Some of the best ways to prevent and treat illness will not be discovered by biologists, chemists or geneticists: They'll be discovered by behavioral researchers, according to Jessie Gruman, PhD, executive director of the Center for the Advancement of Health. She was one of several speakers at a congressional hearing where psychologists and others outlined the public health benefits that could result from increased investment in behavioral research.
The Sept. 25 briefing, "Behavior and health: new research, new hope," showcased the research of psychologists supported by the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), all of which have benefited from the doubling of the National Institutes of Health (NIH) budget to more than $27 billion over the past five years.
"Behavioral research is a core part of what NIH does, and it will be especially important in the coming decades as we try to translate basic research into effective treatments," said Raynard S. Kington, MD, PhD, director of the Office of Behavioral and Social Sciences Research at NIH.
The briefing was co-sponsored by APA, the American Psychological Society and the Federation of Behavioral, Psychological and Cognitive Sciences. Support was also provided by the Decade of Behavior, the Kellogg Foundation and the office of Rep. Patrick Kennedy (D-R.I.).
Helping smokers quit
In recent years, psychologists, neuroscientists and other behavioral researchers have made advances in understanding addiction that are opening up a number of potential new avenues for drug abuse treatment, said David Shurtleff, PhD, acting director of the Division of Neuroscience and Behavioral Research at NIDA. He cautioned, however, that "there's still a lot we don't know about treating addiction."
Timothy B. Baker, PhD, a psychology professor at the University of Wisconsin-Madison, is one of the researchers who is trying to close the gap between basic science and effective treatment.
When he began studying smoking cessation, said Baker, treatment programs were no more effective at producing long-term abstinence than self-directed quitting was. Now, in part because of NIDA-funded research, about 35 percent of patients in treatment programs are successful, compared with only 5 percent of smokers who quit on their own, he said.
At the briefing, Baker presented surprising evidence that depression, irritability and other withdrawal symptoms can reappear months after the initial cessation of smoking. Using Internet-based monitoring of patients' symptoms, he hopes to design interventions that could prevent such delayed withdrawal symptoms from triggering relapse.
"We know so much more than we used to know about treating smoking and other addictions," concluded Baker. "It's an exciting time."
Understanding basic mechanisms
"Translational research"--also known as "bench-to-bedside research"--is critical to NIMH's mission of improving the treatment of mental illness, according to Bruce Cuthbert, PhD, chief of the Adult Psychopathology and Prevention Research Branch at the National Institute of Mental Health.
At one end of the spectrum of translational research are scientists working with practitioners to develop and disseminate new treatments, said Cuthbert; at the other end are researchers using basic science to improve their understanding of clinical disorders.
James Gold, PhD, a professor at the Maryland Psychiatric Research Center at the University of Maryland, is at the latter end of the spectrum. At the briefing, he discussed his use of recent advances in the neuroscience of attention to understand cognitive impairments associated with schizophrenia.
Current treatments for schizophrenia can mostly eliminate hallucinations, delusions and other positive symptoms, he said, but they have little effect on negative symptoms like cognitive impairment and lack of motivation. Now, Gold is using measures of attention developed by Steven Luck, PhD, a psychology professor at the University of Iowa, to uncover the basic cognitive impairments that cause those negative symptoms.
"You know there's smoke, but you can't see the fire," said Gold. "What we're trying to do is bring advances in basic neuroscience into the clinic and find the fire."
The exchange of ideas between basic neuroscience and clinical psychology could eventually benefit both fields, said Gold, because mental disorders offer a unique window into what happens when the brain fails. "Until you see things fall apart, you don't know exactly what held them together," he said.
Improving clinical trials
Behavioral research is a high priority at the NCI, said Robert Croyle, PhD, NCI's associate director for behavioral research, because biomedical treatments are only effective when paired with an in-depth understanding of the factors that influence health behavior.
Behavioral research may even be able to improve the process of biomedical research itself, suggested Croyle. NCI is currently planning a trial of methods of diagnosing lung cancer that will require the enrollment of tens of thousands of patients nationwide, and research by NCI-supported behavioral scientists could help recruitment efforts go more smoothly for both researchers and patients.
In her briefing presentation, Terrance Albrecht, PhD, a psychology and oncology professor at the H. Lee Moffitt Cancer Center at the University of South Florida, discussed her research on one of the most important social situations in clinical trials: the initial meeting between a physician and a patient who is eligible for enrollment.
With the help of a digital video system built using funding from NCI, she said, "we can look at the extent to which communication actually mediates the other determinants of what a patient might decide to do." The results of her research could lead to major improvements in the way patients are recruited into clinical trials.
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