clinical psychology

1. APPLICATION OF HEALTHAPPLICATION OF HEALTH
PSYCHOLOGYPSYCHOLOGY
&&
PREVENTION OF HEALTHPREVENTION OF HEALTH
PROBLEMSPROBLEMS
Lecture 40Lecture 40

2.  Nearly everyone agrees that a few simple behaviors, ifNearly everyone agrees that a few simple behaviors, if
widely practiced, would dramatically reduce the toll ofwidely practiced, would dramatically reduce the toll of
human misery.human misery.
 These include reducing our consumption of salt andThese include reducing our consumption of salt and
fatty foods, driving carefully and using seat belts,fatty foods, driving carefully and using seat belts,
exercising regularly, avoiding cigarettes, andexercising regularly, avoiding cigarettes, and
decreasing stress.decreasing stress.
 But giving advice and having people take it are twoBut giving advice and having people take it are two
very different things.very different things.
 Therefore, psychologists, other behavioral specialists,Therefore, psychologists, other behavioral specialists,
and medical professionals have mounted researchand medical professionals have mounted research
programs to learn how to treat and also prevent aprograms to learn how to treat and also prevent a
variety of potentially harmful human behaviors.variety of potentially harmful human behaviors. health:health:
cigarette smoking, alcohol abuse, and weight control.cigarette smoking, alcohol abuse, and weight control.

3. CIGARETTE SMOKINGCIGARETTE SMOKING
 Increased awareness of the dangers of cigaretteIncreased awareness of the dangers of cigarette
smoking has led to a steady decline since the mid-smoking has led to a steady decline since the mid-
1960s in the percentage of Americans who are1960s in the percentage of Americans who are
habitual smokers .habitual smokers .
 However, rates of smoking differ according to gender,However, rates of smoking differ according to gender,
level of education, and income.level of education, and income.
 One disconcerting trend is that the rate of smoking forOne disconcerting trend is that the rate of smoking for
women has shown much less of a decline than that forwomen has shown much less of a decline than that for
men .men .
 In fact, among white-collar workers, the smoking rateIn fact, among white-collar workers, the smoking rate
for women now exceeds that for men.for women now exceeds that for men.
 Cigarette smoking has been linked to an increasedCigarette smoking has been linked to an increased
creased risk of cardiovascular disease and cancer.creased risk of cardiovascular disease and cancer.
 Even though smoking increases one's e chances ofEven though smoking increases one's e chances of
premature death from diseases such as coronarypremature death from diseases such as coronary
heart disease, cancers of the respiraheart disease, cancers of the respiratorytory tract,tract,
emphysema, and bronchitis, people still smoke. Why?emphysema, and bronchitis, people still smoke. Why?

4.  Possible reasons include tension control, socialPossible reasons include tension control, social
pressure, rebelliousness, the addictive nature ofpressure, rebelliousness, the addictive nature of
nicotine, and genetically influenced personality traitsnicotine, and genetically influenced personality traits
such as extraversion.such as extraversion.
 Tension control and social pressure are thought to beTension control and social pressure are thought to be
reasons for initiation of smoking, whereasreasons for initiation of smoking, whereas
rebelliousness, addiction, and personality are seenrebelliousness, addiction, and personality are seen
primarily as maintaining factors.primarily as maintaining factors.
 A variety of techniques have been used to induceA variety of techniques have been used to induce
people to stop smoking, including educationalpeople to stop smoking, including educational
programs, aversion therapy, behavioral contracts,programs, aversion therapy, behavioral contracts,
acupuncture, cognitive therapy, and group support.acupuncture, cognitive therapy, and group support.
 Relapse rates are high (70-80%), however, andRelapse rates are high (70-80%), however, and
research findings about which cessation approach isresearch findings about which cessation approach is
best are conflicting.best are conflicting.
 Most smokers who do quit, do so on their own.Most smokers who do quit, do so on their own.

5.  The best approach seems to be to prevent the habitThe best approach seems to be to prevent the habit
from starting in the first place.from starting in the first place.
 Unfortunately, education alone does not appear toUnfortunately, education alone does not appear to
deter young people from smoking .deter young people from smoking .
 What appears to be more effective is focusing onWhat appears to be more effective is focusing on
immediate rather than delayed negativeimmediate rather than delayed negative
consequences, teaching coping skills, and increasingconsequences, teaching coping skills, and increasing
feelings of self-efficacy.feelings of self-efficacy.
 One of the early encouraging multiple-componentOne of the early encouraging multiple-component
prevention programs aimed at children and teenagersprevention programs aimed at children and teenagers
was based on social learning principles and used peerwas based on social learning principles and used peer
role models .role models .
 Videotaped presentations, peer modeling, discussionVideotaped presentations, peer modeling, discussion
groups, role playing, monitoring smoking, andgroups, role playing, monitoring smoking, and
checking repeatedly on attitudes and knowledge aboutchecking repeatedly on attitudes and knowledge about
smoking were all used with elementary schoolsmoking were all used with elementary school
children.

6.  Such an approach seems superior to those used withSuch an approach seems superior to those used with
adolescents that focus on long-term negative effectsadolescents that focus on long-term negative effects
from smoking.from smoking.
 The trick seems to be to focus on immediate negativeThe trick seems to be to focus on immediate negative
consequences (for example, from peers) rather thanconsequences (for example, from peers) rather than
delayed ones (such as emphysema).delayed ones (such as emphysema).
 Programs similar to Evans's in Houston have beenPrograms similar to Evans's in Houston have been
undertaken in other states.undertaken in other states.
 Other prevention programs that use student ratherOther prevention programs that use student rather
than adult models to encourage teenagers not tothan adult models to encourage teenagers not to
smoke have been successful as well .smoke have been successful as well .
 Programs that teach refusal skills (practicingPrograms that teach refusal skills (practicing
responding to audio taped offers of cigarettes) alsoresponding to audio taped offers of cigarettes) also
seem to reduce rates of smoking.seem to reduce rates of smoking.

7. ALCOHOL USE AND DEPENDENCEALCOHOL USE AND DEPENDENCE
 It is estimated that about 70% of men and 50% ofIt is estimated that about 70% of men and 50% of
women in the United States consume alcoholicwomen in the United States consume alcoholic
beverages.beverages.
 Although some studies have suggested positive healthAlthough some studies have suggested positive health
benefits from alcohol for light or moderate drinkers,benefits from alcohol for light or moderate drinkers,
consumption of alcohol has also been associated withconsumption of alcohol has also been associated with
a number of negative outcomes.a number of negative outcomes.
 Heavy alcohol use has been associated withHeavy alcohol use has been associated with
increased risk for liver or neurological damage, certainincreased risk for liver or neurological damage, certain
forms of cancer, cardiovascular problems, fetal alcoholforms of cancer, cardiovascular problems, fetal alcohol
syndrome, physical aggression, suicide, motor vehiclesyndrome, physical aggression, suicide, motor vehicle
accidents, and violence.accidents, and violence.
 This extensive list of alcohol-related problems hasThis extensive list of alcohol-related problems has
made the treatment and prevention of alcohol abusemade the treatment and prevention of alcohol abuse
and alcohol dependence (alcoholism) a high priority.and alcohol dependence (alcoholism) a high priority.

8.  Over the years, many treatment approaches haveOver the years, many treatment approaches have
been applied to problem drinkers.been applied to problem drinkers.
 These have ranged from medical treatments andThese have ranged from medical treatments and
medications such as disulfiram (Antabuse) andmedications such as disulfiram (Antabuse) and
naltrexone to traditional psychotherapy and groupnaltrexone to traditional psychotherapy and group
supportive strategies such assupportive strategies such as AlcoholicsAlcoholics
AnonymousAnonymous..
 However, alcoholism is a problem that has beenHowever, alcoholism is a problem that has been
extremely resistant to virtually all intervention, and theextremely resistant to virtually all intervention, and the
relapse rate is high.relapse rate is high.
 Another, more controversial, approach to theAnother, more controversial, approach to the
treatment of alcohol problems istreatment of alcohol problems is controlled drinkingcontrolled drinking..
 As the name implies, this approach has as its goalAs the name implies, this approach has as its goal
light to moderate (but controlled) drinking. Clients arelight to moderate (but controlled) drinking. Clients are
taught to develop alternative coping responses (othertaught to develop alternative coping responses (other
than drinking) and to closely monitor alcohol intake.than drinking) and to closely monitor alcohol intake.

9.  The field is divided as to the merits of this approach,The field is divided as to the merits of this approach,
but research does suggest that controlled drinking is abut research does suggest that controlled drinking is a
viable treatment option for some alcoholics .viable treatment option for some alcoholics .
 Many alcohol treatment programs also incorporateMany alcohol treatment programs also incorporate
relapse preventionrelapse prevention trainingtraining..
 The majority of clients treated for alcohol problemsThe majority of clients treated for alcohol problems
have a relapse episode soon after treatment ishave a relapse episode soon after treatment is
terminated.terminated.
 Rather than see this as a failure (a sign that totalRather than see this as a failure (a sign that total
relapse is imminent), clients are taught coping skillsrelapse is imminent), clients are taught coping skills
and behaviors they can use in "high-risk" situations toand behaviors they can use in "high-risk" situations to
make total relapse less likely.make total relapse less likely.
 Alcohol abuse and dependence are complex problemsAlcohol abuse and dependence are complex problems
that will probably require multimodal treatmentthat will probably require multimodal treatment
strategies.strategies.

10.  Because of the difficulties with secondary and tertiaryBecause of the difficulties with secondary and tertiary
approaches to treatment or prevention, more andapproaches to treatment or prevention, more and
more professionals have turned to primary preventionmore professionals have turned to primary prevention
to forestall the development of problem drinking.to forestall the development of problem drinking.
 For both drinking and drug abuse, programs similar toFor both drinking and drug abuse, programs similar to
those designed to prevent adolescents from smokingthose designed to prevent adolescents from smoking
are being developed.are being developed.
 Often these programs are implemented throughOften these programs are implemented through
health-education courses in high school or mediahealth-education courses in high school or media
campaigns.campaigns.
 School-based prevention programs typically involveSchool-based prevention programs typically involve
one or more of the following components:one or more of the following components:
 Affective education (building self-esteem, increaseAffective education (building self-esteem, increase
decision-making skills);decision-making skills);

11.  Life skills (communication skills,Life skills (communication skills,
assertiveness training);assertiveness training);
 Resistance training (learn to resist pressuresResistance training (learn to resist pressures
to drink alco-hol); andto drink alco-hol); and
 Correction of erroneous perceptions aboutCorrection of erroneous perceptions about
peer norms .peer norms .
 Current research evidence suggests thatCurrent research evidence suggests that
programs that incorporate peer resistanceprograms that incorporate peer resistance
training and correction of misperceptionstraining and correction of misperceptions
regarding peer norms show the mostregarding peer norms show the most
promise (USDHHS, 1997).promise (USDHHS, 1997).

12. OBESITYOBESITY
 Behavioral treatments for obesity have been moreBehavioral treatments for obesity have been more
common than for any other condition.common than for any other condition.
 One reason for this emphasis is that obesity isOne reason for this emphasis is that obesity is
associated with such medical disorders as diabetes,associated with such medical disorders as diabetes,
hypertension, cardiovascular disease, and certainhypertension, cardiovascular disease, and certain
cancers.cancers.
 It is also a socially stigmatizing condition that impairsIt is also a socially stigmatizing condition that impairs
the self-concept and inhibits functioning in a widethe self-concept and inhibits functioning in a wide
array of social settings.array of social settings.
 Often problems of weight can be traced to childhood:Often problems of weight can be traced to childhood:
10-25% of all children are obese, and 80% of these10-25% of all children are obese, and 80% of these
individuals become obese adults .individuals become obese adults .
 Although it is clear that obesity has a geneticAlthough it is clear that obesity has a genetic
component, causes of obesity undoubtedly representcomponent, causes of obesity undoubtedly represent
complex interactions among biological, social, andcomplex interactions among biological, social, and
behavioral factors, and exact mechanisms are difficultbehavioral factors, and exact mechanisms are difficult
to pin down.to pin down.

13.  Traditional medical and dietary methods ofTraditional medical and dietary methods of
treatment have not been very effective; obesetreatment have not been very effective; obese
individuals lose weight but then quickly regainindividuals lose weight but then quickly regain
it.it.
 Furthermore, the dropout rate may be high inFurthermore, the dropout rate may be high in
traditional weight-control programs.traditional weight-control programs.
 Most behavior modification programs includeMost behavior modification programs include
components aimed at restricting certain typescomponents aimed at restricting certain types
of foods, teaching when and under whatof foods, teaching when and under what
conditions to eat, encouraging regular exercise,conditions to eat, encouraging regular exercise,
and maintaining modified eating patterns afterand maintaining modified eating patterns after
the program has ended.the program has ended.
 Again," however, early prevention may be theAgain," however, early prevention may be the
best and safest road to weight control.best and safest road to weight control.

14.  An excellent example of such an approach is theAn excellent example of such an approach is the
Stanford Adolescent Obesity Project.Stanford Adolescent Obesity Project.
 A variety of strategies were used with adolescents inA variety of strategies were used with adolescents in
the hope that control at this age would lead tothe hope that control at this age would lead to
prevention in adulthood.prevention in adulthood.
 The strategies used were self-observation, cueThe strategies used were self-observation, cue
elimination, and social and family support.elimination, and social and family support.
 These interventions were noticeably more effectiveThese interventions were noticeably more effective
when parents were involved.when parents were involved.
 Many investigators are also exploring the possibility ofMany investigators are also exploring the possibility of
using peer group discussion.using peer group discussion.
 A recent ten-year outcome study of a family-basedA recent ten-year outcome study of a family-based
behavioral treatment for childhood obesity suggestsbehavioral treatment for childhood obesity suggests
that early intervention in childhood can effectthat early intervention in childhood can effect
important and lasting changes in weight control.important and lasting changes in weight control.

15. OTHER APPLICATIONSOTHER APPLICATIONS
 Treatment and preventive initiatives must beTreatment and preventive initiatives must be
supplemented with techniques that encourage patientssupplemented with techniques that encourage patients
to cope with medical procedures and to follow medicalto cope with medical procedures and to follow medical
advice.advice.
 COPING WITH MEDICALCOPING WITH MEDICAL
PROCEDURESPROCEDURES
 The' prospect of facing surgery, a visit to the dentist,The' prospect of facing surgery, a visit to the dentist,
or a variety of medical examinations has been enoughor a variety of medical examinations has been enough
to strike fear into the heart of even the strongest.to strike fear into the heart of even the strongest.
 Faced with such procedures, many patients delay theirFaced with such procedures, many patients delay their
visits or even forgo them entirely.visits or even forgo them entirely.
 Health psychologists specializing in behavioralHealth psychologists specializing in behavioral
medicine have developed interventions to helpmedicine have developed interventions to help
patients deal with the stress surrounding suchpatients deal with the stress surrounding such
procedures.procedures.

16. PREPARATION FOR SURGERYPREPARATION FOR SURGERY::
A sizable amount of research has been done onA sizable amount of research has been done on
ways to improve psychological preparation forways to improve psychological preparation for
surgery. Similar to those used to preparesurgery. Similar to those used to prepare
patients for medical examinations andpatients for medical examinations and
procedures, interventions include:procedures, interventions include:
(1) relaxation strategies,(1) relaxation strategies,
(2) basic information about the procedures to be(2) basic information about the procedures to be
used.used.
(3)information concerning the bodily sensations(3)information concerning the bodily sensations
experienced during the procedures, andexperienced during the procedures, and
(4) cognitive coping skills (Brannon & Feist,(4) cognitive coping skills (Brannon & Feist,
2000).2000).

17. HEALTH PSYCHOLOGY: PROSPECTS FORHEALTH PSYCHOLOGY: PROSPECTS FOR
THE FUTURETHE FUTURE
 Health psychology is a growing field, and moreHealth psychology is a growing field, and more
psychologists are entering it every year.psychologists are entering it every year.
 Therefore, it may now be time for the field toTherefore, it may now be time for the field to
take a look at itself and decide how best to traintake a look at itself and decide how best to train
health psychologists and structure programs tohealth psychologists and structure programs to
achieve training goals (Belar, 1997).achieve training goals (Belar, 1997).
 Now we will discuss several health care trends,Now we will discuss several health care trends,
training issues for future health psychologists,training issues for future health psychologists,
and important issues for the field of healthand important issues for the field of health
psychology to address in the future.psychology to address in the future.

18. HEALTH CARE TRENDSHEALTH CARE TRENDS
 By the end of 1997, 85% of Americans belonged toBy the end of 1997, 85% of Americans belonged to
some kind of managed health care plan.some kind of managed health care plan.
 In managed care systems, containing costs is a highIn managed care systems, containing costs is a high
priority.priority.
 We know the great impact managed care has had andWe know the great impact managed care has had and
will have on clinical psychologists.will have on clinical psychologists.
 The impact on health psychologists will be evenThe impact on health psychologists will be even
greater because these specialists often work ingreater because these specialists often work in
medical centers or primary care settings.medical centers or primary care settings.
 Health psychologists, by virtue of their training, areHealth psychologists, by virtue of their training, are
well suited to provide interventions that will serve towell suited to provide interventions that will serve to
cut the costs of medical care .cut the costs of medical care .
 As business and industry realize the costs they mustAs business and industry realize the costs they must
absorb from employees whose habits and lifestylesabsorb from employees whose habits and lifestyles
create absenteeism, inefficiency, and turnover, it iscreate absenteeism, inefficiency, and turnover, it is
expected they will use the skills of healthexpected they will use the skills of health
psychologists more often.psychologists more often.

19.  Although there appears to be an ever-increasing needAlthough there appears to be an ever-increasing need
for clinical psychologists specializing in health orfor clinical psychologists specializing in health or
behavioral medicine, it should also be noted thatbehavioral medicine, it should also be noted that
currently there appears to be a surplus of mentalcurrently there appears to be a surplus of mental
health professionals.health professionals.
 For example, Frank and Ross (1995) estimate thatFor example, Frank and Ross (1995) estimate that
there are approximately 32.8 social workers, 22.8there are approximately 32.8 social workers, 22.8
psychologists, 13.1 psychiatrists, and 4.3 psychiatricpsychologists, 13.1 psychiatrists, and 4.3 psychiatric
nurses for every 100,000 American.nurses for every 100,000 American.
 The problem lies in the overlapping definitions of eachThe problem lies in the overlapping definitions of each
discipline; all claim to assess and treat similardiscipline; all claim to assess and treat similar
problems.problems.
 As the economic stakes become higher, it is likely thatAs the economic stakes become higher, it is likely that
these disciplines self-definitions will incorporatethese disciplines self-definitions will incorporate
concepts and issues once thought to be uniquelyconcepts and issues once thought to be uniquely
characteristic of health psychology and behavioralcharacteristic of health psychology and behavioral
medicine.medicine.

20. TRAINING ISSUESTRAINING ISSUES
 A major source of health psychologists continues to beA major source of health psychologists continues to be
clinical psychology programs.clinical psychology programs.
 The scientist-practitioner and clinical scientist modelsThe scientist-practitioner and clinical scientist models
adopted by most clinical psychology programsenableadopted by most clinical psychology programsenable
them to train clinicians well suited for healththem to train clinicians well suited for health
psychology.psychology.
 Until recently, no other psychology specialty offeredUntil recently, no other psychology specialty offered
the combination of academic, scientific, professional,the combination of academic, scientific, professional,
and hospital experiences required for work in medicaland hospital experiences required for work in medical
settings.settings.
 The roles of methodology, quantitative analysis, andThe roles of methodology, quantitative analysis, and
research design are emphasized.research design are emphasized.
 Other psychology subspecialties are also wellOther psychology subspecialties are also well
represented in health psychology.represented in health psychology.

21.  For the mostFor the most part,part, health psychology is still a kind ofhealth psychology is still a kind of
ad hoc appendage to doctoral programs inad hoc appendage to doctoral programs in
psychology.psychology.
 The student enters a clinical, social, or experimentalThe student enters a clinical, social, or experimental
program and then, in addition to the core experience,program and then, in addition to the core experience,
does some specialized research or takes a practicumdoes some specialized research or takes a practicum
or two in a health-related topic.or two in a health-related topic.
 Perhaps this is augmented by an internship at a healthPerhaps this is augmented by an internship at a health
care site. But essentially, the health experiences arecare site. But essentially, the health experiences are
grafted onto an already existing program in clinicalgrafted onto an already existing program in clinical
psychology or some other related discipline.psychology or some other related discipline.
 Many people are now calling for health psychology toMany people are now calling for health psychology to
be a standard, core training compobe a standard, core training componentnent for allfor all
professional psychologists for example, Frank & Ross,professional psychologists for example, Frank & Ross,
1995).1995).

22.  Because of the importance of health issues and theBecause of the importance of health issues and the
broadening of the definition of clinical and professionalbroadening of the definition of clinical and professional
psychology,psychology,
 Training in areas such as psychopharmacology,Training in areas such as psychopharmacology,
neuropsychology, and psychoneuroimmunology isneuropsychology, and psychoneuroimmunology is
considered essential.considered essential.
 Further, future health psychologists must be trained soFurther, future health psychologists must be trained so
that they can design and conduct studies tothat they can design and conduct studies to
empirically evaluate health outcomes.empirically evaluate health outcomes.
 Currently, some clinical psychology graduateCurrently, some clinical psychology graduate
programs offer "tracks" in health psychology orprograms offer "tracks" in health psychology or
behavioral medicine, but this is the exception ratherbehavioral medicine, but this is the exception rather
than the rule.than the rule.
 In any case, curricular recommendations for healthIn any case, curricular recommendations for health
psychology training continue to be offered.psychology training continue to be offered.

23. OTHER CHALLENGESOTHER CHALLENGES
 Any newly emerging field has problems the definingAny newly emerging field has problems the defining
roles of its members: health psychology is noroles of its members: health psychology is no
exception.exception.
 Years ago. S. E. Taylor t 1984) identified several ofYears ago. S. E. Taylor t 1984) identified several of
these problems.these problems.
 One problem is simply role ambiguity. No one is totallyOne problem is simply role ambiguity. No one is totally
prepared to say just what a health psychologist shouldprepared to say just what a health psychologist should
do-especially in a practical work setting.do-especially in a practical work setting.
 Health psychologists may actually find themselvesHealth psychologists may actually find themselves
without psychology colleagues or role models in thewithout psychology colleagues or role models in the
health setting, which only adds to their confusion.health setting, which only adds to their confusion.
 Second. issues of status also arise. In health settings,Second. issues of status also arise. In health settings,
the physician is clearly at the top of the heap.the physician is clearly at the top of the heap.
 Sometimes the psychologist enjoys much less statusSometimes the psychologist enjoys much less status
in a medical center setting than. for example, in anin a medical center setting than. for example, in an
academic settings.academic settings.

24.  Furthermore, the psychologist and the heath careFurthermore, the psychologist and the heath care
professional may have competing goals.professional may have competing goals.
 The latter may be interested only in identifyingThe latter may be interested only in identifying
immediate ways of helping the patient.immediate ways of helping the patient.
 The psychologist may be more tentative andThe psychologist may be more tentative and
contemplative while thinking about research,contemplative while thinking about research,
theoretical models, and interventions.theoretical models, and interventions.
 As one way of establishing their identity and presenceAs one way of establishing their identity and presence
in settings traditionally dominated by physicians.in settings traditionally dominated by physicians.
 Health psychologists need to document the cost-Health psychologists need to document the cost-
effectiveness of their interven-tions.effectiveness of their interven-tions.
 In this era of health care reform, insurance companiesIn this era of health care reform, insurance companies
and government agencies ate scrupulously examiningand government agencies ate scrupulously examining
ways to drive down the cost of health care.ways to drive down the cost of health care.

25.  Given the many successful and cost-efficientGiven the many successful and cost-efficient
interventions performed by those specializing in healthinterventions performed by those specializing in health
psychology and behavioral medicine, ask Friedman etpsychology and behavioral medicine, ask Friedman et
al. (1995),al. (1995),
 Why haven't these interventions been integrated to aWhy haven't these interventions been integrated to a
greater extent into our health care system? Theygreater extent into our health care system? They
suggest several possible reasons:suggest several possible reasons:
 Many of the data supporting the role of healthMany of the data supporting the role of health
psychology are unknown to physicians.psychology are unknown to physicians.
 Biological origins of diseases and illnesses have beenBiological origins of diseases and illnesses have been
emphasized, causing many to overlook the possibleemphasized, causing many to overlook the possible
benefits of psychosocial explanations and behavioralbenefits of psychosocial explanations and behavioral
interventions.interventions.
 patients may be resistant to psychologicalpatients may be resistant to psychological
interventions and explanations).interventions and explanations).
 Clinical health psychology and behavioral medicineClinical health psychology and behavioral medicine
are still confused with traditional, long-termare still confused with traditional, long-term
psychotherapy.psychotherapy.

26.  Clearly, physicians, insurance companies, theClearly, physicians, insurance companies, the
'federal government, and the general public'federal government, and the general public
need to be educated regarding the role ofneed to be educated regarding the role of
health psychologists, as well as the potentialhealth psychologists, as well as the potential
financial and clinical benefits of theirfinancial and clinical benefits of their
interventions.interventions.
 Another challenge for the field concernsAnother challenge for the field concerns
ethnicity and health.ethnicity and health.
 The health profiles (such as life expectancy andThe health profiles (such as life expectancy and
health status) of various ethnic minorityhealth status) of various ethnic minority
populations in the United States appear to differpopulations in the United States appear to differ
greatly from one another, and more research isgreatly from one another, and more research is
needed on health-promoting and health-needed on health-promoting and health-
damaging behaviors among members of thesedamaging behaviors among members of these
groups.groups.

27.  It is easy to become carried away with the enthusiasmIt is easy to become carried away with the enthusiasm
generated by an exciting new field.generated by an exciting new field.
 This has been true in virtually every area of clinicalThis has been true in virtually every area of clinical
psychology so far.psychology so far.
 However there is still a gap between the field’sHowever there is still a gap between the field’s
promise and its accomplishment.promise and its accomplishment.
 As any experienced clinician will tell you, it is veryAs any experienced clinician will tell you, it is very
hard to change human behavior over the long haul.hard to change human behavior over the long haul.
 Never the less, health psychology most assuredlyNever the less, health psychology most assuredly
deserves our enthusiasm as well as our caution.deserves our enthusiasm as well as our caution.
 Many people are optimistic about the future of healthMany people are optimistic about the future of health
psychology, given the pressing demands of improvedpsychology, given the pressing demands of improved
health care.health care.
 In fact Belar(1997)and others believe that healthIn fact Belar(1997)and others believe that health
psychology is uniquely suited to be the specialty forpsychology is uniquely suited to be the specialty for
the professional practice psychology in twenty-firstthe professional practice psychology in twenty-first
century.century.