This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) from the NIMH to enable Dr. Kamila White to develop expertise in studying psychological factors in patients with noncardiac chest pain (NCCP). This applicant will work closely with her mentor, Dr. David Barlow, and co-mentors Drs. Ernest Gervino, Nicholas Covino (at Beth Israel Medical Center), Tim Brown, and Richard Mayou at Oxford University. Dr. White's short-term goals are to strengthen her theoretical, methodological, and statistical skills in clinical trials and in the study of NCCP. Her long-term goals are to develop an independent lab funded by external sources and to develop a network of research scientists central and peripheral to Boston University devoted to advancing the understanding of anxiety in noncardiac chest pain. The above goals will be accomplished through didactic training and formal investigation of anxiety and psychological vulnerability in patients with noncardiac chest pain who present to an urban, university-affiliated cardiology clinic. The majority of patients with chest pain and normal coronary angiograms complain of continuing chest pain, fear, and preoccupation with heart functioning. Recurrent chest pain and continued anxiety about heart functioning not only cause much personal discomfort but may also lead to significant disability. To date, research on NCCP has been largely descriptive and has been limited by lack of an empirically supported theoretical model. Longitudinal studies examining the causal role of anxiety and psychological risk factors have not been examined in NCCP, but represent an important approach to understanding the development and maintenance of pain in this population. The goals of the proposed research program are 1) to prospectively evaluate a theoretical model of NCCP, 2) to examine the causal role of anxiety and psychological vulnerability factors in predicting long-term disability, and 3) to identify potential protective factors that may be important in intervening with this population. Data from this research program will allow Dr. White to establish an empirical foundation from which to apply these data to the development of novel interventions for patients with NCCP.
