Joseph D. Matarazzo

Behavioral Health and Behavioral Medicine Frontiers for a New Health Psychology

Developments over the past decade in psychology, in medicine, in funding institutions such as the National Institutes of Health, and in industry make clear that the rapidly growing areas of behavioral medi- cine and behavioral health are presenting psychology as well as its sister professions with new opportunities for training, research, and practice. Specific develop- ments within psychology leading to the establishment of APAs Division 38 (Health Psychology) are traced. Also traced are some activities on the national level that have led to the development of organizations with a more interdisciplinary focus. Despite a modicum of overselling in some quarters, behavioral health- and health psychology appear to be ideas whose time has come. Some writers appear to be using the terms be- havioral health, behavioral medicine, and health psychology as synonyms. It is proposed here, how- ever, that henceforth we use the term behavioral medicine for that broad interdisciplinary field of scientific inquiry, education, and practice which concerns itself with health and illness or related dysfunction (e.g., essential hypertension, choles- terolemia, stress disorders, addictive smoking, obesity, etc.); the term behavioral health for a new interdisciplinary subspecialty within behavioral medicine specifically concerned with the mainte- nance of health and the prevention of illness and dysfunction in currently healthy persons; and the term health psychology as a more discipline-specific term encompassing psychologys role as a science and profession in both of these domains. Although each of these terms made its lexical appearance only within the past several years, the idea of the exquisitely delicate and finely tuned relationship between mind and body that they embody is found in the earliest writings of civilization dating back to 5000 B.C. (Ehrenwald, 1976). The name of this mind-body field, has varied from century to century and recently from generation to genera- tion, changing in the 20th century from psycho-

Behavioral Health's Challenge to Academic, Scientific, and Professional Psychology.

In 1964 President Lyndon Johnson, first threatening and next fully using the power of the federal purse, informed this countrys scientific and university professional manpower training communities that federal health-related funds should be used to support fewer basic and theoretical and more applied and practical research and training activities. The 1964 Congress and its successors, and Presidents Nixon, Ford, and Carter, all endorsed this demand that our scientific and teaching institutions refocus their priorities and begin to pay more attention to the human (and the ever-increasing financial) costs associated with the health of our citizens. Before proceeding to discuss these annually escalating financial and human costs and what might be done by psychologists and others to help reduce them, fairness requires that the many legitimate financial costs be excluded from the criticism that follows. Health care in the United States is expensive in part because our citizens, speaking, themselves or through third-party payers, have opted to pay for intensive care and renal dialysis units in hospitals, neonatal heart surgery, computerized axial tomography (CAT) scanners, and many other very costly diagnostic and critical-care life-support services. My criticism is not directed at such defensible costs but instead at the inordinate costs that are associated with preventable health conditions: those associated with smoking and other health risks associated with ones lifestyle. These latter unnecessary costs must be addressed by psychologists and representatives of the other disciplines interested in individual behavior. It became obvious in the 1960s that health expenditures in the United States were growing at a faster rate than the gross national product. This imbalance became increasingly alarming, and it seemed that it might soon become insupportable. Table 1.1 – adapted from Gibson (1979) and Vischi, Jones, Shank, and Lima (1980) – presents some pertinent statistics. For example, in 1950 the

Base rate data for the WAIS-R: test-retest stability and VIQ-PIQ differences.

12.7 billion expenditure for health was only 4.5% of that years gross national product of

Plasma Lipid and Lipoprotein Profiles of Cigarette Smokers from Randomly Selected Families: Enhancement of Hyperlipidemia and Depression of High-Density Lipoprotein

284.8 billion, but by 1965 this percentage had increased to 6.2%, and by 1978 it had increased even further to 9.1%. 1 As further revealed in Figure 1.1, a recent projection through the next decade by Rogers (1980), the president of the Robert Wood Johnson Foundation, indicates that by the year 1990 this figure will fall somewhere between 9.1% and 14% of the gross national product. Supporting his view, the most recent data (shown in the last row of Table 1.1) reveal that total health expenditures …

Co-occurrent use of cigarettes, alcohol, and coffee in healthy, community-living men and women.

The data analyzed were the 14 WAIS-R scores from each of the individuals who comprised the WAIS-R standardization sample. Examined was the individual VIQ-PIQ difference from only the initial examination of each of the 1880 subjects, as well as the test-retest change in each of the 14 WAIS-R scores for each of the 119 subjects who were retested. The results revealed that, although the WAIS-R has excellent psychometric reliability as reflected in its standard error of measurement of a VIQ-PIQ difference and its impressively high test-retest Pearson r values, the actual magnitudes of the differences between the VIQ and PIQ assessed in a single examination, or the magnitudes of gain or loss in the 14 scores on retest, for some of these normal individuals were sufficiently high that such base-rate data should be routinely considered by clinical neuropsychologists and other practitioners.

A literature review of factor analytic studies of the WAIS-R

Cigarette smoking is an important risk factor for coronary heart disease. However, its mechanisms of action remain to be fully explored. The hypothesis of the present study is that 1 mechanism whereby cigarette smoking enhances coronary disease might result from its effects upon the plasma lipids. Accordingly, we measured the plasma lipids and lipoproteins in cigarette smokers, exsmokers and nonsmokers from 233 randomly selected American families. Cigarette smokers (male and female) had significantly lower high-density lipoprotein levels and higher very low density lipoprotein and plasma triglyceride levels than the exsmokers and nonsmokers. The plasma levels of lipids and lipoproteins were related to the number of cigarettes smoked per day. Heavier cigarette smokers (greater than 25 cigarettes/day) had significantly lower high-density lipoprotein levels and significantly higher very low density lipoprotein total cholesterol and plasma triglyceride levels than those who smoked less than 25 cigarettes/day, nonsmokers and exsmokers. The lipid and lipoprotein values of those who smoked less than 15 cigarettes/day were similar to those of exsmokers and nonsmokers. Inasmuch as exsmokers had levels of plasma lipids and lipoproteins similar to those of nonsmokers, these findings add another health-enhancing benefit to the cessation of smoking.

Physical exercise rehabilitation: Long-term dropout rate in cardiac patients

Previous studies have examined intra-individual aggregation in the use of cigarettes, alcohol, and coffee by examining the co-occurrent use of any pair of these three substances. A recent literature review failed to find a single investigation that studied use of all three in the same sample. In the present study, co-occurrent use of all three of these substances was examined in crossvalidated subsamples of 226 male and 245 female healthy, community-living, middle-class Americans. A log-linear analysis was used to compare the proportion of smokers, ex-smokers, and nonsmokers categorized as users of more or less amounts of coffee and alcohol. Although most of the intercorrelations were not strong, the results indicate that for both sexes, smokers and ex-smokers were more likely than nonsmokers to drink greater amounts of alcohol and coffee. Furthermore, for smokers, ex-smokers, and nonsmokers, a majority of individuals who reported drinking more alcohol also reported drinking more coffee. Interestingly, the coffee and alcohol consumption levels of ex-smokers resembled those of smokers more than those of nonsmokers. Also, ex-smokers reported drinking more wine and decaffeinated coffee than either smokers or nonsmokers. Finally, the number of cigarettes smoked per day (daily quantity) was positively related to total alcohol and coffee consumption in men, but not in women. Further studies are recommended to examine the role of individual differences in the development, maintenance, and modification of these three appetitive habits and their co-occurrence.

Psychological testing and assessment in the 21st century.

Wechslers intelligence scales long have been subjected to factor analytic studies in an effort to describe the components of measurable human intelligence. Most authors have extracted a general factor g, as well as a Verbal Comprehension factor, Perceptual Organization factor, and Memory/Freedom from Distractibility factor from a two- or three-factor solution. This article reviews the factor analytic studies done on the 1981 WAIS-R standardization sample and various patient samples in an effort to update and continue to tie together the findings on Wechslers scales across ages and populations. We conclude that although the results of the WAIS-R factor analytic studies reviewed depend upon the statistical approach employed as well as each investigators theoretical perspective, a three-factor solution appears to provide a source of hypotheses about an individuals or a select samples unique abilities and weaknesses worthy of further exploration.

Psychometric and clinical test-retest reliability of the halstead impairment index in a sample of healthy, young, normal men

The long-term dropout rate was examined in a physical exercise rehabilitation program in which 203 cardiac patients were followed for 40 months. The dropout curve was found to be downward-sloping and negatively accelerated with most of the dropouts occurring during the first 3 months. This dropout rate appeared to resemble the group relapse curve previously found in the treatment of addictive behaviors. Implications of the present findings are discussed in terms of the development of strategies to facilitate long-term compliance.

The reliability of psychiatric and psychological diagnosis

As spin-offs of the current revolution in the cognitive and neurosciences, clinical neuropsychologists in the 21st century will be using biological tests of intelligence and cognition that record individual differences in brain functions at the neuromolecular, neurophysiologic, and neurochemical levels. Assessment of patients will focus more on better use of still intact functions, as well as rehabilitating or bypassing impaired functions, than on diagnosis, as is the focus today. Better developed successors to todays scales for assessing personal competency and adaptive behavior, as well as overall quality of life, also will be in wide use in clinical settings. With more normal individuals, use of new generations of paper-and-pencil inventories, as well as biological measures for assessing differences in interests, attitudes, personality styles, and predispositions, is predicted.