Exercise psychology: A view from Europe

ObjectiveTo provide a review and commentary on developments and key issues in the psychology of health-related physical activity (‘exercise psychology’).Design and MethodNarrative review and commentary.ResultsA view from Europe is provided, with an emphasis on European influence and research. Summary commentaries are provided using the behavioural epidemiological framework as an organisational tool. The role of psychology is discussed in the study of physical activity correlates, theory, and interventions.ConclusionsThe European influence in exercise and health psychology has been significant. However, more needs to be known about pre-intentional motivation processes and post-intentional volition, as well as clarifying and extending theories (e.g., translating intentions into behaviour). There is also a need to do more intervention work, and to improve how we conduct, evaluate and report interventions. New issues are emerging, including the study of sedentary behaviour.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

A Multilevel Approach for Reducing Mental Health and Substance Use Disparities Affecting Bisexual Individuals

Despite bisexual individuals being at increased risk for mental health and substance use problems, clinicians’ ability to provide affirmative and competent care to bisexual clients is limited by their lack of bisexual-specific training. To address this common gap in training, this article provides a brief review of bisexual health disparities and the factors that influence them. Then, we describe a multi-level approach for improving the health and well-being of bisexual individuals. This approach addresses factors that influence health at the micro-level (e.g., strategies that clinicians can use to help bisexual clients cope with stigma-related stressors), mezzo-level (e.g., adaptations to clinical environments and training programs that promote bisexual-affirmative care), and macro-level (e.g., advocating for political change and implementing strategies to reduce prejudice against bisexual individuals at the population-level). Specifically, we describe how clinicians can adapt evidence-based interventions to tailor them to the needs of their bisexual clients. Additionally, we discuss the need for bisexual-affirmative clinical training and provide recommendations for how clinical training can be adapted to prepare clinicians to work effectively with bisexual clients. Finally, we describe how population-level interventions can be used to reduce prejudice against bisexual individuals in order to reduce bisexual health disparities. Given the striking health disparities affecting bisexual individuals, there is a critical need to develop, test, and disseminate interventions to improve the health of this population and to prepare clinicians to provide bisexual-affirmative care.     

Factors affecting behavioral health provider turnover in US Air Force primary care behavioral health services

Turnover and retention of integrated behavioral health practitioners in primary care is a significant challenge with limited empirical evidence to inform risk factors. This study used retrospective archival data from the Air Force Medical Service’s Behavioral Health Optimization Program on all civilian contractors hired from September 2012 to November 2014 to examine the potential influence of training background (e.g., social work v. psychology), size of healthcare facility, or the presence of on-site mentors. Turnover was evaluated across a large managed healthcare organization of 121 civilian contractors (psychologists and social workers) in 72 specific clinic settings. These sites varied considerably in regards to geographic location, population diversity, size of patient empanelment, rural, suburban, and urban settings and all provided care to active duty military, their civilian dependents and civilian retirees. Results found that 54% of all psychologists and social workers hired for these positions quit or were fired within 8 months of employment. Smaller medical facilities were found to have a more significant attrition rate compared to medium- and large-sized facilities; no other differences were noted. Findings provide initial insight into a potential critical period in the first year of a behavioral health consultants on-boarding, as well as unique considerations for consultants placed in smaller facilities who may be at elevated risk for attrition. These preliminary findings suggest targeted interventions for new integrated care programs as well as important avenues for future research.     

The Future of Psychology in Departments of Psychiatry

Health care reform has put increasing pressure on faculty of medical schools to become self-supporting. Opportunities for clinical revenue will decrease, but psychologists who are able to generate research funding will become increasingly competitive, albeit as mercenaries, i.e., capable of paying their own way plus generating a profit to support departmental operations and educational programs. Changes in the health care system signal an end to psychiatry's paternalistic relationship to psychology and present opportunities for psychology proactively to influence its future role in health care. Research, political action, and revised scientific mission, models, and roles represent important strategies in the redefining of psychology as a basic science and major profession in health care.     

Clinical Community Psychology: Reflections on the Decades Following Swampscott

The Swampscott report was foundational, but in some ways reflected divisions within community psychology that have continued into the present. Community psychologists trained in the 1970s and, especially, the 1980s confronted a period where the original focus of community mental health began to have less influence in the mental health field due to a variety of public policies, and the growth of third party payments as a significant source of health care funding. Programs that engaged communities and provided a base for prevention interventions were greatly curtailed because of changes in federal legislation and limited opportunities for state and local funding, although prevention interventions found growing interest from research funders. Clinical and community psychologists who trained in this period increasingly looked to a variety of areas outside of mental health. Consequently, the field of community psychology has become more applied and less academic, with increased attention to advocacy, theory, and global perspectives. The sweep of these changes and their implications for the future of the field are discussed here.     

Postdoctoral Internships: Potential Adverse Impacts on Internships, Dissertations, and Trainees

Increased consideration of transforming the predoctoral psychology internship into a postdoctoral training experience has resulted from changes in the training and reimbursement for psychology trainees, concerns about employment of recent graduates, and the perceived limited status of psychology interns within health care settings. Whether this fundamental shift in psychology's training paradigm could resolve any of the problems that have led to its deliberation is not known. The authors identify problems with a postdoctoral internship which may be as thorny as the problems it is intended to ameliorate. It may have unintended adverse effects (e.g., risk of reduced quality in training and dissertations, new pressures on internship programs and trainees, increased licensure quandaries). Until a highly detailed proposal is developed and its full range of potential consequences are analyzed and debated, it is premature for professional organizations to conclude whether such fundamental change should be pursued.     

Health psychology: what will the future bring?

This commentary highlights several important themes and trends in this series of articles focusing on the future of health psychology. First, the challenges posed by changes in populations will only be met if health psychologists can develop a contextual competency. Second, with increasing evidence for the efficacy of health psychology interventions comes heightened interest in testing the effectiveness of these interventions. Third, issues of cost-effectiveness of health psychology will become increasingly important. Fourth, the growing integration of technological advances (e.g., telehealth, the Internet) into health psychology has major implications. Finally, the numerous changes outlined in this series of articles will demand that health psychologists extend and refine their theoretical models including the biopsychosocial model.     

Cultural Considerations for Psychologists in Primary Care

Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients’ health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers’ cultural sensitivity, patient–provider cultural congruency, and patients’ health literacy) can be applied in primary care using the Five A’s Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity.     

Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies

The role of psychologists and other mental health professionals in long‐term care settings is undefined in Australia. Graduate psychology students receive little training in clinical geropsychology, and residential aged care providers do not routinely employ psychologists within such settings. Further, despite high rates of depression, neurocognitive problems, and other mental health problems, residents are rarely referred for evidence‐based psychological treatment. This article presents four case studies showing how psychology services may be employed in such settings within the context of a postgraduate psychology placement programme. These case studies emphasise the importance of engagement, the use of flexible and individualised treatment approaches, and the involvement of family and professional carers in the provision of psychological services. Psychology services in residential settings can have a positive impact on the care of older adults and their families.     

Managing stress or enhancing wellbeing? Positive psychology's contributions to clinical supervision

One of the key functions of clinical supervision as practised by health professionals such as psychologists includes the restoration of wellbeing, but there are few guidelines in the supervision literature on how to go about this. Research into concepts from the field of positive psychology such as work engagement, sense of coherence, self‐efficacy, flow and resilience has begun to provide detailed understanding of workers' happiness, health and betterment. These findings provide possible directions for supervision interventions that go beyond traditional review of self‐care and stress‐management strategies and seek to extend the wellbeing of the supervisee. This article explores the application of positive psychology to enhance the wellbeing of practitioners such as psychologists, who often work in inherently difficult work environments such as the mental health field. Specifically, a narrative approach is proposed as one possible method and practical examples are offered to demonstrate how positive psychology may be applied in the practice of clinical supervision.     

积极情绪与身心健康关系研究的进展

积极情绪与身体健康、心理健康和社会适应有密切的关系。首先,积极情绪不仅能够降低传染性疾病的感染风险,能够影响非传染性疾病病情、病程及死亡率。其次,积极情绪能够降低个体的心理易感性,使个体更好的应对负性或压力事件。最后,现有的研究表明积极情绪和社会交往存在相互促进的关系。现存的直接效应模型和压力缓冲模型解释了积极情绪直接和间接促进健康的机制。未来的研究还需在研究方法和模型完善等方面进一步改进。     

Why and how we should care about the General Data Protection Regulation

Abstract

The General Data Protection Regulation (GDPR) is the new European Union-wide (EU) law on data protection, which is a great step towards more comprehensive and more far-reaching protection of individuals' personal data. In this editorial, we describe why and how we – as researchers within the field of health psychology – should care about the GDPR. In the first part, we explain when the GDPR is applicable, who is accountable for data protection, and what is covered by the notions of personal data and processing. In the second part, we explain aspects of the GDPR that are relevant for researchers within the field of health psychology (e.g., obtaining informed consent, data minimisation, and open science). We focus on questions that researchers may ask themselves in their daily practice. Compliance with the GDPR requires adopting research practices (e.g., data minimisation and anonymization procedures) that are not yet commonly used, but serve the fundamental right to protection of personal data of study participants.     

Ambulatory assessment for physical activity research: State of the science,best practices and future directions

Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 “Physical Activity Assessment – State of the Science, Best Practices, Future Directions” where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessments near real-time, which minimize retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within-subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21st century such as insufficient PA and high levels of sedentary behavior.     

A psychology of the human brain–gut–microbiome axis

In recent years, we have seen increasing research within neuroscience and biopsychology on the interactions between the brain, the gastrointestinal tract, the bacteria within the gastrointestinal tract, and the bidirectional relationship between these systems: the brain–gut–microbiome axis. Although research has demonstrated that the gut microbiota can impact upon cognition and a variety of stress‐related behaviours, including those relevant to anxiety and depression, we still do not know how this occurs. A deeper understanding of how psychological development as well as social and cultural factors impact upon the brain–gut–microbiome axis will contextualise the role of the axis in humans and inform psychological interventions that improve health within the brain–gut–microbiome axis. Interventions ostensibly aimed at ameliorating disorders in one part of the brain–gut–microbiome axis (e.g., psychotherapy for depression) may nonetheless impact upon other parts of the axis (e.g., microbiome composition and function), and functional gastrointestinal disorders such as irritable bowel syndrome represent a disorder of the axis, rather than an isolated problem either of psychology or of gastrointestinal function. The discipline of psychology needs to be cognisant of these interactions and can help to inform the future research agenda in this emerging field of research. In this review, we outline the role psychology has to play in understanding the brain–gut–microbiome axis, with a focus on human psychology and the use of research in laboratory animals to model human psychology.     

Twenty-first century ethical challenges for psychology

Foreseeable social and technological changes will force us to reevaluate our thinking about ethically appropriate ways to fulfill our mission of using psychology to advance human health and welfare in the twenty-first century. Three categories of challenge related to societal and technological changes have become particularly evident. First, increasing patterns of delivering services over substantial distances by electronic means (i.e., telepsychology) demand consideration. Second, we must parse our ethical obligations to individuals, to groups, and to society at large as our influence working behind the scenes as "invisible" psychologists grows. Finally, as we witness the accelerating demise of psychiatry, we must take care not to follow a similar path. As we face new ethical challenges, we must continually ask ourselves where our responsibilities lie as individuals and as a profession. We must learn not to repeat the mistakes of the past and focus instead on optimizing the future for a science and practice of psychology focused on human health and welfare.     

Nursing and psychological treatments

Presents a comment on "Psychological Treatments" by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others.     

Screening for developmental and behavioral problems

Early detection of developmental and behavioral/mental health problems is greatly facilitated when quality instruments are deployed. This article describes how to identify accurate measures and presents standards for screening tests. Included is a table delineating accurate tools for primary care: typically those relying on information from parents (e.g., PEDS, ASQ, PSC, etc.) as well as measures useful in settings where providers have more time and skill at eliciting behaviors from children (e.g., Brigance screens). Screening measures should be used in the context of developmental surveillance; the longitudinal process of incorporating professional observations into decision-making about children's developmental needs.     

What to Do When Evidence-Based Treatment Manuals Are Not Enough? Adapting Evidence-Based Psychological Interventions for Primary Care

Significant barriers exist in accessing high-quality, evidence-based psychological interventions in traditional mental health settings. Adapting these interventions for delivery within primary care is particularly advantageous given that the majority of individuals with mental health conditions are more likely to seek care in this environment much earlier in their course of illness than in specialty mental health clinics. The aim of this paper is to summarize efforts at Mayo Clinic to develop and disseminate evidence-based psychological interventions across multiple primary care clinics. Adaptations aimed at improving access to care, enhancing the quality of care, and incorporating a system of measurement-based outcomes are unique features that are essential to the sustainability and advancement of integrated behavioral health programs within primary care.