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PubMed2002

Behavioral medicine in Hungary: past, present, and future.

During the socialist period before 1989, training in behavioral medicine and behavioral science was not a priority in Hungary's medical schools despite the nation's long tradition of psychosomatic and behavioral medicine. In this article, the authors review the development of behavioral medicine and behavioral science in Hungarian medical schools and outline some of the problems and future challenges these departments face. The resistance of faculty members has influenced the acceptance of behavioral medicine and behavioral science courses, attitudes toward the acceptance of departments of behavioral science, and evaluations of the staff's scientific research. Although research is emphasized in these departments of behavioral medicine, closer integration of teaching, research, and health policy is necessary. The primary message of this approach is that modern physicians should see beyond molecular substances and perceive humans from a total biopsychosocial perspective.

Attitude of Health Personnel↗

PubMed2000

Behavioral medicine in medical education: report of a survey.

Behavioral medicine has become increasingly important in medical education over the past two decades, but adoption of its principles and methods has been slow. Behavioral medicine stresses the effects of human behavior on health and illness using a biopsychosocial approach. It also focuses on the use of the doctor-patient relationship, which, if developed using appropriate communication skills, can result in greater patient satisfaction and increased compliance. The authors surveyed all 124 American medical schools to assess both national trends and specific efforts in the teaching of behavioral medicine principles and methods. A review of the types of behavioral medicine programs offered reveals that eight percent of U.S. medical schools had integrated programs of behavioral medicine. Several successful and effective programs were identified, as were a number of specific curricular components. There are several options available to medical schools to integrate behavioral medicine into medical education. The authors conclude that medical education must include behavioral medicine in order to improve the health of the public and to meet the demands of a changing health care system.

Behavioral Medicine↗

PubMed1986

Innovations in behavioral medicine.

The chapter begins with a brief history of the behavioral medicine movement along with an overview of contemporary activities in the field. Three subsequent sections review technical innovations in major areas of clinical behavioral medicine: treatment, health care delivery, and preventive health care. The final section describes the methodological characteristics of research in behavioral medicine, discusses the field in light of the psychosomatic medicine and behavior modification movements, and calls for a conceptual integration that is authentically behavioristic. Already the quality of research in behavioral medicine appears comparable to that of research in behavior therapy. Even so, when viewed in terms of contemporary methodological desiderata, most of the work is fairly unimpressive. Possibly needed are "hybrid" experimental approaches in which the inferential power of intrasubject phase manipulations and between-subject outcome comparisons are combined. There is good reason to believe that behavioral medicine will follow the historical course of behavior therapy/modification, not the course of psychosomatic medicine. Behaviorally knowledgeable psychologists can become major service providers in liaison with well-informed medical practitioners. Some potentially deleterious influences on the behavioral medicine movement are (inevitable) mentalistic and dualistic thinking and a retreat toward psychosomatic medicine. Field behaviorism as an organizing schema can, in principle, serve as a safeguard against such untoward influences.

Adolescent↗

PubMed2005

Invitation to a dialogue between researchers and clinicians about evidence-based behavioral medicine.

BACKGROUND: Evidence-based behavioral medicine (EBBM) aims to improve the process through which best scientific research evidence can be obtained and translated into best clinical decisions regarding behavioral treatments to improve health. PURPOSE: The objective was to examine some legitimate concerns raised by both clinicians and researchers about the evidence-based movement. METHODS: This article begins with a discussion of clinicians' fears that EBBM devalues clinical judgment and the therapist-patient relationship, will be used to restrict practice, is unnecessary, and is based on research that is irrelevant to clinical decision making. Next we consider researchers' worries that EBBM neglects evidence not based on randomized controlled trials and ignores causal mechanisms. RESULTS: We find that these fears, although understandable, largely reflect misinterpretations of the evidence-based movement. Further, it is suggested that behavioral medicine is in a unique position to enhance the evidence-based movement by encouraging increased attention to treatment mechanisms and to knowledge translation. CONCLUSIONS: Clinicians, researchers, and, importantly, the public will benefit from the evidence-based movement by having a health care system that is built on solid grounds of evidence in determining which treatments should constitute the standard of care. A full partnership between clinicians and researchers is called for to generate the practical, rigorous evidence base needed to take behavioral health treatments to the next level of scientific support and implementation.

Attitude of Health Personnel↗

PubMed2004

Cognitive factors in health psychology and behavioral medicine.

Research in health psychology and behavioral medicine has increased exponentially over the past three decades. Prevention and control efforts across a variety of diseases have recognized that individual difference factors, belief systems, attitudes, behaviors, and environments can affect an individual's health. This work continues, as there has been no abatement in the rate at which aversive, chronic, and life-threatening diseases continue to affect millions of Americans each year. The purpose of this review is to discuss the influence of cognitive factors on health psychology and behavioral medicine using the cancer literature as an example. The main discussion focuses on the impact of cognitive constructs on behavioral medicine and health psychology in cancer, which appears to be widespread. The article concludes with some implications for future research in the area.

Behavioral Medicine↗

PubMed1998

[Inpatient behavioral medicine in chronic skin diseases].

Behavioral medicine is a newer approach in the management of various diseases. In the last years, special programs have been developed for atopic dermatitis, psoriasis vulgaris and other chronic skin diseases. An increase in the patient's self-control could be achieved by optimizing the patient's skills in dealing with their skin disease. The article summarizes the principles and procedures of in-patient behavioral medicine, especially the strategies employed by dermatological training groups and psychotherapeutical groups to help the patient deal with their skin disorder.

Adaptation, Psychological↗

PubMed1997

Toward an improved behavioral medicine.

Never before have the challenges for behavioral medicine been more exciting or more urgent. Because most health problems have their roots in behavioral causes, the role of behavioral medicine is paramount in public health. The challenges focus both on issues related to the way researchers interact, set priorities, and conduct research, as well as priority areas for future research. The principles include a need for more theoretical diversity and critique of theory, more inclusiveness, more cost-consciousness, an acceptance of failure as a fundamental part of behavioral science, and a greater commitment to international health. The priorities encompass a greater focus on basic behavioral science, more attention to the study of risk perception, more study of the problems of children and aging populations, and an urgent need for proven, proactive interventions. Actualization of these principles could help behavioral medicine researchers and practitioners to achieve a much greater impact in improving the public's health both in the U.S. and abroad.

Behavioral Medicine↗

PubMed2002

Behavioral medicine and aging.

A brief history of behavioral medicine and aging is followed by a series of perspectives that help to understand how age is used as a variable in this research, the relative importance of age to declines in cognitive functioning, and the impact of behavioral risk indicators on healthy survival. The authors discuss Alzheimer's disease and the role of age in clinical practice. Also discussed are potential problems in age-related research, ways to improve the knowledge base in behavioral medicine and aging, and thoughts about future challenges to enhance work in behavioral medicine and aging.

Age Factors↗

PubMed1996

The challenges of future behavioral medicine.

To a large extent, behavioral medicine originates from the United States, and more specifically from the scientific traditions of pragmatism and behaviorism. The core notion of individual learning, mastery, and development embedded in these traditions has lent support to an almost exclusive concern with individual behavioral modification. However, individual mastery and welfare are increasingly threatened by powerful adverse socioeconomic and sociocultural developments, especially by growing social inequalities in health and by expanding social disintegration. Social differentials in morbidity and mortality are documented even in the most economically advanced countries where health-damaging lifestyles (e.g., cigarette smoking, diet) and stressful conditions of relative deprivation in occupational life and elsewhere contribute to the observed pattern. In addition, detrimental effects on health produced by social disintegration are manifest, most notably in societies that undergo rapid socioeconomic change. Implications of these developments for future behavioral medicine are discussed at the level of scientific analysis and of preventive and therapeutic intervention.

Journal Article↗

PubMed2003

Behavioral medicine in the prevention and treatment of cardiovascular disease.

Cardiac behavioral medicine is the application of behavioral and psychosocial principles to the prevention and treatment of heart disease. Most biomedical cardiovascular risk factors (e.g., high blood lipids, high blood pressure, diabetes) require behavioral and medical interventions. Other risks, including obesity, high-fat eating pattern, smoking, and inactivity, clearly require lifestyle change. Behavioral medicine screening and intervention have been applied to psychosocial risk factors such as depression, hostility, and social isolation. Appropriate assessment of risk factors is essential because research has demonstrated successful prevention of heart disease and reduction of morbidity and mortality in patients with existing disease. Behavioral interventions have been beneficial in improving cardiac outcomes by enhancing compliance with medication taking and dietary/exercise recommendations. Future needs include the study of psychosocial factors in women and ethnic minorities with heart disease and the integration of behavioral medicine with newer medical technologies designed to detect subclinical biomarkers of heart disease.

Behavioral Medicine↗

PubMed1999

[The role of behavioral medicine and its place in medical practice].

Behavioral medicine is a rapidly developing interdisciplinary field that integrates the biological and psychosocial perspectives of human behavior and apply them to practice of medicine. The aim of behavioral medicine is to analyse, prevent and treat reversible, non-adaptive behavioral patterns, reactions and symptoms. In the early stages of chronic non-infectious illnesses of great epidemiological significance reversible regulation disturbances, non-adaptive behavioral factors (such as smoking, alcohol abuse, etc.) are the most important risk factors, which are closely connected with emotional disturbances, anxiety, depressive symptomatology, hopelessness and learned pathological reactions. Behavioral medicine deals with the recognition, effective treatment and scientific model of these behavioral and psychological problems on different fields of medical practice.

Anxiety↗

PubMed1983

Teaching behavioral medicine by consultation in the family practice center.

The broad goal of the behavioral medicine rotation described here is to help residents become more effective in recognizing, evaluating, and dealing with psychological problems and issues. The preceptor, a clinical psychologist, works with one resident at a time, sees all or most of the resident's patients with the resident, and consults with him or her regarding patient care and related issues. The preceptor is guided by three considerations: (1) the rotation goals and objectives, (2) the resident's expressed learning goals, and (3) the patient's problems and needs. At the beginning of the rotation, the preceptor interviews the resident regarding background and interests in medicine, family practice, and behavioral medicine and then asks the resident to complete a self-evaluation form on interest and skills in behavioral medicine. At the end of the rotation the resident again completes the self-evaluation form. Changes in self-ratings during the rotation indicate that most residents report increased confidence and ability to deal with patients' psychological problems.

Behavioral Medicine↗

PubMed1978

Yale Conference on Behavioral Medicine: a proposed definition and statement of goals.

The Yale Conference on Behavioral Medicine brought a diverse group of behavioral and biomedical scientists together for the purpose of arriving at an interdisciplinary yet consensual definition, statement of goals, and set of recommendations regarding the emerging field of behavioral medicine. It was proposed that behavioral medicine be defined as "the field concerned with the development of behavioral science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and techniques to prevention, diagnosis, treatment, and rehabilitation. psychosis, neurosis, and substance abuse are included only insofar as they contribute to physical disorders as an end point." The rational behind this definition and proposals for future developments in the field are discussed.

Congresses as Topic↗

PubMed2005

Behavioral medicine in Russian family medicine.

The Russian Federation's recently adopted family medicine as a specialty, but with little or no training in psychosocial and behavioral issues, unlike many training programs in other countries. The purpose of this qualitative study was to explore the perceptions and experiences of Russian primary care physicians regarding the practice of behavioral medicine and psychosocial methods. Semi-structured in-depth interviews were conducted with ten Russian family physicians. Examination of key words, phrases, and concepts used by the physicians revealed five themes that physicians related to their incorporation of psychosocial/behavioral medicine methods: (1) factors limiting the practice of behavioral medicine (inadequate training; cultural barriers); (2) demand for behavioral medicine services; (3) patient-doctor issues related to behavioral medicine (e.g., communication); (4) physician's role strain; and (5) intuition and experience. These findings suggest that Russia's new family physicians would benefit from residency and post-graduate curricula in behavioral sciences, tailored to their unique needs.

Attitude of Health Personnel↗

PubMed2004

Effect sizes and statistical testing in the determination of clinical significance in behavioral medicine research.

BACKGROUND: The interpretation of clinical significance continues to be an obstacle for researchers in behavioral medicine. PURPOSE: To review selected behavioral medicine research to critically examine the perception among investigators that behavioral effects on health are small based on common metrics of clinical significance. METHODS: Using quantitative findings from recent behavioral medicine research in medical and psychiatric journals, we explored results in terms of several statistical metrics to assess potential clinical significance: r coefficients, risk ratios, risk difference measures, and attributable risk. RESULTS: Translated into r coefficients, even established health predictors such as smoking, obesity, and fitness had only modest effects (rs =.03-.22), and the range of effect sizes were comparable with those based on psychological predictors including depression and stress-reactivity (rs =.06-.22). In contrast, effects for both classes of predictors were suggestive of clinical significance based on public health statistics. CONCLUSIONS: Our choice of statistics for defining "small" and "large" effect sizes affects the perceived importance of behavioral health findings. In the assessment of health outcomes with low incidence rates, effects expressed as correlations using even the most robust predictors will often appear small. In these instances, we challenge researchers to move beyond conventional data analysis approaches and to expand their clinical interpretation efforts by employing additional statistical methods favored in medicine and public health.

Behavioral Medicine↗

PubMed1987

Status of behavioral medicine in American and Canadian medical training.

This article reports a survey of attitudes and current practices regarding behavioral medicine in American and Canadian medical school departments of psychiatry. Participants were eighty-two chairpersons of departments of psychiatry. Five major areas were addressed concerning the existence, location, and composition of behavioral medicine faculty and their contribution to training and research programs. Results indicate that behavioral medicine is represented in the majority of medical schools and teaching hospitals. Faculty tended to be located in psychiatry. A majority of the respondents did not think that behavioral medicine should be considered a separate clinical specialty area, but in actual practice behavioral medicine was distinct from consultation/liaison psychiatry as often as integrated with it. The analysis of subjects and methods taught in residency training programs suggested a meaningful trend in the data. The implications of these results for models underpinning traditional medical education and psychosomatic medicine are discussed.

Administrative Personnel↗

PubMed1992

Some structural changes that might facilitate the development of behavioral medicine.

Three types of organizational change are considered that may facilitate the development of behavioral medicine teaching, practice, and research over the next decade. The first and most critical of these changes is a consideration of the role of a Department of Behavioral Medicine within the medical school. The second is support for the development of research collaborations across centers, with the advantage of bringing a broader array of expertise and facilities to the solution of health problems. Finally, some changes in the role and organization of scientific societies that support behavioral medicine are considered. It is argued that, without such changes, behavioral medicine will become overly narrow in its focus and will not have the impact on the medical arena that it might otherwise have.

Behavior Therapy↗

PubMed2004

Research to practice: international dissemination of evidence-based behavioral medicine.

BACKGROUND: In recent years, there has been a dramatic rise in the global prevalence of chronic conditions. Cancer, diabetes, cardiovascular diseases chronic lung disorders, and their common behavioral risk factors are escalating rapidly in developing countries, many of which are still struggling with infectious diseases and poor health system infrastructures. PURPOSE: This article examines the role that behavioral medicine can play to improve global health. METHODS: The World Health Organization's Innovative Care for Chronic Conditions Framework provides a model for identifying areas for behavioral medicine influence, including patient-provider interactions, organization of health care, community mobilization, and national policy and financing. RESULTS: Behavioral medicine has a large role to play in international health. Examples from around the world are provided. CONCLUSIONS: Because behavior is the product of multilevel, multifactoral determinants, there are many areas of influence for behavioral medicine specialists who want to contribute to global health. By focusing attention internationally, with special attention toward the needs of developing countries, the field of behavioral medicine will be not only responding to its global responsibilities but also repositioning itself to be increasingly relevant for the 21st century.

Behavioral Medicine↗