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Behavior plays key role in disease development and control, according to 10-year prospective review

Special journal issue highights major advancements in behavioral and psychosocial aspects of health

American Psychological Association

WASHINGTON -- From daily health concerns such as smoking, exercise and diet, to serious diseases such as cancer, HIV/AIDS and diabetes, evidence continues to mount that a wide variety of behavioral interventions are having a major influence in producing useful changes in the risk, management and outcome of many diseases and health problems. The progress of these interventions over the past 10 years is highlighted in a focused issue of the Journal of Consulting and Clinical Psychology, published by the American Psychological Association (APA), and provides more evidence that health, even physical health, is not all medical.

Health researcher's understanding of the role of behavioral factors in the development and course of disease has grown in scope in the past 10 years, with clear signs of the weakening of the boundaries between behavioral medicine and related fields, according to the authors of an introductory article. "In past decades, behavioral medicine was described in part by its differences from traditional clinical psychology and psychiatry. However, the future of the field may involve its unique ability to integrate the assessment and management of matters of mental and physical health in medical care."

Some of the specific issues addressed in the special issue include:

  • Immune Function and Health - Negative emotions can lower immunity and can lead to increased risk for cardiovascular disease, osteoporosis, arthritis and certain cancers. Researchers have found that the endocrine system serves as one central gateway for psychological influences on health; stress and depression can provoke the release of pituitary and adrenal hormones that have multiple effects on immune function and can lead to actual health changes.

  • Coronary Heart Disease - Coronary heart disease (CHD) is the leading cause of death in the United States and over the past decade there has been an increasing amount of evidence regarding the role of psychosocial risk factors in the development of CHD. Studies have demonstrated the negative effects of hostility, depression and social isolation on CHD, with similar results in studies dealing with job stress and social conflict. These risk factors are associated with psychophysiological mechanisms through which stress and emotions could influence CHD and coronary artery disease (CAD). For those who do develop CHD and CAD, there is evidence that psychosocial interventions can improve prognosis.

  • Aging - With people living longer, the sandwich generation has given way to a multiple-generation sandwich, where having up to five generations alive at a time is not impossible. Behavioral medicine and clinical health psychology have a major role to play in the maintenance of health in this increasingly older population, especially as it relates to reductions in smoking, increases in exercise and maintenance of a healthy diet and a normal weight. Survivorship is also increasing in those who are diagnosed with major diseases, such as AIDS and Alzheimer's.

  • Asthma - Asthma flares are commonly triggered by allergens, airway irritants such as tobacco smoke, exercise and cold air. There is no solid evidence indicating that behavioral factors cause asthma, but research shows asthma can be affected by stress, anxiety and sadness. Recent findings show that airways are just as reactive to psychological state as other physiological conditions. Asthma education programs that teach about the nature of the disease, medications and trigger avoidance tend to reduce the incidence of asthma. Psychological interventions showing promise when used with medical treatments include stress management, hypnosis, yoga, training in symptom perception and several biofeedback procedures.

  • Obesity - Approximately 10 to 30 percent of obese persons who seek weight reduction suffer from binge eating. Both cognitive-behavioral therapy, designed specifically to control disordered eating, and interpersonal therapy, originally intended for depression, has been shown to significantly reduce binge episodes. Although research in the past decade has shown that genetic influences predispose some people to obesity, it is becoming clear that the main reason obesity is increasing in the United States is due to a "toxic environment" that implicity discourages physical activity while explicity encouraging the consumption of supersized portions of high-fat, high-sugar foods. Bold public policy initiatives may help prevent the development of obesity.

  • Diabetes - Diabetes management depends almost entirely on behavioral self-regulation. Research over the past decade provides strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of some of the devastating long-term complications of diabetes, and clinical health psychology plays a major role in developing these management programs. As for prevention, psychologists and behavioral scientists are just beginning to play a prominent role in diabetes prevention and genetic risk screening. Also, as with obesity, a public health approach that encourages healthier eating and more physical activity is needed.

Other issues addressed in the special issue include psychological and behavioral interventions for cancer patients, organ transplant patients, somatoform disorders, physical activity and exercise, peptic ulcer and inflammatory bowel disease, end-stage renal disease, chronic pain, irritable bowel syndrome, smoking cessation, HIV/AIDS prevention, genetic testing, arthritis, women's reproductive health, recurrent headache disorders, hypertension, emotional disorders in primary care, and adolescent health.

Technology is likely to continue to play a major role in behavioral medicine research and practice, according to the authors of a closing article. Internet-based programs are showing promising early results for such things as pain management, teen smoking, problem drinking, and eating disorders. Interactive technologies, including laser discs, virtual reality and CD-ROMS have enormous potential in the area of long-distance assessment and treatment efforts. Virtual reality provides patients with opportunities to immerse themselves in highly realistic and challenging treatment environments that are difficult to replicate in treatment settings, such as exposure to combat scenes for veteran's suffering from posttraumatic stress disorder.

The collection of 27 articles follows prior special issues on behavioral medicine published in the same journal in 1982 and 1992. The current special issue coincides with the Decade of Behavior, a multidisciplinary initiative to focus talents, energy and creativity of the behavioral and social sciences on meeting many of society's significant challenges.

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The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 155,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

Articles in the Special Issue of the Journal of Consulting and Clinical Psychology include:

Title: Behavioral Medicine and Clinical Health Psychology: A View from the Decade of Behavior
Author: Timothy W. Smith, Philip C. Kendall, and Francis J. Keefe

Title: Sociodemographic Diversity and Behavioral Medicine
Author: Keith E. Whitfield, Gerdi Weidner, Rodney Clark, and Norman B. Anderson

Title: Applications of Cost-Effectiveness Methodologies in Behavioral Medicine
Author: Robert M. Kaplan, and Erik J. Groessl

Title: Smoking Cessation: Progress, Priorities, and Prospectus
Author: Raymond Niaura, and David B. Abrams

Title: Obesity: Responding to the Global Epidemic
Author: Thomas A. Wadden, Kelly D. Brownell, and Gary D. Foster

Title: Physical Activity and Exercise: Recent Advances and Current Challenges
Author: Patricia M. Dubbert

Title: Psychoneuroimmunology: Psychological Influences on Immune Function and Health
Author: Janice K. Kiecolt-Glaser, Lynanne McGuire, Theodore F. Robles, and Ronald Glaser

Title: Psychosocial Influences on the Development and Course of Coronary Heart Disease: Current Status and Implications for Research and Practice
Author: Timothy W. Smith, and John M. Ruiz

Title: Biobehavioral Approaches to Hypertension
Author: James A. Blumenthal, Andrew Sherwood, Elizabeth C.D. Gullette, Anastasia Georgiades, and Damon Tweedy

Title: Biobehavioral Outcomes Following Psychological Interventions for Cancer Patients
Author: Barbara L. Andersen

Title: Diabetes and Behavioral Medicine: The Second Decade
Author: Linda A. Gonder-Frederick, Daniel J. Cox, and Lee M. Ritterband

Title: Behavioral Research in HIV/AIDS Primary and Secondary Prevention: Recent and Future Directions
Author: Jeffrey A. Kelly, and Seth C. Kalichman

Title: Recent Advances and Future Directions in the Biopsychosocial Assessment and Treatment of Arthritis
Author: Francis J. Keefe, Suxanne J. Smith, Angela L.H. Buffington, Jessica Gibson, Jamie Studts, and David S. Caldwell

Title: Assessment and Psychological Management of Recurrent Headache Disorders
Author: Kenneth A. Holyroyd

Title: Psychological Factors in Chronic Pain: Evolution and Revolution
Author: Dennis Turk, Akiko Okifuju

Title: Psychological Aspects of Asthma
Author: Paul Lehrer, Jonathan Feldman, Nicholas Giardino, Hye-Sue Song, and Karen Schmaling

Title: Psychosocial Factors in End-Stage Renal Disease: An Emerging Context for Behavioral Medicine Research
Author: Alan J. Christensen, and Shawna L. Ehlers

Title: Psychosocial Aspects of Assessment and Treatment of Irritable Bowel Syndrome in Adults and Recurrent Abdominal Pain in Children
Author: Edward B. Blanchard, and Lisa Scharff

Title: Psychosocial Factors in Peptic Ulcer and Inflammatory Bowel Disease
Author: Susan Levenstein

Title: Psychosocial Aspects of Selected Issues in Women's Reproductive Health: Current Status and Future Direction
Author: Annette L. Stanton, Marci Lobel, Sharon Sears, and Robyn Stein DeLuca

Title: Psychological Assessment and Care of Organ Transplant Patients
Author: Mary Ellen Olbrisch, Sharon M. Benedict, Kristine Ashe, and James L. Levenson

Title: Genetic Testing: Psychological Aspects and Implications
Author: Caryn Lerman, Robert T. Croyle, Kenneth P. Tercyak, Heidi Harmann

Title: Emotional Disorders in Primary Care
Author: James Coyne, Richard Thompson, Michael S. Klinkman, and Donald E. Nease Jr.

Title: Behavioral Medicine Approaches to Somataform Disorders
Author: Karl J. Looper, and Laurence J. Kirmayer

Title: Adolescent Health Psychology
Author: Paula G. Williams, Grayson N. Holmbeck, Rachel Neff Greenley

Title: Behavioral Medicine and Aging
Author: Ilene C. Siegler, Lori A. Bastian, David C. Steffens, Hayden B. Bosworth, and Paul T. Costa

Title: Behavioral Medicine: 2002 and Beyond
Author: Francis J. Keefe, Angela L.H. Buffington, Jamie L. Studts, Meredith E. Rumble

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