Behavioral medicine

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Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. [1] The term is often used interchangeably, but incorrectly, with health psychology.[ citation needed ] The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health. [2]

Contents

Behavioral medicine is especially relevant in recent days, where many of the health problems are primarily viewed as behavioral in nature, as opposed to medical. For example, smoking, leading a sedentary lifestyle, and alcohol use disorder or other substance use disorder are all factors in the leading causes of death in the modern society. Practitioners of behavioral medicine include appropriately qualified nurses, social workers, psychologists, and physicians (including medical students and residents), and these professionals often act as behavioral change agents, even in their medical roles.[ citation needed ]

Behavioral medicine uses the biopsychosocial model of illness instead of the medical model. [3] This model incorporates biological, psychological, and social elements into its approach to disease instead of relying only on a biological deviation from the standard or normal functioning.

Origins and history

Writings from the earliest civilizations have alluded to the relationship between mind and body, the fundamental concept underlying behavioral medicine. [2] The field of psychosomatic medicine is among its academic forebears, albeit, it is now obsolete as an psychological discipline. [4]

In the form in which it is generally understood today, the field dates back to the 1970s. The earliest uses of the term were in the title of a book by Lee Birk (Biofeedback: Behavioral Medicine), published in 1973; and in the names of two clinical research units, the Center for Behavioral Medicine, founded by Ovide F. Pomerleau and John Paul Brady at the University of Pennsylvania in 1973, and the Laboratory for the Study of Behavioral Medicine, founded by William Stewart Agras at Stanford University in 1974. Subsequently, the field burgeoned, and inquiry into behavioral, physiological, and biochemical interactions with health and illness gained prominence under the rubric of behavioral medicine. In 1976, in recognition of this trend, the National Institutes of Health created the Behavioral Medicine Study Section to encourage and facilitate collaborative research across disciplines.[ citation needed ]

The 1977 Yale Conference on Behavioral Medicine and a meeting of the National Academy of Sciences were explicitly aimed at defining and delineating the field in the hopes of helping to guide future research. [2] Based on deliberations at the Yale conference, Schwartz and Weiss proposed the biopsychosocial model, emphasizing the new field's interdisciplinary roots and calling for the integration of knowledge and techniques broadly derived from behavioral and biomedical science. [5] Shortly after, Pomerleau and Brady published a book entitled Behavioral Medicine: Theory and Practice, [6] in which they offered an alternative definition focusing more closely on the particular contribution of the experimental analysis of behavior in shaping the field.[ citation needed ]

Additional developments during this period of growth and ferment included the establishment of learned societies (the Society of Behavioral Medicine and the Academy of Behavioral Medicine Research, both in 1978) and of journals (the Journal of Behavioral Medicine in 1977 and the Annals of Behavioral Medicine in 1979). In 1990, at the International Congress of Behavioral Medicine in Sweden, the International Society of Behavioral Medicine was founded to provide, through its many daughter societies and through its own peer-reviewed journal (the International Journal of Behavioral Medicine), an international focus for professional and academic development. [7]

Areas of study

Many chronic diseases have a behavioral component, but the following illnesses can be significantly and directly modified by behavior, as opposed to using pharmacological treatment alone:

Treatment adherence and compliance

Medications work best for controlling chronic illness when the patients use them as prescribed and do not deviate from the physician's instructions. This is true for both physiological and mental illnesses. However, in order for the patient to adhere to a treatment regimen, the physician must provide accurate information about the regimen, an adequate explanation of what the patient must do, and should also offer more frequent reinforcement of appropriate compliance. [1] Patients with strong social support systems, particularly through marriages and families, typically exhibit better compliance with their treatment regimen. [10]

Examples:

Doctor-patient relationship

It is important for doctors to make meaningful connections and relationships with their patients, instead of simply having interactions with them, which often occurs in a system that relies heavily on specialist care. For this reason, behavioral medicine emphasizes honest and clear communication between the doctor and the patient in the successful treatment of any illness, and also in the maintenance of an optimal level of physical and mental health. Obstacles to effective communication include power dynamics, vulnerability, and feelings of helplessness or fear. Doctors and other healthcare providers also struggle with interviewing difficult or uncooperative patients, as well as giving undesirable medical news to patients and their families.[ citation needed ]

The field has placed increasing emphasis on working towards sharing the power in the relationship, as well as training the doctor to empower the patient to make their own behavioral changes. More recently, behavioral medicine has expanded its area of practice to interventions with providers of medical services, in recognition of the fact that the behavior of providers can have a determinative effect on patient outcomes. Objectives include maintaining professional conduct, productivity, and altruism, in addition to preventing burnout, depression, and job dissatisfaction among practitioners. [8]

Learning principles, models and theories

Behavioral medicine includes understanding the clinical applications of learning principles such as reinforcement, avoidance, generalisation, and discrimination, and of cognitive-social learning models as well, such as the cognitive-social learning model of relapse prevention by Marlatt.

Learning theory

Learning can be defined as a relatively permanent change in a behavioral tendency occurring as a result of reinforced practice. [10] A behavior is significantly more likely to occur again in the future as a result of learning, making learning important in acquiring maladaptive physiological responses that can lead to psychosomatic disease. [10] This also implies that patients can change their unhealthy behaviors in order to improve their diagnoses or health, especially in treating addictions and phobias.[ citation needed ]

The three primary theories of learning are:

Other areas include correcting perceptual bias in diagnostic behavior; remediating clinicians' attitudes that impinge negatively upon patient treatment; and addressing clinicians' behaviors that promote disease development and illness maintenance in patients, whether within a malpractice framework or not.

Our modern-day culture involves many acute, microstressors that add up to a large amount of chronic stress over time, leading to disease and illness. According to Hans Selye, the body's stress response is designed to heal and involves three phases of his General Adaptation Syndrome: alarm, resistance, and exhaustion. [10]

Applications

An example of how to apply the biopsychosocial model that behavioral medicine utilizes is through chronic pain management. Before this model was adopted, physicians were unable to explain why certain patients did not experience pain despite experiencing significant tissue damage, which led them to see the purely biomedical model of disease as inadequate. [7] However, increasing damage to body parts and tissues is generally associated with increasing levels of pain. Doctors started including a cognitive component to pain, leading to the gate control theory and the discovery of the placebo effect. Psychological factors that affect pain include self-efficacy, anxiety, fear, abuse, life stressors, and pain catastrophizing, which is particularly responsive to behavioral interventions. [7] In addition, one's genetic predisposition to psychological distress and pain sensitivity will affect pain management. Finally, social factors such as socioeconomic status, race, and ethnicity also play a role in the experience of pain.[ citation needed ]

Behavioral medicine involves examining all of the many factors associated with illness, instead of just the biomedical aspect, and heals disease by including a component of behavioral change on the part of the patient.[ citation needed ]

In a review published 2011 Fisher et al. [11] illustrates how a behavior medical approach can be applied on a number of common diseases and risk factors such as cardiovascular disease/diabetes, cancer, HIV/AIDS and tobacco use, poor diet, physical inactivity and excessive alcohol consumption. Evidence indicates that behavioral interventions are cost effectiveness and add in terms of quality of life. Importantly behavioral interventions can have broad effects and benefits on prevention, disease management, and well-being across the life span. [11]

Journals

Organizations

See also

Related Research Articles

Medical psychology or medico-psychology is the application of psychological principles to the practice of medicine, sometimes using drugs for both physical and mental disorders.

Psychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, behavioral factors on bodily processes and quality of life in humans and animals.

<span class="mw-page-title-main">Biopsychosocial model</span> Explanatory model emphasizing the interplay among causal forces

Biopsychosocial models are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio-environmental factors. These models specifically examine how these aspects play a role in a range of topics but namely psychiatry, health and human development. 

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person's health. For example, certain behaviors can, over time, harm or enhance health. Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes but also of psychological, behavioral, and social processes.

Pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.

Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry, is the branch of psychiatry that specialises in the interface between general medicine/pediatrics and psychiatry, usually taking place in a hospital or medical setting. The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Consultation-liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology and neuropsychiatry.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.

Psycho-oncology is an interdisciplinary field at the intersection of physical, psychological, social, and behavioral aspects of the cancer experience for both patients and caregivers. Also known as psychiatric oncology or psychosocial oncology, researchers and practitioners in the field are concerned with aspects of individuals' experience with cancer beyond medical treatment, and across the cancer trajectory, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life. Founded by Jimmie Holland in 1977 via the incorporation of a psychiatric service within the Memorial Sloan Kettering Cancer Center in New York, the field has expanded drastically since and is now universally recognized as an integral component of quality cancer care. Cancer centers in major academic medical centers across the country now uniformly incorporate a psycho-oncology service into their clinical care, and provide infrastructure to support research efforts to advance knowledge in the field.

George Libman Engel was an American internist and psychiatrist. He spent most of his career at the University of Rochester Medical Center in Rochester, New York. He is best known for his formulation of the biopsychosocial model, a general theory of illness and healing.

Functional disorder is an umbrella term for a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

Cognitive behavioral therapy for insomnia (CBT-I) is a technique for treating insomnia without medications. Insomnia is a common problem involving trouble falling asleep, staying asleep, or getting quality sleep. CBT-I aims to improve sleep habits and behaviors by identifying and changing the thoughts and the behaviors that affect the ability of a person to sleep or sleep well.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.

Symptom targeted intervention (STI) is a clinical program being used in medical settings to help patients who struggle with symptoms of depression or anxiety or adherence to treatment plans but who are not interested in receiving outpatient mental health treatment. STI is an individualized therapeutic model and clinical program that teaches patients brief, effective ways to cope with difficult thoughts, feelings, and behaviors using evidence-based interventions. Its individualized engagement process employs techniques from solution-focused therapy, using a Rogerian, patient-centered philosophy. This engagement process ensures that even challenging, at-risk, and non-adherent patients are able to participate.

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as chronic fatigue syndrome, fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform.

Pain psychology is the study of psychological and behavioral processes in chronic pain. Pain psychology involves the implementation of treatments for chronic pain. Pain psychology can also be regarded as a branch of medical psychology, as many conditions associated with chronic pain have significant medical outcomes. Untreated pain or ineffective treatment of pain can result in symptoms of anxiety, depression, and suicidal thoughts, thus it is vital that appropriate pain management occur in a timely fashion following symptom onset.

Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may include the following areas: psychosocial, cognitive, behavioral, and functional status, self-esteem, coping skills, and quality of life. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal and environmental factors, is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

References

  1. 1 2 Miller, Neal E. (1983). "Behavioral Medicine: Symbiosis between Laboratory and Clinic". Annual Review of Psychology . 34: 1–32. doi: 10.1146/annurev.ps.34.020183.000245 . PMID   6338810.
  2. 1 2 3 4 Matarazzo, J. D. (1980). Behavioral health and behavioral medicine: frontiers for a new health psychology. American Psychologist, 35(9), 807-817.
  3. ↑ Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136.
  4. ↑ Lipowski, Z.J. (February 1986). "Psychosomatic Medicine: Past and Present Part I. Historical Background". The Canadian Journal of Psychiatry. 31 (1): 2–7. doi:10.1177/070674378603100102. ISSN   0706-7437.
  5. ↑ Schwartz, G.E. & Weiss, S.M. (1978). Behavioral medicine revisited: An amended definition. Journal of Behavioral Medicine, 1, 249-251.
  6. ↑ Pomerleau, O.F. & Brady, J.P., Eds. (1979). Behavioral Medicine: Theory and Practice. Baltimore: Williams & Wilkins.
  7. 1 2 3 Keefe, F. J. (2011). Behavioral medicine: a voyage to the future. Annals of Behavioral Medicine, 41, 141-151.
  8. 1 2 Feldman, M. D. (2012). Role of behavioral medicine in primary care. Current Opinion in Psychiatry, 25(2), 121-127.
  9. ↑ Miller, K. E. (2005). "Cognitive Behavior Therapy vs. Pharmacotherapy for Insomnia". American Family Physician. 72 (2): 330. Archived from the original on 2011-06-06.
  10. 1 2 3 4 Wedding, Danny. Behavior and Medicine. 3rd ed. Seattle: Hogrefe & Huber, 2001. Print.
  11. 1 2 Fisher, Edwin B.; Fitzgibbon, Marian L.; Glasgow, Russell E.; Haire-Joshu, Debra; Hayman, Laura L.; Kaplan, Robert M.; Nanney, Marilyn S.; Ockene, Judith K. (May 2011). "Behavior Matters". American Journal of Preventive Medicine. 40 (5): e15–e30. doi:10.1016/j.amepre.2010.12.031. ISSN   0749-3797. PMC   3137947 . PMID   21496745.
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