What is behavioral medicine?

Behavioral medicine is concerned with integrating knowledge into the biological, behavioral, psychological, and social sciences related to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used synonymously, but incorrectly, with health psychology. The practice of behavioral medicine includes health psychology, but also includes applied psychophysiological treatments such as biofeedback, hypnosis and biobehavioral therapy for physical disorders, aspects of occupational therapy, rehabilitation medicine and physical therapy, and preventive medicine. In contrast, health psychology places greater emphasis specifically on the role of psychology in both behavioral medicine and behavioral health.

Behavioral medicine is especially relevant these days, when many health problems are primarily seen as behavioral in nature, as opposed to medical. For example, smoking, sedentary lifestyles and alcohol abuse or other substance abuse are all factors that are major causes of death in today's society. Behavioral health practitioners include nurses, social workers, psychologists and physicians (including medical students and residents) with appropriate qualifications. professionals often act as agents of behavior change, even in their medical roles.

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

Origins and History

Letters from the earliest times of civilization have referred to the mind-body relationship, the fundamental concept underlying behavioral medicine. The field of psychosomatic medicine is one of its academic predecessors, although it is now obsolete as an academic discipline.

As it is commonly understood today, the field dates back to the 1970s. The first references to the term were in the title of a book by Lee Birk ("Biological Feedback: Behavioral Medicine") published in 1973; and on behalf of two clinical research units, the Center for Behavioral Medicine, founded by Ovid F. Pomerleau and John Paul Brady at the University of Pennsylvania in 1973, and the Behavioral Medicine Research Laboratory, founded by William Stewart Agras at Stanford University in 1974. The field subsequently expanded to include research into behavioral, physiological, and biochemical interactions with health and disease, and gained prominence within behavioral medicine. In 1976, recognizing this trend, the National Institutes of Health created the Division of Behavioral Medicine Research to encourage and facilitate collaborative research across disciplines.

The 1977 Yale Conference on Behavioral Medicine and the meeting of the National Academy of Sciences were clearly aimed at defining and delineating the field in hopes of helping to guide future research. Building on the discussions at the Yale conference, Schwartz and Weiss proposed a biopsychosocial model, emphasizing the interdisciplinary roots of the new field and calling for the integration of knowledge and methods widely borrowed from behavioral and biomedical science. Shortly thereafter, Pomerleau and Brady published a book entitled Behavioral Medicine: Theory and Practice, in which they proposed an alternative definition, focusing in more detail on the specific contributions of experimental behavior analysis in shaping the field.

Additional developments during this period of growth and fermentation included the creation of scientific societies (Society of Behavioral Medicine and Academy of Behavioral Medicine Research, both in 1978) and journals (Journal of Behavioral Medicine in 1977 and 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 numerous affiliated societies and through its own peer-reviewed journal (International Journal of Behavioral Medicine), an international focus for professional and academic development.

Behavioral illnesses

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

• Substance abuse: Many studies show that medications are most effective when combined with behavioral interventions
• Obesity: Structured lifestyle interventions are more effective and widely appropriate than drugs or bariatric surgery.
• Hypertension: Deliberate attempts to reduce stress can also reduce high blood pressure
• Insomnia: Cognitive and behavioral interventions recommended as first-line treatment for insomnia

Treatment adherence and compliance

Medications are best for controlling chronic conditions when patients use them as prescribed and do not deviate from the doctor's instructions. This is true for both physiological and mental illnesses. However, in order for the patient to adhere to the treatment regimen, the physician must provide accurate information about the regimen, an adequate explanation of what the patient should do, and must offer reinforcement of the appropriate regimen more frequently. Patients with strong social support systems, especially those in marriages and families, are usually better at adhering to the treatment regimen.

Examples:

• remote monitoring with the patient by telephone or video conference
• case management using a number of medical specialists for continuous monitoring of the patient

Doctor-patient relationship

It is important for physicians to make meaningful connections and relationships with their patients, not just communicate with them, which is often the case in a system that relies heavily on specialized care. For this reason, behavioral medicine emphasizes honest and clear communication between doctor and patient to successfully treat any illness as well as to maintain optimal levels of physical and mental health. Barriers to effective communication include power dynamics, vulnerability and feelings of helplessness or fear. Physicians and other health care providers also struggle with interviewing difficult or uncooperative patients and with communicating unwanted medical news to patients and their families.

The field has increasingly focused on working to share power in relationships as well as educating the clinician to empower the patient to make his or her own behavioral changes. More recently, behavioral medicine has expanded its scope of practice to include interventions with health care providers, recognizing the fact that provider behavior can have a determining influence on patient outcomes. Goals include maintaining professional behavior, productivity, and altruism, as well as preventing burnout, depression, and job dissatisfaction among practitioners.

Principles of learning, models and theories

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

Learning theory

Learning can be defined as a relatively permanent change in behavioral tendency resulting from reinforced practice. As a result of learning, the behavior is significantly more likely to be repeated in the future, making learning important for producing maladaptive physiological responses that can lead to psychosomatic illness. It also means that patients can change their unhealthy behaviors to improve their diagnosis or improve their health, especially in the treatment of addictions and phobias.

Other areas include correcting perceptual bias in diagnostic behavior; correcting clinician attitudes that negatively affect patient care; and addressing clinician behavior that contributes to disease and its persistence in patients, whether or not it is a breach of duty.

Our modern culture includes many acute microstressors that, over time, lead to a great deal of chronic stress leading to illness and malaise. According to Hans Sellier, the body's stress response is designed to heal and includes three phases of its overall adaptation syndrome: anxiety, resistance and exhaustion.

Application

An example of how to apply The biopsychosocial model that behavioral medicine uses is based on the treatment of chronic pain. Before this model was adopted, physicians could not explain why some patients did not experience pain despite significant tissue damage, leading them to believe that a purely biomedical model of illness was inadequate. However, increased damage to body parts and tissues is usually associated with increased levels of pain. Doctors began to include a cognitive component to pain, leading to the gate control theory and the discovery of the placebo effect. Psychological factors influencing pain include self-efficacy, anxiety, fear, abuse, life stressors, and catastrophic pain, which is particularly sensitive to behavioral interventions. In addition, genetic predisposition to psychological stress and pain sensitivity influence pain management. Finally, social factors such as socioeconomic status, race, and ethnicity also play a role in the experience of pain.

Behavioral medicine involves the study of all the many factors associated with the disease, not just the biomedical aspect, and treats the disease, including a component of behavior change on the part of the patient.

In a review published in 2011, Fisher et al. Demonstrate how a behavioral health approach can be applied to a number of common diseases and risk factors, such as cardiovascular disease/diabetes, cancer, HIV/AIDS and tobacco use, poor nutrition, physical inactivity, and excessive alcohol use. Evidence suggests that behavioral interventions are cost-effective and improve quality of life. It is important to note that behavioral interventions can have broad effects and have positive implications for prevention, disease management, and well-being across the lifespan.