CENTER ON BEHAVIORAL MEDICINE
Traditional Approaches-Psychological: Related Paper
Psychological Interventions to Improve Mind-Body Problems
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Psychological Interventions to Improve Mind-Body Problems
Ralph A. Brookholmes
A substantial body of research demonstrates with statistical significance that the mind and emotions influence bodily functions – also known as the mind-body connection. Essentially, three mind-body categories reveal the power of the mind to affect physiological processes: psychoimmunology which focuses on how the mind affects the immune system; psychoneuroendocrinology which focuses on how the mind affects both the nervous and endocrine systems; and psychogenesis which is how the mind can produce disease like states, despite the fact a pathological explanation is not present. In all three categories, research has proven the mind can either enhance physiological process to achieve improved health, or by contrast, the mind can compromise physical health.
Given the mind is capable of compromising one’s physical health, it is plausible that psychological interventions can adjust and improve faulty emotional and thought processes to improve or restore one’s physical health. The aim of this paper is to discuss how various psychological interventions would improve physical health. Specifically, two psychological interventions, along with each of their various respective treatment approaches, will be discussed to address how they would correct maladjusted emotions and thought processes to improve physical health. After all, the role of a health psychologist is to develop and/or implement interventions to help people practice healthy cognitive processes and behaviours and to change poor ones.
Two psychological interventions used to enhance physical health are focussed on attitudinal change and cognitive-behavioural techniques. While attitudinal changes are generally effective to bring about positive health behaviours, they may not be enough. Specifically, they may instil motivation for change but lack the provision of skills or methods necessary to alter or maintain changed behaviour. Given this, attitudinal change intervention will be discussed, however, greater emphasis will be placed on cognitive-behavioural techniques (CBT) as it involves learning new skills to acquire desired target behaviours.
Attitude change is based on the premise that if a therapist can provide correct information about the implications of one’s poor physical health, the individual may be motivated to change their poor habits. Faulty misunderstandings may in fact be the root cause of why some individuals practice faulty health habits or choose not to correct poor health habits in the face of evidence that corrective action will benefit them (Taylor, 2003).
Two attitudinal therapeutic change techniques can be used to alter one’s attitude to improve physical health. First, educating one with reliable, trustworthy information about a physical ailment, its complications, and etiology may serve to correct misunderstandings/ irrational beliefs and empower an individual to shift his/her attitude and behaviour in dealing with an ailment. For example, diabetic clinics host education clinics to explain how certain behaviours can worsen the complications of diabetes. Many diabetics do not believe stress can alter their blood-glucose levels and believe only exercise and food consumption have an effect. Once credible research is presented to these individuals demonstrating increased allostatic load drives up blood-glucose levels, they may be more inclined to limit their stress or adopt stress modulating processes.
A second approach, consistent with educating individuals to effect attitude change, is to instil a sense of fear with shocking statistics or grave information. This technique assumes that if people are fearful that their poor physical health is the result of irrational beliefs or thoughts, they will adjust their beliefs and behaviour accordingly to reduce their fear. For example, an individual who is overweight, smokes, works in a high stress environment, and is overtly flippant about his situation is told that if he does not stop smoking, continues to maintain a poor diet, and subjects himself to chronic stress, he will die of a heart attack. Such a fearful statement, particularly from a credible source such as a health psychologist, may in fact appeal to an individual and cause him to change his attitude to one of concern and ultimately motivate him to seek corrective action.
While the aforementioned attitudinal change interventions may bring about initial positive changes and improved health, these techniques statistically do not result in long-term change for many. Essentially, such techniques are considered superficial, as they do not provide skills for individuals to implement and maintain over time. That said, some individuals who are self-disciplined, educate themselves on how to effect positive change, and develop their own methods to improve their health may very well benefit from these techniques. For the majority, irrational beliefs and a lack of self-efficacy are deeply ingrained and not easily changed by attitudinal change techniques. Therefore, additional intervention techniques are required that will provide skills for individuals to alter behaviour and maintain behaviour change for the long-term; cognitive behavioural therapy techniques can address these matters.
Cognitive and Behaviour Therapy
Cognitive behavioural therapy is comprised of a number of effective interventions, behavioural and cognitive techniques, to improve one’s health. Behavioural therapy techniques are based on the view that psychological disorders and connected behaviours stem from faulty learning. Cognitive therapy assumes the major cause of psychological disorders and associated behaviours are the result of distorted patterns of thought (Baron, Earhard, & Ozier, 1998). When these two therapeutic techniques are combined they often result in the improved functioning over the long-term as individuals learn new coping measures and replace distorted patterns of thought with healthy ones. For simplicity, each of these types of therapies will be addressed separately to demonstrate how they would be effective interventions in resolving faulty emotional and thought processes in order to improve one’s physical health. In discussing these therapeutic interventions, emotional stress and its detrimental physiological aspects will be used to exemplify how the CBTs are effective at improving health.
Behavioural Therapy Techniques
Behavioural therapies focus primarily on present behaviour. Essentially, techniques stemming from this type of therapy assume that either individuals have not acquired skills and behaviours required to cope with problems, or they acquired maladaptive habits and reactions – ones that cause them distress. As such, several behavioural therapy processes aim to provide individuals with the proper skills necessary to cope more effectively or to alter learned patterns of behaviour that cause them distress. Classical conditioning, operant conditioning, and modelling are three proven techniques in improving health.
Emotional stress resulting from one’s inability to cope with threatening stimuli or daily problems is often acquired through conditioning. In other words, stimuli associated with real dangers may acquire the capacity to evoke intense fear reactions that at first were elicited only by the actual danger. For example, one may feel an intense amount of fear when they spill a drink glass. Spilling a drink glass should not instil fear unto itself, however, if the individual was subjected to earlier severe punishment when he or she spilt a drink, then the threat of punishment, an unconditioned stimulus, has been paired with the conditioned stimulus, spilling the glass, to evoke a conditioned response of fear. Chronically experiencing stress for several different situations is linked with suppression of one’s immune system (Kiecolt-Glaser & Glaser, 1988). Two therapies based on classical conditioning, flooding and systematic desensitization, are effective techniques to reduce stress and ultimately improve physical health. First, flooding involves exposing the stressful individual to the feared stimulus, or a mental representation of it, in an environment where he or she cannot avoid it. Under these types of conditions, extinction of fear can occur, so that the stress subsides. With systematic desensitization, a therapist could teach the individuals how to relax themselves, and then while in a relaxed state expose the individual to the stimuli they fear and that causes them stress. Since the individual is experiencing relaxation, which is incompatible with fear, the conditioned link between these stimuli and stress is weakened.
Intervention based upon the principles of operant conditioning often leads to impressive results. Specifically, behaviour is often shaped by the consequences it produces; actions are repeated if they produce positive outcomes or if they allow one to evade negative ones. For example, a stressed individual may be irritable, withdrawn, and angry – all which may compromise one’s physical health if experienced on a chronic basis. With operant conditioning based therapy, once these stress-exhibiting behaviours are identified, events that reinforce and maintain these behaviours are next identified and then efforts are implemented to change the environment so that these maladaptive behaviours no longer receive reinforcement. Therefore, when an individual begins to exhibit stress related behaviours he or she may either reward themselves, or have someone else - a spouse, reward them if they can stop their stressful behaviour and change their environment (changing one’s environment may be a s simple as going for a walk). When one learns that they can in fact be rewarded for behaving in adaptive ways, they often begin to automatically do so in order to improve physical and mental health.
Research indicates modelling is a very effective therapy to teach skills quickly and efficiently. Essentially, modelling is observational learning where an individual witnesses another individual model a desired target behaviour (Bandura, 1986). In order to enhance the efficacy of this type of therapy, it is better when the model is similar to the individual witnessing the desired behaviour. Second, modelling can also be enhanced if the learner looks upon the individual modelling the desired behaviour favourably. For example, if an individual enrols in group therapy stress management, an individual may learn new methods to manage their stress quicker when they observe others similar to them who experience similar stressful situations but have learned appropriate ways to manage their responses. Essentially, this results in a scenario of “if they can do it, so can I”. In addition, if the individual modelling the desired behaviour is one looked upon favourably, for example a boss or sports star, it will improve the probability of one attaining the desired behaviours, as he/she wants to emulate his/her role model.
Cognitive Therapy Techniques
Many psychological disorders stem from faulty or distorted modes of thought. Change these, it is reasoned, and the disorders can be alleviated (Baron, Earhard, & Ozier, 1998). In a sense, what we think strongly affects how we feel and what we do. Using the aforementioned example that stress compromises one’s physical health, the following interventions demonstrate how changing one’s cognitions may prevent the experience of stress and its associated physical side-effects. Two interventions are profiled: rational-emotive therapy and stress inoculation training.
In rational-emotive therapy (RET), individuals often have irrational thoughts that affect their thinking, reasoning, and behaviour. The development of irrational thoughts is generally not the result of consciously choosing to have them, but rather automatic reactions stemming from strong desires to be loved, successful, safe, and comfortable. Generally individuals want these desires to be true and want to be liked and accepted by others, so individuals often permit these desires to colour their perceptions and thinking. Irrational beliefs generally escalate reasonable desires into “musts” as in “I must be perfect”. Closely linked to such irrational thoughts are awful or catastrophic beliefs that if a certain event occurs or fails to occur, the result will be disastrous – another irrational belief. As such, should an undesired event develop, such an individual will interpret it as disastrous, become very distressed, and exhibit maladaptive behaviours. Should these irrational thoughts and adverse stress chronically occur, it will no doubt negatively tax one’s physical health. To combat the development of stress stemming from irrational thoughts and beliefs, RET seeks to force such individuals to recognize their irrational thoughts. For example, a stressed individual states, “it is unbearable and horrible when things are not the way I want them to be”. With RET, a therapist can challenge the irrationality of this individual’s belief to get them to see how unrealistic such a belief is. For example, a therapist may respond by stating, “do you think it is really reasonable that you can control all events so that they are the way you want them to be?” By challenging the individual and having them realize their belief is rather impractical, they can stop these people from being their own worst enemy, reduce the stress they experience, and ultimately improve their health.
Cognitive processes not only influence behaviour but emotional reactions to situations. Detrimental emotions and behaviours often result from anxiety and the stress produced by some individuals who perceive and think a situation will be rather difficult to resolve, Hans Selye’s first stage in his general adaptation syndrome, known as the alarm stage. For some, if the stress is perceived to be insurmountable, it can become crippling and if this is the case for many situations the stress compounds and may lead to poor physical health. To deal with excessive stress and anxiety, Meichenbaum’s Stress Inoculation Training has proven to be an effective therapeutic approach to appropriately manage stress and stave off the possibility of developing poor physical health (Meichenbaum & Deffenbacher, 1988). Three stages are set out in this training. First, the therapist assists an individual to understand the nature of his anxiety and how it is generated. Additionally, individuals learn their anxiety involves an exaggerated emotional reaction associated with troublesome thoughts and expectations. Individuals work with a therapist to identify the situations and circumstances that generate anxiety, as well as accompanying thoughts and emotions. As a result, individuals begin to see their problems objectively and begin to understand that anxiety and stress management requires development of control over their emotions and thoughts and the expectations associated with them. Second, individuals are taught skills to gain control over their emotional reactions. For example, they may learn emotion-management skills, progressive muscle relaxation and breathing exercises, which help regulate physiological arousal. Concurrently, a therapist would help the individual through cognitive restructuring exercises; the exercises increase the individual’s self-awareness of negative thoughts and expectations. The emphasis on the exercises is to change the individual’s maladjusted self-concepts of inadequacy and incompetence; role-playing is often used in this stage. Essentially, this stage then helps the individual physically calm himself and replace irrational thoughts with more appropriate ones. Last, the individual would learn actual coping responses to specific problems. Basically, an individual is encouraged to imagine as accurately as possible, situations that evoke stressful reactions, emotions, and irrational expectations. At this time, the individual is then directed to employ relaxation and the cognitive coping skills he/she acquired in the second stage to alleviate emotional stress. Once the individual is comfortable with is learned in this stage, he/she will be encouraged to apply these skills in the real world. In the end, therapists generally apply this type of training to specific situations that an individual finds stressful, for example, dealing with one’s supervisor.
ConclusionAlthough the mind can compromise one’s physical health, psychological interventions can improve faulty emotional and thought processes to improve one’s physical health. Attitude change, and cognitive behavioural therapy techniques have all proven to be successful in this venue. Although each has its own particular strengths, one does not stand out to be drastically more beneficial than the others for all individuals. Although attitude change is effective, cognitive behaviour techniques provide stressed individuals with specific skills to deal with situations that invoke a stress reaction. As a result, a multidisciplinary tailored approach using the strengths of each of these interventions is often the best approach to assist an individual overcome his/her stress and ultimately improve his/her physical health.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.) – text revision. Arlington, VA: Author.
Bandura, A. (1986). Social foundations of thought and action : A social cognitive theory. Englewoods Cliffs, NJ : Prentice-Hall.
Baron, R.A., Earhard, B., & Ozier, M. (1998). Psychology (2nd ed.). Scarborough, Ontario, Canada: Prentice-Hall.
Blatt, S.J. (1995). The destructiveness of perfectionism: Implications for the treatment of depression. American Psychologist, 50, 1003-1020.
Carlson, N.R. (2004). Physiology of behaviour (8th ed.). Boston: Allyn and Bacon.
Kiecolt-Glaser, J.K., & Glaser, R. (1988). Methodological issues in behavior immunology research with humans. Brain, Behavior, and Immunity, 2, 67-78.
Meichenbaum, D.K., & Deffenbacher, J.L. (1988). Stress inoculation training. Counselling Psychologist, 16, 69-90.
Taylor, S.E. (2003). Health Psychology (5th ed.). New York: McGraw-Hill.