First presentation of my mission since 1986 which during the years has been refined but also is even more gradually increased in its purpose. Then below a draft also to be diskussed, criticized and further developed!
In brief, when primary care are equipped with the below predict is that astonishing increase in efficacy will surprising fast be developed!
First part: my personal, scientific and clinical mission
- I do believe – based on scientific and clinical work during more than 30 years and which gradually in increased even more – that an integrated psychophysiological stress (or behavioral, if you will) medicine platform is decisive more effective investigation/assessment/examination as well as intervention of stress- and lifestyle related diseases!
- This expressed also when most (?) people working in health care no not even know the name/ idiom/conceptualization! Reasons?
- One is that it is possible to identify individuals´ functions in central relevant systems.
- Another is that we can also identify present capacity to influence central relevant systems and, even more, can estimate and predict their possibilities to increased their capacity by own activities to increased it!
- Given they get education and, if needed, coaching to do it! Here biofeedback plays a central role not only to document the process but also to motivate “I can do it” facilitating patients to become “educated resources in their rehab”!
- Out clinical experience motivated the above and also tell the story that it does positively influence the clinicians ourselves!
- More over; patients learn and understand how they prevent lifestyle related diseases and usually (could be better empirical studied then we have had opportunities to do – so clinically estimated) and they also learn how to cope in real world with different kinds of stressor
- To achieve the above we need
- We need to increase (in some cases start up) R&D in many not well investigated patient populations – where I will predict that o-tolerance for hypertension (for those people who want it (if not normal info works it can be “personalized demonstrated” in an convincing way with our measurement paradigm used for at least 25 years – for information firstname.lastname@example.org). Of course some additional workshops is needed for staff working with hypertension
- We need to build up clinical competences which can be done at least in two ways;
- It can be integrated in concerned filed/patient population focused work
- It can be standing alone as a set-up with educated psychophysiologist and assisting staff as we have done (more info mail as above)
- Medical investigation need to be built-up using effective psychophysiological protocol as well as how information is interpreted, communicated as well as used for planning of interventions!
- Patient group education where also different patient populations can also be mixed (we have very good experiences of this) and patients are working together, e.g. in hypertension process measurement showing reactivity, capacity as well as passive relaxation conditions. Most important is learning the biopsychosocial medicine toolbox and each individuals tailoring of how to use the tools most personalized effective.
- Used of effective measurement systems interacting with (at best AI-based) database systems which can be used interactively also by patient where not only clinical data is collected/elaborated but also integrating patients own data! The AI-ReLy – Artificial Intelligence interpreted Reference Library does not exists in the way we have described it but can be developed easily and during a quite short time.
- How can the above be developed into existing health care systems? First, education of staff can be done during work time if 3 hours per week can be used. Then, how can it be included into time structures? Our approach was partly nurse accomplished (welcome, communication, protocol reports by patients, preparation for measurement in the lab), partly by clinicians working with biofeedback and partly group education done by nurses or other relevant educated staff. Critical is to document in an effective useful way for both staff and patients.
- Suggested is a pilot project that really developed to above in randomized clinics and compared with control clinics!
…. more is to come
Draft by Bo von Schéele, professor, IPBM
to be criticized
In Sweden, our development of Integrated Psychophysiological Behavioral Medicine, IPBM, is somewhat otherwise developed than what is representing mainstream of the www.aapb.org. During 30 years, our clinical work and development has been focusing more on education and supervision of patients according to my dissertation 1986 and the manual ”the Patient as an Active, Educated, Competent Resource in her/his Rehabilitation”. This is more described at www.stressmedicin.se and www.stressmedcenter.com
This website is focusing particularly on IPBM.
Point of departure and basic argument is effective health care services addressing lifestyle related diseases and mental disorders will not be effective without a IPBM platform!
My plan is to use this website for planning and discussions of scientific/knowledge issues as well as practical clinical and non-clinical ones.
Why has not Biopsychosocial Medicine (Engel, 1977) and/or IPBM been developed and used in health care while this is really expected to increase clinical and economical efficacy? A possible reason is that still reductionistic medicine dominate in all parts including education. Never really a system integrating paradigm was developed, a useful platform which really could meet requirements for effective treatment of lifestyle related diseases and mental disorders. Most clinical problems relate to both psychological and physiological as well as social issues and psychophysiological R&D try to develop a functional platform for this purpose. Extremely complex – also regarding variations between and within individuals over situations and time – but still this is what lifestyle medicine face. I modern language integrating of “street-” and “booksmart”, that is integration of old (spatial, biological/physiological) and new (verbal, elaborating, rational psychological) parts of our brain substantiated by the use of systems integrated psychophysiology. This although very much in both fields is not well understood while we do have some systems which we understand enough to use in examination, analysis/interpretation, prevention/treatment and evaluation of stress related and many lifestyle related diseases/disorders/problems.
We need not only to further move forwards in R&D and its practical use in clinical and non-clinical life but also ways how to inform/educate/… in ways that interested can use while working full time as well as caring about family and social life in general!
I do think we need to change somewhat focus from what has been done to more focus on education and not on own benefits of using IPBM. Of course, we do need skilled clinical work!!! But we need to look further on while education of interested, patient or not, will create rings on the water!