Biological Barriers in Behavioral Medicine

A "New Looking Glass" for Behavioral Medicine In 1984, John Briggs, a science writer and specialist in interdisciplinary studies teaching at the New School for Social Research, and F. David Peat, a physicist who was for many years a fellow with the National Research Council of Canada, published a book about the revolutions that were taking place in physics, mathematics, chemistry, biology, and neu­ rophysiology and about the scientists whose new theories were changing our understanding about the nature of the universe. The title of their book was Looking Glass Universe, after Lewis Carroll's classic story of Alice and her friends, Through the Looking Glass. Briggs and Peat's book is a well-written, challenging volume about human beings and how they think about old problems in new and sometimes startling ways. I mention Briggs and Peat's book only partially because I happen to have a personal interest in the potential applications of new ways of looking at and thinking about nature and data derived from modern physics and systems theory for health psychology and behavioral medi­ cine (e. g. , Schwartz, 1984). In a letter Wolfgang Linden wrote to me on January 23,1987, he shared with me (at my request) his rough thoughts about his personal goals for this book.

Contenu

1 Self-Regulation Theory in Behavioral Medicine: An Introduction.- Historical Developments.- Potential of the Self-Regulation Theory.- The Modified Health Belief Model.- References.- 2 Biological Barriers in the Treatment of Alcoholism.- Behavioral Treatments for Alcoholism.- Biological Factors Associated with Alcohol Abuse.- Neuropsychological Deficits.- Tolerance and Dependence.- Genetic Factors.- Fluid and Electrolyte Balance.- Implications of Biological Factors Associated with Alcohol Consumption for the Behavioral Treatment of Alcoholism.- Neuropsychological Deficits.- Tolerance and Dependence.- Genetic Factors.- Fluid and Electrolyte Balance.- References.- 3 Causes and Effects of Obesity: Implications for Behavioral Treatment.- Causes of Obesity.- Ingestional Factors.- Postingestional Factors.- Treatment Considerations.- Effects of Obesity.- Ingestional Adaptations.- Postingestional Adaptations.- Implications for Treatment.- A Biobehavioral Treatment Model.- References.- 4 Biobehavioral Approaches to Smoking Control.- Smoking Behavior and Learning.- Operant and Social Learning Theories.- Associative Learning Theory.- Classical Conditioning Theory.- Biobehavioral Processes in Smoking.- Pharmacology of Nicotine.- Nicotine as an Addictive Substance.- Self-Regulatory Aspects of Smoking.- Models of Smoking Processes.- Smoking Initiation.- Maintenance of Smoking Behavior.- Smoking Reduction.- Current Approaches to Smoking Prevention and Reduction.- Smoking Prevention.- Smoking Reduction.- Maintenance of Smoking Reduction.- Implications and Conclusions.- Arousal and Performance Functions.- Affect and Drive.- Research Implications.- References.- 5 Considerations in the Treatment of Insomnia.- The Complaint of Insomnia.- Traditional Treatments for Insomnia.- Behavioral Treatments.- Biological Considerations.- Medications.- Sedative-Hypnotics.- Stimulants, Antidepressants, and Others.- Respiratory Disorders.- Hypoventilation Syndromes.- Apneas.- Circadian Rhythm Disorders.- Aging.- Nocturnal Myclonus and Restless Legs.- Additional Considerations.- Recommendations.- References.- 6 Self-Regulation and Type A Behavior.- Preliminary Findings of the Recurrent Coronary Prevention Project: Attrition and Outcome Data.- A Model of Self-Regulation and Type A Behavior.- Physiological Mechanisms in Type A Behavior.- Behavioral Self-Regulatory Mechanisms in Type A: Seeking Out Challenge.- Cognitive Self-Regulatory Mechanisms in Type A: Symptom Denial, Selective Attention, and Attributional Biases.- Selective Attention and Task Orientation.- Failure: Personal Responsibility Attributions.- Physiological Consequences of Self-Regulatory Mechanisms.- Implications for Treatment.- Timing of the Intervention.- Types of Interventions.- Summary and Directions for Future Research.- References.- 7 Biopsychological Barriers to the Behavioral Treatment of Hypertension.- Behavioral Treatments.- Physiological Regulation of Normal and Abnormal Blood Pressure Levels.- Biopsychological Sequelae of High Blood Pressure.- Implications of Biological and Psychobiological Findings for the Behavioral Treatment of Hypertension.- References.- 8 Psychophysiological Disorders of the Gastrointestinal Tract.- Irritable Bowel Syndrome (IBS).- Psychological Considerations.- Anxiety.- Hysteria.- Depression.- Illness Behavior.- Abdominal Pain.- Placebo Response.- Physiological Factors.- Motility.- Slow-Wave Myoelectric Activity.- Myoelectrical Spike Activity.- Disorders of the Esophagus.- Esophageal Spasms.- Globus Hystericus.- Psychological and Behavioral Treatment Approaches for IBS and Esophageal Disorders.- Summary.- References.- 9 Asthma.- Pathophysiology.- Intermittence.- Variability.- Reversibility.- Psychological Factors.- Emotional Factors.- Suggestion.- The Self-Management of Asthma.- Rationale.- Self-Management Training.- Design.- Dependent Variables.- Results.- Conclusions.- References.- 10 Pain.- Acute versus Chronic Pain.- Psychological Approaches to Pain Management.- Operant Models.- Cognitive-Behavioral Methods.- Biofeedback.- Childbirth.- Biological Mechanisms in Pain.- Endogenous Pain Modulation.- Conclusions.- References.- 11 Understanding and Preventing Relapse.- Commonalities and Differences in the Addictions.- Rates and Definition.- Lapse and Relapse: Process versus Outcome.- The Nature and Process of Relapse.- The Need for a Natural History.- Stages of Change.- The Consequences of Relapse.- Relapse: Failure or Incremental Learning?.- Determinants and Predictors of Lapse and Relapse.- Individual and Intrapersonal Factors.- Negative Emotional States.- Inadequate Motivation.- Response to Treatment.- Coping Skills.- Physiological Factors.- Environmental and Social Factors.- Social Support.- Environmental Stimuli and External Contingencies.- Individual, Environmental, and Physiological Factors: An Interaction.- Prevention of Lapse and Relapse.- Traditional Approaches versus the Prevention Model.- Stage 1: Motivation and Commitment.- Stage 2: Initial Behavior Change.- Stage 3: Maintenance.- Effects of Existing Programs.- Recommendations for Research.- Conclusions.- References.