Read this interview by Osher Research Assistant, Esme Goldfinger, with James (Jim) Doorley, Ph.D.. Dr. Doorley is one of our current Research Fellows in Integrative Medicine, Harvard Medical School and is also Clinical Fellow in Psychology, Department of Psychiatry, Massachusetts General Hospital.
Q: Tell me about your research interests
A: I am interested in better understanding factors that cause, maintain, and exacerbate chronic musculoskeletal pain. I have a specific interest in psychological and behavioral factors, such as pain anxiety and catastrophizing, avoidance of pain and physical activity, and psychological inflexibility (i.e., allowing pain-related experiences to dictate behavior and obstruct valued goal pursuit). I am interested in the potential for mindfulness- and acceptance-based interventions, such as acceptance and commitment therapy (ACT) to increase physical and emotional functioning and reduce pain interference in daily life by promoting psychological flexibility. ACT is efficacious for chronic pain but has not been widely implemented for populations at the highest risk for negative pain-related outcomes, including African Americans and individuals with lower socioeconomic status. To address this issue, I recently submitted a K23 Career Development Award to test the implementation of a brief app-based ACT intervention with supportive telephone coaching for individuals with chronic musculoskeletal pain who receive primary care at the Dimmock Center, a community health center serving the racially diverse neighborhood of Roxbury, MA.
Q: Which of your recent research findings are you most excited about?
My colleagues and I at the Massachusetts General Hospital Center for Health Outcomes and Interdisciplinary Research (CHOIR) aim to better understand the psychological experience of African Americans with chronic musculoskeletal pain to tailor more effective interventions to this high-risk population. We are currently analyzing data from a survey study of 400 African Americans with chronic musculoskeletal pain who use opioids. So far, our results show that pain anxiety and catastrophizing are associated with problematic opioid and other substance use above and beyond the intensity of chronic pain itself and relevant demographic variables (e.g., gender, education, employment status). Consistent with ACT theory, we also found that pain-related psychological inflexibility predicted pain-related interference and disability above and beyond pain intensity and similar demographics, with effects similar to or even stronger than pain anxiety and catastrophizing. These results highlight the potential promise of tailoring ACT and related interventions for this high-risk population.
Q: How do you hope your research impacts the populations you study?
A: I hope that our research catalyzes efforts to tailor existing evidence-based psychotherapies and mind-body interventions for medically underserved individuals with chronic musculoskeletal pain. We know that ACT and other behavioral and cognitive therapies can help patients cope with chronic pain to live fuller lives. However, these therapies have not been sufficiently tested among racially and socioeconomically diverse patient populations. Further, evidence-based therapies like ACT are seldom offered to patients with chronic pain who present to treatment through traditional channels (e.g., primary care, physical therapy, sports medicine). Thus, I’m interested in learning from patients, providers, and other clinical stakeholders about how to best integrate ACT-based interventions into traditional care settings to maximize acceptability, effectiveness, and sustainability.
Q: What are you currently working on?
A: As a current Research Fellow in Integrative Medicine at HMS, I am continuing to build expertise in mind-body interventions for chronic musculoskeletal pain under the supervision of Drs. Gloria Yeh and Peter Wayne. This includes psychologically informed practice (PiP) and psychologically informed physical therapy (PIPT) for the treatment of chronic musculoskeletal pain. I am currently preparing two manuscripts focused on PiP: one advocating for the potential of technology to facilitate PiP scalability and implementation and another building toward a framework for applying PiP in rehabilitation medicine. This work led me to apply for pilot funding to implement a physical therapy intervention informed by acceptance and commitment therapy (PACT) in the outpatient physical therapy department at Massachusetts General Hospital. Our first goal is to conduct focus groups with patients, physical therapists, and clinic staff/leadership to better understand barriers and facilitators to implement PACT. Despite documented implementation concerns in PIPT trials, researchers have not conducted sufficient qualitative research with relevant stakeholders informed by implementation science (e.g., RE-AIM and PRISM frameworks). Our second goal is to use these data to adapt and refine PACT for heterogeneous chronic musculoskeletal pain. PACT, like many other PIPT programs, was originally designed for chronic low back pain but PACT skills are highly transferable to varied pain locations.
Q: What lead you to the topics you study today?
A: I first became interested in mind-body interventions for pain and orthopedic injury through my work in sports medicine and sport psychology settings. During graduate school, I worked as a psychotherapist and concussion specialist in an outpatient sports medicine clinic. I assessed and treated athletes with concussions and addressed maladaptive psychological responses to concussions and other sports injuries (e.g., pain anxiety, fear of reinjury). I enjoyed applying my existing interests in mindfulness- and acceptance-based therapies to help patients change their relationship to pain while reducing activity avoidance and facilitating return to sport. I also witnessed the benefits of concurrent psychotherapy and physical therapy, which led to my current interest in integrating physical and psychological interventions within a single, efficient treatment package. Since then, I’ve become interested in taking what works for athletes and other physically active populations and adapting/tailoring these approaches for medically underserved patients and those with higher levels of activity avoidance.
Dr. James (Jim) Doorley, PhD, is a postdoctoral fellow at the Center for Health Outcomes and Interdisciplinary Research (CHOIR; formerly the Integrated Brain Health Clinical and Research Program) at Massachusetts General Hospital and a Research Fellow in Integrative Medicine at Harvard Medical School. He completed his PhD in clinical psychology at George Mason University, where his research focused on anxiety, positive psychology, change mechanisms of “third-wave” cognitive-behavioral therapies (e.g., psychological flexibility), and athlete mental health. He also worked as a sport psychology consultant, primarily for Division I athletes, with a focus on injury recovery and mental performance optimization. He completed his pre-doctoral internship at MGH/HMS with a focus on testing and delivering mind-body interventions for chronic musculoskeletal pain.
Dr. Doorley currently serves as a clinician for the NCCIH-funded Toolkit for Optimal Recovery study (led by his primary research mentor, Dr. Ana-Maria Vranceanu), a virtual mind-body intervention to prevent persistent pain and disability following acute orthopedic injury among patients with high pain anxiety/catastrophizing. Through his fellowship research, Dr. Doorley aims to: 1) Implement evidence-based mind-body interventions for diverse, underserved patients with chronic musculoskeletal pain, and 2) advance the science of psychologically informed approaches to physical therapy and rehabilitation.