to record the presence of headaches. They would
be taught to record data on the presence of envi-
ronmental stimuli that precede the headache, their
own response to the headache, and the conse-
quences that follow from the symptoms.
Finally, patients receive specific training in relax-
ation. Chapter 14 provides detailed information on
relaxation training. Positive expectancies for a good
outcome are engendered, and the physical condi-
tions are arranged so that relaxation will be easy to
achieve (assuming a comfortable position, loosening
tight clothing, adjusting lighting). Regular practice in
the therapist’s office is followed by practice at home.
How efficacious are relaxation techniques in
treating problems addressed by health psychologists?
Relaxation appears to be effective in treating
hypertension, tension headaches, and anxiety
(Brannon & Feist, 2010). When combined with
guided imagery—a technique in which patients
bring images of peaceful and calm situations to con-
sciousness—relaxation has also proven effective for
treating burn pain and the nausea and anxiety asso-
ciated with chemotherapy (Brannon & Feist, 2010).
Operant MethodsLearned responses may be either maintained or
eliminated through the consequences they bring
about. As we discussed in Chapter 14, behaviors
that are reinforced tend to recur, whereas behaviors
that are not reinforced or are punished tend to
decrease in frequency.
Operant conditioningcan be used in health psy-
chology and behavioral medicine either to increase
behaviors said to lead toward health or to decrease
those said to contribute to health problems. For
example, health psychologists have used operant
methods in addressing pain behaviors (Brannon &
Feist, 2010; Roelofs, Boissevain, Peters, de Jong, &
Vlaeyen, 2002). From an operant perspective, many
of the behaviors displayed by pain patients (com-
plaining, moaning, etc.) have been initiated and
maintained because of positive reinforcement. Fam-
ily members and medical staff may have paid more
attention to the patient following these behaviors.
Additional reinforcers might include sympathy,
time off from work, or fewer expectations from
the family. To change these pain behaviors, family
members and medical staff may be trained to rein-
force more desirable behaviors (e.g., attempts to
become more physically active) and to ignore less
desirable behaviors (e.g., constant complaining).
Research suggests that these approaches to pain
behaviors do show some success, as indicated by
increased physical activity and decreased intake of
pain medication (Brannon & Feist, 2010).
Finally, health psychologists may use contin-
gency contracting. In this method, the therapist
and patient draw up a formal agreement or contract
that specifies the behaviors that are expected as well
as the consequences for certain behaviors. For exam-
ple, patients may be reinforced for participating more
in physical therapy, taking their medication, or
reducing their number of somatic complaints. Rein-
forcement may take the form of tokens that can be
exchanged for something of value to the patient.Cognitive-Behavioral Methods
Health psychologists use a variety of cognitive-
behavioral techniques. These techniques may be
used alone or in concert with other strategies, such
as relaxation or biofeedback. Some of these methods
were discussed in Chapter 14. All of them emphasize
the role of thinking in the etiology and maintenance
of problems. Cognitive-behavioral interventions
seek to change or modify cognitions and perceptions
that are believed to be related to a patient’s problem.
The list of“well-established”empirically sup-
ported treatments (see the link at the end of the chapter)
contains several cognitive-behavioral treatments for
stress or other health problems. In Chapter 14, we
discussed stress inoculation training (SIT) for coping
with various stressors. This approach is used by health
psychologists for a wide varietyof patients (e.g., chronic
pain patients). Other effective cognitive-behavioral
treatments for health problems include those for head-
ache, pain, smoking cessation, and bulimia.
Cognitive-behavioral therapy is a major compo-
nent of a treatment for chronic headaches (Blanchard
& Andrasik, 1985; Martin, Forsyth, & Reese, 2007;
Nash et al., 2004; Thorn et al., 2007). For example,496 CHAPTER 17