Psychology in Physical Healthcare

Psychology in Physical Healthcare

• Psychology plays a crucial role in physical healthcare settings.
• 16.5 million people in England have long-term physical health conditions.
• 4.5 million experience psychological distress related to these conditions.
• People with long-term conditions are 2-3 times more likely to experience mental health difficulties compared to the general population.
• This risk increases to 7 times for people with one or more conditions.
• 10-30% of children are affected by physical health difficulties.
• 11% of children experience significant chronic illnesses that limit daily life.
• 10-37% experience a psychological difficulty.
• This relationship between physical and psychological health accounts for £8-13 billion of the NHS budget in England.
• 50% of GP appointments and 70% of bed days and acute/primary care budgets are related to this.

Definitions

• Acute illness/injury/pain: Pain lasting less than 6 months, a warning sign that something is wrong.
• Chronic pain/condition: Pain lasting more than 6 months. Long-term health conditions that typically have no cure, and are managed using medications and interventions.

What do I do?

• Clinical Psychologist at Great Ormond Street Hospital NHS Foundation Trust.
• Across Psychological and Mental Health Services Department in different medical teams.
• Private practice.

Today's Session Aims

• Understand the background and context of psychology in physical healthcare settings.
• Discuss the role of psychology.
• Discuss models and evidence-base for psychology in physical health.
• Identify the challenges of using psychology in physical healthcare.
• Examine a clinical case study.

What contributes to increased costs?

• Inappropriate psychological support resulting in a 45-75% increase in service costs, regardless of medical condition.
• Costs remain even after considering demographic and clinician factors.
• Unnecessary medical investigations.
• Frequent A&E visits and outpatient appointments.
• Increased medication use and admissions.
• Indirect costs such as missed work and reduced productivity.

Mindy and Body Dualism

• 17th Century philosophy (Descartes).
• Mind and body are separate entities.
• Underpins the medical model.

Biopsychosocial Model

• Biological, social and psychological factors all interact to influence health and well-being.
• Developed by Engel (1977).

Role of Clinical Psychologists

• Clinical work (individual, families/couples, group).
• Joint work with other professionals (multi-disciplinary teams).
• Inpatient and outpatient work.
• Consultation.
• Teaching, education, and training.
• Facilitating reflective practice for medical staff.
• Supervision.
• Research and audit.

What models do we use in physical health?

• Cognitive Behavioral Therapy (CBT)
• Third-wave approaches.
• Compassion-Focused Therapy.
• Acceptance and Commitment Therapy (ACT).
• 5 P's.
• Solution-Focused Approaches.
• Systemic approaches.

Clinical effectiveness of psychological interventions

• Evidence-based interventions (e.g., CBT, third-wave therapies) improve treatment adherence, adjustment to conditions, quality of life, and coping.
• Self-help interventions sometimes improve mood in patients with physical health conditions.
• Studies show psychological interventions improve psychological symptoms and reduce cardiac mortality.
• Short, medium, and long-term psychological interventions improve quality of life in patients with long-term conditions.
• ACT improved psychological stress and depression in patients with Irritable Bowel Disease.
• CBT for migraine reduces frequency and intensity.
• CBT is effective for chronic pain.
• Integrated care models (MDT) improve quality of life and mood for conditions like Type 2 diabetes.
• NICE guidelines recommend psychological approaches as part of interventions for certain physical conditions.

Challenges

• Failure to recognize psychological factors contributing to physical presentations.
• Focusing solely on physiological aspects, ignoring individual factors.
• Risk of pathologizing distress or normal coping responses to stress.
• Using language that pathologizes.

Assumptions

• Assumptions influence perceptions, often unconsciously.

Assumptions - Small Groups

• Identify assumptions about medical conditions and presentations.
• Assess how these influence perceptions.
• Explore assumptions of medical professionals and psychologists.
• Examine how these assumptions impact service users.

Case Example

• 40-year-old male with chronic headaches and fatigue.
• Symptoms started 10 years ago and lost job around the same time.
• Initial GP visit suggesting problem was in his head, leading to 5 years without seeking support.
• Family background of not discussing emotions.
• Triggered by feeling overwhelmed and experiencing light sensitivity.
• Coping strategies focussed primarily on individual efforts without seeking support.

Case Example - Questions

• What information is needed to assess the patient?
• What factors might influence the assessment?
• How can the difficulty be understood?
• What might be maintaining the problem?
• What protective factors may exist?
• What can be done to help?

Further Suggested Reading

• Books available for further information on psychology in physical health are Pain is Really Strange, The Body Keeps the Score, Promoting Psychological Well-Being and others.

References

• List of cited sources for the session. (Multiple authors' names with year).