Behavioral MedicineBehavioral Medicine

Presented byPresented by

Marian Zimmerman, M.A.Marian Zimmerman, M.A.

Behavioral MedicineBehavioral Medicine

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

Early HistoryEarly History

Prehistoric men considered mind and body as Prehistoric men considered mind and body as a unit, attributing physical and mental a unit, attributing physical and mental illnesses to demonic possession or evil illnesses to demonic possession or evil spirits. spirits.

Early Hebrew, Egyptian, and Chinese writings Early Hebrew, Egyptian, and Chinese writings confirm this supernatural view of causality.confirm this supernatural view of causality.

Stone age archaeological findings in Europe Stone age archaeological findings in Europe and South America show evidence of a and South America show evidence of a surgical procedure called trephination that surgical procedure called trephination that some claim shamans used to allow evil some claim shamans used to allow evil forces to leave the body.forces to leave the body.

Ancient GreeceAncient Greece

The sick were treated in temples of The sick were treated in temples of Aesculapius, the god of healing. Aesculapius, the god of healing. Treatments included:Treatments included: DietDiet ExerciseExercise Healing bathsHealing baths Massages to relax the body and mindMassages to relax the body and mind Dream interpretationDream interpretation ““Incubation” in which they were told stories of Incubation” in which they were told stories of

the miraculous cures that had previously taken the miraculous cures that had previously taken place at the temple. place at the temple.

Ancient GreeceAncient Greece

Plato – “it is not proper to cure the eyes Plato – “it is not proper to cure the eyes without the head, not the head without the without the head, not the head without the body, so neither it is proper to cure the body, so neither it is proper to cure the body without the soul… for the part will body without the soul… for the part will never be well unless the whole is well.”never be well unless the whole is well.”

Aristotle – observed that emotions such as Aristotle – observed that emotions such as joy, fear, anger, and courage affect the joy, fear, anger, and courage affect the body, thus linking bodily processes and body, thus linking bodily processes and emotional states. emotional states.

Ancient GreeceAncient Greece

Hippocrates – attributed physical and Hippocrates – attributed physical and mental illnesses to an imbalance of the mental illnesses to an imbalance of the four bodily fluids or humors: blood, black four bodily fluids or humors: blood, black bile, yellow bile, and phlegm. bile, yellow bile, and phlegm.

Galan – four personality types based on Galan – four personality types based on the predominance of the four humors: the predominance of the four humors: choleric, melancholic, sanguine, and choleric, melancholic, sanguine, and phlegmatic.phlegmatic. Believed that “passions” such as grief, anger, Believed that “passions” such as grief, anger,

lust, and fear were related to pathology.lust, and fear were related to pathology. Claimed that 60% of patients suffered from Claimed that 60% of patients suffered from

psychological problemspsychological problems

Middle AgesMiddle Ages

Diseases were believed to be punishment from Diseases were believed to be punishment from God, people turned to priests for healing. God, people turned to priests for healing. Treatments consisted of a mixture of physical Treatments consisted of a mixture of physical remedies, magic, and rituals.remedies, magic, and rituals.

De Adventu MediciDe Adventu Medici, medical textbook in 1140 – , medical textbook in 1140 – after being introduced to the patient “proceed to after being introduced to the patient “proceed to feel the pulse, remembering that it may be feel the pulse, remembering that it may be affected by your arrival, or, the patient being a affected by your arrival, or, the patient being a miser, by thinking of the fee…”miser, by thinking of the fee…”

To prevent death from the Plague, people were To prevent death from the Plague, people were encouraged not to think about death, but instead encouraged not to think about death, but instead to direct their thoughts to pleasing and agreeable to direct their thoughts to pleasing and agreeable things.things.

RenaissanceRenaissance

Descartes proposed what is now referred to as Descartes proposed what is now referred to as Cartesian dualism: the premise that mind and Cartesian dualism: the premise that mind and body are separate entities and that the body are separate entities and that the explanations for bodily processes are to be explanations for bodily processes are to be found in the body itself. By emphasizing the found in the body itself. By emphasizing the materialism of the body, Cartesian dualism materialism of the body, Cartesian dualism deemphasized the importance of emotions in deemphasized the importance of emotions in health.health.

Cartesian dualism served as the impetus for Cartesian dualism served as the impetus for physicians to concentrate and focus treatment physicians to concentrate and focus treatment on the body and leave the mind to philosophers on the body and leave the mind to philosophers and theologians and theologians

Eighteenth CenturyEighteenth Century

Heart rate and temperature were Heart rate and temperature were measured with increased sophistication.measured with increased sophistication.

Pathways between bodily secretions and Pathways between bodily secretions and emotional reactions were identified. emotional reactions were identified.

In 1747, Gaub, a professor of medicine – In 1747, Gaub, a professor of medicine – “the reason why a sound body becomes “the reason why a sound body becomes ill, or an ailing body recovers, very often ill, or an ailing body recovers, very often lies in the mind.”lies in the mind.”

Nineteenth CenturyNineteenth Century

1811 – Benjamin Rush, author of first American textbook of 1811 – Benjamin Rush, author of first American textbook of psychiatry – “actions of the mind” were often the causes of psychiatry – “actions of the mind” were often the causes of diseases and these “actions” might be used for therapeutic diseases and these “actions” might be used for therapeutic purposes.purposes.

Jean Martin Charcot – reported several instances of hysterical Jean Martin Charcot – reported several instances of hysterical states in which physical symptoms that had no medical states in which physical symptoms that had no medical explanation could be induced or removed by hypnosis.explanation could be induced or removed by hypnosis.

1884/85 – James-Lange theory of emotion – connection 1884/85 – James-Lange theory of emotion – connection between emotions and physical responses.between emotions and physical responses.

1892 – Sir William Osler, physician – “In the worry and strain 1892 – Sir William Osler, physician – “In the worry and strain of modern life, arterial degeneration is not only very common of modern life, arterial degeneration is not only very common but develops at a relatively early age. For this, I believe that 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 high pressure at which men live and the habit of working the machine to its maximum capacity are responsible (for the machine to its maximum capacity are responsible (for heart disease) rather than excesses in eating and drinking.”heart disease) rather than excesses in eating and drinking.”

Early Twentieth Century Early Twentieth Century

1904 – Ivan Pavlov receives a Nobel Prize for work 1904 – Ivan Pavlov receives a Nobel Prize for work on the conditioned reflex and digestive gland on the conditioned reflex and digestive gland physiology. His work had profound implications physiology. His work had profound implications for understanding learning and the development for understanding learning and the development of psychophysiological disorders.of psychophysiological disorders.

1911 – APA symposium on the relations of 1911 – APA symposium on the relations of psychology and medical education – medical psychology and medical education – medical students need more training in psychology.students need more training in psychology.

1920s – Walter B. Cannon further studied 1920s – Walter B. Cannon further studied physiological aspects of emotional experiences, physiological aspects of emotional experiences, described the fight or flight response, and coined described the fight or flight response, and coined the term “homeostasis.”the term “homeostasis.”

Psychosomatic MedicinePsychosomatic Medicine

Psychosomatic Medicine emerged between Psychosomatic Medicine emerged between 1920 and 1950 as a combination of 1920 and 1950 as a combination of psychodynamic and psychophysiological psychodynamic and psychophysiological explanations.explanations.

Freud’s work in psychoanalysis and theories Freud’s work in psychoanalysis and theories about hysterical conversion provided a about hysterical conversion provided a theoretical basis for psychosomatic medicine.theoretical basis for psychosomatic medicine.

Recognized the role of psychological and social Recognized the role of psychological and social factors in the etiology, course, maintenance, factors in the etiology, course, maintenance, and treatment of disease, especially diseases and treatment of disease, especially diseases that defied biomedical explanations.that defied biomedical explanations.

Psychosomatic MedicinePsychosomatic Medicine

1935 – Helen Dunbar – Psychosomatic 1935 – Helen Dunbar – Psychosomatic symptoms are associated with certain symptoms are associated with certain personality types, not just a single conflict personality types, not just a single conflict as Freud believed. Influential in founding as Freud believed. Influential in founding the American Psychosomatic Society and the American Psychosomatic Society and its first journal, its first journal, Psychosomatic Medicine.Psychosomatic Medicine.

1950 – Franz Alexander – Specificity 1950 – Franz Alexander – Specificity Theory – psychosomatic symptoms are a Theory – psychosomatic symptoms are a response to specific emotional states that response to specific emotional states that are maintained by unconscious conflicts.are maintained by unconscious conflicts.

No empirical support for either theory.No empirical support for either theory.

Psychosomatic MedicinePsychosomatic Medicine

1938 – Edmund Jacobson – examined the role 1938 – Edmund Jacobson – examined the role of muscle tension in relaxation. Developed of muscle tension in relaxation. Developed progressive muscle relaxation techniques.progressive muscle relaxation techniques.

1953 – Harold Wolff – people have a 1953 – Harold Wolff – people have a characteristic manner of responding to threats characteristic manner of responding to threats which are genetically determined somatic which are genetically determined somatic responses. Stomach responders may develop responses. Stomach responders may develop ulcers, heart responders may develop ulcers, heart responders may develop hypertension.hypertension.

1953 – Hans Selye – stress as a cause of 1953 – Hans Selye – stress as a cause of illness.illness.

Behavioral TherapyBehavioral Therapy

After having success in the early to mid 1960 After having success in the early to mid 1960 with using behavioral therapy to treat with using behavioral therapy to treat psychological problems, psychologists began psychological problems, psychologists began using behavioral therapy to treat medically using behavioral therapy to treat medically related problems such as smoking and obesity.related problems such as smoking and obesity.

In the late 1960s and early 1970s In the late 1960s and early 1970s cardiovascular disease and cancer were the cardiovascular disease and cancer were the top sources of mortality for adults in the US top sources of mortality for adults in the US and it was recognized that behavior played a and it was recognized that behavior played a major role in the etiology and maintenance of major role in the etiology and maintenance of these diseases.these diseases.

BiofeedbackBiofeedback

1960s – First articles published on 1960s – First articles published on biofeedback that applied operant biofeedback that applied operant conditioning to physiological responses.conditioning to physiological responses.

Pioneers in the field began using Pioneers in the field began using biofeedback technology to treat specific biofeedback technology to treat specific health problems such as Raynaud’s Disease.health problems such as Raynaud’s Disease.

1973 – 1973 – Biofeedback: Behavioral MedicineBiofeedback: Behavioral Medicine was published. was published. This is the first appearance of the name This is the first appearance of the name

“behavioral medicine”“behavioral medicine”

OrganizationsOrganizations

1977 – A number of psychologists, 1977 – A number of psychologists, physicians, and other behavioral scientist physicians, and other behavioral scientist attended the Yale Conference and formally attended the Yale Conference and formally defined a new interdisciplinary field they defined a new interdisciplinary field they called Behavioral Medicine.called Behavioral Medicine.

1977 – New division of APA formed – 1977 – New division of APA formed – Health Psychology (division 38).Health Psychology (division 38).

1978 – The Academy of Behavioral 1978 – The Academy of Behavioral Medicine and the Society of Behavioral Medicine and the Society of Behavioral Medicine were both formed.Medicine were both formed.

University of North TexasUniversity of North Texas

1977 – The University of North Texas 1977 – The University of North Texas established a pilot program for doctoral established a pilot program for doctoral training in Clinical Ecology and Behavioral training in Clinical Ecology and Behavioral Medicine to be housed in the psychology Medicine to be housed in the psychology department.department.

1983 – The program changed its name to 1983 – The program changed its name to Health Psychology/Behavioral Medicine.Health Psychology/Behavioral Medicine.

1990 – Joseph Matarazzo, founder of health 1990 – Joseph Matarazzo, founder of health psychology, recognized the UNT program as psychology, recognized the UNT program as the oldest training program in health the oldest training program in health psychology in the United States that is psychology in the United States that is housed within an academic department.housed within an academic department.

ReferencesReferences

Belar, C.D., McIntyre, T.M., & Matarazzo, J.D. (2003). Health Belar, C.D., McIntyre, T.M., & Matarazzo, J.D. (2003). Health psychology. In D.K. Freedheim, (Ed.), psychology. In D.K. Freedheim, (Ed.), Handbook of psychology: Handbook of psychology: Vol. 1. History of psychologyVol. 1. History of psychology (pp. 451-464). Hoboken, NJ: John (pp. 451-464). Hoboken, NJ: John Wiley & Sons, Inc.Wiley & Sons, Inc.

Blanchard, E.B. (1982). Behavioral medicine: Past, present, and Blanchard, E.B. (1982). Behavioral medicine: Past, present, and future. future. Journal of Consulting and Clinical Psychology, 50, Journal of Consulting and Clinical Psychology, 50, 795-796.795-796.

Doster, J.A. & Biggs, Q. (2003). The history of health Doster, J.A. & Biggs, Q. (2003). The history of health psychology/behavioral medicine program at UNT. Retrieved July psychology/behavioral medicine program at UNT. Retrieved July 29, 2006, from University of North Texas, 29, 2006, from University of North Texas, http://www.unt.edu/bmed/historyofbmedatunt.htmhttp://www.unt.edu/bmed/historyofbmedatunt.htm

Lehrer, P. (2003). Applied psychophysiology: Beyond the Lehrer, P. (2003). Applied psychophysiology: Beyond the boundaries of biofeedback (Mending a wall, a brief history of our boundaries of biofeedback (Mending a wall, a brief history of our field, and applications to control of the muscles and field, and applications to control of the muscles and cardiorespiratory systems). cardiorespiratory systems). Applied Psychophysiology and Applied Psychophysiology and Biofeedback, 28, Biofeedback, 28, 291-304.291-304.

Shelton, T.L., Anastopoulos, A.D., & Elliott, C.H. (1991). Behavioral Shelton, T.L., Anastopoulos, A.D., & Elliott, C.H. (1991). Behavioral medicine. In C.E. Walker (Ed.) medicine. In C.E. Walker (Ed.) Clinical psychology: Historical and Clinical psychology: Historical and research foundationsresearch foundations (pp. 443-458). New York: Plenum Press. (pp. 443-458). New York: Plenum Press.