Int.J. Behav. Med.

DOI 10.1007/s12529-016-9611-6

What Is Behavioural Medicine? Commentary on Definition

Proposed by Dekker, Stauder and Penedo
Marie Johnston 1 & Derek Johnston 1

# The Author(s) 2016. This article is published with open access at Springerlink.com

Abstract journals, and if those outside the field can recognise how it
Purpose Dekker et al. (2016) propose an updated definition of might be attractive or useful to them. In this response, we first
behavioural medicine. discuss how the content and focus of behavioural medicine
Method In this commentary, we discuss how the field and the have been changing as a way of thinking about how the defi-
disciplines involved have changed over time before suggest- nition might change before commenting on their proposals.
ing small amendments to the proposed definition.
Results We suggest that the range of medicine which might be
considered ‘behavioural’ is increasing to encompass virtually All Medical Practice Is Behavioural: the Range
all medical practice. In addition, the role of behaviour and the of Medical Practice Recognised to Be ‘Behavioural’
potential for behaviour change as a means of improving health Is Increasing
have become increasingly important. A defining characteristic
of behavioural medicine is the involvement of multiple disci- Leaving aside the basic biomedical and pharmacological sci-
plines, working together or in parallel and, as the extent of the ences, one can argue that all aspects of the ‘practice of the diag-
field expands, more disciplines are likely to be involved. nosis, treatment and prevention of disease’ [2] involve the be-
Conclusion We therefore propose that the definition should haviour of many clinical and other disciplines at all stages in the
represent the full width of the research, practice and disci- process as well as the behaviour of patients and the wider popu-
plines involved in behavioural medicine. lation in interacting with medicine and illness. Early behavioural
medicine investigations mainly concentrated on developing bio-
Keywords Behavioural medicine . Definition . Disciplines . feedback interventions for diverse conditions [3] or the effect of
Behaviour change stressors (including the onset of illness and stress-related behav-
iours, notably type A behaviour) on emotional and physiological
responses and to a very limited extent prediction of disease. The
Introduction field has expanded to include behaviour in all clinical specialties,
from immunology [4] to surgery [5] as well as behaviour in the
Dekker, Stauder and Penedo [1] propose an update of the def- domain of public health [6]. There has been increasing focus on
inition and scope of behavioural medicine. Definitions of a field the behaviour of those delivering healthcare with greater recog-
have value if they enable those within the field to identify with nition that their behaviour may have important influences on
it, for example by attending its conferences and publishing its health outcomes [7–9] and that delivering healthcare may influ-
ence the health outcomes of the professionals themselves [10].
The importance of avoiding ‘unhealthy medicine’ [11] by
* Marie Johnston ensuring that evidence is implemented in practice and that we
[email protected] are not ‘all breakthrough, no follow through’, more work is
being done on knowledge transfer into practice with journals
1
Institute of Applied Health Sciences, University of Aberdeen, such as Implementation Science (http://implementationscience.
Aberdeen, UK biomedcentral.com/ ) and Translational Behavioral Medicine
 Int.J. Behav. Med.

(http://www.springer.com/medicine/journal/13142) psychosocial processes and health but also as a direct cause of

representing these additional fields. In a systematic review of illness or good health and as a target for intervention at pop-
intervention frameworks, Michie et al. [12] noted the range of ulation, community and individual levels. Publications on ‘be-
function and policies engaged in behavioural interventions and, haviour change’ have increased dramatically since the 1970s
by implication, that the range of relevant authorities goes well (see Fig. 1) and have become a priority for government policy
beyond medicine, including educational, fiscal, environmental and for clinical and public health services in many countries
and planning, whose behaviour influences health outcomes. and are illustrated here by the UK Government advisory doc-
It is essential therefore that the definition and scope of uments [13–15].
behavioural medicine are inclusive with respect to the gamut
of medical practice involved.

How Have the Disciplines Changed?

There Is More ‘Behaviour’ in Behavioural Medicine The 1970s and 1980s saw the increasing interest of the mental
health disciplines in somatic health and the public health dis-
Since the original definition, there has been an increasing fo- ciplines in psychological, behavioural and social influences
cus on behaviour as a cause and consequence of health status, on health. New sub-disciplines were emerging as were collab-
to complement the earlier emphasis on stress, emotions, be- orative approaches across disciplines. In psychology, there
liefs, traits and mental health. The Decade of Behavior from was a debate about how to subdivide and label the field, ex-
2000 to 2010 (http://www.asanet.org/footnotes/nov00 emplified in the UK by correspondence about the possible
/indextwo.html ) was a response to the increasing labels for the subdivisions of psychology, including medical,
recognition of the role of behaviour in addressing important health, behavioural health, public health, clinical and clinical
societal challenges including health and has been health.
accompanied by an upsurge in research and practice activity In Fig. 2, we sketch the overlaps between the psychology
related to behaviour. sub-disciplines and the related disciplines that involve multi-
In the 1970s, behavioural medicine research and practice ple disciplines. Similar diagrams could be drawn for each
developed in two main domains: the first largely laboratory discipline involved in behavioural medicine. We suggest two
studies of the effects of stress and coping on physiological main points. First is that there are no clear lines between dis-
processes, and the second centred on psychosocial processes ciplines and sub-disciplines but rather that they merge into
(roughly translated as the interaction between psychic and each other. This seems entirely appropriate for scientific de-
social factors) such as stress, emotions and personality along velopment and is a pattern repeated in other research fields.
with socio-demographic and environmental factors investigat- Nevertheless, it may create difficulties for employment in
ed as determinants of health outcomes and, where modifiable, practical applications where posts are advertised by discipline,
as opportunities for improving health in individuals and pop- but not if they are defined by competences. Scottish
ulations. Gradually, behaviour per se has become more impor- Government developed a competency framework to ensure
tant not only as a key mediator of the relationship between that behaviour change interventions could be delivered by

Fig. 1 ‘Behaviour change’ 1400

citations in Google Scholar from
1970 to 2014 1200
Google Scholar citaons (x 1000)

1000

800

600

400

200

0
1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014
Int.J. Behav. Med.

have expanded their scope, recognising that behavioural fac-

tors influence the full range of health and healthcare out-
comes. At the same time, there has been an increasing empha-
sis on behaviour to complement other psychological processes
in both policy and research.
These aspects of the definition require no updating but the
proposed expanded version is successful in making the extent
of the field more transparent.
However, it is not clear why some elements of the defini-
tion have been lost e.g. why should ‘etiology’ be omitted
when there continues to be investigation of etiology and not
simply as prevention and health promotion. In listing the
biobehavioural mechanisms, it is surely essential to include
Fig. 2 Overlaps between psychological and other disciplines in behavioural processes. Finally, we consider that it is important
behavioural medicine to fully represent the nature of the involvement of the many
behavioural medicine disciplines.
We therefore propose these minor amendments
the people with competence rather than a disciplinary badge (highlighted) to Dekker et al.’s proposal:
[15]. Second, each of the sub-disciplines of psychology has its Behavioral medicine can be defined as the field of re-
own relationship with the multi-disciplinary disciplines and is search involving multiple disciplines concerned with the de-
therefore not entirely interchangeable. velopment and integration of biomedical and behavioral
However, in addition, these subdivisions of psychology knowledge relevant to physical health and disease, and the
have become closer to other mono-disciplines as they engage application of this knowledge to etiology, prevention, health
in the multi-disciplinary process of behavioural medicine. We promotion, diagnosis, treatment, rehabilitation, and care. The
are more likely to collaborate in research with other social scope of behavioral medicine extends from fundamental bio-
sciences such as sociology, geography and economics and behavioral mechanisms (i.e. the interaction of biomedical
other medical sciences such as immunology, cardiology and processes with psychological, behavioral, social, societal,
genetics. These collaborations involve not only meeting with cultural and environmental processes), to behavioral
other disciplines but also co-designing projects, reading each processes in clinical diagnosis and intervention, and in public
other’s literature, using methods from other disciplines that health.
complement or improve those of our own discipline etc. It is
our impression that the same would be true for other disci-
plines involved in behavioural medicine, i.e. that our work in Compliance with Ethical Standards
the domain of behavioural medicine has enabled closer col-
laborations between disciplines. Conflict of Interest The authors declare that they have no conflict of
interest.
There is still a question of how we describe this collabora-
tion between disciplines and the vexed question of inter-
Ethical Approval This article does not contain any studies with human
versus multi-disciplinarity. Choi and Pak [16] define the input participants or animals performed by any of the authors.
of different disciplines to be separate but additive in multi-
disciplinarity but interactive and integrative in interdisciplin- Open Access This article is distributed under the terms of the Creative
ary work. Neither of these definitions fully encompasses the Commons Attribution 4.0 International License (http://
variety of working collaborations in behavioural medicine as creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appro-
both formats contribute to the field. Since there is uncertainty priate credit to the original author(s) and the source, provide a link to the
about the meaning of these terms, it would surely be wiser to Creative Commons license, and indicate if changes were made.
refer to ‘multiple disciplines’ leaving open the range of possi-
ble working relationships. References

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