Handbook of Clinical Health Psychology

Handbook of Clinical Health Psychology Edited by Theodore Millon

Catherine Green

Robert Meagher University of Miaml~ Coral Gables, Florida

PLENUM PRESS. NEW YORK AND LONDON

Library of Congress Cataloging in Publication Data

Main entry under title:

Handbook of clinical health psychology.

Includes bibliographical references and index. 1. Medicine, Psychosomatic. I. Millon, Theodore. II. Green, Catherine, Date- . III.

Meagher, Robert. [DNLM: 1. Attitude to health. 2. Disease-Psychology. 3. Psychology, Clinical. 4. Psychophysiologic disorders-Therapy. WM 90 H236) RC49.H325 1982 616'.001'9 82-11236

ISBN-13: 978-1-4613-3414-9 e-ISBN-13: 978-1-4613-3412-5 DOl: 10.1007/978-1-4613-3412-5

© 1982 Plenum Press, New York Softcover reprint of the hardcover 18t edition 1982 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013

All rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

To the memory of a wise, warm, and witty colleague

PARK DAVIDSON

Whose untimely death has deprived clinical health psychology of one of its

most distinguished contributors

Contributors

James L. Alexander, Department of Rehabilitation, Behavioral Ecology Programs, Baylor College of Medicine, Waco, Texas

Laurence H. Baker, Department of Psychology, University of Connecticut, Newington, Connecticut

Theodore X. Barber, Department of Supportive Services, Cushing Hospital, Fra­mingham, Massachusetts

Cheryl S. Brischetto, Department of Medical Psychology, Oregon Health Sciences Uni­versity, Portland, Oregon

Alvin G. Burstein, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Timothy P. Carmody, Department of Medical Psychology, OTlmlln Health Sciences University, Portland, Oregon

Sonja L. Connor, Department of Medicine, Oregon Health Sciences University, Portland, Oregon

William E. Connor, Department of Medicine, Oregon Health Sciences University, Port­land, Oregon

James C. Coyne, Department of Psychology, University of California, Berkeley, Cali­fornia

Park Davidson, Late of the Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada

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CONTRIBUTORS

Jerald F. Dirks, Division of Psychobiology, National Jewish Hospital and Research Center, and Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado

Barbara Snell Dohrenwend, Division of Sociomedical Sciences, School of Public Health, Columbia University, New York, New York

Bruce P. Dohrenwend, Social Psychiatry Research Unit, Department of Psychiatry, Columbia University, New York, New York

Martin Falletti, Miami Jewish Home and Hospital for the Aged, Miami, Florida

Steven G. Fey, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington

Wilbert E. Fordyce, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington

Catherine J. Green, Department of Psychology, University of Miami, Coral Gables, Florida

Kenneth Holroyd, Department of Psychology, Ohio University, Athens, Ohio

Mardi J. Horowitz, Department of Psychiatry and Center for the Study of Neuroses, Langley Porter Psychiatric Institute, University of California, San Francisco, California

Jan Howard, Behavioral Medicine Branch, National Cancer Institute, National Insti­tutes of Health, Bethesda, Maryland

Nelson F. Jones, School of Professional Psychology, University of Denver, Denver, Colorado

William H. Kaplan, Department of Psychiatry, University of Chicago, Chicago, Illinois

Chase P. Kimball, Division of Biological Sciences and College of the University of Chicago, Chicago, Illinois

Robert A. Kinsman, Division of Psychobiology, NationalJewish Hospital and Research Center, and Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado

Henry M. Levine, Department of Psychology, University of Washington, Seattle, Washington

Sandra M. Levy, Behavioral Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

Sandra Loucks, Department of Psychology and Center for Personal and Educational Development, Trinity University, San Antonio, Texas

James E. Maddux, Department of Psychology, Texas Tech University, Lubbock, Texas

Joseph D. Matarazzo, Department of Medical Psychology, Oregon Health Sciences University, Portland, Oregon

Robert B. Meagher, Jr., Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida

Theodore Millon, Department of Psychology, University of Miami, Coral Gables, Florida

Rudolf H. Moos, Social Ecology Laboratory, Department of Psychiatry and the Behav­ioral Sciences, Stanford University and VA Medical Center, Palo Alto, California

Diane K. Pierce, Department of Medical Psychology, Oregon Health Sciences University, Portland, Oregon

Michael C. Roberts, Department of Psychology, University of Alabama, University, Alabama

Barbara R. Sarason, Department of Psychology, University of Washington, Seattle, Washington

Irwin G. Sarason, Department of Psychology, University of Washington, Seattle, Washington

Gary Sexton, Department of Medicine, Oregon Health Sciences University, Portland, Oregon

Franklin C. Shontz, Department of Psychology, University of Kansas, Lawrence, Kansas

Jeffrey R. Soloman, Altro Health and Rehabilitation Services, 345 Madison Avenue, New York, New York

Jeffrey C. Steger, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington

James J. Strain, Mount Sinai School of Medicine, New York, New York

Rebecca M. Warner, Department of Psychology, University of New Hampshire, Durham, New Hampshire

Herbert Weiner, Department of Psychiatry and Neuroscience, Albert Einstein College of Medicine, and Department of Psychiatry, Montefiore Hospital and Medical Center, New York, New York

Edwin P. Willems, Department of Psychology, College of Social Sciences, University of Houston, Houston, Texas

Logan Wright, Institute of Health Psychology for Children, Oklahoma City, Oklahoma

IX

CONTRlBUTORS

x

CONTRIBUTORS

Sandy K. Wurtele, Department of Psychology, University of Alabama, University, Alabama

Steven Yunik, Douglas Gardens Community Mental Health Center of Miami Beach, Miami Beach, Florida

Preface

We seek to throw down the gauntlet with this handbook, challenging the he­gemony 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 psy­chology 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 assess­ment 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. As valuable as their tools and expertise may be for their respective subject areas, neither discipline possesses the scientist-professional blend that characterizes the coordinated research and services training of the clinical psychologist. Physicians exemplify the standard for professional attitudes and clinical skills, but they are often, at best, novices when it comes to grasping the complex relationships between "psyche" and "soma". Similarly, nonclinical psychologists bring a rich background of knowledge and scientific methodology to their realms of study, but only rarely do they have the requisite grounding and service expertise ,called for in direct patient care. As a consequence of their respective strengths and shortcomings, a symbiotic, if peculiar hybrid has emerged-a unit composed of

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PREFACE

physician and experimental psychologist. It seems time to us for the third and perhaps most essential member to join this health care team-the clinical psy­chologist. It is hoped that this handbook will activate an increased involvement on their part.

Coral Gables, Florida

THEODORE MILLON

CATHERINE]' GREEN

ROBERT B. MEAGHER, JR.

Contents

Chapter 1. On the Nature of Clinical Health Psychology

THEODORE MILLON

1

1. Some Historical and Philosophical Reflections............................... 2 1.1. Historical Notes .......................................................... 2 1.2. Bridging the Mind-Body Dichotomy................................... 3

2. Problems of Boundary and Definition ........................................ 5 2.1. Psychosomatic Medicine ................................................. 5 2.2. Medical Psychology ....................................................... 6 2.3. Rehabilitation Psychology.. ...... ........ .. ..... .... .. ........... .. .. .... 6 2.4. Health Care Psychology ................................................. 6 2.5. Behavioral Medicine..................................................... 7 2.6. Behavioral Health. ... .. ................. ........... .. .... .. .. . .. ......... 8 2.7. Health Psychology ........................................................ 8 2.8. Clinical Health Psychology.............................................. 8

3. The Domain of Clinical Health Psychology ................................. 10 3.1. Personality: The Styles of Coping........................... .......... 11 3.2. Psychogenic Attitudes: Objective and Subjective Stressors .......... 14

4. Clinical Settings and Functions of Health Psychologists.... . . . . . . . . . . . . . . .. 17 4.1. The Clinical Settings of Health Psychology....... . . . . . . . . . . . . . . . . . . .. 17 4.2. The Clinical Functions of the Health Psychologist ................... 18

5. Training Clinical Health Psychologists....................................... 19 5.1. Need for Formal Training ............................................. 20 5.2. Problems in Program Development ................................... 20 5.3. General Training Goals ................................................. 21 5.4. University of Miami Clinical Health Track ........................... 23

6. References ....................................................................... ~5

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PART 1. THE KNOWLEDGE DOMAIN OF CLINICAL HEALTH PSYCHOLOGY

Chapter 2. Psychobiological Factors in Bodily Disease

HERBERT WEINER

29

31

1. The Development of Psychosomatic Concepts.............................. 32 1.1. Behavioral Factors in Disease .......................................... 34 1.2. Social Factors in Disease ................................................ 35

2. The Current Status of Psychosomatic Concepts ............................ 36 3. The Predisposition to Disease ................................................ 37 4. The Onset and Initiation of Disease ......................................... 40 5. Initiating Mechanisms of Disease ............................................. 42 6. Social and Psychological Effects of Illness ................................... 46 7. Factors That Sustain Disease .................................................. 47 8. Conclusion ........................... ; ......................................... 48 9. References ..................................................................... 49

Chapter 3. Psychological Processes Induced by Illness, Injury, and Loss 53

MARDI J. HOROWITZ

1. Experiences during Intrusive and Denial States ............................ 54 1.1. Perception and Attention............................................... 55 1.2. Ideas and Feelings Related to the Event .............................. 57 1.3. Conceptual Attributes of Intrusive and Denial States ................ 57 1.4. Emotional Attributes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 58 1.5. Sorn,atic Attril;mtes ....................................................... 58 1.6. Action Patterns.......................................................... 58

2. Contents of Concern .......................................................... 58 2.1. Fear of Repetition ....................................................... 59 2.2. Shame over Helplessness or Emptiness ............................... 59 2.3. Rage at "the Source" .................................................... 59 2.4. Guilt Feeling or Shame over Aggressive Impulses ................... 60 2.5. Fear of Aggressivity ..................................................... 60 2.6. Survivor Guilt. ........................................................... 60 2.7. Fear of Identification or Merger with Victims ........................ 60 2.8. Sadness in Relation to Loss ............................................. 61 2.9. Recapitulation ........................................................... 61

3. Coping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 61 4. Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 63

4.1. Goals of Treatment for Stress Response Syndromes ................. 64 4.2. The Pattern of Psychological Treatment. ............................. 64 4.3. Summary ................................................................ 66

5. References .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 66

Chapter 4. The Risks and Course of Coronary Artery Disease: A Biopsychosocial Perspective

WILLIAM KAPLAN AND CHASE KIMBALL

69

1. Premorbid Phase: Who Is At Risk? .......................................... 71 1.1. Mind over Body ......................................................... 71 1.2. Risk Related to Biochemistry, Personal Habits, and Family

History ................................................................... 72 1.3. The Risk of the Coronary-Prone Behavior Pattern .................. 75

2. Biological Mediators of Coronary Artery Disease ........................... 76 3. Psychosocial Risk Factors of Coronary Artery Disease ..................... 77 4. Psychopathology as a Risk Factor ............................................ 78 5. Hospital-Phase Risk Factors ................................................... 79

5.1. Coronary Care Unit: Risks the Technology Fails to Treat .......... 79 5.2. The Risk of Getting Better: Transfer from the Coronary

Care Unit ................................................................ 80 5.3. The Risk of Delirium. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . .. . . . . . . .. . . .. 81 5.4. Disturbances of Sleep in the Coronary Care Unit. ................... 82

6. Posthospital Phase ............................................................. 82 6.1. Length of Hospitalization: Is More Better?......................... 82 6.2. Psychological Risks during Convalescence ............................ 83

7. Conclusion..................................................................... 84 8. References ...................................................................... 86

Chapter 5. Some Issues in Research on Stressful Life Events

BARBARA SNELL DOHRENWEND AND BRUCE P. DOHRENWEND

91

1. Evidence about the Relationship of Life Stress to Illness ................. 92 2. Definition of Populations of Life Events.................................... 94 3. Measurement of the Magnitudes of Life Events. . . . . . . . . . . . . . . . . . . . . . . . . . . 95 4. Research Design .............................................................. 97 5. Mediation of the Impact of Stressful Life Events.... . . . . . . . . . . . . . . . . . . . . . . 98 6. Conclusion.................................................................... 100 7. References ............................................. : . . . . . . . . . . . . . . . . . . . . .. 101

Chapter 6. Stress, Coping and Illness: A Transactional Perspective

J AMES COYNE AND KENNETH HOLROYD

103

1. Stress as an Environmental Event........................................... 104 2. Stress as a Response .......................................................... 106 3. A Transactional Conception of Stress ....................................... 108

3.1. AppraisaL ............................................................... 108 3.2.Coping .................................................................. 109

4. Coping and Health .................... ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 110

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5. Coping Skills Treatment ..................................................... III 6. Transactional Conceptions of Causality ..................................... 113 7. Stress in Its Social Context. .................................................. 114

7.1. Social Support .......................................................... 115 7.2. The Family .............................................................. 117 7.3. Family Interventions ................................................... 120

8. Concluding Remarks ......................................................... 121 9. References .................................................................... 122

Chapter 7. Coping with Acute Health Crises

RUDOLF H. Moos

129

1. Crisis Theory as a General Perspective ..................................... 129 2. A Conceptual Framework .................................................... 131

2.1. Sociodemographic and Personal Factors ............................. 132 2.2. Illness-Related Factors ................................................. 133 2.3. Physical and Social-Environmental Factors .......................... 133 2.4. Mediating Factors: Appraisal and Activation ........................ 134 2.5. Major Adaptive Tasks .................................................. 135 2.6. Major Types of Coping Skills ......................................... 138

3. The Crisis of Illness: Coping with Cancer.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 140 4. The Crisis of Treatment: Unusual Hospital Environments ............... 143 5. The Therapeutic Role of Staff .............................................. 145 6. References .................................................................... 149

. Chapter 8. Adaptation to Chronic Illness and Disability 153 FRANKLIN C. SCHONTZ

1. A Paradox ..................................................................... 154 1.1. Resolution ............................................................... 155 1.2. Adaptation to What? ................................................... 155

2. Implications .................................................................. 155 2.1. An Example ............................................................. 156

3. Fundamental Differences in Viewpoints.................................... 159 3.1. Introduction ........................................................... 159 3.2. Research Implications .................................................. 159

4. Scope and Limitations ........................................................ 160 5. Differences in Problem Definition ........................................... 160

5.1. Possible Resolutions .................................................... 161 6. Perceptions of Locus of Problems ........................................... 161

6.1. Possible Resolution ..................................................... 162 7. Attitudes toward Subjectivity ................................................ 163

7.1. Possible Resolution ..................................................... 164 8. Values ......................................................................... 164

8.1. Possible Resolution ..................................................... 165

9. Temporal Perspective ....................................................... 166 9.1. Possible Resolution..................................................... 166

10. Units of Measurement and Conceptualization ............................ 167 10.1. Possible Resolution .................................................... 167

11. Decision Making. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 168 11.1. Possible Resolution .................................................... 169

12. General Reconciliation of the Two Viewpoints ........................... 169 13. A Final Question ............................................................ 170 14. References ................................................................... 171

PART II. THE CLINICAL SETTINGS OF HEALTH PSYCHOLOGY 173

Chapter 9. The Psychologist as Health Care Clinician

ALVIN G. BURSTEIN AND SANDRA LOUCKS

175

1. Historical Review ............................................................. 175 1.1. Ideological Issues....................................................... 175 1.2. Traditional and More Recent Hospital Roles for Psychologists .... 181

2. Contemporary Pressures ..................................................... 183 2.1. Problems in the Health Care System ................................. 183 2.2. Credentialing and Intraprofessional Strains ......................... 184 2.3. Legal Conflict with Psychiatry ......................................... 185

3. Pragmatics of Practice ........................................................ 186 4. The Future yield ............................................................. 187 5. Implications for Training .................................................... 188 6. References .................................................................... 189

Chapter 10. Pediatric Psychology: Health Care Psychology for Children

MICHAEL C. ROBERTS, JAMES E. MADDUX, SANDY K. WURTELE, AND LOGAN WRIGHT

191

1. Introduction .................................................................. 191 1.1. Rationale of Pediatric Psychology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 191 1.2. Characteristics of Pediatric Psychology ............................... 192 1.3. Overview of Chapter. .................................................. 194

2. Definitions and Conceptualizations of Pediatric Psychology .............. 195 2.1. Underlying Philosophy ................................................ 195 2.2. Definitional Characteristics ............................................ 195 2.3. Psychological Aspects .................................................. 196 2.4. Conceptualizations of Roles and Functions .......................... 197

3. Development of Pediatric Psychology ....................................... 198 3.1. Historical Milestones ................................................... 198 3.2. Society of Pediatric Psychology ........................................ 198 3.3. Training ................................................................. 199 3.4. Accumulation of Knowledge through Research ..................... 199

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4. The Clinical Practice of Pediatric Psychology .............................. 200 4.1. Types of Intervention .................................................. 201 4.2. Examples of Pediatric Psychological Functioning ................... 202 4.3. Models of Consultation ................................................ 204 4.4. Characteristics of Practice Procedures ................................ 205

5. A Survey of Research: Selected Topics ..................................... 207 5.1. Range of Research Activity ............................................ 207 5.2. Chronic Conditions .................................................... 207 5.3. Acute Conditions ....................................................... 210 5.4. Developmental Disorders .............................................. 211 5.5. Terminal Illness and Death ........................................... 213

6. Research: The Future of Pediatric Psychology ............................. 213 6.1. Compliance to Medical Regimens ..................................... 214 6.2. Psychogenic Pain ....................................................... 215 6.3. Prevention .............................................................. 215 6.4. Protocols and Standardized Procedures .............................. 216 6.5. Additional Areas of Research ......................................... 217

7. Concluding Comments ....................................................... 217 8. References .................................................................... 218

Chapter 11. The Psychologist as Geriatric Clinician 227

JEFFREYSOLOMON, MARTIN FALETTI, AND STEVEN YUNIK

1. Developmental Features of Later Life ...................................... 228 1.1. Health Changes ...... ; ................................................. 228 1.2. Psychological Changes ................................................. 229 1.3. Social Changes .......................................................... 229 1.4. Personality Changes .................................................... 230

2. Testing and Assessment. ..................................................... 231 2.1. Goals in Clinical Assessment with Older Adults ..................... 231 2.2. Instrumenting Assessment ............................................. 234 2.3. Psychological Assessment .............................................. 235

3. Therapy and Clinical Practice ............................................... 236 3.1. Efficacy .................................................................. 236 3.2. Technique ............................................................... 237

4. Research ...................................................................... 241 4.1. Designs in Aging Research ............................................ 242 4.2. Issue Areas in Aging Research ........................................ 244

5. Concluding Statement ........................................................ 247 6. References .................................................................... 247

Chapter 12. Collaborative Efforts in Liaison Psychiatry 251

JAMES J. STRAIN

1. The Precepts of Liaison Psychiatry .......................................... 252 2. The Practice of Primary, Secondary, and Tertiary Prevention ........... 253

3. The Fostering of Diagnostic Accuracy ...................................... 254 4. Clarification of the Status of the Caretaker ................................ 260

4.1. Evaluating the Doctor .................................................. 261 4.2. Evaluating the Family .................................................. 263

5. The Provision of Ongoing Education to the Nonpsychiatric Staff to Promote Autonomy ........................................................... 263

5.1. The Pre-Ombudsman Meeting ........................................ 264 5.2. The Ombudsman Rounds ............................................. 264

6. The Development of Core Biopsychosocial Knowledge ................... 268 7. Promotion of Structural Changes in the Medical Setting ................. 271 8. Commentary .................................................................. 273 9. References .................................................................... 274

Chapter 13. The Psychologist as Social Systems Consultant

REBECCA M. WARNER

277

1. Introduction .................................................................. 277 1.1. Definition of a System ................................................. 277 1.2. General Systems Theory ............................................... 278 1.3. Social Systems Involved in Health Care .............................. 279

2. Basic Issues in Social System Theory ....................................... 283 2.1. Introduction ............................................................ 283 2.2. Social Ties ............................................................... 283 2.3. Social Roles ............................................................. 284 2.4. Cross-Level Linkage among Systems ................................. 284 2.5. Mutual Contingency ................................................... 285 2.6. Summary of Key Concepts ............................................ 286 2.7. Patient Assessment ..................................................... 286

3. Applications of the Systems Approach to Health Care .................... 287 3.1. Social Ties and Health ................................................. 287 3.2. Doctor and Patient Roles .............................................. 288 3.3. Interface between Social and Physiological Processes ............... 291 3.4. Doctor-Patient Communication ....................................... 295

4. Discussion ..................................................................... 297 5. References .................................................................... 298

Chapter 14. Behavioral Cardiology with Emphasis on the Family Heart Study: Fertile Ground for Psychological and Biomedical Research 301

JOSEPH D. MATARAZZO, WILLIAM E. CONNOR, STEVEN G. FEY,

TIMOTHY P. CARMODY, DIANE K. PIERCE, CHERYL S. BRISCHETTO,

LAURENCE H. BAKER, SONJA L. CONNOR, AND GARY SEXTON

1. Introduction .................................................................. 30 I 1.1. Behavioral Cardiology ................................................. 303

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2. The Evolution of Behavioral Cardiology at the University of Oregon School of Medicine ........................................................... 305

2.1. The Family Heart Study: Recruitment and Baseline ................ 306 2.2. The Family Heart Study: Intervention Phase ....................... 308 2.3. The Family Heart Study: Control Groups ........................... 311

3. RecruitmentStudies .......................................................... 312 3.1. Joiners versus Nonjoiners ............................................. 312 3.2. Health Survey Results .................................................. 314 3.3. Recruitment Phase: Summary of Results ............................. 316

4. Health Attitudes and Biomedical Status .................................... 317 4.1. Health Attitudes and Plasma Cholesterol Level ..................... 318 4.2. Health Attitudes and Obesity ......................................... 319 4.3. Internal Locus of Control and Biomedical Status ................... 320 4.4. Health Attitudes of Smokers and Nonsmokers ...................... 320 4.5. Health Attitudes and Leisure Activity ................................ 320 4.6. Health Attitudes: Implications of Our Findings ..................... 321

5. Cigarette Smoking ............................................................ 323 5.1. Smokers' Use of Coffee, Alcohol, and Other Drugs ................ 324 5.2. Psychological Characteristics and Smoking Status ................... 326 5.3. Biomedical Characteristics and Smoking Status ..................... 326 5.4. Leisure Exercise and Smoking Status ................................ 329 5.5. Cigarette Smoking: Implications of Our Findings .................. 332

6. Conclusion .................................................................... 333 7. References .................................................................... 334

PART III. THE CLINICAL FUNCTIONS OF THE HEALTH PSYCHOLOGIST

Chapter 15. Psychological Assessment in Medical Settings

CATHERINE J. GREEN

337

339

1. Psychological Analysis in Medical Settings .................................. 340 2. Assessment Trends in Medical Settings ..................................... 340

2.1. General Criteria for Test Evaluation ................................. 341 2.2. Criteria for Assessing Tests Used with Medical Populations ....... 342

3. Symptom Checklists .......................................................... 343 3.1. Cornell Medical Index (CMI) ......................................... 343 3.2. Symptom Check List-90 (SCL-90) ................................... 344

4. Single-Trait Instruments ..................................................... 347 4.1. Internal-External Scale (I-E Scale) .................................. 347 4.2. Beck Depression Inventory ............................................ 349 4.3. State-Trait Anxiety Inventory (STAT) .............................. 351

5. Life-Style Inventories ......................................................... 353 5.1. Jenkins Activity Survey QAS) ......................................... 354 5.2. Life Experiences Survey (LES) ........................................ 356

6. Personality Inventories ....................................................... 358 6.1. 16 Personality Factor Inventory (16 PF) ............................. 359

6.2. Minnesota Multiphasic Personality Inventory (MMPI) .............. 361 6.3. Millon Behavioral Health Inventory ( MBHI ) ....................... 364

7. Discussion ..................................................................... 370 8. References .................................................................... 370

Chapter 16. Assessing the Impact of Life Changes 377 IRWIN G. SARASON, HENRY M. LEVINE, AND BARBARA R. SARASON

1. Assessing Life Changes ....................................................... 378 1.1. Schedule of Recent Events ............................................ 378 1.2. The Life Experiences Survey ......................................... 379 1.3. The Diversity of Approaches to Assessing Stressful Life Events ... 381

2. Life Change and the Onset of Illness ....................................... 382 3. Moderators of Stressful Life Events ......................................... 384

3.1. Sensation Seeking ...................................................... 385 3.2. Locus of Control ....................................................... 386 3.3. Social Support .......................................................... 386

4. Methodological Issues in Assessing Stressful Life Events ................. 390 4.1. Types of Events ........................................................ 391 4.2. Magnitude of Events ................................................... 392 4.3. Timing of Events ....................................................... 392 4.4. Meaning of Events ................................................... " 392 4.5. Causality versus Correlation ........................................... 383 4.6. Moderator Variables ................................................... 393

5. Cognitive Appraisal and the Experience of Stress ......................... 394 6. References .................................................................... 395

Chapter 17. Behavioral Indicators of Client Progress after Spinal Cord Injury: An Ecological-Contextual Approach 401

EDWIN P. WILLEMS AND JAMES L. ALEXANDER

1. Background .................................................................. 401 2. Observational Developments ................................................. 403 3. Reduction and Selection ...................................................... 406 4. Clinical Personnel as Estimators ............................................. 408 5. Self-Observation and Report of Behavior .................................. 411 6. Prediction of Outcomes ...................................................... 413 7. Concluding Comments ....................................................... 415

Chapter 18. Issues in Patient Compliance

PARK O. DAVIDSON

417

1. MedicaICompliance .......................................................... 418

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2. Social Compliance ............................................................. 421 2.1. Social Exchange ........................................................ 422 2.2. Social Power ........................................................... 423 2.3. Social Influence ......................................................... 423 2.4. Forced Compliance .................................................... 424 2.5. Attribution Processes .................................................. 425

3. Behavioral Compliance ....................................................... 426 3.1. Self-Reinforcement. .................................................... 427 3.2. Self-Monitoring ........................................................ 428 3.3. Behavioral Contracting ................................................ 428 3.4. Self-Instructional Training ............................................ 428

4. Other Compliance-Improvement Strategies ................................ 429 5. Some Paradoxes ............................................................... 429 6. References .................................................................... 430

Chapter 19. Psychomaintenance of Chronic Physical Illness: Clinical Assessment of Personal Styles Affecting Medical Management 435

ROBERT A. KINSMAN, JERALD F. DIRKS, AND NELSON F. JONES

1. Psychomaintenance of Physical Illness ...................................... 435 2. Two Assumptions Relating to Assessment. ................................. 436 3. Examples of Psychomaintenance ............................................ 437 4. The Context of Psychomaintenance ......................................... 438 5. Psychomaintenance and Its Assessment in Asthma ........................ 441

5.1. Characteristics of Asthma and Its Treatment. ....................... 441 5.2. The Battery of Asthma Illness Behavior (BAIB) .................... 442 5.3. The Empirical Basis of the BAIB: Nine Personal Styles ............ 443

6. Examples of Assessment and Treatment ................................... 450 6.1. Patient A: A Low Panic-Fear Personality, Symptom Disregarder. 450 6.2. Patient B: A High Panic-Fear Personality, Vigilant Patient. ....... 454 6.3. Patient C: A Moderate Panic-Fear Personality, Vigilant Patient ... 457 6.4. Patient D: A Moderate Panic-Fear Personality, Typical Patient ... 459 6.5. Summary of the Psychomaintenance Assessment Approach and

Its Implications for Treatment. ....................................... 461 7. Relevance and Generality of Psychomaintenance .......................... 462 8. References .................................................................... 464

Chapter 20. Behavioral Health Care in the Management of Chronic Pain

JEFFREY STEGER AND WILBERT FORDYCE

1. Some Behavioral Concepts in Pain Treatment. ............................ 467 1.1. Pain as Behavior ........................................................ 468

1.2. Respondent versus Operant Pain Behavior. ......................... 469 1.3. Acute versus Chronic Pain ............................................ 470 104. Behavioral Health Care Goals ......................................... 471 1.5. Review of Behavioral Strategies in Pain Treatment ................. 472

2. Behavioral Health Care Techniques ........................................ 475 2.1. Evaluation Procedures ................................................. 475 2.2. Treatment Strategies ................................................... 482 2.3. Use of Adjunct Pain Treatment ..................................... 493 204. Contraindications for Behavioral Health Care ..................... 494

3. Conclusion .................................................................... 495 4. References .................................................................... 495

Chapter 21. Cognitive Behavior Therapy in Health Psychology 499

ROBERT B. MEAGHER, JR.

1. Theoretical Issues in Cognitive Behavioral Therapy ...................... 500 2. A Theoretical Model of Behavior Change .................................. 501

2.1. Description of the ModeL ............................................. 501 2.2. Assessment .............................................................. 502 2.3. A Critical Appraisal of the Model .................................... 503

3. Issues in Cognitive Behavioral Assessment. ................................ 504 4. Cognitive Behavioral Therapy for Type-A CHD Patients ................ 505 5. Cognitive Behavioral Approach to Pain Treatment ....................... 507 6. Program Blending Cognitive Behavioral Aspects of Chronic Pain

Treatment .................................................................... 509 6.1. Theoretical Assumptions .............................................. 509 6.2. Program Overview ..................................................... 510 6.3. Assessment .............................................................. 510 6.4. Physical Therapy ....................................................... 511 6.5. Occupational/Recreational Therapy .................................. 511 6.6. Rehabilitation Specialist. ............................................... 512 6.7. Physical Medicine ...................................................... 512 6.8. Psychology Program ................................................... 512 6.9. Research ................................................................ 514

7. Conclusion .................................................................... 514 8. References .................................................................... 515

Chapter 22. Hypnosuggestive Procedures in the Treatment of Clinical Pain: Implications for Theories of Hypnosis a'Y!d Suggestive Therapy 521

THEODORE x. BARBER

1. Hypnosuggestive Procedures in Surgery .................................. 522 2. Postsurgical Effects of Hypnosuggestive Procedures ..................... 524

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XXIV

CONTENTS

3. Hypnosuggestive Procedures in the Treatment of Back Pain ........... 526 4. Hypnosuggestive Procedures in the Treatment of Tension Headaches

and Migraines ............................................................... 529 5. Hypnosuggestive Procedures for Cancer Pain ............................ 532 6. Hypnosuggestive Procedures with Burn Patients ......................... 534 7. Hypnosuggestive Procedures for Dental Pain ............................ 535 8. Hypnosuggestive Procedures for Childbirth Pain ........................ 538 9. Effects of Hypnosuggestion on Experimental Pain ...................... 540

10. "Good" Hypnotic Subjects and the Relief of Pain ........................ 543 11. Recommendations for More Effective Hypnosuggestive Procedures ... 545

11.1. Useful Preliminary Procedures ...................................... 545 11.2. Useful Verbal Suggestions ........................................... 546 11.3. Useful Nonverbal Suggestions ....................................... 551

12. Overview: Hypnosuggestive Approaches to Pain ......................... 553 13. References ................................................................... 554

Chapter 23. Patient-Centric Technologies: A C linical- Cultural Perspective 561

SANDRA M. LEVY AND JAN HOWARD

1. The Domains of Patient Power .............................................. 562 1.1. Experiential Expertise ................................................. 563 1.2. Integrative Expertise ................................................... 564 1.3. Initiator Expertise ...................................................... 566 104. Informative Expertise .................................................. 569 1.5. Implementive Expertise ............................................... 571

2. Patient-Centric Technologies-Unilateral and Shared .................... 574 2.1. Unilateral Technologies ............................................... 574 2.2. Shared Technologies ................................................... 576 2.3. Emergent Inventory of Patient Tools and Skills ..................... 578

3. Health Care Delivery as a Bidirectional Process ........................... 581 4. References .................................................................... 582

Author Index

Subject Index

587

605