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The inner coherence of psychosomatic medicine
No full textThe problem: The body-mind dualism of somatic medicine is resolved through the concept of psychosomatic medicine. More unspecific descriptions such as "integrative medicine" (which does not clarify what should be integrated) or the "holistic approach" (which comes close to esoterics) suggest the unity of mind, body and soul, although the term "psycho-somatic" still reflects dualistic thinking. Past approaches: The American Psychosomatic Society has been considering a name change for years, partially to rid itself of the dualistic label, but so far these efforts have not resulted in a viable alternative. Engel's concept of biopsychosocial medicine supposes a triangular array of the body, mind, and social environment, setting body and mind into a relationship with each other and with a third party. Based on the physician-patient relationship (Balint), psychosomatic medicine can be understood in a broader sense as "relationship medicine," covering not only the use of the interpersonal relationship as a medical agent, but also a science of medicine that puts mind, body, and social environment into a theoretical framework of interrelations, with the perspective of integrating the different system levels. The translation processes among the system levels are, for example, addressed by biosemiotics (v. Uexkull). Consequences: Both clinical medicine and medical research, if they intend to be psychosomatic, need to take these theoretical concepts into account and utilize them practically for (team)work with patients. Together with a clear differentiation from other cultures of (para)medicine, this can serve to develop a "psychosomatic identity.
Biopsychosocial factors in pathogenesis and manifestation of coronary heart disease
No full textPsychosocial factors have always been considered important causes of heart disease. Because of its extraordinary epidemiological and political relevance, coronary heart disease (CHD) has received special scientific attention in this field. However, the abundance of literature dealing with its biological, psychological and social precursors is in sharp contrast with a lack of comprehensive models trying to integrate the results of different scientific traditions. This paper gives a brief overview of the present state of psychosocial research on etiological factors in CHD. Instead of solely relying on attempts to identify supposedly independent risk factors, it emphasizes the importance of dynamic biopsychosocial processes, which finally lead to manifest coronary disease. The paper outlines an approach which integrates clinical and empirical findings in a bio-psycho-socio-dynamic model. This model is open to future extension. It may be helpful for better understanding individual patients as well as scientific findings. By providing hypotheses, which are suggested to go beyond the still predominating reductionistic, linear models, it may furthermore be a basis for future research in psychosocial cardiology
The inner coherence of psychosomatic medicine
No full textThe problem: The body-mind dualism of somatic medicine is resolved through the concept of psychosomatic medicine. More unspecific descriptions such as "integrative medicine" (which does not clarify what should be integrated) or the "holistic approach" (which comes close to esoterics) suggest the unity of mind, body and soul, although the term "psycho-somatic" still reflects dualistic thinking. Past approaches: The American Psychosomatic Society has been considering a name change for years, partially to rid itself of the dualistic label, but so far these efforts have not resulted in a viable alternative. Engel's concept of biopsychosocial medicine supposes a triangular array of the body, mind, and social environment, setting body and mind into a relationship with each other and with a third party. Based on the physician-patient relationship (Balint), psychosomatic medicine can be understood in a broader sense as "relationship medicine," covering not only the use of the interpersonal relationship as a medical agent, but also a science of medicine that puts mind, body, and social environment into a theoretical framework of interrelations, with the perspective of integrating the different system levels. The translation processes among the system levels are, for example, addressed by biosemiotics (v. Uexkull). Consequences: Both clinical medicine and medical research, if they intend to be psychosomatic, need to take these theoretical concepts into account and utilize them practically for (team)work with patients. Together with a clear differentiation from other cultures of (para)medicine, this can serve to develop a "psychosomatic identity.
Psychotherapy in patients with coronary heart disease
No full textIn patients with coronary heart disease, psychosomatic-somatopsychic interactions are frequent and clinically relevant. Starting in the 1960s, psychosocial interventions have been used to improve the patient's wellbeing and disease outcomes. Besides educational and non-specific supportive interventions or relaxation trainings, more specific psychotherapeutic interventions have been reported. Many of these interventions aim at reducing distress and promoting healthy behaviors, thereby slowing down the disease process. More recently, studies have also been made on the psychotherapy for psychiatric comorbidities. In the largest psychotherapy trial in coronary patients, the ENRICHD trial, 2,481 post-myocardial infarction patients with depression or low perceived social support were randomized to receive up to six months of cognitive behavioral psychotherapy or treatment as usual. The treatment resulted in a marked reduction in depressive symptoms. However, given the high remission rate in the control group, the net treatment effect was modest. The targeted reduction in mortality was not achieved. The current state of the literature does not yet allow to give general evidence-based treatment recommendations. It rather requires the development of differential indications, the refinement of existing treatment concepts and the exploration of alternative psychotherapeutic methods. Individual treatment decisions must be based on the specific case, on the well-documented subjective benefits of psychotherapy in coronary patients as well as on theoretical assumptions about stress management and relaxation trainings and on general knowledge about the effectiveness of psychotherapy obtained in other patient groups. When working with coronary patients, psychotherapists should be aware of the cardiac condition and its typical precursors and consequences. They should also closely collaborate with the patients' cardiologists and family physicians
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