|
Table of Contents
The American Psychological Association (APA) is a professional
organization with more than 150,000 members. The following is
excerpted from the APA Health Psychology Division web site (www.health-psych.org)
What a Health Psychologist
Does and How to Become One
Recent advances in psychological, medical, and physiological research have
led to a new way of thinking about health and illness. This
conceptualization, 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. The term "health psychology" is often interchanged with the
terms "behavioral medicine" or "medical psychology". In contemporary
research and medical settings, 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 assessment and treatment services. Many health
psychologists focus on prevention through research and clinical
interventions designed to foster health and reduce the risk of disease.
While more than half of health psychologists provide clinical services as
part of their duties, many health psychologists function in non-clinical
roles primarily involving teaching and research.
The Work Setting of a Health Psychologist: Health psychologists
participate in health care in a multitude of settings including primary
care programs, inpatient medical units, and specialized health care
programs such as pain management, rehabilitation, women's health,
oncology, smoking cessation, headache management, and various other
programs. They also work in colleges and universities, corporations, and
for governmental agencies.
Clinical Activities: Assessment approaches often include cognitive
and behavioral assessment, psychophysiological assessment, clinical
interviews, demographic surveys, objective and projective personality
assessment, and various other clinical and research-oriented protocols.
Interventions often include stress management, relaxation therapies,
biofeedback, psychoeducation about normal and patho-physiological
processes, ways to cope with disease, and cognitive-behavioral and other
psychotherapeutic interventions. Healthy people are taught preventive
health behaviors. Both individual and group interventions are utilized.
Frequently, health psychology interventions focus upon buffering the
effect of stress on health by promoting enhanced coping or improved social
support utilization.
Research: Health psychologists are on the leading edge of research
focusing on the biopsychosocial model in areas such as HIV, oncology,
psychosomatic illness, compliance with medical regimens, health promotion,
and the effect of psychological, social, and cultural factors on numerous
specific disease processes (e.g., diabetes, cancer, hypertension and
coronary artery disease, chronic pain, and sleep disorders). Research in
health psychology examines: the causes and development of illness, methods
to help individuals develop healthy lifestyles to promote good health and
prevent illness, the treatment people get for their medical problems, the
effectiveness with which people cope with and reduce stress and pain,
biopsychosocial connections with immune functioning, and factors in the
recovery, rehabilitation, and psychosocial adjustment of patients with
serious health problems.
|
Pain. It is the most common symptom of Chiari and syringomyelia and
probably the most difficult to deal with. The pain from these
conditions can be particularly difficult to treat and can affect every
aspect of a person's being: physical, mental, emotional, and
spiritual. Some people seek help from pain clinics, some choose to
fight on their own; but no matter how we deal with it, for many the pain is
there every single day.
What are the psychological implications of battling pain every day?
Dr. Frank Keefe, Professor of Psychiatry and Behavioral Sciences at Duke
University, is a licensed psychologist who specializes in pain research.
He has published numerous papers on the subject, acts as an editor for
several professional journals, and serves on scientific advisory panels
dealing with chronic pain. We put Dr. Keefe In The Spotlight (via
email) to shed some light on the subject... What is
Health Psychology?
K: Health Psychology is a field within psychology that seeks to
advance the contributions of psychology to the understanding of health and
illness through basic and clinical research, education, and service
activities and encoruages the integration of biomedical information about
health and illness with current psychological knowledge.
How did you
become interested in Health Psychology in general and pain research in
particular?
K: As a graduate student in psychology and in my early careeer
I was active in doing some of the early research on biofeedback, so health
psychology was a logical direction for my interests. My interests in pain
stemmed from a problem I experienced with a herniated disk in my lower back
that led to a back surgery and a long and painful recovery.
Being
diagnosed with a serious illness – which may result in permanent damage
and/or chronic pain – can be quite a shock; what are some of the
psychological aspects of dealing with an event like that?
K: Three important aspects are individuals' thoughts, feelings,
and coping strategies. In the realm of thoughts, expectations (e.g. about
self, others, and the future), beliefs (e.g. belief in personal abilities to
control pain) are very important. In the realm of feelings, some persons
struggle with feelings of anxiety, guilt, and depression that can interfere
with their abilities to adjust to the illness. In the realm of coping, over
time most people develop a range of coping strategies such as learning how
to pace their activities, set reasonable goals, use distraction methods, and
calm themselves when pain is severe.
Are there
specific treatment techniques which have been shown to be effective in
helping people adjust to chronic disease?
K: Training in pain coping skills has been shown in a number of
studies to reduce pain and reduce disability.
What are some
of the signs that someone trying to deal with a chronic illness should seek
professional help?
K: In terms of psychological changes, one should be concerned
if an individual has persistent problems with withdrawing from others,
weight loss, difficulty concentrating, memory problems, sleep problems,
irritability, and pronounced feelings of discouragement and depression.
Post-Traumatic
Stress Disorder (PTSD) research has shown that early intervention with a
relatively few number of counseling sessions can be effective in reducing
later symptoms of PTSD; do you see an equivalent with the early shock of
diagnosis and surgery?
K: Would most people benefit from some type of early
intervention before surgery? This is a very interesting idea, but one that
has not received much research attention. It is quite logical to assume,
though, that early intervention before surgery might be effective.
How can an
individual best adjust to living with a chronic disease, especially with
reduced function and capabilities?
K: Develop a variety of active coping strategies that enable
them to deal with the challenges of the disease. Avoid relying solely on
passive coping methods such as bedrest or avoiding daily situations that
might be challenging. Find ways around obstacles so that you are able to
remain involved in a varied lifestyle.
Are there any
predictors – such as family support, locus of control, etc. – for whether
people will successfully adjust to living with a chronic disease?
K: Converging lines of evidence suggest that one of the most
consistent predictors is a sense of confidence in one's abilities to manage
the disease.
How do you
define pain?
K: Pain has been defined as an unpleasant sensory and emotional
experience that is due to tissue damage.
Why do
people’s perceptions of pain differ?
K: Because higher nervous centers of the brain that are
responsible for thoughts, feelings, and behaviors can influence whether pain
signals reach the pain [centers].
Is it possible
to objectively compare different types of pain and are some types of pain
more difficult to manage psychologically than others?
K: Pain is a subjective phenomenon so direct comparison is not
possible. Psychological pain management approaches have been found
effective with both chronic pain syndromes (e.g. headaches, low back pain)
and disease-related pain conditions (e.g. arthritis, cancer pain).
It seems like
it is important for many people with chronic pain to have others believe
they are in pain; why is this affirmation important?
K: Because individuals with chronic pain often have to rely on
others. If the significant others who need to provide support question the
validity of the person's pain, then they will not be as effective in
providing support.
What is the
link between pain and depression?
K: A subgroup of individuals having persistent pain develop a
major problem with depression. This is estimated to be about 30% of
individuals seen in pain clinics. In general, persons with pain who
are depressed experience higher levels of pain and disability.
How has the
thinking on pain management evolved over the years?
K: A revolution has occurred in thinking about how to treat chronic
pain. Rather than viewing chronic pain as a simple sensory event, health
professionals now recognize that it is a multidimensional problem that needs
to be considered from a biological, psychological, and social perspective.
This change has influenced how chronic pain is managed.
Do you think
that doctors are too reluctant to prescribe pain medicines? If so, what can
be done to change this?
K: Pain specialists are not reluctant to prescribe pain
medicines, in my experience.
Is every case
of pain management unique or are certain techniques being proven more
effective than others?
K: Every case is unique and requires a careful assessment
before a treatment plan is implemented.
Can
psychological intervention alone reduce the perception of pain?
K: These interventions are rarely used alone for chronic pain.
Laboratory studies of experimental pain, though, have shown that
psychological interventions can reduce the perception of controlled
experimental pain stimuli.
Psychologically, do people who try to manage pain on their own fare better
or worse than people who seek help from pain specialists?
K: This is hard to answer since those who seek care usually
have a more severe and disabling problem.
Where is your
research currently focused and where is it headed?
K: Our research currently focuses on the effects of involving
spouses/partners and caregivers in training in pain coping skills. We are
currently analyzing the results of a study testing the effects of a
partner-guided pain coping skills training intervention for cancer patients
who are at end of life.
Do you think
there will be major advances in the near future on managing chronic pain?
K: Yes, particularly in two areas: 1) early intervention, 2)
tailoring treatments to the unique needs of the patient.
What advice do
you have for someone facing a lifetime of pain?
K: Take stock of how you are doing periodically. Be honest and
realistic with yourself. If you are having problems implement and monitor a
systematic plan for dealing with those problems. Seek help from others to
implement your plan.
What advice do
you have for the family trying to support someone in pain?
K: Acknowledge that your family member is having pain and is
suffering. Help them build upon and expand their coping strengths, rather
than solely focusing on coping limitations.
What motivates
you as a scientist?
K: The belief that our research might reduce pain and suffering
in persons struggling with disease-related pain.
Return To Table Of Contents |
In the Spotlight:
Frank Keefe, Ph.D.
Professor of Psychiatry and Behavioral Sciences
Duke University
Qualifications:
-
Licensed
Psychologist in Massachusetts, North Carolina, and Ohio
-
Professor in
Anesthesiology, Professor Psychology: Social & Health Sciences, Duke
University
-
Past President of
the APA Health Psychology Division
-
Consultant to the
American Pain Society
-
Section Editor for
the journal Pain
-
Associate Editor for
the journal Health Psychology
Education:
-
Post-doctoral Fellow,
Harvard Medical School, 1976-78
-
M.S., Ph.D Clinical
Psychology, Ohio Unversity, 1973, 1975
-
B.A. Psychology,
Bowdoin College, 1971
Research Interests:
Selected Publications:
-
Keefe
FJ, Lumley MA, Buffington AL, Carson JW, Studts JL, Edwards CL,
Macklem DJ, Aspnes AK, Fox L, Steffey D. Changing face of pain: evolution
of pain research in psychosomatic medicine.
Psychosom Med. 2002 Nov-Dec;64(6):921-38.
-
Keefe
FJ, Smith S. The assessment of pain behavior: implications for applied
psychophysiology and future research directions. Appl
Psychophysiol Biofeedback. 2002 Jun;27(2):117-27.
-
Keefe
FJ, Smith SJ, Buffington AL, Gibson J, Studts JL, Caldwell DS. Recent
advances and future directions in the biopsychosocial assessment and
treatment of arthritis. J Consult Clin Psychol. 2002
Jun;70(3):640-55.
-
Keefe
FJ, Lumley M, Anderson T, Lynch T, Studts JL, Carson KL. Pain and
emotion: new research directions. J Clin Psychol. 2001
Apr;57(4):587-607.
-
Keefe
FJ. Pain behavior observation: current status and future
directions. Curr Rev Pain. 2000;4(1):12-7.
Current Grants:
-
Spouse-guided pain management training for cancer pain. Principal
Investigator. (NCI)
-
Tailoring Cognitive Behavioral Treatment for Cancer Patients with Pain.
Principal Investigator. (NCI)
-
Gender, Coping, and the Arthritis Pain Experience. Principal Investigator. (NIAMS)
|