The Role of Behavioral Medicine in Integrated Healthcare

  • Dawn K. Wilson
  • Allison M. Sweeney


This chapter reviews evidence from randomized controlled trials that demonstrate the importance of behavioral interventions for improving lifestyle behaviors and preventing and treating chronic diseases. Taking a lifespan approach, we review trials including participants ranging from children to elderly adults, and show that critical components of effective interventions include targeting self-regulation and self-efficacy through strategies such as self-monitoring, receiving feedback, developing action plans, and utilizing effective goal setting strategies. Although limited research exists on comparing the effectiveness of integrating behavioral health experts into the integrated care team, the effects of traditional randomized trials show the consistent effectiveness of implementing behavioral interventions with a high fidelity of delivery. Furthermore, there is a growing literature that supports the cost-effectiveness of behavioral interventions on reducing hospital utilization and medication usage. Thus, the field of behavioral medicine has the potential to play a fundamental role in reducing healthcare utilization and costs by improving lifestyle habits that have been related to the prevention of chronic diseases.


Healthcare Behavioral interventions Self-regulation Motivational interventions Life span 


  1. Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27, 379–387.CrossRefPubMedGoogle Scholar
  2. Armstrong, M. J., Mottershead, T. A., Ronksley, P. E., Sigal, R. J., Campbell, T. S., & Hemmelgarn, B. R. (2011). Motivational interviewing to improve weight loss in overweight and/or obese patients: A systematic review and meta-analysis of randomized controlled trials. Obesity Reviews, 12, 709–723.PubMedGoogle Scholar
  3. Ayotte, B. J., Margrett, J. A., & Hicks-Patrick, J. (2010). Physical activity in middle-aged and young-old adults the roles of self-efficacy, barriers, outcome expectancies, self-regulatory behaviors and social support. Journal of Health Psychology, 15, 173–185.CrossRefPubMedGoogle Scholar
  4. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prenctice-Hall, Inc.Google Scholar
  5. Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31, 143–164.CrossRefGoogle Scholar
  6. Clark, N. M., Janz, N. K., Dodge, J. A., Schork, M. A., Wheeler, J. R., Liang, J., ... & Santinga, J. T. (1997). Self-management of heart disease by older adults: Assessment of an intervention based on social cognitive theory. Research on Aging19, 362–382.CrossRefGoogle Scholar
  7. Corbin, J. M., & Strauss, A. (1988). Unending work and care: Managing chronic illness at home. San Francisco, CA: Jossey-Bass.Google Scholar
  8. Diabetes Prevention Program Outcomes Study Research Group, Orchard, T. J., Temprosa, M., Barrett-Connor, E., Fowler, S. E., Goldberg, R. B., … Watson, K. E. (2013). Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: A report from the DPP Outcomes Study. Diabetic Medicine, 30, 46–55.CrossRefGoogle Scholar
  9. Diabetes Prevention Program Research Group. (1999). The Diabetes Prevention Program: Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care, 22, 623–634.CrossRefGoogle Scholar
  10. Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346, 393–403.CrossRefGoogle Scholar
  11. Diabetes Prevention Program Research Group. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374, 1677–1686.CrossRefGoogle Scholar
  12. Diabetes Prevention Program Research Group. (2012). The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: An intent-to-treat analysis of the DPP/DPPOS. Diabetes, 35, 723–730.Google Scholar
  13. Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493–503.CrossRefGoogle Scholar
  14. Gortmaker, S. L., Peterson, K., Wiecha, J., Sobol, A. M., Dixit, S., Fox, M. K., & Laird, N. (1999). Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Archives of Pediatrics & Adolescent Medicine, 153, 409–418.CrossRefGoogle Scholar
  15. King, A. C., Sallis, J. F., Dunn, A. L., Simons-Morton, D. G., Albright, C. A., Cohen, S., … Coday, M. C. (1998). Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings. Medicine & Science in Sports & Exercise, 30, 1086–1096.CrossRefGoogle Scholar
  16. LeFort, S., Gray-Donald, K., Rowat, K., & Jeans, M. (1998). Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain. Pain, 74, 297–306.CrossRefPubMedGoogle Scholar
  17. Look AHEAD Research Group. (2006). The look AHEAD study: A description of the lifestyle intervention and the evidence supporting it. Obesity, 14, 737–752.CrossRefGoogle Scholar
  18. Look AHEAD Research Group. (2007). Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: One-year results of the look AHEAD trial. Diabetes Care, 30, 1374–1383.CrossRefGoogle Scholar
  19. Look AHEAD Research Group. (2013). Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. New England Journal of Medicine, 369, 145–154.Google Scholar
  20. Look AHEAD Research Group. (2014a). Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study. Obesity, 22, 5–13.CrossRefGoogle Scholar
  21. Look AHEAD Research Group. (2014b). Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes. Diabetes Care, 37, 2548–2556.CrossRefGoogle Scholar
  22. Lorig, K., Gonzalez, V. M., & Ritter, P. (1999). Community-based Spanish language arthritis education program: a randomized trial. Medical Care, 37, 957–963.CrossRefPubMedGoogle Scholar
  23. Lorig, K., & Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26, 1–7.CrossRefPubMedGoogle Scholar
  24. Lorig, K. R., Ritter, P., Stewart, A. L., Sobel, D. S., Brown, B. W., Jr., Bandura, A., … Holman, H. R. (2001). Chronic disease self-management program: 2-year health status and health care utilization outcomes. Medical Care, 39, 1217–1223.CrossRefPubMedGoogle Scholar
  25. Lorig, K. R., Ritter, P. L., Dost, A., Plant, K., Laurent, D. D., & McNeil, I. (2008). The expert patients programme online, a 1-year study of an internet-based self-management programme for people with long-term conditions. Chronic Illness, 4, 247–256.CrossRefPubMedGoogle Scholar
  26. Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Jr., Bandura, A., Ritter, P., … Holman, H. R. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Medical Care, 37, 5–14.CrossRefGoogle Scholar
  27. Luepker, R. V., Perry, C. L., McKinlay, S. M., Nader, P. R., Parcel, G. S., Stone, E. J., ... & Kelder, S. H. (1996). Outcomes of a field trial to improve children’s dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health (CATCH). Jama, 275, 768–776.CrossRefPubMedGoogle Scholar
  28. Michie, S., Abraham, C., Whittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy eating and physical activity interventions: A meta-regression. Health Psychology, 28, 690–701.CrossRefPubMedGoogle Scholar
  29. Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64, 527–537.CrossRefPubMedGoogle Scholar
  30. Mitchell, T. B., Amaro, C. M., & Steele, R. G. (2016). Pediatric weight management interventions in primary care settings: A meta-analysis. Health Psychology, 35, 704–713.CrossRefGoogle Scholar
  31. Pan, X. R., Li, G. W., Hu, Y. H., Wang, J. X., Yang, W. Y., An, Z. X., … Howard, B. V. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and diabetes study. Diabetes Care, 20, 537–544.CrossRefPubMedGoogle Scholar
  32. Perry, C. L., Sellers, D. E., Johnson, C., Pedersen, S., Bachman, K. J., Parcel, G. S., ... & Cook, K. (1997). The Child and Adolescent Trial for Cardiovascular Health (CATCH): intervention, implementation, and feasibility for elementary schools in the United States. Health Education & Behavior, 24, 716–735.CrossRefGoogle Scholar
  33. Resnicow, K., & McMaster, F. (2012). Motivational interviewing: Moving from why to how with autonomy support. International Journal of Behavioral Nutrition and Physical Activity, 9, 1–9.CrossRefGoogle Scholar
  34. Resnicow, K., McMaster, F., Bocian, A., Harris, D., Zhou, Y., Snetselaar, L., … Hollinger, D. (2015). Motivational interviewing and dietary counseling for obesity in primary care: An RCT. Pediatrics, 135, 649–657.CrossRefPubMedGoogle Scholar
  35. Schroeder, S. (2007). We can do better: Improving the health of the American people. New England Journal of Medicine, 357, 1221–1228.CrossRefPubMedGoogle Scholar
  36. Sheeran, P., Klein, W. M., & Rothman, A. J. (2016). Health behavior change: Moving from observation to intervention. Annual Review of Psychology Advance Online Publication.Google Scholar
  37. Simons-Morton, D. G., Blair, S. N., King, A. C., Morgan, T. M., Applegate, W. B., O’Toole, M., ... & Shih, J. H. (2001). Effects of physical activity counseling in primary care: The Activity Counseling Trial: A randomized controlled trial. JAMA: Journal of the American Medical Association, 286, 677–687.Google Scholar
  38. Spear, B. A., Barlow, S. E., Ervin, C., Ludwig, D. S., Saelens, B. E., Schetzina, K. E., & Taveras, E. M. (2007). Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics, 120, S254–S288.CrossRefPubMedGoogle Scholar
  39. Stead, L. F., Bergson, G., & Lancaster, T. (2008). Physician advice for smoking cessation Cochrane review. London: The Cochrane Library.Google Scholar
  40. Stoto, M. A. (2013). Population health in the Affordable Care Act era. Washington, DC: AcademyHealth.Google Scholar
  41. Suhrcke, M., Nugent, R. A., Stuckler, D., & Rocco, L. (2006). Chronic disease: An economic perspective. London: Oxford Health Alliance.Google Scholar
  42. Sweeney, A. M., Wilson, D. K., & Lee Van Horn, M. (2017). Longitudinal relationships between self-concept for physical activity and neighborhood social life as predictors of physical activity among older African American adults. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 67.Google Scholar
  43. Tuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka, P., … Salminen, V. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344, 1343–1350.CrossRefPubMedGoogle Scholar
  44. Wilson, D. K., Kitzman-Ulrich, H., Williams, J. E., Saunders, R., Griffin, S., Pate, R., … Sisson, S. B. (2008). An overview of “The Active by Choice Today” (ACT) trial for increasing physical activity. Contemporary Clinical Trials, 29, 21–31.CrossRefPubMedGoogle Scholar
  45. Wilson, D. K., Trumpeter, N. N., St George, S. M., Coulon, S. M., Griffin, S., Lee Van Horn, M., … Gadson, B. (2010). An overview of the “Positive Action for Today’s Health” (PATH) trial for increasing walking in low income, ethnic minority communities. Contemporary Clinical Trials, 31, 624–633.CrossRefPubMedGoogle Scholar
  46. Wilson, D. K., Van Horn, M. L., Kitzman-Ulrich, H., Saunders, R., Pate, R., Lawman, H. G., ... & Mansard, L. (2011). Results of the “Active by Choice Today”(ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Health Psychology, 30, 463–471.CrossRefPubMedGoogle Scholar
  47. Wilson, D. K., Van Horn, M. L., Siceloff, E. R., Alia, K. A., St George, S. M., Lawman, H. G., … Gadson, B. (2015). The results of the “Positive Action for Today’s Health” (PATH) trial for increasing walking and physical activity in underserved African-American Communities. Annals of Behavioral Medicine, 49, 398–410.CrossRefPubMedGoogle Scholar
  48. Wilson, D.K, Christensen, A., Jacobson, P., & Kaplan, R.M. (2018). Special Issue on Standards for Economic Analyses for the Field of Health Psychology and Behavioral Medicine. Health PsychologyGoogle Scholar
  49. Woolf, S. H., & Aron, L. (Eds.). (2013). US health in international perspective: Shorter lives, poorer health. Bethesda, MD: National Academies Press.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyBarnwell College, University of South CarolinaColumbiaUSA

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