If Not Us, Who? If Not Now, When? Paths Forward in Science, Patient Care, and Training to Maximize the Impact of Cardiovascular Behavioral Medicine

Abstract

It has been almost 50 years since a group of internationally recognized scientists conducting research on the interaction of psychology and biology and the contribution of this interaction to health and illness convened the Yale Conference on Behavioral Medicine. This conference launched a new interdisciplinary field devoted to “the development of behavioral science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation”(Schwartz et al., 1977). The body of research that precipitated this conference had, as its major focus, the identification of behavioral and psychosocial factors associated with risk of cardiovascular disease (CVD) and the pathophysiological processes underlying these relationships. Seminal research by scientists, such as Marianne Frankenhaeuser (1986) and John Mason (1968), demonstrated the effects of stress on cardiovascular function in humans and the role of the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis in these effects, work that followed on the heels of stress research pioneers Hans Selye andWalter Cannon. Research by two cardiologists, Meyer Friedman and Ray Rosenman, identified the “behavior pattern A”—an action-emotion complex that came to be called type A behavior pattern and later (perhaps erroneously) type A personality (Petticrew et al., 2012). Their research agenda included the development and testing of a stress reduction intervention that relied upon cognitive–behavioral principles and techniques delivered in small groups of post-MI patients (Bracke & Thoresen, 1996). The key questions addressed by their clinical trial were (a) Could type A behavior be changed? and (b) If so, would this change be associated with a reduction in recurrent cardiac events? The answers to both questions were yes.