Behavioral Medicine Research

Introduction

To help one better understand the goal and purpose of Behavioral Medicine here are some selected research articles which give a good picture of the evidenced based practices which are utilized in Behavioral Medicine settings.

Strategies involved in integrating Depression into Primary Care of the Elderly, included depression education, support of antidepressant medication management, delivery of Problem Solving Treatment in PrimaryCare (PST-PC) (a brief psychotherapy for depression), behavioral activation, and referrals to medical, psychological and/or social services as indicated.

Oishi, S.M., Shoai, R., Katon, W., Callahan, C., Unutzer, J. & IMPACT Investigators (2003). Impacting Late Life Depression: Integrating a Depression Intervention into Primary Care. Psychiatric Quarterly, 74(1), 75-89. Click here to view article

The following study concluded that successful ageing is not only about the maintenance of health, but about maximizing one’s psychological resources, namely self-efficacy and resilience. Increasing use of preventive care, better medical management of morbidity, and changing lifestyles in older people may have beneficial effects on health and longevity, but may not improve their quality of life. Adding years to life and life to years may require two distinct and different approaches, one physical and the other psychological.

Primary Care Mental Health Integration Model of VA

The use of Depressive Care Management, Behavioral Health Laboratory with online care management and collocated collaborative care between Primary Care Physicians and Behavioral Health Staff have been utilized to establish the PCMHI Model in the VA.

Pomerants, A. S.  & Sayers, S.L.(2010). Primary Care-Mental Health Integration in Healthcare in the Department of Veterans Affairs. Families, Systems, & Health, 28(2), 78–82. DOI: 10.1037/a0020341 Click here to view article

In 2013 there was a report out on an evaluation of the Veterans Health Administration's (VHA) medical home program, the largest integrated US health system to implement the model, providing primary care for more than 5 million patients nationwide. The data showed that in-person primary care visit rates slightly decreased, while increases were seen in non-traditional visits, such as phone encounters, enhanced personal health record use, and electronic messaging to providers.  The findings also demonstrated improvement in post-hospitalization follow-up and home telemonitoring after enhancements to care coordination processes.

Rosland, A., Nelson, K., Sun, H., Dolan, E.D., Maynard, C., Bryson, C., Stark, R., Shear, J.M., Kerr, E., Fihn, S.D. & Schectman, G. (2013). The Patient-Centered Medical Home in the Veterans Health Administration. The American Journal of Managed Care, 19(7), 263-272. Click here to view article

Universal Screening of Behavioral Contributions to Poor Health

Behaviors such as tobacco use, excessive drinking, drug use, poor diet, and physical inactivity are responsible for 40% of deaths, most chronic diseases, and disability, and $539 billion in costs for health care and productivity loss in the United States. For this reason it is imperative for Behavioral Medicine approaches included universal testing for these types of behaviors for all patients.

Brown, R.L. (2011). Configuring Health Care for Systematic Behavioral Screening and Intervention. Population Health Management, 14(6), 299-305.  DOI: 10.1089/pop.2010.0075 Click here to view article

Chronic Fatigue Syndrome

Results from this research study indicated that the CFS sample had a very high incidence (58%) of previously undiagnosed primary sleep disorder such as sleep apnea/hypopnea syndrome and restless legs/periodic limb movement disorder. They also had very high rates of self-reported insomnia and nonrestorative sleep. Narcolepsy and CFS participants were very similar on psychological adjustment: both these groups had more psychological maladjustment than did control group participants. This data suggest that primary sleep disorders in individuals with CFS are underdiagnosed in primary care settings and that the psychological disturbances seen in CFS may well be the result of living with a chronic illness that is poorly recognized or understood.

Fossey, M., Libman, E., Bailes, S., Baltzan, M., Schondorf, R., Amsel, R.  & Fichten, C.S. (2004). Sleep Quality and Psychological Adjustment  in Chronic Fatigue Syndrome. Journal of Behavioral Medicine 27(6), 585-604. Click here to view article

Type 2 Diabetes

Review of 12 Trials with 522 patients with use of (counseling, cognitive behavior therapy, motivational interviewing or psychodynamic therapy) to improve diabetes control found improved glycemic control.

Ismali, K., Winkley, K. & Rabe-Hesketh, S. (2004). Systematic Review and Meta-analysi of rando trials of Psychological interventions to Improve Glycaemic Control in Patients with Type 2 Diabetes. The Lancet, 363(May 15, 2004), 1589-1597. Click here to view article

Cardiac Rehabilitation

Methods include improving knowledge about coronary heart disease and reducing  misconceptions, helping patients initiate and maintain lifestyle changes (e.g., smoking, eating and exercise) by goal setting and action planning, managing stress and reducing psychological distress, enhancing adherence to medical advice and cardiac medication, and improving the quality of life by restoring confidence.

Michie, S., O’Connor, D., Bath, J. Giles, M & Earll, L. (2005).Cardiac rehabilitation: The psychological changes that predict health outcome and healthy behavior. Psychology, Health & Medicine, 10(1), 88-95. Click here to view article

One study showed that since many patients referred to cardiac rehabilitation are obese that diet therapy, exercise training, nutritional and psychological counseling for both

obesity and psychological distress was included as important components in the Cardiac Rehabilitation Programs evaluated.

Manzonia, G.M., Villaa, V., Comparea, A., Castelnuovoa,G., Nibbiod, F., Titond, A., Molinaria, E. & Gondoni, L.A. (2011). Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: A practice-level study. Psychology, Health & Medicine, 16(2), 178–189 Click here to view article

Sexual Dysfunction

Research on Male Sexual dysfunction i.e., erectile dysfunction, hypogonadism, and premature ejaculation, has been shown to be associated with physical and psychological health. There is a strong correlation between sexual dysfunction and

cardiovascular disease, metabolic syndrome, quality of life, and depression. For these reasons this article calls for greater integration of Behavioral Health Strategies in dealing with patients with these conditions.

Tan, H.M., Tong, S.F. & Ho, C.K. (2012). Men’s Health: Sexual Dysfunction, Physical, and Psychological Health—Is There a Link? Journal of Sexual Medicine, 9, 663–671. DOI: 10.1111/j.1743-6109.2011.02582.x Click here to view article

Psychosomatic Complaints to Primary Care Physicians

The consequences model labels psychosocial stress as consequences rather than as causes of unexplained physical symptoms and aims to change the consequences in that complaints of unexplained physical symptoms reduces.

Zonneveld, L.N.L., Duivenvoorden, H.J., Passchier, J & van ’t Spijker, A. (2010). Tailoring a Cognitive Behavioural Model for Unexplained Physical Symptoms to Patient’s Perspective: A Bottom-Up Approach. Clinical Psychology and Psychotherapy. 17, 528–535 Click here to view article

Pediatrics

Pediatric Cancer

Patient's psychosocial plan was designed during weekly team meeting there was coordination of patient care was discussed with entire medical team. They attempt to identify issues at an early stage and coordinate psychosocial care in a manner that alleviates ome of the stressors associated with pediatric cancer or blood disorders. Their team aims to enhance the quality of life of all patients and their families.

Cruz-Arieta, E. Weinshank, L. (2008).Multidisciplinary Approach to Psychosocial Care: The Stephen D.Hassenfeld Model. Primary Psychiatry,15(7):63-57. Click here to view article

Need for Integration of Mental Health Services in Pediatric Care

Primary care clinics have become the de facto mental health clinics for teens with mental health problems such as depression, as evidenced by a survey of multidisciplinary experts; however, there was little guidance found for primary care professionals who are faced with treating this population.

Eapen, V. & Jairam, R. (2009) Integration of child mental health services to primary care: challenges and Opportunities. Mental Health in Family Medicine, 6, 43–8. Click here to view article

Psychosomatic Pediatric Abdominal Pain (Recurrent Abdominal Pain – RAP)

For children with psychosomatic RAP, a special method for integrated psychological and somatic treatment is probably effective. These children have a special pattern of Tender Points related to their disorder, which diminishes with improvement in the disorder.

Alfven, G. & Lindstrom, A. (2006). A New Method for the Treatment of Recurrent Abdominal Pain of Prolonged Negative Stress Origin. Acta Pædiatrica, 96, 76-81. DOI:10.1111/j.1651-2227.2006.00028.x Click here to view article

Integrated Behavioral Health Services with At-Risk Families

The Starting Early Starting Smart initiative recognized the importance of providing the full spectrum of early prevention and intervention services to both children and their caregivers to promote optimal health and development during the early childhood years.

Morrow, C.E., Elana Mansoor, E.,Hanson, K. L., April L. Vogel, A. L., Rose-Jacobs, R.,  Genatossio, C.S., Windham, A. & Bandstra, E. S. (2010). The Starting Early Starting Smart Integrated Services Model: Improving Access to Behavioral Health Services in the Pediatric Health Care Setting for At-Risk Families with Young Children. Journal of Child and Family Studies, 19, 42–56. DOI 10.1007/s10826-009-9280-z Click here to view article