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Behavioral intervention in health care
363
BOOKS REVIEWS
Behavioral Intervention in Health Care By LAURA Westview
Press,
Boulder,
In this book Dr. Gordon pursues the noteworthy task of educating health care professionals about the theoretical, empirical, and practical aspects of applying behavioral principles in the treatment of a variety of medical problems. She accomplishes her goal by: (1) emphasizing the relevance and importance of behavioral medicine for the health care field, (2) demonstrating the clinical significance of behavioral assessment and intervention for specific health care problems, and (3) providing the interested reader with a fairly extensive bibliography at the end of each chapter. The author begins by defining the area of behavioral medicine and focusing upon its applications for prevention and treatment. She underscores the basic tenets of the behavioral approach and discusses its paradigms in the context of health care. The second chapter is basically an overview of both the utility (including clinical tips) and limitations of a variety of behavioral and cognitivebehavioral techniques including self-monitoring, the specification of treatment goals, stimulus control, behavior relaxation, biofeedback, covert strategies, rehearsal, and aversive therapy. Sursystematic desensitization, prisingly, Dr. Gordon warns, “Despite much enthusiasm for behavioral intervention, other techniques must at times be utilized as part of a treatment program (p. 20).” These other techniques are the client-centered and psychodynamic approaches. Of course, today there appears to be little question about the value of relationship variables (genuineness, unconditional positive regard and empathy) as necessary-but not sufficient conditions-for therapeutic change in behavior therapy (Goldstein, 1973). La Voge and Beck (1978) have even suggested that the established efficacy of behavioral procedures may be enhanced by relationship variables. The merging of behavioristic and psychodynamic formulations in treatment is quite another story-although somewhat popular in some circles today. This notion is difficult to accept in view of the lack of evidence that analytic interpretations add anything to the efficacy of behavioral interventions-e.g. implosive therapy versus flooding (Rimm and Master, 1974). In the second chapter the nuts and bolts issues of behavioral analysis and the relationship between behavioral assessment and the selection of an intervention are discussed. The author then proceeds to describe six clinical problems-insomnia, hypertension, alcoholism, obesity, headache and pain. Although these problems are only a few of the health care complaints to which behavioral procedures have been successfully applied, they are among the more common complaints encountered by health care professionals. The reader will find useful information regard-
B. GORDON
Colorado,
1982, 129 pp., $15.00
ing each of these problems with respect to their prevalence, etiology, behavioral conceptualization and the efficacy of behavioral interventions, methodological shortcomings of the literature, and clinical strategies for interested practitioners. Chapter 4 is devoted entirely to patient non-adherence to medical advice. Non-compliance, a notorious problem for health care professionals, negatively influences the course of treatment and maintenance. Clinical strategies to overcome the sabotaging effects of non-compliance are reviewed. In the fifth chapter Dr. Gordon focuses her attention upon issues surrounding the psychological impact of hospitalization, physician-patient communication, referral and consultation. In the final chapter, the current status and future of behavioral medicine are discussed. In conclusion, the book is concise, up to date, highly readable, and at the level of health care professionals unfamiliar with behavior modification. However, since health care professionals seem usually to be unsophisticated about theoretical psychology, a chapter on learning theory would have been helpful. Nonetheless, the book is an interesting introduction to the exciting field of behavioral medicine and will undoubtedly whet the appetite of many a health care provider searching for answers to practical problems. It will also prove a useful addition to behavioral curricula in medical training centers. ROBERT
A. DITOMASSO
West Jersey Health System Family Practice Residency Tatem-Brown Family Practice Center Voorhees, NJ 08043, U.S.A. and Psychology in Education Division University of Pennsylvania Phila., PA 19104, U.S.A.
REFERENCES DeVoge J. T. and Beck S. (1978) The therapist-client relationship in behavior therapy. In Progress in Behavior Modification (Ed. by Hersen M., Eisler, R. M. and Miller, P. M.). Academic Press, New York. Goldstein A. (1973) Behavior therapy. In Current Psychotherapies (Ed. by Corsini R.). F. E. Peacock Publishers, Illinois. Rimm D. C. and Masters J. C. (1974) Behavior Therapy: Techniques and Empirical Findings. Academic Press, New York.
BOOKS REVIEWS
Behavioral Intervention in Health Care By LAURA Westview
Press,
Boulder,
In this book Dr. Gordon pursues the noteworthy task of educating health care professionals about the theoretical, empirical, and practical aspects of applying behavioral principles in the treatment of a variety of medical problems. She accomplishes her goal by: (1) emphasizing the relevance and importance of behavioral medicine for the health care field, (2) demonstrating the clinical significance of behavioral assessment and intervention for specific health care problems, and (3) providing the interested reader with a fairly extensive bibliography at the end of each chapter. The author begins by defining the area of behavioral medicine and focusing upon its applications for prevention and treatment. She underscores the basic tenets of the behavioral approach and discusses its paradigms in the context of health care. The second chapter is basically an overview of both the utility (including clinical tips) and limitations of a variety of behavioral and cognitivebehavioral techniques including self-monitoring, the specification of treatment goals, stimulus control, behavior relaxation, biofeedback, covert strategies, rehearsal, and aversive therapy. Sursystematic desensitization, prisingly, Dr. Gordon warns, “Despite much enthusiasm for behavioral intervention, other techniques must at times be utilized as part of a treatment program (p. 20).” These other techniques are the client-centered and psychodynamic approaches. Of course, today there appears to be little question about the value of relationship variables (genuineness, unconditional positive regard and empathy) as necessary-but not sufficient conditions-for therapeutic change in behavior therapy (Goldstein, 1973). La Voge and Beck (1978) have even suggested that the established efficacy of behavioral procedures may be enhanced by relationship variables. The merging of behavioristic and psychodynamic formulations in treatment is quite another story-although somewhat popular in some circles today. This notion is difficult to accept in view of the lack of evidence that analytic interpretations add anything to the efficacy of behavioral interventions-e.g. implosive therapy versus flooding (Rimm and Master, 1974). In the second chapter the nuts and bolts issues of behavioral analysis and the relationship between behavioral assessment and the selection of an intervention are discussed. The author then proceeds to describe six clinical problems-insomnia, hypertension, alcoholism, obesity, headache and pain. Although these problems are only a few of the health care complaints to which behavioral procedures have been successfully applied, they are among the more common complaints encountered by health care professionals. The reader will find useful information regard-
B. GORDON
Colorado,
1982, 129 pp., $15.00
ing each of these problems with respect to their prevalence, etiology, behavioral conceptualization and the efficacy of behavioral interventions, methodological shortcomings of the literature, and clinical strategies for interested practitioners. Chapter 4 is devoted entirely to patient non-adherence to medical advice. Non-compliance, a notorious problem for health care professionals, negatively influences the course of treatment and maintenance. Clinical strategies to overcome the sabotaging effects of non-compliance are reviewed. In the fifth chapter Dr. Gordon focuses her attention upon issues surrounding the psychological impact of hospitalization, physician-patient communication, referral and consultation. In the final chapter, the current status and future of behavioral medicine are discussed. In conclusion, the book is concise, up to date, highly readable, and at the level of health care professionals unfamiliar with behavior modification. However, since health care professionals seem usually to be unsophisticated about theoretical psychology, a chapter on learning theory would have been helpful. Nonetheless, the book is an interesting introduction to the exciting field of behavioral medicine and will undoubtedly whet the appetite of many a health care provider searching for answers to practical problems. It will also prove a useful addition to behavioral curricula in medical training centers. ROBERT
A. DITOMASSO
West Jersey Health System Family Practice Residency Tatem-Brown Family Practice Center Voorhees, NJ 08043, U.S.A. and Psychology in Education Division University of Pennsylvania Phila., PA 19104, U.S.A.
REFERENCES DeVoge J. T. and Beck S. (1978) The therapist-client relationship in behavior therapy. In Progress in Behavior Modification (Ed. by Hersen M., Eisler, R. M. and Miller, P. M.). Academic Press, New York. Goldstein A. (1973) Behavior therapy. In Current Psychotherapies (Ed. by Corsini R.). F. E. Peacock Publishers, Illinois. Rimm D. C. and Masters J. C. (1974) Behavior Therapy: Techniques and Empirical Findings. Academic Press, New York.