Behavioral Medicine

Richard P. Sloan, Ph.D., Director
Emilia Bagiella, Ph.D., Assistant Professor of Clinical Biostatistics
Ethan E. Gorenstein, Ph.D., Assistant Professor of Clinical Psychology (in Psychiatry)
Kenneth Gorfinkle, Ph.D., Assistant Professor of Clinical Psychology (in Psychiatry)
Catherine E. Monk, Ph.D., Assistant Professor of Clinical Psychology (in Psychiatry)
Felice A. Tager, Ph.D., Assistant Professor of Clinical Psychology (in Psychiatry)
Daniel F. Seidman, Ph.D., Assistant Professor of Clinical Psychology (in Psychiatry)
Elizabeth S. Mezzacappa, Ph.D., Assistant Professor of Clinical Psychology (in Psychiatry)
Edward Katkin, Ph.D., Visiting Professor

The department’s research focuses on the contribution of psychological and behavioral factors to the onset, progression, and management of physical and mental disease. Projects range from the purely behavioral to the cellular, with new studies extending to gene expression. Our goal is to elucidate the mechanisms by which psychological and behavioral factors confer risk of physical and mental disease.

Cardiovascular Psychophysiology
In collaboration with Drs. Michael Myers in Developmental Psychobiology, Peter Shapiro in Consultation/Liaison Psychiatry, Jack Gorman in Clinical Psychobiology, and J. T. Bigger, Jr., in the Department of Medicine, the research program of Dr. Richard Sloan examines the mechanisms by which psychological risk factors such as hostility, depression, and anxiety contribute to the risk of heart disease. Departmental research explores a psychophysiological model of coronary disease that identifies the autonomic nervous system as the link between psychological factors and atherosclerosis. Specifically, the model suggests that by enhancing parasympathetic control of the heart, already known by cardiologists to promote survival following myocardial infarction, potentially pathogenic oscillations in blood pressure can be buffered. This model is the basis of several ongoing investigations funded by NIMH and NHLBI to explore factors which alter cardiac autonomic control: aerobic conditioning, cognitive-behavioral reduction of hostility, and surgical denervation.

Dr. Elizabeth Mezzacappa has extended this research. Following recently published evidence that the rate of heart rate recovery after exercise stress testing predicts mortality in patients with coronary artery disease, she has demonstrated that normal subjects with risk factors for heart disease, e.g., family history, have slower heart rate recovery after psychological challenge than normal subjects without risk factors.

Cognitive-Behavioral Reduction of Anxiety in Older Adults
It is widely recognized that in older adults, use of anxiolytic medications, although effective, may pose problems due to the age-related reduced threshold for side effects including oversedation, confusion, memory deficit, and falls. To address this problem, Dr. Ethan Gorenstein, in collaboration with Dr. Laszlo Papp of the Biological Studies Unit, has been exploring the capacity of short-term, cognitive-behavioral treatment (CBT) to reduce the dependence of older adults on anxiolytics. In this NIMH-funded study, elderly patients with Generalized Anxiety Disorder who want to reduce dependence on anxiolytic medication are randomized either to receive CBT plus medical management for tapering anxiolytic medication, or medical management alone. Outcome is assessed in terms of success at medication taper as well as psychological symptom reduction.

Maternal Emotions, Fetal Behavior, & the Etiology of Psychopathology
Dr. Catherine Monk, along with Drs. Michael Myers and William Fifer from Developmental Psychobiology, is engaged in longitudinal studies of fetal and infant development, studying the long-term consequences of pregnant women's mood states on child outcomes. They hypothesize that alterations in the intrauterine environment associated with pregnant women's psychiatric symptomatology influence fetal development and thereby contribute to the familial transmission of mental illness. Specifically, they are investigating fetal heart rate patterns in relation to maternal anxiety and depression and the neurobehavioral characteristics of these infants at birth and 4 months old. These projects have received support from NIMH, NARSAD, the March of Dimes, the CPMC Office of Clinical Trials, and the Sackler Institute.

Cognitive, Behavioral, and Autonomic Sequelae of Physical Disease
With increased success of treatment, cancer has become a chronic, rather than an acute disease. Correspondingly, the number of cancer survivors has increased substantially. With this success, however, has come concern that treatment may have long-term effects that may increase the risk of second cancers, heart disease, and cognitive impairment. In studies funded by the American Cancer Society and the Avon Foundation, Drs. Felice Tager and Paula McKinley, in collaboration with Drs. Freya Schnabel, Beth Ann Ditkoff, and Dawn Hershman in the Department of Medicine, are investigating the possibility that treatment for cancer causes subtle but measurable neuropsychological deficits. Anecdotal evidence has suggested that chemotherapy regimens including alkylating agents may be implicated in brain dysfunction. Their studies will obtain controlled neuropsychological data on pediatric cancer survivors and in women receiving chemotherapy treatment for breast cancer.

Smoking Cessation in Managed Dental Care Facilities in the Community
Dr. Daniel Seidman, along with colleagues from the School of Dental and Oral Surgery, has been active in research designed to assess the delivery of smoking cessation services in managed dental care settings and in the community. With funds from the American Legacy Foundation, he and colleagues from the School of Dental and Oral Surgery are evaluating the effectiveness of introducing and operating a smoking cessation clinic in a storefront clinic from the NYPH Ambulatory Care Network. In related work, Dr. Seidman and colleagues have received funding from the American Legacy Foundation to develop a CD training program to help dentists help their patients to stop using tobacco. This CD will be tested through the managed dental care organization of Aetna.

The “Health Effects” of Religious Activity
Claims about religion, spirituality, and health appear with increasing frequency today, both in the popular media and in professional journals. Corresponding to the rise in these beliefs are increasing calls to incorporate religious and spiritual activities into clinical practice. Over half of U.S. medical schools now include courses on religion and spirituality for medical students.

What began as a casual inquiry into the validity of these claims by Drs. Richard Sloan and Emilia Bagiella has evolved into an ongoing program of research in this area. In publications in the Lancet, the New England Journal of Medicine, and the Annals of Behavioral Medicine as well as several book chapters, they identify significant methodological failures of papers that purport to demonstrate health benefits of religious activity. They also identify significant ethical problems raised by attempts to bring religious activity into clinical medicine.