Catherine Stanger, PhD

Associate Professor, Geisel School of Medicine at Dartmouth

Behavior Economic Interventions; Adolescent Substance Use; Medical Adherence; Technology Delivered Interventions

Dr. Catherine Stanger is an Associate Professor at the Geisel School of Medicine at Dartmouth. She received her PhD in Clinical Psychology from Rutgers University in 1990. She was a postdoctoral fellow and faculty member at the University of Vermont from 1989 to 2005, and then was an Associate Professor at the University of Arkansas for Medical Sciences until she moved to Dartmouth in 2012. Over the last 20 years, in collaboration with Dr. Budney, she has conducted extensive research on the development and evaluation of innovative family based interventions, specializing in parenting interventions for diverse populations including substance abusing parents, and adolescents with substance use problems. Her clinical research has focused on innovative ways to use incentives to motivate behavior change in both teens and parents, and she has collaborated with groups across the country to use her interventions. In addition, it has integrated research on decision making and brain processes into her work in order to understand risk factors and to improve treatment outcomes. Most recently, she has adapted her family based intervention to help teens with type 1 diabetes improve their metabolic control.  This intervention includes cognitive training to improve executive function, and is delivered entirely over the internet.  Dr. Stanger’s work has been funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Child Health and Human Development.  She is a Fellow of Division 28 (Psychopharmacology and Substance Abuse) and Division 50 (Addictions) of the American Psychological Association.

She is the proud mother of three children, and likes to walk in the woods with the dogs, listen to audiobooks (because reading for pleasure has become too rare, but driving around is not!), garden, bake, and try to hold back time by going to the gym several times a week.

Selected Publications:

Stanger C, Ryan SR, Fu H, Landes RD, Jones BA, Bickel WK, et al. Delay discounting predicts adolescent substance abuse treatment outcome. Exp Clin Psychopharmacol. 2012;20(3):205-12. PMID:22182419.

Burstein M, Stanger C, Dumenci L. Relations between parent psychopathology, family functioning, and adolescent problems in substance-abusing families:disaggregating the effects of parent gender. Child Psychiatry and Human Development. 2012 Aug;43(4):631-47. PMID: 22392413.

Stanger C, Budney AJ, Bickel WK. A developmental perspective on neuroeconomic mechanisms of contingency management. Psychology of Addictive Behaviors. 2013 Jun;27(2):403-15. PMID: 22663343.

Brown PC, Budney AJ, Thostenson JD, Stanger C. Initiation of abstinence in adolescents treated for marijuana use disorders. Journal of Substance Abuse Treatment. 2013 Apr;44(4):384-90. PMID: 23085041.

Ryan SR, Stanger C, Thostenson J, Whitmore JJ, Budney AJ. The impact of disruptive behavior disorder on substance use treatment outcome in adolescents. Journal of Substance Abuse Treatment. 2013 May-Jun;44(5):506-14. PubMed PMID: 23228436.

Stanger C, Ryan SR, Delhey LM, Thrailkill K, Li Z, Li Z, et al. A multicomponent motivational intervention to improve adherence among adolescents with poorly controlled type 1 diabetes: a pilot study. Journal of Pediatric Psychology. 2013 Jul;38(6):629-37. PMID: 23699750.

Stanger C, Elton A, Ryan SR, James GA, Budney AJ, Kilts CD. Neuroeconomics and adolescent substance abuse: individual differences in neural networks and delay discounting. Journal of the American Academy of Child and Adolescent Psychiatry. 2013 Jul;52(7):747-55 e6. PMID: 23800488.

Applying Novel Technolgies and Methods to Inform the Ontology of Self-Regulation

Funding Source: National Institutes of Health Common Fund, National Institute on Drug Abuse

Project Period: Phase 1: 09/15/2015 – 08/31/2018; Phase 2: 09/01/2018 – 08/31/2020

Principal Investigator(s): Lisa A. Marsch, PhD (Dartmouth) and Russell Poldrack, PhD (Stanford)

Other Project Staff: Alan I. Green, MD; David MacKinnon, PhD; Sun Jung Kim, PhD: Emily Scherer, PhD; Haiyi Xie, PhD; Mary Ann Greene, MS; Ian Eisenberg; Patrick Bissett, PhD; Susan Whitfield-Gabrieli; Jesse Dallery, PhD; Ellen Peters, PhD; Michael Lowe, PhD; Michaela Kiernan, PhD; Judith Prochaska, PhD

Project Summary:

Health risk behavior, including poor diet, physical inactivity, tobacco and other substance use, causes as much as 40% of the illness, suffering, and early death related to chronic diseases.   Non-adherence to medical regimens is an important exemplar of the challenges in changing health risk behavior -- and is common, costly (due to increased utilization of healthcare services), and associated with poor patient outcomes.    Although an array of interventions have been shown to be effective in promoting health behavior change, much of this work has been siloed (focused on one disorder at a time).  Additionally, interventions are typically intended to engage multiple mechanisms of behavior change, but the mechanisms by which they actually work are infrequently systematically examined.   

One promising domain of putative behavior change targets is that of self-regulation -- a person’s ability to manage cognitive, motivational, and emotional resources to act in accordance with his/her long-term goals.  The Center for Technology and Behavioral Health, a national NIH-funded P30 “Center of Excellence” uses science to inform the development, evaluation, and implementation of technology (web, mobile)-based self-regulation tools for behavior change targeting a wide array of populations and health behaviors.  This work examines behavioral phenomena (and the mechanisms by which they work) ranging from substance abuse, mental health, chronic pain management, medication adherence, diet, exercise, diabetes, and smoking.  Self-regulation tools offered on mobile platforms enable widespread reach and scalability of effective interventions.

In this project, we will examine putative targets (processes) of behavior change within the self-regulation mechanism domain across contexts, populations, and assays – in 3 primary levels of analysis: (1) psychological (e.g., constructs such as self-efficacy; emotion regulation; response inhibition), (2) behavioral (e.g., tasks of reward responsiveness; temporal horizon), and (3) biological (structural and functional MRI of key neural circuitry).   We will evaluate the extent to which we can engage and manipulate these putative targets both within and outside of laboratory settings (using a novel mobile self-regulation monitoring and intervention platform).  We will conduct this work with two populations for which behavior plays a critical role in the course of medical regimen adherence, health, and health outcomes: (1) smokers and (2) obese/overweight persons.   We will then examine cross-assay validity and cross-context and cross-sample reliability of assays to identify relations among self-regulatory targets. We will finally evaluate the degree to which engaging targets produces a desired change in medical regimen adherence (across 4 week self-regulation interventions) and health behavior among smokers and obese/overweight persons.   

This project will identify valid and replicable assays of mechanisms of self-regulation across populations to inform an ontology of self-regulation that can ultimately inform development of health behavior interventions of maximal efficacy and potency.

Public Health Relevance:

Because the need to alter health-related behavior is ubiquitous across medicine, understanding the extent to which the principles of effective health behavior change (and the mechanisms by which they work) are similar or differ across health conditions and settings is a critically important area of scientific inquiry -- and may inform more efficient, cost-effective, and patient-centered care.  This line of research may allow us to make great strides in crafting “precision medicine” approaches for a wide array of populations.
Note:  CTBH Director, Dr. Marsch, is affiliated with the small business that developed a mobile platform tool to be used as part of this project.  This relationship is managed by her academic institution.

Applying Novel Technologies and Methods to Inform the Ontology of Self-Regulation


May 15, 2015

Ethics and Social Justice in Research Involving Vulnerable Populations

Celia B. Fisher, PhD
Marie Ward Doty University Endowed Chair and Professor of Psychology,
Director Center for Ethics Education and Director HIV and Drug Abuse Prevention Research Ethics Institute
Fordham University

About the Presentation:

The presentation will identify challenges and opportunities for the responsible conduct of research with racial/ethnic, sexual minority, and economically disenfranchised children and adults. Topics will include defining minimal risk, waiving guardian permission, developing population sensitive confidentiality and disclosure polices for high risk social behavioral research and studies involving genetic testing, the importance of community collaboration and research on research ethics will be discussed.  

About the Presenter:

Celia B. Fisher, Ph.D., the Marie Ward Doty Endowed University Chair and Professor of Psychology, is founding Director of the Fordham University Center for Ethics Education and the NIDA funded HIV and Drug Abuse Prevention Research Ethics Training Institute. She chaired the Environmental Protection Agency’s Human Studies Review Board and the American Psychological Association’s Ethics Code Task Force and was a member of the Secretary’s Advisory Committee on Human Research Protections (SACHRP) the National Academies' Revisions to the Common Rule for the Protection of Human Subjects in Research in the Behavioral and Social Sciences, the National Institute of Mental Health Data Safety and Monitoring Board, and the Institute of Medicine’s Committee on Clinical Research Involving Children. She was awarded the Lifetime Achievement Award for Excellence in Human Research Protection in 2010 and named a 2012 Fellow of the American Association for the Advancementof Science. She is the author of Decoding the Ethics Code: A Practical Guide for Psychologists (3rd edition, 2013); co-editor of eight books, including The Handbook of Ethical Research with Ethnocultural Populations and Communities (2006, Sage Publications) and Research with High-Risk Populations: Balancing Science, Ethics, and Law (2009, APA Publications); and over 150 theoretical and empirical publications. Her federally funded research focuses on understanding participant perspectives on ethics policies and practices.

Michael L. Gordy, PhD

Senior Global Health Consultant

Global Health; Economics; Health Outcomes

Dr. Michael L. Gordy is an independent consultant, based in France, whose specialties are Global Health issues, the economic and political aspects of climate change, and the interface between climate change and health outcomes. His clients include the World Meteorological Organization (WMO), the World Health Organization (WHO), the United Nations International Strategy for Disaster Risk Reduction (UNISDR), and the Global Disinfection Initiative (GDI A/S).

Dr. Gordy received a PhD from the University of Texas at Austin and a BA from Carleton College. He did a post-doctoral year at Boston University, funded by the Milbank Foundation, on the subject of the political economy of the US health care system. He worked as director of a program in the ethics of the professions in the University Professors Program at Boston University before moving to France in 1981. Since then he has consulted on organizational strategy for numerous corporations, large and small, and has consulted on various topics for many international organizations.

Dr. Gordy has been named a Senior Global Health Consultant at the Center for Technology and Behavioral Health at Dartmouth.

Development and Evaluation of Novel Mobile Phone and Location-based Systems to Promote Resilience and Healthy Lifestyles among College Students

Funding Source: Dartmouth College Office of the Provost Seed Funding

Project Period: June 2015 – June 2016

Principal Investigator: Sarah Lord, PhD

Other Project Staff: Elizabeth Carpenter-Song, PhD (Co-PI); Andrew Campbell, PhD (Co-PI); Lorie Loeb (Co-PI); Sunny Kim, PhD (Research Associate/Project Coordinator)

Partners: Dartmouth College Health Services: Ann Bracken, MD; Virginia Brack, MD; The Wellness Center (Student Health Promotion and Wellness): Caitlin Barthelmes, MPH

Project Summary:
College students rank stress and sleep as the top two factors that negatively impact academic performance. High stress and poor sleep are also associated with impaired decision making and exacerbation of illnesses. In this project, we will develop, implement and evaluate an innovative interactive digital health communication initiative on the Dartmouth College campus that integrates behavioral science, mobile technology, engaging digital content, and state-of-the-art location-based technologies to: 1) build awareness about the causes and consequences of stress and poor sleep, 2) foster stress management skills and healthy lifestyle choices among students, and 3) promote knowledge about, and use of, campus support resources.  Our goal is to bring effective information about stress and healthy lifestyles to students in ways that are engaging and fun, useful, and accessible where and when students need it.

HealthMatters brings together faculty and students from CTBH, the Department of Computer Science and the Digital Arts, Leadership and Innovation Lab, Anthropology, Dartmouth College Health Services, Student Health Promotion, and the broader Dartmouth student community. A Student Advisory Board and participatory approach will ensure that students are involved in all aspects of the design, development, implementation and evaluation of the digital health communication system. Early formative research with students (and conducted by students) will determine the content, approach, and optimal technologies for the initiative. Students will test the system throughout the development process.  HealthMatters will be evaluated in a limited campus deployment with 40 students using qualitative and qualitative methods to assess technical feasibility and acceptance by students.

Public Health Relevance:
This cross-disciplinary project aligns with Moving Dartmouth Forward by promoting attitudes and skills for healthy lifestyle choices by students. If successful, this project will be a valuable resource to students, offer a campus-based technology infrastructure and collaborative framework for other health initiatives, and serve as a foundation for future funding initiatives to evaluate the digital health communication system more broadly for impact on student outcomes (i.e., academic performance, well-being, campus resource utilization.)