people’s emotional reactions and behaviors regarding health and illness. Social factors, including support of family and friends, institutions, communities, culture, politics, and economics, can have profound effects as well. Indeed, scientific evidence is increasing on the effects of psychological and social factors on biology, and recent studies have demonstrated that psychosocial stress may be a significant risk factor for a variety of diseases (Barefoot et al., 2000; Carroll et al., 1976; Everson et al., 1996; Frasure-Smith et al., 1993; Kawachi et al., 1996; Leserman et al., 2000; Mayne et al., 1996; Orth-Gomer et al., 1993). In the case of heart disease, for example, psychosocial stress appears to contribute directly to atherosclerotic processes by narrowing blood vessels, thus restricting circulation (Bairey Merz et al., 2002; Williams et al., 1991).
Theories underlying behavioral interventions aimed at modifying disease course are based on the assumptions that behavioral and psychosocial influences on disease course are modifiable and that curtailing unhealthy practices will slow disease progression or minimize the recurrence of disease following treatment (IOM, 2000). Understanding that behavior can be changed and that proven methods are available to facilitate such change allows physicians to provide optimal interventions—behavioral and nonbehavioral—to improve the health of patients. Identifying personal, familial, social, and environmental factors that may affect a patient’s health enables physicians to provide better, more patient-centered care (IOM, 2001a, 2003a). In addition, physicians must be able to recognize their own personal and social biases and perceptions to best serve the needs of their patients.
Although the scientific evidence linking biological, behavioral, psychological, and social variables to health, illness, and disease is impressive, the translation and incorporation of this knowledge into standard medical practice appear to have been less than successful. To make measurable improvements in the health of Americans, physicians must be equipped with the knowledge and skills from the behavioral and social sciences needed to recognize, understand, and effectively respond to patients as individuals, not just to their symptoms. Sobel (2000:393), an expert in mind–body health care, notes that “more and more studies point to simple, safe and relatively inexpensive interventions that can improve health outcomes and reduce the need for more expensive medical treatments. Far from a new miracle drug or medical technology, the treatment is simply the targeted use of mind–body and behavioral medicine interventions in a medical setting.” Thus, physicians with an understanding of disease causation that extends beyond biomedical approaches are more likely to see better intervention outcomes than have been achieved to date (IOM, 2000).
The limitations of a strictly biomedical approach to health care as described by Engle suggest the need for a model of medical school education designed to provide an integrative and multilevel understanding of how biological, psychological, and social variables interact in health and illness (Engel, 1977). Others have expanded upon and explicated such a biopsychosocial model (Anderson and