Learning goals Clinical Health Psychology in Medical Science

For the course Clinical Health Psychology in Medical Science (Tilburg University, bachelor psychology, year 2) I answered all learning goals you need to know for the exam.

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Summary Clinical health Psychology in Medical
Science
All incidence and prevalence rates based on data from the USA
Table of Contents

Chapter 1: Psychology and Population Health Management
Population health management is an integrated approach to improve the health of an entire
population by targeting the systems and policies that affect health care quality, access and
outcomes.
Form a clinical psychology perspective  clinical applications and interventions targeted at an
entire population.
Population health interventions are often integrated into the standard clinical settings, with a
shift in emphasis from individual patients with identified disorders/diseases to a larger target
population. E.g. routine screening of all patients for tobacco use in a family medicine clinic,
followed by a brief intervention or referral care.
Brief interventions can be:
o Provided by health care professionals, e.g. psychologist as behavioural health
consultant
o Technological approaches
o Face-to-face therapy
Tobacco use, overweight and obesity, and excessive alcohol use are the three greatest
contributors to mortality in America.

Population Health Management: An Overview
Classic example in history of the use of population health:
- John Snow discovered the source of the 1848 cholera epidemic in London. He found
that death due to cholera highly correlated with locations surrounding certain water
pumps. He theorized that cholera might be spread through contaminated water
supplies.
The modern-day population health emerged because the traditional approach of explaining
and treating illness on an individual level was too limiting.

Definitions of Population Health and Disease Management
Population health emerged from disease management.
Disease management = clinical interventions and approaches for individuals who have already
developed a specific disease. Others use a broader explanation for the term, including the
early interventions as well.

Disease management consists of a group of coherent interventions designed to prevent or
manage one or more chronic conditions using a systematic, multidisciplinary approach and
potentially employing multiple treatment modalities. The goal of disease management is to
identify persons at risk for one or more chronic conditions, to promote self-management by
patients and to address the illnesses or conditions with maximum clinical outcome,
effectiveness and efficiency regardless of treatment setting(s) or typical reimbursement
patterns.
Birkofer, L.. Handbook of Clinical Psychology in Medical Settings : Evidence-Based
Assessment and Intervention, edited by Christine M. Hunter, et al., Springer, 2014.
ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/uvtilburg-
ebooks/detail.action?docID=1781925.
Created from uvtilburg-ebooks on 2020-03-29 03:21:53.

Primary preventions = interventions such as prevention programmes.
Secondary preventions = interventions in an at-risk population
Tertiary preventions = interventions in populations already diagnosed with an illness to help
control symptoms and severity.
Ssurveillance includes methods to measure or assess the health status of a population. E.g.
review of electronic medical records to determine the prevalence of tobacco use or obesity in
specific population.
Cognitive-behavioral interventions at population level:
Passive:
- Adding fluoride to the water supplies  everyone’s dental health improved.
Four primary categories of environmental factors that can be modified to affect population
behavior:
1) Availability
2) Physical structures
3) Social structures and policies
4) Media and cultural messages

Tobacco Use
o Problem:
In America tobacco is responsible for ± 1in 5 deaths. There is no safe level of tobacco
use so everyone who uses is target population for health interventions.
o Population-level interventions:
Universal assessment and treatment in primary care settings.
Tailored self-help intervention through computer-based programs (however, mainly
effective if person is already really motivated to quit).
Telephone counseling is another option. This one is particular effective as an adjacent
interventions. Often used in combination with self-help methods.

Weight Management
o Problem:
Number of people Being overweight and obesity is rising. Obesity is a major risk factor
for numerous chronic disease such as CVD, diabetes etc.
o Interventions:
Most effective: multisession cognitive-behavioral treatments. Mostly done by face-to-
face counseling, but can also be done via technologies such as telephone and internet.
PDA = personal digital assistants who provide an outlet for self-monitoring of diet and
exercise behaviors.
Excess Alcohol Consumption
o Problem:
often referred to as problem drinking, heavy drinking or at-risk drinking. Doesn’t have
to be accompanied by alcohol dependence. Heavy drinking = when you drink more
than two standard drinks of alcohol per day (men) and more than one (women). Excess
alcohol consumption is associated with an increased risk of many medical conditions
such as cancer, pancreatitis, gastritis and cirrhosis as well as neurological and
cardiovascular problems. Alcohol is the third leading cause of death in America.
Binge drinking = having five or more drinks at one sitting.
It costs a lot of money  public; higher health care costs, private; higher costs due to
decreased productivity and higher insurance costs.
However, there is a safe and healthy level of alcohol consumption:
Max of 2 drinks per day for men and 1 for women is associated with reduced health
risks and total mortality.
o Interventions:
Most effective is intense individual treatment using either CBT or medication or a
combination of the two.
Largest randomized controlled trial was the Combined Pharmacotherapies and
behavioural Interventions (COMBINE) study.
However, such intensive CBT sessions are not available for everyone.
Brief interventions about one’s motivation have shown to be effective as well.
Web-based interventions are another approach such as the Screening and brief
Intervention (SBI). It includes assessment tools in the screening phase, along with
assessment questions and personalized feedback in the intervention portion.
Drinker’s Check-Up (DCU) is another one: uses brief motivational interventions and
can be utilized as a separate intervention or as an introduction to alcohol treatment.
Consists of integrated assessment, feedback and decision-making modules. Uses the
FRAME approach.

These lifestyle factors contributing to morbidity and mortality – tobacco use, overweight/obese
alcohol consumption – can be significantly improved through population health management.
Chapter 2: A History of Clinical Psychology in Medical Settings
Roots in History of Clinical Health Psychology
Formal start of Clinical Psychology in the 1890s by Lightner Witmer – also founder of the first
psychological clinic (mainly for children with speech problems, sleep disturbances and
behavioural problems).
Witmer defined “clinical Psychology” as the observational or experimental study of people to
promote change. He used the word ‘clinical’ because he felt he was resembling medicine at
the time – intense observation and care of patients.

Physical health was absent of clinical psychology in this time, it was considered as exclusively
to be in the medicine’s domain.