Evidence for the efficacy of behavioral approaches to the treatment
and management of physical illness is mounting, as is the evidence
for behavioral interventions for psychological disorders. A
pressing question that remains is how to effectively treat
co-morbid physical and psychological illnesses. Diseases co-occur
more often than not, and the co-occurrence of physical and
psychological illnesses is associated with greater impairment and
healthcare costs. Unfortunately, the treatment literature has
traditionally been disease-specific, with fewer insights and
discoveries regarding the underlying processes of co-morbid
physical and psychological illnesses, and even fewer of approaches
to treatment.Research on co-morbidities between physical and
psychological illnesses has focused primarily on depression. Quite
extensive literatures describe the negative impact of depression on
type 2 diabetes, cardiovascular disease, cancer, obesity, pain, and
other physical illnesses. More recently, higher rates of physical
illness have been documented in individuals with bipolar disorder,
anxiety disorders, schizophrenia, and impulse control disorders.
Studies emanating from the National Comorbidity Survey-Replication
(NCS-R), the only U.S. population-based database that includes
diagnostic information on all DSM-IV psychological disorders, have
revealed strong links between a number of physical and
psychological illnesses. These data draw attention to the
prevalence of physical and psychological co-morbidities at the
population level, which has stimulated research on the
biobehavioral mechanisms of those co-morbidities, with the goal of
developing and improving treatment approaches. As this area of
research grows, practical resources are needed for clinicians and
researchers who encounter individuals with co-morbid physical and
psychological illnesses in their work. This book is the first to
provide a comprehensive overview of psychological co-morbidities of
physical illness, biological and behavioral mechanisms of those
co-morbidities, and implications for treatment. Each chapter
focuses on a physical condition, such as obesity, type 2 diabetes,
HIV infection, tobacco dependence, cardiovascular disease, cancer,
asthma, pain, irritable bowel syndrome, autoimmune disorders, and
obstetric/gynecological conditions. Chapters are structured to
cover 1) the epidemiology of the most prevalent co-morbid
psychological disorders within that physical condition (e.g.,
depression and other mood disorders, anxiety disorders, psychotic
disorders, impulse control disorders, and eating disorders; 2)
biobehavioral mechanisms of the co-morbidity; 3) a review of the
behavioral treatment literature including evidence-based practice
guidelines (where available); and 4) treatment considerations
including issues of stepped care, evidence-based treatment
decisions, treatment sequencing, treatment blending, treatment
interactions, and contraindications. Content is guided by available
research evidence and relevant theoretical models, and it is
presented in such a way as to inform clinical practice, identify
important gaps in the research literature, and provide directions
for future research. The book serves as a tool for clinicians and
researchers who work in the area of behavioral medicine in medical,
academic, and/or training settings. Patients with psychological and
medical co-morbidities may be encountered by clinicians working in
either mental health or medical settings, where the presenting
problem could be either the psychological disorder or the medical
disorder. As such, assessment and treatment issues are discussed
from both perspectives. For the clinician, the book reviews brief
assessment tools, provides practical summaries of the treatment
outcome literature and treatment considerations (e.g., treatment
sequencing, contraindications), and includes treatment decision
hierarchies that help the clinician incorporate each facet of
evidence-based decisions (the evidence, patient characteristics,
and their own expertise). For the researcher, the book brings
together the literature for the medical and psychological disorder,
highlighting still unanswered research questions relevant to the
co-morbidity. Literature relevant to the underlying biobehavioral
mechanisms of the co-morbidity as well as treatment are summarized.
While a vast literature exists for the treatment of these disorders
in isolation, one important purpose of this book is to bring
together this literature to uncover specific areas in need of
future study that will further our understanding of why different
disorders co-occur and the best ways to treat them when they do.
General
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