Handbook of Clinical Health Psychology

Handbook of Clinical Health Psychology

by T. Millon, C. Green, R. Meagher

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Handbook of Clinical Health Psychology by T. Millon, C. Green, R. Meagher

We seek to throw down the gauntlet with this handbook, challenging the he­ gemony of the "behavioral medicine" approach to the psychological study and treatment of the physically ill. This volume is not another in that growing surfeit oftexts that pledge allegiance to the doctrinaire purity of behavioristic thinking, or conceptualize their subject in accord with the sterility of medical models. Diseases are not our focus, nor is the narrow band of behavioral assessment and therapy methodologies. Rather, we have sought to redefine this amorphous, yet burgeoning field so as to place it squarely within the province of a broadly-based psychology-specifically, the emerging, substantive discipline of health psy­ chology and the well-established professionalism and diverse technologies of clinical psychology. The handbook's title-Clinical Health Psychology-reflects this reorientation explicitly, and Chapter 1 addresses its themes and provides its justifications more fully. In the process of developing a relevant and comprehensive health assess­ ment tool, the editors were struck by the failure of clinical psychologists to avail themselves of the rich vein of materials that comprise the psychosocial world of the physically ill. Perhaps more dismaying was the observation that this field was being mined-less than optimally-by physicians and nonclinical psychologists.

Product Details

ISBN-13: 9780306409325
Publisher: Basic Books
Publication date: 10/01/1982
Pages: 632

Table of Contents

1. On the Nature of Clinical Health Psychology.- 1. Some Historical and Philosophical Reflections.- 1.1. Historical Notes.- 1.2. Bridging the Mind-Body Dichotomy.- 2. Problems of Boundary and Definition.- 2.1. Psychosomatic Medicine.- 2.2. Medical Psychology.- 2.3. Rehabilitation Psychology.- 2.4. Health Care Psychology.- 2.5. Behavioral Medicine.- 2.6. Behavioral Health.- 2.7. Health Psychology.- 2.8. Clinical Health Psychology.- 3. The Domain of Clinical Health Psychology.- 3.1. Personality: The Styles of Coping.- 3.2. Psychogenic Attitudes: Objective and Subjective Stressors.- 4. Clinical Settings and Functions of Health Psychologists.- 4.1. The Clinical Settings of Health Psychology.- 4.2. The Clinical Functions of the Health Psychologist.- 5. Training Clinical Health Psychologists.- 5.1. Need for Formal Training.- 5.2. Problems in Program Development.- 5.3. General Training Goals.- 5.4. University of Miami Clinical Health Track.- 6. References.- I. The Knowledge Domain of Clinical Health Psychology.- 2. Psychobiological Factors in Bodily Disease.- 1. The Development of Psychosomatic Concepts.- 1.1. Behavioral Factors in Disease.- 1.2. Social Factors in Disease.- 2. The Current Status of Psychosomatic Concepts.- 3. The Predisposition to Disease.- 4. The Onset and Initiation of Disease.- 5. Initiating Mechanisms of Disease.- 6. Social and Psychological Effects of Illness.- 7. Factors That Sustain Disease.- 8. Conclusion.- 9. References.- 3. Psychological Processes Induced by Illness, Injury, and Loss.- 1. Experiences during Intrusive and Denial States.- 1.1. Perception and Attention.- 1.2. Ideas and Feelings Related to the Event.- 1.3. Conceptual Attributes of Intrusive and Denial States.- 1.4. Emotional Attributes.- 1.5. Somatic Attributes.- 1.6. Action Patterns.- 2. Contents of Concern.- 2.1. Fear of Repetition.- 2.2. Shame over Helplessness or Emptiness.- 2.3. Rage at “the Source”.- 2.4. Guilt Feeling or Shame over Aggressive Impulses.- 2.5. Fear of Aggressivity.- 2.6. Survivor Guilt.- 2.7. Fear of Identification or Merger with Victims.- 2.8. Sadness in Relation to Loss.- 2.9. Recapitulation.- 3. Coping.- 4. Treatment.- 4.1. Goals of Treatment for Stress Response Syndromes.- 4.2. The Pattern of Psychological Treatment.- 4.3. Summary.- 5. References.- 4. The Risks and Course of Coronary Artery Disease: A Biopsychosocial Perspective.- 1. Premorbid Phase: Who Is At Risk?.- 1.1. Mind over Body.- 1.2. Risk Related to Biochemistry, Personal Habits, and Family History.- 1.3. The Risk of the Coronary-Prone Behavior Pattern.- 2. Biological Mediators of Coronary Artery Disease.- 3. Psychosocial Risk Factors of Coronary Artery Disease.- 4. Psychopathology as a Risk Factor.- 5. Hospital-Phase Risk Factors.- 5.1. Coronary Care Unit: Risks the Technology Fails to Treat.- 5.2. The Risk of Getting Better: Transfer from the Coronary Care Unit.- 5.3. The Risk of Delirium.- 5.4. Disturbances of Sleep in the Coronary Care Unit.- 6. Posthospital Phase.- 6.1. Length of Hospitalization: Is More Better?.- 6.2. Psychological Risks during Convalescence.- 7. Conclusion.- 8. References.- 5. Some Issues in Research on Stressful Life Events.- 1. Evidence about the Relationship of Life Stress to Illness.- 2. Definition of Populations of Life Events.- 3. Measurement of the Magnitudes of Life Events.- 4. Research Design.- 5. Mediation of the Impact of Stressful Life Events.- 6. Conclusion.- 7. References.- 6. Stress, Coping and Illness: A Transactional Perspective.- 1. Stress as an Environmental Event.- 2. Stress as a Response.- 3. A Transactional Conception of Stress.- 3.1. Appraisal.- 3.2. Coping.- 4. Coping and Health.- 5. Coping Skills Treatment.- 6. Transactional Conceptions of Causality.- 7. Stress in Its Social Context.- 7.1. Social Support.- 7.2. The Family.- 7.3. Family Interventions.- 8. Concluding Remarks.- 9. References.- 7. Coping with Acute Health Crises.- 1. Crisis Theory as a General Perspective.- 2. A Conceptual Framework.- 2.1. Sociodemographic and Personal Factors.- 2.2. Illness-Related Factors.- 2.3. Physical and Social-Environmental Factors.- 2.4. Mediating Factors: Appraisal and Activation.- 2.5. Major Adaptive Tasks.- 2.6. Major Types of Coping Skills.- 3. The Crisis of Illness: Coping with Cancer.- 4. The Crisis of Treatment: Unusual Hospital Environments.- 5. The Therapeutic Role of Staff.- 6. References.- 8. Adaptation to Chronic Illness and Disability.- 1. A Paradox.- 1.1. Resolution.- 1.2. Adaptation to What?.- 2. Implications.- 2.1. An Example.- 3. Fundamental Differences in Viewpoints.- 3.1. Introduction.- 3.2. Research Implications.- 4. Scope and Limitations.- 5. Differences in Problem Definition.- 5.1. Possible Resolutions.- 6. Perceptions of Locus of Problems.- 6.1. Possible Resolution.- 7. Attitudes toward Subjectivity.- 7.1. Possible Resolution.- 8. Values.- 8.1. Possible Resolution.- 9. Temporal Perspective.- 9.1. Possible Resolution.- 10. Units of Measurement and Conceptualization.- 10.1. Possible Resolution.- 11. Decision Making.- 11.1. Possible Resolution.- 12. General Reconciliation of the Two Viewpoints.- 13. A Final Question.- 14. References.- II. The Clinical Settings of Health Psychology.- 9. The Psychologist as Health Care Clinician.- 1. Historical Review.- 1.1. Ideological Issues.- 1.2. Traditional and More Recent Hospital Roles for Psychologists..- 2. Contemporary Pressures.- 2.1. Problems in the Health Care System.- 2.2. Credentialing and Intraprofessional Strains.- 2.3. Legal Conflict with Psychiatry.- 3. Pragmatics of Practice.- 4. The Future Yield.- 5. Implications for Training.- 6. References.- 10. Pediatric Psychology: Health Care Psychology for Children.- 1. Introduction.- 1.1. Rationale of Pediatric Psychology.- 1.2. Characteristics of Pediatric Psychology.- 1.3. Overview of Chapter.- 2. Definitions and Conceptualizations of Pediatric Psychology.- 2.1. Underlying Philosophy.- 2.2. Definitional Characteristics.- 2.3. Psychological Aspects.- 2.4. Conceptualizations of Roles and Functions.- 3. Development of Pediatric Psychology.- 3.1. Historical Milestones.- 3.2. Society of Pediatric Psychology.- 3.3. Training.- 3.4. Accumulation of Knowledge through Research.- 4. The Clinical Practice of Pediatric Psychology.- 4.1 Types of Intervention.- 4.2. Examples of Pediatric Psychological Functioning.- 4.3. Models of Consultation.- 4.4. Characteristics of Practice Procedures.- 5. A Survey of Research: Selected Topics.- 5.1. Range of Research Activity.- 5.2. Chronic Conditions.- 5.3. Acute Conditions.- 5.4. Developmental Disorders.- 5.5. Terminal Illness and Death.- 6. Research: The Future of Pediatric Psychology.- 6.1. Compliance to Medical Regimens.- 6.2. Psychogenic Pain.- 6.3. Prevention.- 6.4. Prools and Standardized Procedures.- 6.5. Additional Areas of Research.- 7. Concluding Comments.- 8. References.- 11. The Psychologist as Geriatric Clinician.- 1. Developmental Features of Later Life.- 1.1. Health Changes.- 1.2. Psychological Changes.- 1.3. Social Changes.- 1.4. Personality Changes.- 2. Testing and Assessment.- 2.1. Goals in Clinical Assessment with Older Adults.- 2.2. Instrumenting Assessment.- 2.3. Psychological Assessment.- 3. Therapy and Clinical Practice.- 3.1. Efficacy.- 3.2. Technique.- 4. Research.- 4.1. Designs in Aging Research.- 4.2. Issue Areas in Aging Research.- 5. Concluding Statement.- 6. References.- 12. Collaborative Efforts in Liaison Psychiatry.- 1. The Precepts of Liaison Psychiatry.- 2. The Practice of Primary, Secondary, and Tertiary Prevention.- 3. The Fostering of Diagnostic Accuracy.- 4. Clarification of the Status of the Caretaker.- 4.1. Evaluating the Doctor.- 4.2. Evaluating the Family.- 5. The Provision of Ongoing Education to the Nonpsychiatric Staff to Promote Autonomy.- 5.1. The Pre-Ombudsman Meeting.- 5.2. The Ombudsman Rounds.- 6. The Development of Core Biopsychosocial Knowledge.- 7. Promotion of Structural Changes in the Medical Setting.- 8. Commentary.- 9. References.- 13. The Psychologist as Social Systems Consultant.- 1. Introduction.- 1.1. Definition of a System.- 1.2. General Systems Theory.- 1.3. Social Systems Involved in Health Care.- 2. Basic Issues in Social System Theory.- 2.1. Introduction.- 2.2. Social Ties.- 2.3. Social Roles.- 2.4. Cross-Level Linkage among Systems.- 2.5. Mutual Contingency.- 2.6. Summary of Key Concepts.- 2.7. Patient Assessment.- 3. Applications of the Systems Approach to Health Care.- 3.1. Social Ties and Health.- 3.2. Doctor and Patient Roles.- 3.3. Interface between Social and Physiological Processes.- 3.4. Doctor-Patient Communication.- 4. Discussion.- 5. References.- 14. Behavioral Cardiology with Emphasis on the Family Heart Study: Fertile Ground for Psychological and Biomedical Research.- 1. Introduction.- 1.1. Behavioral Cardiology.- 2. The Evolution of Behavioral Cardiology at the University of Oregon School of Medicine.- 2.1. The Family Heart Study: Recruitment and Baseline.- 2.2. The Family Heart Study: Intervention Phase.- 2.3. The Family Heart Study: Control Groups.- 3. Recruitment Studies.- 3.1. Joiners versus Nonjoiners.- 3.2. Health Survey Results.- 3.3. Recruitment Phase: Summary of Results.- 4. Health Attitudes and Biomedical Status.- 4.1. Health Attitudes and Plasma Cholesterol Level.- 4.2. Health Attitudes and Obesity.- 4.3. Internal Locus of Control and Biomedical Status.- 4.4. Health Attitudes of Smokers and Nonsmokers.- 4.5. Health Attitudes and Leisure Activity.- 4.6. Health Attitudes: Implications of Our Findings.- 5. Cigarette Smoking.- 5.1. Smokers’ Use of Coffee, Alcohol, and Other Drugs.- 5.2. Psychological Characteristics and Smoking Status.- 5.3. Biomedical Characteristics and Smoking Status.- 5.4. Leisure Exercise and Smoking Status.- 5.5. Cigarette Smoking: Implications of Our Findings.- 6. Conclusion.- 7. References.- III. The Clinical Functions of the Health Psychologist.- 15. Psychological Assessment in Medical Settings.- 1. Psychological Analysis in Medical Settings.- 2. Assessment Trends in Medical Settings.- 2.1. General Criteria for Test Evaluation.- 2.2. Criteria for Assessing Tests Used with Medical Populations.- 3. Symptom Checklists.- 3.1. Cornell Medical Index (CMI).- 3.2. Symptom Check List—90 (SCL-90).- 4. Single-Trait Instruments.- 4.1. Internal-External Scale (I-E Scale).- 4.2. Beck Depression Inventory.- 4.3. State-Trait Anxiety Inventory (STAT).- 5. Life-Style Inventories.- 5.1. Jenkins Activity Survey QAS).- 5.2. Life Experiences Survey (LES).- 6. Personality Inventories.- 6.1. 16 Personality Factor Inventory (16 PF).- 6.2. Minnesota Multiphasic Personality Inventory (MMPI).- 6.3. Millon Behavioral Health Inventory (MBHI).- 7. Discussion.- 8. References.- 16. Assessing the Impact of Life Changes.- 1. Assessing Life Changes.- 1.1. Schedule of Recent Events.- 1.2. The Life Experiences Survey.- 1.3. The Diversity of Approaches to Assessing Stressful Life Events.- 2. Life Change and the Onset of Illness.- 3. Moderators of Stressful Life Events.- 3.1. Sensation Seeking.- 3.2. Locus of Control.- 3.3. Social Support.- 4. Methodological Issues in Assessing Stressful Life Events.- 4.1. Types of Events.- 4.2. Magnitude of Events.- 4.3. Timing of Events.- 4.4. Meaning of Events.- 4.5. Causality versus Correlation.- 4.6. Moderator Variables.- 5. Cognitive Appraisal and the Experience of Stress.- 6. References.- 17. Behavioral Indicators of Client Progress after Spinal Cord Injury: An Ecological-Contextual Approach.- 1. Background.- 2. Observational Developments.- 3. Reduction and Selection.- 4. Clinical Personnel as Estimators.- 5. Self-Observation and Report of Behavior.- 6. Prediction of Outcomes.- 7. Concluding Comments.- 18. Issues in Patient Compliance.- 1. Medical Compliance.- 2. Social Compliance.- 2.1. Social Exchange.- 2.2. Social Power.- 2.3. Social Influence.- 2.4. Forced Compliance.- 2.5. Attribution Processes.- 3. Behavioral Compliance.- 3.1. Self-Reinforcement.- 3.2. Self-Monitoring.- 3.3. Behavioral Contracting.- 3.4. Self-Instructional Training.- 4. Other Compliance-Improvement Strategies.- 5. Some Paradoxes.- 6. References.- 19. Psychomaintenance of Chronic Physical Illness: Clinical Assessment of Personal Styles Affecting Medical Management.- 1. Psychomaintenance of Physical Illness.- 2. Two Assumptions Relating to Assessment.- 3. Examples of Psychomaintenance.- 4. The Context of Psychomaintenance.- 5. Psychomaintenance and Its Assessment in Asthma.- 5.1. Characteristics of Asthma and Its Treatment.- 5.2. The Battery of Asthma Illness Behavior (BAIB).- 5.3. The Empirical Basis of the BAIB: Nine Personal Styles.- 6. Examples of Assessment and Treatment.- 6.1. Patient A: A Low Panic-Fear Personality, Symptom Disregarder..- 6.2. Patient B: A High Panic-Fear Personality, Vigilant Patient.- 6.3. Patient C: A Moderate Panic-Fear Personality, Vigilant Patient.- 6.4. Patient D: A Moderate Panic-Fear Personality, Typical Patient.- 6.5. Summary of the Psychomaintenance Assessment Approach and Its Implications for Treatment.- 7. Relevance and Generality of Psychomaintenance.- 8. References.- 20. Behavioral Health Care in the Management of Chronic Pain.- 1. Some Behavioral Concepts in Pain Treatment.- 1.1. Pain as Behavior.- 1.2. Respondent versus Operant Pain Behavior.- 1.3. Acute versus Chronic Pain.- 1.4. Behavioral Health Care Goals.- 1.5. Review of Behavioral Strategies in Pain Treatment.- 2. Behavioral Health Care Techniques.- 2.1. Evaluation Procedures.- 2.2. Treatment Strategies.- 2.3. Use of Adjunct Pain Treatment.- 2.4. Contraindications for Behavioral Health Care.- 3. Conclusion.- 4. References.- 21. Cognitive Behavior Therapy in Health Psychology.- 1. Theoretical Issues in Cognitive Behavioral Therapy.- 2. A Theoretical Model of Behavior Change.- 2.1. Description of the Model.- 2.2. Assessment.- 2.3. A Critical Appraisal of the Model.- 3. Issues in Cognitive Behavioral Assessment.- 4. Cognitive Behavioral Therapy for Type-A CHD Patients.- 5. Cognitive Behavioral Approach to Pain Treatment.- 6. Program Blending Cognitive Behavioral Aspects of Chronic Pain Treatment.- 6.1. Theoretical Assumptions.- 6.2. Program Overview.- 6.3. Assessment.- 6.4. Physical Therapy.- 6.5. Occupational/Recreational Therapy.- 6.6. Rehabilitation Specialist.- 6.7. Physical Medicine.- 6.8. Psychology Program.- 6.9. Research.- 7. Conclusion.- 8. References.- 22. Hypnosuggestive Procedures in the Treatment of Clinical Pain: Implications for Theories of Hypnosis and Suggestive Therapy.- 1. Hypnosuggestive Procedures in Surgery.- 2. Postsurgical Effects of Hypnosuggestive Procedures.- 3. Hypnosuggestive Procedures in the Treatment of Back Pain.- 4. Hypnosuggestive Procedures in the Treatment of Tension Headaches and Migraines.- 5. Hypnosuggestive Procedures for Cancer Pain.- 6. Hypnosuggestive Procedures with Burn Patients.- 7. Hypnosuggestive Procedures for Dental Pain.- 8. Hypnosuggestive Procedures for Childbirth Pain.- 9. Effects of Hypnosuggestion on Experimental Pain.- 10. “Good” Hypnotic Subjects and the Relief of Pain.- 11. Recommendations for More Effective Hypnosuggestive Procedures.- 11.1. Useful Preliminary Procedures.- 11.2. Useful Verbal Suggestions.- 11.3. Useful Nonverbal Suggestions.- 12. Overview: Hypnosuggestive Approaches to Pain.- 13. References.- 23. Patient-Centric Technologies: A Clinical-Cultural Perspective.- 1. The Domains of Patient Power.- 1.1. Experiential Expertise.- 1.2. Integrative Expertise.- 1.3. Initiator Expertise.- 1.4. Informative Expertise.- 1.5. Implementive Expertise.- 2. Patient-Centric Technologies—Unilateral and Shared.- 2.1. Unilateral Technologies.- 2.2. Shared Technologies.- 2.3. Emergent Inventory of Patient Tools and Skills.- 3. Health Care Delivery as a Bidirectional Process.- 4. References.- Author Index.

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