Michael P. Carey

Introduction

Michael P. Carey is an American clinical health psychologist whose career has been spent on a single practical question: can talking to people change the behaviors that make them sick, and can that change be measured honestly?

He is Professor Emeritus of Psychiatry and Human Behavior and of Behavioral and Social Sciences at Brown University, and previously directed the Center for Behavioral and Preventive Medicine at The Miriam Hospital in Providence, Rhode Island, from 2011 to 2020. Before moving to Rhode Island he spent twenty-five years at Syracuse University, where he founded the Center for Health and Behavior and held one of the university's two Dean's Professorships of the Sciences.

His output is unusually large — Brown's research profile credits him with more than 400 peer-reviewed papers, roughly 30 book chapters, and two books — and unusually concentrated. Most of it concerns sexual risk behavior, HIV prevention, alcohol use, and the measurement problems that plague all three. He is a licensed clinical psychologist and has been elected to Fellow status in the American Psychological Association, the Association for Psychological Science, and the Society of Behavioral Medicine.

Carey belongs to a generation of clinical psychologists who moved outward from the therapy room into public health, and his work sits at the boundary where psychological theory meets epidemiology. That location is also where the strongest criticisms of his field originate, and he has spent much of his career addressing them directly rather than ignoring them.

Early Life and Education

Carey was raised in the United States and completed his undergraduate degree in psychology at St. Lawrence University in Canton, New York, graduating magna cum laude in 1980. As an undergraduate he was elected to Phi Beta Kappa, received his department's outstanding graduate prize, and won undergraduate research awards from the American Psychological Association and Sigma Xi — an early signal that his interests were empirical rather than purely clinical. He had also spent 1978 abroad as an exchange student at the Austro-American Institute in Vienna.

After graduating he held a Thomas J. Watson Foundation fellowship for a year of independent travel and study in Western Europe. He then entered the clinical psychology program at Vanderbilt University in Nashville, earning his master's degree in 1984 and his Ph.D. in 1986. Between those two milestones he completed his clinical internship — in clinical health psychology, at Brown University in Providence, in 1985–86 — which is worth noting because it is the institution he would return to permanently a quarter-century later.

Carey's training is a useful corrective to a common assumption about health psychologists. He was not trained as an epidemiologist or a public health scientist. He was trained as a clinical psychologist, in a department strongly influenced by behavior therapy, and the tools he brought to public health problems — structured assessment, functional analysis of behavior, controlled trial design — came from that clinical tradition. He continued formal coursework well after his doctorate, taking classes at Ohio State University's psychology department in 1990 and at the schools of public health at the University of Michigan and Johns Hopkins University in the early 1990s, effectively retraining himself in population health methods on the job.

Academic and Professional Career

Carey joined Syracuse University as Assistant Professor of Psychology in 1986, was promoted to Associate Professor in 1990 and to full Professor in 1995, and was named Dean's Professor of the Sciences in the College of Arts and Sciences in 2007. He founded and directed Syracuse's Center for Health and Behavior, an interdisciplinary unit that gave psychological research on health behavior an institutional home. During the same period he held a series of clinical and adjunct appointments in medicine rather than psychology — clinical research psychologist at the Syracuse VA Medical Center, clinical assistant professor of urology at the SUNY Health Science Center, and later adjunct professorships of medicine at SUNY Upstate Medical University and the University of Rochester School of Medicine. The pattern is consistent: he built his career inside medical settings while remaining a psychologist.

Early funding came from the National Institute of Mental Health in the form of a Scientist Development Award in 1993 and an Independent Scientist Award in 1998, the awards that in practice determine whether a young behavioral scientist can sustain an independent research program.

In 2011 he moved to Brown University as Professor of Psychiatry and Human Behavior in the Alpert Medical School and Professor of Behavioral and Social Sciences in the School of Public Health, both as a research scholar, and became Director of the Center for Behavioral and Preventive Medicine at The Miriam Hospital, a post he held until 2020. He also co-directed an NIH-funded postdoctoral training program in child and adolescent biobehavioral HIV research from 2011 to 2022. He remained at Miriam as a senior research scientist until 2022, when he took emeritus status at Brown.

Alongside his own trials he built a long collaborative network: meta-analytic work with Blair T. Johnson at the University of Connecticut, alcohol and sexual-risk trials in the townships outside Cape Town with Seth Kalichman, and extensive collaboration with Kate B. Carey on college drinking. He served on the boards of the Society of Behavioral Medicine and of the APA's health psychology division, worked as an associate editor for several journals, and reviewed for the NIH, the CDC, and more than eighty journals.

Major Contributions to Psychology

Behavioral Interventions for HIV and Sexual Risk

Carey's central line of work has been designing and testing brief behavioral interventions to reduce sexual risk behavior, delivered to populations at elevated risk: people living with HIV, patients at STI and emergency clinics, urban adolescents, college students, and men in South African drinking venues. The interventions typically combine risk information, motivational work drawn from motivational interviewing, and concrete behavioral skills — condom negotiation, partner communication, planning around alcohol use — in a small number of sessions designed to be deliverable in real clinics rather than in laboratories.

The design philosophy matters more than any single trial. Carey's studies are generally short, manualized, and evaluated against active rather than no-treatment control conditions, which produces smaller effect estimates than lenient designs but more credible ones.

Measurement of Sexual Behavior and HIV Knowledge

Carey's most widely used contributions are arguably instruments rather than theories. The Brief HIV Knowledge Questionnaire, developed with Kerstin Schroder, became a standard measure in prevention research. With Ilana Spector and Lynne Steinberg he developed the Sexual Desire Inventory, and with Spector he produced influential critical reviews of the prevalence and incidence of sexual dysfunctions.

Equally important is a strand of methodological work — notably with Schroder and Peter Vanable — examining how accurately people can report their own sexual behavior. Their conclusion is uncomfortable for the whole field: self-reports of sexual behavior are subject to recall failure and social desirability bias, and the size of the resulting error is often comparable to the intervention effects researchers are trying to detect. That Carey published this critique of his own primary outcome measure is one of the more honest moves in the literature.

Meta-Analysis as a Tool for Health Psychology

With Johnson, Lori Scott-Sheldon, and others, Carey applied meta-analysis systematically to health behavior change. The best known of these syntheses examined the behavioral effects of HIV counseling and testing, individual-level interventions to reduce college student drinking, and computer-delivered interventions for health promotion across 75 randomized trials. Later work extended the method to stress management for heart failure patients and to complementary approaches for chronic pain in military populations. The cumulative message of these reviews is deflationary in a productive way: interventions work, but modestly, and the field's published record overstates them.

Adaptation to the Biomedical Era

From roughly 2010 onward Carey's work shifted to fit a changed prevention landscape. Rather than defending behavioral counseling as a standalone strategy, his later trials targeted behaviors that make biomedical tools work — antiretroviral medication adherence, HIV and hepatitis C testing uptake among emergency department patients who initially declined, and pre-exposure prophylaxis uptake among adolescent sexual minority males. This included exploratory trials of telephone-delivered mindfulness training for adherence and sexual risk among people living with HIV.

Major Publications

  • Sexual Dysfunction: A Guide for Assessment and Treatment (1991; second edition 2001), with John P. Wincze — a clinical treatment manual published by Guilford Press in the series edited by David H. Barlow.
  • "Incidence and Prevalence of the Sexual Dysfunctions: A Critical Review of the Empirical Literature" (1990), with Ilana P. Spector.
  • "The Sexual Desire Inventory: Development, Factor Structure, and Evidence of Reliability" (1996), with Ilana P. Spector and Lynne Steinberg.
  • "Effects of HIV Counseling and Testing on Sexual Risk Behavior: A Meta-Analytic Review of Published Research, 1985–1997" (1999), with Lance S. Weinhardt, Blair T. Johnson, and Nicole L. Bickham.
  • "Development and Psychometric Evaluation of the Brief HIV Knowledge Questionnaire" (2002), with Kerstin E. E. Schroder.
  • "Methodological Challenges in Research on Sexual Risk Behavior: II. Accuracy of Self-Reports" (2003), with Kerstin E. E. Schroder and Peter A. Vanable.
  • "Individual-Level Interventions to Reduce College Student Drinking: A Meta-Analytic Review" (2007), with Kate B. Carey, Lori A. J. Scott-Sheldon, and Kelly S. DeMartini.
  • "Computer-Delivered Interventions for Health Promotion and Behavioral Risk Reduction: A Meta-Analysis of 75 Randomized Controlled Trials, 1988–2007" (2008), with David B. Portnoy, Lori A. J. Scott-Sheldon, and Blair T. Johnson.

Impact and Legacy

Carey's practical influence runs through instruments and syntheses more than through any signature theory. The Brief HIV Knowledge Questionnaire and the Sexual Desire Inventory are used by researchers who have never read his trials, and his meta-analyses are routinely cited in guideline documents on sexual risk reduction and college drinking. Through the Syracuse and Brown centers, and through the postdoctoral program he co-directed, he trained a substantial cohort of behavioral HIV researchers; Brown's department named him its Mentor of the Year in 2018, and Syracuse awarded him the William Wasserstrom Prize for graduate teaching and mentoring in 2000.

The serious criticism of his field is not about fraud or sloppiness but about magnitude. Meta-analyses, including several he co-authored, find that behavioral interventions reduce self-reported sexual risk behavior by roughly 10 to 30 percent relative to controls — statistically real, but probably too small to move HIV incidence at a population level. The EXPLORE trial, the only large behavioral counseling trial for men who have sex with men evaluated against HIV infection itself rather than self-report, produced an 18.2 percent reduction in incidence with a confidence interval spanning zero. Critics drew the obvious conclusion: if the outcome that matters is infection, behavioral counseling alone has not demonstrated it.

Two further criticisms cut deeper. First, the primary outcome is usually self-reported and therefore vulnerable to exactly the biases Carey himself documented — participants who have just received a risk-reduction session have an obvious motive to report less risk. Second, systematic reviews of the behavioral prevention literature repeatedly find that most primary trials carry a high risk of bias, that few measure biological endpoints such as STI incidence, and that effects decay over follow-up.

The defense, which Carey's own record supports, has several parts. He published the self-report critique rather than suppressing it, and pushed for reporting standards that would let readers judge accuracy. His trials frequently used active control conditions, which shrink apparent effects; the EXPLORE result is also partly explained by risk reduction in the control arm rather than by failure in the intervention arm, since control participants received repeated counseling, testing, and detailed behavioral questionnaires. And rather than defending behavioral counseling as a substitute for biomedical prevention, his later program reoriented toward the behaviors on which pre-exposure prophylaxis, testing, and treatment-as-prevention depend — a tacit concession that the original framing set the bar in the wrong place, and a reasonable answer to it.

What remains unresolved is whether brief behavioral interventions can ever produce effects large and durable enough to matter epidemiologically on their own. Carey's work is best read as a careful negative-plus-partial-positive result on that question: the effects are real, smaller than early enthusiasm suggested, and most useful when attached to a biomedical tool that does the heavy lifting.

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References

  • Carey, M. P., & Carey, K. B. (1990). Behavioral medicine and health psychology. Handbook of Behavior Modification.

Last updated: 2026-10-20

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