We have identified 5 barriers, which we believe have impeded the impact of mind-body (behavioral) medicine on the general medical community. Each of these is a theme of our infrastructure proposal, and will be addressed by 4 Cores. The 1st theme concerns causal mechanisms: much of the evidence relating stress, cognitions, and emotions to chronic disease is based on observational studies. We propose that such mechanisms are better tested within interventional trials, and that the same mediators may be involved in different types of behavioral intervention. Accordingly, in Core A (Mechanisms) we will develop 2 test batteries, one evaluating behavioral factors (based on cognitive adaptation theory), and the other biological factors (based on the concept of allostatic load), and we will assess their causal status 3 ongoing behavioral clinical trials. The 2nd theme is lack of standardization of measures of psychological variables, which will be dealt with by the proposed battery in CoreA, and also a Cochrane review of other relevant assessment areas in Core D (Dissemination). The 3rd theme is health disparities and ethnicity. The prevalence and adverse consequences of most chronic diseases are worse in minority populations, and psychosocial factors are thought to play a major role. However, many of the instruments used to evaluate these have not been adequately tested in these populations. Core B (Minority Health Oversight) will address these issues. The 4th theme is information technology (Core C). Communication between patients and investigators or therapists is critical to any behavioral medicine endeavor, and we propose developing new techniques for data acquisition using tablet and hand-held computers, which should improve the quality of the data. In addition, behavioral medicine is interdisciplinary, and Core c will facilitate communications between investigators both within the Columbia community and outside it. The 5th theme is dissemination (Core D) - we believe that most medical practitioners are simply unaware of the existing achievements of behavioral medicine, and this Core will perform and disseminate Cochrane reviews of behavioral intervention trials and assessment instruments. The ultimate goal will be to make our findings available to 3 target audiences: 1) the network of investigators at Columbia; 2) the behavioral medicine community; and 3) the general medical community.
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