President's Message: Provocative Questions in Behavioral Medicine
Michael Diefenbach, PhD, SBM President
Michael Diefenbach, PhD
The academic year is ending, grant and review deadlines have passed, and summer is here!
Before you take a well-deserved breather and re-charge your batteries, I would like to tell you a bit about what’s going on at SBM. Over the past months, we have laid the ground work for assessing the future of behavioral medicine. Last week we launched our big initiative that we are calling the “Provocative Questions in Behavioral Medicine.” Some of you might have heard me introduce this initiative during our annual business meeting in Washington, DC, or read about it briefly in the last Outlook.
In short, I would like to engage you, our members, in a visioning exercise about the future of behavioral medicine. Think about it as the next “big questions” we need to work on, or think about it in terms of “grand challenges,” “moonshot” ideas, or “provocative questions.” When thinking about your moonshot idea or provocative question, take a 30,000 foot view. We don’t want to hear about your next grant idea; that’s much too specific. Rather, we are interested in broad challenges that our field faces that need a concerted research effort. These challenges could be persistent problems in behavioral medicine that we still have not solved, or they could be new challenges that in your view will become prominent areas of research in the coming years.
This is an opportune time for our society to engage in such an exercise. Our membership is at an all-time high, diverse with representatives from many disciplines, and our annual meetings showcase the latest scientific breakthroughs. In addition, other groups such as the Behavioral Medicine Research Council and representatives within the National Cancer Institute are also interested in identifying future areas of research. This confluence of efforts will shape our field in the next years and we have the unique chance to be a major contributor. I would like to highlight that our Provocative Questions initiative is a crowdsourced effort. We are interested in responses from all members, but specifically from those in training and at the beginning of their careers who represent the future of behavioral medicine. I hope this will motivate you to spend a bit of time to complete the questionnaire that you received. Be creative, and give it some serious thought.
Once we have received many diverse provocative questions, a steering committee of members representing academia, industry, and funding organizations will categorize and cluster the questions. This process will be guided by KnowInnovations, a company that specializes in conducting visioning exercises. Once this first round of analytics is accomplished, we will share the results with you and will give you another opportunity for input. The complete results will be shared during the next Annual Meeting in San Francisco.
I would like to thank you in advance for your time and effort with this truly grassroots effort. I’m excited about the project and can’t wait to see your provocative questions.
An Interview with Outlook's New Editor, Crystal Lumpkins, PhD
Megan McVay, PhD; Publications and Communications Council Chair
Crystal Lumpkins, PhD
The SBM Publication & Communication Council is excited to welcome Dr. Crystal Lumpkins as our new editor of Outlook. Dr. Lumpkins is an Associate Professor and residency research director in the Department of Family Medicine at the University of Kansas. Welcome Dr. Lumpkins, and congratulations on your inaugural issue!
We expect that readers would be interested to get to know our new editor, and learn a bit about her vision for Outlook. Dr. Lumpkins also has had an interesting career path that provides an example of the many types of backgrounds from which SBM members come, and the many career paths they follow. We have interviewed Dr. Lumpkins.
You have an interesting career background that makes you a great fit for this position. Can you tell us a bit about what you did prior to obtaining your PhD?
I often marvel at how my career has evolved; no one could have told me that my career path would begin in the newsroom and take me to the classroom and health disparities research with the community. Before obtaining my PhD from the University of Missouri-Columbia (UMC) in 2007, I worked in University Communications at the University of Missouri-Kansas City (UMKC) while teaching as an adjunct at other local colleges. Prior to serving as a writer at UMKC, I was a freelance writer for the Albuquerque Journal and morning associate producer for KOB TV 4. These positions gave me an opportunity to write in different formats, informed my thesis that focused on Community Journalism and forced me to focus and complete a Dual Masters in Media Communication and Management. After obtaining the B.J. (Bachelors of Journalism) in 1992 from UMC, I worked as an on-air general assignment reporter and promotions writer at various affiliates in Kansas and Missouri.
You have a strong interest in Community Based Participatory Research (CBPR). Can you tell us a bit about this part of your professional life?
CBPR is a natural extension of who I am as a researcher and a combination of my previous experiences in public relations, community journalism and volunteerism within the African American community. This approach has allowed me to work with and alongside underserved communities to leverage population health communication that is equitable, relevant, relatable and impactful for positive behavior outcome.
What is your favorite thing about being an SBM member?
SBM has offered so much to me as a member; it is hard to state my favorite thing about being a member. As a health communication scholar and member since 2015, I have been able to connect and collaborate with others, receive important training to enhance what I do as a researcher and network with social and behavioral scientists throughout the country. The friendships I’ve developed have also been wonderful.
How do you envision Outlook relating to social media? Is there an opportunity to use social media to promote Outlook?
Absolutely! We’re hoping to use Outlook as a cross-promotion tool where the articles that appear in Outlook will also appear in SBM social media. We’re hoping that this will encourage an exchange between authors and those who frequent our social media pages. Please look for this and join the conversation to communicate our science.
Is there anything else you want to say about your vision for the future of Outlook?
Yes, I’m hoping that Outlook will serve as a tool to increase our engagement with external stakeholders. Our first priority is to the membership but I believe we must also engage with like-minded organizations as this will help to increase visibility of who we are and what we do and why proven behavioral medicine is critical for the betterment of society.
Ok, last question: If members have ideas for articles for Outlook, what should they do?
Thank you for this question! If members have ideas for the newsletter, they can send those to Andrew Schmidt at firstname.lastname@example.org at or me at email@example.com. We want to hear from you!
Getting into the Mix: Resources for Mixed Methods Research Training
Heather McGinty, PhD; Evidence-Based Behavioral Medicine SIG Co-Chair
Health science researchers are increasingly incorporating qualitative data with quantitative data, and giving much needed context and multi-level perspectives to complex health phenomena. Mixed methods research seeks to combine the worlds of quantitative data (e.g., frequency or magnitude) and qualitative data (e.g., meaning or contextual understanding). The goal is to integrate these unique forms of data, rather than simply append one to the other. Each data type should expand upon and help inform the other.
In 2010, the National Institutes of Health Office of Behavioral Social Sciences Research brought together leaders in the field to provide guidance and best practices for utilizing these approaches in health research.1 They created a report highlighting mixed methods research designs, recommendations for resources and training in mixed methods, and developing high-quality mixed methods research grant applications. While this guide provides valuable information, specific training in the design, conduct, and analysis of mixed methods research or consultation with experts is highly desirable. We offer a number of suggestions for current training opportunities and resources for those interested in learning the skills and craft of mixed methodology.
The Inter-university Consortium for Political and Social Research offers a number of three to five day workshops in their Summer Program in Quantitative Methods of Social Research including introductory and advanced workshops in mixed methods. Find more information about the workshops here.
Stanford Medicine has a three-day intensive Mixed Methods Research workshop for those interested in designing or analyzing mixed methods research projects. Participants are encouraged to bring their in-progress work to use in the workshop. Learn more here.
The University of Michigan Mixed Methods Program offers several training workshops throughout the year and consultation services for those designing research proposals in the social and health sciences. Visit www.mixedmethods.org for more information about past and upcoming workshops, consultation services, and other resources.
The University of Michigan School of Social Work also offers a 30-hour continuing education Web-Based Certificate Program in Mixed Methods Research. The curriculum is comprised of five core areas and is designed for social and health science experts to build their skills in scientific research. More information for upcoming cohorts is available here.
University of Oxford Department for Continuing Education offers a Mixed Methods in Health Research short course module with both virtual learning environment and face-to-face teaching experiences. Students will be able to design, implement, and analyze a mixed methods research project. For more information, click here.
Harvard Catalyst has an online, eight-week introductory course in mixed methods research available to scholars affiliated within the national Clinical Translational Science Award (CTSA) consortium or Harvard Catalyst members. Additional information about the program is available at the Harvard Catalyst website.
The University of Nebraska-Lincoln created an 18-credit, graduate certificate program in Mixed Methods Research through their graduate studies in Educational Psychology. Courses may be completed online during a 12-month period through six 3-credit hour courses for enrollees. More information including the application process can be found here.
- Creswell JW, Klassen AC, Plano Clark VL, Smith KC for the Office of Behavioral and Social Sciences Research. Best practices for mixed methods research in the health sciences. August 2011. National Institutes of Health.
Aiming High: A Profile of SBM Member and U.S. Public Health Service Captain Christine Hunter, PhD
Margaret Schneider, PhD; SBM Member Delegate
Christine Hunter, PhD., ABPP
Perhaps you have wondered about the professional path that has led some of our behavioral medicine colleagues to prominent positions at the National Institutes of Health (NIH). Maybe you noticed some SBM members in uniform, and wondered about the role of behavioral medicine in the military. Or maybe you were fortunate enough to have a really fantastic Program Officer at the NIH who made you realize that within that large government entity there reside a number of truly talented, caring, and inspirational individuals eager to do what they can to move behavioral medicine science forward. For all of these reasons and more I decided to use this space in Outlook to present the highlights of an interview that I conducted with Captain Christine Hunter, PhD, ABPP, of the U.S. Public Health Service, who is currently the Deputy Director of the Office of Behavioral and Social Sciences Research (OBSSR) at the NIH.
When I asked Dr. Hunter to describe her professional path, she described it in terms of a series of opportunities that opened up because she kept her options open. Trained as a clinical psychologist, she has kept her license active throughout more than 20 years of employment as she has followed a trajectory that has gradually moved farther away from clinical practice. This strategy has afforded her numerous chances to take on new professional challenges, including running the behavioral medicine clinic and clinical programing at the inpatient clinic at Keesler Air Force Base in Mississippi soon after her internship in clinical psychology. Dr. Hunter feels that her decision to join the Air Force provided a wide range of career options and opportunities which resulted in her eventual appointment as the Director of Behavioral Research at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); a position she held for 11 years.
At NIDDK, Dr. Hunter found that the NIH culture suited her perfectly. She considers herself a collaborative scientist, and found that the NIH is an ideal place to be if you value being part of a team, juggling lots of different responsibilities, and influencing science from the 10,000 foot view. She cautions that the NIH is not the best place to be if you are the type of person that wants to take a project from beginning to end and have it done solely under your direction, yet she is quick to emphasize that working at the NIH is both deeply rewarding and scientifically challenging. Her job has involved mentoring junior investigators, supporting senior investigators as they shape the field, bringing together the top minds in behavioral medicine to address timely issues, and consensus building among her colleagues to move toward a product.
Throughout her remarkable career, Dr. Hunter has looked toward SBM as her professional home. In over 25 years of membership, she has rarely missed an Annual Meeting, and she always looks forward to the presidential addresses as a chance to watch people at the top of their field give back and demonstrate their belief in the organization. For SBM members interested in a career with NIH, Dr. Hunter wants to emphasize that there is much to recommend this professional pathway. The most common time to make this shift is soon after fellowship or mid-career, after one has demonstrated a capability for critical thinking and has achieved some independent scientific experience. Dr. Hunter’s own transition to her current position as Deputy Director of OBSSR was the organic result of a lifetime of keeping her options open and enthusiastically embracing each new challenge, and to hear her describe her work, it is clear that she could not be happier.
Funding Your Health Equity Research in an Evolving Era: Trends and Tips from National Funding Organizations
Kassandra I. Alcaraz, PhD, MPH, Kelseanna Hollis-Hansen, MPH & Rachel M. Ceballos, PhD; Health Equity SIG
Disparities in health are not merely health-related differences between populations but those that are systematic, avoidable (preventable), and suffered by socially, economically, or environmentally disadvantaged groups.1,2 A distinct yet related concept, health equity, is the goal of eliminating disparities in health by giving focused attention to the needs of those at greatest risk of poor health and addressing underlying causes of disparities such as social inequities.1 Achieving health equity requires new and targeted approaches in which researchers and communities are essential partners in creating long-term population impact.
Health equity-focused efforts have evolved in recent years. To reflect on this evolving era, we interviewed leaders from two national organizations that fund an array of health equity research. Elvan Daniels, MD, MPH is Scientific Director, Cancer Prevention & Control Research, Extramural Research at the American Cancer Society (ACS). Kerry Anne McGeary, PhD is Senior Program Officer, Research-Evaluation-Learning at the Robert Wood Johnson Foundation (RWJF). Below, Drs. Daniels and McGeary share their insights about health equity research trends, grant application tips, and more.
From your perspective, how has health equity research evolved in recent years? What type of health equity research is becoming more prominent? Less prominent?
Dr. Daniels: There has been movement from mostly behavioral research to studies focusing on multiple determinants of health and multilevel research using a variety of study designs. Studies range from interventions involving (a) clinical practices and communities, to (b) communities and public health entities, and (c) health services research evaluating the impact of health policy using a variety of large databases. Less prominent are simple explanatory studies.
Dr. McGeary: I have seen a growth in research with a community, not within or for a community. The community based participatory approaches have grown. However, the disparities researchers still dominate the conversation. More and more they are using the term “health equity” to describe their work.
What tips do you have for investigators seeking funding for health equity research? In your view, what do the best health equity research proposals have in common?
Dr. Daniels: [Promising studies are those] that address root causes of disparities with novel interventions to address barriers or propose unique solutions. These studies typically build upon previous research and involve partnerships with academic and community partners or primary care, specialty care, and community partnerships.
Dr. McGeary: Investigators should be offering a solutions-focused research design, working with a community’s needs at the forefront, and addressing systemic barriers to achieving the best health outcomes.
Similarly, what are some common pitfalls in unsuccessful health equity grant applications?
Dr. Daniels: Common pitfalls are proposing research with a special population [but] failure to frame the research around two or more determinants of health the researchers believe drive the issue of inequity, lack of theory or conceptual framework, and failure to state how the research finding will contribute to achieving health equity.
Dr. McGeary: They are addressing disparities or the reason for disparities, [but] not offering solutions for the systemic barriers that are driving disparities.
What do you see as key future directions and priorities for health equity research funding?
Dr. Daniels: [ACS will] continue to require that applicants focus their research on at least two root causes and multilevel interventions involving interdisciplinary teams.
Dr. McGeary: The directions are related to frameworks, methodologies, and measures for improving health equity.
Is there anything else you’d like to share with prospective health equity grant applicants?
Dr. Daniels: Yes, we are in the process of refreshing our Priority Area for Health Equity which will include a [revised] definition and guideline principles ACS has developed with an Advisory Group to promote health equity across the Society, with support through funding from RWJF.
Dr. McGeary: Keep addressing the root causes that are at the heart of the stark disparities we see today. Do not shy away from the investigation of an area of work because it is outside your research agenda or scope of work.
- Braveman P. What are health disparities and health equity? We need to be clear. Public Health Rep. 2014;129 Suppl 2(Suppl 2):5–8.
- Braveman PA, Kumanyika S, Fielding J et al. Health disparities and health equity: the issue is justice. Am J Public Health. 2011;101 Suppl 1(Suppl 1):S149–S155.
What’s New with the ETCD Council? An interview with ETCD Chair Amy Huebschmann, MD
Education, Training, and Career Development (ETCD) Council Corner
Sherri Sheinfeld Gorin, PhD, FSBM; ETCD Council member
Welcome to the “Education, Training, and Career Development (ETCD) Council corner!” In each issue of Outlook, and in accord with our mission, the ETCD provides SBM members with opportunities and support to enhance their training and career development throughout all phases of their careers in behavioral medicine. In this issue, we interview ETCD Chair, Amy Huebschmann, as she enters her last year in this post. Council member Sherri Sheinfeld Gorin discusses the accomplishments of the ETCD, as well as Amy’s career path, and how it led her to SBM.
How did you become interested in the field of behavioral medicine?
I was trained as a physician, and my initial clinical research was in addressing barriers to exercise for patients with type 2 diabetes, so that naturally involved developing a greater understanding of the science of physical activity behavior. As a general internist physician working in primary care with an older patient population, I am also very interested in pragmatic methods for primary care teams to support patients with diabetes and other chronic diseases to make healthy lifestyle behavior choices. We know that in-person clinic visits are typically too few and far between to meaningfully support lifestyle behavior change.
How did you become interested in SBM?
My behavioral science consultant for my K-award was Dr. Andrea Dunn who is very involved in SBM, and she encouraged me to join SBM to enhance my behavioral science training for my K-award. I did so and have never looked back; SBM has been my go-to place for developing research ideas and collaborations.
How long have you been a member?
Is this your first leadership position in SBM? If not, what other leadership positions have you had with SBM?
I chaired the Diabetes SIG from 2016-2017, and I have continued to enjoy collaborating with colleagues in the Diabetes SIG to present symposia and pre-courses together.
How does the ETCD match your own interests and expertise?
I am passionate about lifelong learning and mentoring – my children joke that I don’t know when to stop going to school – so the ETCD is a great fit for me. I am currently a co-director of our Primary Care Health Services Research fellowship at the University of Colorado and a senior faculty member on our NHLBI-funded Dissemination and Implementation science K12 award. In this role, I focus on training researchers who conduct implementation research in health systems.
What have been the major accomplishments of the ETCD under your leadership?
We were already providing excellent career development opportunities when I took over the council, so I am thankful to our past chairs and council members for their excellent work over time. Our two major accomplishments under my leadership were both collaborative efforts. The first was to establish a formal collaboration with the Student SIG to allow our two groups to join forces to guide the programming for students and post-doctoral fellows. This collaboration with the Student SIG was made possible by our enthusiastic ETCD council liaison to the Student SIG – Dr. Morgan Lee.
The second major accomplishment was our development of an annual series of webinars that address topics of career development for SBM members across different career stages. The webinar series is possible through our collaboration with the Student SIG and several other SIGs that have been willing to lead a session. The webinar series also benefited from our council’s use of a set of career development goals for SBM members across different career stages; these goals guided each of the webinars. These career development goals also inform the events that we develop for the annual meeting. For example, for in annual “Meet the Professors” session, we have sought to have each table address a different career development theme, such as obtaining R01 funding, work-life balance, addressing mid-career needs, and exploring non-academic career paths.
What do you plan to do in your final ETCD year?
We are excited to have one of our ETCD Council members, Dr. Courtney Bonner, spearheading a Leadership pre-course for early career professionals that we will offer at SBM 2020. This is proposed as a parallel program to the Leadership Institute for mid-career professionals, and is focused on enhancing diversity as a leader. If you are interested in this opportunity and you are a post-doctoral fellow, junior faculty member, or in an early-career industry position, please save-the-date for the SBM 2020 pre-course on April 1, and look for applications for this pre-course to come out in Fall 2019.
What suggestions do you have for your successor?
Be a good listener to the career development needs of our members, and seek to offer programs that fit the different needs of students, post-doctoral fellows, early career, and mid-career stages.
Thank you for sharing your time, expertise, and experience with SBM. It’s been my own pleasure to work with you. No doubt, not only your successor, but all of us will continue to gain from your contributions to the ETCD in the future.
The ETCD welcomes input from all SBM members as to the types of topics we should address as a Council. Please e-mail Andrew Schmidt at firstname.lastname@example.org if you have a suggestion for us.
The Society of Behavioral Medicine’s Leadership Institute is turning 5!
The institute will proudly celebrate its fifth anniversary at the 41st SBM Annual Meeting & Scientific Sessions in San Francisco, CA, April 1-4, 2020
2019 Leadership Institute Fellows
For four great years, SBM’s Leadership Institute has provided mid-career SBM members the training and skills they need to advance their careers and take on more leadership roles in their respective professions. During the past four years, 139 fellows have participated in the program. SBM Past-President Marian Fitzgibbon, PhD, founded the institute after she noticed many leadership programs focused on early or senior career professionals, but few were devoted to the unique challenges of mid-career behavioral scientists. The 2020 program will begin with a two-day in-person intensive workshop at the Annual Meeting. It will continue throughout the year via conference calls with SBM senior leaders, and one-on-one meetings with career coaches. Participants also identify a leadership project during the year that is presented at a poster session at the next annual meeting. The goal of the leadership project is to translate skills learned during the leadership institute into something tangible, reflecting their leadership journey.
Past participants have raved about the Leadership Institute’s impact on careers advancement.
“I needed this leadership workshop,” said a surveyed participant. “It challenged me to push beyond my comfort zone. [The Leadership Institute] helped me to appreciate the core essence of my leadership style while showing me where I need to grow as a leader.”
“I'm already coming away with tons of ideas for making life more manageable and for getting to the next level in my career,” said another participant. “I feel extremely fortunate to have taken part.”
The fifth anniversary class will enjoy sessions on developing their leadership style, self-assessment, building an inclusive workplace, building collaborative teams, negotiations and conflict resolution skills, and how best to pitch their next great idea. Participants will also get to connect with one another on a professional and personal level.
As one past participant put it, “It’s good to have this type of input early. It’s also great to do it with peers.”
Congratulations to all the Leadership Institute participants from the past four years! Applications for the 2020-21 fifth anniversary institute will be available on the SBM website this fall. Be sure to apply and take your leadership skills to the next level!
Mindful Aging: A Pathway toward Improved Health and Quality of Life
Katarina Friberg-Felsted, PhD & Elizabeth Orsega-Smith, PhD; Aging SIG
As the United States’ aging population continues to grow, enhancing quality of life in this patient cohort has become an area of emphasis, evidenced in part by the National Institutes of Health’s call to improve the biological and psychological health of this population.1 New avenues are being used to explore innovative and effective ways of improving older adults’ physical and mental health outcomes. The connection between the mind and body is germane to many biopsychosocial processes. Mindfulness, as defined by Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction, means “paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally."2 This behavior is linked to changes in areas of the brain responsible for affect regulation and how we react to stressful impulses, influencing body functions from heart rate to immune function.3 Mindfulness has proven effective in treating many mental and physical health outcomes, decreasing symptoms and increasing quality of life.4,5,6,7
These areas of research are relevant across SBM membership – they influence both aging and complementary and integrative therapies and address social determinants of health, health inequities, and diversity initiatives. These areas of research are also prioritized in The National Center for Complementary and Integrative Health’s 2016 Strategic Plan, which includes objectives related to mind-body connection.
- “advance understanding of the mechanisms through which mind and body approaches affect health, resilience, and well-being”
- “conduct studies in ‘real world’ clinical settings to test the safety and efficacy of complementary health approaches, including their integration into health care”8
Mindfulness interventions to treat older adults’ physical and psychological conditions may be particularly advantageous for this population. Typical pharmaceutical treatments often used as first line of treatment can present a higher risk to an older adult.9,10 Medication trials typically exclude those over 65, and as such, drug reactions in an older adult patient may be unexpected, and patients may not respond the way clinical trials have shown them to. Further, polypharmacy is a higher concern in an older population, with potential drug interactions providing unexplored and unwanted side effects. Finally, some medications tend to show reduced efficacy with long-term use.11
It appears that mindfulness, or being in the present moment, is something that older adults may be more accepting of than younger adults, due to their ability to maintain emotional functioning.12,13 Consequently, studies show that their level of mindfulness are higher than the younger population.14 A review of the literature shows that mindfulness-based interventions in older adults found that most interventions have been conducted in community–dwelling older adults who were referred by health professionals or interested in gaining mindfulness training on their own.15 These interventions targeted symptoms with psychological distress ( i.e. depression, stress), physical illness (i.e. chronic obstructive pulmonary disease , diabetes) or pain. Other applications of mindfulness in older adults include relationships with cognitive and emotional well-being, protection against stress, mood states, and successful aging.16,17,18,19 It has also been suggested that traditional mindfulness based interventions should be modified to meet the needs of older adults ( i.e. shortened length of interventions, altered delivery of programs) and expand its application to examine the impact on other age –related diseases.15
One innovative area for mindfulness application is urinary incontinence in older adult women.20,21,22 Urinary incontinence presents in two disparate ways: stress urinary incontinence (SUI) and urge urinary incontinence (UUI). While stress urinary incontinence, typically caused by poor muscle tone, can often be successfully addressed with physical therapy or general lifestyle behavior changes, urge urinary incontinence is often idiopathic and refractory. Preliminary research has shown UUI responsive to mindfulness.20,21,23 The mechanism for this may be a reduction in catastrophizing the event and learning to respond to stimuli in the accepting and non-judgmental way as learned through mindfulness training.20,21,24,25
Older adults deserve better treatment options leading to improved health related quality of life. Mindfulness training may be a pathway towards better health and improved quality of life in this older adult population.
- Ospina, M. B., Bond, T. K., Karkhaneh, M., Buscemi, N., Dryden, D. M., Barnes, V., ... Shannahoff-Khalsa, D. (2008) Clinical trials of meditation practices in health care: Characteristics and quality. Journal of Alternative and Complementary Medicine, 14, 1199-1214. doi:10.1089/acm.2008.0307.
- Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. Hachette UK.
- Gallegos AM, Hoerger M, Talbot NL, et al. (2013) Toward identifying the effects of the specific
- components of mindfulness-based stress reduction on biologic and emotional outcomes among older adults. Journal of Alternative and Complementary Medicine, 19(10), 787-792.
- Creswell, J. D., Irwin, M. R., Burklund, L. J., Lieberman, M. D., Arevalo, J. M., Ma, J., . . . Cole, S. W. (2012). Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: A small randomized controlled trial. Brain, Behavior, and Immunity, 26(7), 1095-1101.
- Moss, A. S., Reibel, D. K., Greeson, J. M., Thapar, A., Bubb, R., Salmon, J., & Newberg, A. B. (2015). An adapted mindfulness-based stress reduction program for elders in a continuing care retirement community: Quantitative and qualitative results from a pilot randomized controlled trial. Journal of Applied Gerontology, 34(4), 518-538. doi:10.1177/0733464814559411
- Moynihan, J. A., Chapman, B. P., Klorman, R., Krasner, M. S., Duberstein, P. R., Brown, K. W., & Talbot, N. L. (2013). Mindfulness-based stress reduction for older adults: Effects on executive function, frontal alpha asymmetry and immune function. Neuropsychobiology, 68(1), 34-43.
- Young, L. A., & Baime, M. J. (2010). Mindfulness-based stress reduction: Effect on emotional distress in older adults. Complementary Health Practice Review, 15(2), 59-64.
- National Center for Complementary and Integrative Health. (2016). 2016 strategic plan: Exploring the science of integrative health. Bethesda, MD: National Institutes of Health.
- Franco, I. (2011). The central nervous system and its role in bowel and bladder control. Current Urology Reports, 12(2), 153-157. doi:10.1007/s11934-010-0167-8
- Mannesse, C. K., Derkx, F., De Ridder, M., & van der Cammen, T. (2000). Contribution of adverse drug reactions to hospital admission of older patients. Age and Ageing, 29(1), 35-39.
- Kelleher, C. J., Cardozo, L. D., Khullar, V., & Salvatore, S. (1997). A medium-term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance. British Journal of Obstetrics and Gynaecology, 104(9), 988-993.
- Charles, S. T., & Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61, 383–409. doi:10.1146/annurev.psych.093008.100448
- Urry, H. L., & Gross, J. J. (2010). Emotion Regulation in Older Age. Current Directions in Psychological Science, 19(6), 352–357. doi:10.1177/0963721410388395
- Hohaus, L. C. and Spark, J. (2013). Getting better with age: do mindfulness and psychological well-being improve in old age? European Psychiatry, 28(1), 1. doi:/10.1016/S0924-9338(13)77295-X
- Geiger, P. J., Boggero, I. A., Brake, C. A., Caldera, C. A., Combs, H. L., Peters, J. R., & Baer, R. A. (2016). Mindfulness-based interventions for older adults: a review of the effects on physical and emotional well-being. Mindfulness, 7(2), 296-307.
- Fiocco AJ, Mallya S. The importance of cultivating mindfulness for cognitive and emotional well-being in late life. Journal of Evidence-Based Complementary & Alternative Medicine. 2015;20:35–40.
- de Frias CM, Whyne E. (2015). Stress on health-related quality of life in older adults: the protective nature of mindfulness. Aging & Mental Health, 19, 201–206.
- Orsega-Smith E, Goodwin S, Ziegler M, Greenawalt K, Turner J, Rathie E. Aging and the Art of Happiness: Time Effects of A Positive Psychology Program with Older Adults. (2019) OBM Geriatrics, 3(1), 19. doi:10.21926/obm.geriatr.1901029.
- de Frias CM. (2013). Memory compensation in older adults: the role of health, emotion regulation, and trait mindfulness. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 69, 678–685.
- Baker, J., Costa, D., Guarino, J. M., & Nygaard, I. (2014). Comparison of mindfulness-based stress reduction versus yoga on urge urinary incontinence: A randomized pilot study with 6-month and 1-year follow-up visits. Female Pelvic Medicine and Reconstructive Surgery, 20(3), 141-146. doi:10.1097/spv.0000000000000061
- Baker, J., Costa, D., & Nygaard, I. (2012). Mindfulness-based stress reduction for treatment of urge urinary incontinence: A pilot study. Female Pelvic Medicine and Reconstructive Surgery, 18(1), 46-49. doi:10.1097/SPV.0b013e31824107a6
- Felsted, K.F., and Supiano, K. P. (2019a). Using mindfulness approaches to treat urinary urge incontinence in older adult women: A scoping review. Integrative Journal of Nursing and Health, 2(1), 42-50.
- Felsted, K. F., and Supiano, K. P. (in press, 2019b). Mindfulness-Based Stress Reduction Versus a Health Enhancement Program in the Treatment of Urge Urinary Incontinence in Older Adult Women A Randomized Controlled Feasibility Study Research in Gerontological Nursing. Thorofare, NJ: Healio.
- Boyes, A. (Jan 10, 2013). What is catastrophizing? Cognitive distortions. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-practice/201301/what-is-catastrophizing-cognitive-distortions
- Garland, E. L., Gaylord, S. A., Palsson, O., Faurot, K., Douglas Mann, J., & Whitehead, W. E. (2012). Therapeutic mechanisms of a mindfulness-based treatment for IBS: Effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. Journal of Behavioral Medicine, 35(6), 591-602. doi:10.1007/s10865-011-9391-z
Physical Activity SIG Member Spotlight: Dr. Melicia Whitt-Glover, Gramercy Research Group
Dori Rosenberg, PhD, MPH, Rachel Millstein, PhD, MHS, & Linda Trinh, PhD; Physical Activity SIG members
Melicia Whitt-Glover, PhD
We recently interviewed physical activity expert, Dr. Whitt-Glover, about her research and how she founded her own research group.
What is your area of research?
Primarily health equity/health disparities. Much of my previous intervention work has focused on engaging low income and/or racial/ethnic minority population in health behavior change interventions to prevent and treat chronic disease (primarily obesity, hypertension, and diabetes). I've recently moved into dissemination and translation work, but I'm still fairly new to the game. Our other line of work is in program evaluation, primarily working with community-based organizations to evaluate their initiatives.
Tell us about Gramercy Research Group
Gramercy Research Group was founded in 2009. We are a public health research firm, specializing in community-based behavioral interventions focused primarily on racial/ethnic minority and low-income communities. Our mission is to combine faith, science and research to develop evidence-based programs that help individuals adopt and sustain healthy lifestyles. We provide services in the areas of program planning, program and research implementation and evaluation, dissemination, and team management and training. We are a woman- and minority-owned small business. Our initial work was primarily with the faith community and the name Gramercy combines the words grace and mercy.
Describe your training and what influenced your decision to found your own research group?
My bachelors and masters degrees are in Exercise Science, both from the University of North Carolina at Chapel Hill. My doctorate is in Epidemiology from the University of South Carolina in Columbia. I completed a postdoctoral fellowship at the University of Pennsylvania in Philadelphia, PA. My first official academic position (after my postdoc) was at Wake Forest University School of Medicine. While completing a K award, I took a course at the University of Michigan during the summer epidemiology sessions. While there I met a woman who owned an independent research firm--the first time I had ever heard of such a thing. We hit it off and I began consulting with her firm. At the same time, I was conducting community-based research through Wake Forest. I felt that I would be more effective at connecting with the local community if I was not affiliated with one of the academic institutions. Using the model for the firm that I was consulting with, I branched out and started Gramercy Research Group in 2009. This past March we celebrated our 10th year in business.
What challenges have you encountered?
We are 100% soft money so obtaining and maintaining funding is always a challenge. It's also hard to identify a good mix of new and experienced staff.
What advice would you give students and trainees who are interested in pursuing a similar career path?
I would encourage you to work in an academic setting or within an existing research and evaluation firm to build a reputation, get exposure to research and evaluation, secure publications and grant funding, and get a feel for how business works. Present at professional meetings and network as much as possible. Most of my work is funded by grants and contracts, and contracts can be greatly impacted by who you know.
Julie C. Gass, MA, PhD, Ryan J. Kalpinski, PhD, Justin M. Kimber, MA & Katherine Hall, PhD; Military and Veterans' Health SIG
Members of the Society of Behavioral Medicine are not strangers to the prevalence and costs associated with multimorbidity (i.e., co-occurrence of two or more disorders). The Military and Veteran’s Health SIG of SBM has members who are acutely aware of the uniquely high costs that multimorbidity has on active duty military and US Veterans. In this article, we review some of the basic research on multimorbidity and its impact in these populations, and finish with a call to service for all researchers who may have opportunities to work with Department of Defense (DoD) and Veterans Administration (VA) to improve the lives of our Servicewomen/Servicemen and Veterans who live with multimorbidity.
Those who Serve. In 2018, DoD Secretary Jim Mattis and Under Secretary Robert Wilkie released “Deploy or get out,” which outlines the importance of health and physical fitness as paramount to military readiness.1 This standard aims to reinvigorate the DoD’s focus on achieving optimal numbers of ‘deployable’ members, especially during times of active conflict. When military members are injured or ill, their ability to deploy and continue serving in the military is limited. Whether military members sustain injuries or become ill following deployment activities or other natural changes in their health, their active duty career depends on the speed with which they return to health. Multimorbidity among active duty members most often results in early medical retirement or administrative separation and premature transition to the VA system where most of the research has historically been implemented. Multimorbidity not only affects careers, it impairs our Nation’s ability to defend against foreign and domestic enemies.
Those who Have Served. In part directly due to their service, Veterans are at higher risk than civilians for many of the common diagnoses associated with multimorbidity (cardiovascular diseases, diabetes, cancer, mental health conditions).1-2 Though some of the contributing factors to Veteran’s multimorbidity are non-modifiable (e.g., past exposure to chemicals, military injuries, experiencing trauma), many aspects of Veteran’s multimorbidity are partially attributable to health-risk behaviors, such as smoking, excessive alcohol use, and overweight/obesity, in addition to mental health concerns such as depression. Furthermore, post-deployment reintegration problems predict later development of mental and physical problems,3 and Veterans who have seen combat are at the highest risk of conditions associated with multimorbidity.4 There is evidence that military- and Veteran issues (e.g., moral injury, military sexual trauma) specifically increase risk of modifiable diseases.5-7 Therefore, we surmise that Veterans have complex and unique needs that we cannot ignore – from reintegration to moral injury to military sexual trauma, Veteran-specific issues deserve a seat at the table when discussing behavioral interventions to reduce multimorbidity.
What are we Doing About it and What Else can we Do? Many SBM members currently work within DoD/VA settings, and we were very excited to see many presentations, symposia, plenary sessions and posters at the March Annual Meeting that focused on strategies to improve Servicemembers/Veteran’s health. Increased research and strategic planning is key – behavioral health researchers are excellently poised to improve the health of Servicemembers and Veterans. Members of SBM can contribute by (a) collaborating across systems and with DoD/VA researchers, (b) recruiting Veterans (and if possible, military members) into your research samples to improve representation, and (c) creating innovative technologies and practice to treat multimorbidity. Together, we at SBM can say “Thank You for your Service” by conducting research to improve the health and well-being of all those who have served.
- Department of Defense. (2018, July 30). Retention Determinations for Non-Deployable Service Members (DoD Instruction 1332.45). Washington, DC. Retrieved from https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/133245p.pdf?ver=2018-08-01-080044-667
- Hoerster, K. D., Lehavot, K., Simpson, T., McFall, M., Reiber, G., & Nelson, K. M. (2012). Health and health behavior differences: US Military, veteran, and civilian men. American journal of preventive medicine, 43(5), 483-489.
- Lehavot, K., Hoerster, K. D., Nelson, K. M., Jakupcak, M., & Simpson, T. L. (2012). Health indicators for military, veteran, and civilian women. American journal of preventive medicine, 42(5), 473-480.
- McAndrew, L. M., D’Andrea, E., Lu, S. E., Abbi, B., Yan, G. W., Engel, C., & Quigley, K. S. (2013). What pre-deployment and early post-deployment factors predict health function after combat deployment?: a prospective longitudinal study of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) soldiers. Health and quality of life outcomes, 11(1), 73.
- Thomas, M. M., Harpaz-Rotem, I., Tsai, J., Southwick, S. M., & Pietrzak, R. H. (2017). Mental and Physical Health Conditions in US Combat Veterans: Results From the National Health and Resilience in Veterans Study. The primary care companion for CNS disorders, 19(3).
- Jacob, L., Haro, J. M., & Koyanagi, A. (2018). Post-traumatic stress symptoms are associated with physical multimorbidity: Findings from the Adult Psychiatric Morbidity Survey 2007. Journal of affective disorders, 232, 385-392.
- Washington, D. L., Davis, T. D., Der-Martirosian, C., & Yano, E. M. (2013). PTSD risk and mental health care engagement in a multi-war era community sample of women veterans. Journal of general internal medicine, 28(7), 894-900.
- Westphal, R. J., & Convoy, S. P. (2015). Military culture implications for mental health and nursing care. OJIN: The Online Journal of Issues in Nursing, 20(1), 47-54.
Em Adams, PhDc, MS; Complementary and Integrative Medicine SIG member
|Arlene Schmid, PhD
||Marieke Van Puymbroeck, PhD
Dr. Arlene Schmid is an Occupational Therapist and Associate Professor at Colorado State University. Dr. Marieke Van Puymbroeck is a Recreational Therapist and Professor at Clemson University. Dr. Schmid and Dr. Puymbroeck have collaborated for over a decade on the use of yoga as a therapeutic intervention to improve function and wellbeing in individuals with neurological conditions.
How did you get started in this line of research?
Dr. Schmid: As an Occupational Therapist, I used yoga with my patients. I went to get my PhD solely so I could do yoga research.
Dr. Puymbroeck: Arlene made me go to a yoga class, and I hated it. Eventually I ended up in another yoga class and in my first downward dog I thought; Oh, I think this would be a great intervention for caregivers of people with stroke! My college had an internal funding mechanism, so I wrote my first grant on yoga for stroke caregivers.
Dr. Schmid: We’ve been funded pretty consistently since 2006. We’ve learned to do a lot with a little money. Now we have this really good track record; for a $50,000 grant we got six published papers and the research base for an NIH grant. That’s what funders want to see, to know that our team will be really productive and do a lot of work with a little bit of money.
How has your research evolved over the years?
Dr. Puymbroeck: Broadly speaking, our methodology is much more sophisticated. We have been very conscientious about looking at the data we collected and figuring out how we can improve the study, finding out what the limitations were, and homing in on different mechanisms we were interested in studying. We’ve figured out what we’re targeting and how to target the mechanism better.
What advice would you give to early career professionals?
Dr. Schmid: I think writing groups have been one of the best things we have ever learned. We’ve had papers published with zero revisions because four people had already looked at it and ripped it apart. The way we write grants is to have one person who will take it and run with it, and then the other person provides a thorough critique.
Dr. Puymbroeck: We’re so lucky we get to do this together. However, it’s not just luck; we were very intentional about our collaboration. We met frequently to learn how to align our work. We had to really understand each other’s areas and learn to value it. We both bring similar but different perspectives, and we’ve figured out how to align our work to be really productive—both in publishing our results and securing funding for our work.
What do you see as future opportunities in complementary and integrative medicine?
Dr. Schmid: I think there is a lot of opportunity to help therapists integrate it into practice. We’re showing complementary and integrative medicine works, but how do we help therapists use it? This application piece is important, for complementary and integrative medicine.
Preparing Students for Careers after Graduation: The Value of Community-Academic Partnerships
In the era of 200 character tweets and 10 second attention spans, university level teaching has met new challenges. It is no longer only the job of an educator to relay information to students, but it has become their job to captivate their students' attentions with practical, innovative teaching methodologies that prepare them for careers after graduation. Community-academic partnerships, offer a potential solution (e.g., service learning project, work integration learning, internships, and apprenticeships).
In 2018, the Association of American Colleges and Universities (AACU) conducted a survey of company executives and found that only 57% of executives consider college graduates prepared for an entry-level position at their companies, and only 34% believe college graduates have the necessary skills and knowledge to be promoted1. Both down 10% from only five years ago.2 These substantial reductions in students’ hiring potential signifying a growing concern from businesses, that college students are not adequately prepared for careers beyond graduation.3 Of the skills and attributes that business value most, employers report that graduates do not have global/intercultural competency (79.3%), leadership skills (77%), oral and written communication skills (58.4%), professionalism/work ethic (57.5%), and critical thinking and problem solving skills (44.2%), revealing important discrepancies between what employers are looking for and what university educators teach.4 During the last presidential keynote, at SBM’s most recent annual meeting, all types of SBM members (e.g., university professors, industry leaders, graduate and undergraduate students) voiced their support for finding better methods to prepare students for careers outside of academia. Results from the AACU report suggest that community-academic partnerships, in the form of internships/apprenticeships (94%) and community projects (83%) may be that opportunity.1
- Community-academic partnerships improve student’s cultural competency,5 leadership and communication skills, and work ethic. When working in communities, students have the opportunity to interact with practitioners and community members whose viewpoints and lived experiences may be substantially different from their own. Community organizations require students to show up on time, listening to and respect others opinions, and develop and receive feedback on their ideas. Although many of these processes already occur in the classroom, community organizations interact with culturally and socioeconomically diverse populations, which provides a broad range of perspectives that cannot be reproduced in a classroom setting. Additionally, community-based organizations evaluate ideas based on feasibility and impact, while university classrooms often evaluate on the quality and the content of the work. Many times an exciting academic idea, may have significant barriers for real world application. By participating in community-academic partnerships, students gain firsthand experience on how real world barriers influence the ideas they are developing through their coursework.
- Community-academic partnerships prepare students for careers outside academia. University classes teach new knowledge, but many times they don’t teach application of knowledge. Community organizations offer tangible problems, which require multifaceted solutions that can’t be reproduced in a classroom. When working in a community, there is a degree of uncertainty that comes from working with real people and problems, which teaches students how to apply skills as situations arise. Community partnerships also allow students to learn from individuals who have significant experience applying these skills, while gaining professional contacts that could lead to careers after graduation.
- Community-academic partnerships foster trust between universities and the surrounding community. Many universities already promote community-academic partnerships in their mission statement, but formation of these partnerships require frequent and extended dialogue between the university and community organizations. By engaging in this dialog, universities learn about the local needs within the community and each entity benefits through the collaborations that they build together. Benefits to the university could take the form of student-engagement projects, educational seminars, research studies, or through other avenues that offer application and translation of knowledge to real world settings. Benefits to the community come through a greater understanding of the importance of research, the provision of resources to organizations (e.g., free skilled labor, program assessment, needs assessment, health fairs), and by teaching community members how to protect the communities they work in (e.g., requirement of community-based participatory research processes).6 Each of these projects aids in the trust building process, which ultimately improves the community perception of the value that universities have to offer.
In a time where the utility of education has come into question3 and knowledge has become readily accessible, universities must do more than provide new knowledge. If universities wish to remain competitive in preparing individuals for careers, then universities must provide opportunities for students to grow, gain experiences, and create connections that will foster careers after graduation. Community-academic partnerships offer this opportunity.
- Hart Research Associates. (2018). Fulfilling the American Dream: Liberal Education and the Future of Work. (Washington, DC: Association of American Colleges and Universities, 2018). Retrieved from: https://www.aacu.org/sites/default/files/files/LEAP/2018EmployerResearchReport.pdf.
- Hart Research Associates. (2015). IT TAKES MORE THAN A MAJOR: Employer Priorities for College Learning and Student Success (Washington, DC: Association of American Colleges and Universities, 2018). Retrieved from: https://www.aacu.org/sites/default/files/files/LEAP/2013_EmployerSurvey.pdf
- Michael Staton. (2015). When a Fancy Degree Scares Employers Away. Harvard Business Review. Retrieved from https://hbr.org/2015/01/when-a-fancy-degree-scares-employers-away
- Jeremy Bauer-Wolf. (2018). Overconfident Students, Dubious Employers. Inside Higher ED. Retrieved from https://www.insidehighered.com/news/2018/02/23/study-students-believe-they-are-prepared-workplace-employers-disagree.
- Schutte, T., Tichelaar, J., Dekker, R. S., van Agtmael, M. A., de Vries, T. P., & Richir, M. C. (2015). Learning in student‐run clinics: A systematic review. Medical education, 49(3), 249-263.
- Caldwell, W. B., Reyes, A. G., Rowe, Z., Weinert, J., & Israel, B. A. (2015). Community partner perspectives on benefits, challenges, facilitating factors, and lessons learned from community-based participatory research partnerships in Detroit. Progress in community health partnerships: research, education, and action, 9(2), 299-311.
How to Participate in Type 1 Diabetes Research: An Introduction to the T1D Exchange Registry
Type 1 diabetes is an intensive chronic condition involving self-management of blood glucose, insulin dosing, exercise and food.1 More than a million people have type 1 diabetes in the United States.2 That number is expected to rise to 5 million by 2050. Importantly, less than a third of people with type 1 diabetes meet target blood glucose management goals.3 In the last 30 years there has been a significant change in technology used to manage type 1 diabetes.4 The T1D Exchange Registry, a web-based platform, is an innovative research study using data collected from adults and children with type 1 diabetes. The purpose is to improve the lives of people with type 1 diabetes by providing a platform to drive meaningful treatment, care, and policy with the goal of harnessing real-world data from the type 1 diabetes community. Participants will also have the ability to take part in more research opportunities in the future. The typical clinical trial environment fails to reflect the reality in which the drug or medical device may be used outside of the lab, and there may be entire groups of people missing from the analysis. Real-world evidence can fill in knowledge gaps of how a new drug or device is being used in the real world.
The Registry aims to give people with type 1 diabetes and their supporters opportunities to participate in the latest T1D Exchange-sponsored or affiliated research with the goal of accelerating care solutions and influencing public policy and insurance coverage. The Registry is already filling gaps, despite launching less than 6 months ago. “It’s been really exciting to see the diversity of experiences from participants who have joined in the early days,” says Wendy Wolf, PhD, director of the T1D Exchange Registry. “Even geographically, we already have participants from 43 states in the U.S. and 1 territory.” Specifically, the Registry will develop a more accurate snapshot of the type 1 diabetes population nationally. These answers can hopefully help advance the discovery and development of new treatments for type 1 diabetes, and inform future policy and insurance decisions. Participants will also be offered opportunities to take part in additional studies related to type 1 diabetes through this Registry - endless possibilities for new discoveries, which can evolve as the needs of the type 1 diabetes community’s needs evolve.
T1D Exchange expects to offer the following to researchers in the future: 1) datasets from the Registry cohort or specific sub-populations, 2) sponsored research opportunities, including the ability to submit a sub-study to the Registry cohort as a whole or from specific sub-populations and 3) clinical trial awareness and recruitment. For more information or if you want to join the T1D Exchange as a participant, contact email@example.com or go to https://t1dexchange.org/research/registry/.
- American Diabetes Association (2018, November). Living with Type 1. Retrieved from http://www.diabetes.org/living-with-diabetes/recently-diagnosed/living-with-type-1-diabetes.html?loc=lwd-slabnav
- American Diabetes Association (2018, March). Statistics about Diabetes. Retrieved from
- JDRF (2015, January). Type 1 Diabetes Facts. Retrieved from https://www.jdrf.org/t1d-resources/about/facts/
- Gonder-Frederick, L. A., Shepard, J. A., Grabman, J. H., & Ritterband, L. M. (2016). Psychology, technology, and diabetes management. American Psychologist, 71(7), 577.
Innovative Formats to Deliver Behavioral Interventions in Primary Care
Benjamin P. Van Dyke, PhD, Julie C. Gass, PhD, Tziporah Rosenberg, PhD, Christina B. Shook, PsyD & Jennifer S. Funderburk, PhD; Integrated Primary Care SIG
A number of evidence-based behavioral interventions for a variety of concerns that significantly impact health, such as insomnia, are suitable for primary care. However, implementation of these interventions lags behind. Due to primary care embracing the medical home model of care, it has become a place for diverse interprofessional teams to work together to help improve patient care. Embedded behavioral health providers or care managers are becoming more common, providing new opportunities for behavioral interventions. Several new formats for team delivery of interventions in primary care exist, which maximize efficiency by sharing responsibility and taking advantage of team members’ strengths. We review several formats that provide opportunities for clinicians as well as researchers for translation of behavioral treatments.
Interprofessional group medical visits (a.k.a. shared medical appointments) represent an opportunity for interprofessional healthcare team members to treat patients who share a common concern (e.g.., chronic pain) by combining group didactic sessions with brief 1:1 medical visits. Patients engage in regularly scheduled group visits in which they benefit from improved access to their healthcare providers, the benefit of behavioral interventions with additional members of a health care team (e.g., health educator), and an opportunity to share experiences. These group visits capitalize on the skills of the multidisciplinary team while enhancing focus on patient self-management, social support, enhanced access to care, and more time with their care team.
A conjoint appointment happens when two providers with different areas of expertise meet simultaneously with the patient to deliver an intervention, which can occur on an as-needed basis (ex. clinical pharmacist and health psychologist). This type of encounter can be especially useful for patients with behaviorally driven medical issues (e.g., diabetes, untreated sleep apnea) because it allows for a medical expert (e.g., physician) and other members of the team, such as an embedded behavioral health expert, to work together with the patient to tackle a complex problem. For instance, a patient who has not responded to advice to reduce their alcohol use may benefit from both providers conjointly, where the primary care provider can share the medical implications of continued alcohol use and the embedded behavioral health provider can use motivational interviewing to increase readiness to change.
An interdisciplinary evaluation and consult clinic allows patients to be seen by a team of multidisciplinary providers (e.g., primary care, psychology, pharmacy, physical therapy, etc.) during one appointment, where patients are typically evaluated in a group shared medical visit, provided relevant education, and obtain a private physical exam which results in a personalized interdisciplinary treatment plan. This approach can reduce wait times, streamline referral pathways, and enhance “buy-in” for follow-up care. For example, patients with chronic pain receive education on medications and the gate-control/neuromatrix model of pain, are evaluated in a group by psychology and clinical pharmacy, and receive conjoint physical exams from a pain physician or physician assistant as well as a physical therapist before participating in the formulation of an individualized multidisciplinary treatment plan. It is similar to an interdisciplinary geriatric primary care evaluation clinic.
- Bloor LE, Fisher C, Grix B, Zaleon CR, Wice S. Conjoint sessions with clinical pharmacy and health psychology for chronic pain: enhancing participation in behavioral management. Federal Practitioner. 2017 Apr;34(4):35. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370402/
- Burns R, Nichols L, Martindale-Adams J, & Graney MJ. Interdisciplinary geriatric primary care evaluation and management: two-year outcomes. Journal of the American Geriatric Society. 2000 Jan; 48(1): 8-13. Link: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1532-5415.2000.tb03021.x
- Kirsh, S. R., Aron, D. C., Johnson, K. D., Santurri, L. E., Stevenson, L. D., Jones, K. R., & Jagosh, J. (2017). A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?. BMC health services research, 17(1), 113. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291948/
An additional resource regarding these team-delivered interventions is SBM’s Integrated Primary Care Special Interest group. Feel free to contact us for further assistance or look at our website for additional information: https://www.sbm.org/membership/special-interest-groups/integrated-primary-care
New Articles from Annals of Behavioral Medicine and Translational Behavioral Medicine
SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine: Practice, Policy, Research (TBM), continuously publish online articles, many of which become available before issues are printed. Three recently published Annals and TBM online articles are listed below.
SBM members who have paid their 2019 membership dues are able to access the full text of all Annals and TBM online articles via the SBM website by following the steps below.
- Go to the Members Only section of the SBM website.
- Log in with your username and password.
- Click on the Journals link.
- Click on the title of the journal which you would like to electronically access.
To check if you are a current SBM member, or if you are having trouble accessing the journals online, please contact the SBM national office at firstname.lastname@example.org or (414) 918-3156.
Annals of Behavioral Medicine
Alana L Conner, Danielle Z Boles, Hazel Rose Markus, Jennifer L Eberhardt, Alia J Crum
Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans.
We explored the content, cultural patterning, and health correlates of diverse Americans’ health mindsets.
Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants’ mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1’s results to develop a closed-ended instrument.
In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans.
Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health.
Stephanie J Wilson, Alex Woody, Avelina C Padin, Jue Lin, William B Malarkey, Janice K Kiecolt-Glaser
Lonely people’s heightened risks for chronic health conditions and early mortality may emerge in part through cellular aging. Lonelier people have more severe sympathetic responses to acute stress, increasing their risk for herpesvirus reactivation, a possible path to shorter telomeres. Parasympathetic function may modulate this risk.
The current study aimed to examine the associations among loneliness, herpesvirus reactivation, and telomere length, with parasympathetic activity as a moderator, in healthy middle-aged and older adults.
A sample of 113 healthy men and women of ages 40–85 provided blood samples that were assayed for telomere length, as well as the latent herpesviruses cytomegalovirus (CMV) and Epstein-Barr virus (EBV). They also provided heart rate variability (HRV), a measure of parasympathetic activity, and reported on their feelings of loneliness.
Lonelier people with lower HRV (i.e., lower parasympathetic activity) had greater CMV reactivation and shorter telomeres compared with their less lonely counterparts, above and beyond demographics, health behaviors, resting heart rate, and social network size. However, loneliness was not associated with viral reactivation or telomere length among those with higher HRV. In turn, greater CMV and EBV reactivation was associated with shorter telomeres.
Taken together, these data implicate parasympathetic function in novel links between loneliness and accelerated cellular aging.
Derek W Johnston, Julia L Allan, Daniel J H Powell, Martyn C Jones, Barbara Farquharson, Cheryl Bell, Marie Johnston
One of the striking regularities of human behavior is that a prolonged physical, cognitive, or emotional activity leads to feelings of fatigue. Fatigue could be due to (1) depletion of a finite resource of physical and/or psychological energy or (2) changes in motivation, attention, and goal-directed effort (e.g. motivational control theory).
To contrast predictions from these two views in a real-time study of subjective fatigue in nurses while working.
One hundred nurses provided 1,453 assessments over two 12-hr shifts. Nurses rated fatigue, demand, control, and reward every 90 min. Physical energy expenditure was measured objectively using Actiheart. Hypotheses were tested using multilevel models to predict fatigue from (a) the accumulated values of physical energy expended, demand, control, and reward over the shift and (b) from distributed lag models of the same variables over the previous 90 min.
Virtually all participants showed increasing fatigue over the work period. This increase was slightly greater when working overnight. Fatigue was not dependent on physical energy expended nor perceived work demands. However, it was related to perceived control over work and perceived reward associated with work.
Findings provide little support for a resource depletion model; however, the finding that control and reward both predicted fatigue is consistent with a motivational account of fatigue.
Translational Behavioral Medicine
Kaile M Ross, Emma C Gilchrist, Stephen P Melek, Patrick D Gordon, Sandra L Ruland, Benjamin F Miller
Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices’ claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).
Shawna M Sisler, Naomi A Schapiro, Linda Stephan, Jayme Mejia, Andrea S Wallace
National pediatrics guidelines recommend screening all patients for unmet social needs to improve self-management of chronic conditions and health outcomes and to reduce costs. Practitioners involved in training pediatric clinicians need to understand how to prepare pediatric clinicians to effectively conduct social needs screening and where current training methods fall short. Our qualitative study investigated whether using “standardized” patients during trainee education improved trainees’ ability to assess and address adolescent patients’ social needs. Vulnerable adolescents should be prioritized in social determinants of health translational research because increased risk taking and emotionality may predispose this population to lower self-esteem and self-efficacy. We trained 23 adolescents (aged 16–18) recruited from an urban health-career education program to act as standardized patients (SPs). Two cohorts of nurse practitioner trainees (n = 36) enrolled in a simulation where the patient-actor presented with a minor chief complaint and related a fabricated complex social history. Pre-encounter, Cohort 1 (n = 18) reviewed psychosocial screeners; Cohort 2 (n = 18) were given in-depth information about social needs before meeting patients. SPs gave individualized feedback to trainees, and self-reflections were analyzed using thematic analysis.
In Cohort 1, trainees identified some social needs, yet few intervened. Trainees expressed discomfort in: (a) asking socially sensitive questions and (b) triaging patient versus clinician priorities. Cohort 2 demonstrated improvements compared to Cohort 1 in identifying needs yet had similar difficulty with organization and questioning.
Trainees were able to utilize a lower-stakes interaction with patient-actors to raise awareness regarding a patient’s sensitive needs and to organize care surrounding these patient-centered concerns.
Sarah Ellen Braun, Patricia Anne Kinser, Bruce Rybarczyk
Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.
Honors and Awards
Congratulations to the following Society of Behavioral Medicine (SBM) members who recently received awards or were otherwise honored. To have your honor or award featured in the next issue of Outlook, please email email@example.com.
Steven Blair, PED
Dr. Blair was recently recognized as an Expertscape World Expert, placing him in the top 0.1% of scholars writing about Physical Fitness over the past 10 years.
Dr. DiClemente was given the 2019 Jack Mendelson Award from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and will give an honorary lecture at the National Institutes of Health.
Tisha Felder, PhD, MSW
Dr. Felder was selected by the National Minority Quality Forum as one of their 2019 40 under 40 Leaders in Minority Health.
Leslie Hausmann, PhD
Dr. Hausmann was the recipient of an Outstanding Contribution to Science (Medical) award from the Federal Executive Board Excellence in Government Award Program.
Dr. Hausmann was also recently named a Certified Facilitator of the National Research Mentoring Network Entering Mentoring Program.
Amelie Ramirez, MPH, DrPH
Dr. Ramirez has been named chair of the Department of Epidemiology and Biostatistics (soon to be renamed the Department of Population Health Sciences) at UT Health San Antonio.
Cara C. Young, PhD, RN, FNP-C
Dr. Young was recently inducted as a fellow in the American Association of Nurse Practitioners.
Members in the News
The following SBM members and their research were recently featured in news articles, videos, or journals. To have your news spot featured in the next issue of Outlook, please email firstname.lastname@example.org.
John Allegrante, PhD, LHD (Hon.); Lorien Abroms, ScD
Drs. Allegrante and Abroms co-chaired the 2nd Digital Health Promotion Executive Leadership Summit, which was convened June 3-4 in Washington, DC, with Dr. Sherry Pagoto, SBM immediate past president, as a featured speaker.
Paul Estabrooks, PhD
Dr. Estabrooks was interviewed by Nebraska NPR on the health risks of a sedentary lifestyle.
Sherry Pagoto, PhD
Dr. Pagoto was quoted in an article in The Verge about health disparities in rural communities.
Ken Resnicow, PhD
Dr. Resnicow was quoted in a New York Times article on motivation interviewing.
John Torous, MD
Dr. Torous was featured in a Washington Post article about the ways in which health apps collect and share personal data.