I take great pleasure in introduction of the winner of the 2010 APA Division 38 Excellence in Health Psychology Research Award. This year’s awardee has made significant and sustained contributions to health psychology, with direct applications to a variety of diseases including hypertension, Raynaud’s Disease and other significant disorders. But most notably, our awardee has established much of our current understanding of behavioral mechanisms in the etiology and treatment of diabetes. Richard S. Surwit, PhD is Professor and Vice Chairman, and Chief of the Division of Medical Psychology in the Department of Psychiatry at Duke University Medical Center. I have known Richard for 28 years, as a friend and as a mentor. During that time, Richard has been a significant driving force in establishment of the emerging field of Behavioral Diabetology.

The recent acceleration of the incidence of diabetes and obesity in our culture is deeply disturbing. But even more shocking is that what we once knew as “Adult Onset Diabetes” is not just for adults any more. Sadly, the aggressive penetration of obesity and Type II Diabetes into our youth is a frightening wakeup call and a dire warning. Moreover, diabetes and obesity are now clustering in metabolic syndrome and multiplying the risk for our number one killer of men and women, coronary heart disease. Since his first seminal publications on diabetes and behavior in 1982 (Surwit, Sovern & Feinglos, 1982) and 1983 (Surwit, Feinglos & Scovern, 1983), Richard’s systematic research program has pioneered biobehavioral investigation of both Type I and Type II Diabetes. And he has attacked this using a converging spectrum of methodologies, from basic research on etiology to applied findings that have fundamentally changed our approach to management and treatment of diabetic patients.

Most notably, Richard’s research has clarified the interactions between genes and environment on expression of the diabetic phenotype. He has studied the neuroendocrinology of stress on insulin resistance and hyperglycemia in animals, including the genetically obese mouse (ob/ob), mice with diet-induced diabetes and genetically selected miniature swine; and also in human populations including African American women and diabetes-prone Pima Native Americans. His mouse strain with diet-induced diabetes is the most widely used mouse model of diet induction of diabetes and obesity. His studies of the interaction of stress hormones and adipose tissue mass on glucose metabolism have reached beyond behavioral science into more basic integrative physiology.

From the bench to the bedside, Richard’s research has changed the practice of diabetology. For example, he has outlined the therapeutic effects of diet, exercise, stress management, leptin supplementation and anxyolytic benzodiazepines. His work has been applied to better understanding of diabetes effects on cognitive function, autonomic neuropathy and other indices of pathophysiology and clinical course. Finally, during the past quarter century, Richard pioneered the use of computers to help physicians and patients better manage complex chronic diseases. His work has resulted in six U.S. and multiple foreign patents for innovative devices and systems for better patient treatment.

Richard Surwit is one of the founding fathers of the emerging field of behavioral diabetology. I am pleased that APA’s Division 38 now recognizes Richard as this year’s recipient of the Excellence in Health Psychology Research Award.

References

• Surwit, R.S., Scovern, A.W., & Feinglos, M.N. (1982). The role of behavior in diabetes care.Diabetes Care, 5, 337-342.
• Surwit, R.S., Feinglos, M.N., & Scovern, A.W. (1983). Diabetes and behavior: A challenge for health psychology. American Psychologist, 38, 255-262.

Dr. Grace completed her PhD in 2001 in Applied Social Psychology, thus is 9 years past her final academic degree. Since then, she has been an active researcher in the field of psychosomatic medicine, first as a post-doctoral fellow then as a Scientist at the University Health Network, Toronto General Research Institute in Ontario, Canada. She is now also a tenured position at York University, and several other cross-appointments.

She currently has 70 papers published or in press in journals with moderate to high impact factors. One of these papers was recently recognized for the Dorfman award for best original article published in the journal Psychosomatics. According to ISI global citation thresholds, 37.5% of her articles are categorized as “highly cited”. This is in addition to 6 symposia, 78 abstracts, 23 presentations, 32 invited presentation, 7 government report or Clinical Practice Guideline chapters, and 8 papers under review (plus 2 invited for revision and resubmission).

Her strong external funding history totals almost $5.5 million dollars, including 2 operating grants as Principal Investigator from our national health research funding agency called CIHR, which is the Canadian equivalent of NIH, as well as a career salary grant.

She is actively involved in graduate training and providing service to the community. All but one of her graduate students has held external funding scholarships, and all have defended within the recommended program duration. Her service activities include membership on the Canadian Association of Cardiac Rehabilitation Board of Directors, and on chronic disease management working groups at the provincial and regional level. She serves on the Editorial Board of the Journal of Cardiopulmonary Rehabilitation and Prevention.

Her research program centers on psychosomatic issues in cardiovascular care and cardiac health services. Specifically, she investigates (1) the influence of emotional health on the recovery process from acute cardiac events and procedures, and (2) how these psychological factors influence access to and participation in secondary preventive services.

Arguably the most meritorious publication which she has contributed to the field to date explored the question of depression timing in the presence of acute coronary syndromes with regard to onset, history and persistence, and how this is associated with mortality. Depression is associated with increased morbidity and mortality among coronary artery disease (CAD) patients, after controlling for severity and prognostic indicators. With outstanding questions regarding mechanisms, screening and treatment, this work was undertaken. The manuscript presented data from a cohort of over 900 cardiac patients from multiple hospitals. Administrative databases were used to ascertain five-year mortality rates. After adjusting for prognostic indicators such as cardiac disease severity, previous medical history and smoking, depressive symptomatology during hospitalization was significantly predictive of mortality (HR=1.9), but depressive history was not. This work was published in 2005 in the American Journal of Cardiology. The findings were highlighted in Nature Clinical Practice: Cardiovascular Medicine (2006, 3[1], p.6), and the paper has been cited 45 times to date. In particular, it has incited a line of replication studies starting with a paper by deJonge et al. published in JACC(48 [11], pp. 2204-2208).

She has since tested the relationship of depression onset timing to in-hospital complications. This manuscript is currently in press in the journal Psychosomatics. She has also undertaken a meta-analysis to investigate whether a new onset of depression post-CAD is linked to greater mortality and morbidity among CAD patients. Results confirmed it was (RR=2.13) and this paper is submitted to JAMA.

In general, she has outstanding achievements for a researcher only 9 years after her final degree. Dr Grace is an extraordinarily productive as a researcher, a gifted teacher and a delightful, generous and warm colleague!

Dr. Daniel Bruns is a clinical health psychologist in full-time practice in Greeley, Colorado. He works in a multidisciplinary practice providing diagnostic and treatment services for medical patients suffering from injuries or illness. Many consider integrated care to be the ideal model for American health care; Dr. Bruns is the consummate example of a psychologist successfully delivering psychological services as part of an integrated care setting. He has always been concerned with the widespread misperception that psychologists treat only mental health conditions.

To address this, in 1998, he created a website containing information, presentations and webinars about topics such as integrated primary care, somatization, pre-surgical psychological evaluations, billing, guidelines and evidence-based practice. The website has drawn nearly two million visitors from approximately 130 countries. Information published on his website – http://www.healthpsych.com – was incorporated into the Official Disability Guidelines and California medical regulations.

Dr. Bruns has been very active in the area of medical guidelines and the passage of biopsychosocial legislation, particularly in Colorado, but these efforts have had impact nationwide. Through Dr. Bruns efforts, Colorado became the first state to have regulations that mandated a biopsychosocial medical treatment model in the worker compensation system. Dr. Bruns took a leadership role in the development of these worker compensation guidelines, including the Colorado Chronic Pain Guidelines. Portions of the Colorado guidelines pertaining to psychological services have since been adopted by the Official Disability Guidelines (used by payors and governments), and by the states of California, Texas, Oklahoma, Kansas and Delaware. Dr. Bruns used secondary data sources to examine the impact of this biopsychosocial law on the medical costs of 520,000 injured workers in Colorado over a 15 year period. Using the financial data of 29.2 million injured workers in 45 other states as a baseline, he demonstrated that Colorado’s medical inflation in the workman’s compensation system dropped sharply after the adoption of the biopsychosocial model. The existence of the database to conduct this analysis was almost unknown, and access was extremely limited. It took Dr. Bruns the better part of a year to gain access to the database but his findings are truly remarkable.

Dr. Bruns also has a substantive publication record that is highly relevant to the practicing clinician. Particularly noteworthy is his work developing a published standardized test for medical patients, the Battery for Health Improvement 2 (BHI 2). Developing the BHI 2 required 18-years of research, dealing with a range of theoretical and psychometric issues and extensive data collection involving 50 psychologists and 50 other professionals; years were then spent on the development of software that writes a computerized report narrative. The BHI 2 is published by Pearson Assessments and is considered one of only two major standardized psychological inventories developed specifically for medical patients.

Dr. Bruns has delivered yeoman’s service to Division 38. His practical knowledge and conceptual clarity have been invaluable to the Interdivisional Healthcare Committee (IHC) – a group of like-minded divisions that work together to bring mutual concerns to the attention of the APA Practice Directorate; Dr. Bruns served as Division 38’s representative to the IHC. He has also served as Chairperson for Division 38’s Clinical Health Services Council, a member of the Division 38 Board, the Division 38 liaison to APA’s Committee for the Advancement of Professional Psychology, a member of Long Range Plan Guideline Subcommittee, and a member of the Medical Psychology Subcommittee. The Division and all of APA have benefited greatly from Dr. Bruns service; hopefully, he will remain engaged for many years to come.

Dr. Bruns has accomplished all of this without any support from a university, hospital or grant, and for the most part without free access to medical library services. All of his research and service activities are entirely self-funded. Academics publish and provide service as part of the terms of their employment. Dr. Bruns is in full time practice and does this kind or work entirely pro bono- a demonstration of his commitment to clinical health psychology as a field. Division 38 is honored to recognize his service and accomplishments with the Timothy B. Jeffrey Memorial Award for Outstanding Contributions to Clinical Health Psychology.

Dr. Beverly Thorn’s long-standing commitment to and work for Division 38 is well known to all of us. In addition to serving as the President-elect (2006-2007), President (2007-2008), and past-President (2008-2009) of Division 38, she has served the Division in the following capacities: Liaison to Division 12 (1999 – 2001); APA Council of Representatives (2000 – 2006); Health Care/Health Sciences Caucus Executive Committee (2001-present; Chair, 2005-2007); Co-Chair, Steering Committee for Clinical Health Psychology Institutes (2002 – 2009); Liaison to Society of Behavioral Medicine (SBM) Evidence-Based Behavioral Medicine Committee (EBBM, 2004-present); representative to the trans-society training council on evidence based practice (2005 – present); and Member, Search Committee for Editor of Health Psychology (2009). She has served on the Editorial Board of Health Psychology since 2007. She has been an indefatigable crusader on behalf of health psychology, fighting off threats to the field both internal and external. Her long-standing willingness to take on issues and problems that threaten our specialty is admirable, and would justify giving her the award on that basis alone.

In addition to her work specifically for the Division, Dr. Thorn has a long history of scholarship related to health issues. She has been investigating the source of the well-documented but little understood gender differences in the report of pain. Her results have demonstrated that these differences stem more from differences in gender role and cognitive appraisal than they do from biological difference between men and women. Her work in the area of pain is nationally and internationally known, and it is results like these that have helped to build that reputation. Similarly she has used her knowledge of pain to develop interventions for low literacy, primarily African American mostly chronic pain suffers in rural Alabama. This unique work has garnered much attention from her peers, and she is often called upon to describe and present her procedures and results. This work, with a population that is often poorly-served and typically ignored, is yet another major component of her long-standing commitment to furthering the field of health psychology.

Finally, many people know Bev best for her work mentoring other professionals, both within health psychology and within clinical psychology more generally. Bev Thorn has literally been the role model, confidant, and adviser for a whole generation of women who serve as Directors of Clinical Training (DCTs). When Bev first began as a DCT, women in those roles were the overwhelming minority. While it is still primarily a man’s position in most clinical programs, those women who have started to do the job have relied on Bev as the exemplar for doing so.

It should be clear by now that Dr. Beverly Thorn is well deserving of the Nathan W. Perry, Jr. Award for Career Service to Health Psychology. Not only does she meet the standard for her work for the Division, she augments that work with her other accomplishments — research, teaching, and mentoring — that demonstrate her service to the field both nationally and internationally.