Knowing versus doing: The value of behavioral change models for emotional communication in oncology

Responding to emotion is a central function of communication in medicine. However, many clinicians miss opportunities to engage their patients’ emotions, and these lapses can negatively affect the patient’s relationship with the clinician. As such, responding to emotion serves as a useful example of communication challenges in cancer care. The clinician’s response to emotion is likely influenced by cognitive, social, economic, and cultural factors. In psychology, models of behavioral change seek to understand and predict how individuals will act in specific circumstances by incorporating these multiple determinants. However, behavioral change models have not been applied specifically or rigorously to clinicians’ communication behaviors in oncology. In this article, we argue that applying such models in oncology can provide benefits to clinicians and communication researchers. To frame this argument, we will apply the Information–Motivation–Behavioral Skills (IMBS) model of behavioral change to communication about emotion in oncology. We will then propose specific ways in which applying behavioral change models to communication can benefit clinicians and patients. Improving communication behaviors requires more than commonsense solutions. Behavioral change models might support the enactment of communication skills and knowledge, bridging the gap between “knowing” and “doing.”     

Psychologists on the faculties of United States schools of medicine: Past, present and possible future

This review covers the growth in the numbers of psychologists in U.S. medical schools from only a few individuals in 1910 to the present 2500 of them. Also described are the developments in: (1) administrative organizations of these faculty psychologists (e.g., in departments of psychiatry, behavioral science, pediatrics, medicine, neurology, rehabilitation medicine, and even autonomous departments of medical psychology), (2) their present faculty ranks, (3) salary levels, and (4) responsibilities, as well as perceived power relationships in which psychologists find themselves relative to other disciplines. Finally, some possible patterns in the future development of medical psychology during 1980–1990 are sketched, with speculations on the influence current developments in behavioral medicine and behavioral health may have on the future of medical psychology.     

Proposal for an Update of the Definition and Scope of Behavioral Medicine

Purpose

We aim to provide an update of the definition and scope of behavioral medicine in the Charter of ISBM, as the present version was developed more than 25 years ago.

Methods

We identify issues which need clarification or updating. This leads us to propose an update of the definition and scope of behavioral medicine.

Results

Issues in need of clarification or updating include the scope of behavioral medicine (biobehavioral mechanisms, clinical diagnosis and intervention, and prevention and health promotion); research as an essential characteristic of all three areas of behavioral medicine; the application of behavioral medicine; the terminology of behavioral medicine as a multidisciplinary field; and the relationship and distinction between behavioral medicine, mental health, health psychology, and psychosomatic medicine.

Conclusion

We propose the following updated definition and scope of behavioral medicine: “Behavioral medicine can be defined as the multidisciplinary field concerned with the development and integration of biomedical and behavioral knowledge relevant to health and disease, and the application of this knowledge to prevention, health promotion, diagnosis, treatment, rehabilitation, and care. The scope of behavioral medicine extends from biobehavioral mechanisms (i.e., the interaction of biomedical processes with psychological, social, societal, cultural, and environmental processes), to clinical diagnosis and intervention, and to public health.”

     

Behavioral Medicine in China: History,Current Status,and Future Development

Background

Behavioral medicine in China has developed quickly in the last three decades.

Purpose

We briefly summarized the history, the main scope and achievements, and the future development of behavioral medicine in China.

Method

We did a literature search and discussed with senior scholars in behavioral medicine in China.

Results

The concept and main scope of behavioral medicine in China have been developed largely in accordance with the international perspective. Research in behavioral medicine in China significantly contributed to the better understanding of the relationship between various health behavioral factors and psychosomatic disorders and possible mechanisms of this relationship. The following aspects will be the main areas to be further developed in behavioral medicine in China: (1) Basic theories of behavioral medicine and theoretical mechanisms of higher nervous activities in human behavior regulation. (2) Etiology, pathogenesis, and mechanisms of common diseases that are closely related to human lifestyle behaviors. (3) Assessment criteria for unhealthy and disease-related behaviors. (4) Behavioral therapy of psychosomatic disorders, and rehabilitation technologies of disability. (5) Application of major findings from research of behavioral medical science in clinical practice and in health promotion of the whole society.

Conclusion

Behavioral medicine in China, as a multidisciplinary subject, plays a relevant role in preventing behavior-related psychosomatic diseases and in promoting health of the public.     

青少年阈下抑郁中西医心理行为治疗的研究进展

阈下抑郁是一种未达到重症抑郁诊断标准,存在至少两种以上抑郁症状的抑郁症亚型。由于青少年阈下抑郁发病率较高,医院、社区各层面医疗工作者开始针对其开展中心理行为干预。研究通过回顾阈下抑郁概念、评估方式、近年来中西医心理行为治疗效果等研究成果,发现中医在“扶阳抑阴”的理论指导下开展团体心理治疗、电针结合心理等方法,均显示出较好的临床疗效。西医多通过行为认知疗法、运动疗法、网络自助干预等对青少年进行心理干预。     

Psychosomatic medicine: emerging trends and perspectives

Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.     

In utero immune programming of autism spectrum disorder (ASD)

Maladaptation of immune tolerance at the maternal-fetal interface affects balanced maternal-fetal cross-talk and placental health and is associated with adverse pregnancy outcomes. The concept of in utero programming of childhood and adulthood diseases has revolutionized the research on the role of pregnancy in maternal, neonatal, and adult health. However, it is not yet well understood whether dysregulation of uterine immunity contributes to any health consequences during childhood or later in life. Recent observations in mice and humans have strongly supported the notion that uterine immunity during pregnancy determines the health trajectory of the offspring and significantly impacts cognitive function and mental health. Importantly, IL-17a producing Th17 T cells have been projected as the main contributors to heterogeneous pathological and behavioral phenotypes associated with autism spectrum disorder (ASD). However, since normal pregnancy is associated with little or no Th17 cells at the maternal-fetal interface, it is not clear how and when the Th17 T cells are generated and which interventions can ameliorate the ASD-like features in newborns. We propose that infection-associated uterine immune activation within a critical window of development may propel trans-differentiation of Th17 T cells that eventually affect fetal brain development and induce ASD-like behavioral phenotype in the offspring.     

The potential impact of sexual equality on health.

There are major differences between the sexes in morbidity and mortality rates. At all ages males have higher death rates and are more frequently afflicted with the chronic diseases associated with considerable reductions in longevity. Trend data indicate that males have become relatively more disadvantaged during a period characterized by major advances in medicine and increased access to care. In contrast, rates of disability and use of services are higher among females. There is some evidence that these differences are associated more with behavioral than with biologic factors. Certain shifts in age-specific mortality rates reflect sex-role-related changes in behavior--e.g., increased consumption of tobacco by women and a reversal in sex mortality ratio for cancer of the lung. Changes in sex roles may affect directly, or indirectly through family dynamics, the health status of both sexes.     

Adverse birth factors predict cognitive ability, but not hand preference

Objective: There is a persistent theory that birth stress and subsequent brain pathology play an important role in the manifestation of left-handedness. Evidence for this theory, however, is mixed and studies are often beset with problems related to small sample sizes and unreliable health reports. Method: To avoid these issues, this study used a sample of approximately 10,000 children from the British Cohort Study. The study contains objective birth-health reports and comprehensive measures of socioeconomic status, handedness, cognitive ability, and behavioral/health issues. Results: Regression analyses showed that variables associated with birth stress affected cognitive/behavioral/health outcomes of the child. Despite this, these same factors did not affect the direction or degree of hand preference. Conclusions: We have therefore demonstrated a dissociation whereby adverse birth factors affect the brain's cognitive ability, but not handedness, and by implication, cerebral lateralization. The study also demonstrated a link between left-handedness and reduced levels of cognitive ability. This link cannot be due a generalized birth-stress mechanism and may be caused by specific mechanisms related to changes in cerebral dominance. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Mechanisms of Behavior Modification in Clinical Behavioral Medicine in China

Background

Behavior modification, as the core of clinical behavioral medicine, is often used in clinical settings.

Purpose

We seek to summarize behavior modification techniques that are commonly used in clinical practice of behavioral medicine in China and discuss possible biobehavioral mechanisms.

Methods

We reviewed common behavior modification techniques in clinical settings in China, and we reviewed studies that explored possible biobehavioral mechanisms.

Results

Commonly used clinical approaches of behavior modification in China include behavior therapy, cognitive therapy, cognitive–behavioral therapy, health education, behavior management, behavioral relaxation training, stress management intervention, desensitization therapy, biofeedback therapy, and music therapy. These techniques have been applied in the clinical treatment of a variety of diseases, such as chronic diseases, psychosomatic diseases, and psychological disorders. The biobehavioral mechanisms of these techniques involve the autonomic nervous system, neuroendocrine system, neurobiochemistry, and neuroplasticity.

Conclusion

Behavior modification techniques are commonly used in the treatment of a variety of somatic and psychological disorders in China. Multiple biobehavioral mechanisms are involved in successful behavior modification.     

Clinical science and human behavior

The debate between mentalism/cognitivism and behaviorism is analyzed, and it is concluded that behaviorism is the philosophy more closely associated with psychology as a behavioral science, the cognitive approach being more closely aligned with biological science. Specific objections to mentalistic interpretations of behavioral phenomena are detailed, and examples from clinical psychology are used to show the importance of behavioral approaches in applied domains. It is argued that the relation between behavior theory and clinical psychology is critical to the continued advancement of applied psychology. Behavior analysis is offered as a direct, applied extension of behavior theory as well as a highly practical and effective approach for understanding, explaining, and modifying the factors that contribute to and maintain maladaptive behaviors.     

Neo-Lamarckian medicine

Darwinian medicine is the treatment of disease based on evolution. The underlying assumption of Darwinian medicine is that traits are coded by genes, which are often assumed to be sequences of DNA nucleotides. The quantitative genetic ramification of this perspective is that traits, including disease susceptibility, are either caused by genes or by the environment, with genotype-by-environment interactions usually considered statistical artefacts. I emphasize also examining those epigenetic signals that can be altered by environmental perturbations and then transmitted to subsequent generations. Although seldom studied, environmentally-alterable meiotically-heritable epigenetic signals exist and provide a mechanism underlying genotype-by-environment interactions. Environment of a parent can affect its descendants by heritably altering epigenetic signals. Neo-Lamarckian medicine is the application of these evolutionary epigenetic notions to diseases and could have enormous public health and environmental policy implications. If industrial contaminants adversely affect organisms by meiotically-heritably altering their epigenetic signals, then cleaning up these contaminants will not remedy the problem. Once contaminants have adversely altered an individual's epigenetic signals, this harm will be transmitted to future generations even if they are not exposed to the contaminant. Exposure to environmental shocks such as free radicals or other carcinogens can alter cytosine methylation patterns on regulatory genes. This can cause cancer by up-regulating genes for cell division or by down-regulating tumour suppressor genes. Environmentally-alterable meiotically-heritable epigenetic signals could also underlie other diseases, such as diabetes, Prader-Willi syndrome, and many complex diseases. If environmentally-altered meiotically-heritable epigenetic effects are widespread - which is an important open empirical question - they have the potential to alter paradigmatic views of evolutionary medicine and the putative dichotomy of nature versus nurture. Neo-Lamarckian medicine would thereby shift emphasis from cure to prevention of diseases.     

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.     

Quality of Life Therapy and Assessment in Health Care

An integrative model of quality of life is proposed as a way to correct for terminological inconsistencies and to guide further quality of life research and health care applications. Research and theory supporting the need for routine quality of life assessment and intervention in general medicine, psychiatry, clinical psychology, behavioral medicine, and gerontology are discussed. Clinical guidelines for and research on quality of life assessment and intervention in health care are presented and reviewed. An integrated service delivery system in which quality of life assessments and interventions are considered coequal with those aimed at ameliorating physical and psychological symptoms is proposed along with a future program of research.     

Behavioral Medicine and Prevention of Non-Communicable Diseases in China: Current Challenges and Future Directions

Purpose

We describe the emergence of recent public health challenges in China, particularly those regarding lifestyle-related non-communicable diseases (NCDs). We also summarize some recent examples of behavioral medicine research and practice in relation to the prevention and control of NCDs in China. Finally, we describe recent changes in the public health system in China and how behavioral medicine research and practice can be incorporated into this system to address these public health challenges.

Methods

We considered research and policy literature from both China and Western countries in order to evaluate the relevance of the field of behavioral medicine for addressing the rising NCDs in China.

Results

Rapid economic development and related social and environmental changes have brought about increasing wealth and lifestyle changes in China, along with new public health challenges related to the prevention and control of NCDs. The field of behavioral medicine has much to offer China in addressing these public health challenges. Although behavioral medicine research and practice are still at an early stage in China, there are encouraging signs of its development, particularly resulting from international collaborations with researchers from Western countries. The next stage of this field’s development in China will involve increased integration of behavioral medicine into public health education, training, and the health system. However, this process of integration will need to build on China’s traditional approaches to public health training, research, and practice.

Conclusions

Although the field of behavioral medicine in public health is still in its infancy in China, we argue that the practice and principles of behavioral medicine are important for successfully addressing the substantial burden of NCDs now and in the future.     

Predicting Colonoscopy Screening Behavior and Future Screening Intentions for African Americans Older than 50 Years

Abstract

African Americans experience a disproportionate burden of morbidity and mortality from colorectal cancer, which may be due to low adherence to screening recommendations. Previous studies have found relationships between decision-making factors and screening behavior, but few have looked at both cognitive and affective factors or within a specifically African American sample. To better understand determinants that drive screening behavior, this study examines affective, cognitive, and social variables as predictors of colonoscopy in an age-eligible African American population. Participants completed surveys assessing affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, knowledge, fear of colonoscopy, perceived risk, and colorectal cancer worry and fear. Regression analysis was used to model decision-making constructs as predictors of screening behavior/intentions. Affective, cognitive, and health care experience variables predicted colonoscopy completion and intentions. Provider-level factors and previous cancer screenings predicted prior screening only, but not intentions. Affective and cognitive components of perceived risk were associated with decreased likelihood of colonoscopy behavior, but increased likelihood of colonoscopy intentions. These findings suggest that colonoscopy decision making involves a complex array of both cognitive and affective determinants. This work extends our knowledge of colorectal cancer screening decision making by evaluating the effects of these multiple determinants on screening behavior in an African American sample. Future work exploring the interplay of affect and cognitions as influences on colonoscopy decision making and how health care experiences may moderate this effect is needed to develop effective intervention approaches and reduce screening disparities.     

Effects of mindfulness on psychological health: a review of empirical studies

Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research.     

Social support and risk for cardiovascular disease and cancer: a qualitative review examining the role of inflammatory processes

Abstract

Social support has long been recognised as a protective factor against life stress and poor health. However, the mechanism through which it exerts its effects is unknown. As the role of inflammation in the development of diseases, such as cardiovascular disease and cancer, has gained significant attention over the last decade, it has been hypothesised that psychosocial factors affect disease progression by influencing the inflammatory process (Sher, 2000). Social support is one such factor that could influence the immune system response, leading to differing disease outcomes. A meditational model is proposed, in which social support affects the level of inflammation an individual experiences, producing differing health outcomes. A critical review of the literature linking social support and inflammation was conducted to help elucidate the relation between these two variables as possible causal factors of disease progression in patients with cardiovascular disease or cancer. Results of the studies were mixed, suggesting that social support and inflammation may be linked, though it is premature to claim that inflammation is the mechanism through which social support exerts salubrious effects on health.     

Effect of personality type on pharmacodynamics through changing pharmacokinetics

A few studies have showed that there is an association between the genetic polymorphisms of drug-metabolizing enzyme, CYP2D6, to persons with different personality type. More and more evidences suggested that personality type is kind of behavioral or psychological factor which might influence the pharmacodynamics as well as patient's gender, age, disease, and genetic background. We hypothesized that personality affect the pharmacodynamics through changing pharmacokinetic mediated by different polymorphism of drug-metabolizing enzymes. Since many major diseases, from cancer to infectious disease, are involved with risky Type A personality, we appeal for attention to the clinical pharmacologist and psychiatrists further to study personality pharmacokinetics for individualized medicine.