Behavioral Medicine

1. Behavioral Medicine Presented by Marian Zimmerman, M.A.

2. Behavioral Medicine • Interdisciplinary field concerned with the development and integration of behavioral and biomedical science, knowledge, and techniques relevant to health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation.

3. Early History • Prehistoric men considered mind and body as a unit, attributing physical and mental illnesses to demonic possession or evil spirits. • Early Hebrew, Egyptian, and Chinese writings confirm this supernatural view of causality. • Stone age archaeological findings in Europe and South America show evidence of a surgical procedure called trephination that some claim shamans used to allow evil forces to leave the body.

4. Ancient Greece • The sick were treated in temples of Aesculapius, the god of healing. Treatments included: • Diet • Exercise • Healing baths • Massages to relax the body and mind • Dream interpretation • “Incubation” in which they were told stories of the miraculous cures that had previously taken place at the temple.

5. Ancient Greece • Plato – “it is not proper to cure the eyes without the head, not the head without the body, so neither it is proper to cure the body without the soul… for the part will never be well unless the whole is well.” • Aristotle – observed that emotions such as joy, fear, anger, and courage affect the body, thus linking bodily processes and emotional states.

6. Ancient Greece • Hippocrates – attributed physical and mental illnesses to an imbalance of the four bodily fluids or humors: blood, black bile, yellow bile, and phlegm. • Galan – four personality types based on the predominance of the four humors: choleric, melancholic, sanguine, and phlegmatic. • Believed that “passions” such as grief, anger, lust, and fear were related to pathology. • Claimed that 60% of patients suffered from psychological problems

7. Middle Ages • Diseases were believed to be punishment from God, people turned to priests for healing. Treatments consisted of a mixture of physical remedies, magic, and rituals. • De Adventu Medici, medical textbook in 1140 – after being introduced to the patient “proceed to feel the pulse, remembering that it may be affected by your arrival, or, the patient being a miser, by thinking of the fee…” • To prevent death from the Plague, people were encouraged not to think about death, but instead to direct their thoughts to pleasing and agreeable things.

8. Renaissance • Descartes proposed what is now referred to as Cartesian dualism: the premise that mind and body are separate entities and that the explanations for bodily processes are to be found in the body itself. By emphasizing the materialism of the body, Cartesian dualism deemphasized the importance of emotions in health. • Cartesian dualism served as the impetus for physicians to concentrate and focus treatment on the body and leave the mind to philosophers and theologians

9. Eighteenth Century • Heart rate and temperature were measured with increased sophistication. • Pathways between bodily secretions and emotional reactions were identified. • In 1747, Gaub, a professor of medicine – “the reason why a sound body becomes ill, or an ailing body recovers, very often lies in the mind.”

10. Nineteenth Century • 1811 – Benjamin Rush, author of first American textbook of psychiatry – “actions of the mind” were often the causes of diseases and these “actions” might be used for therapeutic purposes. • Jean Martin Charcot – reported several instances of hysterical states in which physical symptoms that had no medical explanation could be induced or removed by hypnosis. • 1884/85 – James-Lange theory of emotion – connection between emotions and physical responses. • 1892 – Sir William Osler, physician – “In the worry and strain of modern life, arterial degeneration is not only very common but develops at a relatively early age. For this, I believe that the high pressure at which men live and the habit of working the machine to its maximum capacity are responsible (for heart disease) rather than excesses in eating and drinking.”

11. Early Twentieth Century • 1904 – Ivan Pavlov receives a Nobel Prize for work on the conditioned reflex and digestive gland physiology. His work had profound implications for understanding learning and the development of psychophysiological disorders. • 1911 – APA symposium on the relations of psychology and medical education – medical students need more training in psychology. • 1920s – Walter B. Cannon further studied physiological aspects of emotional experiences, described the fight or flight response, and coined the term “homeostasis.”

12. Psychosomatic Medicine • Psychosomatic Medicine emerged between 1920 and 1950 as a combination of psychodynamic and psychophysiological explanations. • Freud’s work in psychoanalysis and theories about hysterical conversion provided a theoretical basis for psychosomatic medicine. • Recognized the role of psychological and social factors in the etiology, course, maintenance, and treatment of disease, especially diseases that defied biomedical explanations.

13. Psychosomatic Medicine • 1935 – Helen Dunbar – Psychosomatic symptoms are associated with certain personality types, not just a single conflict as Freud believed. Influential in founding the American Psychosomatic Society and its first journal, Psychosomatic Medicine. • 1950 – Franz Alexander – Specificity Theory – psychosomatic symptoms are a response to specific emotional states that are maintained by unconscious conflicts. • No empirical support for either theory.

14. Psychosomatic Medicine • 1938 – Edmund Jacobson – examined the role of muscle tension in relaxation. Developed progressive muscle relaxation techniques. • 1953 – Harold Wolff – people have a characteristic manner of responding to threats which are genetically determined somatic responses. Stomach responders may develop ulcers, heart responders may develop hypertension. • 1953 – Hans Selye – stress as a cause of illness.

15. Behavioral Therapy • After having success in the early to mid 1960 with using behavioral therapy to treat psychological problems, psychologists began using behavioral therapy to treat medically related problems such as smoking and obesity. • In the late 1960s and early 1970s cardiovascular disease and cancer were the top sources of mortality for adults in the US and it was recognized that behavior played a major role in the etiology and maintenance of these diseases.

16. Biofeedback • 1960s – First articles published on biofeedback that applied operant conditioning to physiological responses. • Pioneers in the field began using biofeedback technology to treat specific health problems such as Raynaud’s Disease. • 1973 – Biofeedback: Behavioral Medicine was published. • This is the first appearance of the name “behavioral medicine”

17. Organizations • 1977 – A number of psychologists, physicians, and other behavioral scientist attended the Yale Conference and formally defined a new interdisciplinary field they called Behavioral Medicine. • 1977 – New division of APA formed – Health Psychology (division 38). • 1978 – The Academy of Behavioral Medicine and the Society of Behavioral Medicine were both formed.

18. University of North Texas • 1977 – The University of North Texas established a pilot program for doctoral training in Clinical Ecology and Behavioral Medicine to be housed in the psychology department. • 1983 – The program changed its name to Health Psychology/Behavioral Medicine. • 1990 – Joseph Matarazzo, founder of health psychology, recognized the UNT program as the oldest training program in health psychology in the United States that is housed within an academic department.

19. References • Belar, C.D., McIntyre, T.M., & Matarazzo, J.D. (2003). Health psychology. In D.K. Freedheim, (Ed.), Handbook of psychology: Vol. 1. History of psychology (pp. 451-464). Hoboken, NJ: John Wiley & Sons, Inc. • Blanchard, E.B. (1982). Behavioral medicine: Past, present, and future. Journal of Consulting and Clinical Psychology, 50, 795-796. • Doster, J.A. & Biggs, Q. (2003). The history of health psychology/behavioral medicine program at UNT. Retrieved July 29, 2006, from University of North Texas, http://www.unt.edu/bmed/historyofbmedatunt.htm • Lehrer, P. (2003). Applied psychophysiology: Beyond the boundaries of biofeedback (Mending a wall, a brief history of our field, and applications to control of the muscles and cardiorespiratory systems). Applied Psychophysiology and Biofeedback, 28, 291-304. • Shelton, T.L., Anastopoulos, A.D., & Elliott, C.H. (1991). Behavioral medicine. In C.E. Walker (Ed.) Clinical psychology: Historical and research foundations (pp. 443-458). New York: Plenum Press.