Behavioral Medicine

Pharmacometabolomics

Led by Rima Kaddurah-Daouk, PhD, the Center for Pharmacometabolomics at Duke is the coordinating center for Pharmacometabolomics Research Network, which includes more than fifteen academic centers. It is also home for the Molecular Psychchiatry Metabolomics Program program, where metabolomics is used to map pathways implicated in neuropsychiatric diseases. 

The Pharmacometabolomics Research Network is a collaborating network established with funding from NIGMS. Its goal is to integrate the rapidly evolving science of metabolomics with molecular pharmacology and pharmacogenomics to move toward the creation of a new discipline: “pharmacometabolomics.”

This multi-institutional interdisciplinary research consortium involves centers of excellence in metabolomics and metabolomic bioinformatics, together with centers for molecular pharmacologic and pharmacogenomic science that will move beyond focused scientific collaboration to create an environment in which a cooperative, iterative process of hypothesis generation and testing will be applied to achieve the union of metabolomic and pharmacologic science to create pharmacometabolomics. This merge has the potential to accelerate advances in our understanding of mechanisms of drug action and individual variations in drug response.

What is Metabolomics?

Pharmacometabolomics & Personalized Medicine

Pharmacometabolomics Research Projects

Under the molecular psychiatry program at Duke, we bring the power of metabolomics technologies to interrogate perturbations in networks and pathways in psychiatric disorders such as schizophrenia, depression, Alzheimer’s disease and addiction disorders. Additionally, we investigate metabolic effects of drugs used for the treatment of these diseases.

We are grateful for the funding we have received for these projects from the Stanley Foundation, NASAD, National Institute of Neurological Disorders and Stroke (NINDS), National Institute of General Medical Sciences (NIGMS), National Institute of Mental Health (NIMH) and the Alzheimer’s Drug Discovery Foundation.
 

Mood Disorders Precision Medicine Consortium

The Mood Disorders Precision Medicine Consortium (MDPMC) is an integrated team of academic researchers dedicated to improving the lives of patients who suffer from major depressive disorder and bipolar disorder. Comprised of leading experts in the fields of genetics, metabolomics, neuroimaging, bioinformatics, and clinical trials, the MDPMC’s mission is to achieve the precision medicine goals of individualizing treatment for mood disorder patients based on an integrated biological understanding of their illnesses and variation in response to treatments.

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Schizophrenia: A Major Public Health Problem

Schizophrenia is arguably one of the most disabling of all diseases, being relatively common, with onset typically in adolescence and running a lifelong disabling course. Approximately five percent of patients end their lives by suicide and overall patients die prematurely (from cardiometabolic deaths not just suicide) some 25 years earlier than the general population. Schizophrenia, by any estimate a devastating condition, is characterized by highly distressing positive symptoms (e.g., delusions and hallucinations), negative symptoms (e.g., impaired volition, and emotion), impaired cognition and social functioning. Although the exact etio-pathobiology of schizophrenia remains elusive, fundamental abnormalities in phospholipids (which play a critical role in membrane structure/ function and neurotransmission) as well as key neurotransmitter pathways (dopamine, serotonin, glutamate) are evident in schizophrenia.

Through our schizophrenia research, we have used lipidomics analysis and confirmed that there are major changes in phospholipids early in the disease process (Kaddurah-Daouk et al. 2007). Additionally, we have mapped, in greater detail, perturbations in neurotransmitter and purine pathways (Yao et. al. 2009, 2010, 2011). Metabolic signatures of three antipsychotic drugs are being studied and a first report describing their impact on lipid metabolism has been published (Kaddurah-Daouk et al. 2007).

Alzheimer’s Disease

Alzheimer’s disease (AD) is the leading cause of dementia, affecting over five million people in the U.S., with more than 10 million aging baby boomers estimated to be at risk in the coming decades. Although the cause for AD is still not known, it is clear that there are profound biochemical alterations in multiple pathways in the AD brain. The lack of validated “mega” metabolic platforms has limited the ability to simultaneously study the dozens of different biochemical pathways that may be affected in AD both in relation to each other as well as in relation to other biomarkers and progression. Such studies could also help derive peripheral biomarkers (e.g. plasma or urine) that would offer simplicity and cost effectiveness for use in a wide range of settings. Metabolomics is the systematic study of the “metabolome,” the complete repertoire of small molecules present in cells, tissues or organisms. Metabolomics provides a powerful new approach to evaluate global biochemical changes in AD.

In AD, we have several ongoing studies where we are mapping metabolic signatures early in the disease process and comparing metabolic changes that occur centrally and peripherally. Metabolic data are also being integrated with data from imaging studies and other omics data.

Addictions

Through our addiction research, we have mapped metabolic signatures for exposure to cocaine and opioids (Mannelli et al. 2009 & Patkar et al. 2009).

Projects within the Pharmacometabolomics Research Network:

• Depression
• Hyperlipidemia
• Antiplatelet Therapy
• Antihypertensives

Behavioral Medicine Research Center

The Behavioral Medicine Research Center (BMRC) was founded in 1986, when an anonymous corporate gift established the BMRC endowment, which has grown to its present level in excess of $20M. The income from the endowment is used to support the research, clinical and training missions of the center. Unrestricted research support for 10+ senior BMRC investigators from various departments and disciplines has enabled them to undertake pilot studies, enhance ongoing studies and support trainees who work on their research projects. This seed money has played an important role in BMRC investigators' success in obtaining over $100M in peer reviewed grant support from the NIH.

BMRC investigators' research programs cover the entire spectrum of behavioral medicine, ranging from studies of basic mechanisms whereby psychosocial and behavioral factors affect the development and course of medical disorders using techniques of molecular biology and genetics in both animal and human models to the development and evaluation of innovative behavioral treatment and prevention interventions for a broad range of medical disorders, including cardiovascular diseases, pain syndromes, diabetes and gastrointestinal disorders. BMRC financial support of the collaboration between Department of Psychiatry & Behavioral Sciences health psychologists and the Arts & Science Department of Psychology & Neuroscience played an important role in the Clinical Psychology PhD program in the Department of Psychology & Neuroscience being ranked among the top 10 programs in the U.S.

Behavioral Health & Technology Lab

Mobile Technology

Neuromodulatory Treatments for Pain Management in Traumatic Brain Injury (TBI)

• Funding Agency: U.S. Department of Defense
• Principal Investigator/Lab: Eric Elbogen, PhD
• Mobile Technology Used: Mobile applications for iPod Touch
• Purpose of the Study: To test the feasibility and effectiveness of using mobile neuromodulatory applications for reducing pain symptoms in veterans with TBI
   

Mobile Health Application for Family and Behavioral Health Provider Communications

• Funding Agency: InferLink Corporation
• Principal Investigator/Lab: Eric Elbogen, PhD
• Mobile Technology Used: Mobile application for iPhone and Android
• Purpose of the Study: To examine feasibility, tolerability, utilization, and effectiveness of using the SupportTeam mobile application in the context of Cognitive Behavioral Therapy (CBT) for veterans with post-traumatic stress disorder (PTSD)
   

Pain Management Using Mobile Technology in Veterans with PTSD and TBI

• Funding Agency: National Center for Complementary and Integrative Health
• Principal Investigator/Lab: Eric Elbogen, PhD
• Mobile Technology Used: Mobile application for iPod Touch, Neurosky mobile neurofeedback headset
• Purpose of the Study: To test the feasibility and effectiveness of using mobile neurofeedback devices for reducing pain symptoms in veterans with PTSD and TBI
   

Currently Enrolling Research Studies

• Neuromodulatory Treatments for Pain Management in TBI
  This randomized controlled trial aims to explore the efficacy of neuromodulatory treatments for chronic pain for post-9/11 veterans with co-occuring pain and TBI. 

Other Research Studies

• Mobile Health Application for Family and Behavioral Health Provider Communications
  The goal of this study is to learn more about improving the quality of treatments for Veterans with PTSD and anger using a supportive mobile application (app) for smartphones. Read the related publication.
   

• Pain Management Using Mobile Technology in Veterans with PTSD and TBI
  The purpose of this study is to determine whether a mobile technology program may help with chronic pain. This research study involves Veterans using an iPod Touch® and NeuroSky® MindWave headset to practice neurofeedback, which is a form of biofeedback that allows people to train their brains to be in a calmer, more relaxed state. Read the related publication.
   

• Neural Markers and Rehabilitation of Executive Functioning in Veterans with Traumatic Brain Injury and Post-Traumatic Stress Disorder
  This study aims to explore the relationship between brain function and connectivity in selective pathways/circuits, neuropsychological functioning, and cognitive rehabilitation response in Veterans with both TBI and PTSD. Participants use iPod touch apps and programs that address and aim to improve different facets of cognitive functioning, and family members are trained as "mentors" to reinforce use of the applications in everyday living environments. Read the related publication.
   

• Improving Money Management Skills for Veterans With Psychiatric Disabilities
  Using an individualized, psycho-educational intervention called $teps for Achieving Financial Empowerment ($AFE), this study aims to teach veterans with psychiatric disabilities how to save money, create a viable budget, avoid money scams and financial exploitation, and access vocational and mental health resources. Read the related publication.
   

Core Research Faculty and Staff

• Eric Elbogen, PhD: Professor in the Department of Psychiatry at Duke University, Director of the Duke Behavioral Health and Technology Laboratory, and Local Recovery Coordinator at the Durham VA Medical Center.
• Amber Alsobrooks, MS, MA, LPA: Licensed Psychological Associate and Clinical Research Coordinator for the Duke Behavioral Health Technology Lab.
• Sara Battles, MEd: Clinical Research Coordinator for the Duke Behavioral Health Technology Lab with a Master’s in Education for Counseling.
• Megan Lanier, BS: Clinical Research Specialist with the Duke Behavioral Health and Technology Lab
• Alexandra Thompson, BS: Clinical Research Specialist with the Duke Behavioral Health and Technology Lab

Click on a faculty member’s name to view their profile, including their grants and publications.

Contact Us

919-681-1613
vetstudy@duke.edu
2424 Erwin Road, Hock Plaza Suite G05, Durham, NC 27705
psychiatry.duke.edu
durham.va.gov

Pain Prevention & Treatment

Current NIH-Funded Studies

• Caregiver-guided pain management intervention for patients with advanced cancer

• Yoga-based symptom management for women with metastatic breast cancer

• Mechanisms of psychosocial interventions for chronic back pain, including cognitive therapy, behavioral therapy and mindfulness
• Perisurgical coping skills intervention to enhance the outcomes of knee replacement surgery in osteoarthritis patients
• Adherence and symptom management intervention for breast cancer patients taking adjuvant endocrine therapies
• Optimizing delivery of a behavioral cancer pain intervention 

Faculty

• Francis Keefe, PhD (director)
• Daphne McKee, PhD
• Laura Porter, PhD
• Rebecca Shelby, PhD
• Tamara Somers, PhD

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Behavioral Cardiology & Clinical Behavioral Medicine

Techniques Used by the Lab

• Ambulatory blood pressure monitoring
• Echocardiography
• Heart rate variability
• Vascular stiffness
• Vascular endothelial function
• Carotid intima-media thickness
• Exercise treadmill testing
• Accelerometry
• Medication adherence
• Lifestyle interventions, including exercise, coping skills training and stress management, DASH diet and weight reduction

Current NIH-Funded Studies

• The use of the DASH diet and exercise in the management of treatment resistant hypertension
• Mechanisms responsible for the increased risk of hypertension and left ventricular hypertrophy in African Americans
• The effects of diet and exercise on neurocognition in older adults with evidence of cognitive impairments without dementia
• Behavioral determinants of disease progression and outcome in patients with congestive heart failure
• The use of exercise and pharmacotherapy for patients with symptoms of elevated anxiety and coronary heart disease
• Causes and consequences of a blunted "dip" in blood pressure during nighttime sleep

Faculty

• James A. Blumenthal, PhD (director)
• Andrew Sherwood, PhD (co-director)
• Benson Hoffman, PhD
• Krista Ingle, PhD
• Patrick J. Smith, PhD
• Gregory Stonerock, PhD
• Lana Watkins, PhD

Click on a faculty member’s name to view their profile, including their grants and publications.

Traumatic Stress & Health Research

With the ultimate goal of developing and implementing innovative behavioral interventions to reduce negative health behaviors (e.g., smoking), particularly in high-risk medical or psychiatric patients, the laboratory examines mechanisms associated with health outcomes and at risk groups.

Techniques & Approaches Used by the Lab

• Mobile health (mHealth) applications to promote behavioral change
• Tele-health to increase reach of behavioral interventions
• Ambulatory monitoring of physiology and behavior
• Behavioral interventions to reduce substance misuse (smoking, alcohol, cannabis)
• Behavioral interventions to increase physical activity

Current NIH & VA Studies

• The Effect of Reducing Posttraumatic Stress Disorder Symptoms on Cardiovascular Risk
  The proposed research is relevant to public health because the findings will indicate whether autonomic nervous system dysfunction, inflammation, and vascular endothelial dysfunction are the direct result of PTSD symptoms or an indirect effect secondary to behaviors related to trauma exposure. NIH R01HL130322 (PIs: Beckham and Watkins) 

• Gene x Environment Effects on PTSD
  The purpose of this project is to identify how genetic and epigenetic factors interact with trauma exposure to predict PTSD and other forms of psychopathology among Iraq/Afghanistan-era veterans. IK2 CX000525 VA Clinical Science Research and Development (Kimbrel, PI) 

• Genetic and Epigenetic Dissection of PTSD
  The goal of this project is to examine the underlying cause of PTSD by evaluating genetic variants, DNA methylation and environmental influences in trauma exposed populations. VA Merit Review (Beckham, PI) 

• Non-suicidal Self-Injury (NSSI) is Veterans with PTSD
  The goals of this project include: (1) Quantifying the prospective impact of NSSI on key functional outcomes, including treatment utilization, functional impairment, and risk for suicidal behavior, and (2) Identifying factors that underlie and maintain NSSI in Veterans with PTSD. VA Merit Review (Kimbrel, PI) 

• Mobile Contingency Management for Concurrent Abstinence from Alcohol and Smoking
  This treatment development project is designed to refine a combined treatment for smoking cessation and alcohol use disorder. NIH R34AA023877 (PIs: Dedert and Calhoun) 

• A personalized mHealth approach to smoking cessation for Veterans living with HIV. 
  VA 1K2 HX002398 (Wilson, PI) 

• Preventing Suicide through Implementation of Safety Planning for Peer Support Specialists
  The objective of this project is to prevent suicide among firefighters by developing and implementing an online safety planning training program for firefighter peer support specialists. FEMA EMW-2017-FP-00385 (Kimbrel, PI) 

• Impact of Reduced Cannabis Use on Functional Outcomes
  The overall objective of this study is to use ecological momentary assessment, a real-time, naturalistic data collection method, to prospectively study the impact of reduced frequency of cannabis use on functional outcomes (e.g., mental health symptoms, health-related quality of life) among heavy cannabis users. R21-DA045113 (PIs: Kimbrel/Beckham, Multiple PIs) 

• Using ‘Big Data’ and precision medicine to assess and manage suicide risk in U.S. veterans
  The objectives of this multi-site, multi-PI project, which is jointly funded by a VA CSRD Merit Award, VACO, and the Department of Energy (DoE) are to: (1) use machine learning and AI to develop personalized, longitudinal risk scores for acute suicidal behavior in Veterans; (2) conduct the largest GWAS of suicidal behavior to date among ~450,000 Veterans; (3) develop tools that will help VA clinicians and administrators identify high-risk Veterans as well as effective interventions and public health approaches to reduce the occurrence of death by suicide and suicidal behavior among Veterans. VA I01CX001729 (Beckham, PI) 

Faculty

• Jean C. Beckham, PhD
• Patrick S. Calhoun, PhD
• Eric A. Dedert, PhD
• Paul A. Dennis, PhD
• Nathan A. Kimbrel, PhD
• Elizabeth E. Van Voorhees, PhD
• Sarah M. Wilson, PhD

Click on a faculty member’s name to view their profile, including their grants and publications.

Cancer Symptom Management & Support

Current Studies

• Evaluation of an intervention to improve adherence and symptom management for breast cancer patients taking adjuvant endocrine therapies. (PI Shelby; NIH)
• Comparison of diabetes education and a diabetes self-management intervention for women with breast cancer and type 2 diabetes. (PI Shelby; American Cancer Society)
• Optimizing delivery of a behavioral cancer pain intervention using a SMART (PI Somers; NIH)
• In Person and Mobile Health Coping Skills Training for Improving Symptom Management and Daily Steps in Hematopoietic Stem Cell Transplant Patients. (PI Somers; Cancer Control Population Sciences Pilot Award)
• Meaning-Centered Psychotherapy and Pain Coping Skills in Advanced Cancer (PI: Winger; American Cancer Society Postdoctoral Fellowship Award

Clinical Services

Clinical Training

Faculty

• Rebecca Shelby, PhD
• Tamara Somers, PhD
• Sarah Kelleher, PhD
• Caroline Dorfman, PhD
• Catherine Majestic, PhD

ACT in Context Research: Eating Disorders

Acceptance and Commitment Therapy (ACT) in Context Research is affiliated with the ACT at Duke program. The laboratory uses contextual behavioral science to understand and treat human suffering. Although humans suffer in many ways, the ACT in Context lab focuses on maladaptive eating and weight control that arise from an adversarial relationship with the body and signals arising from the body, including hunger and satiety, as well as emotions and the somatic constitutes of emotion. Most of our work has focused on two populations for whom this issue is life-threatening: individuals with anorexia nervosa and individuals with type 1 diabetes who withhold insulin to control weight.

We use multi-modal and ecological momentary assessment methods to elucidate functional relationships between momentary experience and behavior and develop and test novel applications of ACT.

Our work also extends to other chronic illnesses in which eating, weight and physical activity are central issues in reducing mortality or morbidity risk (e.g., type 2 diabetes), and includes grant-funded research in the area of eating disorders and maladaptive eating and weight control, novel adaptations of ACT and diabetes management; affiliated patient care and training clinic (specializing in ACT); and opportunities for graduate students, interns, residents and fellows to participate in research or related clinical training and services.

Areas of Investigation

• Real-time assessment and intervention strategies
• Experiential avoidance
• Interoceptive awareness
• Use of acceptance, mindfulness and values in the treatment of maladaptive eating and weight control
• Restriction, binge eating and insulin omission
• Novel ACT treatments

Collaborations

• Visceral sensitivity in anorexia nervosa
• Disgust and fear conditioning in anorexia nervosa
• ACT for fibromyalgia syndrome
• Virtual reality eating disorder prevention programs
• Development of an ambulatory device to train emotional awareness and emotion regulation
• Telehealth for COPD

Funded Research Projects

• Acceptance-based separated family treatment for adolescents with anorexia nervosa
• Real-time bio-behavioral precursors to eating disorder symptoms among individuals with type 1 diabetes
• mHealth intervention for individuals with type 1 diabetes who restrict insulin to lose weight
• Appetite regulation among individuals with type 1 diabetes
• ACT intervention for type 2 diabetes delivered in primary care

• Rhonda M. Merwin, PhD (director)
• Ashley A. Moskovich, PhD
• Lisa K. Honeycutt, LPC

Click on a faculty member’s name to view their profile, including their grants and publications.

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