Research Centers

Cardiac Psychiatry Research Program

The Cardiac Psychiatry Research Program (CPRP) aims to improve the mental health and medical outcomes of patients with heart disease.

Cardiac Psychiatry Research Program logo

Our research program focuses on the connections between mental health, behavior, and cardiac outcomes.

We are interested in the impact of mood and anxiety disorders on cardiac health, and how different treatments for these disorders may impact quality of life and function. Depression and anxiety have been identified as risk factors for poor cardiac outcomes and death, independent of traditional cardiac risk factors such as high blood pressure, smoking, or diabetes. Unfortunately, depression and anxiety go unrecognized and untreated in the vast majority of patients with heart disease, despite the existence of safe and effective treatment. We have performed two randomized trials of care management for cardiac patients who have depression or anxiety disorders to determine whether having a care manager helps these patients to have better outcomes and better quality of life, and have examined the impact of psychiatric medications on cardiac health.

Contact Information

To find out more about our projects and team, contact us at 617-724-9142 or at jhuffman@partners.org

In addition, we are increasingly interested in the role of positive thoughts and emotions in cardiovascular health. There is some suggestion that positive psychological states, like optimism and gratitude, may independently predict superior cardiovascular health, yet these connections have not been closely studied in patients who have existing heart disease. We are examining the impact of optimism and gratitude on medical outcomes in both depressed and nondepressed patients who had a recent cardiac event. In addition, we have adapted positive psychological exercises to this population to determine if such exercises can boost optimism, gratitude, and self-efficacy in persons with heart disease. We are performing ongoing studies to better develop these exercises and to determine whether they may affect biology, health behaviors, and key cardiac outcomes. We are also working to adapt these positive psychological interventions to patients with other medical illnesses.

Finally, we are exploring the use of positive psychological interventions for patients with serious mood disorders or recent suicide attempts, to determine whether cultivating these positive states provides benefit in these populations as well. Optimism and other positive states have been linked to lower rates of suicidal thoughts and suicide attempts, and an approach that focuses on this aspect of mental health may be a novel and powerful approach.

Click on the tabs to learn more about our team, our projects, and our publications.

Team

Jeff Huffman, MDJeff Huffman, M.D. is the Director of the Cardiac Psychiatry Research Program (CPRP), Director of Inpatient Psychiatry Research, and an Associate Professor of Psychiatry at Harvard Medical School. He currently serves as principal investigator for over ten projects, and has been awarded grants from the American Heart Association, the Templeton Foundation, American Foundation for Suicide Prevention, and the National Institutes of Health. He has many peer-reviewed publications, including over 60 first-author or senior-author publications, and has mentored medical students, psychiatry residents, research fellows, psychologists, social workers, and junior psychiatrist faculty. His areas of interest include the impact of psychiatric illness on patients with cardiac disease, and the development and use of positive psychological interventions in a wide range of populations.


Christopher Celano, MDChristopher Celano, M.D. is a faculty psychiatrist at MGH and an Instructor in Psychiatry at Harvard Medical School and has worked on CPRP projects since 2010. He is a recipient of the NIH Loan Repayment Program, and has ongoing Dupont-Warren and Livingston Fellowships through Harvard Medical School to study the impact of positive psychological interventions in patients with bipolar disorder. He has published over ten articles with the team, and is an active co-investigator on multiple projects. His area of interest is the development and study of positive psychological interventions in patients with mental illness and cardiovascular disease.


Scott Beach, MDScott Beach, M.D. is a faculty psychiatrist at MGH and an Instructor in Psychiatry at Harvard Medical School and in his third year with the CPRP. He has been awarded the Livingston and Dupont-Warren Fellowships by Harvard Medical School for his project examining galvanic skin response in heart failure patients with and without depression. He is an active co-investigator on multiple projects and has had ten articles published, in press, or submitted in the past 12 months. Scott’s areas of interest include QTc prolongation with psychotropic medications, the physiologic effects of depression in patients with heart disease, and catatonia.


James Januzzi, MDJames Januzzi, M.D. is an Associate Professor of Medicine in the Division of Cardiology at Harvard Medical School, and the Director of the Cardiac Intensive Care Unit at MGH. He is a well-established researcher at MGH with over 200 peer-reviewed research publications, over 100 review articles and chapters, and has edited 3 text books. He is internationally known as an expert in the study of biomarkers in patients with heart failure and other cardiac illnesses, and has served as a section editor on the recent American College of Cardiology/American Heart Association clinical practice guidelines for heart failure, and was the lead for the heart failure section for the Universal Definition of Myocardial Infarction Global Task Force. He has served as the primary cardiologist on projects for the CPRP for the past 9 years, including collaborative care depression and anxiety management trials in hospitalized cardiac patients, and studies of positive psychological states in persons with heart disease.


Laura Suarez, MDLaura Suárez, M.D. graduated from Pontificia Universidad Javeriana medical school in Bogota, Colombia in 2008. Laura is a research fellow and has been with the program for 1 year. Laura manages patient censuses, completes chart reviews, and manages the CPRP databases. Over the past year she has written papers, presented posters at scientific meetings, and developed written materials for the team’s projects. She plans to attend a residency program in psychiatry with a special focus on addiction.


Carol Mastromauro, MSW, LICSWCarol Mastromauro, M.S.W., L.I.C.S.W. is the interventionist for the CPRP. She is a clinical research social worker who has been with the team for six years. Carol specializes in anxiety and depression treatment and positive psychology interventions for cardiac populations. She has administered interventions to more than 200 subjects during her time at the CPRP, and recruited and evaluated over 350 cardiac inpatients for the SUCCEED and MOSAIC studies. Prior to joining the CPRP, Carol worked in geriatric research on memory disorders and was a member of the vanguard MGH team, which was one of the first two programs in the nation to offer genetic presymptomatic testing for Huntington’s Disease. Currently, she conducts qualitative interviews for our newest study with cardiac patients.


Christina DuBois, BAChristina DuBois, B.A. graduated from Skidmore College in 2011 summa cum laude with a degree in psychology. She serves as the lead research coordinator for the CPRP and is in her third year with the program. She has delivered positive psychology interventions, performed qualitative interviews, and coordinated several of the team’s projects. Currently, she is the interventionist for a collaborative positive psychology project with the Diabetes Outpatient Center. Previously, Tina interned at a hospice, a group home for runaway youth, and a domestic violence center as a financial resource coordinator. She plans to pursue a career in advocacy for mental health and well-being.


Eleanor Beale, BAEleanor Beale, B.A. graduated from Skidmore College in 2012 summa cum laude with a degree in psychology. In her second year with the program, she is the lead research coordinator for GRACE and is currently working on the up and coming HOPE study looking at the effectiveness of a positive psychology intervention in a population with Major Depressive Disorder. She also doubles as a resource coordinator for the Inpatient Psychiatric Unit. Previously, Ellie developed functional behavioral assessments for a day program for individuals with developmental disabilities, and interned at a substance abuse center. Ellie plans on returning to school for a graduate degree in psychology.

Shannon Moore, BAShannon Moore, B.A. graduated from the University of Delaware in 2011 magna cum laude with degrees in psychology and sociology. She is in her first year with the program, and is the research coordinator for the CPRP’s newest studies. She conducts visits for the GRACE study and is in charge of data, transcribing, and coding for the PEACE study. She is currently helping to launch the HOPE study, a project focusing on positive psychology for Major Depressive Disorder. Previously, Shannon conducted research in child development following early adversity and foster care. She also worked with patients with severe psychosis in a residential treatment facility. She plans to pursue a degree in clinical psychology.


Emma Lenihan, BAEmma Lenihan, B.A. graduated from the University of Greenwich, London with a degree in psychology. She has been with the CPRP for 6 years, and has conducted study assessments for a wide range of projects. She is also an active member of the study teams at the Depression Clinical and Research Program and Center for Addiction Management at MGH.


Oriana Vesga López, M.D.Oriana Vesga López, M.D. is a faculty psychiatrist at MGH and co-investigator on the foundation-supported CPRP projects related to gratitude in cardiac patients and study of positive psychological interventions. She is also a recipient of the NIH Kirschstein National Research Service Award from the NIH to study the impact and management of common mental disorders in females in low-income countries. In addition to her work with the CPRP, her most recent work is focused on understanding the psychosocial manifestations of well-being and distress in war-affected adults in Liberia, a post-conflict country in West Africa. This is her first year working with the CPRP.


Brian Healy, PhDBrian Healy, Ph.D. is an Assistant Professor in the Department of Neurology at Harvard Medical School, a member of the Biostatistics Center at Massachusetts General Hospital, and an Instructor in Biostatistics at the Harvard School of Public Health. Dr. Healy is also the lead biostatistician for the Partners Multiple Sclerosis Center, which is affiliated with Brigham and Women's Hospital. His primary research interest is statistical methods development and application for modeling of multiple sclerosis. Recently, he has begun working with Cardiac Psychiatry Research Program, and he has participated in the design and analysis of several studies.




Collaborators MGH Faculty

Dr. Elyse Park (qualitative research and motivational interviewing): Mongan Institute for Health Policy

Dr. Steven Safren (behavioral intervention development): Behavioral Medicine Service

Dr. Andrés Bedoya (behavioral interventions)

Dr. Hanna Gaggin (cardiology)

The Benson-Henry Institute for Mind-Body Medicine, MGH

External Collaborators

Dr. Matthew Nock (prediction and prevention of suicide/self-harm), Department of Psychology, Harvard University

Dr. Linda Collins (novel methods of optimizing and evaluating multicomponent behavioral interventions), the Methodology Center, Penn State University

Dr. Todd Kashdan, (positive psychology and interventions to increase well-being), the Center for Consciousness & Transformation, George Mason University

Dr. Julia Boehm, (positive psychology), Department of Psychology, Chapman University

Bruce Rollman (treatment of depression and anxiety in cardiac patients) University of Pittsburgh Medical Center


Alumni

Medical Students:
Gillian Sowden
Chris Doughty
Christina Carr

Residents:
Curtis Wittmann
Amy Taylor
Leah Bauer

Faculty/Fellows:
Felicia Smith
Andres Caro
Trina Chang
Giselle Perez-Lougee

Research Coordinators:
Marguerite Beiser
Rita Seabrook

Social Work and Nursing Interventionists:
Rachel Rodman
Stephanie Mahnks
Meaghan Morrison

 

Special thanks: Our work has also been generously supported by the esteemed Avery D. Weisman, MD, of the eponymous MGH Psychiatry Consultation Service and a long-standing national leader in psychosomatic medicine. His support has allowed the CPRP to continue to investigate the associations between positive and negative emotional states and physical health and well-being, and we are forever indebted.


Ongoing Projects

Positive Emotions after Acute Coronary Events (PEACE)
Developing a positive psychology intervention to improve cardiac health behaviors

National Institutes of Health: National Heart Lung and Blood Institute (1R01HL113272-01A1)
This project aims to systematically develop a positive psychological intervention for patients with a recent acute coronary syndrome to determine if such an intervention leads to greater participation in health behaviors (e.g., better diet, more physical activity) in the weeks and months following the acute cardiac event.
Principal Investigator (PI): Jeff Huffman

Gratitude Research in Acute Coronary Events (GRACE)
The impact of gratitude on biology and behavior in persons with heart disease

Greater Good Science Center/Templeton Foundation
This project aims to prospectively study the connections between positive psychological states (e.g., gratitude, optimism), measured 2 weeks after an acute coronary syndrome, and improvements in biomarkers and health behaviors at 6 months. Enrollment is complete (N=166) and we are beginning data analysis. We hypothesize that patients who report higher levels of positive emotions/thoughts will have greater improvement in biology and behavior.
PI: Jeff Huffman

Assessment of autonomic dysfunction in patients with heart failure
Dupont-Warren and Livingston Fellowships, Harvard Medical School

This study aims to examine the impact of depression on autonomic nervous system function in patients hospitalized with heart failure. Matched patients with and without major depression will have measurements taken of galvanic skin response and urinary catecholamines, and we hypothesize that autonomic dysfunction will be greater in depressed patients, independent of the severity of cardiac illness.
PI: Scott Beach

Positive Psychology for Bipolar Disorder (PPBP)
Development of a positive psychology intervention to reduce suicide risk in patients with bipolar disorder
Dupont-Warren and Livingston Fellowships, Harvard Medical School
This is a pilot study of a 4-week positive psychological intervention (planned N=30) for patients hospitalized for bipolar disorder. Subjects in the intervention arm will complete a positive psychological exercise in the hospital, followed by exercises over the subsequent 4 weeks; participants in the control arm will compete cognitive/recollection tasks. Outcome measures include assessments of feasibility, acceptability, and clinical impact.
PI: Christopher Celano

Happiness, Optimism, and Positive Emotions (HOPE))
Development of a positive psychology intervention to reduce suicide risk

American Foundation for Suicide Prevention Standard Research Grant
This is an exploratory study of a 6-week positive psychological intervention (planned N=50) for patients hospitalized with major depressive disorder and who had suicidal thoughts prior to admission. Participants in the intervention arm will complete a positive psychological exercise in the hospital, followed by exercises over the subsequent 6 weeks; participants in the control arm will compete cognitive/recollection tasks. Outcome measures include assessments of suicidality/hopelessness, mood symptoms, and overall intervention feasibility.
PI: Jeff Huffman

Boosting Emotions and Happiness in Outpatients Living with Diabetes (BEHOLD)
A positive psychology program for patients with type 2 diabetes: Pilot study

This is a pilot study of a 10-week positive psychological intervention (planned N=10) for outpatients who have type 2 diabetes and poor adherence to one or more diabetes-related health behaviors. Participants will complete 7 exercises over the course of 10 weeks. Outcome measures include assessments of feasibility, acceptability, and clinical impact of the intervention.
PI: Jeff Huffman

Recently Completed Projects

 

Management of Sadness and Anxiety in Cardiac Disease (MOSAIC)
A collaborative care program to improve treatment of anxiety disorder in hospitalized patients with cardiac disease

American Heart Association Grant-in-Aid
This was a randomized controlled trial of a care management program to manage depression and anxiety disorders among patients hospitalized for cardiac illness (N=183). A multidisciplinary collaborative care intervention, led by a social work care manager, was initiated in the hospital and continued by phone for 6 months after discharge. The intervention was associated with improvements in mental-health related quality of life at 6 months, reduced depressive symptoms, and better overall functioning. Patients randomized to the collaborative care intervention also had higher rates of treatment of a mental health disorder. 
PI: Jeff Huffman

Screening Utilization and Collaborative Care for more Effective and Efficient treatment of Depression (SUCCEED)
A collaborative care program to improve depression management in cardiac patients
American Heart Association (0735530T)
This was a randomized controlled trial (N=175) of a care management program to manage depression among patients hospitalized for cardiac illness. A multidisciplinary collaborative care intervention, led by a social work care manager, was initiated in the hospital and continued by phone for 12 weeks after discharge. The intervention was associated with improvements in depression, mental health-related quality of life, and cognitive symptoms (versus usual care) during the intervention and improved adherence and cardiac symptoms following the intervention.
PI: Jeff Huffman

 

Positive Psychology for Suicidal Inpatients (PPSI)
Development of a positive psychology intervention to reduce suicide risk

Center for Disease Control (R01 DP000339)
This was an exploratory study of nine positive psychological exercises in patients hospitalized for suicidal thoughts or a suicide attempt. Participants (N=61) were administered exercises in random order during their admission, and rated the ease of completion and impact of the exercises before and after completion. Overall, the exercises were feasible, well-accepted, and associated with short-term improvements in key symptoms in this cohort.
PI: Jeff Huffman

Happiness in Health
Mind-body interventions in cardiac patients

Center for Disease Control (R01 DP000339)
This was a three-arm pilot study examining the feasibility of three positive psychological exercises (on gratitude, optimism, and altruism) in patients hospitalized for heart failure or an acute coronary syndrome. The exercises were well-accepted, and the positive psychology exercises appeared to lead to greater improvements compared to the active (relaxation response) and attentional (recollection) control conditions.
PI: Jeff Huffman

Selected Recent Publications

  1. Denninger JW, Bhasin M, Huffman J, Niles H, Creager M, Pande R, Liberman T, Fricchione G, Benson H, Zusman R. Clinical and genomic effects of a relaxation response-based mind-body intervention in stage I hypertension. J Altern Complement Med. 2014 May;20(5):A54.

  2. Huffman JC, Mastromauro CA, Beach SR, Celano CM, DuBois CM, Healy BC, Suarez L, Rollman BL, Januzzi JL. Collaborative care for depression and anxiety disorders in patients with recent cardiac events: The Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial. JAMA Intern Med. 2014 Apr 14. Epub ahead of print.

  3. Huffman JC, Niazi S, Rundell J, Sharpe M, Katon WJ. Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the Academy of Psychosomatic Medicine Research and Evidence-Based Practice Committee. Psychosomatics. 2013, in press. 2014 Mar-Apr;55(2):109-22.

  4. Huffman JC, DuBois CM, Healy BC, Boehm JK, Kashdan TB, Celano CM, Denninger JW, Lyubomirsky S. Feasibility and utility of positive psychology exercises for suicidal inpatients. Gen Hosp Psychiatry. 2014 Jan-Feb;36(1):88-94.

  5. Huffman JC. Review: depression after myocardial infarction is associated with increased risk of all-cause mortality and cardiovascular events. Evid Based Ment Health. 2013 Nov;16(4):110.

  6. Rollman BL, Huffman JC. Treating Anxiety in the Presence of Medical Comorbidity: Calmly Moving Forward. Psychosom Med. 2013 Oct;75(8):710-2.

  7. Beach SR, Kostis WJ, Celano CM, Januzzi JL, Ruskin JN, Noseworthy PA, Huffman JC. Meta-analysis of Selective Serotonin Reuptake Inhibitor (SSRI)-associated QTc prolongation. J Clin Psychiatry. 2013, in press.

  8. Huffman JC, Beach SR, Suarez L, Mastromauro CA, DuBois CM, Celano CM, Rollman BL, Januzzi JL. Design and baseline data from the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized controlled trial. Contemp Clin Trials. 2013 Nov:36(2):488-501.

  9. Celano CM, Beale EE, Moore S, Wexler DJ, Huffman JC. Positive psychological characteristics in diabetes: a review. Curr Diabetes Rep. 2013 Dec;13(6):917-29.

  10. Beach SR, Januzzi JL, Mastromauro CA, Healy BC, Beale EE, Celano CM, Huffman JC. Patient Health Questionnaire-9 score and adverse cardiac outcomes in patients hospitalized for acute cardiac disease. J Psycho Res. 2013 Nov;75(5):409-13.

  11. Celano CM, Suarez L, Mastromauro C, Januzzi JL, Huffman JC. Feasibility and Utility of Screening for Depression and Anxiety Disorders in Patients With Cardiovascular Disease. Circ Cardiovasc Qual Outcomes. 2013 Jun 11. 

  12. Sowden GL, Mastromauro CA, Seabrook RC, Celano CM, Rollman BL, Huffman JC. Baseline physical health-related quality of life and subsequent depression outcomes in cardiac patients. Psychiatry Res. 2013 Jun 5. 

  13. Huffman JC, Celano CM, Beach SR, Motiwala SR, Januzzi JL. Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol. 2013;2013:695925. 

  14. Beach SR, Celano CM, Noseworthy PA, Januzzi JL, Huffman JC. QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics. 2013 Jan-Feb;54(1):1-13. 

  15. Dubois CM, Beach SR, Kashdan TB, Nyer MB, Park ER, Celano CM, Huffman JC. Positive psychological attributes and cardiac outcomes: associations, mechanisms, and interventions. Psychosomatics. 2012 Jul-Aug;53(4):303-18. 

  16. Wexler DJ, Porneala B, Chang Y, Huang ES, Huffman JC, Grant RW. Diabetes differentially affects depression and self-rated health by age in the U.S. Diabetes Care. 2012 Jul;35(7):1575-7. 

  17. Caro MA, Sowden GL, Mastromauro CA, Mahnks S, Beach SR, Januzzi JL, Huffman JC. Risk factors for positive depression screens in hospitalized cardiac patients. J Cardiol. 2012 Jul;60(1):72-7. 

  18. Bauer LK, Caro MA, Beach SR, Mastromauro CA, Lenihan E, Januzzi JL, Huffman JC. Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. Am J Cardiol. 2012 May 1;109(9):1266-71. 

  19. Celano CM, Mastromauro CA, Lenihan EC, Januzzi JL, Rollman BL, Huffman JC. Association of baseline anxiety with depression persistence at 6 months in patients with acute cardiac illness. Psychosom Med. 2012 Jan;74(1):93-9. 

  20. Huffman JC, Mastromauro CA, Boehm JK, Seabrook R, Fricchione GL, Denninger JW, Lyubomirsky S. Development of a positive psychology intervention for patients with acute cardiovascular disease. Heart Int. 2011 Oct;6(2):e14. 

  21. Celano CM, Huffman JC. Depression and cardiac disease: a review. Cardiol Rev. 2011 May-Jun;19(3):130-42. 

  22. Huffman JC, Mastromauro CA, Sowden G, Fricchione GL, Healy BC, Januzzi JL. Impact of a depression care management program for hospitalized cardiac patients. Circ Cardiovasc Qual Outcomes. 2011 Mar;4(2):198-205. 

  23. Huffman JC, Mastromauro CA, Sowden GL, Wittmann C, Rodman R, Januzzi JL. A collaborative care depression management program for cardiac inpatients: depression characteristics and in-hospital outcomes. Psychosomatics. 2011 Jan-Feb;52(1):26-33. 

  24. Huffman JC, Doughty CT, Januzzi JL, Pirl WF, Smith FA, Fricchione GL. Screening for major depression in post-myocardial infarction patients: operating characteristics of the Beck Depression Inventory-II. Int J Psychiatry Med. 2010;40(2):187-97. 

  25. Huffman JC, Smith FA, Fricchione GL, Januzzi JL, Nadelman S, Pirl WF. Depression and failure of cholesterol lowering after acute myocardial infarction. Prim Care Companion J Clin Psychiatry. 2010;12(1):PCC.08m00766. 

  26. Huffman JC, Celano CM, Januzzi JL. The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatr Dis Treat. 2010 May 6;6:123-36. 

  27. Bauer LK, Huffman JC. Is low cholesterol associated with depression in cardiac patients? Int J Cardiol. 2010 Dec 3;145(3):537-9. 

  28. Sowden G, Mastromauro CA, Januzzi JL, Fricchione GL, Huffman JC. Detection of depression in cardiac inpatients: feasibility and results of systematic screening. Am Heart J. 2010 May;159(5):780-7. 

  29. Huffman JC. Could being happy give you a healthy heart? Future Cardiol. 2009 Jul;5(4):325-7. 

  30. Huffman JC, Smith FA, Blais MA, Januzzi JL, Fricchione GL. Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction. J Psychosom Res. 2008 Dec;65(6):557-63. 

  31. Sowden GL, Huffman JC. The impact of mental illness on cardiac outcomes: a review for the cardiologist. Int J Cardiol. 2009 Feb 6;132(1):30-7. 

  32. Huffman JC, Smith FA, Blais MA, Taylor AM, Januzzi JL, Fricchione GL. Pre-existing major depression predicts in-hospital cardiac complications after acute myocardial infarction. Psychosomatics. 2008 Jul-Aug;49(4):309-16.

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