ABPP Clinical Health Psychology cheat sheet

Biopsychosocial model (Engel, 1977): health outcomes are jointly determined by biological, psychological, and social levels; no single level is sufficient to explain illness or treatment response.

Biopsychosocial formulation requires specifying predisposing, precipitating, perpetuating, and protective factors across all three levels for a given patient.

Diathesis-stress model: a vulnerability (biological or psychological) plus a stressor produces disorder; risk is multiplicative, not merely additive.

Allostatic load: cumulative physiological wear from repeated adaptation to stress, indexed by dysregulated cortisol, blood pressure, inflammatory markers, and metabolic measures.

HPA axis stress response: hypothalamic CRH drives pituitary ACTH, which drives adrenal cortisol release; cortisol then feeds back negatively on hypothalamus and pituitary.

Psychoneuroimmunology: psychological stress alters cytokine activity (e.g., elevated IL-6 and CRP), linking mood and social factors to inflammation and disease progression.

Placebo and nocebo effects are measurable psychobiological phenomena mediated by expectancy and conditioning; they belong in trial design and informed consent discussions.

Health psychology research hierarchy: RCTs strongest for efficacy, but external validity in real-world medical settings often requires effectiveness and pragmatic trial designs.

Transtheoretical (Stages of Change) model stages: precontemplation, contemplation, preparation, action, maintenance; interventions are matched to stage, and relapse recycles to earlier stages.

Motivational interviewing core elements (OARS): open questions, affirmations, reflections, summaries; the counselor targets change talk and avoids the righting reflex.

Health Belief Model constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.

Theory of Planned Behavior: attitudes, subjective norms, and perceived behavioral control predict intention, which predicts behavior; perceived behavioral control also predicts behavior directly.

Social Cognitive Theory (Bandura): behavior is shaped by reciprocal determinism among person, behavior, and environment; self-efficacy and observational learning are central.

Prevention levels: primary (prevent onset, e.g., vaccination), secondary (early detection, e.g., screening), tertiary (reduce disability and complications in established disease).

Screening program criteria include a common and detectable preclinical phase, an acceptable and valid test, effective early treatment, and favorable benefit-to-harm balance.

Relapse prevention distinguishes a lapse from relapse; attributions of a lapse to stable internal causes increase escalation, whereas restructuring them reduces it.

Reliability refers to consistency; validity refers to whether a score supports the intended interpretation and use; a reliable test can still be invalid for a specific purpose.

Internal consistency is estimated with Cronbach's alpha or KR-20; alpha is a function of item intercorrelation and test length, not unidimensionality alone.

Test-retest and interrater reliability are reported with ICC or kappa; kappa corrects for chance agreement and is preferred for categorical clinical ratings.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence: for the same sensitivity and specificity, PPV rises as prevalence rises, and low-prevalence settings yield many false positives.

Standard error of measurement (SEM) = SD × √(1 − reliability); confidence intervals around an observed score are built as observed score ± z × SEM.

Common health-psychology measures: PHQ-9 (depression), GAD-7 (anxiety), AUDIT-C (alcohol), Pain Catastrophizing Scale, SF-36 or PROMIS (function and quality of life).

Behavioral assessment methods include self-monitoring diaries, actigraphy, ecological momentary assessment, and structured functional analysis of antecedents and consequences.

A functional analysis specifies antecedents, behavior, and consequences (ABC) to identify maintaining contingencies before selecting an intervention target.

CBT is first-line psychological treatment for insomnia (CBT-I), chronic pain, and many adjustment presentations; CBT-I components include stimulus control, sleep restriction, and cognitive restructuring.

Graded exposure and graded activity are used for fear-avoidance in chronic pain and cardiac rehabilitation; pacing precedes quota-based activity escalation.

Relaxation and biofeedback target physiological arousal via slow breathing, progressive muscle relaxation, and HRV or EMG feedback; efficacy depends on skill acquisition with practice.

Motivational interviewing is effective for substance use and treatment adherence; it is directive in goal but nonconfrontational in style.

Problem-Solving Therapy and behavioral activation are evidence-based for depression in medical populations and are adaptable to brief formats.

Acceptance and Commitment Therapy targets psychological flexibility through acceptance, defusion, present-moment awareness, self-as-context, values, and committed action.

Hypnosis and guided imagery are adjuncts for procedural pain and distress; they do not replace indicated analgesia or anesthesia.

Stepped-care models allocate low-intensity interventions (self-help, digital, group) first and reserve specialist psychotherapy for nonresponders or high severity.

Common psychological responses to chronic illness include grief over lost function, anxiety, depression, and adjustment disorder; distinguish normative distress from a diagnosable disorder.

Illness representations (Leventhal's Common-Sense Model) comprise identity, cause, timeline, consequences, controllability, and coherence; these beliefs predict coping and adherence.

Adherence to chronic regimens averages roughly 50% in chronic disease; nonadherence is often unintentional (forgetting, complexity, cost) rather than oppositional.

Health literacy and regimen complexity are modifiable adherence barriers; simplifying dosing and using teach-back improve comprehension and adherence.

Fear-avoidance model of chronic pain: catastrophic interpretation of pain leads to fear, avoidance, disuse, and depression, which further maintain disability.

Disability is not predicted by impairment severity alone; self-efficacy, catastrophizing, depression, and social support add incremental prediction of functional outcome.

Cardiac rehabilitation and pulmonary rehabilitation improve function and mood; depression after myocardial infarction predicts worse cardiac outcomes and mortality.

Rehabilitation goal setting should be patient-centered, specific, measurable, and time-bound, with interdisciplinary agreement on the target activity and outcome measure.

Consultation models: patient-centered (clinician evaluates and advises about the patient), consultee-centered (builds the referring clinician's capacity), and program-centered (targets system or service design).

Effective consultation questions specify the referral question, the urgency, the decision the consultee faces, and the acceptable timeframe for response.

Interprofessional collaboration requires negotiated role clarity, shared goals, and mutual accountability; role confusion is a leading cause of team dysfunction.

SBAR (Situation, Background, Assessment, Recommendation) is a structured handoff format that reduces communication errors in medical teams.

In team meetings, the psychologist contributes behavioral formulation, differential diagnostic input, capacity and adherence observations, and treatment recommendations within scope.

Curbside consultation carries risk: advice given without direct assessment or documentation should be framed as provisional and documented appropriately.

Warm handoffs and integrated primary care (co-located or embedded) improve engagement relative to referral to external specialty mental health.

Conflict within teams is managed by separating task conflict (productive) from relationship conflict (destructive) and by clarifying decision authority.

Cultural formulation (DSM-5-TR Outline for Cultural Formulation) addresses cultural identity, illness explanations, psychosocial stressors, clinician-patient relationship, and overall assessment.

Explanatory models elicit the patient's beliefs about cause, onset, mechanism, course, and appropriate treatment; discordance with the biomedical model predicts nonadherence.

Health disparities are systematic differences in health associated with social disadvantage; they persist after adjusting for many clinical factors.

Social determinants of health include income, education, housing, food security, neighborhood, and occupational exposures; they shape exposure and access more than individual choice alone.

Minority stress model: chronic stigma-related stress explains elevated mental and physical health burden in marginalized groups beyond general stress exposure.

Implicit bias affects clinical communication and decision-making; evidence supports structured assessment and counter-stereotypic exposure rather than simple awareness training alone.

Language access requires qualified interpreters, not family members; using untrained interpreters increases errors and breaches confidentiality.

Measurement invariance must be established before comparing scores across cultural or linguistic groups; otherwise group differences may reflect instrument bias.

Informed consent requires decisional capacity, adequate disclosure, comprehension, and voluntariness; capacity is decision-specific, not a global patient trait.

Four capacity abilities (Appelbaum): understanding, appreciation, reasoning, and expressing a choice; a patient may refuse treatment and still retain capacity.

Confidentiality limits in medical settings include imminent danger to self or others, suspected abuse or neglect, court order, and duty-to-protect statutes that vary by jurisdiction.

HIPAA permits disclosure for treatment, payment, and operations; psychotherapy notes receive heightened protection and generally require separate authorization.

Multiple relationships are not automatically unethical; risk rises when the secondary relationship could impair objectivity or exploit the patient.

Competence and scope of practice: psychologists practice within boundaries of training and experience and obtain supervision or refer when outside competence.

Record keeping: document assessment, formulation, recommendations, consent, and consultation communications; records may be discoverable in litigation.

Research ethics: IRB approval, informed consent, minimization of risk, and equitable selection of participants under the Belmont principles of respect, beneficence, and justice.

Supervision best practices include a written supervision contract specifying goals, methods, evaluation criteria, and due-process procedures for remediation.

Supervisor roles are evaluative and gatekeeping as well as supportive; the supervisor bears responsibility for client welfare and trainee development.

Developmental supervision models (e.g., Integrated Developmental Model) adjust structure and support to trainee autonomy level across skill domains.

Direct observation (live or recorded) provides stronger competency evidence than trainee self-report; use behaviorally anchored rating scales.

Program evaluation types: needs assessment, process (implementation) evaluation, outcome evaluation, and cost or efficiency analysis.

Logic models link inputs, activities, outputs, short-term outcomes, and long-term impact; they guide selection of measurable indicators.

Quality improvement uses PDSA cycles (plan-do-study-act) and run charts to test small changes before scaling; distinguish QI from human-subjects research.

Competency frameworks (e.g., profession-wide competencies) define observable benchmarks for practicum, internship, and postdoctoral progression.