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Summary Literature of Medical Psychology
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This is a summary of all the literature of Medical Psychology
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Medical Psychology
C1 Psychology and Medicine
C2 Symptoms and Illness
C2 Functional Somatic Syndromes: one or many?
C3 Stress and Health
C3 Protective and Damaging Effects of Stress Mediators
C4 Stress-induced Immune Dysfunction: Implications for Health
C5 Neuroscience and Biobehavioral Reviews
C6 Personality and Risk of Physical Illness
C7 The Interaction Between Psychologic Distress and Biobehavioral Processes in
Cardiovascular Disease
C8 The Role of Neuro-Immune Interactions in Cancer-Related Fatigue: Biobehavioral
Risk Factors and Mechanisms
C9 The Relationship of Fatigue in Breast Cancer Survivors with Quality of Life and
Factors to address in Psychological Interventions
C10 Type 2 Diabetes Mellitus and Psychological Stress – a Modifiable Risk Factor
C11 Endpoints in Medical Communication Research, proposing a Framework of
Functions and Outcomes
C11 Shared Decision Making: Concepts, Evidence, and Practice
C11 Active Patients as Powerful Communicators
, Psychology and Medicine
Psychology, health, and medicine
The importance of psychology for health and medicine is increasingly recognized. This
rests on extensive evidence that psychological factors are important in many aspects of
physical and mental health. Psychology’s breadth of scope can make it hard for
healthcare professionals to work out which parts are most relevant to clinical practice. A
further challenge is that psychological and social services are often separated from
physiologically oriented services.
What is health?
As healthcare professionals you are embarking on careers that involve helping people to
get better. Health operates on many levels such as the physical, subjective, behavioral,
functional, and social. ‘Health’ is not easy to define and is very individual. It is clear that
health issues are complex and require our consideration of the individual. We need to
recognize that, for individuals, health and illness are subjective states of wellbeing. We
also need to take account of disease in the form of underlying pathology. At least a third
of physical symptoms in primary care have no identifiable organic cause and 10-15% of
primary care patients have a history of multiple unexplained symptoms. We therefore
need to think of health on many levels. The World Health Organization (WHO) attempted
this by defining health very broadly as ‘a state of complete physical, mental, and social
wellbeing and not merely the absence of disease of infirmity’. However, this definition
has been criticized for being too broad. How we define health has wide-ranging
implications for the treatments provided by health services. The way we define health
has implications for who can be seen as responsible for our health and for which
treatments we offer.
Ultimately, the multidimensional nature of health makes finding an adequate definition
difficult. Antonovsky therefore proposed that we think of health as a continuum from
optimal wellness to death.
Why is psychology important?
The importance of treating the person and not just the disease is widely recognized.
Understanding more about people will help us treat then more effectively.
‘Psychology is just common sense’
Often statements from psychological research coincide with common sense. much
common sense is in fact contradictory. In some cases, psychological research has
confirmed common-sense views, although in other cases it has rejected these.
‘Psychology is interesting but not useful’
In order to treat people effectively, we need to be able to 1) diagnose the problem
accurately and 2) treat that problem appropriately. Psychology can help in both these
areas. Accurate diagnoses are more likely if we understand how people’s experiences
shape their perception and reporting of symptoms, and help-seeking behavior. Effective
communication skills also help in making an accurate diagnosis and in agreeing
appropriate treatment for each individual. Psychology can also help us to understand
psychological symptoms. The majority of people with psychological symptoms will
present with physical symptoms. Evidence shows there is a strong link between physical
health and psychological health: if we concentrate on only one side, we risk missing
,important information and prescribing ineffective treatment. People with psychological
disorders are also at an increased risk of illness. Psychology can appear abstract of
ambiguous with many competing theories. The ambiguity or uncertainty this involves
may contrast directly with the large amount of physiological and anatomical facts
students are required to learn in the first few years of their training. A lot of medical
practice is about dealing with uncertainty, often in the face of patients who want
certainty.
‘Psychology is not real medicine’
Most students will come to their medical studies keen to learn about the workings of the
body, how it goes wrong, and how to fix it. Such a view is not new: it stems from a
belief in dualism, according to which the mind and body are independent. The
disadvantage of dualism is that it provided the basis for the biomedical approach or
model.
The science of mind and body
There is now increasing evidence that the mind and body are integrally linked and
important in health. The mind is influenced by our body and bodily experiences.
Psychological research has shown that sensorimotor feedback can influence our thoughts
and emotions. Facial feedback has also been shown to reduce stress responses like heart
rate and skin conductance. The importance of bodily feedback in how we think and feel
extends beyond an individual. It is now clear that other people’s actions can influence
neuronal activity in our brains and that animals and humans have mirror neurons which
fire both when we carry out a specific act and when we see other perform the same
action. The science of the mind and body has therefore moved beyond simple separation
of mind and body to show that they are independent and influence each other in
numerous ways, as does our environment and the people around us.
Different approaches to medicine and healthcare
Biomedical approach
The biomedical approach assumes that all disease can be explained in terms of
physiological processes: therefore, the treatment acts on the disease and not on the
person. Social and cultural change is important and the reduction of infectious disease
cannot be explained on a purely biomedical basis. People in lower social classes are at
more risk of illness and death from a variety of causes. This increased risk is partly due
to differences in lifestyles. The role of lifestyle in illness illustrates the importance of
psychosocial factors, yet these are not considered by the biomedical model. It is not only
lifestyle that is important. Individual factors such as personality, health, behaviors, and
beliefs also affect health. A good example of the effect of our beliefs on health and
illness is the placebo effect, whereby people recover because they think they are going
to recover, as opposed to recovering because of pharmacological or physical treatment.
The biomedical approach cannot account for any of these effects of social and
psychological factors on health.
Biopsychosocial approach
The biopsychosocial approach is a framework that does incorporate biological,
psychological and social factors. External factors include the sociocultural environment,
pathogenic stimuli, and any treatment that the individual receives. Internal factors
include personal history, psychosocial processes, and physiological and biochemical
mechanisms. The biopsychosocial approach provides a clear framework that sums up
what many healthcare professionals already intuitively know. It is an improvement on
the biomedical approach in that it makes the links between psychological and social
factors and health explicit.
, The biopsychosocial approach has implications for research, education and clinical
practice. It should lead to more comprehensive research that examines the multiple
levels, systems, and factors involved in health. This in turn should lead to a more holistic
approach – that is, treatment of the whole person. The biopsychosocial approach still is
not widely used or practiced in medicine or psychology. So, we still have a long way to
go to properly incorporate the biopsychosocial approach into medicine. We can see that
barriers to applying the biopsychosocial approach include facts that 1) it is not possible
to address all the factors that influence illness, and 2) in order to plan treatment, we
need to think in terms of linear causality rather than circular causality.
We all need to consciously remind ourselves to explore factors at each level of the
biopsychosocial approach when assessing and treating people. This tendency to focus on
biology or psychology emerges in debates about nature and nurture. The problem with
many nature-nurture debates is that health and wellbeing are determined by nature and
nurture. The evolving field of epigenetics focuses on how environmental factors –
including social contextual factors – regulate the activity and expression of genes:
vulnerability. Better knowledge of epigenetic processes could help the planning of public
health interventions so that they are delivered at key times.
Social diversity and health
Within any population, there is wide variation in health behaviors and health outcomes
along the lines of age, sex, education, socioeconomic status (SES), ethnicity, sexual
orientation, and other demographic variables. The conditions in which people are born,
grow up, and live influence their health. People with lower levels of education and/or
income tend to report less healthy patterns of behavior, report poorer physical and
psychological wellbeing, and have shorter life expectancy. People from ethnic minorities
tend to have poorer health. It is important to consider whether health services and
individual health professionals are aware of, and responsive to, cultural diversity.
Life expectancy is several years shorter for men than for women. Women are more likely
than men to engage in screening behaviors or to consult health professionals. Sex and
sex differences are biologically based: they refer to comparisons between people who
are biologically female and people who are biologically male. Gender refers to the social
construction of femininities and masculinities through ‘feminine and masculine’
behaviors. Many social behaviors have clear links to traditional definitions of gender.
Furthermore, many health-related behaviors have clear gender stereotypes: boys and
men are encouraged to take risks and not to show weakness, whereas women are often
expected to take care of themselves and others. Health behaviors and health outcomes
also vary along the lines of sexual identity. Important reasons for poorer wellbeing and
less healthy behavior among LGBT people include minority stress. Furthermore, many
LGBT people may avoid health services because health professional do not understand
their specific needs. When designing and providing health services we must be
responsive to diversity and intersectionality.
Conclusion
It is important to consider psychological and social factors for a number of reasons.
Historically, the lack of focus on psychosocial factors in healthcare was perpetuated by a
widespread belief in mind-body separation and the pervasiveness of the biomedical
approach. The biopsychosocial approach is consistent with current evidence and shows
that we need to consider biological, psychological, social, and macro-cultural factors in
health and healthcare.
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