The Role of Cognitive-Behavioral Therapy in Behavioral Medicine: Introduction to the Special Issue
Hart, Trevor A., Journal of Cognitive Psychotherapy
Behavioral medicine focuses on assessment, treatment, and prevention of medical problems and promotion of health, using the behavioral sciences (e.g., International Society of Behavioral Medicine). Behavioral medicine is strongly rooted in cognitive-behavioral therapy (CBT) both historically and in its use of CBT theories and techniques. The articles from the present special issue present the relation between cognition and behavior in both basic research and intervention studies. These articles extend the role of CBT into medical and public health settings, thereby expanding the ability of CBT therapists to help patients with medical problems and those who are at high risk for developing medical problems.
Keywords: cognitive-behavioral therapy; psychotherapy; behavioral medicine; health interventions; health psychology
Behavioral medicine is the field concerned with the etiology, diagnosis, treatment, rehabilitation, and prevention of medical problems, and the promotion of health via behavioral sciences (International Society of Behavioral Medicine, 2008; Society of Behavioral Medicine, 2009). Behavioral medicine overlaps significantly with health psychology, but as an interdisciplinary field, behavioral medicine goes beyond psychology to include medicine, nursing, public health, and other allied health professional disciplines to further science and practice. Behavioral medicine rejects the traditional biomedical model which is still often found in medical settings, which assumes that 1) disease is caused only by biological pathogens, 2) psychological and/or social factors are unimportant or irrelevant, and 3) health is merely the absence of disease. In contrast, behavioral medicine assumes the biopsychosocial model, which proposes that health is defined by "physical, mental, and social well-being and not merely the absence of disease or infirmity" (World Health Organization, 2007).
Behavioral medicine is strongly rooted in cognitive-behavioral therapy (CBT), both historically and in its use of CBT theories and techniques. For example, most stress management interventions for medical patients (e.g., Antoni et al., 2001; Parker et al., 1995; Surwit et al., 2002) are conceptually grounded in the stress management interventions initially developed for patients with anxiety disorders (e.g., Meichenbaum, 1972). Behavioral medicine seeks to apply CBT to help patients change cognitions (e.g., low self-efficacy for health-related behavior, maladaptive cognitions regarding coping with disease) and daily behaviors (e.g., diet, exercise, smoking, sexual behavior) that may increase the risk for disease (e.g., cancer, diabetes, cardiovascular disease, HIV/ AIDS). Due to the commonalities between CBT for psychiatric disorders and CBT in behavioral medicine, and due to the high comorbidity between psychiatric and medical disorders among treatment-seeking patients (e.g., Scott et al., 2007), it is therefore logical to present recent findings from a broad array of topics in behavioral medicine in the Journal of Cognitive Psychotherapy. These articles present the relation between cognition and behavior in both basic research and intervention studies.
The first two articles present preliminary findings from cognitive-behavioral interventions to promote stress management and reduce psychological distress among medical patients. Both studies are notable for their use of sound behavioral principles in the world of recent technological advancements. Irvine et al.'s study, presenting characteristics associated with cognitive-behavioral treatment engagement for cardiac patients receiving an implantable cardioverter defibrillator, and the association between treatment engagement and lower posttraumatic stress outcomes, expands our understanding of how to use stress management techniques with patients undergoing treatments related to advanced medical technologies. With the recent advances in human immunodeficiency virus (HIV) medical care that have changed HIV from a fatal disease to a severe but chronic medical condition, Brown, Vanable, Carey, and Elin present an overview of their intervention to promote stress management among HIVpositive women. …