BEHAVIORAL TREATMENT OF DISEASE NATO CONFERENCE SERIES I Ecology " Systems Science '" Human Factors IV Marine Sciences V Air-Sea Interactions VI Materials Science III HUMAN FACTORS Volume 8 Mental Workload: Its Theory and Measurement Edited by Neville Moray Volume 9 Human Evoked Potentials: Applications and Problems Edited by Dietrich Lehmann and Enoch Callaway Volume 10 Human Consequences of Crowding Edited by Mehmet R. GUrkaynak and W. Ayhan Le Compte Volume 11 The Analysis of Social Skill Edited by W. T. Singleton, P. Spurgeon, and R. B. Stammers Volume 12 Coping and Health Edited by Seymour Levine and Holger Ursin Volume 13 Processing of Visible Language 2 Edited by Paul A. Kolers, Merald E. Wrolstad, and Herman Bouma Volume 14 Intelligence and Learning Edited by Morton P. Friedman. J. P. Das, and Neil O'Connor Volume 15 Human Detection and Diagnosis of System Failures Edited by Jens Rasmussen and William B. Rouse Volume 16 Anthropometry and Biomechanics: Theory and Application Edited by Ronald Easterby, K. H. E. Kroemer, and Don B. Chaffin Volume 1 7 Manned Systems Design: Methods, Equipment, and Applications Edited by J. Moraal and K.-F. Kraiss Volume 18 Women and the World of Work Edited by Anne Hoiberg Volume 19 Behavioral Treatment of Disease Edited by Richard S. Surwit, Redford B: Williams, Jr., Andrew Steptoe, and Robert Biersner BEHAVIORAL TREATMENT OF DISEASE Edited by Richard S. Surwit and Redford B. Williams, Jr. Duke University Medical Center Durham, North Carolina Andrew Steptoe St. George's Hospital Medical School University of London London, England and Robert Biersner Naval Medical Research and Development Command Bethesda, Maryland Published in cooperation with NATO Scientific Affairs Division PLENUM PRESS· NEW YORK AND LONDON Library of Congress Cataloging in Publication Data NATO Symposium on Behavioral Medicine (1 981 : Karas Cape, Greece) Behavioral treatment of Disease. (NATO conference series. III, Human factors; v. 19) "Proceedings of a NATO Symposium on Behavioral Medicine, held June 30-July 3, 1981, at Porto Carras, Chalkidiki, Greece" - T.p. verso. "Published in cooperation with NATO Scientific Affairs Division." Includes bibliographical references and index. 1. Medicine and psychology-Congresses. 2. Behavior therapy-Congresses. 3. Medicine, Psychosomatic-Congresses. I. Surwit, Richard S. II. North Atlantic Treaty Organization. Division of Scientific Affairs. III. Title. IV. Series: [DNLM: 1. Behavior therapy. 2. Behavior. W3 N138 v. 19/WM 425 N279b 1981) R726.5.N371981 616'.001'9 82-12363 ISBN-13: 978-1-4613-3550-4 e-ISBN-13: 978-1-4613-3548-1 DOl: 10.1007/978-1-4613-3548-1 Proceedings of a Nato Symposium on Behavioral Medicine, held June 30-July 3, 1981, at Porto Carras, Chalkidiki, Greece © 1982 Plenum Press, New York Softcover reprint of the hardcover 1s t edition 1982 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher DEDICATION This book is dedicated to the memory of Philip Handler, former James B. Duke Professor of Biochemistry and President of the National Academy of Sciences. We are indebted to him for his valuable assistance in the organization of this Symposium. v PREFACE Behavioral Treatment of Disease: A NATO Symposium on Behavioral Medicine was held on June 30th through July 3rd, 1981 at Porto Carras, Neo Marmaras, Greece. It was a multi disciplinary meeting which provided an opportunity for North American and European scientists from ten different NATO member countries to share the emerging principles and technology of behavioral treatment of disease. In addition, it served as a forum whereby continued high level research in the area was stimulated. Financial support for the symposium was initially provided by the Scientific Affairs Division or the North Atlantic Treaty Organization as part of their continuing seri.es of scientific symposia. Funds made available by a grant from the United States Office of Naval Reseach permitted widespread inter national participation in the symposium. We would like to thank each of these organizations for their support in making the symposium possible. In particular, we would like to thank Dr. B. A. Bayraktar of the Scientific Affairs Division of NATO and Dr. Donald Woodward of the U.S. Office of Naval Research. Though both of these men were unable to attend the meeting personally, they provided invaluable assistance in its planning. The organization of this symposium was carried out in consultation with a special organizing committee which consisted of John Basmajian, Niels Birbaumer. John Bou10ugouris, Charles Mertens, and Dieter Vait1. We would like to express our partic ular appreciation to Barbara Jackson and Cynthia Mongeon who prepared these precedings for publication and who were re·sponsible for coordinating various aspects of the symposium from its inception. vii viii PREFACE Finally, we would like to thank Mr. John Carras for the warm hospitality he provided to all participants which helped make the meeting a success. Richard S. Surwit, Ph.D. Redford B. Williams, Jr., Andrew Steptoe, D. Phil Robert Biersner, Ph.D., Commander, USN Durham, North Carolina September, 1981 CONTENTS Behavioral Treatment of Disease: Introduction • • . • . • • •• 1 Richard S. Surwit SECTION I: CORONARY HEART DISEASE Behavioral Mechanisms in the Pathophysiology of Coronary Heart Disease. • • . • • • • • • 5 Redford B. Williams, Jr. Primary Prevention of Coronary Heart Disease. . • • • . . • • • 23 Chandra Patel Secondary Prevention of Coronary Heart Disease. • • • • • • • • 43 James A. Blumenthal and Robert Califf Type A Intervention: Finding the Disease to Fit the Cure. • • • • • • • • • • • • • • • . • •.••• 71 Ethel Roskies SECTION II: ISCHEMIC DISORDERS Behavioral Treatment of Raynaud's Disease •..•••••••• 87 Richard S. Surwit Pathophysiology and Behavioral Treatment of Scleroderma .••• 101 Robert Freedman and Paul Wenig The Behavioral Treatment of the Symptoms of Ischemic Heart Disease • ..••. 115 Derek W. Johnston SECTION III: HYPERTENSION Pathophysiology of Hypertension: CNS and Behavioral Com- ponents • • . • • • • • . . • • • • •• 129 Redford B. Williams, Jr. ix x CONTENTS Hypertension from the Standpoint of Behavioral Medicine • • • • • • • • • • • • • • • • • • • • • . • • 139 David Shapiro Control of Cardiovascular Reactivity and the Treatment of Hypertension. • • • • • . • • • . • • • • • . 159 Andrew Steptoe Relaxation Treatment for Hypertension Guido L.R. Godaert ••••••••• • • 173 The Effectiveness and Cost-Benefits of Behavioral Methods in the Treatment of Essential Hypertension • • • • • • • 185 Dieter Vaitl and Harald Lachnit SECTION IV: NEUROMUSCULAR REHABILITATION EMG Feedback in Neuromuscular Control. • • • '. • • • • . • • • 201 John V. Basmajian EMG Feedback in Neuromuscular Rehabilitation of Spasmodic Torticollis: Therapeutic Electromy- graphy .••.•••.•.••••••••.•••••• 215 Joseph Brudny Behavioral Treatment of Fecal Incontinence • • • • • • • • . • 235 Bernard T. Engel Potentialities of Automation and Continuous Recording and Training in Life . . • . . 245 Neal Miller & Barry R. Dworkin SECTION V: HEADACHE Pathophysiology of Headache for Behavioral Therapists. • • • • 259 J.R. Graham Biofeedback in the Treatment of Migraine • • • • • • • • • • 273 Jackson Beatty Behavioral Treatment of Migraine • • • • • • • • • • • • • • • 285 Niels Birbaumer and G. Haag Psychophysiology of Migraine and Tension Headache. • • • • • • 299 Birgit KrBner CONTENTS xi SECTION VI: CHRONIC PAIN Pain: Its Pathophysiology, A Brief Review. 315 Blaine S. Nasho1d and J. Ove1men Levitt Behavioral Assessment of Pain . . • 329 Bernard Tursky and Larry D. Jamner . . . . . . Behavioral Analysis of Chronic Pain 353 Wilbert E. Fordyce . . . . Behavioral Treatment of Pain. 371 Francis J. Keefe and Andrew R. Block SECTION VII: MILITARY APPLICATIONS Military Applications of Behavioral Medicine. • • . 389 Robert J. Biersner SECTION VIII: THEORETICAL ISSUES IN BEHAVIORAL MEDICINE The Control of Behavior: Theoretical Considerations for Be- haviora1 Medicine 405 Arthur J. Bachrach Behavioral Medicine: The Biobehaviora1 Perspective 421 Stephen M. Weiss and Gary E. Schwartz Behavioral Medicine and Psychiatry: A Dialogue 437 Joseph Brady Behavioral Medicine and Pscyhiatry: A Dialogue . . . . . . . 453 Charles Mertens de Wilmars . . . . . . . . . . . . . . . . Index . • . . . . . . 457