Psychosocial Determinants of Health and Illness Laboratory

Health and illness are determined by more than disease-causing agents like bacteria, genetic predispositions, or environmental exposures.  Psychosocial and behavioral factors such as depression, anger and hostility, stress, exercise, and diet, for example, also heavily contribute to whether people remain healthy or become sick.  

For 30 years, our laboratory has been devoted to identifying these non-medical factors, understanding their mechanisms of action, and testing interventions to address them.  We have used conventional experimental approaches, observational studies, “quasi-natural” experiments, and field studies to elucidate how these factors “get under the skin” to influence the risk of disease in those who are healthy and affect recovery in those who already are sick.   

Much of our work involves exploring the role of the nervous system health and illness and we have approached this matter by studying the effects of increasing or decreasing nervous system regulation of the heart.  In normal healthy individuals, the behavior of the heart is heavily regulated by the nervous system and we can use heart rate as a readout of underlying physiology.  Disrupting this control of the heart by cutting the nerves would be enormously informative but highly unethical.  However, several medical treatments either do precisely this or something very similar.  After cardiac transplantation, the graft heart is no longer connected to the nervous system and beats solely based on its intrinsic pacemakers.  Somewhat similarly, patients with end stage heart disease now routinely receive ventricular assist devices that free the diseased heart from the burden of pumping blood into the circulation.  We have capitalized on these quasi-experimental models of functionally disconnecting the heart from the circulation to test the role that an intact heart plays in the response to psychological stress.   

Less dramatically, we have employed laboratory studies in which groups of participants – some healthy and some with disease – are exposed to stresses designed to mimic real world challenges but in the controlled setting of the laboratory where we can precisely measure the physiology associated with disease and determine how it is affected by stress.  We have combined this approach with interventions such as aerobic exercise training and cognitive behavioral treatment of hostility and anger to test the mechanisms by which these psychological states influence health and illness and how these interventions promote wellbeing.  

Some important questions can be answered outside of the laboratory, in observational studies of large cohorts of participants who vary in important dimensions related to health, e.g., early life adversity, exposure to environmental challenges, and socioeconomic status.  Over the course of many years, we have participated in many such studies that have enrolled thousands of participants in whom many dimensions of health and illness are measured multiple times over decades.  Using this approach, we have demonstrated, for example, that specific branches of the nervous system are essential to regulation of the immune system and the development of coronary artery disease.  

Finally, recognizing that laboratory studies, while powerful investigational tools, nonetheless represent highly artificial situations and thus may limit the generalizability of findings.  An alternative approach is to collect data in the real world, capitalizing on the increasing availability of tiny wearable monitors that now can measure underlying physiology that decades ago required a room full of equipment to measure.  Using these monitors as well as smartphone-based assessments of psychological states as they vary throughout the day allows us to understand how the “texture of everyday life” contributes to the elevation and reduction of the risk of disease in the real world, not the artificial environment of the scientists’ laboratories.  

Principal Investigator

Research Staff