Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Recent trends in behavioral medicine Urs M. Nater a , Jens Gaab b , Winfried Rief c and Ulrike Ehlert b Purpose of review Behavioral medicine is an interdisciplinary field, integrating research from a variety of disciplines. This review focuses on recent advances and developments in behavioral medicine. Recent findings Stress, as well as having a role in the etiology and maintenance of somatic disease and somatoform disorders, is an important factor in the behavioral medicine literature. Consequentially, recent advances in psychological interventions targeting these conditions were developed. Furthermore, a variety of psychobiological mechanistic studies investigating the dysregulations of stress axes in conditions relevant to behavioral medicine have been undertaken. Summary Studies investigating factors and processes relevant to health and illness clearly demonstrate the impact of psychosocial factors such as stress. The biopsychosocial perspective becomes increasingly sophisticated, focusing on specific disease processes and empirically tested and effective interventions. Keywords behavioral medicine, cognitive–behavioral therapy, psychobiological factors, stress Curr Opin Psychiatry 19:180–183. ß 2006 Lippincott Williams & Wilkins. a Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA, b Institute of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland and c Institute of Psychology, Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany Correspondence to Urs M. Nater PhD, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA Tel: +1 404 712 8515; fax: +1 404 727 3233; e-mail: unater@emory.edu Sponsorship: U.M.N. acknowledges the Swiss National Science Foundation for financial support. Current Opinion in Psychiatry 2006, 19:180–183 Abbreviation HPA hypothalamus–pituitary–adrenal ß 2006 Lippincott Williams & Wilkins 0951-7367 Introduction Behavioral medicine represents an interdisciplinary approach to investigate and integrate psychological and biomedical factors, and processes relevant to health and illness. It encompasses the application of this knowledge to the promotion of health and the prevention, therapy, and rehabilitation of illness [1]. As evidenced by this definition, research in behavioral medicine is vast and therefore an almost unmanageable wealth of literature has been produced. Owing to the sheer extent of relevant literature, this review of the recent trends in behavioral medicine has to be restricted. Therefore, we focus on recent publications dealing with etiological, diagnostic, and therapeutic aspects of (1) psychobiological processes assumed to play a role in the transmission of stress into somatic conditions, (2) somatoform symptoms and syn- dromes, and (3) medical disorders. General psychobiological findings and models Conservative estimates suggest that stress accounts for approximately 30% of the overall costs of illness and accidents, summing up to 0.5 – 3.5% of the gross domestic product across Western nations. These figures make stress and its prevention an important enterprise for science and society. There are a number of possible perspectives on stress. From a macroperspective, social determinants of health need to be recognized and political actions are warranted [2  ,3]. Work-related stress is related to the onset of a number of serious conditions [4], with studies now elucidating possible psychobiological mechanisms [5]. In an attempt to elu- cidate the mechanisms of stress-related health changes, endocrine stress responses have been the focus of interest in previous research. A variety of possible modu- lators of psychobiological stress responses have been examined: situational [6  ] as well as individual factors [7  ], genetics [8  ], and early development [9]. A better understanding of these psychobiological mechanisms also facilitates the development of interventions. For example, modification of cognitive appraisal attenuates the cortisol response to psychosocial [10  ] and pharma- cological challenges [11  ]. Somatic disease The influence of psychological factors on the onset and course of somatic diseases increasingly receives empiri- cal evidence. For example, although multiple sclerosis (MS) has been linked to stress, ever since it was described by Charcot, the idea that stress might trigger 180