Behavioral Medicine—A Partnership
Leslie Robison, Ph.D.
Many people are familiar
with the term "behavioral medicine" but are unsure of what it actually is
and how it is of relevance to CBH. The following is my overview of what
behavioral medicine is and how it contributes to the mosaic of mental
health services. In
general, behavioral medicine is a field of study that encompasses physical
medicine and psychology. Traditionally, the two areas have been viewed as
mutually exclusive. Many of us learned about the mind-body dilemma and the
antiquated idea that the mind and body are two separate entities within a
person that have little interaction. Although few people today believe
that the mind and body are independent of one another, providers are still
trained to treat either physical illness or mental illness separately-with
the possible exception of psychiatry. A dilemma arises for many providers
when confronted with people who have a physical illness that creates
problems in their life or when mental illness prevents them from being
able to care for their physical illness. Behavioral medicine tries to
address this dilemma by focusing primarily on the psychological and
behavioral factors that adversely affect the course of a medical
condition. Extensive research has found that psychological and behavioral
factors may significantly impact many medical conditions including
diabetes, dermatological disorders, gastrointestinal disorders,
cardiovascular disease, renal disease, oncological disease, neurological
conditions, and pulmonary and rheumatologic disorders. There are numerous
ways in which psychological and behavioral factors can impact physical
illness:
Psychiatric
disorders may complicate a physical illness. For example, major
depression leads to decreased motivation and self-care. Thus, a person
with major depression and diabetes may be less likely to monitor their
blood-sugar levels and/or put forth the effort needed to maintain a
healthy diet. Major depression has been found to be a leading culprit in
the complication of many illnesses including heart disease, multiple
sclerosis, and Parkinson's disease. Personality styles may
influence the onset and course of a disease. There are personality
traits that can impact the course of an illness. For example, research has
found that hostility, a component of the well-known Type A personality, is
a good behavioral predictor for cardiovascular disease. Personality styles
can also impact physical illness by affecting patients' relationships with
their health care providers. Certain personality characteristics can
interfere with the relationship making it difficult for the person to
obtain and/or work with a medical provider. One such characteristic is
known as pathologic denial-when people deny the presence or seriousness of
a physical problem to the degree that it prevents them from seeking needed
medical services. Conversely, some personality traits aid treatment, such
as healthy denial-when people may deny the full extent of their physical
illness but are still motivated to seek treatment in order to "recover"
completely. Psychosocial factors may influence medical and psychiatric
outcome. Limited social support, social isolation, and limited
socioeconomic resources can lead to increased stress levels. In turn, as
many of us know, increased stress can adversely affect people's health
and/or their ability to connect with needed services. An example: research
has shown a very interesting relationship between relaxation and the
response to cancer treatments. A study was conducted comparing two groups
of cancer patients. One group received chemotherapy and the second group
was taught relaxation in conjunction with chemotherapy. In comparison to
the group that received chemotherapy alone, the relaxation group appeared
to have a better response, a lower mortality rate, and fewer recurrences
of the cancer. Other
psychosocial factors affecting health treatment outcomes include
maladaptive health behaviors. These are behaviors that we
know are unhealthy but we still do regardless of "knowing better." These
include cigarette smoking, alcohol and/or drug use, overeating, and a
sedentary lifestyle, to name a few. Mental health providers who
practice within the field of behavioral medicine are presented with the
challenge of determining the relationship between the physical and the
psychological. The nature of this relationship can determine the type of
intervention needed. Interventions vary widely and include: a. treatment
for a co-morbid (co-existing) psychological disorder(s),
b.
facilitating adjustment to a chronic illness,
c. teaching behavioral
management of symptoms, and
d. assisting in treatment planning in
order to enhance adherence to a treatment regimen.
Challenges for Providers
Collaboration.
Regardless of the exact nature of an intervention, one key factor in
successful management and treatment of physical and psychological
illnesses is the collaboration of all providers. When the physician
and mental health provider are working together with the person towards a
common goal, a positive outcome is more likely. In addition, this
collaboration may decrease the impact of a person's problematic
personality traits (if present) on treatment. Time. Another challenge
for behavioral medicine is time. In contrast to many medical
interventions, behavioral interventions typically take more time to become
effective. Clients and providers need to be persistent and patient with
respect to symptom improvement. Many techniques and skills require time
and practice to become effective. Given appropriate time, these
interventions can lead to improved quality of life for the individual and
decrease over-utilization of medical services. Thus, these treatments can
be more cost effective for both clients and providers. We may need to expand our
thinking about treatment so we (mental health providers and physicians)
become even more collaborative in our work. As the fields of physical
medicine and mental health become increasingly focused on treating the
whole person, behavioral medicine will continue to grow as a field.
David Spiegel,
M.D. (1995) summed up the field of behavioral medicine perfectly with the
following statement, "…a sound body may be, in part, the product if not
the home of the sound mind."
References:
Psychological Factors Affecting Medical Conditions (1995). A.
Stoudemire (Editor). American Psychiatric Press, Inc. Washington
D.C.Handbook of Health
and Rehabilitation Psychology (1995). A. Goreczny (Editor). Plenum
Press. New York. Psychiatric Care of the
Medical Patient (1993). A. Stoudemire & B. Fogel (Editors). Oxford
University Press. New York.