INTRODUCTION
Until the mid-60's, about the role of the clinical psychologist is focused, above all, the evaluation and treatment of problems which are usually grouped under the name of mental disorders, but thereafter, he began to pay special attention to other fields related to health in a broader sense. In the past 25 years, the scope of clinical psychology has broadened considerably.
New areas of application of psychological intervention focusing on the following objectives:
- Increasing the health and welfare of people.
- prevention and modification or alleviation of diseases related to psychosocial aspects that can be controlled.
- In cases of chronic conditions, achieving better performance and the maximum possible welfare of both patients, and those close
The factors that have contributed to widening the scope of clinical psychology and more specifically in Behavior Modification:
- In contemporary society the conditions that seriously affect health, in many cases, are related to lifestyle unhealthy, both personal and social demands as behavioral deficits or excesses.
too serious infectious diseases (AIDS) may influence the normal behavior of people.
- social concern, increasing its develop prevention before the disease in its earliest stages and the growing interest in increasing the quality of life of people.
In short, the field of action of clinical psychology and behavior modification has widened considerably in the last three decades, covering both the diseases whose emergence, development, intensity, maintenance, relief, removal or recurrence seem to depend on psychosocial variables, such as changes in chronic health, whose powerful psychological and social consequences should be considered within the overall treatment strategy, extending also to the prevention of disease and increased health welfare and quality of life of healthy individuals by controlling the psychosocial variables that are relevant in this field.
The specific weight of these new applications of psychological intervention in the area of \u200b\u200bhealth, has led to the development of a specialty, Behavioral Medicine and a subspecialty, Behavioral Health.
Behavioral Medicine was defined as "the interdisciplinary field that deals with the development and integration of knowledge and skills specific to behavioral and biomedical sciences related to health and disease and the application of this knowledge and these techniques to prevention, diagnosis The tratamieno and rehabilitation. "
Thus, Behavioral Medicine encompasses both prevention and treatment of biopsychosocial and psychosomatic disorders and their harmful consequences to health and wellness. However, according to Matarazzo, the definition of this specialty does not emphasize enough the importance of health maintenance and disease prevention, necessitating the subspecialty of Behavioral Health.
Behavioral Health, "an interdisciplinary field dedicated to promoting a philosophy of health that stresses individual responsibility in the application of knowledge and techniques of behavioral and biomedical sciences, for health maintenance and disease prevention and dysfunction through a variety of self-initiated activities, individual or shared "
Thus Behavioral Health deals more specifically the field of health and disease prevention, while Behavioral Medicine, not to mention the specific parcel , provides, likewise, treatment of disease and consolidated and improved quality of life for both patients and persons close to them.
OBJECTIVES OF NEW AREAS OF APPLICATION OF PSYCHOLOGICAL INTERVENTION
Overall, behavioral intervention in this new field, you can go to 4 goals:
- Primary prevention: This includes the application of behavioral strategies to strengthen health and prevent the occurrence of diseases that are not yet present. Secondary prevention
- : contemplates the use of strategies to eliminate or control high-risk situations and mild before the problem gets worse (axis: application of a treatment to stop smoking before cancer develops).
- Disease Treatment: the use of intervention programs for the modification of already consolidated disorders (axis: packet behavioral techniques to overcome chronic pain)
- Tertiary Prevention: covers the implementation of strategies with two goals: reducing the likelihood of relapse and to alleviate the adverse effects resulting from chronic conditions. Whereas
- Stress management, which includes the modification of potentially stressful situations and coping responses The usual
- learning or elimination of habitual behaviors that promote or damage health.
- Modification of specific responses and / or relevant environmental conditions specific to each disorder.
The existence of stressful situations in nature, is not sufficient to present the stress response, requiring an adverse interaction between stressful situations and relevant personal variables.
Thus the presence of certain patterns of behavior and / or unhealthy coping styles, such as type A behavior pattern, or the tendency to deny, avoid or escape from the stressful situation, or the absence of behavioral patterns and styles healthier coping, such as the pattern called mental toughness or strength, appear to increase the likelihood of potentially stressful situations cause a detrimental effect.
also noted that the impact of stress depends on the finding that then, on the one hand, the situation and, secondly, of the own resources available to address this situation. The interaction of the two valuations seems to depend stressful situations are perceived by the subject as an injury, a threat or a challenge.
In these assessments may involve factors such as information available, the greater or lesser tendency to process information and evaluate their own resources in an objective, and the existence of effective skills in the repertoire of the individual.
Therefore, behavioral intervention for stress management, should take into account different aspects: the stressful environmental conditions, behavioral patterns and styles coping, how to evaluate stressful situations and their own resources and abilities of individuals to self-manage stressful situations.
Many of these interventions focus on changing the stressful environment of people.
Other times, the intervention focuses on the subjects themselves, for example, training them to master significant skills, relax, use self-instruction. These skills are resources that increase the effectiveness of people to manage the stressful demands of the environment or their own forms of stress.
addition, the procedure can be performed with the aim of modifying the willingness of people to react stress to the stressful demands. For example, changing beliefs, attitudes and values \u200b\u200bto be unreasonable or disproportionate favor a misperception of the stressful situations of their own resources to cope, as well as altering the extent possible, patterns of behavior and risk coping styles (Type A, etc.)
behavioral intervention to control habitual behaviors
Certain common behaviors, by excess or defect, are related to health, or strengthened, by increasing the risk of disease. The leading causes of death could diminish control habits such as diet, snuff consumption, exercise, etc.
As in the case of stress, the application of behavioral treatments to modify health-related habits acquired a significant rise from the 70's.
To date, behavioral intervention focused mainly on eliminating harmful habits, and only anecdotally in healthy habits. The intervention usually includes techniques based on classical conditioning and operant techniques.
Another important element of these treatments, perhaps the most essential, is to strengthen the perception of self-efficacy subjects. Thus, they must perceive that they are able to achieve the objective have been proposed. In this process, an appropriate strategy is to set realistic goals. You must set a final goal and intermediate targets closer to him gradually, the attainment of short-term goals will act thus, as reinforcement of desired behavior and help strengthen the perception of efficacy.
In the process of changing habits related to health are especially critical now that the intervention should be prevented and controlled with great care. It also should prevent relapses, anticipating risk situations that make them more likely and preparing the patient to deal with such situations effectively. In this line, in the case of habits to remove, it must prevent withdrawal symptoms, training patients to control this problem without resorting to behavior eliminated.
behavioral intervention on biopsychosocial alterations
As noted biopsychosocial alterations are considered those in which processes of acquisition, development, intensity, maintenance, relief, removal or repair involving the behavior of individuals and environment in which they unfold.
The application of these treatments has focused in a number of disorders. Including cardiovascular disorders, emphasizing mainly hypertension. In this context, intervention has focused on the direct control of blood pressure reduction in the level of sympathetic activation, control of stressful experiences through various strategies, the acquisition of eating habits and healthy exercise.
Another area of \u200b\u200bintervention has been associated with pain, in particular the chronic headache and functional dysmenorrhea, intervention may include use of biofeedback or relaxation techniques. Have also been used cognitive-behavioral strategies to control the impact of pain, as in the case of stress inoculation adapted to dealing with this problem, training in skills for coping with stressful situations that can cause pain, and operant techniques to eliminate enhancers that may contribute the maintenance of pain.
gastrointestinal disorders, often closely related to stress, and in some cases with few healthy habits. In this area apply as relaxation techniques and coping strategies to reduce and manage stress activation, exposure techniques to eliminate symptoms acquired by classical conditioning, operant techniques to remove reinforcers related disorders and biofeedback techniques with two possible targets: the modification of specific physiological responses to the problem being treated and the decrease in psychophysiological activation. Another
stress disorder is associated with bronchial asthma. The treatment of this disease is stress management through various channels: information to patients and their families, prevention of the most stressful and patient preparation to deal effectively with flare-ups. You can also apply psychological techniques to encourage proper adherence to medication and modify behavioral excesses and deficits associated with the disorder.
insomnia can also benefit from behavioral intervention. The aim is to restore normal sleep patterns. Basically, the usual treatment involves modifying behaviors associated with sleep, and managing stress and activation of sleep affect behavior. You can use techniques such as stimulus control, restricting the time of sleep, relaxation, biofeedback, paradoxical intention and cognitive techniques.
neuromuscular rehabilitation is a work area which can also contribute to behavioral strategies. Specifically, biofeedback can help patients improve their control over muscle activity, or to increase muscle activity deteriorated well to reduce muscle hyperactivity. They are also appropriate psychological techniques to control stress experienced by patients, strengthening adherence to physical therapy and lifestyle changes that in many cases, are essential.
In this line, the psychological intervention can be very useful in the rehabilitation of sports injuries. Buceta has detailed the psychological techniques that can contribute to the recovery of injured athletes, helping them control the emotional impact of injury, to strengthen their motivation and confidence regarding the rehabilitation and prepare for stressful situations. In addition, psychological techniques such as biofeedback, relaxation, practice in imagination, self-instruction and strategies to control pain, are useful to optimize the process of wound healing.
psychological techniques can also be very appropriate in the treatment of patients with diabetes, cancer, AIDS or those who have suffered a heart attack.
IMPLEMENTATION OF INTERVENTION PSYCHOLOGICAL
Despite the growing interest in psychological aspects in the field of biopsychosocial diseases, yet very few psychologists who regularly work in this field. In many cases, they focus on research related to doctoral dissertations or projects, but few have investigated continuity, let alone those with jobs in hospitals and health centers to meet the needs of these patients, or dedicated specifically to these populations in private practice.
same time, the number of medical professionals nurses, physiotherapists and social workers interested in gaining knowledge of psychology through lectures or courses of different types. They believe they can improve their work with patients if the dominant psychological concepts and strategies, sometimes, try to assume the role that really should make a psychologist.
is clear that health professionals are not psychologists, in direct contact with patients, can help better if they master concepts and psychological strategies to incorporate into their work as doctors, physiotherapists, nurses, etc., But that does not mean they can do the work of a psychologist. Sometimes the psychologist not necessary, but when it is, is irreplaceable and, indeed, in his absence, or does one or other professionals often get it wrong.
In short, the psychological work of psychologists and other health professionals are different and complementary.
The distinction between psychological work and psychological work of other health professionals is essential for patients who have biopsychosocial disorders can benefit from all the potential psychological intervention. This distinction should be reflected in the training courses that teach other professional psychologists, in general, these courses should stop Please note:
- recognition of the importance of differentiating the psychologist intervention of psychological intervention in other health professionals, providing arguments to justify this distinction.
- Accentuate the significance of both types of psychological intervention and the importance of both interact properly when appropriate.
- Explain what the psychological intervention of psychologists in each particular context.
- focus primarily on psychological concepts and strategies that may include other health professionals to their daily tasks.
Overall, it can influence the psychological functioning of patients, to encourage healthy behavior through three lines of action: Controlling
- antecedent stimuli and consistent, both external and internal.
- Supporting an appropriate psychological disposition of patients, taking into account that this provision can be more flexible or more rigid and therefore more or less open to external influence.
- Coaching patients to master skills to self-manage their own behavior.
health professionals not psychologists should acquire relevant knowledge, rather than acting simply to "common sense." Psychology is not common sense are both scientific and often differ in shades that can be transcendent in the audit process, and are sometimes completely opposite.
a) Strategies to control external stimuli
is interesting that health professionals understand what the functional analysis of behavior, and be able to apply to a basic level.
They must also learn basic principles of learning, may be of interest to learn to use strategies such as operant stimulus control, the use of incompatible behavior, social and material reinforcement through various techniques, extinction and positive and negative punishment.
Finally, since one of the aims of psychological interventions is to contribute to stress management is also important that health professionals know what is psychosocial stress, and learn to identify potentially stressful situations and stimuli.
is interesting that health professionals understand what the functional analysis of behavior, and be able to apply to a basic level.
They must also learn basic principles of learning, may be of interest to learn to use strategies such as operant stimulus control, the use of incompatible behavior, social and material reinforcement through various techniques, extinction and positive and negative punishment.
Finally, since one of the aims of psychological interventions is to contribute to stress management is also important that health professionals know what is psychosocial stress, and learn to identify potentially stressful situations and stimuli.
b) Strategies to influence the psychological disposition more flexible
is highly desirable for health professionals to acquire knowledge enabling them to understand what is available to patients about the disease and its treatment. They must also learn to develop a good relationship with patients. They must master verbal and nonverbal strategies to increase their interpersonal effectiveness.
It is also advisable to learn to communicate information to patients, taking into account the contents in each case be transmitted, how they should do and should seek psychological objectives. In general, it is important that the transmission of information will contribute to two objectives: to reduce uncertainty and strengthen the patient's perception of control over the disease and the healing process itself.
An interesting technique in this context is the establishment of objectives focused on the patient's own behavior (performance goals) instead of referring to the consequences of behavior (outcome goals). This strategy may lead to a realistic expectation and result in a successful experience should be promoted an internal attribution, targeted, controlled and, as appropriate, stable or unstable with respect to the success achieved. Work in this direction will promote the strengthening of confidence and motivation of the patient.
sometimes must seek to increase the initial motivation of patients and motivation to achieve high and stable during the treatment process. It is therefore appropriate that dominate the way in which meaningful models can be used, and how they can improve the relationship between costs and benefits, taking into account the weight and immediacy of both, and the strategies through which they can involve the patient in making therapeutic decisions.
also interesting that health professionals understand the importance of reducing patient anxiety at certain times and may use strategies such as the approach of "trial periods" or paradoxical intention.
Finally, it is very suitable for such treatment professionals to acquire skills to effectively manage the conflict or uncooperative patients.
psychologist psychological intervention
is highly desirable for health professionals to acquire knowledge enabling them to understand what is available to patients about the disease and its treatment. They must also learn to develop a good relationship with patients. They must master verbal and nonverbal strategies to increase their interpersonal effectiveness.
It is also advisable to learn to communicate information to patients, taking into account the contents in each case be transmitted, how they should do and should seek psychological objectives. In general, it is important that the transmission of information will contribute to two objectives: to reduce uncertainty and strengthen the patient's perception of control over the disease and the healing process itself.
An interesting technique in this context is the establishment of objectives focused on the patient's own behavior (performance goals) instead of referring to the consequences of behavior (outcome goals). This strategy may lead to a realistic expectation and result in a successful experience should be promoted an internal attribution, targeted, controlled and, as appropriate, stable or unstable with respect to the success achieved. Work in this direction will promote the strengthening of confidence and motivation of the patient.
sometimes must seek to increase the initial motivation of patients and motivation to achieve high and stable during the treatment process. It is therefore appropriate that dominate the way in which meaningful models can be used, and how they can improve the relationship between costs and benefits, taking into account the weight and immediacy of both, and the strategies through which they can involve the patient in making therapeutic decisions.
also interesting that health professionals understand the importance of reducing patient anxiety at certain times and may use strategies such as the approach of "trial periods" or paradoxical intention.
Finally, it is very suitable for such treatment professionals to acquire skills to effectively manage the conflict or uncooperative patients.
psychologist psychological intervention
One
of the roles of psychologists in this area is to train and advise health professionals that are in direct contact with patients. Will be also appropriate for psychologists to work together with these professionals, designing intervention programs.
However, on other occasions, are psychologists themselves who will have to apply directly operant techniques or other strategies outlined in the previous section, to control external stimuli may also be required to apply techniques based on classical conditioning to alter the relationship between antecedent stimuli and responses and, finally, provided that are in direct contact with patients, have to intervene to a greater or lesser extent, to favorably influence their psychological disposition more flexible.
addition, psychologists should be responsible to act by two ways: training patients to master the psychological skills that enable them to self-manage their own behavior and the weakening of the psychological disposition stiffer.
The patients' psychological skills include self-assessment procedures such as internal experiences, the self-reports, goal setting, relaxation techniques, self-instruction, thought stopping, techniques for problem solving and coping any specific strategy that might be helpful. The training for the mastery of skills will promote effective psychological functioning of patients, contributing, inter alia, aims to manage stress and develop healthy habits.
With respect to the most rigid psychological disposition, it has to do with beliefs and attitudes irrational or disproportionate affect information processing and behavior of patients, favoring a high stress and / or the presence of low habitual behaviors healthy. In these cases, the progressive weakening of the dysfunctional beliefs and attitudes, replacing a rigid style of cognitive functioning to a more flexible, requires the intervention of a psychologist specialized in cognitive therapy highly.
There is, therefore, to "convince" the patient from their mistakes, or give, however, other alternative arguments, pointing out that it is not so serious is happening, or telling him to think positively, but favor a complex change process that takes time and great skill by the therapist. It is a very serious mistake to pretend that other health professionals apply this type of therapy, including psychologists will be specialized for such use and gain experience if they are to deal successfully with an intervention of this nature.
Moreover, psychologists should also be responsible for the psychological assessment of patients, although it is interesting to have the cooperation of other professionals.
Likewise, when the assistance involves the performance of individual professionals and / or the application of different techniques, psychologists should be those that have an overall view and control the treatment process in its entirety.
Finally, psychologists working in this area should be used to working with other health professionals, accepting, in many cases, senior of these in the organization of the interdisciplinary team.
of the roles of psychologists in this area is to train and advise health professionals that are in direct contact with patients. Will be also appropriate for psychologists to work together with these professionals, designing intervention programs.
However, on other occasions, are psychologists themselves who will have to apply directly operant techniques or other strategies outlined in the previous section, to control external stimuli may also be required to apply techniques based on classical conditioning to alter the relationship between antecedent stimuli and responses and, finally, provided that are in direct contact with patients, have to intervene to a greater or lesser extent, to favorably influence their psychological disposition more flexible.
addition, psychologists should be responsible to act by two ways: training patients to master the psychological skills that enable them to self-manage their own behavior and the weakening of the psychological disposition stiffer.
The patients' psychological skills include self-assessment procedures such as internal experiences, the self-reports, goal setting, relaxation techniques, self-instruction, thought stopping, techniques for problem solving and coping any specific strategy that might be helpful. The training for the mastery of skills will promote effective psychological functioning of patients, contributing, inter alia, aims to manage stress and develop healthy habits.
With respect to the most rigid psychological disposition, it has to do with beliefs and attitudes irrational or disproportionate affect information processing and behavior of patients, favoring a high stress and / or the presence of low habitual behaviors healthy. In these cases, the progressive weakening of the dysfunctional beliefs and attitudes, replacing a rigid style of cognitive functioning to a more flexible, requires the intervention of a psychologist specialized in cognitive therapy highly.
There is, therefore, to "convince" the patient from their mistakes, or give, however, other alternative arguments, pointing out that it is not so serious is happening, or telling him to think positively, but favor a complex change process that takes time and great skill by the therapist. It is a very serious mistake to pretend that other health professionals apply this type of therapy, including psychologists will be specialized for such use and gain experience if they are to deal successfully with an intervention of this nature.
Moreover, psychologists should also be responsible for the psychological assessment of patients, although it is interesting to have the cooperation of other professionals.
Likewise, when the assistance involves the performance of individual professionals and / or the application of different techniques, psychologists should be those that have an overall view and control the treatment process in its entirety.
Finally, psychologists working in this area should be used to working with other health professionals, accepting, in many cases, senior of these in the organization of the interdisciplinary team.
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