Date of Submission

2002

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

Department Chair

Arthur Freeman, Ed.D., ABPP

First Advisor

Robert A. DiTomasso, Ph.D., ABPP, Chairperson

Second Advisor

Arthur Freeman, Ed.D., ABPP

Third Advisor

Barbara Golden, Psy.D., ABPP

Abstract

The incidence of nonadherence to medical advice is estimated to be as high as 98%, with a typical range of 30% to 60%. This case study focused on the assessment and treatment of a patient suffering from uncontrolled essential hypertension, who was inconsistent in her adherence to the prescribed medical regimen and who demonstrated a significant health risk as a result. From baseline (pretreatment) to termination (followup), the patient attended a total of 9 sessions over a 12-week period. Assessment involved clinical interviews and an original self-administered instrument, the Health Behavior Profiling Questionnaire (HBPQ). The HBPQ was designed to assess the multitude of possible causes that contribute to nonadherence, especially directed to patients with chronic disease. The treatment plan was developed based on the identified problems and upon the unique circumstances and characteristics of the individual patient. Cognitive-behavioral techniques, combined with other indicated and empirically validated psychotherapeutic modalities, provided an effective treatment regimen. The patient increased her adherence and achieved a normal and stabilized blood pressure. Her mean blood pressure readings decreased 16.87% systolic and 19.78% diastolic from baseline to follow-up. The positive outcome in this case points to the potential efficacy of an individualized treatment package based on an individually administered assessment procedure. The assessment procedure utilized in this case study could potentially be utilized with any patient suffering from chronic illness where nonadherence with the medical regimen is either suspected or founded. Research regarding the reliability and validity of the HBPQ is required.

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