Medicine:Behavioral medicine

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Short description: Medical approaches incorporating psychology and sociology

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.[2] 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.[3]


Behavioral medicine uses the biopsychosocial model of illness instead of the medical model.[4] 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.[citation needed]

Origins and history

Writings from the earliest civilizations have alluded to the relationship between mind and body, the fundamental concept underlying behavioral medicine.[3] The field of psychosomatic medicine is among its academic forebears, albeit, it is now obsolete as an psychological discipline.[5]


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.[6]

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:

  • Substance use: many studies demonstrate that medication is most effective when combined with behavioral intervention [7]
  • Hypertension: deliberate attempts to reduce stress can also reduce high blood pressure
  • Insomnia: cognitive and behavioural interventions are recommended as a first line treatment for insomnia[8]
  • Diabetes: Research suggests diet and exercise as one of the main treatments for diabetes [9][10]

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.[11]

Examples:

  • telemonitoring through telephone or video conference with the patient
  • case management by using a range of medical professionals to consistently follow up with the patient

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.[12]

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.[7]

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.[citation needed]

Learning theory

The three primary theories of learning are:[citation needed]

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.[citation needed]

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.[11]

Applications

In a review published 2011 Fisher et al.[13] 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.[13]

Journals

  • Annals of Behavioral Medicine
  • International Journal of Behavioral Medicine
  • Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine
  • Journal of Behavioral Health and Medicine
  • Journal of Behavioral Medicine

Organizations

  • Association for Behavior Analysis International's Behavioral Medicine Special Interest Group
  • Society of Behavioral Medicine
  • International Society of Behavioral Medicine
  • The Lifestyle Change and Behavioral Health (LCBH) Study Section

See also

References

  1. ↑ 1.0 1.1 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. ↑ Fischer, Christopher (19 July 2008). "What Is Health Psychology & Behavioral Medicine?". BMedReport. https://www.bmedreport.com/archives/69. 
  3. ↑ 3.0 3.1 Matarazzo, J. D. (1980). Behavioral health and behavioral medicine: frontiers for a new health psychology. American Psychologist, 35(9), 807-817.
  4. ↑ Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136.
  5. ↑ 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. PMID 3512067. http://dx.doi.org/10.1177/070674378603100102. 
  6. ↑ Keefe, F. J. (2011). Behavioral medicine: a voyage to the future. Annals of Behavioral Medicine, 41, 141-151.
  7. ↑ 7.0 7.1 Feldman, M. D. (2012). Role of behavioral medicine in primary care. Current Opinion in Psychiatry, 25(2), 121-127.
  8. ↑ Miller, K. E. (2005). "Cognitive Behavior Therapy vs. Pharmacotherapy for Insomnia". American Family Physician 72 (2): 330. http://www.aafp.org/afp/2005/0715/p330.html. 
  9. ↑ Gonder-Frederick, Linda A.; Cox, Daniel J.; Ritterband, Lee M. (June 2002). "Diabetes and behavioral medicine: the second decade". Journal of Consulting and Clinical Psychology 70 (3): 611–625. doi:10.1037/0022-006x.70.3.611. ISSN 0022-006X. PMID 12090372. 
  10. ↑ Surwit, R. S.; Scovern, A. W.; Feinglos, M. N. (1982). "The role of behavior in diabetes care". Diabetes Care 5 (3): 337–342. doi:10.2337/diacare.5.3.337. ISSN 0149-5992. PMID 6756844. 
  11. ↑ 11.0 11.1 Wedding, Danny. Behavior and Medicine. 3rd ed. Seattle: Hogrefe & Huber, 2001. Print.
  12. ↑ Feldman, Mitchell D.; Berkowitz, Seth A. (March 2012). "Role of behavioral medicine in primary care". Current Opinion in Psychiatry 25 (2): 121–127. doi:10.1097/YCO.0b013e3283503576. ISSN 1473-6578. PMID 22249080. 
  13. ↑ 13.0 13.1 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. PMID 21496745. 



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