CENTER OF EXCELLENCE FOR THE STUDY OF HEALTH AND CHRONIC ILLNESSES

DIRECTOR: Robert J. Gatchel, Ph.D., ABPP.

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The Center of Excellence for the Study of Health and Chronic Illnesses was originally established in response to the changing healthcare landscape in the United States. It reflects marked changes in major health threats, as well as renewed interest in prevention and evidence-based treatments across medical disciplines. One important factor that had prompted these changes was the now dramatic differences in the major health threats and problems over the past century. At the turn of the 20th century, major causes of mortality were predominantly infectious, including pneumonia and influenza, polio and tuberculosis. One hundred years later, modern medicine had conquered many of these diseases, and chronic illnesses (such as heart disease, hypertension, cancer and diabetes) have taken their place. Unlike infectious diseases, modern chronic illnesses are caused in part by aging and lifestyle, and they present management as well as prevention and assessment problems.

Robert Gatchel
Robert Gatchel, Ph.D., ABPP

To a great extent, stress, lifestyle, exercise, diet, drug and tobacco use, and other biobehavioral factors appear to contribute to "wear and tear" on the body, and to an acceleration of the aging process. Most of these factors are modifiable, and offer important new ways to reduce illness risks, as well as the personal, financial, and medical toll of many chronic illnesses. These changes in the nature of serious chronic illnesses, highlighted by the emergence of chronic illnesses caused by maladaptive behaviors and lifestyles, pose a number of very important challenges for systematic study, evaluation, and intervention. The importance of environmental, gender and genetic factors also needs to be addressed.

It should also be noted that the goals of our originally developed Center were perfectly aligned with the very important and influential Institute of Medicine's (IOM) Report on "Living Well with Chronic Illness: A Call for Public Health Action" [Committee on Living Well with Chronic Disease: Public Action to Reduce Disability, Improve Functioning and Quality of Life. Institute of Medicine (2012), Washington D.C. The National Academies Press]. This major IOM Report was written as "… a guide for immediate and precise action to reduce the burden of all forms of chronic illnesses through the development and implementation of cross-cutting and coordinated strategies to help Americans live well…" (A-1).

As importantly, the Center directly addresses one of the four major themes of UT Arlington's STRATEGIC PLAN|2020: Health and the Human Condition. For this theme, "UT Arlington will focus on health and the human condition from distinct yet broadly encompassing vantage points. We will explore health management within physical, mental, emotional, and social contexts. Health innovations will be distinguished by diagnostic, prognostic, and technological advancements that help people live longer, healthier, and happier lives. A century ago, the average American lived to be about 55 years old. Today we are likely to approach 80. Unrelenting scientific curiosity and exploration have made this dramatic increase possible and led to life-saving breakthroughs in the diagnosis and treatment of serious diseases and other ailments. But progress that improves our quality of life extends beyond the physical realm. Examination of the arts and humanities helps us understand the nature of the human condition and the broader cultural and social fabric that characterizes our very existence and contributes to our collective well-being."

Indeed, our Center was developed to coordinate and stimulate biobehavioral/medical research and community-based education and prevention efforts pertaining to the causes, assessment and management of chronic illnesses. This Center is meant to fill this important "preparation void." Some examples of disorders/areas that can be studied in the Center include the following:

• aging issues (e.g., cognitive and motor functioning)

• early intervention for dementia

• chronic pain and disability

• cancer

• cardiovascular disorders

• diabetes

• fibromyalgia

• multiple sclerosis

• traumatic brain injury

• wound healing.

Because of the great prevalence and scope of these chronic illness problems, the Center is well positioned to seek Congressional earmark funds, as well as other federal/state extramural funding, for its' further development. Moreover, the Center has access to the most recent "cutting edge" biotechnology for the study of these chronic disorders and health (e.g., genetics, brain imaging, immune system functioning, stress system measures, as well as various psychosocial measures such as emotional distress and coping). Thus, again, the primary focus of this Center will continue to be on the integration of the social and biobehavioral sciences with more traditional biological sciences and chemistry at the interface with biomedical research.

It should also be noted that a strong characteristic of research conducted at the Center is that it is not assumed that there is usually a direct causal link between some construct/event (such as stress) and health outcomes (such as chronic illness). Rather, there are often various mediators (such as coping skills like self-efficacy) and moderators (such as demographic variables associated with access to healthcare) that can “enter the equation.” Methods had to be developed for integrating such potential mediators and moderators into clinical research. These provided the threads that helped to better understand the full fabric of the medical construct being evaluated. One must always consider the potential importance of these various “threads” in order to better understand the full fabric of biobehavioral processes and chronic illnesses. It should also be noted that illness-health issues associated with aging is also an important area to be studied. Indeed, currently, there are approximately 35 million Americans, 65 years of age or older, accounting for 12.4% of the population. By the year 2030, it is projected that about 20% of the population will be 65 years of age or older. Unfortunately, the current healthcare system and government policy-makers are not being proactive in preparing for this "great surge" of older citizens and their chronic illnesses who will make up a significant proportion of the population in the United States.

Finally, because one of the most frequently-cited reasons for patients in the U.S. to seek medical care is due to pain, a major topic of investigations by the Center in the past few years has been pain. A significant milestone for the Center was the completion of few large research projects: “An Implementation and Biobehavioral Study of Temporomandibular Joint and Muscle Disorders” (NIH: $4,154,904, direct and indirect costs); and “The STRONG STAR Multidisciplinary PTSD Research Consortium: A Randomized Controlled Study of the Treatment of Comorbid PTSD and Pain” (DOD: $1,521,564, direct and indirect costs). Indeed, these research topics were prompted by the fact that, according to statistics from the National Academy of Sciences, the societal costs of chronic pain and related disability in the U.S. alone is $560-635 billion each year. Unfortunately, many chronic pain conditions cannot yet be successfully treated. We need more clinical research to develop better pain assessment and treatment methods. In fact, another influential IOM Report, “Relieving Pain in America” [Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Institute of Medicine (2011), Washington D.C. The National Academies Press highlighted the urgent need for the development of better methods for pain management because the ever-increasing costs associated with current treatment approaches cannot be sustained. Relatedly, in presenting its Pain Research Agenda for the 21st Century (in the December 2014 issue of The Journal of Pain), the American Pain Society stated that “Our works in developing the pain research agenda showed that even the most optimistic estimates indicate that pain research is woefully underfunded relative to its prevalence, disease burden and economic toll.” Unfortunately, many chronic pain conditions cannot yet be successfully treated. More clinical research is still needed to develop better treatment methods. Thus, social, economic and biobehavioral research of pain has become increasingly important for the Center in this area of medicine and healthcare.

In 2010, the College of Science at The University of Texas at Arlington made an initial major commitment to this Center, with the allocation of 1,100 square feet of space, an allocation of $35,000 for renovation of that space, and the allocation of $300,000 from the very competitive UT System-wide STARS/Emerging Technology Fund program competition awarded to Dr. Gatchel for the development of a comprehensive bioassay/genetics laboratory. These have been state-of-the-art renovations/developments. Subsequently, as another more significant commitment to this Center, Dr. Gatchel helped the University raise an endowment of $1 million to initially help "jump-start" the infrastructure of the Center, as well as for cost-sharing requirements for certain grants in order to make it a visible Center of Excellence. The vision of the Center continues to be to make it nationally- and internationally- "recognized" for clinical and medical research, for the study of health and chronic illnesses. Of course, an ongoing task for this Center is to obtain some gifts from the private sector to further grow the monetary base of the Center that will actually support the many costs associated with conducting the important biobehavioral/medical research needed, as well as its' other educational goals.

The Director of the Center is Dr. Robert J. Gatchel. Dr. Gatchel is a Distinguished Professor of Psychology, as well as the Nancy P. & John G. Penson Endowed Professor of Clinical Health Psychology, College of Science, at The University of Texas at Arlington. Before joining the University of Texas at Arlington faculty in 2004, he was the Elizabeth H. Penn Professor of Clinical Psychology, Professor in the Departments of Psychiatry, Anesthesiology & Pain Management, and Rehabilitation Counseling, all at The University of Texas Southwestern Medical Center at Dallas for 25 years.

Dr. Gatchel has always been involved in new "cutting edge" areas of science and medicine. He has conducted extensive evidence-based clinical research, much of it continuously funded over 30 years by grants from the National Institutes of Health (NIH), the Department of Defense (DOD), and the National Science Foundation (NSF). He was also the recipient of consecutive Research Scientist Development Awards from NIH, as well as a prestigious Senior Scientist Award from NIH. His grant-funding experience continues to play an important role in the Center as a means of infusing new research projects into it. As of the Summer, 2015, Dr. Gatchel has published over 380 scientific journal articles, 134 book chapters and has authored or edited 26 books. In addition, he has received numerous awards and honors associated with his clinical research work, including the following: the Volvo Award for Low-Back Pain Research in 1986 from the International Society for the Study of the Lumbar Spine (which is the preeminent international research society for the study of painful spinal disorders); the 1994 Research Recognition Award from the North American Spine Society (NASS); the Award for Significant Contributions to Health Psychology, APA Division 38, 1997; NASS' 2001 Henry Farfan Award for Outstanding Contributions to the Field of Spine Care; Award for Outstanding Contributions to the Academy of Behavioral Medicine Research, 2002; the Award for Significant Contributions to the Field of Temporomandibular Joint and Occlusion Research, 2003; Visiting Scholar Program Awardee, Liberty Mutual Research Center for Safety and Health, Summer 2003; the 2003 Award for Outstanding Contributions to Science from the Texas Psychological Association; the 2004 Award for Distinguished Professional Contributions to Applied Research from the American Psychological Association; the 2006 John Liebeskind Pain Management Research Award from the American Academy for Pain Management; the 2008 Wilbert Fordyce Clinical Investigator Award from the American Pain Society; UT Arlington's Academy of Distinguished Scholars Award, 2008; the Pain Management Center of Excellence Award in 2008 from the American Pain Society; the 2009 Health Care Heroes Award from the Fort Worth Business Press/Health Point; the 2011 Distinguished Career Contributions to Health Psychology Award (Division 38 of the American Psychological Association); the 2011 Graduate Dean's Excellence in Doctoral Mentoring Award, The University of Texas at Arlington; and the 2011 Texas Psychological Association's Distinguished Lifetime Achievement Award. The citation of one of his awards (the 2004 Award from the American Psychological Association) best summarizes his impact in the fields of pain and medicine:

"For exceptional and pioneering research and training in clinical psychology. Robert J. Gatchel's research has strengthened the biopsychosocial approach to physical and mental health disorders and made possible the early identification and successful treatment of patients at risk for the development of chronic pain. He has led many in the medical profession to carefully consider salient psychological and social factors. His tireless leadership in the area of health psychology has inspired his colleagues in the field of psychology and numerous medical specialties. Most important, his work has led to the amelioration of suffering and disability of thousands of people."

Dr. Gatchel has long-established intra- and inter-institutional clinical research collaborations. He is also actively collaborating with many other scientists in Canada and Europe. Here at UT Arlington, he is collaborating with the following Departments/Colleges: College of Science; College of Nursing and Health Innovation (which is the largest College of Nursing in the State of Texas), with its innovative SMART-HOSPITAL that has become a prototype for others to be developed throughout the country; the Department of Kinesiology; the Department of Biomedical Engineering; the Department of Industrial, Manufacturing and Systems Engineering; and the Human Centered Computing Laboratory, Department of Computer Science and Engineering. He also plays a very active role as a Clinical Professor at UT Southwestern Medical Center at Dallas, where he has collaborated with many departments (Anesthesiology & Pain Management; Orthopaedic Surgery; Physical Medicine & Rehabilitation; and Psychiatry, just to name a few). He is also the Director of Biopsychosocial Clinical Research at the Osteopathic Research Center, The University of Texas Health Science Center, in Fort Worth, and Clinical Professor at Baylor College of Dentistry, Dallas (which is part of the Texas A&M system). Finally, the Bioassay Laboratory of the Center has cultivated active contracts with faculty members in the Departments of Psychology and Social Work, the Shimadzu Institute, as well as Clarkson University. Thus, this active clinical research collaboration provides the synergy to gather the best "intellectual minds" of scientists/physicians in the North Texas area.

The Center is centrally located in the North Texas area, where it receives a great deal of national and international attention. UT Arlington is a comprehensive research institution, with more than 51,000 students in capmus-based and online degree programs. It is the second largest institution in the Univesity of Texas System. In fact, the Chronicle of Higher Education lists UT Arlington as the nation's sixth fastest growing public research universities, with a more than 61% increase in enrollment from the Fall, 2000 to the Fall, 2010. Also, both the Texas Rangers Ballpark and the Cowboys Stadium in Arlington have made us even more visible because of active alliances we have made with them, as well as with the City of Arlington. Finally, in order to help in the success and further development of the Center, it has an active Board of Advisors, recruited from academia.

In summary, the goals of our Center are perfectly aligned with the Heatlh and the Human Condition theme of UT Arlington's STRATEGIC PLAN 2020, as well as the influential Institute of Medicine Report to develop more effective approaches to reduce the increasing burden of all forms of chronic illnesses in the United States, and the great burden and cost of pain associated with them. As one of the IOM Reports appropriately highlights: "Knowing is not enough; we must apply. Willing is not enough, we must do." -- Goethe