Faculty Spotlight: Cardiac Psychologist, Katharine Sears Edwards

January 12, 2023

Katharine Sears Edwards, PhD, is a Clinical Assistant Professor of Medicine at Stanford, in the division of Cardiovascular Medicine and is one of the few cognitive behavioral therapists in the country who specializes in cardiology. Last month, CVI interviewed Dr. Edwards about her career path, her connection to former cardiology legend Paul Dudley White, and her unique niche in cardiovascular health.

How are cardiology and psychology related?

Some of the most common problems that I see are panic disorder and health anxiety. There are overlaps between panic symptoms and cardiac symptoms: such as shortness of breath, chest, pain, palpitations. Some of these symptoms can come purely from anxiety. Anyone who practices general cardiology sees a lot of anxiety because patients often think there's something wrong with their hearts. But anxiety is also a big part of post-event adjustment. Anxiety is very common in reaction to cardiac events such as heart attacks, dangerous arrythmias, or ICDs.

I see both patients who have never had any cardiac problems and are convinced that they do, and patients who have had an event or device placed and feel overly anxious about it.

Does that mean you’re using behavioral methods to work with cardiology patients?

Yes; I'm primarily trained as a cognitive behavioral therapist and all of the interventions I do are behavioral, not medication based. Cognitive behavioral therapy is an approach that looks at how our thoughts and our behaviors influence our emotions, and vice versa. It has a very strong evidence base and I use it to treat depression, panic, trauma, and adjustment. I also want to say that part of the reason that I was hired at Stanford is because the cardiologists here care about people's lives in a holistic way.

How common is it that institutions take such a holistic approach to patient treatment?

It’s becoming more and more common in specialty care, and I would say the VA was on the forefront of including psychology in primary care, which is one of the reasons why it was a great place to train. But there are still very few specialty clinics where you’ll find an embedded psychologist. A psychology presence is more common in pain, oncology, and sleep, but having a psychologist in a different specialty clinic like cardiology is rare. I know of a handful, maybe 10, in the country. And when I tell people I’m a cardiac psychologist, they ask, what is that? It's becoming more common but it's still not something that you're going to find in every health care system.

One of the things I hope to do at Stanford in the future is to build a training program so that we can train more clinical psychology fellows in cardiac behavioral medicine. Not only will it improve programs, but it will raise visibility about this career path.

How did you become a behavioral therapist who works in cardiology?

I entered graduate school wanting to do health psychology because my grandmother White passed away when I was 18 and it affected me a lot. I had a special interest in how people cope with the end of life. During my PhD, I transitioned into working on anxiety disorders because of an excellent faculty member and then returned to the health focus during my residency. I completed an internship in behavioral medicine at the Palo Alto VA and then I was selected as the VA’s postdoctoral fellow in behavioral medicine.

Do you also work with patient populations who are facing end-of-life?

Yes, absolutely. Stanford has an incredible palliative care team that work with patients at end of life, and I have seen patients who are struggling because they are confronting mortality issues with, for example, heart failure or arrhythmia. I recently saw a patient whose device didn't correct her lethal arrhythmia and she was concerned that she would suddenly pass away. So, my work involves end-of-life issues and providing coping strategies to plan as much as possible and simultaneously manage anxiety and depression. I work with patients clarify personal values so they can focus on quality of life in the time that they have left.

I understand you are related to a very eminent cardiologist, Paul Dudley White. How exactly are you connected?

He died before I was born but my great grandfather, Franklin Warren White, was first cousins with Paul Dudley White. He was a little bit older than Paul and was already working at Mass General Hospital in Boston as a gastroenterologist when Paul was rising in his career. My great grandfather mentored him and my great grandmother taught him how to dance! Franklin’s son, my grandfather, was very effusive about Paul and my mother passed that enthusiasm down to us. What I remember the most was that Paul was about being healthy and promoted the benefits of exercise. He was one of the fathers of preventive cardiology. He was known for riding his bicycle around the Charles River in Boston. Just recently the American Heart Association has recognized sleep problems (and will soon recognize stress) as risk factors for cardiovascular disease. So, in some ways, I feel like I’m carrying on his work in prevention.

Katharine Sears Edwards, PhD

Paul Dudley White. "Preventing heart attacks. He taught by example." 1968 Boston Globe photo, courtesy of Katharine Sears Edwards

I also remember hearing family stories about how Paul wanted to record the heart rate of a whale. He was known for being one of the first people to bring an EKG machine to the US. He was really interested in electrophysiology and had the hypothesis that smaller animals would have faster heart rates than larger animals. So, he chased whales around trying to record their heart rate. Now that I've ended up in this field, I’ve read more about him and learned that he was known for his optimism. The field of behavioral medicine is about helping people cope and optimism is a great quality to have. Sometimes, in cognitive therapy, I'm actually teaching people how to be more optimistic… or at least less pessimistic.

I've also learned that he was respectful, kind, and very supportive of patients. For example, he would include them in bedside discussions, which was not typical for his era. I think kindness and respect are always important, and especially for patients that are struggling with a sudden diagnosis of a frightening illness.

So, my connection to Paul feels special now, even though we never met.

What kind of work do you do and how does it influence your research?

What I do in the clinic day-in and day-out is deliver brief behavioral interventions for treating depression, anxiety, stress, trauma, and other emotional distress. When people have a persistent stress reaction, it often boils down to sympathetic nervous system activation. Over time, that can take a toll on the body and increase risk for cardiovascular disease.

In general, my research interests are in the potential benefit of brief behavioral interventions to improve cardiovascular health. Research over the past 20 years points towards a relationship between emotional distress and cardiac health, but there are few definitive findings that brief behavioral interventions reduce cardiac risk.

For example, my pilot data suggest that cardiac patients who increase their sleep efficiency with CBT for insomnia have lower blood pressure at post-treatment and cardiac patients who complete an 8-week Mindfulness Based Stress Reduction class have lower blood pressure at post-treatment and 3-month follow up. Furthermore, post-event and post-procedure CBT-based interventions may significantly reduce anxiety levels and improve coping in cardiac patients. I’m also hoping to do some future research on biofeedback interventions.

Through my clinical work, I've already observed how effective these interventions can be in terms of helping people manage stress, and thus better manage other cardiovascular risk factors. I have many patients who’ve lost more than 50 pounds, quit smoking, or started an exercise program and they're so much healthier after having done some emotional work to manage their depression, anxiety, or stress. The real question in my mind is, what works for whom and when? For example, does everyone need in-person therapy when there are so many amazing apps out there? What do people need as an adjunct to their cardiac care that would be enough for them? I think that these are interesting questions, because there are many different interventions and many different ways we can deliver them.