Congratulations on your recent promotion! Can you tell us about your career path from Clinical Psychologist to Research Associate?
Thank you! The functioning of the mind and its interplay with physical health has always been something fascinating to me. Consequently, my doctoral thesis in clinical psychology was an in-depth investigation of how individuals cope with cancer, basically examining the interrelationships between symptoms of anxiety, depression, insomnia, fatigue, and pain over the disease care trajectory. For several years, I also worked as a clinician with individuals suffering from cancer and chronic pain helping to alleviate their psychological distress and finding more meaning in life despite their health challenges. Conducting research and clinical work concurrently is very stimulating as both areas nourish each other! In fact, this is what brought me to public health: many patients I have seen wondered to what extent “stress” was involved in the development or progression of their disease. The cancer literature at that time was somewhat limited, and results were inconsistent, sometimes because of methodological pitfalls. Thus, I joined HSPH in May 2014, to acquire training from world-leading experts in social epidemiology and further investigate this question. As a postdoctoral fellow and now a research associate, I aim to disentangle whether psychological distress (e.g., anxiety, depression, insomnia) is related to future risk of cancer and reduced survival in cancer patients, and if this association could be explained by the adoption of an unhealthier lifestyle (e.g., physical inactivity, unfavorable diet, smoking). This research is of considerable importance because it identifies modifiable determinants of cancer, which is one leading causes of death worldwide.
What are the next objectives in your research, and who will you be collaborating with from the Lee Kum Sheung Center for Health and Happiness?
At the Center for Health and Happiness, I participate in novel research that considers psychological well-being (e.g., optimism, emotional vitality, life satisfaction) as an asset against risk of cardiometabolic disease, and if it may favor a healthier lifestyle. I also co-lead a working group on the measurement of psychological well-being with Tyler VanderWeele. One of our goals is to unravel the role of psychological well-being on chronic disease incidence and mortality, beyond statistical adjustment for confounding variables including negative factors (e.g., anxiety, depression) and self-rated health, and to explore if distinct dimensions of well-being have a different impact on health outcomes.
My future research will integrate my expertise in both negative and positive health determinants. Specifically, I am interested in understanding whether emotion regulation (how individuals adaptively or maladaptively manage emotional experiences) is a critical higher order process that influences biological and behavioral pathways involved in chronic diseases and longevity. These ideas unfold from work conducted with my HPSH colleagues Paola Gilsanz, Murray Mittleman, and Laura Kubzansky in which we proposed a theoretical framework using emotion regulation to understand existing, sometimes conflicting results on the psychological determinants of hypertension in adults (2015; Current Hypertension Reports). More recently (2017; Current Opinion in Behavioral Sciences), Farah Qureshi, Allison Appleton, Laura Kubzansky, and I extended this theoretical model by positing that emotion regulation is a psychological process that potentially impacts multiple chronic diseases, and their shared potential pathways (e.g., lifestyle, chronic inflammation), across the life course.
What are the potential implications of learning more about emotion regulation both from a clinical health psychology perspective and from a public health perspective?
From a clinical health psychology standpoint, emotion regulation is a capital process because it is transdiagnostic, which means that difficulties in regulating emotions are shared by multiple psychiatric diagnoses and may drive various psychological symptoms. Prior work, including my own research, also hypothesizes that emotion regulation as an overarching determinant would affect a wide array of biobehavioral pathways and chronic diseases including mortality. Consequently, a better understanding of the interplay between emotion regulation and physical health may not only help prevent deleterious behavioral and biological processes, incident chronic diseases and reduced longevity, but also improve the mental health of disease-free individuals and medical patients, a critical outcome on its own.
From a public health standpoint, identifying such an upstream determinant is of major relevance because both psychological distress and chronic diseases are generating tremendous costs in the U.S., using around 86% of the nation’s health care expenditures. Additionally, worse mental and physical health are related to elevated disabilities (e.g., lower work productivity). Bearing in mind these direct and indirect expenses, enhancing emotion regulation abilities has the potential to yield substantial cost reduction and enhanced capacity at the population level. Notably, 1 out of 2 Americans suffered from a chronic disease in 2012, and nearly 20% reported mental illness in 2015. Viewing emotion regulation as an overarching determinant may facilitate knowledge transfer and in turn, cost reduction. For instance, experienced clinicians (e.g., psychologists) may train health care providers (e.g., general practitioners, clinical nurse specialists) in delivering key emotion regulation strategies to their patients. In fact, adopting a transdiagnosis approach will help to narrow the number of therapeutic strategies needed. In this way, I hope this research will identify pivotal interventions that will have a greater impact on mental and physical health at the population level.
Thank you, Claudia!
Read more about Claudia’s work here and follow her on Twitter @claudiatfitz.
-Interview by Whitney Waddell
