Matthew M. Burg, PhDprofessor of medicine (cardiovascular medicine), has devoted much of his career to studying how stress and psychological experiences contribute to heart disease and its consequences. Burg, a clinical psychologist, was recently elected president of the Behavioral Medicine Research Academyan organization of researchers elected by their peers in recognition of their work to advance the broad field of behavioral health.
We spoke with Burg about his presidency, his recent research, and his aspirations to better integrate behavioral and psychological health into cardiovascular medicine.
Congratulations on your election as President of the Academy of Behavioral Medicine Research. What does this new role mean to you?
Being elected President of the Academy by my peers is an incredible honor.
I believe my election is not only recognition of my research, but also recognition that we can do more to contribute to external conversations to improve public health. For several years, I have encouraged my colleagues in the academy to speak out and comment on issues related to public health. As behavioral health experts, we have the knowledge and responsibility to share what we know to help prevent disease and improve the health of our population.
More than half of the chronic disease burden can be attributed to individuals’ lifestyle and living conditions. To address the burden of chronic disease, we must do more to integrate psychological and behavioral health, a field called behavioral medicine, with public health.
You were the first clinical psychologist to hold a position in cardiovascular medicine at Yale. How do you think this arrangement helps improve patient care?
We know that behavioral and psychological health are essential to patient well-being. Some studies show that integrating behavioral medicine into medical care improves patient outcomes, increases patient satisfaction, and reduces healthcare utilization.
For example, studies have found that combating depression in a patient with a chronic illness will improve their blood pressure, lipid levels, etc. These changes are likely due to the patient now adopting a healthier lifestyle and taking their medications.
Yale has made progress in this effort. We have now brought Kim Smolderen, Ph.D.And Allison Gaffey, Ph.D.both clinical psychologists, who conduct research and see patients. I hope we continue to integrate behavioral and psychological health into clinical care.
What do we know about the impact of mental health and psychological experiences on the cardiovascular system?
We know there is a clear relationship between psychological experiences and the heart, but we are still learning about the direct effects of negative emotions on the cardiovascular system.
I recently co-wrote a study examining how negative emotions affect endothelial functionwhich is a biomarker of very early risk of heart disease. In a healthy person, the endothelium expands and contracts depending on the metabolic needs of different areas of the body. In our study of healthy people, we found that simply telling a story that made you angry or anxious can damage your endothelial cells. This damage or death of endothelial cells could lead to coronary heart disease.
Our study provides additional evidence that negative emotions and the effects of stress have very real biological effects that are part of the heart disease trajectory.
Are there interventions to eliminate or reduce the impact of this physical reaction?
Yes, in other publications we have shown that a simple stress reduction intervention eliminates this response.
We tested a centering interventionwhere we asked a person to think about what they really value. Then, when we asked them to think about a situation that made them feel stressed or angry, these emotions no longer had the same negative effect on endothelial function.
This was a small study with only a small number of participants, but it shows the promise of these interventions. If you expand it and focus on people at high risk of major cardiac events, you could make a huge difference in patient outcomes.
Why is it difficult to integrate behavioral and psychological health into clinical care?
One of the challenges is reimbursement models. Medicare, Medicaid, and private insurance companies offer meager reimbursement for psychological services. Changing culture is difficult, especially in healthcare, where many people and entities are involved in caring for patients in both inpatient and outpatient settings.
Another important challenge is that we do not have models of care to refer to. My goal is to test integrated cardiovascular care delivery models in which we address depression, anxiety, loneliness, stress, and lifestyle behaviors to help prevent and slow the development of heart disease.
Behavioral health research needs to expand into the clinical realm to implement some of these interventions earlier in the research process. We also need to consider a broad range of outcomes such as patient satisfaction, unnecessary care utilization, and patient engagement in their own care.
If we show improvement in these results, I hope it will inspire others to change their payment model and culture and overcome other barriers.
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Spicer J, Shimbo D, Johnston N, Harlapur M, Purdie-Vaughns V, Cook J, Fu J, Burg MM, Wager TD. Prevention of stress-induced endothelial injury through values affirmation: a proof-of-principle study. Ann Behav Med. June 2016;50(3):471-9. doi: 10.1007/s12160-015-9756-6. PMID: 26608279; PMCID: PMC5087990.