Undoubtedly, research on Health Psychology has developed dramatically over the last few years in Spain, and it would be infeasible to document the totality of all that has been accomplished in this area in the last decade by Spanish Psychologists.
Howevere, by focussing on some central themes and research teams that serve as examples of the most important Spanish contributions to Health Psychology it is possible to show the extent of the accomplishments in the area in recent years.
Here we find works which have emphasized that behavior is implicated in an individual's vulnerability to microorganisms (Bayes, 1987) and in his ability to cope with illness (Bayes, 1985; Costa and Lopez, 1986; Labrador and Castro, 1987, Fernández and Perez, 1987). Bayes emphasized that psychological variables can influence the immune system thereby affecting health and illness.
M. Valdes and T. de Flores, in Barcelona, have also studied the possible relationship between stress and the functioning of the immune system. In their book Psicobiología del Estrés (The Psychobiology of Stress) they state that the results of animal experimentation and of human clinical observation show the immuno-suppressor effects of stress (Valdes and Flores, 1985).
In Sevilla, Barriga, Fernández, Leon, Martinez and cols. have worked on "psychophysical reactivity to stress" studying the effects of exposure to uncontrollable situations on subjects with Type A behavior patterns (Fernández et. al. 1988).
In reference to the relationship between behavior patterns and coronary diseases, the majority of research topics concern Type A behavior. The research team directed by M. Valdes and T. de Flores is currently finishing an extensive project on this behavior pattern and an analysis of its etiological role in coronary diseases (Flores, et al. 1985; Flores and Valdes, 1986; Valdes and Flores, 1987; Bernardo et al., 1987). At the University of Granada, Jaime Vila coordinates the work being done on the explanatory mechanism which links psychological or behavioral aspects with biological or organic aspects in the case of coronary treatments (Fernández and Vila, 1989a). In Madrid (in the UNED, i.e. Open University), J. Bermúdez deals with the psychological factors of the etiology of cardiovascular diseases. He describes risk behaviors (Type A) and explains the psychological mechanism behind their evolution and the physiological mechanism which leads to coronary disorders. (Bermúdez, 1989).
A number of studies concerning the consistently established relationships between determined stressful events, health and other physiological and social aspects such as satisfaction and networks of social support have carried out in Madrid (Autonomous University) by Fernández-Ballesteros and her research team (Fernández-Ballesteros et al., 1987) on a specific population (i.e. those over 65 years of age). Retirees are also being studied in Alicante by J. Miquel and his cols. Their work involves evaluating biochemical variables and psychological parameters, with the purpose of establishing significant associations between biochemistry and psychology in order to program therapeutic interventions (Ribera, 1986; Ribera et al., 1987; Ribera, Reig and Miquel, 1988; Ribera and Reig, 1989).
Finally the topic of organizational stress in health institutions is being researched by J.M. Peiró and his colleagues at the University of Valencia. They are working on role performance and work stress in health professionals in hospitals (Peiró and Zurriaga, 1985; Peiró, Zurriaga and Meliá, 1986; Zurriaga, 1987; Zurriaga and Valcárcel, 1989). In Alicante, Reig, Ribera and Cartagena have explored several aspects related to the mental health of nurses (stress, depression and professional frustration) (Cartagena et al., 1986; Ribera, Cartagena and Reig, 1987), and J. Rodríguez-Marín and his collaborators have studied the effect the stressful characteristics of hospitals as health care organizations have on patients (Rodriguez-Marín, 1986b; Rodriguez-Marín, López and Pastor, 1989a). At the Universidad Complutense in Madrid, J. M. Prieto (1977a, 1977b) studied the personality profile of nursing students at the Red Cross Hospital and compared it to that of psychology students. Both groups showed quite similar profiles, while at the same time their profiles differed greatly from those of other groups of the same age and cultural level. Both groups were interested in caring for the ill. A doctoral dissertation currently being written by M. D. Rodriguez and directed by J. M. Prieto shows that nursing students' learning styles emphasize concrete experience and active experimentation whereas psychology students rely on abstract conceptualization and active experimentation. As practitioners they each maintain differentiated patterns as regards experiential learning in real clinical situations.
Another of the pathologies tied to psychological and behavioral factors is psychogenic pain. Valdés, Núñez, et al. that have studied this particular pathology (Núñez et al., 1989; Valdés et al., 1988; Valdés et al., 1989) suggest the importance of considering different etiological hypotheses: psychogenic pain either as a psychosomatic syndrome or as determined by psychobiological factors.
In Madrid, Vallejo and Labrador (1983) have proposed a psychobiologic model to explain severe headaches.
In the case of dysfunctional behavior related to eating habits, obesity is one of the problems which has received the most attention. In Spain in the l970's approximately 30% of the population could be considered obese, especially in the group women over 35. 9.2% of young children were also considered obese. C. Saldaña (University of Barcelona) studied behaviors related to the appearance and treatment of obesity. His book Obesidad (Obesity) (Saldaña and Rossell, 1988) is an important source of information on the subject, not only with reference to the behavioral assessment of obesity, but also as regards the modification and behavioral therapy for its treatment (García and Saldaña, 1986). From a practical point of view, another book, Prevención y Tratamiento de la Obesidad (The Prevention and Treatment of Obesity) (Vera and Fernández, 1989) is also noteworthy.
In this field the use of biofeedback as a therapeutic instrument is one of the cores of interest in Spain. For many years, J. A. Carrobles has been working in this area on very diverse problems ranging from pedophilia to myopia, from neuromuscular rehabilitation to headaches (Carrobles, 1977; 1978; 1981; 1983; Carrobles, Cardona y Santacreu, 1981). Biofeedback, the book by Carrobles and Godoy (1987), constitutes a sample of the work that has been done. Many other authors are also working on this topic from both theoretical and applied perspectives (Blas and Labrador, 1984; Carmona, 1980; Fernandez and Roa, 1983; Godoy and Riquelme, 1985; Jimenez, Calzada and Garcia, 1985; Labrador, 1983; Leon, 1986; Pegalajar and Vila, 1985; Puente et al., 1985; Saldaña, 1983; Simon and Peralbo, 1985; Vallejo, 1984; Vallejo and Labrador, 1984; Vila, 1982; 1984.)
The "placebo effect" is another of the problems which has aroused great interest. At the University of Oviedo, Marino Pérez and his colleagues have conducted extensive research on this subject, approaching it as a clinical phenomena and suggesting a psychological approach for explaining it (Perez, 1989; Perez and Martinez, 1987). These same researchers have developed some interesting research on the possibility of a psychological treatment for specific health problems (essential hypertension, irritable colon syndrome, and constipation) (Pérez, 1990). Amigo is one of the foremost researchers in the area of hypertension. He has focused his work on the analysis of the application of cognitive and behavioral techniques to hypertension and on the assessment of its efficacy in regulating high blood pressure (Amigo, 1989; Amigo, Buceta y Bueno, 1989; Amigo & Buceta, 1990). C. Fernández and M. Pérez have conducted research which assesses the application of some behavior modification techniques to irritable colon syndrome patients (Fernández, 1989; Pérez, 1990).
Research on behavioral treatments of pain is also important. J. Moix in Barcelona has developed and tested a behavioral scale for assessing pain (Moix, 1990) and W. Penzo has finished some interesting work on behavioral assessment of chronic pain (Penzo, 1986). At the University of Alicante, Pastor and her cols, have conducted research on the pain experienced by some rheumatism patients whose pain has no organic cause (Pastor et al., 1989;Pastor et al., 1990a; 1990b; 1990c; 1992). In Madrid (Universidad Complutense), Vallejo has reviewed the psychological approach to pain (functional analysis of chronic pain and behavioral techniques for pain treatment) and has found evidence of possible uncontrolled therapy effects in the biofeedback treatment of chronic pain (Vallejo, 1984).
Coping responses to illness were researched by Spanish psychologists during the last decade. The effects of emotional reactions and the degree of availability of information have been studied in breast-cancer patients by E. Ibáñez, P. Barreto and their research group in Valencia (Andreu et al., 1988; Barreto, 1984; Barreto, Capafons and Ibañez, 1987; Ibáñez, 1988.) In Alicante, research has been conducted by J. Rodriguez-Marín on psychosocial variables related to cancer progression, on psychological reactions, and on coping mechanisms used by mastectomy, laryngectomy and ostomy patients (Lopez et al., 1990; Rodriguez-Marín, 1986a; Rodriguez-Marín et al., 1988; Rodriguez-Marín et al., 1989). In Barcelona (Autonomous University) Blasco (1992) has carried aout a stduy about the relationships between previous thoughts about distressful side-effects of chemotherapy and the intensity of anxiety and nausea experienced after receiving this treatment in cancer patients. Blasco and Bayés (1992) have also proposed an index to assess the "illness adaptation" in cancer patients by applying a previous questionnaire developed by Font (1988) which was conceived to evaluated the quality of life of oncologic patients. Coping with the chronic pain experienced by rheumatism patients, or the pain related to retinal detachment surgery or with the hospitalization experience itself, has been studied by Pastor, López-Roig and Rodríguez-Marín (López-Roig et al., 1990; López-Roig et al., 1991; Pastor, Lopez-Roig and Rodríguez-Marín, 1990; Pastor, et al. 1991; Rodriguez-Marín, 1986b; 1987; Rodriguez-Marín, Lopez-Roig and Pastor, 1991; Rodríguez-Marín etal., 1992). The stressful effects and the physiological concomitants of some birth-control methods (such as the IUD) have been studied by J. J. Mira (Mira, 1988). At the University of La Laguna (Canary Islands), V. Pelechano and his collaborators have conducted research about coping skills used by chronic physically-ill patients and about personality dimensions in the coping strategies (Pelechano, 1990; Sosa, Pelechano and Capafons, 1990; Pelechano, Matud and Miguel, 1993).
Finally I must mention the pioneering research being done in Spain by V. Pelechano on the psychological impact of motherhood. He has noted the effect of hospitalization on women who have just given birth, who often demonstrate illness behaviors (Pelechano, 1981).
Health promotion and health education have been of increasing concern to Spanish researchers and practitioners during the last decade.
In this regard, Costa and Lopez (1986) emphasized the mutual goals of health promotion and health education: to develop good health habits in people; to modify habits and behaviors that negatively affect an individual's health; to promote a change in those external factors and processes by which behavior can be damaging to health; and to ensure that health be accepted as a top priority by individuals, groups and communities. From this general theoretical approach, Costa, Lopez and their colleagues (Costa et al., 1983; 1985; 1989) studied patient education on self-care as a framework for solving other health problems. They have created and implemented successful programs for training patients in the self-care related to a variety of diseases. Health education as an instrument of health promotion, has also been considered by M. Martínez, J. M. Leon, I Fernández and S. Barriga in Sevilla (Martínez et al., 1987)
Some of the approaches to illness prevention currently used in Spain have considered the psychological aspects involved in AIDS prevention programs (Arranz and Bayes, 1988). According to Bayes (1989), effective AIDS prevention programs must be based on a functional analysis of behavior in order to understand the persistence of risk-behaviors. From this point of view, a psychological model for AIDS prevention has been proposed by Bayes and Ribes (1989). A similar approach has been taken by C. Fernández who has developed intervention programs to promote good dental hygiene habits. (Fernandez and Gil, 1988; Tejerina, Perez and Echevarria, 1987.)
The contribution of Health Psychology in Spain to illness prevention has also been concerned with another important field: substance abuse. Similar models on early prevention of drug and alcohol abuse have been developed by D. Maciá (1984; 1986) at the University of Murcia and J.A. García in Alicante (García and López, 1988). In the last few years, the number of drug-addiction prevention programs has greatly increased. Both the theoretical and practical projects related to substance abuse have focused on the school setting. (Calafat el al., 1985; 1989; Vega, 1984.)
To promote healthy behaviors concerning sexual intercourse, pregnancy and the prevention of gynecological problems, Mira and van der Hofstadt (1987) have designed and tested a program by which midwives can provide information and counseling services on sex-related issues to women.
Finally, in Madrid, Fernández-Ballesteros and her coworkers have conducted a series of research studies in elderly care homes (Fernández-Ballesteros et al., 1988a, 1988b). They have also devised instruments for the assessment of programs and care services and have used them to evaluate the quality geriatric care programs in and around Madrid. (Fernández-Ballesteros et al., 1990). Likewise, in order to improve elderly people's ability to cope with stressful situations, the same group has devised and tested two intervention programs to be used in community settings for prevention and rehabilitation (Fernández-Ballesteros et al., 1987).
JOSÉ RAMÓN CORREAS GONZALEZ
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