Behavioral medicine is an interdisciplinary field of medicine 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. The term is often used interchangeably, and incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and biobehavioral 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. This topic must also be distinguished from behavioral health, which focuses on prevention of disease, whereas medicine emphasizes remediation and healing of illness. Behavioral medicine is especially relevant in America, where many of the health problems are primarily behavioral in nature, as opposed to medical. For example, smoking, leading a sedentary lifestyle, and abusing alcohol or other drugs are all factors in the leading causes of death in the United States. Practitioners of behavioral medicine include appropriately qualified nurses, psychologists, and physicians (including medical students and residents), and these professionals often act as behavioral change agents, even in their medical roles.
Behavioral medicine uses the biopsychosocial model of illness instead of the medical model. 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 mentioned the relationship between mind and body which fundamentally represents the idea of behavioral medicine. One of its academic forebears is the field of psychosomatic medicine. The field of behavioral medicine exploded during the late 1970s as a result of several national conferences on the subject, including the Yale Conference on Behavioral Medicine in 1977 and also a meeting of the National Academy of Sciences. These meetings resulted in the establishment of both a journal (Journal of Behavioral Medicine) and a formal organization (Academy for Research in Behavioral Medicine). Today, many American medical schools emphasize the relationship between doctor and patient and recognize its healing power.
The International Society of Behavioral Medicine, established in 1990 at the International Congress of Behavioral Medicine in Sweden, is the leading non-profit organization in the field, with many national daughter-organizations. Its annual conferences and peer-reviewed journal have become a focus for professional and academic development.
Topics in behavioral medicine
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 abuse: many studies demonstrate that medication is most effective when combined with behavioral intervention 
- Obesity: structured lifestyle interventions are more effective widely suitable than drugs or bariatric surgery.
- Hypertension: deliberate attempts to reduce stress can also reduce high blood pressure
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. Patients with strong social support systems, particularly through marriages and families, typically exhibit better compliance with their treatment regimen.
- 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
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.
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.
Learning can be defined as a relatively permanent change in a behavioral tendency occurring as a result of reinforced practice. 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. This also implies that patients can change their unhealthy behaviors in order to improve their diagnoses or health, especially in treating addictions and phobias.
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.
Application of behavioral medicine
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. 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. 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.
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.
- Annals of Behavioral Medicine (http://www.springer.com/medicine/journal/12160)
- International Journal of Behavioral Medicine (http://www.springer.com/medicine/journal/12529)
- Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine BAO
- Journal of Behavioral Health and Medicine BAO
- Journal of Behavioral Medicine (http://www.springer.com/medicine/journal/10865)
- Association for Behavior Analysis International
- Society of Behavioral Medicine
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