What is Behavioral Medicine?
Amaro Laria, Ph.D. and Kim Larsson, R.N. C.S. Ph.D.
Behavioral Medicine (often referred to as “B-Med”) is an interdisciplinary field that utilizes behavioral health techniques (CBT, DBT, relaxation, hypnosis, biofeedback, mindfulness meditation, motivational interviewing, and others) to treat a variety of medical and mental health conditions. A more informal way to refer to Behavioral Medicine is “Mind-Body Medicine.” However, b-med also looks at factors that go beyond the “mind” and the “body,” such as social and lifestyle factors that affect health.
What conditions are treated in B-Med?
Behavioral Medicine primarily targets the treatment of medical conditions that are exacerbated by stress and other psychological factors, including chronic pain, hypertension, diabetes, IBS (irritable bowel syndrome), migraine headaches, TMJ (temporal-mandibular joint disorder), skin disorders, and sexual disorders, among others.
The field also specializes in the treatment of conditions that are associated with particular behaviors, habits and lifestyle, such as: insomnia, obesity and smoking.
In addition, Behavioral Medicine interventions can be applied to the treatment of most common mental health disorders, such as: depression, anxiety disorders (panic, generalized anxiety, phobias, PTSD, OCD), and ADHD, among others.
What specialty training do B-Med clinicians have?
Behavioral Medicine clinicians typically have a background in one of the mental health disciplines (psychologists, psychiatrists, social workers, psychiatric nurses, and mental health counselors), but there’s a growing number of medical providers (physicians, osteopaths, dentists, nurses, physician assistants, nutritionists) undergoing training in b-med interventions given the application of this specialty area in the treatment of medical conditions.
Unfortunately, there’s no nationally or internationally-recognized standardized certification process in Behavioral Medicine, which limits the ability of the consumer to screen for qualified clinicians. In general, for someone to self-represent as a “B-Med Specialist,” s/he should have no less than two years of specialized training in the utilization of Behavioral Medicine techniques (e.g., CBT, relaxation training, meditative techniques, MI, hypnosis, biofeedback, etc.) under the supervision of a qualified licensed B-Med specialist. In addition, the B-Med specialist must be a competent licensed clinician in one of the mental health disciplines. S/he must have demonstrated competence in the implementation of a variety of psychotherapeutic approaches (CBT, psychodynamic, family systems, etc.) to treat a wide range of psychological problems and conditions.
How does B-Med actually work?
Behavioral Medicine specialists use a variety of psychological interventions to address patients’ physical and/or emotional-behavioral problems. In particular, they rely on interventions that target the effects of psychological stress or maladaptive behaviors in their medical or psychological symptoms.
For example, a migraine sufferer may experience an increase in frequency, intensity and duration of migraine episodes while undergoing significant emotional distress. This patient’s condition may benefit significantly from learning a variety of stress management skills, such as diaphragmatic breathing, progressive muscle relaxation, mindfulness, imagery, etc. to reduce the impact of stress. The patient may also use biofeedback as a way to teach her/himself to increase temperature in their hands. Research suggests that increasing hand temperature may help improve blood flow (by causing vasodilation, or expansion of blood vessels), which, with sustained practice, may decrease headache frequency, severity, and duration in some migraine sufferers.
The clinician may also use CBT (cognitive-behavioral therapy) skills to help identify and modify thoughts and situational factors that may be intensifying the headaches. The clinician may rely on motivational interviewing techniques to increase the patient’s level of motivation to follow treatment recommendations by their medical providers. However, it’s important to understand that behavioral medicine doesn’t provide a “quick fix” for patients’ medical or mental health problems. It requires a regular active involvement in their treatment, sustained motivation, openness to make significant changes in lifestyle factors, and consistent home practice of newly acquired skills, in order to obtain positive results.
What’s the empirical evidence on the effectiveness of B-Med interventions?
A variety of Behavioral Medicine techniques have demonstrated effectiveness with various medical and mental health conditions. Some of these empirically-based techniques include:
- Relaxation training (progressive muscle relaxation, diaphragmatic breathing, autogenic training, visualization, etc.)
- CBT (cognitive behavioral therapy)
- Clinical hypnosis
- DBT (dialectic behavioral therapy)
- Mindfulness meditation
- Integrative psychotherapy
- Motivational Interviewing
- ACT (acceptance & commitment therapy)
B-med techniques have demonstrated effectiveness in alleviating symptoms associated with the following medical and mental health conditions (this is only a partial list):
- Headaches (tension and migraines)
- Other chronic pain (e.g., neuromuscular pain, TMJ, osteoarthritic pain, fibromyalgia and IBS)
- Cardiovascular conditions (hypertension, coronary heart disease, patients at risk for a 2nd heart attack)
- Sleep disorders (particularly insomnia)
- Weight management (as adjunct to nutrition and exercise program)
- Skin disorders (psoriasis, acne, alopecia, etc.)
- Sexual disorders
Who’s a good candidate for B-Med treatment?
- Patients who suffer from a medical condition that appears to be intensified by stress, maladaptive behaviors or habits, or other psychological factors.
- Patients suffering from any psychological condition (e.g., anxiety, depression) who are looking for “hands-on” practical interventions to target symptom-reduction.
- Motivated patients who are ready to make concrete behavioral changes in their lives by taking an “active participant” stance in their treatment (i.e., ready to make a commitment to attend therapy regularly and engage actively in their treatments by being open to explore factors reinforcing their symptoms and follow-up with treatment recommendations).
- Anyone interested in more insight-oriented therapy to clarify goals in their life, but especially those interested in more pro-active patient-centered treatment approaches.
Suggestions for further readings in B-Med
- Why Zebras Don't Get Ulcers: An Updated Guide to Stress, Stress Related Diseases, and Coping, 2nd ed. by Robert M. Sapolsky (1998).
- Stress and Health: Biological and Psychological Interactions, Behavioral Medicine and Health Psychology, by William R. Lovallo (2004).
- Managing Stress: Principles And Strategies For Health And Well-Being, 6th edition by Brian Luke Seaward (2008).
- www.smb.org/about/faq (The Society of Behavioral Medicine)