Handbook of Clinical Health Psychology / Edition 1 available in Hardcover
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Handbook of Clinical Health Psychology
John Wiley & Sons
Copyright © 2003
Susan Llewelyn, Paul Kennedy
All right reserved.
Introduction and Overview
University of Oxford, UK
The science and practice of clinical health psychology represents one of the most successful
expansions in the discipline of psychology in the past 20 years. Clinical health psychology
is becoming a success story. It is now recognised that psychological issues play a crucial
role in almost every health care condition, and that addressing these issues will increase
well-being and quality of life. From centres specialising in cancer and heart disease to those
working with dermatology and trauma, clinical health psychologists have become part of
the health care team in many parts of developed health economies. They have contributed
to the increasing range of treatments offered to patients and to the growing sophistication
of interventions available, and have increased awareness of the need for bothevidence-based
practice and research. Despite this, however, there is still a very long way to go
until psychological input is available to all patients and all staff in health care. Provision of
clinical heath psychology services remains patchy outside the larger centres, particularly
those outside the economically developed world. This volume documents much of what
has been achieved so far, and indicates what is still to be achieved.
The twenty-first century has already seen a range of astounding developments in the provision
of health care, primarily but not only in the more economically advantaged countries,
and will undoubtedly see many more. Advances in biotechnology, genetics and knowledge
management systems have already resulted in profound changes in what is seen as possible
and desirable in health, and this explosion in knowledge and application will almost certainly
continue. Central to these changes are psychological issues which impact on and are
impacted by the changing nature of health care. This volume, published near the start of
the century, provides an overview of what we know now about clinical health psychology,
and how current knowledge is put into practice. Written mainly by authors who are both
academics and clinical practitioners, each chapter also raises questions for the future, as the
discipline comes to elaborate its understanding and the range of possible applications.
As editors of this volume we think it is important to open with a brief consideration of
some of the key issues in health care, even if many of these facts are by now reasonably well
known. These issues not only provide a context for the practice of clinical health psychology,
but also demonstrate the need for it. The list is not comprehensive but is illustrative of the
inseparability of health care from wider social and demographic developments.
Eight out of ten of the top causes of death in the developed world have psychosocial
components in their aetiology and/or maintenance. Forty-five per cent of all causes of
death are cardiovascular in nature (see Chapter 6).
About half of all the people who have ever lived to be 65 or older are alive today (see
Sixteen out of 20 of the most frequently diagnosed conditions in primary care have
some behavioural component which could be amenable to intervention by clinical health
Approximately 5% of the health care budget is spent on prevention, and disproportionate
expenditure is spent in the last two weeks of people's lives.
In the USA, for example, 19% of the population over the age of five have some form of
disability. Of those over 65 years, 42% are disabled.
Approximately three million people world-wide die each year from a tobacco-related
disease. Ninety per cent of COPD is caused by smoking (see Chapter 9).
Also, the growing diseases of civilisation (cancer, coronary heart disease) are mediated
by social isolation, obesity and substance abuse.
Chronic, but not acute, conditions are the main focus of health care, at least in the
All this suggests that psychological issues must play an increasingly central role in the
provision of health care in all types of setting, from primary care to specialist centres. An
ageing population in developed countries means that probably the major issues presented
to health care providers are the problems of living with chronic conditions and disability,
such that quality of life issues become prominent (68% of health care costs are spent on
management of chronic conditions (see Chapter 5)). Health care providers need to become
adept at helping people to manage the consequences of disability and ill health, in order to
help them to increase their functional abilities, and to develop a wide range of methods of
ensuring social and vocational engagement and support. Associated with this are issues of
choice and rationing, given that it is unlikely that it will prove possible for most nations to
manage to fund the spiralling costs resulting from developments in research in biogenetics
and pharmacology. Societies will also need to develop ways of helping people to deal with
predictive information and resulting choices. We need to help people to behave in healthier
ways, given that we know that many illnesses or disabilities could have been prevented. For
the discipline of clinical health psychology, all this means that we need more parsimonious
and predictive models of health behaviour, together with research that develops the evidence
base. We also need to ensure that research in this area is resourced. We need to demonstrate
that psychological and rehabilitative issues are just as important to health care as medical
or pharmacological intervention. Most crucially, we need to put these models and this
evidence into practice, so that patients and health care providers can benefit from what we
Another way of putting this is that, as health care providers, we all need to be aware of
ethical, moral and emotional issues in health care, not just the technical aspects (Crossley,
2001). Patients are people before they are patients, and so are health care providers.
THIS VOLUME: OVERVIEW
This volume aims to provide an over view of what we know about clinical health psychology,
and how to apply that knowledge. Putting together any Handbook is inevitably an ambitious
venture. Its intention is to provide a comprehensive overview of the practice of clinical
health psychology in the twenty-first century for practitioners, researchers, academics and
students in clinical psychology, health psychology, psychiatry, nursing and other therapeutic
professions. It aims primarily to be a well-referenced but practical resource which provides
an authoritative, up-to-date guide to empirically validated interventions in the psychology
of health care. It is intended to be used frequently by practitioners, trainees and others
who will use the resource when approaching work in a particular area of clinical health
psychology. Strategic issues are discussed throughout the book, together with a consideration
of some of the research issues which limit or explain the evidence that is presented.
This should allow practitioners of clinical health psychology to judge what may be helpful
for their own particular area of practice or research, and to learn from the endeavours of
Although it is a Handbook, we hope that this volume is not used as a "cookbook",
whereby specific approaches are taken off the shelf for use in all situations. Instead we hope
that it will help practitioners to ensure that their practice is informed by concepts, models
and evidence that are "state of the art". Full references are provided to key texts, although
the text does not aspire to be encyclopaedic. Given the vast and ever-expanding range of
knowledge in clinical psychology, the Handbook cannot hope to be comprehensive, and it
would be quite easy for any reader to spot areas that have had to be omitted. Having said
that, we hope that all the major conceptual and service delivery issues have been introduced,
such that a reasonably comprehensive overview of today's clinical health psychology can
be obtained by a dedicated reader.
The book has been structured to allow the systematic presentation of conceptual, process,
content and contextual issues in the practice of clinical health psychology. Prior to the main
body of the Handbook-i.e. in the introductory five chapters-the book considers contextual
issues and the importance of topics including communication, technology, ageism and
power, all of which have an impact on how clinical health psychology is delivered by
practitioners and experienced by recipients of services.
Chapter 2 by Belar looks at the importance of underlying models for the effective practice
of health psychology, with an emphasis on the biopsychosocial model. Chapter 3 by Kennedy
and Llewelyn, Chapter 4 by Michie and Wren, and Chapter 5 by Elliott and Rivera provide
summaries of evidence concerning patients', staff's and families' experience of crucial
aspects of the delivery of care, such as communication, adherence and stress.
Making up the main body of the text, Chapters 6 to 22 are written by established practitioners,
each of whom has been asked to provide a well-supported account of knowledge
in key areas of application in clinical health psychology. Each contributor has written a
conceptual synthesis of the area, and has demonstrated how key models are related to
formulation, service delivery and research. Areas covered include heart disease, oncology,
diabetes, spinal cord injury, gynaecology, reproductive health, pain, chronic fatigue,
trauma, dermatology, transplants, health problems of older adults, COPD, obesity, cognitive
impairment and HIV. There are other areas that could have been included, but we hope to
have captured a reasonable cross-section of present practice. We have not tried to impose a
consistent style onto authors, but to allow contributors to present their area in as informative
a way as possible. Nonetheless, each chapter provides information on:
the condition and the effective psychological input that can be or has been provided;
the theoretical perspectives that underpin theory and practice of health psychology in the
the methods that have been used to research the area, and the limitations of application;
the agenda for future research and policy in the area.
Each chapter should thus constitute an authoritative account of the main areas of practice
within clinical health psychology, following the structure noted above. Although most of the
evidence discussed concerns work with adults, some of the chapters do discuss the practice
of clinical psychology with children. Naturally, children and families are often affected by
the conditions discussed, even if they are not the patients. It is the case, however, that the
bulk of this text does not specifically consider the issues raised by working with children.
We understand that the publishers are planning a subsequent volume concerning clinical
health psychology with children.
After the main body of the text, the concluding six chapters provide, first, a consideration
of the adequacy and scope of research methodology in clinical health psychology, and,
second, on account of the wider context within which clinical health psychology is delivered.
The authors are all concerned in different ways with what a clinical health psychologist can
contribute in terms of knowledge, research and theory. Chapter 23 by Owens explores the use
of research themes in clinical health psychology, including consideration of the particular
demands of doing quantitative research in applied, clinical settings, while Chapter 24 by
Stiles looks at the growth of qualitative methodology, and ways of ensuring reliability and
validity. Chapter 25 by Bennett considers the social context of health, the impact of poverty,
and reduced access to resources by substantial numbers of patients in most health care
systems in the world. New developments in the delivery of clinical health psychology are
considered in Chapter 26 by Glueckauf and his colleagues, in which there is discussion of
current information-based societies, with particular emphasis on telemedicine. Chapter 27
by Frank and his colleagues explores policy issues, while Chapter 28 provides an overall
account of the practice of clinical health psychology and its likely future development.
Chapter 28 also considers implications for professional development, as well as training,
and concludes by looking at ways forward in clinical health psychology in responding to
the challenges raised in all the chapters.
Throughout the Handbook, the biopsychosocial model is the major theoretical model
underpinning all contributions, but use is also made of other models. In particular, the cognitive
model is advocated for most of the interventions, given the strength of the evidence
base for this approach. Overall, it is intended that the book will act as an informative
guide to the delivery of effective interventions in a changing and challenging health care
Excerpted from Handbook of Clinical Health Psychology
Copyright © 2003 by Susan Llewelyn, Paul Kennedy.
Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of ContentsAbout the Editors.
List of Contributors.
Chapter 1. Introduction (Susan Llewelyn and Paul Kennedy).
Chapter 2. Models and Concepts (Cynthia Belar).
Chapter 3. The Person's Experience of Healthcare (Paul Kennedyand Sue Llewelyn).
Chapter 4. Staff Experience of the Healthcare System (BarbaraWren and Susan Michie).
Chapter 5. The Experience of Families and their Carers in HealthCare (Timothy R Elliott and Patricia Rivera).
Chapter 6. Cardiac Conditions (Wolfgang Linden).
Chapter 7. Oncology (Kristin Kilbourn and Patricia E.Durning).
Chapter 8. Chronic Pain (Dennis C. Turk and Elena S.Monarch).
Chapter 9. Chronic Obstructive Pulmonary Disease: A BehaviouralMedicine Approach (Margreet Scharloo and Adrian A. Kaptein).
Chapter 10. Treatment of Obesity (Michael G. Perri and Joyce A.Corsica).
Chapter 11. Diabetes Mellitus (Suzanne Bennett-Johnson and DawnNewman Carlson).
Chapter 12. Working with Cognitively Impaired Clients (JeriMorris).
Chapter 13. Psychological Aspects of Acquired Hearing Impairmentand Tinnitus (Laurence McKenna, David Mark Baguley and GerhardAndersson).
Chapter 14. Spinal Cord Injury (Jane Duff and Paul Kennedy).
Chapter 15. Clinical Practice Issues in Solid OrganTransplantation (Michelle R. Widows and James R. Rodrigue).
Chapter 16. Chronic Fatigue Syndrome (Michael Sharpe).
Chapter 17. Gynaecology (Pauline Slade).
Chapter 18. Accident and Trauma (Gary Latchford).
Chapter 19. Reproductive Health (Beth Alder).
Chapter 20. Appearance Anxiety (Gerry Kent).
Chapter 21. Psychological Management for Sexual Health and HIV(Barbara Hedge).
Chapter 22. Associations between Ageing, Health and Behaviour(Mary Gilhooly and Eileen McDonach).
Chapter 23. The Nature of Evidence in Clinical Health Psychology(Richard Glynn Owens).
Chapter 24. Qualitative Research: Evaluating the Process and theProduct William B. Stiles).
Chapter 25. The Social Context of Health (Paul Bennett).
Chapter 26. Telehealth and Chronic Illness: Emerging Issues andDevelopments in Research and Practice (Robert L. Glueckauf, etal.).
Chapter 27. The Relevance of Health Policy to the Future ofClinical Health Psychology (Robert G. Frank, et al.).
Chapter 28. Convergence, Integration and Priorities (PaulKennedy and Sue Llewelyn).
What People are Saying About This
“…very readable and extensively referenced…a formidable resource...” (Accident & Emergency Nursing, No.13, 2005)