Health Psychology

We live in an age of chronic health conditions. Chronic pain, diabetes, heart disease, inflammatory bowel disorders, obesity, and sleep apnea are just a few of the most common chronic conditions. Many patients and healthcare providers attempt to treat these conditions by solely medical approaches. It makes sense, of course. Many, if not most, of these conditions are medical conditions. So, it makes sense to take medications and get different types of medical procedures and surgeries in order to try to get better. These medical treatments are usually worthwhile to pursue.

Typically, however, medications and the different medical procedures and surgeries for chronic health conditions are only modestly effective. After all, these conditions are chronic. There are no cures for chronic conditions. Medical treatments for chronic health conditions are usually worthwhile to pursue, but they do not cure the conditions. They typically reduce the symptoms associated with these conditions only somewhat. As a consequence, if patients and their healthcare providers rely only on these ways to get better, patients tend to become only modestly better.

Fortunately, medical treatments for the chronic health conditions listed above are not the only way to get better. Most everyone recognizes that, for chronic health conditions, there is a role for the patient to make healthy lifestyle changes that will positively affect the course of their chronic condition. In other words, there are many things that patients can do to get better in addition to getting appropriate medical care. Most everyone knows many of these healthy lifestyle changes: quitting smoking, beginning an exercise routine, losing weight and eating healthier, managing stress, among other things. Doing these things will help to manage the chronic health conditions listed above. Most everyone knows it too.

Here’s the problem, though. Knowing that it is good to do is simply not enough to get people to make these healthy lifestyle changes. How many smokers know that it causes lung cancer and heart disease? Probably, every smoker knows it. Despite knowing it, most smokers continue to smoke. How many overweight people know that it’s not healthy for them? Again, probably every overweight person knows it. How many of these overweight people know it causes diabetes and leads to heart disease? Probably, many, if not most, overweight people know it. Does knowing it, though, lead to eating healthier, beginning an exercise routine, and achieving a healthy weight? Knowing that it is unhealthy to be overweight simply does not lead to making these healthy changes for most people.

So, what would help people with chronic health conditions do what they know they need to do? What is it that allows some people to make healthy lifestyle changes and some others to keep putting it off, despite knowing that it would help them?

Psychologists who study how people make changes have consistently found that the key factor is motivation. Patients with chronic health conditions who make healthy lifestyle changes have a high degree of motivation for change. Those who don’t make healthy lifestyle changes have a low motivation for change. And here is another interesting finding from psychologists who research such things: to find and maintain motivation for change, most people need someone to do it with. When left by themselves, most people just won’t do it. However, when they have someone who coaches them through the process and can do so over time, most people will make healthy lifestyle changes. Change and growth is always easier when you do it with someone.

Now, isn’t this true with most any way that people make personal changes? Think back to the teachers who had the biggest impact on you or to the doctors who provided you with the best care. With few exceptions, they will be the ones with whom you had the best relationship. Similarly, think also to the religious leader who had the biggest impact on your spiritual life or the therapist who helped you to overcome a depression or anxiety. In most cases, change and growth is best done in a relationship with a person who assists you through the process.

Psychologists have long been recognized as the experts in behavior change. Most people think of psychologists as mental health providers. They think of psychologists as healthcare providers who help people to overcome things like depression, anxiety, divorce, and the like. For decades, however, there have been psychologists who work outside the mental health field and instead work with medical patients, particularly with patients who have chronic health conditions. They are called ‘health psychologists.’

Health psychologists treat patients with chronic health conditions by coaching them on how to make healthy lifestyle changes that will positively affect their health and reduce the symptoms of their chronic conditions. It is becoming increasingly routine to have a health psychologist in a team of healthcare providers who treat patients with chronic health conditions. Indeed, it is widely accepted that cutting edge healthcare for patients with chronic health conditions involves a team-based interdisciplinary model of care. Such care involves coordinated care with a physician, health psychologist, physical therapist, and nutritionist, among others. The role of the health psychologist is to help patients to make healthy lifestyle changes and most importantly, finding and maintaining the motivation to make such healthy changes.

Among all the different types of healthcare professionals, the health psychologist is in the best position to help patients make healthy lifestyle changes. First, health psychologists are the experts in health behavior changes like quitting smoking; finding and maintaining the motivation to eat healthier, lose weight, and begin an exercise routine; coping with chronic pain; and managing stress. Second, they are experts in developing a helping relationship that is so important in finding and maintaining motivation for change. Health psychologists make it a priority to establish a positive, therapeutic relationship and, within this relationship, they help people make changes that affect their health and well-being. Health psychologists listen to their patients, respect the autonomy of their patients, and build trust with their patients. Within this mutually respectful and trusting therapeutic relationship, health psychologists provide expert advice on how to live well despite having a chronic health condition. Third, making healthy lifestyle changes takes time. Health psychologists are one of the last types of healthcare professionals whose appointments last for a fifty-minute hour. This amount of time allows for thorough discussion of how to go about making healthy lifestyle changes. Typically, health psychologists see their patients on a weekly, every other week or monthly basis, depending on the complexity of the health condition being treated.

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

Murray J. McAllister, PsyD, is a pain psychologist and consults to health systems on improving pain. He is the editor and founder of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. In its mission is to lead the field in making pain management more empirically supported, the ICP provides academic quality information on chronic pain that is approachable to patients and their families. 

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