conditioned emotional reactions that, if chronic,
can produce such persistent tissue changes as ulcers,
neurodermatitis, or essential hypertension. These
kinds of symptoms have been treated by health psy-
chologists in various ways. In the case of respondent
techniques, extinction or systematic desensitization
interventions are commonly used.
Inextinction, a conditioned emotional reaction
is eliminated by creating a situation in which the
conditioned stimuli are no longer associated with
the environmental stimuli that generated the
behavior. This approach can be used, for example,
to eliminate children’s fears of visiting the dentist.
The child is brought to the dentist’s office, familiar-
ized with the office personnel, allowed to meet
other children who have successfully negotiated
the terrors of dentistry, and so on. In short, the
child’s emotional reactions are extinguished
because, over time, less anxiety is aroused in the
dentist’s office. A variation would be exposure
techniques, described in Chapter 14. Instead of
the gradual approach just described, the child,
under professional supervision, would be forced to
remain in the “terrifying situation,” the anxiety
would peak and then rapidly diminish, and the
child would thereby learn that the anxiety was
needless. The result is extinction of the anxiety
responses.
Systematic desensitizationis a good example of
counterconditioning (see Chapter 14). If the patient
can be taught to relax in the face of anxiety-
provoking stimuli, the anxiety diminishes.Relaxa-
tiontechniques are designed to enable individuals to
produce a state of lowered arousal through their
own efforts. As a preliminary step, patients are usu-
ally taught the basic behavioral principles related to
their symptoms and how therapy relates to the
implementation of these principles. For example, a
patient whose stressful lifestyle has led to some
physical problems would be taught the relationship
between lifestyle and illness by means of a fairly
extensive verbal explanation (or reading material).
Following this, a thorough psychophysiological
assessment might be conducted using recording
equipment, self-ratings of tension, and the thera-
pist’s own observation.
Next, patients are taught to self-monitor. For
example, they might be trained in how and whenBOX17-2 Focus on Professional Issues
The Role of Health Psychology: HIV and Acquired Immune Deficiency Syndrome (AIDS)The Centers for Disease Control (CDC) estimates that
approximately 50,000 people arenewly infectedwith
HIV each year in the United States, and approximately
1.2 million of Americans age 13 or older arecurrently
infected with HIV. Adolescence and young adulthood
are developmental vulnerability periods for the acqui-
sition of HIV. Once HIV infection reaches stage 3, a
diagnosis of AIDS is made. Cumulatively, approximately
600,000 people have died in the United States from
AIDS, with the annual figure now hovering at about
16,000 per year. Although these annual rates are lower
than they were 10 years ago, HIV and AIDS continue to
be a major public health problem because there is no
known cure. Therefore, prevention of high-risk behav-
ior (unprotected sex; injection drug use) is paramount.
The use of antiretroviral therapies (ART) has been
shown to delay the clinical progression of HIV and to
decrease AIDS-related deaths. In order for ART to bemaximally effective, however, high levels of adherence
to ART are necessary (Gonzalez, Barinas, & O’Cleirigh,
2011). Unfortunately, substance use and substance use
disorders are frequent among those with HIV/AIDS,
and these substance use problems are associated with
significantly lower adherence rates for ART (Sande-
lowski, Voils, Chang, & Lee, 2009). For example, Hen-
dershot et al. (2009) found that across 40 studies
alcohol users with HIV or AIDS were only about half as
likely to be adherent to ART than those who did not
use alcohol. Similar patterns are observed for other
substances like heroin, cocaine, marijuana, and even
tobacco. Therefore, health psychologists are encour-
aging physicians to screen for substance use and abuse
in those with HIV/AIDS so that cognitive-behavioral
interventions to treat underlying depression and anxi-
ety as well to promote adherence can be used when
appropriate (Gonzalez, Barinas, & O’Cleirigh, 2011).HEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 495