With the Federal Government's health reform agenda focused on reducing hospital stays and better management of chronic health conditions to prevent hospital admissions, the specialisation of health psychology has much to offer. Health psychology encompasses the biological, psychological and social determinants of health and illness within the context of healthcare systems and the wider community. Its practitioners have expertise in understanding the psychology of health risk factors, beliefs and attitudes, as well as models of behaviour change in health promotion and acute and chronic illness. Health psychologists are employed in a variety of settings including government health departments and health promotion organisations, hospital medical units, pain management and rehabilitation facilities, community health centres and primary health care practices. Three prominent applications of health psychology are profiled below.
The number of hospitalisations per annum is a measure of the burden of severe illness in the population. It is influenced by the age profile of the population, the incidence of acute disease and injury, the availability of health services and treatment options. Hospitalisation is costly to the individual and health care system (Allen, 2010). The recent reports of the Federal Government's National Health and Hospitals Reform Commission and the National Preventative Health Taskforce recommend a model of health care that emphasises prevention and effective management of disease through efficacious primary and secondary health care services. This model of health care is absolutely necessary in light of the ageing population in Australia, where preventative and cost-effective management of disease is a desired outcome. Health psychology interventions can assist with minimising hospital stay and associated healthcare costs, reducing the secondary trauma of hospitalisation, and preventing relapse requiring costly re-admissions.
A randomised controlled study on the effects of preparation for surgery reported that patients demonstrated positive effects from relaxation training and cognitive coping strategies (Shelly et al., 2009). Specifically, positive surgery-specific post-operative attitudes and behaviours were reported. Additionally, health psychology research has indicated less surgical pain during the recovery process and a higher level of activity, such as return to normal daily activities at follow-up, compared to controls (Mirö et al., 1999). Psychological intervention with women undergoing mastectomy indicated that all women believed psychological consultation aided decision-making and preparation for surgery (Patenaude et al., 2008). Strong support was also demonstrated for the role of the health psychologist in deciding and adapting to the surgery.
Allen, F. (2010). Health Psychology and Behaviour in Australia. NSW: McGraw Hill.
Mirö, J., & Raich, R.M. (2009). Preoperative preparation for surgery: an analysis of the effects of relaxation and information provision. Clinical Psychology and Psychotherapy, 6(3), 202-209.
Patenaude, A.F., Orozco, S., Li, X., Kealin, C.M., Gadd, M., Matory, Y., Mayzel, K., Roche, C.A., Smith, B.L., Farkas, W., & Garber, J.E. (2008). Support needs and acceptability of psychological and peer consultation: Attitudes of 108 women who had undergone or were considering prophylactic mastectomy. Psycho-Oncology, 17(8), 831-843.
Shelley, M., Pakenham, K. I., & Frazer, I. (2009). Cortisol changes interact with the effects of a cognitive behavioural psychological preparation for surgery on 12-month outcomes for surgical heart patients. Psychology and Health, 24(10), 1139-52.
The World Health Organisation (WHO) describes chronic medical conditions as a hidden epidemic, with chronic diseases such as heart disease, stroke, cancer and diabetes being the leading causes of mortality and disability in the world. Chronic diseases are estimated to be the largest contributor to the burden of disease for individuals and the healthcare system in Australia and their predicted prevalence is expected to continue to rise. The National Preventative Health Taskforce (2008) has identified obesity and smoking as two of the main health priority targets in Australia. It states: "Put together, smoking, obesity, harmful use of alcohol, physical inactivity, poor diet and the associated risk factors of high blood pressure and high blood cholesterol cause approximately 32% of Australia's illness burden... In total the overall costs to the healthcare system associated with [the three risk factors of smoking, obesity and alcohol misuse] is in the order of almost $6 billion per year, whilst lost productivity is estimated to be almost $13 billion."
The evidence base for psychological treatment intervention and prevention in chronic disease self-management is well documented. A Cochrane review identified that psychological and behavioural interventions played an important role in reducing risk factors for cardiovascular disease (Hackett et al., 2008). Shaw et al. (2005) demonstrated that behaviour therapy and cognitive behavioural interventions show significant benefits in reducing weight.
Health psychology has played an important role in Australia's efforts to successfully develop and implement prevention strategies, for example related to heart health (Oldenberg & Owen, 1990). It has been clearly identified that chronic health conditions require people to adopt numerous treatment requirements, and that health behaviour change is a crucial component of adherence to these requirements. The WHO (2003) reported that awareness of health and illness knowledge alone is no guarantee that individuals will change their health behaviours. Many people cannot achieve the required behaviour change without professional guidance. Health psychologists play a vital role in identifying the behaviours, beliefs and attitudes that negatively impact on the prevention and management of chronic disease and assist in increasing adherence to prescribed medicines, medical testing and lifestyle changes. This is achieved through motivational interviewing techniques, assessing readiness to change, goal setting, managing positive illness perception changes, identifying interactions between medications and psychological functioning, and determining psychosocial factors and influences.
Additionally, recent literature has supported the value of inter-professional care for positive patient outcomes in the management of chronic diseases. Interdisciplinary chronic disease and lifestyle risk management networks, facilitated by health psychologists, are currently being established across Australia to ensure more effective collaboration in consumer health care.
Hackett, M.L., Anderson, C.S., House, A., & Halteh, C. (2008). Interventions for preventing depression after stroke. Cochrane Database of Systematic Reviews, Issue 3. Art No. CD003689 DOI:10.1002/ 145651858. CD003689.pub3.
National Preventative Health Taskforce. (2008). Australia: the healthiest country by 2020. Discussion paper. Canberra: Commonwealth of Australia.
Oldenberg, B., & Owen, N. (1990). Health psychology in Australia. Psychology and Health. 4(1), 73-81.
Shaw, K., O'Rourke, P., Del Mar, C., & Kenardy J.(2005). Psychological interventions for overweight or obesity. Cochrane Database of Systematic Reviews, Issue 2. Art No. CD003818 DOI:10.1002/ 14651858. CD003818.pub2.
The National Pain summit in Canberra in March this year was the first comprehensive initiative in Australia to establish a national strategy to improve the assessment and treatment of all forms of pain. One in five Australians, including children and adolescents, will suffer chronic pain in their lifetime and up to 80 per cent of people living with chronic pain are missing out on treatment that could improve their health and quality of life (Walsh et al., 2008). It has been estimated that chronic pain costs the Australian economy $34 billion per annum and is the nation's third most costly health problem. It is anticipated that the application of evidence-based psychological treatments could save half of these annual costs and improve the lives of many patients, families and communities.
In the psychological and environmental/social domains, there is ample evidence that important factors play a significant, and sometimes dominant, role in the ongoing experience of chronic pain and in the impact that the pain has on the individual's quality of life. For example, changes in neurotransmitters associated with mood changes such as anxiety and depression are similar to those seen in chronic pain. Fear-avoidance behaviour is frequently associated with chronic pain and leads to a downward spiral of reduced activity, de-conditioning, postural changes and loss of muscle support of various joints and also the spine (Leeuw et al., 2007). Cochrane database reviews demonstrate the outcome efficacy and effectiveness of treatment intervention and prevention of chronic pain by health psychologists for both children and adults (Toumbourou, 2010). In addition, evidence that children and adolescents can develop psychological techniques to manage pain provides a theoretical basis for further exploration of preventative interventions.
Psychological care for chronic pain involves cognitive and behavioural interventions covering three areas: non-drug treatment; reduction of emotional stress (for example depression, anxiety, fear, guilt and grief); and improved adherence to medical, physical and other strategies to achieve good quality of life. Group cognitive behavioural therapy focusing on beliefs and behaviours has been demonstrated to have effective therapeutic applications in pain management (Lamb et al., 2010). In particular it has been noted to be more cost-effective and associated with longer term outcomes than other interventions for pain relief such as acupuncture, spinal manipulation and hypnosis. A randomised controlled trial with patients with subacute chronic lower back pain found that, compared to advice alone, the cognitive behavioural group intervention was associated with significant benefits in nearly all outcomes at 3, 6 and 12 months. Psychological interventions embed strategies that ensure positive management of chronic pain is maintained over a long period of time. No one treatment is necessarily successful in eliminating pain. Most people have to adapt to the presence of chronic pain and learn self-management in the face of persistent pain and accompanying symptoms.
Lamb S.E., Hansen, Z., Lall, R., Castelnuovo, E., Withers, E.J., Nichols, V, Ptter, R., & Underwood, M.R. (2010). Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. The Lancet, 375, 916-923.
Leeuw, M., Goosens, M. E., Linton, S. J., Crombez, G., Boersma, K. & Vlaeyen, J. W. (2007). The fear avoidance model of musculoskeletal pain: The current state of scientific evidence. Journal of Behavioural Medicine, 30(1), 77-94.
Toumbourou, J. W. (2010). The effectiveness of health psychology interventions: Evidence for systematic reviews. Melbourne: Australian Psychological Society College of Health Psychologists
Walsh, N. E., Brooks, P., Meike Hazes, J. M., Walsh, R. M., Dreinhöfer, K., Woolf, A. D., Ăkesson, K., & Lidgren, L. (2008). Standards of Care for Acute and Chronic Musculoskeletal Pain: The Bone and Joint Decade (2000-2010). Archives of Physical Medicine Rehabilitation, 89, 1830-45.
* Prepared in collaboration with Dr Esben Strodl MAPS, Cathy Wagner MAPS, Dr Jacqui Stanford MAPS and Dr Thomas Fuller MAPS