PSY004 1 Health Psychology

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Answer:

Introduction:

For a health psychologist, it is necessary for them to conduct baseline assessment of clients with psychological issues. It helps them to determine the factors or risk that has lead to the specific health behavior or psychosocial issues in client. This in turn helps them to develop relevant action plan to promote health and well-being in affected person. In the pre modern era, health psychologists are conducting psychological evaluation by the application of several relevant models and theories. The application of these models in psychological evaluation helps them to assess individual behavior, personality and cognitive abilities of client. The main purpose is to determine the factors or context in client’s life that is hindering their ability to feel and behave in a constructive manner (Levitt, Pomerville & Surace, 2016). The process of health psychology assessment and method of psychological assessment is presented in this essay by the case study of Tracey, a 36 year old female with a child. The essay also critically evaluates two theories in relation to selected targeted behavior for the client based on the needs analysis process.

Part 1: Needs analysis of the client based on history, context and risk:

The needs analysis is presented for Tracey, a 36 year old female who has come to the GP with complains of lethargy and feeling low throughout the day. She is also not happy with her weight. Her concern about weight is true because she has a BMI of 32 which puts her into clinically obese category. Her lifestyle and eating habit is also one of the reasons for putting on weight. Review of her lifestyle suggests that she seldom eats healthy meal and binges on fast food and chocolates a lot. For instance, Tracey goes to pub 2-3 times a week and drinks wine. She works in a nursery school and on her way home, she often eat chocolate. Snacking on crisps and ice cream is also common for her in the evening. Hence, unhealthy lifestyle is one of the identified risk factor that has increased weight of Tracey and this in turn has resulted in negative psychological consequences for her.  This is proved by the research by Eyres et al., (2014) too as the study showed that obese people have lower self-esteem and tends to get more serious disorders like depression and eating disorders too. Obese people also feel inactive compared to normal weight individuals because it takes more efforts for them to engage in physical activity (Bhurosy & Jeewon, 2014). The same is the case with Tracey as engages in binge eating however she feels she does not eat much. Hence, binge eating and unhealthy diet and obesity is the antecedent that causes feelings of tiredness and the consequence of this is that it would increase risk of diabetes and other chronic disease in client.

Tracey’s complains of feeling tired and low is also seen due to poor physical activity. The review of her current lifestyle shows that she does not do any exercise or go for a walk. Although she has used a slimming club in the past and she used to run 2-3 times a week with her partner, however she does not feel the need to exercise now because she always rushes around her children. Hence, poor physical activity is one of the identify risk factors that has resulted in increased weight for Tracy as well as feelings of tiredness. In addition, in future, this behavior is likely to increases the risk of developing Type 2 diabetes in the client. There are numerous research literatures which have illustrated the relation between physical activity and feelings of energy and fatigue. Puetz, (2006) explained that physical activity combats feelings of low energy and dose-response relationship was found between physical activity and feelings of energy and fatigue. Evidence has also showed that lack of exercise and physical activity also makes people unhappy and hampers their quality of life. Regular exercise improves stress response and addresses symptoms of depression, poor self-image and cognitive decline in clients. Hence, increasing physical activity must be a priority to change behavior of Tracy.

Family history of client also gives idea about health risks factors or other factors contributing to current behavioral change in client. In case of Tracey, it has been found that Tracy has a past medical history of gestational diabetes and her mother was also diagnosed with type 2 Diabetes. Hence, there is increases risk of Tracey also developing the condition. Unhealthy eating and poor physical activity is likely to increases the risk too, hence there is a  need for action plan in this area too. As Tracey is clinically obese, this is also most likely to increase the risk of developing Type 2 diabetes in the future. Eckel et al., (2011) has revealed that most of the patients with type 2 diabetes are obese and the global epidemic of obesity is the main reason for high prevalence of type 2 diabetes. The common link between obesity and diabetes is deranges fatty acid metabolism, insulin resistance and defect in the cellular processes like mitochondrial dysfunction. Al-Goblan, Al-Alfi, & Khan, (2014) clarified the mechanism linking diabetes mellitus and obesity by stating that obesity increases the amount of fatty acids, hormones, cytokines and pro-inflammatory markers which plays a role in the development of insulin resistance. Hence, it is proved that weight gain and body mass is central to the high incidence of type 2 diabetes and Tracey’s risk was also high due to high BMI.

To change the behavior of Tracey and identify the appropriate intervention for her, it will be necessary for health psychologist to assess the current status of the behavior in Tracey. The main behavioral issues for which she went to the GP was feelings of low mood, fatigue and not satisfied with her weight. However, the main behavior causing this behavior change included unhealthy food consumption, poor exercise and physical activity regimen and family history of diabetes. Hence, the current need is to assess the frequency, duration and intensity of fatigue and low feeling in client and find out Tracey’s current level of physical activity and food intake. This would be beneficial in controlling symptoms of sadness in client and reducing the risk of causing depression.

Socio-cultural factors might also be a reason for low mood and feelings of fatigue in Tracey. One indication from the case scenario regarding social cause of low mood is that her partner is not living together with her. It has been mentioned that she went to slimming club and walk when her partner live together. Hence, lack of support from partner might have increased life stress and feelings of low moods in Tracey. It is also a reason for her poor motivation to change her lifestyle.  Rao et al., (2008) also explains that interpersonal relationship plays a major role in the development of feelings of hopelessness and low mood and poor self-esteem. In addition, psychosocial factor might be a reason for low mood too. For instance, links between nutrition and depression has been found. Impaired food patterns like skipping meals and desire for sweet foods are intertwined with human cognition, behaviors and emotions. Poor choice of selecting foods also contributes to depression; hence it will also be essential for health psychologist to consider doses of dietary supplements for Tracey.

In relation to the behavioral and health risk identified in Tracey, the main role of health psychologist is to achieve the target behavior of active lifestyle and feelings of happiness and high self-esteem in client. By means of a planned session with client till 3 months, it is proposed to implement appropriate interventions for Tracey that support in achieving the outcome of reducing body mass, promoting healthy eating and 30 minutes of physical activity every day.

Part 2: Evaluate theories and models associated with target health outcome:

Some of the relevant theories that predetermine the target health outcome of achieving active lifestyle and high self-esteem in client include the social cognitive theory. The application of the concept of this theory in therapy session is likely to help health psychologist in achieving the desired outcome for client because Tracey has little motivation to change her lifestyle. Although she does not do any exercise or went to walk, she feels that she is active throughout the day. Hence, the cognitive behavioral model can help psychologist to make Tracey aware of the risk to her health due to unhealthy lifestyle and poor physical activity. Cognitive approach to treatment of client is based on two theories-one is the learning theory and other is the emotional processing theory. Learning theories are related to behavioral approaches as it aims to modify behavior of an individual by means of changing environmental cues (Eysenck, 2013). Hence, in the context of Tracey, her attitude towards making changes in her lifestyle can be done by means of reinforces such as giving the fear that inadequate physical activity might lead to development of diabetes and other chronic disease in client. In addition, the emotional processing theory can provide a framework to psychologist to use emotional experiences to affect behavior of client. Cognitive, behavioral and learning theories are all part of this approach and emotional re-experiencing can motivate the client to avoid negative behavior in their life (Zalta et al., 2014).

The above theory is useful to change the attitude of Tracey towards her life during the session. To promote well-being of Tracey, the most important priority is to modify her attitude and behavior towards maintaining healthy lifestyle. After the alteration of thought, it will be easy for Tracey to follow necessary nutritional and physical activity guidelines provided by psychologist.  However, the disadvantage of using the cognitive behavioral therapy for changing the behavior of client is that it does not explore personal emotions and emphasize too much on negative thoughts of clients instead of positive evaluation. This may have an impact on perceived self-efficacy and self-regulatory strategies of client and lead to intention-behavior gap. Hence, when motivating Tracey to change her view regarding food habits and physical activity throughout the day, the factor of planning, action control and maintenance of self-efficacy will have an impact on immediate exercise intervention and later physical activity in Tracey (Rhodes & Bruijn, 2013). Therefore, changing the intention of client to the targeted behavior is critical because theories of planned behavior have shown that behavioral intentions affect the process of adoption and maintenance of physical activity. Hence, while planning specific intervention for Tracey, it is necessary to put emphasis on intention because it is proximal antecedent of behavioral enactment.  

The limitation mentioned in social cognitive model can be addressed by HAPA (Health Action Process Approach) model and the com-B model for behavioral wheel while designing behavioral change intervention for Tracey. The advantage of HAPA model is that focus a lot on intention and motivation process to change client’s behavior. The model proposes developing an intention (motivation) phase followed by the plan of action (volition) phase to engage people in health behavior (MacPhail et al., 2014). Hence, this model is most relevant for Tracey as first phased will enhance her motivation to change her lifestyle by means of activities like risk awareness of poor lifestyle and task self-efficacy by adapting healthy lifestyle. This will help in the formation of intention to change health risk behavior and adapt healthy behavior in life. After this, the process of action planning regarding daily nutritional supplements and exercise regimen can be developed for Tracey. This will her to gain back her self-esteem and feel happy and satisfied with her life. Another advantage of the HAPA model is that it also focus on recovery self-efficacy unlike other models by focusing on addressing disengagement from planned action in client (MacPhail et al., 2014). Despite the advantages, one limitation of the HAPA model is that it can create mismatch between needs of client and the physical activity program if participants were not in the stage of pre-intention, intention and action while these stages of intervention.

The Com-B model with behavioral change wheel is another theoretical model to design behavioral change interventions. This framework proposes a behavioral system consisting of the condition of capability, opportunity and motivation (COM-B system). This model evaluates the psychological and physical capacity to engage in an activity and motivation and opportunity further completes the process needed to change existing behavior and adopt a new behavior. The advantage of this behavioral change wheel framework is that it incorporates context of client very naturally and this maximizes the effectiveness and implementation of interventions for specific clients (Michie, van Stralen & West, 2011). The limitation is the reliability of the behavioral change wheel in creating efficient design has not been established by enough studies.

Part 3: Application of theories and models into practice:

From the analysis of HAPA model and the COM-B system model, it is understood that both the model are the most effective models to bring behavioral change in Tracey and motivate her to adapt healthy lifestyle. While implementing behavioral change interventions by means of above two model, the cognitions that will be a focus of attentions for health psychologist will include the intention, self-efficacy and risk awareness of Tracey to bring changes to her lifestyle and motivation to initiate exercise or physical activity again. Hence, after analyzing the HAPA model and Com-B model, the most important theoretical construct that will be of important during the therapy session includes the motivation and intention of client to change. The justification for this is that focusing on client’s intention promotes effective allocation of resource and identification of motivation to change behavior can also help psychologist to maintain behavior and teach coping skills to enhance the self-efficacy of clients.  

The breakdowns of the behavioral change session plan for Tracey are as follows:

Target behavior: The main goal of the session to make the client lose weight and perform 20 minutes of physical activity and attain the goal of high self-esteem and active life style for clients within 10 weeks.

Current status of target behavior: Currently, Tracey does not engage in any physical activity or take part in any slimming programs. From the socio-cultural context, it can be said that Tracey does not have any support from her family member or her partners to engage in physical activity. Hence, her motivation to engage in physical activity needs to be modified by means of other emotional reinforcers. To implement the behavioral change intervention for Tracey, it will also be necessary to diagnose client’s capability, motivation and opportunity available to engage in physical activity in daily life. This can be done by interview with client.

Theoretical construct of interest

Assessment methods

Methods to facilitate behavior change

Behavioral homework

Intention to change behavior (HAPA and COM-B model)

Psychometric tools like psychological mindedness scale to assess readiness for physical activity and cognitive therapy

Motivational interview with client

Encouraging client to observe the positive impact of physical activity on her mood and feelings and keep a track of it

Self-efficacy and capability for physical exercise (social cognitive theory)

Use of situational confidence questionnaire to identify feelings of client in different situation

Use of Com-B model or Health Belief model to facilitate emotional processing and making client aware of the benefits of active lifestyle for health benefits

Check client self-efficacy in doing physical activity without any provocation everyday.

Risk awareness (HAPA Model)

Questionnaire to assess client’s knowledge regarding risk factor of unhealthy lifestyle

Providing real life examples regarding the benefits or limitation of not engaging in physical activity

Assess risk awareness of client after 10 day by means of set of questionnaire during the interview session.

Conclusion:

The essay summarized the process of behavioral change assessment for clients with psychological issues and the use of relevant theories to bridge the intention-behavior gap during the implementation of treatment intervention. Considering the limitation of several other models, the essay discussed the importance of HAPA model and Com-B model as it focused on modifying the intention of client to change their behavior. Considering this element is critical as it determines the efficacy of the therapy and the likelihood of achieving targeted outcome for client.

Reference:

Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, 587.

Bhurosy, T., & Jeewon, R. (2014). Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic status?. The Scientific World Journal, 2014.

Eckel, R. H., Kahn, S. E., Ferrannini, E., Goldfine, A. B., Nathan, D. M., Schwartz, M. W., ... & Smith, S. R. (2011). Obesity and type 2 diabetes: what can be unified and what needs to be individualized?. The Journal of Clinical Endocrinology & Metabolism, 96(6), 1654-1663.

Eyres, S. L., Turner, A. I., Nowson, C. A., & Torres, S. J. (2014). Does diet-induced weight change effect anxiety in overweight and obese adults?. Nutrition, 30(1), 10-15.

Eysenck, H. J. (2013). Learning theory and behaviour therapy. Readings in Clinical Psychology, 349.

Levitt, H. M., Pomerville, A., & Surace, F. I. (2016). A qualitative meta-analysis examining clients’ experiences of psychotherapy: A new agenda. Psychological bulletin, 142(8), 801.

MacPhail, M., Mullan, B., Sharpe, L., MacCann, C., & Todd, J. (2014). Using the health action process approach to predict and improve health outcomes in individuals with type 2 diabetes mellitus. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, 469.

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 42.

Puetz, T. W. (2006). Physical activity and feelings of energy and fatigue. Sports medicine, 36(9), 767-780.

Rao, T. S., Asha, M. R., Ramesh, B. N., & Rao, K. J. (2008). Understanding nutrition, depression and mental illnesses. Indian journal of psychiatry, 50(2), 77.

Rhodes, R. E., & Bruijn, G. J. (2013). How big is the physical activity intention–behaviour gap? A meta?analysis using the action control framework. British journal of health psychology, 18(2), 296-309.

Zalta, A. K., Gillihan, S. J., Fisher, A. J., Mintz, J., McLean, C. P., Yehuda, R., & Foa, E. B. (2014). Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure. Journal of Consulting and Clinical Psychology, 82(1), 171.

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