What is Behavioral Medicine?

Behavioral medicine (BM) is a newly developing field of study which integrates behavioral, psychosocial, and biomedical concepts and practices to prevent, diagnose, and treat patients with psychosomatic disorders. The practice of BM targets the relation between how both thought and behavior can affect mental and physical health.

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Evolution of Behavioral Medicine

BM emerged in the late 19th century as a subordinate of psychosomatic medicine. The psychoanalysis therapists recognized that most medical disorders are caused by behavioral patterns. This finding resulted in the evolution of BM. In 1975, the first research laboratory was created at Stanford to analyze behavioral medicine. The contribution from the Yale conference on Behavioral Medicine led to the official launch of the field in the year 1977. After 1982, greater investments in research began and this led to the advancement of organized study in BM.

Therapy Programs of Behavioral Medicine

Behavioral therapy

It is a response-based therapy that helps an individual to acquire new positive behaviors that either decrease the severity of or eradicate mental conditions such as addiction, anxiety, phobias, and obsessive-compulsive disorder. It has two basic techniques.

• Classical conditioning: This principle of behavior therapy is normally known as applied behavioral analysis, which employs several methods to attain a change in behavior.
• Flooding: Flooding is commonly known as extended exposure treatment, and has beem found effective for phobias and anxiety. For example, if an individual is afraid of dogs, he is exposed to dogs for long periods to reduce the intensity of the fear.
• Desensitization: Individuals are asked to list the particular situations or things that make them extremely sensitive. Based on this list, the therapist teaches relaxation techniques, which when practiced regularly helps to overcome hypersensitivity.
• Aversion therapy: This method makes use of substances or techniques that produce an antagonistic effect to unwanted behaviors in many ways. For example, some medications produce side effects such as nausea, vomiting, and severe headaches when ingested along with alcohol. These medications are sometimes prescribed for alcohol addicts as a means of helping them to give up the undesirable alcoholism behavior as a result of the adverse reactions caused by the drug-alcohol binding.
• Operant conditioning: This theory has given rise to the following schemes for the management of behavior:
• Reinforcement concept: The therapist either rewards an individual as a result of a desired behavior change or imposes a penalty for not altering the undesirable behavior.
• Modeling: A good behavioral model is fixed as the target to which an individual is to aim in order to get rid of an unwanted behavior. The model might be a therapist or any other person close to the patient.
• Extinction: This theory suggests that reduction in anxiety results by repeated encounters with anxiety-raising situations without unpleasant results.

Cognitive behavioral therapy (CBT)

CBT is a type of psychotherapy that is commonly known as talk treatment. It combines the disciplines of psychotherapy and behavioral therapy. This therapy aims to change the motif of thoughts that affects the behavior and feelings of a person. CBT is beneficial for persons with mental disorders such as depression, posttraumatic stress disorder, eating disorder, addiction and insomnia.
In a typical CBT session, the following things may happen:

• the patient and therapist interact about mental problems like anger which are experienced by the patient
• the therapist teaches new skills that include biofeedback and relaxation techniques for the management of mental symptoms faced by the person
• the patient has to practice the learned skills at home and apply them in day-to-day life.

Dialectical behavior therapy (DBT)

Since this is a type of CBT, it pursues the same procedure that helps to transform negative thinking patterns into positive thoughts leading to desirable behaviors. DBT additionally creates a psychosocial environment for individuals, so that they can practice the management of their emotions and change their behavior. It was found effective for individuals with eating disorders, substance dependence and depression.

Biofeedback therapy

During this type of therapy, the therapist connects electrodes to the patient’s skin to detect the range of mental activities that is associated with irregular body functions. The therapy enables the person to practice the control of involuntary body functions such as the heart rate and muscle tension, through relaxation techniques. It is effective in managing many chronic health problems and stress-related illnesses.

Integrative Therapies of Behavioral Medicine

The term integrative therapy refers to the combination of supportive therapies with other therapies like CBT and behavioral therapy in order to provide effective rehabilitation for patients with psychosomatic disorders.

Relaxation training

This training helps to calm a person to achieve a state of reduced stress, pain, and anxiety. It includes progressive muscle relaxation, deep breathing, creative visualization or listening to music.  

Mindfulness therapy

This therapy focuses on the power of meditation to target the reduction of the recurrence of symptoms in those who are vulnerable to repeated episodes. The therapy helps to address difficult situations by creating an increased awareness of one’s surroundings and interior milieu, which helps the individual to act with less emotion.

Distress tolerance

This skill educates patients to tolerate pain during difficult situations through distraction techniques.

Cerebral blood flow training

This training increases the performance and functioning of the brain by enabling improved blood flow to specific regions of the brain.

References

• http://www.medicinenet.com/script/main/art.asp?articlekey=31817
• http://ecp.acponline.org/marapr02/trask.pdf
• https://link.springer.com/article/10.1007/s12529-014-9405-7
• http://www.counselling-directory.org.uk/behavioural.html
• https://depts.washington.edu/psyclerk/secure/psychotherapy.pdf
• http://www.mayoclinic.org/tests-procedures/biofeedback/home/ovc-20169724
• https://intermountainhealthcare.org/services/brain-spine/neurosciences-institutes/spine-institute/assessment-and-treatment/treatment/behavioral-medicine/

Further Reading

• All Behavioral Medicine Content

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.