Behavioral Medicine in Medical Education: Report of a Survey
Gary Rosenberg, Andrew Weissman in Behavioral Social Work in Health Care Settings, 2016
Behavioral medicine can be defined as: “the development and integration of biomedical, psychosocial and behavioral science knowledge and techniques and the application of this knowledge and these techniques to etiology, diagnosis, treatment, rehabilitation and prevention” (University of Miami program). It is important to study behavioral medicine, as human behaviors include a number of avoidable risk factors which are responsible for most of the premature mortality in this country. Medical training programs across the country have begun to incorporate the principles of behavioral medicine into their curricula in order to enrich the ability of physicians to treat patients and to improve the health of the public. The traditional approach of medicine, that of treating diseases or diseased organ systems, is increasingly being expanded by research pointing to psychosocial, environmental and economic factors affecting health and illness. A biopsychosocial approach encompasses such conditions as poverty, social isolation, psychosocial risk and protective factors, and psychiatric disorders, which influence health outcomes across many kinds of illnesses. This approach offers a more comprehensive route to both medically effective and cost-effective treatments and outcomes (Gruman & Chesney, 1995).
Brief Treatment Approaches for Addressing Chronic Pain in Primary Care Settings
Andrea Kohn Maikovich-Fong in Handbook of Psychosocial Interventions for Chronic Pain, 2019
The physical dimension of chronic pain covers a wide array of factors, including stress, physical deconditioning, and neurological pain processes (e.g., central sensitization of pain). The relationship between chronic pain and stress has been widely examined and supported. Chronic stress is a common (if not constant) chronic pain comorbidity likely affecting chronic pain through central mechanisms (e.g., activation of the hypothalamic–pituitary–adrenal axis) and distal mechanisms (e.g., increased muscle tension, changes in mood, distressed social interactions; Blackburn-Munro & Blackburn-Munro, 2001). As stress levels increase, pain and pain-related disability also tend to increase. Therefore, using proven brief methods of stress management are likely to contribute to effective chronic pain management outcomes. Relaxation skills are considered the “aspirin of behavioral medicine,” and numerous options/strategies for relaxation skills training are available, allowing the psychologist to tailor interventions to the needs and interests of the patient (Russo, Bird, & Masek, 1980). Brief relaxation strategies are conducive to the brevity of primary care appointments and include diaphragmatic breathing, short progressive muscle relaxation protocols, and guided imagery, all of which show good outcomes for pain (Nahin, Boineau, Khalsa, Stussman, & Weber, 2016).
Behavioral intervention for sleep disorders
S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer in Sleep and Psychosomatic Medicine, 2017
CBT with a mindfulness-based approach, known as mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR), have gained great popularity in the fields of psychiatry and behavioral medicine. The main goal of these programs is to develop metacognitive awareness cultivated through meditation practices and mindfulness exercises in order to manage the negative emotional reactions associated with various distressful mental and physiological symptoms. Many empirical studies have demonstrated the effectiveness of MBCT and MBSR in improving mental and physical health. These approaches have also been applied in the treatment of sleep disturbance. They are often combined with the concepts and techniques of CBT-I and have generated positive results in both primary and comorbid insomnia.74–83
Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review
Published in Physiotherapy Theory and Practice, 2020
Maria Sandborgh, Elizabeth Dean, Eva Denison, Maria Elvén, Johanna Fritz, Petra von Heideken Wågert, Johan Moberg, Thomas Overmeer, Åsa Snöljung, Ann-Christin Johansson, Anne Söderlund
In building the curriculum, the planners and developers were committed to including behavioral content and competencies, which had been established by a recognized scholarly consortium. The International Society for Behavioral Medicine is such a body. It defines behavioral medicine as an interdisciplinary field dealing with the integration of psychosocial, behavioral and biomedical knowledge, which is relevant for health promotion, diagnosis, treatment, and rehabilitation (International Society of Behavioral Medicine, 2014). Within this context, the physiotherapist conducts a comprehensive examination/assessment of the behaviors underlying the patient’s/client’s movement and functional capacity complaints, complementing the standard pathophysiologically and biomechanically based examination/assessment. The physiotherapist then provides evidence-informed individualized instructions and recommendations to the patient/client based on shared decision-making. The instructions and recommendations are designed and delivered consistent with the patient’s/client’s needs and wants regarding knowledge, literacy, learning style, autonomy, cognitions, and beliefs about health as well as his or her disability, shared goal setting, and readiness to change health-related behavior (Denison and Åsenlöf, 2012). Consistent with the ICF, movement and functional ability are fundamental to the patients’/clients’ ability to achieve their personal activity and social participation goals and, correspondingly, to their health-related quality of life.
Augmented behavioral medicine competencies in physical therapy students’ clinical reasoning with a targeted curriculum: a final-semester cohort-comparison study
Published in Physiotherapy Theory and Practice, 2022
Maria Elvén, Elizabeth Dean, Anne Söderlund
In Sweden, eight universities offer undergraduate programs in physical therapy. The duration of the program is three years, leading to a Bachelor’s of Science Degree in Physical Therapy (Häger-Ross and Sundelin, 2007). Clinical reasoning competencies are incorporated within the learning objectives of entry-level education programs (Swedish Council for Higher Education, 1993) and the means of achieving these objectives are established by each university, in turn resulting in some variations in their curricula. Universities with physical therapy programs have made efforts to incorporate theoretical and practical components pertaining to a biopsychosocial and behavioral approach into their curricula. One university in Sweden has recently reported its processes for integrating behavioral medicine content and competencies throughout its curriculum (Sandborgh et al., 2020). Behavioral medicine is defined as a multidisciplinary field dealing with the integration of biomedical and behavioral knowledge in relation to diagnosis, treatment, rehabilitation, care, health promotion and disease prevention (Dekker et al., 2020). Implementing a behavioral medicine approach in physical therapy implies that the bi-directional relationship between people’s daily living behaviors and diseases, disorders and health are the focus in client management and that associations between biomedical, psychosocial and behavioral factors underpin assessment, analysis, intervention, and evaluation (Åsenlöf, Denison, and Lindberg, 2005; Sandborgh et al., 2020).
Physical therapists’ experiences of learning and delivering a complex behavioral medicine intervention to adolescents with pain
Published in Physiotherapy Theory and Practice, 2021
Sara Frygner-Holm, Pernilla Åsenlöf, Gustaf Ljungman, Anne Söderlund
A growing body of research suggests that behavioral medicine treatment (BMT) is effective within the PT context for adults (Åsenlöf, Denison, and Lindberg, 2005; Bring, Åsenlöf, and Soderlund, 2016; Sandborgh, Lindberg, Åsenlöf, and Denison, 2010; Soderlund and Lindberg, 2001) but also in adolescents (Holm et al., 2016). Behavioral medicine (BM) embraces “the development and integration of psychosocial, behavioral and biomedical knowledge relevant to health and illness and the application of this knowledge to prevention, etiology, diagnosis, treatment and rehabilitation” (International Society of Behavioral Medicine, 2019). In the context of pediatric PT, BMT could include physical exercises and various methods for supporting adherence to exercise and other behavioral changes hindering optimal functioning. Examples of interfering factors are low self-efficacy, anxiety, catastrophizing/negative thoughts and pain-related fear (Carpino et al., 2014; Eccleston et al., 2004; Holm, Ljungman, Åsenlöf, and Soderlund, 2013; Simons and Kaczynski, 2012).
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