of modern neuropsychopharmacology, carried out experiments in the 1970s that showed that illness quickly occurred when there was inhibition of action in rats. Rats in exactly the same stressful situations but whom were not inhibited in their behavior (those who could flee or fight—even if fighting is completely ineffective) had no negative health consequences. He proposed that psychosomatic illnesses in humans largely have their source in the constraints that society puts on individuals in order to maintain hierarchical structures of dominance. The film My American Uncle, directed by Alain Resnais and influenced by Laborit, explores the relationship between self and society and the effects of the inhibition of action.

In February 2005, the Boston Syndromic Surveillance System detected an increase in young men seeking medical treatment for stroke. Most of them did not actually experience a stroke, but the largest number presented a day after Tedy Bruschi, a local sports figure, was hospitalized for a stroke. Presumably they began misinterpreting their own harmless symptoms, a group phenomenon now known as Tedy Bruschi syndrome.

Robert Adler is credited with coining the term Psychoneuroimmunology (PNI) to categorize a new field of study also known as mind-body medicine. The principles of mind-body medicine suggest that our mind and the emotional thoughts we produce have an incredible impact on our physiology, either positive or negative.

PNI integrates the mental/psychological, nervous, and immune system, and these systems are further linked together by ligands, which are hormones, neurotransmitters and peptides. PNI studies how every single cell in our body is in constant communication—how they are literally having a conversation and are responsible for 98% of all data transferred between the body and the brain.

Dr. Candace Pert, a professor and neuroscientist who discovered the opiate receptor, called this communication between our cells the ‘Molecules of Emotion' because they produce the feelings of bliss, hunger, anger, relaxation, or satiety. Dr. Pert maintains that our body is our subconscious mind, so what is going on in the subconscious mind is being played out by our body.