Current Psychosomatic Practice

Abstract

Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.

Healing Dysfunctional Identity: Bridging Mind-Body Intervention to Brain Systems

“…Thus, these results suggest that most unpleasant feelings an individual may perceive may result from projecting negative affective potentials in the sgACC onto a distal object represented in the dmPFC, which manifests as displeasure directed against someone else. This may explain the apparent irritability in patients with mood disorders or other mind-body illnesses [57].…”

From the Lesson of George Engel to Current Knowledge: The Biopsychosocial Model 40 Years Later

“…An important drive to reductionism has been determined by the growth of evidence-based medicine that is likely to concentrate on single factors, failing to give suitable weight to clinical variations and all therapeutic components [3][4][5] . Personalized/precision medicine, referred to as genomics-based knowledge, has promised to approach each patient as the biological individual he or she is [6][7][8] .…”

“…3. Affective disturbances, such as depression and anxiety, as well as illness behavior (the ways in which individuals experience, perceive, evaluate, and respond to their own health status), may affect the course, therapeutic response, and outcome of any given illness episode [3] . 4.…”

“…Psychological well-being and resilience have been found to play a protective role in the dynamic balance between health and disease [13][14][15] . Thus, the need to include consideration of function in daily life, productivity, performance of social roles, intellectual capacity, and emotional stability and well-being, has emerged as a crucial part of clinical investigation and patient care [3] . Another major criticism was on the traditional concept of disease, which tends to be restricted to what can be understood or recognized by the physician [1] .…”

“…The aim of treatment should be the identification of all modifiable biological and nonbiological factors, and the attainment of individual goals [16] . Accordingly, the traditional boundaries among medical specialties, based mostly on organ systems (e.g., cardiology, gastroenterology) appear to be more and more inadequate in dealing with symptoms and problems that require an integrated approach [3] .…”