Evidence continues to mount that a wide variety of behavioral interventions are having a major influence in producing useful changes in the risk, management and outcome of many diseases and health problems.
Included are daily health concerns such as smoking, exercise and diet, to serious diseases such as cancer, HIV/AIDS and diabetes.
The progress of these interventions over the past 10 years is highlighted in a focused issue of the Journal of Consulting and Clinical Psychology, published by the American Psychological Association (APA), and provides more evidence that health, even physical health, is not all medical.
Health researcher's understanding of the role of behavioral factors in the development and course of disease has grown in scope in the past 10 years, with clear signs of the weakening of the boundaries between behavioral medicine and related fields, according to the authors of an introductory article.
"In past decades, behavioral medicine was described in part by its differences from traditional clinical psychology and psychiatry. However, the future of the field may involve its unique ability to integrate the assessment and management of matters of mental and physical health in medical care."
Some of the specific issues addressed in the special issue include:
* Immune Function and Health - Negative emotions can lower immunity and can lead to increased risk for cardiovascular disease, osteoporosis, arthritis and certain cancers. Researchers have found that the endocrine system serves as one central gateway for psychological influences on health; stress and depression can provoke the release of pituitary and adrenal hormones that have multiple effects on immune function and can lead to actual health changes.
* Coronary Heart Disease - Coronary heart disease (CHD) is the leading cause of death in the United States and over the past decade there has been an increasing amount of evidence regarding the role of psychosocial risk factors in the development of CHD. Studies have demonstrated the negative effects of hostility, depression and social isolation on CHD, with similar results in studies dealing with job stress and social conflict. These risk factors are associated with psychophysiological mechanisms through which stress and emotions could influence CHD and coronary artery disease (CAD). For those who do develop CHD and CAD, there is evidence that psychosocial interventions can improve prognosis.
* Aging - With people living longer, the sandwich generation has given way to a multiple-generation sandwich, where having up to five generations alive at a time is not impossible. Behavioral medicine and clinical health psychology have a major role to play in the maintenance of health in this increasingly older population, especially as it relates to reductions in smoking, increases in exercise and maintenance of a healthy diet and a normal weight. Survivorship is also increasing in those who are diagnosed with major diseases, such as AIDS and Alzheimer's.
* Asthma - Asthma flares are commonly triggered by allergens, airway irritants such as tobacco smoke, exercise and cold air. There is no solid evidence indicating that behavioral factors cause asthma, but research shows asthma can be affected by stress, anxiety and sadness. Recent findings show that airways are just as reactive to psychological state as other physiological conditions. Asthma education programs that teach about the nature of the disease, medications and trigger avoidance tend to reduce the incidence of asthma. Psychological interventions showing promise when used with medical treatments include stress management, hypnosis, yoga, training in symptom perception and several biofeedback procedures.
* Obesity - Approximately 10 to 30 percent of obese persons who seek weight reduction suffer from binge eating. Both cognitive-behavioral therapy, designed specifically to control disordered eating, and interpersonal therapy, originally intended for depression, has been shown to significantly reduce binge episodes. Although research in the past decade has shown that genetic influences predispose some people to obesity, it is becoming clear that the main reason obesity is increasing in the United States is due to a "toxic environment" that implicity discourages physical activity while explicity encouraging the consumption of supersized portions of high-fat, high-sugar foods. Bold public policy initiatives may help prevent the development of obesity.
* Diabetes - Diabetes management depends almost entirely on behavioral self-regulation. Research over the past decade provides strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of some of the devastating long-term complications of diabetes, and clinical health psychology plays a major role in developing these management programs. As for prevention, psychologists and behavioral scientists are just beginning to play a prominent role in diabetes prevention and genetic risk screening. Also, as with obesity, a public health approach that encourages healthier eating and more physical activity is needed.
Other issues addressed in the special issue include psychological and behavioral interventions for cancer patients, organ transplant patients, somatoform disorders, physical activity and exercise, peptic ulcer and inflammatory bowel disease, end-stage renal disease, chronic pain, irritable bowel syndrome, smoking cessation, HIV/AIDS prevention, genetic testing, arthritis, women's reproductive health, recurrent headache disorders, hypertension, emotional disorders in primary care, and adolescent health.
Technology is likely to continue to play a major role in behavioral medicine research and practice, according to the authors of a closing article.
* Internet-based programs are showing promising early results for such things as pain management, teen smoking, problem drinking, and eating disorders.
* Interactive technologies, including laser discs, virtual reality and CD-ROMS have enormous potential in the area of long-distance assessment and treatment efforts.
* Virtual reality provides patients with opportunities to immerse themselves in highly realistic and challenging treatment environments that are difficult to replicate in treatment settings, such as exposure to combat scenes for veteran's suffering from posttraumatic stress disorder.
The collection of 27 articles follows prior special issues on behavioral medicine published in the same journal in 1982 and 1992. The current special issue coincides with the Decade of Behavior, a multidisciplinary initiative to focus talents, energy and creativity of the behavioral and social sciences on meeting many of society's significant challenges.
Journal of Consulting and Clinical Psychology
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