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Behavioral Medicine

Clinician Talking with Young Adult Cancer PatientBehavioral medicine is an interdisciplinary field focused on the integration of behavioral, psychosocial and biomedical science in an effort to understand, prevent and treat disease. Among the first behavioral medicine programs in the country, Duke draws together experts from clinical psychology, public health, nutrition and medicine. Our services are led by prominent clinical scientists who are internationally recognized for their contributions to advancing the well-being of individuals, families and communities.

Changes in behavior and lifestyle can improve health, prevent disease and reduce symptoms of illness, including cardiovascular diseases, pain syndromes, diabetes and gastrointestinal disorders. Behavioral medicine faculty develop and implement innovative behavioral interventions that combine research, cutting-edge technology and the best clinical practices to promote healthy lifestyles, prevent disease and reduce the impact of chronic illnesses.

Our faculty develop innovative interventions aimed at improving health and functioning in a variety of patient populations that are tested in clinical trials. Duke faculty lead and collaborate with other scientists nationwide in many of the clinical trials that define the evidence base for clinical best practices. We're currently engaged in a number of clinical trials aimed at helping individuals achieve behavioral changes in order to improve their health and functioning in areas such as cardiovascular disease, chronic pain, obesity and weight management and smoking cessation.

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. 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.”

 

What is Metabolomics?

Metabolomics is the study of metabolism at the global level. It involves systematic study of the "metabolome," the complete repertoire of small molecules present in cells, tissues or organisms. The identities, concentrations and fluxes of these compounds represent the product of interactions that extend from gene sequence to include gene expression, protein expression and the total cellular environment, an "environment" that, in the clinical setting, includes drug exposure. Metabolomics has been identified as an important area for technical development under the NIH Roadmap Initiative. Sophisticated metabolomic analytical platforms and informatics tools have been developed that make it possible to begin the process of defining signatures for disease and for response to drugs used to treat disease.

 

Pharmacometabolomics & Personalized Medicine

Pharmacometabolomics is the use of the techniques of metabolomics to define metabolomic signals that will provide insight into mechanisms of drug action or mechanisms responsible for individual variation in drug response phenotypes. Those phenotypes can vary from life threatening adverse drug reactions to lack of the desired therapeutic efficacy. Pharmacometabolomics could contribute significantly to our attempts to truly individualize drug therapy.
 

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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Alzheimer’s Disease Metabolomics Consortium

The Alzheimer’s Disease Metabolomics Consortium is a bold initiative funded by the National Institute of Aging that brings together leaders in Alzheimer’s disease clinical and basic research to work in close collaboration with centers of excellence in metabolomics, genetics, biochemistry, engineering and bioinformatics.

The Consortium aims to define metabolic failures across the trajectory of disease connecting peripheral and central changes. We define alterations in biochemical pathways and networks that can help us gain deeper understanding of disease mechanisms and that can highlight novel targets for drug design.

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Alzheimer’s Gut Microbiome Project

The Alzheimer Gut Microbiome Project is an initiative funded by the National Institute of Aging to investigate the role of the gut microbiome and metabolome in Alzheimer's Disease pathogenesis and in the development of neuropsychiatric symptoms. It brings together 40 scientists from 14 academic institutions to define the role of complex bidirectional interconnections involving the diet, exposome, lifestyle influences, gut microbiome and genome on the metabolome to inform about individuality, vulnerability and unique trajectories of Alzheimer’s disease.

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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

The Duke Behavioral Health and Technology Lab at Duke University Medical Center conducts clinical research on the use of mobile technology to help improve the mental health and wellbeing of Veterans and military Service members. Our mission is to create accessible, effective, and easy-to-use mobile technology solutions to common mental health concerns, so that Veterans can take an active role in their own path to healing.
 
The Duke Behavioral Health and Technology Lab joined the Duke research community in 2016, and current studies are supported by grants awarded by the National Institute of Health and the United States Department of Defense.
 

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
     

 

Interested in Participating in Research Studies?

At the Duke Behavioral Health & Technology Lab, we look for new ways to improve health and well-being through the use of mobile technology and behavioral health interventions. Periodically, we have new opportunities for people to participate in our studies. If you would like to be considered for participation in a future study, please consider joining the Duke Behavioral Health and Technology Data Repository.

Learn More
 

 

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

The overall goal of our research is to develop, implement, and evaluate novel approaches to assess and treat persistent pain, symptoms (e.g., fatigue, nausea) and the physical psychological demands associated with chronic medical illnesses (e.g., cancer, arthritis). Our faculty are involved in developing an array of psychosocial interventions to help patients and their family members cope with these challenges.
 
Our faculty have expertise in cognitive-behavioral interventions (e.g., pain coping skills training), emotional disclosure protocols, virtual reality interventions, mind-body interventions (e.g., yoga, mindfulness) and couple-based interventions, as well as telephone-based and mHealth interventions utilizing videoconferencing and web-based delivery.
 

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

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

Behavioral Cardiology & Clinical Behavioral Medicine

With the ultimate goal of developing, implementing and evaluating psychological and lifestyle interventions for primary and secondary prevention of cardiovascular diseases, the laboratory examines mechanisms underlying the development of cardiovascular disease and seeks to better understand the impact of psychosocial factors on health and illness.
 

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
Postdoctoral fellows, cardiology fellows, residents and medical students have the opportunity to participate in this work.
 

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

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

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

Cancer Symptom Management & Support

The Cancer Symptom Management & Support program focuses on conducting clinical research and providing behavioral medicine services to address the psychological, social, behavioral and symptom management needs of cancer patients and their families. This program is a division of the Duke Pain Prevention & Treatment Research program and part of the Duke Cancer Patient Support Program.
 
Program faculty have expertise in developing and evaluating interventions focused on emotional distress, symptom management, adherence, sexual health and comorbid chronic health conditions. A range of modalities for delivering interventions are being evaluated, including in person, telephone and mobile health technology-based strategies.

 

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

Oncology behavioral medicine services are provided through the Duke Cancer Patient Support Program. These services are available for patients, their families and caregivers in the outpatient clinics of the Duke Cancer Center, Duke Women’s Cancer Care Raleigh and the Duke Adult Blood and Marrow Transplant Program. 
 

Clinical Training

Training, focused on behavioral medicine in the oncology setting, is provided for clinical psychology trainees completing postdoctoral training, doctoral internship and practicum rotations as part of doctoral training. This program is based on a scientist-practitioner model of training.
 
Clinical experiences include CBT-based psychotherapy, manualized behavioral interventions for symptom management, health behavior interventions and psychological assessment. Experiences aim to provide trainees with knowledge and skills for treating psychological, social, behavioral and symptom management issues that occur during the cancer experience. 
 

Faculty

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

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
Faculty

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

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Biofeedback and Pain Management

Our program seeks to understand and treat psychological and psychophysiological contributors and consequences associated with the onset, maintenance, and resolution of chronic pains. Applying scientific methods, we study, evaluate and treat chronic pains in a wide range of disease states including low back, failed back surgery syndromes, fibromyalgia, sickle cell disease, headaches, trauma and injury related pains, neuropathic conditions, phantom limb pains, post-surgical pains, urological and gastric pains. We also treat conversion disorders and somatoform presentations that include pain and neurological symptoms. The laboratory has a long and successful history treating conditions like chronic pain, hypertension, Raynaud’s Disease, and other conditions where autonomic dysregulation is common using biofeedback, pain coping skills training and psychotherapy.

 

Clinical Services

  • Clinical EMG and Thermal Biofeedback
  • Short- and long-term psychotherapy
  • Crisis management
  • Consult liaison service
  • Pre-surgical/ procedure psychological screening
  • Pre-narcotic psychological screenings
  • Coping skills training/ Relaxation training
  • Anxiety and stress management
  • Natural language psychological testing and interventions (Spanish)
  • Couples therapy
  • IME and forensic evaluations
  • Diagnostic assessments and psychotherapy with multicultural and diverse populations to include natural language Spanish evaluations and treatment
  • Personality testing

 

Research

Research in our laboratory focuses on a range of clinical interests represented by our diverse senior and junior faculty as well as trainees. These include, but are not limited to, psychosocial and medical factors that influence the manifestation of pain in diverse populations of patients with Sickle Cell Disease, diabetes, and chronic regional pain syndromes (CRPS). Studies include the exploration of genetic, medical, and psychosocial factors associated with the conceptualization, evaluation and treatment of chronic pains in patients with Fibromyalgia and dementias as well as diverse populations that are aging healthily with and without chronic pains. Active studies also include explorations of clinical pain outcomes in diverse patients undergoing surgical weight management, and explorations of the relationship of chronic pains to perceived body image and body mass index (BMI).  Lastly, we study social conditions associated with clinical health outcomes among Hispanic, Afro-Caribbean and Black populations and psychosocial factors that predict cardiovascular risk among diverse patients with chronic pains.

 

Training Opportunities

We host and train MD, PhD, and RN trainees in all phases of academic development to include undergraduate, graduate, practicum, internship, and post-doctoral training experiences.

 

Faculty

We are proud of our diverse faculty, trainees and staff allowing our service to effectively serve a wide range of clinical populations.

Miriam Feliu, PsyD
Katherine Applegate, PhD
LaBarron Hill, PhD
Keisha-Gaye N. O’Garo, PsyD

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