I began the research that led to social action theory as a doctoral student at Stanford Univesity in the 1970’s while studying cognitive-behavioral counseling, assessment, and evaluation with Carl Thoresen (Education) and Albert Bandura (Psychology). A post-doctoral appointment as a Research Associate in Cardiology and Psychiatry at Stanford with C. Barr Taylor, Robert DeBusk, and Helena Kraemer afforded the opportunity to develop a goal focused social-environmental framework for the newly emerging field of behavioral medicine. My early studies examining the effects of social-relational goals and marital problem-solving transactions on blood pressure in patients with hypertension produced key initial components of the social action analysis of environmental stress.

The early promise of a social-ecological approach to stress reduction for heart health was highlighted further by my clinical trial of a couples’ problem-solving training intervention for maritally distressed cardiac patients with hypertension. This study produced the first experimental evidence that enhancing couples’ transactive problem-solving abilities can dampen the patient’s blood pressure responses during arguments. Another influential early study provided the first evidence that perceptions of self-efficacy powerfully shape people’s ability to achieve important activity goals by changing their behavior. This work demonstrated the importance of modifying patients’ and spouses’ self-efficacy perceptions when seeking to strengthen the patient’s adherence to physical activity recommendations following a heart attack. This work produced the goal focused self-efficacy assessment and intervention approach to promoting heart health that later would form a central component of the Stanford Five City Study of heart disease prevention.

Social action theory formed the basis and guiding rationale for the community-based cardiovascular health studies that I was able to launch in Baltimore upon moving to Johns Hopkins University in 1981. This community focus was influenced by my work at Stanford and by my earlier postgraduate social justice studies in Philadelphia and New York City with associates of Dr. Martin Luther King, Jr. Those experiences had included professional training in community organizing and counseling with Black clergy in the civil rights movement who led city churches that served low-income neighborhoods. Experiences in multiracial urban communities marked by poverty, disorder, and violence led me to investigate the social-relational and neuro-cognitive mechanisms that enable people to engage in self-regulation and pursue their important life goals under adversity by building a supportive social world. Social action theory yielded a naturalistic, bottom-up research program that combined observational and experimental investigations with diverse populations in community settings.

In the Baltimore studies, four large public high schools that served low- to middle-income neighborhoods participated in research that included school-wide screenings of blood pressure, health habits, family history of illness, neighborhood environments, personality, emotion, and stress-related strivings, followed by intensive studies testing social action theory predictions. In these studies, known as Project Heart, thousands of students and their parents took part in health evaluations and preventive interventions. Students found to be at higher cardiovascular risk (due to high normal blood pressure) participated in school-based laboratory experiments measuring stress responses to mental and socio-emotional challenges presented in standard laboratory tasks and intensive stress interviews. These studies included the first randomized clinical trial (RCT) of self-calming and relaxation training to lower blood pressure in high-risk Black and White urban youth, as well as an RCT evaluating the effectiveness of school-based aerobic exercise to lower blood pressure in high-risk adolescent girls.

The controlled trial of self-calming produced the first experimental evidence that progressive muscle relaxation and diaphragmatic breathing exercises performed daily in school can dampen cardiovascular arousal and lower resting blood pressure in Black and White youth who live in neighborhoods with high levels of poverty, violence, and disorder. Participants enjoyed the training. However, the demands of their daily lives impeded their use of self-calming skills by shaping the youths’ goals and priorities. It turned out that those demands involved threats to strivings for growth, social potency, and safety. This key discovery inspired a new quest to determine if these three strivings might form vital mediating paths linking social environments and emotions to cardiovascular health—pathways that the leading theories of stress did not consider. My subsequent research therefore sought to map and bridge this crucial causal void.

 Further Project Heart research indicated that striving for personal and social-relational growth, or transcendence striving, improves energy regulation and promotes health. But persistently trying to influence or control other people (agonistic striving) and persistently trying to withdraw to be safe (dissipated striving) can chronically activate stress systems by generating ongoing interpersonal struggles or paralyzing self-perceptions of personal incapability and low worth. The findings suggested that harsh worlds erode physical health by chronically threatening a person’s social power—fostering agonistic striving, or by diminishing their social worth or status—fostering dissipated striving. By affecting the intensity, duration, predictability, and controllability of power or status threats, the three basic strivings contribute to individual differences in exposures and responses to adverse events and influence health and development over the life course.

An invitation from Syracuse University in 1996 to chair the Department of Psychology and establish an all-University Center for Health and Behavior afforded the opportunity to extend the Baltimore Project Heart research to a different city. The creation of the new Center (directed by Dr. Michael P. Carey) enabled the launch of new Project Heart studies involving more than a thousand high school students from multiracial low- to middle-income city neighborhoods. These studies, together with new research by health scientists at Vanderbilt University and the US Veterans Administration, replicated Project Heart’s earlier findings and tested, refined, and extended the social action theory model of biologically adaptive strivings to problems of chronic pain and alcohol use disorders.