Spotlight on… Tibor Palfai, PhD

Can you tell us about your academic and professional background, and what led you to work in the field of alcohol and HIV research?

I completed my undergraduate degree at the University of Toronto and had the opportunity to do research and take classes with a number of well-established cognitive psychologists who were there at the time. I then completed my PhD in clinical psychology at Yale University under the guidance of Dr. Peter Salovey where I studied the impact of mood on social cognition. My first experience in alcohol research was during my internship year at Brown University. I stayed on there as a T-32 post-doctoral fellow at the Center for Alcohol and Addictions where I studied cue reactivity and alcohol-related cognition. During this time, I met a number of colleagues with whom I collaborated on alcohol research projects for many years following. I started at Boston University as an Assistant Professor in the Department of Psychological and Brain Sciences and during my first year I met a physician at the medical school who was looking to collaborate on alcohol intervention development for medical populations. I worked with Dr. Richard Saitz over several years, and it was through his work in Boston ARCH that started my interest in alcohol interventions for people with HIV. Parallel to this, I developed a collaboration with Dr. Stephen Maisto at Syracuse University on understanding how alcohol impacts HIV-risk behavior. This research involved the use of experimental paradigms to study the effects of alcohol on decisions making related to sexual risk and the development of interventions to reduce heavy drinking and sexual risk behavior.

Can you tell us about your role within the ARCHER P01? What questions does your research aim to answer?

The Boston ARCHER P01 seeks to address co-morbid conditions among PWH that impact functioning. Because chronic pain is a common comorbidity for PWH who engage in unhealthy drinking that has a considerable impact on functioning, it is important to develop efficacious, accessible intervention approaches that can address these conditions. I am the Project Lead for this randomized controlled trial that seeks to test the efficacy of an integrated, videoconferencing-based intervention to reduce heavy alcohol use and improve pain management among people with HIV who engage in unhealthy drinking and have chronic pain. The intervention includes strategies that are applicable to both alcohol and pain reduction and is delivered through a telehealth format in just 7 sessions. The study also seeks to provide insight into a number of other issues including: (1) how pain and alcohol are associated with one another among PWH (2) what are the mechanisms of behavior change that underlie improved pain management and reduced alcohol use, and (3) what is the role of individual difference factors in treatment response.

How do you hope that the findings from ARCHER will ultimately impact clinical care, interventions, or public health policies?

The goal of this program of research is to develop scalable, effective approaches to address these common co-occurring conditions for PWH. Should this trial indicate that this is an efficacious approach, we will explore efforts to integrate this into health settings and continue to develop the technology components of this intervention approach to increase its scalability. The advantage of this telehealth approach is that it could be part of a centralized behavioral health system that may be implemented in a wide range of hospital department and community health centers.

Tell us about some of your other work outside of ARCHER. Any recent findings or insights that you find especially promising or exciting?

I am also interested in alcohol and HIV prevention research, namely (1) the development of web and mobile interventions and (2) developing better understanding of the role of alcohol on decision-making related to HIV risk. For the latter question, my colleagues and I have used ecological momentary assessment (EMA) to study how alcohol and other contextual variables impact cognitive processes related to risky sexual decision making. One of our objectives has been to utilize cognitive measures that have been traditionally studied in the laboratory, in a format that can be used in the field through EMA. We have used a mobile working memory task a novel EMA “condom effort discounting task” to measure within-subject effects of intoxication on processes related to sexual risk. Among our findings in the initial studies with men-who-have-sex-with-men (MSM), we have found that within-subject increases in intoxication reduces working memory and motivational processes related to condom use at the daily level. Our current project is examining how intoxication interacts with other contextual variables (e.g., perceived partner attractiveness, arousal) at the between and within-subjects’ levels to predict sexual risk, and whether this is mediated by cognitive-motivational processes that we have identified in previous work.

What advice would you give to students or early-career investigators interested in alcohol or HIV research?

In my view, the two most important things for a research career are to (1) develop expertise in an area [or two] and (2) develop collaborations. The first one sounds obvious but there are often many factors that pull researchers in many different directions to study many different topics. This certainly can be enjoyable but it doesn’t replace the sense of meaning, purpose, and engagement of focusing a career on developing a depth of knowledge in one or two areas. It may take some time to find an area or two in which you wish to specialize but it is worth thinking about this as you start on your career. This is related to the second important goal, which is to develop collaborations. The most enjoyment I have had in my research career has always been working with others on projects. Every facet of the research enterprise is enriched by doing it collaboratively. Developing expertise provides one important pathway for helping you broaden your collaborations. This, along with working with established investigators in the field, attending conferences, and being part of conference and grant review committees are all important ways to develop these collaborations.