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As clinicians have discovered that stress and related psychological and sociocultural factors may contribute to physical disorders, they have applied psychological treatments to more and more medical problems. The most common of these interventions are relaxation training, biofeedback, meditation, hypnosis, cognitive interventions, support groups, and therapies to increase awareness and expression of emotions. The field of treatment that combines psychological and physical approaches to treat or prevent medical problems is known as behavioral medicine.

As you saw in Chapter 4, people can be taught to relax their muscles at will, a process that sometimes reduces feelings of anxiety. Given the positive effects of relaxation on anxiety and the nervous system, clinicians believe that relaxation training can help prevent or treat medical illnesses that are related to stress.

Relaxation training, often in combination with medication, has been widely used in the treatment of high blood pressure (Moffatt et al., 2010). It has also been of some help in treating headaches, insomnia, asthma, diabetes, pain, certain vascular diseases, and the undesirable effects of certain cancer treatments (McKenna et al., 2015; Nezu et al., 2011).

As you also saw in Chapter 4, patients given biofeedback training are connected to machinery that gives them continuous readings about their involuntary body activities. This information enables them gradually to gain control over those activities. Somewhat helpful in the treatment of anxiety disorders, the procedure has also been applied to a growing number of physical disorders.

In a classic study, electromyograph (EMG) feedback was used to treat 16 patients who had facial pain caused in part by tension in their jaw muscles (Dohrmann & Laskin, 1978). In an EMG procedure, electrodes are attached to a person’s muscles so that the muscle contractions are detected and converted into a tone (see pages 118–119). Changes in the pitch and volume of the tone indicate changes in muscle tension. After “listening” to EMG feedback repeatedly, the 16 patients in this study learned how to relax their jaw muscles at will and later reported that they had less facial pain.

EMG feedback has also been used successfully in the treatment of headaches and muscular disabilities caused by strokes or accidents. Still other forms of biofeedback training have been of some help in the treatment of heartbeat irregularities, asthma, high blood pressure, stuttering, and pain (McKenna et al., 2015; Freitag, 2013; Young & Kemper, 2013).

Although meditation has been practiced since ancient times, Western health care professionals have only recently become aware of its effectiveness in relieving physical distress. Meditation is a technique of turning one’s concentration inward, achieving a slightly changed state of consciousness, and temporarily ignoring all stressors. In the most common approach, meditators go to a quiet place, assume a comfortable posture, utter or think a particular sound (called a mantra) to help focus their attention, and allow their mind to turn away from all outside thoughts and concerns. Many people who meditate regularly report feeling more peaceful, engaged, and creative. Meditation has been used to help manage pain and to treat high blood pressure, heart problems, asthma, skin disorders, diabetes, insomnia, and even viral infections (Manchanda & Madan, 2014; Stein, 2003; Andresen, 2000).

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One form of meditation that has been used in particular by patients suffering from severe pain is mindfulness meditation (Barker, 2014; Kabat-Zinn, 2005). Here, as you read in Chapters 2 and 4, meditators pay attention to the feelings, thoughts, and sensations that are flowing through their mind during meditation, but they do so with detachment and objectivity and, most importantly, without judgment. By just being mindful but not judgmental of their feelings and thoughts, including feelings of pain, they are less inclined to label them, fixate on them, or react negatively to them.

As you saw in Chapter 1, people who undergo hypnosis are guided by a hypnotist into a sleeplike, suggestible state during which they can be directed to act in unusual ways, feel unusual sensations, remember seemingly forgotten events, or forget remembered events. With training, some people are even able to induce their own hypnotic state (self-hypnosis). Hypnosis is now used as an aid to psychotherapy and to help treat many physical conditions.

Hypnosis seems to be particularly helpful in the control of pain (Jensen et al., 2014, 2011). One case study describes a patient who underwent dental surgery under hypnotic suggestion. After a hypnotic state was induced, the dentist suggested to the patient that he was in a pleasant and relaxed setting listening to a friend describe his own success at undergoing similar dental surgery under hypnosis. The dentist then proceeded to perform a successful 25-minute operation (Gheorghiu & Orleanu, 1982). Although only some people are able to go through surgery while anesthetized by hypnosis alone, hypnosis combined with chemical forms of anesthesia is apparently helpful to many patients (Lang, 2010). Beyond its use in the control of pain, hypnosis has been used successfully to help treat such problems as skin diseases, asthma, insomnia, high blood pressure, warts, and other forms of infection (Becker, 2015; McBride, Vlieger, & Anbar, 2014; Modlin, 2002).

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People with physical ailments have sometimes been taught new attitudes or cognitive responses toward their ailments as part of treatment (Hampel et al., 2014; Syrjala et al., 2014). For example, an approach called self-instruction training, or stress inoculation training, has helped patients cope with severe pain (D’Arienzo, 2010; Meichenbaum, 1993, 1977, 1975). In this training, therapists teach people to identify and eventually rid themselves of unpleasant thoughts that keep emerging during pain episodes (so-called negative self-statements, such as “Oh no, I can’t take this pain”) and to replace them with coping self-statements instead (for example, “When pain comes, just pause; keep focusing on what you have to do”).

If anxiety, depression, anger, and the like contribute to a person’s physical ills, interventions to reduce these negative emotions should help reduce the ills. Thus it is not surprising that some medically ill people have profited from support groups and from therapies that guide them to become more aware of and express their emotions and needs (Bell et al., 2010; Hsu et al., 2010). Research suggests that the discussion, or even the writing down, of past and present emotions or upsets may help improve a person’s health, just as it may help one’s psychological functioning (Kelly & Barry, 2010; Smyth & Pennebaker, 2001). In one study, asthma and arthritis patients who wrote down their thoughts and feelings about stressful events for a handful of days showed lasting improvements in their conditions. Similarly, stress-related writing was found to be beneficial for patients with either HIV or cancer (Corter & Petrie, 2011; Petrie et al., 2004).

Studies have found that the various psychological interventions for physical problems tend to be equally effective (Devineni & Blanchard, 2005). Relaxation and biofeedback training, for example, are equally helpful (and more helpful than placebos) in the treatment of high blood pressure, headaches, and asthma. Psychological interventions are, in fact, often most helpful when they are combined with other psychological interventions and with medical treatments (Jensen et al., 2014, 2011; Hembree & Foa, 2010). In a classic study, ulcer patients who were given relaxation, self-instruction, and assertiveness training along with medication were found to be less anxious and more comfortable, to have fewer symptoms, and to have a better long-term outcome than patients who received medication only (Brooks & Richardson, 1980). Combination interventions have also been helpful in changing Type A patterns and in reducing the risk of coronary heart disease among people who display Type A kinds of behavior (Ladwig et al., 2014; Harlapur et al., 2010).

Clearly, the treatment picture for physical illnesses has been changing dramatically. While medical treatments continue to dominate, today’s medical practitioners are traveling a course far removed from that of their counterparts in centuries past.