Clinical psychology is a field of psychology that specializes in diagnosing and treating mental, emotional, and behavioral disorders. It involves researching and applying principles and methods to understand, predict, and alleviate maladjustment, disability, and discomfort. The biopsychosocial model views health as being influenced by biological, psychological, and social factors that interact in complex ways. Understanding these interactions helps provide more accurate diagnoses and effective treatments that consider the whole person.

1. CLINICAL PSYCHOLOGY
UNIVERSITY OF BURA
O
FACULTY OF MEDICINE AND HEALTH SCIENCE
S
LECTURER: ESTEFANIA CUBERO SIERRA

2. INTRODUCTIONTO CLINICAL
PSYCHOLOGY

3. PSYCHOLOGY
Psychology: the study of the mind and behavior
.
Diverse scienti
fi
c discipline comprising several major branches of research, as well as several
subareas of research and applied psychology.
Research involves observation, experimentation, testing, and analysis to explore the biological,
cognitive, emotional, personal, and social processes or stimuli underlying human and animal
behavior.
Practice involves the use of psychological knowledge for any of several purposes: to
understand and treat mental, emotional, physical, and social dysfunction; to understand and
enhance behavior in various settings of human activity; and to improve machine and building
design for human use.

4. • Clinical psychology provides mental health services for people of all ages and from
all walks of life
.
• Methods and techniques may vary from practice to practice.
• Focus: assessing clients’ mental health through psychological assessment and
testing, and providing appropriate interventions
.
(Division 12 of the American Psychological Association, 2016).
CLINICAL PSYCHOLOGY

5. CLINICAL PSYCHOLOGY
Clinical psychology:
fi
eld of psychology that specializes in the research,
assessment, diagnosis, evaluation, prevention, and treatment of emotional and
behavioral disorders
.
Clinical Psychology involves: research, teaching and services relevant to the
applications of principles, methods, and procedures for understanding,
predicting, and alleviating intellectual, emotional, biological, psychological, social
and behavioral maladjustment, disability and discomfort.

6. WHAT IS HEALTH
?

7. HEALTH
Health operates on many levels: physical, subjective, behavioural, functional, and social.
People think of health in six different ways (Blaxter, 1990):
Not having
symptoms of
illness.
Having physical
or social
reserves.
Having healthy
lifestyles.
Being
physically fit or
vital.
Psychological
wellbeing.
Being able to
function.

8. Which of these definitions we use will have implications for who receives
treatment.
Health issues are complex and require our consideration of the individual.
Health and illness are subjective states of wellbeing.
Does the person feel or think they are healthy or ill? Do they have physical
symptoms that they believe mean there is a problem with their health?

9. LUNA PETER KATE
22 and a university student.
Healthy diet; keen athlete.
Her mother died of breast
cancer when Jenny was 13
and Jenny’s older sister has
just been diagnosed with it.
Screening shows that Jenny is
carrying a mutation in the
BRCA gene which means she
is at high risk of breast cancer.
She has been offered surgery
to remove both breasts as a
preventative measure.
Businessman aged 50.
He’s been training to run a
marathon (42 km)
.
Peter did it once when he was
younger and fitter, but had to
stop
.
Last week he attempted it and
m a n a g e d t o f i n i s h t h e
marathon without stopping. He
says it was exhilarating.
He has terminal liver cancer
and approximately six months
left to live.
32 and divorced with four
children under the age of 7.
She works part-time.
Her ex-husband has remarried
and has a new baby
.
Karen is upset and finds it hard
to maintain a relationship.
She is depressed and smokes
30 cigarettes a day.
Four weeks ago she tried to kill
herself through a paracetamol
overdose and woke up in
hospital.

10. Definition Features of definition Are they healthy or ill?
LUNA PETER KATE
Physical Absence of diseas
e
Not vulnerable to diseas
e
Strong physical reserve
s
Physically fit, has vitality
Subjective No symptoms of physical illness
Behavioral Living a healthy lifestyle
Functional Able to function in day-to-day life
Psychosocial Psychosocial wellbeing
Social Able to contribute to society
Cultural Matches cultural norm for health
DEFINITIONS OF HEALTH

11. Definition Features of definition Are they healthy or ill?
LUNA PETER KATE
Physical Absence of diseas
e
Not vulnerable to diseas
e
Strong physical reserve
s
Physically fit, has vitality
Health
y
Il
l
Health
y
Healthy
Il
l
Il
l
Il
l
Healthy
Health
y
Health
y
Health
y
Ill
Subjective No symptoms of physical illness Healthy Ill Healthy
Behavioral Living a healthy lifestyle Healthy Healthy Ill
Functional Able to function in day-to-day life Healthy Healthy Ill
Psychosocial Psychosocial wellbeing Healthy Healthy Ill
Social Able to contribute to society Healthy Healthy Ill
Cultural Matches cultural norm for health Healthy Ill Ill
DEFINITIONS OF HEALTH

12. How we define health has wide-ranging implications for the treatments
provided
.
Antonovsky (1987) proposed that we think of health as a continuum from
optimal wellness to death.
Health
promotio
n
They operate on the
wellness side of the
continuum to
encourage people to
choose a lifestyle that
oprimises their
health.
Medical
treatment
It focuses on the
illness side of the
continuum when
people show signs or
symptoms of illness.

13. ILLNESS- WELLNESS CONTINUUM

14. WHAT ISTHE IMPORTANCE OF
PSYCHOLOGY
IN MEDICINE
?

15. IMPORTANCE OF PSYCHOLOGY
IN MEDICINE
Each person is a unique mix of thoughts, emotions, personality,
behavior patterns, and their own personal history and experiences.
Understanding more about people helps us treat them more
effectively.
Healthcare practices often imply a mechanical view of the body
and medicine where mind and body are independent. This
approach (biomedical) is unhelpful.

16. In order to treat people effectively we need to be able to:
diagnose the problem accuratel
y
treat that problem appropriately.
Accurate diagnoses are more likely if we understand how people’s experiences
shape their perception and reporting of symptoms, and help-seeking behaviors.
Negotiating an effective treatment plan rests on understanding decision-making
processes, what makes people more likely to adhere to treatment, and the influence of
people’s beliefs and emotions
.
Understanding psychological and social processes helps diagnose and treat people
more effectively.

17. Psychology helps understand psychological symptoms (e.g. anxiety, depression),
as well as diagnostic disorders (e.g. panic disorder, major depressive disorder,
schizophrenia).
The majority of people with psychological symptoms will present with physical
symptoms
.
There is a strong link between physical health and psychological health: if we
concentrate on only one side, we risk missing key information and prescribing
ineffective treatments.
Psychological interventions -cognitive behavior therapy (CBT)-, can be effective in
managing or treating illnesses that have physical and psychological components.

18. Psychology will often present competing theories and supporting or conflicting
.
Psychology requires a different way of thinking, but this method is a useful skill
in itself –essential in medical practice. A lot of medical practice is about dealing
with uncertainty, often in the face of patients who want certainty.
I.e, people will rarely present with clearly defined textbook symptoms. Thus,
medical doctors often have to form a hypothesis, then find a way to test it, and
then reformulate it if needed
.
Understanding the psychosocial context of a person’s symptoms and concerns
will help you reach a more probable diagnosis and/or provide reassurance in the
face of uncertainty.

19. MIND AND BODY
Mind and body are interdependent and influence each other in numerous ways,
as does our environment and the people around us
.
Our mind influences physiological factors (fight-flight stress responses, pain,
and physical symptoms).
Many aspects of cognition are influenced by our bodily state and experiences.
I.e., memory making and recall, decision making and judgement, concepts and
language.

20. APPROACHESTO MEDICINE AND
HEALTHCAR
E
(BIOMEDICAL & BIO-PSYCHO-SOCIAL)

21. I. BIOMEDICAL APPROACH
It assumes that all diseases can be explained in terms of physiological processes:
therefore the treatment acts on the disease and not on the person.
There is a linear progression of causality from the pathogen to the person and
not the other way around. Psychological and social processes are separate and
incidental.

23. II. BIO-PSYCHO-SOCIAL APPROACH
Framework that includes biological, psychological, and social factors
.
Later expanded to include ethnicity and culture as additional factors
.
It takes into account internal and external factors that have an impact on health.

24. External factors
•Sociocultural environment (poverty,
available support structures,
access to healthcare),
environmental factors and
legislation
.
•Pathogenic stimuli (being exposed
to a virus, passive smoking, living
in an area high in radon gas).
•Any treatment that the individual
receives which can act on the
pathogenic stimuli or the person.
Internal factors
•Personal history (ethnicity, genetics,
learned behavior, developmental
processes, and previous illnesses)
.
•Psychosocial processes (lifestyle,
sociability, personality, mood,
perception of symptoms, behavior,
adherence to treatment)
.
•Physiological and biochemical
mechanisms.

25. Illness is caused by many factors at different levels, rather than purely by pathogens.
Responsibility for health and illness rests on individuals and society.
Physical, psychological, and social factors all influence, and are influenced by, each
other.
There is rarely a simple and linear cause–effect relationship between one factor and
illness.
Difficulties in clinical practice if we need to choose or prioritize one treatment.
KEY: think in terms of a hierarchy of causes (e.g. one cause is more important
than others) and linearity of treatment (e.g. removing this cause will remove illness)

26. THREE P’S
1. Predisposing factors: things which make people more susceptible to mental
illness (increase the risk).
2. Precipitating factors: events or experiences which in
fl
uence whether a
predisposition to a mental illness is ‘activated’. Not every person with the same
predisposing factors will develop a psychiatric disorder – precipitating factors may
interact with predisposing factors to bring about psychopathology.
3. Perpetuating factors: they act after the onset of illness to prolong its duration.
Sometimes diseases are self-perpetuating.

27. Predisposing
factors
•Genetic factor
s
•Experiences in
uter
o
•Birth traum
a
•Childhood context
Precipitating
factors
•Diseas
e
•Drug us
e
•Stres
s
•Social changes
Perpetuating
factors
•Disease factor
s
•Social context
Constitution Illness
Recovery or
chronic illness

29. Aspect Biomedical Biopsychosocial
Mind- body relationship Separate; independent
(dualism)
Part of dynamic system; they
influence each other
Cause of disease Pathogens Multiple factors at different levels
Casuality Linear Circular
Psychosocial factors Irrelevant Essential
Approach to illness and
treatment
Reductionist Holistic
Responsibility for health Medical professionals-
e.g. to combat disease
Individuals/ society- e.g. healthy
lifestyle
Focus on treatment Erradication or
containment of
pathology
Physical, psychological, and
social factors contributing to
illness
Focus of health
promotion
Avoidance of
pathogens
Reduction of physical,
psychological, and social risk
factors

30. This tendency to focus on biology or psychology emerges in debates about
nature and nurture
.
Health and wellbeing are determined by nature and nurture.
Health status is more than simply a consequence of biological, physiological,
or genetic factors; it is also affected by much broader economic, social,
cultural, and environmental elements.
Nature
Inherited traits are
the determinant of
behaviour and
wellbeing (genes).
Nurture
Learned behavior is
the determinant
(environment and
psychosocial
context).

31. NOTES IN CLINICAL PRACTICE
Psychological and physical symptoms are highly related.
Understanding and changing health behavior would do more than anything else to
reduce morbidity and mortality in our society
.
People respond differently to illness so it’s important not to assume every person can/
should be treated the same way
.
Tolerance of ambiguity and the ability to test alternative explanations for symptoms are
essential clinical skills.
The holistic approach means we should consider biomedical factors, lifestyle behavior,
psychological factors (e.g. beliefs, emotions, symptoms), and social factors.

32. REFERENCES
• Alliant International University. What is Clinical Psychology? Accessed October 3, 2022, https://
www.alliant.edu/blog/what-clinical-psychology
• Antonovsky, A. (1987) Unraveling the Mystery of Health: How People Manage Stress and Stay Well.
San Francisco, CA: Jossey-Bass
.
• Ayers, Susan; de Visser, Richard. Psychology for Medicine and Healthcare (p. 409). SAGE
Publications. Kindle Edition.
• Cooper, R. (2014) Diagnosing the Diagnostic and Statistical Manual of Mental Disorders : Fifth
Edition. Routledge
.
• Division 12 of the American Psychological Association (2016) Clinical psychology. Retrieved Sept
22, 2022 from https://div12.org