Springer Series in Behavioral Psychophysiology and Medicine – serie

Cardiovascular disease continues to be the number ioral medicine" was developed and shaped into the one source of morbidity and mortality in our coun- following definition: try. Despite a 35% reduction since 1964, these Behavioral medicine is the interdisciplinary field con- diseases, particularly coronary heart disease cerned with the development and integration of behav- (CHD), claim nearly 1,000,000 lives each year in ioral and biomedical science knowledge and techniques the United States (Havlik & Feinleib, 1979). relevant to the understanding of health and illness and The Framingham study, among others, has iden- the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. tified three major risk factors implicated in the de- (Schwartz & Weiss, 1978) velopment of CHD: smoking, elevated serum cho- lesterol, and high blood pressure (Castelli et at., This concept of "biobehavioral" collaboration 1986).Given that these factors account for less challenged scientists and clinicians of many disci- than 50% of the variance associated with CHD plines to consider how they might more effectively (Jenkins, 1976), it has become obvious that addi- develop diagnostic, treatment, and prevention tional risk factors must be identified if further pro- strategies by merging their perspectives to address gress is to be made in disease prevention and simultaneously, among others, behavioral, psy- control.

Explanations of abnormal behavior that emphasize the importance of physiological determinants of disorder are relatively unpopular among psychologists, especially among those who work as clinicians in an ap~ plied setting. The reasons for this are theoretical and historical, as well as practical. Physiology and its associated biological disciplines of bio~ chemistry, pharmacology, and genetics are traditionally more associated with medicine; their use to underpin explanations and treatments of behavioral abnormality has consequently demanded knowledge to which most psychologists are not exposed and skills that are unavailable to them. The dichotomy thus created between medical and psychologi~ cal approaches has caused many psychologists to disregard physiologi~ cal factors. Even when the latter are recognized as important, many psychologists have been unwilling to admit to the fact, in the belief that by doing so they will commit themselves to an overly medical model of psychological disorder, undermining what they see as preferred views of abnormality. As I have become increasingly aware in following the progress of this book, in the United States the theoretical issues in this debate have been further sharpened by professional rivalries (present but less explicit on the European scene from which I write) between medical and nonmedical health care workers, regarding facilities for and approaches to the treatment of the mentally disturbed. Faced with these divisions of interest, psychologists have available two courses of action.

An attractive feature of self-regulation therapies is that, instead of doing something to the patients, they teach them to do something for them­ selves. Furthermore, the fact that the patient is able to do something to cope with his or her health problem can produce a significant reduction in the stress that may have contributed to that problem and in the additional stress that it produces. While the idea that the mind can playa role in the health of the body and some therapeutic techniques based on this idea are not new, remarkable scientific advances have been made recently in the area of self-regulation and health. There has been an exciting and rapidly accel­ erating increase in our basic science knowledge of homeostasis, or, in other words, how the body regulates itself in order to maintain health. Technical and conceptual advances are increasing our knowledge of the details of such regulation at all levels-cells, tissues, organs, organ sys­ tems, and the body as a whole. We are learning how the competing demands of different elements at each of these levels are adjusted by the brain, which, with its neural and humoral mechanisms, is the supreme organ of integration of the body.

In this groundbreaking work, distinguished contributors explore the myriad relationships between networks of social support and the development, treatment, and rehabilitation of individuals with cardiovascular disease. Chapters span the range from conceptual to methodological issues, and take into account gender, environmental, and cultural differences. The book will provide a wealth of information for clinicians and students in the fields of behavioral medicine, psychophysiology, and cardiovascular disease.

This is Robert Fried's third book on the crucial role of breathing and hyperventilation in our emotional and physical health. The first, The Hyperventilation Syndrome (1987), was a scholarly monograph, and the second, The Breath Connection (1990a), was a popular version for the lay reader. This book combines the best features of both and extends Dr. Fried's seminal work to protocols for clinical psychophysiology and psy­ chiatry. Hoping to avoid misunderstanding, he has taken systematic care to introduce relevant electrical, physiological, and psychological concepts in operational language for the widest possible professional audience. Any clinician not thoroughly experienced in respiratory psycho­ physiology and biofeedback will leave these pages with profound new insight and direction into an aspect of our liveswhich we innocently take for granted as "common sense"-the role of breathing in health and illness. Einstein viewed such common sense as "that set of prejudices we acquired prior to the age of eighteen." I am impressed that Dr. Fried mirrors Einstein's uncanny genius in not accepting the obvious­ breathing is not "common sense" but, rather, is a pivotal psycho­ physiological mechanism underlying all aspects of life.

Although the injunction "Know thyself" was inscribed over the site of the Delphic Oracle, the concept is of much more ancient lineage. Thousands of years ago, the wise men of the East had learned to exert authority over a broad range of bodily experiences and functions using techniques that are still taught today. But it is only in the past few decades that the West has become aware once again of the range of control that the central nervous system can maintain over sensation and body function. Medicine has moved slowly in integrating these concepts into the classic medical model of disease despite a growing body of evidence that links emotional state, thought, and imagery to immunocompetence, tissue healing, and bodily vigor. It is precisely the role of a volume such as this, reflecting a fascinating conference in Munich, to emphasize and reemphasize these ideas. We are fortunately well beyond the sterile behaviorism of Watson with its com­ plete negation of the significance of mental operations. But many still consider suspect those forces and mechanisms, however powerful, that seem to originate from brain-mind activity. The chapters in this book, with their emphases on the mind-body continuum as a bridge to self­ regulation and health, provide a modern "School of Athens" in bringing these concepts to wider acquaintance.

This book is an articulate, concise, contemporary introduction to the study of important variables underlying cardiovascular reactivity. Its strength is in the combination of a scholarly but nonpedantic approach to cardiovascular psychophysiology and a solid understanding of be­ havioral medicine approaches to the study of hypertension. The topics covered are central to the study of relationships between behavior and cardiovascular reactivity; the list of suggested readings at the end of each chapter provides excellent guidance for more detailed study of specific issues. It has now been more than a dozen years since Plenum Press published Paul Obrist's seminal monograph Cardiovascular Psycho­ physiology. The volume had a major impact in relating cardiovascular regulation to behaving individuals and in developing thoughtful hy­ potheses concerning such factors as they might pertain to hypertension. The impact of that work extended across scientific disciplines as well as aross continents. At the time the Obrist book was published, a young psychologist, J. Rick Turner, was completing his Ph. D. thesis in psychol­ ogy at the University of Birmingham, England, on heart rate reactions to psychological challenge. After continued collaboration for the next several years with his former Ph. D. mentor, Douglas Carroll, Turner joined the Obrist laboratory at the University of North Carolina. Al­ though Obrist unfortunately died during Turner's tenure in the labora­ tory, collaboration continued with Kathleen Light and Andrew Sher­ wood. The enlightened legacy of the North Carolina laboratory can clearly be seen in this text.

Phantom pain is an intriguing mystery that has captured the imagination of health care providers and the public alike. How is it possible to feel pain in a limb or some other body part that has been surgically removed? Phantom pain develops among people who have lost a limb or a breast or have had internal organs removed. It also occurs in people with totally transected spinal cords. Unfortunately, phantom pain is a medical night­ mare. Many of the people reporting phantom pain make dispropor­ tionately heavy use of the medical system because their severe pains are usually not treated successfully. The effect on quality of life can be devas­ tating. Phantom pain has been reported at least since 1545 (Weir Mitchell as related by Nathanson, 1988) and/ or experienced by such diverse people as Admiral Lord Nelson and Ambroise Pare (Melzack & Wall, 1982; Davis, 1993). The folklore surrounding phantom pain is fascinating and mirrors the concepts about how our bodies work that are in vogue at any particu­ lar time. Most of the stories relate to phantom limbs and date from the mid-1800s. The typical story goes like this: A man who had his leg ampu­ tated complained about terrible crawling, twitching feelings in his leg. His friends found out where the leg was buried, dug it up, and found maggots eating it. They burned it, and the pain stopped. Another man complained of a swollen feeling with frequent stinging or biting pains.

Author Gyorgy Adam maintains there is a type of sensory system active within the internal organs that appears to be, in some measure, independent of the traditional senses. Variously termed viscerosensory perception, internal perception, or internal cognition, this system operates largely outside of consciousness. Adam employs the extensive data he has gathered over many years to demonstrate how "hidden" internal signals originating in the alimentary tract, the cardiovascular system, and the kidneys may influence emotional states. Visceral Perception is the only comprehensive treatment of this elusive subject.

The idea for this volume developed when we were co-teaching our introductory, mas­ ter's-level course in the Department of Health Behavior at the UAB School of Public Health, a core course for all masters of public health students in the school regardless of the department in which they enrolled or the focus of their studies. Hence, in the course we sought to provide both students in our department, as well as those who might not ever again take a health behavior course, with an overview that would both truly represent the field and substantially provide educational, research, and public health practice benefits. This was, and continues to be, a challenge with the diversity of students specializing in fields that include not only health behavior but also bio­ statistics, environmental health sciences, epidemiology, health care organization and policy, international health, and maternal and child health. The course that we taught attempted to provide the students with an overview of some of the important health promotion and disease prevention theories, methods, and policy issues, while re­ viewing applications of these theories and methods to promoting health and pre­ venting disease through a variety of channels, for a variety of disease outcomes, and among a variety of populations. Since no one text provided this variety of readings, we depended on readings and guest lectures.

Phantom pain is an intriguing mystery that has captured the imagination of health care providers and the public alike. How is it possible to feel pain in a limb or some other body part that has been surgically removed? Phantom pain develops among people who have lost a limb or a breast or have had internal organs removed. It also occurs in people with totally transected spinal cords. Unfortunately, phantom pain is a medical night­ mare. Many of the people reporting phantom pain make dispropor­ tionately heavy use of the medical system because their severe pains are usually not treated successfully. The effect on quality of life can be devas­ tating. Phantom pain has been reported at least since 1545 (Weir Mitchell as related by Nathanson, 1988) and/ or experienced by such diverse people as Admiral Lord Nelson and Ambroise Pare (Melzack & Wall, 1982; Davis, 1993). The folklore surrounding phantom pain is fascinating and mirrors the concepts about how our bodies work that are in vogue at any particu­ lar time. Most of the stories relate to phantom limbs and date from the mid-1800s. The typical story goes like this: A man who had his leg ampu­ tated complained about terrible crawling, twitching feelings in his leg. His friends found out where the leg was buried, dug it up, and found maggots eating it. They burned it, and the pain stopped. Another man complained of a swollen feeling with frequent stinging or biting pains.

Author Gyorgy Adam maintains there is a type of sensory system active within the internal organs that appears to be, in some measure, independent of the traditional senses. Variously termed viscerosensory perception, internal perception, or internal cognition, this system operates largely outside of consciousness. Adam employs the extensive data he has gathered over many years to demonstrate how "hidden" internal signals originating in the alimentary tract, the cardiovascular system, and the kidneys may influence emotional states. Visceral Perception is the only comprehensive treatment of this elusive subject.

The idea for this volume developed when we were co-teaching our introductory, mas­ ter's-level course in the Department of Health Behavior at the UAB School of Public Health, a core course for all masters of public health students in the school regardless of the department in which they enrolled or the focus of their studies. Hence, in the course we sought to provide both students in our department, as well as those who might not ever again take a health behavior course, with an overview that would both truly represent the field and substantially provide educational, research, and public health practice benefits. This was, and continues to be, a challenge with the diversity of students specializing in fields that include not only health behavior but also bio­ statistics, environmental health sciences, epidemiology, health care organization and policy, international health, and maternal and child health. The course that we taught attempted to provide the students with an overview of some of the important health promotion and disease prevention theories, methods, and policy issues, while re­ viewing applications of these theories and methods to promoting health and pre­ venting disease through a variety of channels, for a variety of disease outcomes, and among a variety of populations. Since no one text provided this variety of readings, we depended on readings and guest lectures.

A "New Looking Glass" for Behavioral Medicine In 1984, John Briggs, a science writer and specialist in interdisciplinary studies teaching at the New School for Social Research, and F. David Peat, a physicist who was for many years a fellow with the National Research Council of Canada, published a book about the revolutions that were taking place in physics, mathematics, chemistry, biology, and neu­ rophysiology and about the scientists whose new theories were changing our understanding about the nature of the universe. The title of their book was Looking Glass Universe, after Lewis Carroll's classic story of Alice and her friends, Through the Looking Glass. Briggs and Peat's book is a well-written, challenging volume about human beings and how they think about old problems in new and sometimes startling ways. I mention Briggs and Peat's book only partially because I happen to have a personal interest in the potential applications of new ways of looking at and thinking about nature and data derived from modern physics and systems theory for health psychology and behavioral medi­ cine (e. g. , Schwartz, 1984). In a letter Wolfgang Linden wrote to me on January 23,1987, he shared with me (at my request) his rough thoughts about his personal goals for this book.

Despite the widespread use of psychophysiological concepts and meth­ ods in behavior therapy, there is no text devoted specifically to the subject. The publication of this book is necessary and timely, and should promote a better appreciation of the physiological roots of behavior therapy. The important connections between physiology and behavior thera­ py receive insufficient recognition nowadays, despite the fact that his­ torically one of the two main streams of behavior therapy grew out of a physiological basis. Wolpe's early work was closely connected to phys­ iology, and in contemporary behavior therapy, Lang's critical contribu­ tion is firmly based in psychophysiology. The physiological component is prominent in Lang's highly productive three-systems analysis of emo­ tion and in its application to psychological disorders. In addition, there are philosophical reasons for maintaining the close connection between behavior therapy and physiology. The existence of these connections, and their justification, can raise few objections, and it is therefore curious that a book on this significant subject has not appeared earlier. The importance of physiology for behavior therapy can be illus­ trated by considering the nature of a behavior therapy deprived of its physiological connections. It would survive, certainly, but as a rather scrawny, uninteresting orphan among many clamorous competitors.

This book is an articulate, concise, contemporary introduction to the study of important variables underlying cardiovascular reactivity. It has now been more than a dozen years since Plenum Press published Paul Obrist's seminal monograph Cardiovascular Psycho­ physiology.

Although the injunction "Know thyself" was inscribed over the site of the Delphic Oracle, the concept is of much more ancient lineage. Thousands of years ago, the wise men of the East had learned to exert authority over a broad range of bodily experiences and functions using techniques that are still taught today. But it is only in the past few decades that the West has become aware once again of the range of control that the central nervous system can maintain over sensation and body function. Medicine has moved slowly in integrating these concepts into the classic medical model of disease despite a growing body of evidence that links emotional state, thought, and imagery to immunocompetence, tissue healing, and bodily vigor. It is precisely the role of a volume such as this, reflecting a fascinating conference in Munich, to emphasize and reemphasize these ideas. We are fortunately well beyond the sterile behaviorism of Watson with its com­ plete negation of the significance of mental operations. But many still consider suspect those forces and mechanisms, however powerful, that seem to originate from brain-mind activity. The chapters in this book, with their emphases on the mind-body continuum as a bridge to self­ regulation and health, provide a modern "School of Athens" in bringing these concepts to wider acquaintance.

Cardiovascular disease continues to be the number ioral medicine" was developed and shaped into the one source of morbidity and mortality in our coun- following definition: try. Despite a 35% reduction since 1964, these Behavioral medicine is the interdisciplinary field con- diseases, particularly coronary heart disease cerned with the development and integration of behav- (CHD), claim nearly 1,000,000 lives each year in ioral and biomedical science knowledge and techniques the United States (Havlik & Feinleib, 1979). relevant to the understanding of health and illness and The Framingham study, among others, has iden- the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. tified three major risk factors implicated in the de- (Schwartz & Weiss, 1978) velopment of CHD: smoking, elevated serum cho- lesterol, and high blood pressure (Castelli et at., This concept of "biobehavioral" collaboration 1986).Given that these factors account for less challenged scientists and clinicians of many disci- than 50% of the variance associated with CHD plines to consider how they might more effectively (Jenkins, 1976), it has become obvious that addi- develop diagnostic, treatment, and prevention tional risk factors must be identified if further pro- strategies by merging their perspectives to address gress is to be made in disease prevention and simultaneously, among others, behavioral, psy- control.

This is Robert Fried's third book on the crucial role of breathing and hyperventilation in our emotional and physical health. The first, The Hyperventilation Syndrome (1987), was a scholarly monograph, and the second, The Breath Connection (1990a), was a popular version for the lay reader. This book combines the best features of both and extends Dr. Fried's seminal work to protocols for clinical psychophysiology and psy­ chiatry. Hoping to avoid misunderstanding, he has taken systematic care to introduce relevant electrical, physiological, and psychological concepts in operational language for the widest possible professional audience. Any clinician not thoroughly experienced in respiratory psycho­ physiology and biofeedback will leave these pages with profound new insight and direction into an aspect of our liveswhich we innocently take for granted as "common sense"-the role of breathing in health and illness. Einstein viewed such common sense as "that set of prejudices we acquired prior to the age of eighteen." I am impressed that Dr. Fried mirrors Einstein's uncanny genius in not accepting the obvious­ breathing is not "common sense" but, rather, is a pivotal psycho­ physiological mechanism underlying all aspects of life.

In this groundbreaking work, distinguished contributors explore the myriad relationships between networks of social support and the development, treatment, and rehabilitation of individuals with cardiovascular disease. Chapters span the range from conceptual to methodological issues, and take into account gender, environmental, and cultural differences. The book will provide a wealth of information for clinicians and students in the fields of behavioral medicine, psychophysiology, and cardiovascular disease.

An attractive feature of self-regulation therapies is that, instead of doing something to the patients, they teach them to do something for them­ selves. Furthermore, the fact that the patient is able to do something to cope with his or her health problem can produce a significant reduction in the stress that may have contributed to that problem and in the additional stress that it produces. While the idea that the mind can playa role in the health of the body and some therapeutic techniques based on this idea are not new, remarkable scientific advances have been made recently in the area of self-regulation and health. There has been an exciting and rapidly accel­ erating increase in our basic science knowledge of homeostasis, or, in other words, how the body regulates itself in order to maintain health. Technical and conceptual advances are increasing our knowledge of the details of such regulation at all levels-cells, tissues, organs, organ sys­ tems, and the body as a whole. We are learning how the competing demands of different elements at each of these levels are adjusted by the brain, which, with its neural and humoral mechanisms, is the supreme organ of integration of the body.