Behavioral medicine: the challenge of integrating psychological and behavioral approaches into primary care.

The effects of psychological and behavioral factors on physical illness are increasingly recognized. For example, depression and anger have repeatedly been reported as key predictors of a poor recovery following myocardial infarction, independent of specific disease indices.1–3 Depression, anticipatory nausea, and anxiety are often common in cancer patients.4–8 Depression and anxiety have also been associated with greater levels of physical disability, diminished quality of life, and increased health care utilization.9 In fact, psychological and behavioral factors are relevant to some of the most common chronic illnesses (e.g., cancer, chronic pain, cardiovascular disease, Crohn disease, diabetes, asthma/chronic obstructive pulmonary disease). With increased recognition of and empirical support for the contribution of psychological and behavioral variables in the development, maintenance, and/or exacerbation of disease comes the need for increased treatment options that incorporate not only the best of biomedical knowledge but also of biobehavioral science. In this article, we present some thoughts on how “applied” behavioral medicine can be incorporated into health care, particularly primary care. To help readers understand behavioral medicine, we briefly review some of the evidence supporting behavioral medicine interventions for patients with cardiovascular disease and cancer. We then discuss how we have applied a conceptual model to implement behavioral medicine interventions into care at our own institution. Our goal is to encourage further dialogue on how to integrate behavioral medicine interventions into evidence-based health care.