The overarching goal of this program is to design and conduct research for the purpose of further understanding and promoting the integration of the physical, emotional and intellectual aspects of health in treatment and in theory. We support this goal through both treatment and exploratory research. Our treatment research studies seek to enhance behavioral medicine interventions and the relapse prevention of health-related conditions. Furthermore, we seek to identify the physiological, neurobiological and psychological mechanisms behind such health conditions and how they interact.
Our present studies focus on the effects of a novel telephone-based system (TIVR) for relapse prevention in participants who have completed skills-based Cognitive-Behavioral Therapy (CBT) groups for chronic pain management and/or weight control. In addition we study the mechanism of pain and coping by utilizing functional MRI (see Functional Brain Imaging Program).
We are most grateful for the enthusiastic participation of our patient volunteers, without whom none of this research would be possible.
Faculty and staff involved in this research program include:
Elena Ramirez, Ph.D., Licensed Psychologists, Weight Control Specialist
Janet Kahn, Ph.D., Research Consultant
Lari Young, M.D., Research Associate
We are currently conducting the following projects:
Therapeutic IVR for Relapse Prevention in Chronic Pain
The primary goal of this project, funded by the National Institute of Health (NIH), directed by Magdalena Naylor, M.D., Ph.D, is to examine the effectiveness of a telephone based self-help system (TIVR, see below) as a tool to management of chronic pain and to prevent relapse into pain behaviors. Patients who complete the 11-week group CBT for management of chronic pain are eligible to participate in this project.
Chronic pain is a common and seriously debilitating condition. Medical and surgical interventions produce only variable results and frequently pain is not adequately controlled. When cure is not possible and pain becomes chronic, self-management of pain becomes a valuable treatment option. Numerous controlled clinical trials of group cognitive-behavioral therapy (CBT) have demonstrated its effectiveness for treatment of chronic pain. However, maintenance of coping skills after CBT training has been completed is variable, and patients may experience decline in therapeutic benefit within several weeks.
To reduce relapse into pain behaviors we developed and pilot-tested a telephone-based Therapeutic Interactive Voice Response (TIVR) system as a tool for maintenance enhancement extension of group coping skills training.
The TIVR has four components: 1) an automated daily questionnaire for self monitoring, 2) a didactic review of coping skills, 3) guided behavioral rehearsals of CBT coping skills, and 4) monthly feedback messages recorded on to the TIVR by the therapist. All four components can be accessed remotely by patients via any touch-tone phone. The present study is a randomized controlled trial (RCT) of the TIVR in patients with chronic musculoskeletal pain. Patients completing our 11-week group CBT for management of chronic pain are randomly assigned to one of three treatment conditions. Participants will be followed for 1 year, with quarterly check-up intervals. Our pilot studies have shown not only maintenance of improvement gained by group participation, but continued improvements in pain levels, ability to function and perceptions of control over pain at 4 and 8 months following treatment with TIVR.
Our collaborators on these projects include Frank Keefe, Ph.D., Professor of Psychiatry and Behavioral Sciences and Anesthesiology, Duke Medical Center, and Dennis C. Turk, Ph.D., the John and Emma Bonica Professor of Anesthesiology and Pain Research at the University of Washington.
This study is for adults (ages 18 and over) who have chronic musculoskeletal pain lasting longer then 6 months and who have completed our 11-week CBT skills group for management of chronic pain. Patients with pain from cancer or cancer treatment are not eligible for this study. Participants in our research will receive complimentary quarterly evaluations by our staff for 1 year and will also be reimbursed $25 quarterly for their time.
For more information on this study, contact Kim Garrett at (802-847-2673 or 847-COPE) e-mail MBMC@vtmednet.org
Can Cognitive Behavioral Therapy (CBT) modify the dysfunctional emotional and sensory neural circuitry associated with chronic pain as examined by functional magnetic resonance imaging (fMRI)? An fMRI Pilot Study
The primary goal of this investigation is to use functional magnetic resonance imaging (fMRI) to study the impact of group cognitive behavioral therapy (CBT) on emotional neural circuitry in healthy individuals as well as those with chronic pain. Chronic pain is a multifaceted experience involving both sensory input and the emotions. Psychotherapeutic treatments for chronic pain management can be effective for treating the emotional components of the overall pain experience.
This study is for adults (ages 18 and over) who have chronic musculoskeletal pain lasting longer then 6 months and who are enrolled in our 11-week CBT skills group for management of chronic pain. Patients with pain from cancer or cancer treatment are not eligible for this study. Participants in our research will undergo two MRI exams and evaluations by our staff.
All fMRI research is done in collaboration with UVM's Functional Brain Imaging Program directed by Drs. Paul Newhouse and Julie Dumas.
Our goals at the MindBody Medicine Clinic are to pursue research projects that lead to improvements in diagnosing and successfully treating individuals with persistent pain. For more information on this study, contact the MBMC at (802-847-2673 or 847-COPE) e-mail MBMC@vtmednet.org
A Randomized, Controlled Trial of Telephone-Based Extended Therapy for Post-Cognitive Behavior Therapy (CBT) Weight Maintenance
Recruitment for this research study is closed.
This Pilot Study, funded by a New Research Initiative (NRI) through the University of Vermont and run by Dr. Magdalena Naylor, M.D., Ph.D., is designed to explore a novel telephone-based system called Therapeutic Interactive Voice Response (TIVR) as a tool to promote and maintain weight loss and reduce relapse rates after successful weight reduction in obese patients. Patients who complete the UVM Weight Control Program directed by Dr. Elena Ramirez, Ph.D. of The Vermont Center for Cognitive Behavior Therapy are eligible to participate in this project which uses the telephone to administer a confidential daily self-monitoring questionnaire through the TIVR to report weight, caloric intake totals, nutritional values and length of time spent exercising (TIVR Component 1). Additionally, participants can review and rehearse specific skills (TIVR Component 2 & 3) learned during the 18 weeks of Group Cognitive Behavioral Therapy (CBT). Participants also receive confidential and personalized monthly messages that have been recorded by the therapist (TIVR Component 4). The daily calls begin immediately upon completion of CBT and randomization to either a control (no TIVR) or six months of treatment group (TIVR use). Subjects in both groups will be assessed at the conclusion of the six-month TIVR trial, and 6 months later (i.e.12 months post CBT).
In addition to the TIVR, all research participants will be invited to take part in an objective measure of changes in body size, composition, and metabolism that may occur as a result of weight loss and maintenance. This portion of the study involves 4 visits to the General Clinical Research Center (GCRC) at the Fletcher Allen Medical Center.
Previous weight loss research suggests that continued assistance post CBT can prolong and amplify therapeutic impact. The study may help us determine whether a TIVR maintenance protocol will enhance the beneficial effects of an 18-week cognitive behavioral therapy (CBT) weight loss program for obesity either through continuance of weight loss or weight maintenance.
