Showing papers in "American Psychologist in 2014"

The benefits of playing video games

Abstract: Video games are a ubiquitous part of almost all children's and adolescents' lives, with 97% playing for at least one hour per day in the United States. The vast majority of research by psychologists on the effects of "gaming" has been on its negative impact: the potential harm related to violence, addiction, and depression. We recognize the value of that research; however, we argue that a more balanced perspective is needed, one that considers not only the possible negative effects but also the benefits of playing these games. Considering these potential benefits is important, in part, because the nature of these games has changed dramatically in the last decade, becoming increasingly complex, diverse, realistic, and social in nature. A small but significant body of research has begun to emerge, mostly in the last five years, documenting these benefits. In this article, we summarize the research on the positive effects of playing video games, focusing on four main domains: cognitive, motivational, emotional, and social. By integrating insights from developmental, positive, and social psychology, as well as media psychology, we propose some candidate mechanisms by which playing video games may foster real-world psychosocial benefits. Our aim is to provide strong enough evidence and a theoretical rationale to inspire new programs of research on the largely unexplored mental health benefits of gaming. Finally, we end with a call to intervention researchers and practitioners to test the positive uses of video games, and we suggest several promising directions for doing so.

Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research.

Abstract: Over the past three decades, cognitive-behavioral therapy (CBT) has become a first-line psychosocial treatment for individuals with chronic pain. Evidence for efficacy in improving pain and pain-related problems across a wide spectrum of chronic pain syndromes has come from multiple randomized controlled trials. CBT has been tailored to, and found beneficial for, special populations with chronic pain, including children and older adults. Innovations in CBT delivery formats (e.g., Web-based, telephone-delivered) and treatments based on CBT principles that are delivered by health professionals other than psychologists show promise for chronic pain problems. This article reviews (a) the evidence base for CBT as applied to chronic pain, (b) recent innovations in target populations and delivery methods that expand the application of CBT to underserved populations, (c) current limitations and knowledge gaps, and (d) promising directions for improving CBT efficacy and access for people living with chronic pain.

Interdisciplinary chronic pain management

Abstract: Chronic pain is a significant and costly problem in the United States as well as throughout the industrialized world. Unfortunately, there have been concerns about the effectiveness of traditional medical interventions, suggesting the need for alternative chronic pain treatment strategies. However, the introduction of the biopsychosocial model of pain during the past decade stimulated the development of more therapeutically effective and cost-effective interdisciplinary chronic pain management programs. In the present article we briefly review the history of pain management, discuss the major components of a "true" interdisciplinary pain management program, focus on the evidence-based outcomes that have documented the effectiveness of such interdisciplinary pain management programs, and note the barriers that have blocked the wider use of such programs. Finally, we discuss future directions in interdisciplinary pain management.

Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress.

Abstract: Over 30 years ago, treatments based broadly within cognitive behavioral therapy (CBT) began a rise in prominence that eventually culminated in their widespread adoption in chronic pain treatment settings. Research into CBT has proliferated and continues today, addressing questions very similar to those addressed at the start of this enterprise. However, just as it is designed to do, the process of conducting research and analyzing evidence reveals gaps in our understanding of and shortcomings within this treatment approach. A need for development seems clear. This article reviews the progress of CBT in the treatment of chronic pain and the challenges now faced by researchers and clinicians interested in meeting this need for development. It then focuses in greater detail on areas of development within CBT, namely acceptance and commitment therapy (ACT) and mindfulness-based approaches, areas that may hold potential for future progress. Three specific recommendations are offered here to achieve this progress.

Life is pretty meaningful.

Abstract: The human experience of meaning in life is widely viewed as a cornerstone of well-being and a central human motivation. Self-reports of meaning in life relate to a host of important functional outcomes. Psychologists have portrayed meaning in life as simultaneously chronically lacking in human life as well as playing an important role in survival. Examining the growing literature on meaning in life, we address the question "How meaningful is life, in general?" We review possible answers from various psychological sources, some of which anticipate that meaning in life should be low and others that it should be high. Summaries of epidemiological data and research using two self-report measures of meaning in life suggest that life is pretty meaningful. Diverse samples rate themselves significantly above the midpoint on self-reports of meaning in life. We suggest that if meaning in life plays a role in adaptation, it must be commonplace, as our analysis suggests.

Family and parent influences on pediatric chronic pain: a developmental perspective.

Abstract: Pain that recurs or persists is unfortunately a common experience for children. One of the unique considerations in pediatric chronic pain management is the bidirectional influences of children's pain experiences and parental and family factors. In this review we present a developmental perspective on understanding pediatric chronic pain and disability, highlighting factors relevant from infancy to adolescence, and family and parent influences. Preliminary evidence indicates that developmental processes are influenced and may also shape the pediatric pain experience. Parent emotions, behaviors, and health also play a role in children's pain experiences, where overly protective parent behaviors, increased distress, and history of chronic pain are important parent-level influences. Research on family-level influences has revealed that families of children with chronic pain have poorer family functioning (e.g., more conflict, less cohesion) than families of healthy children. Several important gaps exist in this research, such as in understanding basic developmental processes in children with chronic pain and how they influence children's perception of and responses to pain. Also, there is a lack of longitudinal data on family relationships and individual adjustment to allow for understanding of whether changes occur in parenting over the course of the child's chronic pain experience. Although parent interventions have been successfully incorporated into many cognitive-behavioral treatments for children with chronic pain conditions, little guidance exists for adapting intervention strategies to be developmentally appropriate. Additional research is needed to examine whether parent interventions are effective at different developmental stages and the best way to incorporate developmental goals into treatment.

With malice toward none and charity for some: ingroup favoritism enables discrimination.

Abstract: Dramatic forms of discrimination, such as lynching, property destruction, and hate crimes, are widely understood to be consequences of prejudicial hostility. This article focuses on what has heretofore been only an infrequent countertheme in scientific work on discrimination-that favoritism toward ingroups can be responsible for much discrimination. We extend this counterthesis to the strong conclusion that ingroup favoritism is plausibly more significant as a basis for discrimination in contemporary American society than is outgroup-directed hostility. This conclusion has implications for theory, research methods, and practical remedies.

From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System.

Abstract: Despite their established efficacy and recommendation--often as first-line treatments--in clinical practice guidelines, evidence-based psychotherapies (EBPs) have largely failed to make their way into mainstream clinical settings. Numerous attempts over the years to promote the translation of EBPs from science to practice, typically relying on one-dimensional dissemination approaches, have yielded limited success. As part of the transformation of its mental health care system, the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs (VA) is working to disseminate and implement a number of EBPs for various mental and behavioral health conditions throughout the VA health care system. This article examines VHA's multidimensional model and specific strategies, involving policy, provider, local systems, patient, and accountability levels, for promoting the national dissemination and implementation of EBPs in VHA. In addition, the article identifies key lessons learned and next steps for further promoting EBP delivery and sustainability in the VA health care system. Beyond promoting the availability of effective treatments for veterans returning from Iraq and Afghanistan and for veterans of previous combat eras, VHA's EBP dissemination and implementation model and key lessons learned may help to inform other private and public health care systems interested in disseminating and implementing EBPs.

Expertise in psychotherapy: an elusive goal?

Abstract: It has been argued that psychotherapy is a profession without any expertise (Shanteau, 1992). We examine the validity of this claim, reviewing the literature on expertise, clinical decision making, and psychotherapeutic outcome assessment, and find it a reasonable assessment. There is no demonstration of accuracy and skill that is associated with experience as a therapist. We posit that this absence of an expertise-experience relation is attributable to therapists' lack of access to quality outcome information regarding their interventions and an overreliance on fallible information-processing strategies even when such outcome information is available. The research on providing outcome feedback is reviewed, and although it does relate to client improvement, it has not been shown to be associated with any gains in therapist skill or expertise. We propose a model of outcome information usage and specific a priori hypothesis testing as a means of developing expertise. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Overview of persistent pain in older adults.

Abstract: With the shifting age demographics of the U.S. population, more psychologists will be asked to provide clinical services to older adults. Given the high prevalence of persistent pain in aging, in many cases this will mean providing empirically supported interventions for pain and the interference it creates. The purpose of this review is to provide a broad overview of the scope and impact of persistent pain in older people and to discuss mechanisms by which persistent geriatric pain can lead to suffering and disability. We consider the unique context of pain in older adulthood and review differences between older and younger people in terms of pain perception, the social network, beliefs about pain, pain-related coping, and adherence to pain medication. Finally, we discuss special issues affecting pain management in older adults, including dementia, polypharmacy, and barriers to accessing adequate pain care. This review also highlights a need for greater provider training in pain management to meet the needs of a changing U.S. population.

Critical cultural awareness: contributions to a globalizing psychology.

Abstract: The number of psychologists whose work crosses cultural boundaries is increasing. Without a critical awareness of their own cultural grounding, they risk imposing the assumptions, concepts, practices, and values of U.S.-centered psychology on societies where they do not fit, as a brief example from the 2004 Indian Ocean tsunami shows. Hermeneutic thinkers offer theoretical resources for gaining cultural awareness. Culture, in the hermeneutic view, is the constellation of meanings that constitutes a way of life. Such cultural meanings-especially in the form of folk psychologies and moral visions-inevitably shape every psychology, including U.S. psychology. The insights of hermeneutics, as well as its conceptual resources and research approaches, open the way for psychological knowledge and practice that are more culturally situated.

Competencies for psychology practice in primary care.

Abstract: This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

Contributions of psychology to the understanding and treatment of people with chronic pain: why it matters to ALL psychologists.

Abstract: Chronic pain is a prevalent problem with significant costs to individuals, significant others, and society. In this article, which introduces the American Psychologist special issue on chronic pain, we provide an overview of the seminal contributions made by psychologists to our current understanding of this important problem. We also describe the primary treatments that have been developed based on psychological principles and models of pain, many of which have demonstrated efficacy for reducing pain and its impact on psychological and physical functioning. The article ends with an enumeration of directions for future research and clinical practice. We believe that the chronicle of psychology's role in improving our understanding and treatment of pain provides a model for how psychologists can have a significant influence on many fields, and that the models and approaches developed for understanding and treating pain may be of use to psychologists working in other areas. Thus, we think that chronic pain is an important area of study that offers insights about translational research for ALL psychologists.

Racial/ethnic disparities in the assessment and treatment of pain: psychosocial perspectives.

Abstract: Racial/ethnic disparities not only are prevalent throughout the U.S. health care system but also have proved refractory to change. Such disparities are evident and similarly persistent in the treatment of patients with chronic pain conditions, exacting high personal and societal costs. While psychosocial factors contribute significantly to this intractable problem, an integrated examination of the literature is lacking. This article provides an overview of psychosocial factors that contribute to disparities in the treatment of chronic pain patients and in their adjustment to pain. It focuses initially on aspects of pain assessment that can occasion disparate care. Because pain is a subjective phenomenon that often defies objective medical assessment, it is particularly susceptible to social psychological influences, such as stereotypes. We pay particular attention to negative racial/ethnic stereotypes as well as to the circumstances that are likely to trigger stereotype-driven judgments. Subsequent sections review psychosocial factors that can influence a patient's experience of pain, those that can influence the patient-provider interaction, and those that operate in the public health environment. After each section, we suggest actions that could address identified issues related to clinical care, research, and policy. Policy recommendations generally are linked to provisions of the Affordable Care Act. We conclude with a discussion of the role that psychology should play in future efforts to address the persistent problem of racial/ethnic disparities in pain care.

The occasional case against broad dissemination and implementation: Retaining a role for specialty care in the delivery of psychological treatments.

Abstract: Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.

Hypnotic approaches for chronic pain management: clinical implications of recent research findings.

Abstract: The empirical support for hypnosis for chronic pain management has flourished over the past two decades. Clinical trials show that hypnosis is effective for reducing chronic pain, although outcomes vary between individuals. The findings from these clinical trials also show that hypnotic treatments have a number of positive effects beyond pain control. Neurophysiological studies reveal that hypnotic analgesia has clear effects on brain and spinal-cord functioning that differ as a function of the specific hypnotic suggestions made, providing further evidence for the specific effects of hypnosis. The research results have important implications for how clinicians can help their clients experience maximum benefits from hypnosis and treatments that include hypnotic components.

New evidence about language and cognitive development based on a longitudinal study: hypotheses for intervention.

Abstract: We review findings from a four-year longitudinal study of language learning conducted on two samples: a sample of typically developing children whose parents vary substantially in socioeconomic status, and a sample of children with pre- or perinatal brain injury. This design enables us to study language development across a wide range of language learning environments and a wide range of language learners. We videotaped samples of children's and parents' speech and gestures during spontaneous interactions at home every four months, and then we transcribed and coded the tapes. We focused on two behaviors known to vary across individuals and environments-child gesture and parent speech-behaviors that have the potential to index, and perhaps even play a role in creating, differences across children in linguistic and other cognitive skills. Our observations have led to four hypotheses that have promise for the development of diagnostic tools and interventions to enhance language and cognitive development and brain plasticity after neonatal injury. One kind of hypothesis involves tools that could identify children who may be at risk for later language deficits. The other involves interventions that have the potential to promote language development. We present our four hypotheses as a summary of the findings from our study because there is scientific evidence behind them and because this evidence has the potential to be put to practical use in improving education.

Mind the gap: why many geneticists and psychological scientists have discrepant views about gene-environment interaction (G×E) research.

Abstract: As our field seeks to elucidate the biopsychosocial etiologies of mental health disorders, many traditional psychological and social science researchers have added, or plan to add, genetic components to their programs of research. An understanding of the history, methods, and perspectives of the psychiatric genetics community is useful in this pursuit. In this article we provide a brief overview of psychiatric genetic methods and findings. This overview lays the groundwork for a more thorough review of gene-environment interaction (G×E) research and the candidate gene approach to G×E research that remains popular among many psychologists and social scientists. We describe the differences in perspective between psychiatric geneticists and psychological scientists that have contributed to a growing divide between the research cited and conducted by these two related disciplines. Finally, we outline a strategy for the future of research on gene-environment interactions that capitalizes on the relative strengths of each discipline. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Psychologists and pediatricians: Opportunities for collaboration in primary care.

Abstract: Despite an early interest in pediatrics among psychologists and a natural partnership between psychology and pediatrics, psychologists' impact on services for children in primary care settings could be much greater than it is. The purpose of this article is to describe the special contributions of pediatric psychologists and pediatricians in the development of comprehensive, integrated systems of health care for children; the importance of health behavior change as a preventive measure in the lives of children and adolescents; and how psychologists, through their leadership in clinical, research, and advocacy efforts, can harness the important resources of family relationships to promote the health of children.

Feminism and psychology: critiques of methods and epistemology.

Abstract: Starting in the 1960s, many of the critiques of psychological science offered by feminist psychologists focused on its methods and epistemology. This article evaluates the current state of psychological science in relation to this feminist critique. The analysis relies on sources that include the PsycINFO database, the Publication Manual of the American Psychological Association (American Psychological Association, 2010), and popular psychology methods textbooks. After situating the feminist critique within the late-20th-century shift of science from positivism to postpositivism, the inquiry examines feminists' claims of androcentric bias in (a) the underrepresentation of women as researchers and research participants and (b) researchers' practices in comparing women and men and describing their research findings. In most of these matters, psychology manifests considerable change in directions advocated by feminists. However, change is less apparent in relation to some feminists' criticisms of psychology's reliance on laboratory experimentation and quantitative methods. In fact, the analyses documented the rarity in high-citation journals of qualitative research that does not include quantification. Finally, the analysis frames feminist methodological critiques by a consideration of feminist epistemologies that challenge psychology's dominant postpositivism. Scrutiny of methods textbooks and journal content suggests that within psychological science, especially as practiced in the United States, these alternative epistemologies have not yet gained substantial influence.

An introduction to primary care and psychology.

Abstract: The health care system in the United States has been less effective and more expensive than it needs to be, but the organizational and political will to address these shortcomings is beginning to emerge. These changes are particularly noticeable in primary care, at the heart of an improved health care system. The value of primary care turns on its comprehensiveness, which means that behavioral health care-health behavior change, mental health care, management of psychological symptoms and psychosocial distress, and attention to substance abuse-must be woven into the fabric of primary care practice. This integration is beginning to happen as psychologists and other behavioral health clinicians are incorporated as essential team members in the patient-centered medical home and other emerging models of primary care. This article introduces psychologists to the fundamental changes taking place in primary care and to the various roles that psychologists can play in the new health care system. We describe the extensive breadth and diversity of primary care by age, sex, setting, and type of clinical problem and the implications of this variety for the psychologist's role. This description is not simply a clinical exercise: Transformation of the primary care system also has policy, educational, and research dimensions. We describe how psychologists are essential to these functions as well.

Psychology and social networks: a dynamic network theory perspective.

Abstract: Research on social networks has grown exponentially in recent years However, despite its relevance, the field of psychology has been relatively slow to explain the underlying goal pursuit and resistance processes influencing social networks in the first place In this vein, this article aims to demonstrate how a dynamic network theory perspective explains the way in which social networks influence these processes and related outcomes, such as goal achievement, performance, learning, and emotional contagion at the interpersonal level of analysis The theory integrates goal pursuit, motivation, and conflict conceptualizations from psychology with social network concepts from sociology and organizational science to provide a taxonomy of social network role behaviors, such as goal striving, system supporting, goal preventing, system negating, and observing This theoretical perspective provides psychologists with new tools to map social networks (eg, dynamic network charts), which can help inform the development of change interventions Implications for social, industrial-organizational, and counseling psychology as well as conflict resolution are discussed, and new opportunities for research are highlighted, such as those related to dynamic network intelligence (also known as cognitive accuracy), levels of analysis, methodological/ethical issues, and the need to theoretically broaden the study of social networking and social media behavior (PsycINFO Database Record (c) 2014 APA, all rights reserved)

A synopsis of South African psychology from apartheid to democracy.

Abstract: In this concatenated overview, the development of psychology in South Africa is traced from its origins in the late 19th century to the present. The seminal influences on the science and practice of psychology of the racialized polity and the responses to the prevailing regimen are also explored. The significant events in the patinated layers of psychological discourse and consequent policies in these constrained circumstances are traversed. Despite the nonracial era occasioned by the formation of the Psychological Society of South Africa three months before the advent of democracy under Nelson Mandela in 1994, the profession of psychology remains demographically skewed. Nevertheless, psychology in the current democratic dispensation enjoys a high profile and is actively engaged in ongoing and reflexive self-examination to ensure that it is more accessible and truly serves humanity. If Africa is psychology's last frontier, the critical denouement of the various issues confronting psychology in the southern tip of the African continent will provide a positive growth path that is likely to merit attention beyond its borders.

The cultural lens approach to evaluating cultural validity of psychological theory.

Abstract: In this article, we introduce the cultural lens approach (CLA), a novel approach to evaluating the extent to which a psychological theory applies across cultural groups. The CLA requires scholars to apply their accumulated knowledge about cultural influences and differences (e.g., independent and interdependent self-construals; Markus & Kitayama, 1991) to the ways in which theoretical propositions are interpreted and operationalized. First we highlight three limitations in existing approaches to cultural validity and the ways in which the CLA addresses these limitations. Next, we articulate the five steps involved in the CLA and apply it to three different theories from social, vocational, and positive psychology to demonstrate its broad utility. In all cases, we highlight how applying the CLA can generate multiple novel testable hypotheses to stimulate future research and to advance knowledge that is culturally sensitive.

Applying the interprofessional patient aligned care team in the Department of Veterans Affairs: Transforming primary care.

Abstract: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving more than 8 million veterans. VHA is currently undergoing extensive changes to its health care delivery model, moving toward the full implementation of the patient-centered medical home. Mental health providers, including psychologists working in primary care, are playing key roles in this transformation to interprofessional teams and systems-as clinicians, researchers, program evaluators, and educators. Moreover, VHA mental health staff serves critical leadership functions supporting primary care in the broad transformation that is required to implement the medical home. In this article, we review the implementation of mental health integration into this new model of care.

Opportunities for psychologists in palliative care: Working with patients and families across the disease continuum.

Abstract: Interdisciplinary palliative care services have been rapidly expanding in health care settings over the past 10 years, particularly through the establishment of interdisciplinary palliative care teams. Relatively few of these teams formally include psychologists, although their skills of enhancing patients' and families' well-being and lessening suffering make an enormous contribution to the care provided. In this article, we define palliative care in broad terms, distinguishing it from hospice and end-of-life care. Using a case-based approach, we then explore the contribution of psychologists to the patient- and family-centered approach espoused by palliative care, including the knowledge, skills, and self-awareness needed to work effectively with these very ill patients and their families. We close with a call to action to better train and integrate psychologists into the rapidly growing field of palliative care.

Proximity of providers: Colocating behavioral health and primary care and the prospects for an integrated workforce.

Abstract: Integrated behavioral health and primary care is emerging as a superior means by which to address the needs of the whole person, but we know neither the extent nor the distribution of integration. Using the Centers for Medicare and Medicaid Services' National Plan and Provider Enumeration System (NPPES) Downloadable File, this study reports where colocation exists for (a) primary care providers and any behavioral health provider and (b) primary care providers and psychologists specifically. The NPPES database offers new insights into where opportunities are limited for integration due to workforce shortages or nonproximity of providers and where possibilities exist for colocation, a prerequisite for integration.

Psychological pain interventions and neurophysiology: Implications for a mechanism-based approach.

Abstract: This article provides an illustrative overview of neurophysiological changes related to acute and chronic pain involving structural and functional brain changes, which might be the targets of psychological interventions. A number of psychological pain treatments have been examined with respect to their effects on brain activity, ranging from cognitive- and operant behavioral interventions, meditation and hypnosis, to neuro- and biofeedback, discrimination training, imagery and mirror treatment, as well as virtual reality and placebo applications. These treatments affect both ascending and descending aspects of pain processing and act through brain mechanisms that involve sensorimotor areas as well as those involved in affective-motivational and cognitive-evaluative aspects. The analysis of neurophysiological changes related to effective psychological pain treatment can help to identify subgroups of patients with chronic pain who might profit from different interventions, can aid in predicting treatment outcome, and can assist in identifying responders and nonresponders, thus enhancing the efficacy and efficiency of psychological interventions. Moreover, new treatment targets can be developed and tested. Finally, the use of neurophysiological measures can also aid in motivating patients to participate in psychological interventions and can increase their acceptance in clinical practice.

Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions.

Abstract: The rapid transformation of primary care in the United States provides an opportunity for psychologists to become actively involved as integrated members of primary care teams in the provision of services for adults with chronic disease. The differences between primary care clinicians and psychologists with respect to education, culture, practice styles, reimbursement, and roles, however, pose notable barriers to effective integration. In this report we review models of collaboration, barriers to effective integration of services, and potential areas in which psychologists can make major contributions both to direct service delivery and to primary care practice, with special reference to the care of adults with chronic conditions.