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Risks and Limitations
All forms of medicine carry risks. The main risk in behavioral medicine is its potential for psychosocial morbidity, usually in the form of self-blame. If the patient has unrealistic expectations about what they believe should happen in using such techniques, and they don't get the results they expect, they may conclude, "I must be doing it wrong," and perhaps have a sense of failure or inadequacy.

The fact is that one can do everything right and still have symptoms. These techniques are a contribution to a comprehensive treatment approach overtime, but are not curative in themselves. The degree of the contribution will vary from one person to the next, but there are no guarantees. Care providers need to address this fact directly with PWC's who are using such approaches, to assure that they have a realistic perspective.

Another risk is over-reliance on these approaches at the exclusion of other forms of medicine. It bears repeating that behavioral medicine is complementary to other effective forms of treatment, not exclusive.

One limitation is that many methods require an ability to sit quietly and, in some cases, focus the mind on the process. Some patients suffering from extremes of agitation, cognitive dysfunction, or debilitating fatigue may at times have difficulty following through with a routine of regular practice. Those who do best are able to sustain a regular practice and achieve cumulative benefits over time.

Conclusions
Clinical experience indicates that PWC's who use behavioral self help strategies in this complementary way have better medical outcomes, and improved self-efficacy in managing many symptoms, than those who rely solely on medical intervention alone.

The challenge of living with a serious illness for which there is no medical cure provokes us to explore all options. There is a real danger in "false despair" if one believes oneself to be powerless.
Until a medical cure is discovered, there is a great deal PWC's can do to help themselves manage symptoms, improve their quality of life, and promote their well-being. Kept in proper perspective, behavioral medicine can make a significant contribution to a comprehensive approach.

References

1. Benson H. The Relaxation Response, New York: Avon Books, 1975,and Beyond the Relaxation Response, New York: Berkley Books, 1985.
2. Auerbach JE, Oleson TD, Solomon GF. A behavioral medicine intervention as an adjunctive treatment for HIV related illness. Psychology and Health1992; 6:325-34.
3. Collinge, W. (1989). H.I.V. and quality of life: Outcomes of a psychosocial intervention program. Tenth Annual Proceedings, Society of Behavioral Medicine, p. 41.
4. Fawzy FI, Kemeny ME, Fawzy NW, Elashoff R, Morton D, Cousins N, FaheyJL. A structured psychiatric intervention for cancer patients. II. Changesover time in immunological measures. Archives of General Psychiatry1990; 47:729-35.
5. Kiecolt-Glaser J, Glaser R, Williger D, Stout J. Psychosocial enhancement of immunocompetence in a geriatric population. Health Psychology1985; 4:25-41.
6. Kiecolt-Glaser J, Glaser R, Strain E. Modulation of cellular immunity in medical students. Journal of Behavioral Medicine 1986; 9:311-20.
7. Zachariae R, Kristensen JS, Hockland P, Ellegaard J, Metze E, HoklandM. Effect of psychological intervention in the form of relaxation and guided imagery on cellular immune function in normal healthy subjects. Psychotherapyand Psychosomatics 1990; 54:32-9.
8. Hall HR, Minnes L, Tosi M, Olness K. Voluntary modulation of neutrophil adhesiveness using a cyberphysiologic strategy. International Journal of Neuroscience 1992; 63:287-97.
9. Hall HR, Mumma GH, Longo S, Dixon R. Voluntary immunomodulation: A preliminary study. International Journal of Neuroscience 1992; 63:275-85.
10. Gruber B, Hall N. Immune system and psychological changes in metastatic cancer patients using relaxation and guided imagery: A pilot study. ScandinavianJournal of Behavior Therapy 1988; 17:25-45.
11. Collinge W, Kabbal J. Evocative breath therapy and immunoenhancement: a pilot study. Manuscript submitted for review.
12. Tomasi TB. The Immune System of Secretions. Englewood Cliffs: Prentice Hall, 1976.
13. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effects of psychosocial treatment on survival of patients with metastatic breast cancer. TheLancet October 14, 1989, 888-91.
14. Cunningham AJ. The influence of mind on cancer. Canadian Psychologist1985; 26:13-19.

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 About The Author
William Collinge MPH, PhDWilliam Collinge, PhD, MPH is a consultant, author, speaker and researcher in the field of integrative health care. He has served as a scientific review panelist for the National Institutes of Health in mind/body......more
 
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