Professional Point

This year's State Leadership Conference theme, "Health and Behavior: Taking Psychology Back to the Future," was intended to convey a broad vision for psychology's future--a future replete with opportunities for new and diverse activities, but one that also takes advantage of our profession's tradition and rich heritage. Importantly, this future of the profession also takes into account the unprecedented public focus that is now being placed on the effects of lifestyle, behavior and stress on health and illness.

The "mind-body connection," as it is often referred to by the public, is for the first time receiving mainstream media coverage. Also for the first time, real dollars are starting to flow into prevention, health promotion and disease management, areas where behavior and behavior change provide the foundation for assuring health and treating illness. Policy-makers are even looking to these areas for solutions to the country's broken health-care system. Integrating mind with body, behavior with health and the psychological with the physical all hold a credible promise of achieving the long-sought elusive goal of improved health care, while simultaneously controlling, if not reducing, health-care costs.

A future health-care system that relies on connections between behavior and health reaches squarely back into psychology's past. What policy-makers and the public are now just starting to realize, psychology has known for years if not decades: The research, the knowledge base, and the technologies to change behavior in ways that benefit health do exist. And, much of the research, the knowledge base and the technologies are actually psychology's work. Psychologists have been among the first to produce the evidence leading to understanding the connection between behavior and health or to have fashioned interventions that incorporate it. Most psychologists will recall the early work of Neal Miller, which demonstrated instrumental learning of visceral responses and led to biofeedback treatment for hypertension, cardiac arrhythmias, gastrointestinal symptoms and headaches. The field of health psychology made significant contributions to the understanding of the influence of behavior, lifestyle or personality on diseases such as diabetes, asthma and cardiovascular disease, resulting in better management of those diseases. And the areas of neuropsychology and rehabilitation psychology have contributed greatly to the knowledge of brain-behavior relationships.

In addition to the growing recognition of the connection between health and behavior, structures that were built to keep behavioral health and physical health separate are now being dismantled. The creation of the health and behavior Current Procedural Terminology (CPT) codes, which recognize and reimburse psychological services provided for physical health disorders, has contributed to this development. Also, insurers are beginning to eliminate behavioral health carve-outs in order to integrate medical and behavioral services. Even the managed behavioral health-care carve-outs are themselves developing more disease-management capabilities that integrate behavioral health and physical health.

In light of all of these developments, an important question for our profession is how to effectively use what we know in today's health-care environment. While we may have the necessary knowledge, we will more than likely need to change the way we use it today and in the future. First, we must move beyond the narrow conception of ourselves as mental health professionals and begin to see ourselves as comprehensive health professionals. Relatedly, we must begin to see ourselves more as experts in behavior to most effectively use what we know and to maximize our impact and opportunity in a health-care environment increasingly aware of the important role of behavior. This conception of ourselves is not intended to replace our practice as mental health professionals, but, instead, to encompass and enhance it.

We also must find ways to pro-actively reach beyond those who come to our offices for treatment if we are to increase the profession's impact on the many risk behaviors that influence health and illness. No matter how efficacious treatments may be with patients who come to our office for help, they will never be effective with people who do not seek help for their risk behaviors. We need to reach out to people, communities and populations to address those risk behaviors that affect their health.

To be most effective in a climate that increasingly recognizes the role of behavior in health and illness, psychologists will need to innovate and be willing to practice differently than in the past, not so much with entirely new skills as in new settings and with new approaches to the way we use the skills we have.