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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 [1]. 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 [2]. This topic must also be distinguished from behavioral health, which focuses on prevention of disease, whereas medicine revolves around remediation or 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 [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
[edit]Writings from the earliest civilizations mentioned the relationship between mind and body which fundamentally represents the idea of behavioral medicine [2]. One of its academic forebears is the field of psychosomatic medicine.
Topics in Behavioral Medicine
[edit]Behavior-related illnesses
[edit]- Many chronic disease have a behavioral component, but the following illnesses can be significantly and directly modified by behavior, as opposed to using medicine alone:
Treatment adherence and compliance
[edit]- 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 [6].
- Examples:
- telemonitoring
- case management
Doctor-patient relationship
[edit]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, honest and clear communication between the doctor and the patient is very important to successfully treating any illness, and also to maintaining 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.
- Social support
- marriage
- family
- Social support
- Physician well-being
- 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 (feldman review).
Psychodynamic formulations
[edit]Behavioral medicine includes understanding the clinical applications of defense mechanisms such as denial, projection, regression, and transference (med school textbook).
Learning theory
[edit]Learning can be defined as a relatively permanent change in a behavioral tendency occurring as a result of reinforced practice (med school textbook). A behavioral 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 (med school textbook). 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:
- classical conditioning
- operant conditioning
- modeling
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.
Example of a behavioral pathway leading to a medical diagnosis: Stress and Illness
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 (med school textbook).
The International Society of Behavioral Medicine is the leading non-profit organization in the field, with many national daughter-organizations. Its annualconferences have become a focus for professional and academic development.
Applications of behavioral medicine
[edit]See also
[edit]Journals
[edit]Annals of Behavioral Medicine (http://www.springer.com/medicine/journal/12160)
Journal of Behavioral Medicine (http://www.springer.com/medicine/journal/10865)
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
Organizations
[edit]Association for Behavior Analysis International [1] Society of Behavioral Medicine
References
[edit]- ^ Miller, N.E. (1983). Behavioral medicine: symbiosis between laboratory and clinic. Annual Review of Psychology, 34, 1-31
- ^ a b Matarazzo, J.D. (1980). Behavioral health and behavioral medicine: frontiers for a new health psychology. American Psychologst, 35(9), 807-817.
- ^ Engel, G.L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136
- ^ Feldman, M.D. (2012). Role of behavioral medicine in priamry care. Current Opinion in Psychiatry, 25(2), 121-127
- ^ 2
- ^ Miller, N.E. (1983). Behavioral medicine: symbiosis between laboratory and clinic. Annual Review of Psychology, 34, 1-31
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