Not unlike colleagues in basic biomedical sciences who partner with their academic institutions to form private corporations- “biotech spinoffs”- to facilitate technology transfer with respect to research findings in cellular and molecular biology, Virginia Williams and I have formed a “behavioro-tech” spinoff company, Williams LifeSkills, Inc., to further develop and market the LifeSkills system to both medical and corporate, as well as individual, buyers. Our corporate strategy is based on the premise, growing out of the research already reviewed, that psychosocial factors increase risk and costs of medical illness and that well-designed and implemented behavioral intervention packages have the potential to reduce these risks and costs. Preliminary analyses of data from corporate settings show significant decreases in hostility/anger, depression, and social isolation in persons following participation in the LifeSkills Workshop.
There has been one randomized clinical trial (Gidron, Davidson, & Bata, 1999) that used a group hostility-control intervention based on the earlier Anger Kills model and found decreases in both self-report and behaviorally assessed hostility levels, as well as diastolic blood pressure that were sustained over a 2-month follow-up period in post-MI patients randomized to the intervention as compared to patients receiving usual care. Although small in scale, this trial provides, along with the other clinical trials described earlier, encouraging evidence that structured group-based behavioral interventions that teach a set of key coping skills have real potential to improve prognosis once major illness is present. Only time will tell, but it is likely that such interventions have a role in primary prevention as well.
It is now possible to look back over the past quarter century and reflect with some pride on the accomplishments of behavioral medicine and health psychology during this exciting period. We are no longer gathered into guilds, each jealously defending its own particular psychosocial risk factor against the encroachments of other, competing guilds. Instead, we now realize that the psychosocial risk factors being studied separately do not occur in isolation from one another and associated biobehavioral characteristics, but tend to cluster in the same individuals and groups. It appears that, like the Vichy inspector played by Claude Raines in Casablanca, we have rounded up “the usual suspects” and find they belong to the same gang.
There has also been considerable progress toward identifying the biological and behavioral pathways whereby these psychosocial risk factors (including combinations of them, which are common) actually participate in the etiology is medical disease. We are just beginning to use the new tools of cellular and molecular biology in this endeavor. However, there are already exciting portents that we will be able to identify not only the basic mechanisms whereby clusters of psychosocial and biobehavioral risk characteristics participate in pathogenesis, but also the basic neurobiological mechanisms responsible for the clustering in the first place.
Finally, and most exciting and satisfying of all, in the not-too-distant future it appears increasingly likely that we will be able to apply what we have learned to reduce human suffering and disease and, at the same time, enhance well- being and quality of life.
Preparation of this chapter was supported in part by grants POlHL36587 and ROl-HL44998 from the National Heart, Lung, and Blood Institute; grants 5P60-AG11268 and PO2-AG12058 from the National Institute on Aging; grant KOl-MH70482 from the National Institute of Mental Health; the Duke Clinical Research Unit grant MOlRR30; and research support from the Fetzer Institute and the John D. and Catherine T. McArthur Foundation.
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