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CLINICAL AND CONSULTING SERVICES Cardiovascular Measurement
Psychological Assessment and Intervention
Statistical Consulting Cardiovascular MeasurementNoninvasive MeasurementsAmbulatory Blood Pressure (ABP) MonitoringABP Monitors: Blood pressure monitoring during routine daily activities is performed using the Suntech AccuTracker II, a computer-based monitor with established validity and reliability. Assessments: Typical monitoring is for a 24-hour period on a workday, with four readings/hour while awake and two/hour while asleep. Utility: Ambulatory blood pressure monitoring provides unique information that is valuable for a variety of clinical and research settings, including: diagnosis of hypertension; evaluation of white coat hypertension, evaluation of the efficacy of blood pressure medications; clinical evaluation of the effective duration of antihypertensive medications; assessment of the effects of specific daily work/home activities on blood pressure. Other blood pressure monitoring capabilities include:
Impedance CardiographyImpedance cardiography presents a noninvasive method of measuring cardiac output and contractility using disposable chest electrodes which measure electrical bioimpedance. With concurrent blood pressure measurement, impedance cardiography provides continuous assessment of:
Heart Rate VariabilityHeart rate variability is assessed on the basis of ECG R-wave interval analysis during spontaneous breathing and paced respiration. A second procedure involves use of the Finapres to simultaneously record beat-by-beat interbeat interval and blood pressure. These techniques provide the basis for spectral and/or sequence analysis to generate a number of indices of autonomic function, including:
Vascular StructureStrain gauge plethysmography is used to measure forearm blood flow. This measurement is taken while the forearm tissue is ischemic, following 10 minutes of forearm exercise while blood flow to the forearm is completely occluded by a tourniquet. By measuring blood flow and blood pressure simultaneously, minimal forearm vascular resistance (MFVR) is derived. The MFVR measure is a validated index of vascular hypertrophy, making MFVR a useful measurement in the assessment of hypertensive vascular disease. Endothelial FunctionVascular endothelial function is assessed by a validated noninvasive ultrasound technique. The index of endothelial function is referred to as flow-mediated dilation (FMD) of the brachial artery, and is expressed as the percentage increase in diameter of the brachial artery resulting from increased endothelial shear stress, which is produced by reactive hyperemia. The ultrasound assessment procedure takes less than an hour. The resulting images are stored digitally and analyzed using PC-based software. AtherosclerosisCarotid artery intima-media thickness (IMT) is measured using ultrasound imaging of the left and right common carotid arteries. The assessment phase takes less than 30 minutes, and PC-software image analysis yields measures of carotid IMT based upon 12 sets of measurements. For more information, contact Andrew Sherwood, PhD at (919) 684-3828. Cardiovascular MeasurementInvasive MeasurementsPlasma CatecholaminesThe optimal methodology for drawing blood for assessment of plasma epinephrine and norepinephrine under different behavioral conditions it to take an integrated sample over the period of interest. Our sampling procedure involves the insertion of a cannula into a forearm vein. The cannula is connected by heparin-treated polyehylene tubing to a blood withdrawal pump (Cormed ML6 continuous blood withdrawal system). Blood is collected in Ethylenediaminetetraacetic acid (EDTA) treated sample-tubes at a rate of 2 ml/min. Samples are immediately cold-centrifuged and the plasma pipetted and frozen at -80C until the time of HPLC assay. Beta adrenergic Receptor ResponsivenessThe standardized isoproterenol sensitivity test is used to evaluate B-adrenergic receptor responsiveness. This test has been widely used since 1972 and its safety and reliability have been well proven. It is through the use of this test that studies indicate that there is a progressive impairment of B-sensitivity in human hypertension. This test involves the intravenous infusion of progressively increasing bolus doses of isoproterenol until a criterion response is observed. The target response is to produce an increase in heart rate of 25 bpm, assessed on the basis of the shortest three-successive ECG R-R intervals following drug injection, compared to the shortest three R-R intervals at rest (pre-injection). Alpha Adrenergic Receptor ResponsivenessThe procedure used for assessing A-adrenergic responsiveness is analogous to the B-responsiveness test described above, but this time using the Ax agonist phenylephrine, to stimulate vascular A1 receptors. In this test, criterion response is represented by a dose which raises mean arterial pressure by 25 mmHg (PD25). We have found PD25 responses to indicated significantly greater A1 sensitivity in African Americans compared to Caucasians, suggesting that A-adrenergic receptor function may be related to the higher prevalence of hypertension in African Americans. Baroreceptor Reflex FunctionGain of the baroreceptor system is derived from the slope of the peak changes in cardiac interbeat interval (IBI) associated with peak change in blood pressure in response to bolus doses of phenylephrine (see A-adrenergic receptor responsiveness procedure). This procedure is a widely used and validated technique for measuring baroreceptor gain. Our studies indicate that noninvasive estimates of baroreceptor function, using continuous blood pressure and IBI data, provide comparable information to the phenylephrine procedure. For more information, contact Andrew Sherwood, PhD at (919) 684-3828. Psychological Assessment and InterventionAnger ManagementGoals: This program is designed to help participants recognize, evaluate, and learn strategies to reduce their anger and hostility. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: This 6-session workshop is based upon the best-selling book Anger Kills by Redford and Virginia Williams. The workshop teaches participants techniques to identify, evaluate, and reduce anger. The workshop is designed to reduce the number of occasions that anger occurs, teach different response options to anger, and to improve the overall quality of relationships. For more information, contact James A. Blumenthal, PhD at (919) 684-3828. Relaxation Training and BiofeedbackGoals: This program is designed to help participants master deep muscle relaxation and gain control over physiological responses to stress and pain. The program is useful for persons with chronic and acute anxiety problems, Type A behavior, cardiovascular conditions such as hypertension, and pain, including headaches. Entry Criteria: Physician referral; Self-referral Program: Participants will work one-on-one with a trained staff member who will provide instruction in progressive muscle relaxation techniques and biofeedback using specialized equipment. Participants will learn skills to help them identify and alter physiologic responses to stress and pain both in the laboratory and at home. For more information, contact James A. Blumenthal, PhD at (919) 684-3828. Couples CounselingGoals: This program is designed to help couples who are in distressed or “self-defeating” relationships. Relationship enhancement counseling is also available for those couples who want to strengthen a generally positive relationship. The program is also appropriate for couples who are learning how to adjust to chronic illness in one partner. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: Participants will have weekly meetings with a clinical psychologist who will assist the couple in learning communication skills to improve the quality of their relationship. Examples of skills emphasized in therapy include effective methods of expressing thoughts and feelings and problem-solving techniques. The therapist serves as a facilitator to help the couple develop tools that can be used to solve a variety of relationship problems. For more information, contact Jennifer Norten, PhD at (919) 684-3828. Health Psychology ClassesGoals: This is an 8-hour experiential seminar that will help participants better understand individual stress reactions, develop coping skills to handle stress, examine priorities, and set and achieve health and quality-of-life goals. Entry Criteria: Physician referral; Self-referral Program: This 8-hour class covers stress management, coping skills reducing unwanted aspects of Type A behavior, breaking habits, improving communication skills, examining priorites, and setting/achieving health and quality-of-life goals. For more information, contact James A. Blumenthal Ph.D. at (919) 684-3828. Individual CounselingGoals: This program is designed to help participants cope with life stress, chronic illness, problems in living, and more severe psychological disorders such as major depression, post-traumatic stress disorder, or other mood or anxiety disorders. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: Participants will be assigned to an individual therapist based on presenting issues. Participants will meet regularly with the therapist who will provide supportive therapy and/or more structured services, depending on participant needs. Participants will learn to recognize maladaptive behavior patterns, and will be assisted in learning how to implement strategies for behavior change. For more information, contact Mike Babyak, PhD at (919) 684-3828. Mental Stress TestingOverview: In mental stress testing, patients/volunteers are exposed to a variety of mental challenges in a controlled laboratory environment, while their behavioral and physiological responses are closely monitored and recorded. Stressors: Examples of our established mental stress tests include: public speaking, mental arithmetic, reaction time, reverse mirror tracing, anger interview. Facility: Our test facilities include acoustic chambers, which provide a quiet, electrically-shielded and temperature-regulated environment. Measurements: Our current facility permits monitoring of blood pressure, heart rate, heart contractility, stroke volume, cardiac output, systemic vascular resistance, plasma epinephrine, norepinephrine and cortisol responses during mental stress. Utility: Mental stress is often associated with pronounced physiological activation. Individuals differ markedly in their cardiovascular responses during mental stress. For example, heart rate responses may range from no discernible change to increases of over 100 bpm. Studies of cardiovascular responses during stress suggest that hyperreactivity is linked to the development of cardiovascular disease. Physiological responses during stress also provide objective assessment of a patient's stress response, permitting evaluation of treatment effects on stress. Stress response physiology is also a useful tool for evaluating autonomic nervous system function. For more information, contact Andrew Sherwood, PhD at (919) 684-3828. Psychological AssessmentGoals: Diagnosis of psychopathology, personality disorders, and neuropsychological deficits including assessment of depression, anxiety, Type A behavior, memory disturbances, and eating disorders. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: Interview and psychological testing using standardized psychometric instruments (e.g., MMPI, SCL-90, Beck Depression Inventory, JAS etc.), projective testing (e.g., TAT, Rorschach, etc.), and neuropsychological measures (Reitan-Halstead Battery) is available. Patients will meet with a clinical psychologist for one or more diagnostic interview and testing sessions. Comprehensive reports will be provided to the referring physician. For further information, contact James A. Blumenthal, PhD at (919) 684-3828. For more information, contact Mike Babyak, PhD at (919) 684-3828. Sexual Dysfunction CounselingGoals: This program is designed to help participants cope with sexual problems such as erectile dysfunction, premature ejaculation, low sexual desire, orgasmic difficulties, etc. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: Participants will meet with a clinical psychologist who will assist patients in identifying and modifying physical, psychological, and relationship factors contributing to sexual dysfunction and/or dissatisfaction. When indicated, referral to appropriate medical subspecialties including urology, endocrinology, and gynecology will be expedited. Treatment may involve work with the participants sexual partner, as well as individual counseling. For more information, contact Steve Herman, PhD at (919) 684-6475. Smoking Cessation CounselingGoals: For the person who wishes to stop smoking, this program will assist the participant in breaking the nicotine addiction decisively and developing a healthier overall lifestyle. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: The program begins with an intensive assessment interview with Dr. Herman, who reviews the participant’s smoking habit and identifies factors critical in accomplishing permanent smoking cessation. An individually-tailored cessation plan is then implemented, which may include nicotine replacement and/or pharmacotherapy, self hypnosis or relaxation training, lifestyle modifications, and other appropriate interventions. For more information, contact Steve Herman, PhD at (919) 684-6475.
Stress ManagementGoals: This program is designed to help participants learn to manage reactions to stress. It is particularly appropriate for persons with high levels of stress, “Type A personalities,” and patients at risk for heart disease, although it will be useful for all people who want to learn how to decrease the stress in their lives. Candidates: Program and non-program participants Entry Criteria: Physician referral; Self-referral Program: This program consists of individual and group training in stress management techniques. The group consists of a series of 16 1.5 hour sessions. Initial sessions include discussion about the role of stress in the development of coronary heart disease. Later sessions involve instruction in specific skills to reduce the affective, behavioral, cognitive, and physiologic components of stress. This program can also be offered individually. For more information, contact James A. Blumenthal, PhD at (919) 684-3828. Weight Loss CounselingGoals: This program is designed to help participants implement behavioral strategies to lose weight. Candidates: Program and non-program participants Entry Criteria: Physician referral, Self-referral Program: This is an individually tailored program based upon behavioral weight loss principles. Participants will meet with a clinical psychologist who will help the patient identify psychological and behavioral barriers to weight loss. Participants will work with the psychologist to develop and implement a individualized plan for behavior change. This program serves as an adjunct to nutritional and medical services. For more information, contact James A. Blumenthal, PhD at (919) 684-3828. Statistical ConsultingConsultation is available for design and analysis in the following areas:Design and PlanningSelecting appropriate
measures AnalysisANOVA, ANCOVA, MANOVA,
MANCOVA Confirmatory factor analysis Partial least squares
modeling (soft-modeling) For more information, contact Mike Babyak, PhD at (919) 684-3828. |
