Clinical Neuroscience Fellow Looks Into the Brain to Improve OCD Treatments

Updated on Dec 18, 2023 | Featured, Psychiatry

Andrew H. Smith, MD, PhD

“What drives people to keep having certain thoughts and engaging in certain behaviors, well past the point when it is adaptive?”

That is the question underlying the research of Andrew H. Smith, MD, PhD, a clinical neuroscience fellow at the Icahn School of Medicine at Mount Sinai. He is studying the brain circuitry of obsessive-compulsive disorder (OCD) at the Nash Family Center for Advanced Circuit Therapeutics (C-ACT) at Mount Sinai West.

Dr. Smith has studied compulsive behavior—a feature of several psychiatric illnesses—from multiple angles. During his doctoral work at Yale University, he studied the genetics of compulsive behaviors, with a focus on compulsion in substance use. Now he is turning his attention from genetics to brain circuitry. His current work uses implantable devices to collect data about brain activity in people with OCD, with a long-term goal of improving treatments for this challenging disorder.

“Unfortunately, many patients with OCD are not where they want to be after treatment with psychotherapy and medication. What’s unique about this study is that it builds on clinical treatment. During the course of a patient’s treatment, we offer them the opportunity to partner with us on research that allows us to uncover what is happening in their brains.” –Andrew H. Smith, MD, PhD

Dr. Smith began working at the Center during his psychiatry residency in Mount Sinai’s physician-scientist program. After graduating in 2022, he stayed to expand his research experience through the T32 postdoctoral research fellowship in psychiatry. The competitive fellowship, funded by the National Institute of Mental Health, is designed to bridge the clinician-scientist gap to translate findings in neuroscience into better treatments for patients.

In his T32 project, Dr. Smith works with participants who come to Mount Sinai for deep brain stimulation (DBS) for obsessive-compulsive disorder.

“Unfortunately, many patients with OCD are not where they want to be after treatment with psychotherapy and medication,” Dr. Smith says. “What’s unique about this study is that it builds on clinical treatment. During the course of a patient’s treatment, we offer them the opportunity to partner with us on research that allows us to uncover what is happening in their brains.”

Deep Brain Stimulation for OCD

The Center focuses on innovative research to advance the use of neuromodulation for hard-to-treat neuropsychiatric disorders. Neuromodulation includes a range of interventions, from non-invasive techniques like transcranial magnetic stimulation (TMS) to deep brain stimulation (DBS), which involves surgically implanting electrodes into brain tissue.

Under the direction of Helen Mayberg, MD, Founding Director of C-ACT and Professor, Psychiatry, Neurology, Neuroscience, and Neurosurgery, Dr. Smith is collaborating with a multidisciplinary team of experts including Martijn Figee, MD, PhD, Associate Professor,  Psychiatry, Neurology, Neuroscience, and Neurosurgery; Ignacio Saez, PhD, Assistant Professor,  Neurology, Neuroscience, and Neurosurgery; and Xiaosi Gu, PhD, Associate Professor, Psychiatry, and Neuroscience and Director of Mount Sinai’s Center for Computational Psychiatry.

“In my previous research in computational genetics, I learned a lot about the genetic building blocks of compulsive thoughts and behaviors. This study allows me to pursue a line of research that directly involves working with patients who really need our help,” Dr. Smith says.

The first-line therapy for OCD involves medications and psychotherapy, followed by non-invasive neuromodulation tools like TMS. When patients don’t see significant improvements from those therapies, they may be candidates for treatment with DBS.

“With DBS, we can target the deep regions of the brain that we think are holding patients back and keeping them stuck in thought and behavioral loops,” Dr. Smith says.

Researchers at the Center were already studying DBS in patients with OCD, evaluating them over the course of treatment using a battery of cognitive tests. That study is allowing the researchers to better understand which cognitive processes—such as mental flexibility or sensitivity to environmental stimuli—are changing during treatment, as a person’s symptoms improve over time. In his fellowship research, Dr. Smith is adding to that work by exploring how brain activity changes as people’s cognitive processes and behaviors change during treatment.

Such research only became possible recently, when the U.S. Food and Drug Administration cleared the use of a new generation of DBS devices that record neural activity over time, in addition to providing brain stimulation.

“Once these devices are implanted, we can study people’s brain changes directly, in a way that has never been done in patients,” Dr. Smith says. “This device allows us to ask new scientific questions in a very direct way.”

DBS for OCD and Beyond

By connecting the dots between brain activity, cognitive processes, and behaviors, Dr. Smith hopes the research will paint a more detailed picture of OCD in the brain.

“Our goal is to more fully understand how brain stimulation is leading, bit by bit, to changes in what the brain does when faced with obstacles,” he says.

The research is also an opportunity to learn more about the underlying brain circuits involved in other illnesses, including the compulsive use of substances.

“If we can learn more about the neural circuits driving compulsive thinking and behavior, we can fine-tune non-invasive interventions such as medication or TMS. Ultimately, it may help us develop better treatments for more patients, so we don’t need to rely on surgery and DBS,” he says.

The T32 fellowship is a two-year program, so Dr. Smith considers this research a pilot study to demonstrate how the new implantable devices can be used to better understand compulsive behaviors. Those data will support his application for an NIH Career Development (K) Award, which he hopes will enable him to further this line of inquiry and launch his independent research career.

“The T32 fellowship program is designed to give candidates the time and space to define their intellectual contribution to the department. It has allowed me to build on the strength of the expertise at Mount Sinai without duplicating what anyone else is already doing,” Dr. Smith says. “I am thankful to be able to work with such an incredible interdisciplinary team of mentors, doing research that can optimize techniques for helping the patient sitting in front of me.”

 

 

Learn more about the Nash Family Center for Advanced Circuit Therapeutics
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Mount Sinai Researcher Launches Three Studies of Alzheimer’s Disease in Asian Americans

Updated on Oct 5, 2023 | Diversity and Inclusion, Featured, Psychiatry, Research

Clara Li, PhD, a clinical neuropsychologist and Associate Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, has received new grants that will total more than $12 million from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). The funding will support three new projects that seek to improve the diagnosis and treatment of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in Asian Americans.

Asian Americans are historically under-represented in clinical research on AD/ADRD. As a result, many older adults with Asian ancestry do not receive adequate diagnosis and treatment for mild cognitive impairment (MCI) or AD/ADRD.

Clara Li, PhD

“Chinese is the third-most-spoken language in the United States after English and Spanish, yet we don’t have many of these tools available,” Dr. Li explains. She’s hoping to change that, with three new studies launched in 2023.

Adapting Assessments for Alzheimer’s: Chinese Translation and Cultural Adaptation

In one of the studies, a five-year effort, Dr. Li will develop assessment tools that are linguistically and culturally adapted for older adults who speak Cantonese or Mandarin, with the hope to extend it to other Asian languages in the future.

Researchers rely on assessment tools from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS) to identify research participants with cognitive impairment or AD/ADRD. But those tests were developed for English speakers and Western cultures.

“I’ve seen many Asian American patients who try to take the English tests because a Chinese version isn’t available, and the language is a barrier,” Dr. Li says. “Sometimes a test would suggest cognitive impairment, but when I would translate the test myself into Chinese, the patient would score in the normal range.”

Language isn’t the only barrier. Cultural differences also make the test confusing for many Asian American patients. When asked to identify an image of a witch on the standard test, for instance, some of Dr. Li’s patients said “janitor” or “cleaner”—a common error because witches aren’t typically depicted with brooms in Chinese culture.

The lack of adequate tests hampers diagnosis and treatment, and also affects research seeking to better understand AD/ADRD in Asian Americans.

“Because we can’t enroll patients unless they can take the tests in English, many are excluded from studies. As a result, Asian Americans make up less than 2 percent of the participants in U.S. clinical trials,” Dr. Li explains. “If we want to increase diversity in research, we need to adapt these materials for Chinese speakers and eventually other Asian languages.”

A Research Infrastructure for Alzheimer’s Disease in Asian Americans

In the second study, Dr. Li will develop a research infrastructure and tools for studying AD/ADRD in older Asian Americans. She and her colleagues will develop questionnaires to fully characterize Asian American participants, including social determinants of health and any environmental or lifestyle factors that could increase or decrease their risk of developing AD/ADRD.

This five-year study will also investigate blood samples from Asian American participants to determine whether there may be novel biomarkers in this population, and whether known biomarkers are relevant to people from Asian backgrounds.

“Amyloid and tau are well known as biomarkers associated with Alzheimer’s disease, but those biomarkers were developed primarily from Caucasian samples. Therefore, the generalization of these findings in Asian Americans is not always clear, including criteria for amyloid and tau burden to establish AD/ADRD risk,” she says. “There may be different thresholds for those biomarkers in different populations.”

Support for Mild Cognitive Impairment

Dr. Li’s third newly funded project is a two-year pilot clinical trial. She and her colleagues will adapt the Memory Support System (MSS) for use in Chinese Americans who speak Cantonese or Mandarin. The MSS is a memory calendar training program to help older adults with MCI organize and remember their daily activities. The system is a component of the Healthy Action to Benefit Independence & ThinkingÒ (HABIT) Program, an evidence-based intervention that provides lifestyle and behavioral treatments for older adults with MCI.

“I see patients with MCI who want to do something to prevent the development of dementia, but if they can’t speak fluent English, they aren’t able to participate in clinical trials,” Dr. Li says. “We hope that by adapting this program, we can offer Chinese American older adults with MCI an opportunity to participate in a trial that seeks to improve memory and function, as well as their mood and quality of life.”

Alzheimer’s Disease Research at Mount Sinai

In addition to the three new studies Dr. Li has launched this year, she is leading two clinical trials at the Alzheimer’s Disease Research Center at Icahn Mount Sinai and is the site Principal Investigator for the Asian Cohort for Alzheimer’s Disease (ACAD) study, a multisite project to analyze genetic data to identify risk variants for Alzheimer’s disease in Asian Americans and Asian Canadians.

Through these projects, she hopes to improve research participation, diagnosis, and treatment related to patients of Asian ancestry—an effort that is long overdue, she says.

“There’s a lot of work that needs to be done. In addition to research inequities, there aren’t enough bilingual physicians outside the community, which often makes it difficult for Asian American older adults to receive integrated specialty care, leading to delayed diagnosis and treatment for AD/ADRD,” she adds.

Mount Sinai serves a diverse patient population and is committed to improving care by addressing bias and racism. Icahn Mount Sinai and Mount Sinai Health System created the Center for Asian Equity and Professional Development to address the equity and professional development challenges faced by Asian Americans and Pacific Islanders.

Learn more about the Alzheimer’s Disease Research Center

The Days Are Getting Shorter, Here’s Why You May Be Feeling Down

Updated on Oct 3, 2023 | Mental Health, Psychiatry, Your Health

Autumn brings about many things: leaves on the ground, cooler temperatures, and of course, Halloween. But while many look forward to a reprieve from the summer months, the start of the season can introduce new challenges. Seasonal depression—commonly known as seasonal affective disorder (SAD)—is a temporary condition estimated to affect 10 million Americans each year.

Mariana Figueiro, PhD, Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and Director of the Light and Health Research Center at Mount Sinai, explains the effects of SAD and how those who experience it can manage the disorder.

What are the symptoms of seasonal affective disorder, and what causes it?

Symptoms of seasonal affective disorder vary, but in general, it includes feeling down or depressed as well as experiencing a lack of interest and energy. People tend to be sleepier and tend to overeat, especially carbohydrates. And, as with any depressive episode, there could be suicidal thoughts. These depressive symptoms occur at specific times of the year, typically the fall and winter, and there is a full remission at other times of the year, such as the spring and summer.

Unfortunately, the cause of the disorder is still unclear, but there are some competing theories. One is that the start of autumn causes circadian rhythm disruption. Another is that the photoreceptors in the eye are not as sensitive to light, and another is serotonin reuptake dysfunction, which is an imbalance in serotonin levels. But the most prominent theory is that, due to the lack of or delay in getting morning light, the biological clock in the brain is out of phase with your natural light-dark patterns, affecting the timing of the sleep cycle. As such, your biological clock is telling you that it is 6:30 in the morning, but your watch is telling you differently. That mismatch can be the cause of seasonal depression.

Does the disorder only affect people who live in cities with long winters, or are people in warmer climates affected as well?

It tends to mostly affect people who live at higher latitudes, as these areas have less daylight availability in the winter months.

In the United States, higher latitude areas will be the northernmost states such as Alaska, Washington, Michigan, New York, and Maine. In the New York metropolitan area, we have about 15 hours of daylight at the height of summer but only about nine hours in the dead of winter. This contrast is starker in areas that are farther north. Barrow, Alaska—the northernmost city in our northernmost state—has 67 straight days of darkness in the winter.

Within high latitude populations, the prevalence of SAD varies between one and 10 percent. But it can happen at lower latitudes, it’s just less prevalent.

How can I recognize and manage SAD?

If you go to a physician, there are standardized questionnaires—such as the seasonal pattern assessment questionnaire—that you can take. But, in general, if year after year you begin to crave carbohydrates, lose energy, lose interest in things, overeat, and oversleep around October, that’s a good sign that you should seek a formal SAD diagnosis.

Once you consult a physician, they will discuss how you can manage the disorder. There are two common ways to treat SAD. One would be medication—typically an antidepressant or a selective serotonin reuptake inhibitor—that would be prescribed by a physician. The other is non-pharmacological: light therapy. Exposing yourself to light—be it morning, natural, or electric indoor light—will help resynchronize your biological clock so that it matches your local time. You can do this by adding more lights in the home, opening up your windows, and trying to be outside during daybreak. And if you work from home, try to sit facing a window. Making your environment brighter during the day will help get more light to the back of the eye, which is what you want in order to be an effective treatment for seasonal depression.

Has light therapy been used to treat other illnesses?

Yes, it has. The Light and Health Research Center at Mount Sinai has done a number of studies showing that—outside of treating seasonal depression—there is a definite benefit to exposing people to bright days and dim nights. For instance, in a study with Alzheimer’s disease patients, the lighting was changed in their nursing homes and assisted living facilities to simulate bright days and dim nights. The results were a very robust, positive impact on their sleep, mood, and behavior. In other applications, we worked with persons with mild cognitive impairment and sleep disturbance from mild traumatic brain injury to see how light therapy can help. And we have been working with breast cancer and myeloma transplant patients to see if delivering light therapy during a transplant or during chemotherapy will help to minimize fatigue and improve their sleep.

There are various applications. You can even use it to try to get your teenager to go to bed and wake up earlier. The addition of light can have many positive effects on life.

Learn more about the Light and Health Research Center at Mount Sinai
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Mount Sinai Researchers Publish First Genome-Wide Analysis of Binge Eating Disorder

Sep 22, 2023 | Featured, Psychiatry, Research

Binge eating disorder is the most common eating disorder in the United States, thought to affect as many as 3 percent of people during their lifetimes. Yet it remains poorly understood.

Now, researchers from the Icahn School of Medicine at Mount Sinai have made important progress with the first genome-wide analysis of binge eating disorder (BED). The study, published in Nature Genetics in August, identified genes that appear to be associated with BED risk. The study also found evidence that iron metabolism may play a role in the disease.

“By applying machine learning to the study of binge eating disorder, we’ve gained important insights into this poorly understood condition, and a new tool for exploring other underdiagnosed diseases,” says Panos Roussos, MD, PhD, Professor of Psychiatry, and Genetics and Genomic Sciences at Icahn Mount Sinai and Director of the Center for Disease Neurogenomics, who is a co-author of the study. “By combining Neuroscience with genomics and big data analysis, we can discover more about how the brain works and ultimately prevent psychiatric disease.”

A Fresh Look at Binge Eating Disorder

Binge eating disorder has significant impacts on a person’s health and well-being. “It can cause substantial distress and impairment in quality of life,” says Trevor Griffen, MD, PhD, a psychiatrist and neuroscientist who collaborated on the recent study while he was a fellow in child and adolescent psychiatry at Mount Sinai. “BED often co-occurs with other psychiatric disorders, such as depression, ADHD, and substance use, and seems to be a nexus of metabolic dysfunction, with associations to conditions like diabetes and high blood pressure.”

Trevor Griffen, MD, PhD

Yet it took a long time for the scientific community to recognize BED as a distinct disorder. It was first included as a new diagnosis when the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2014. As a result, the diagnosis is all but absent in the electronic health records and large biobanks that researchers tap into for large-scale genetic analyses. Luckily, the Mount Sinai team developed a workaround.

“A big part of this study was using machine learning to figure out the people most likely to have BED,” says lead author David Burstein, PhD, a data scientist at Mount Sinai who works in the labs of Dr. Roussos and study co-author Georgios Voloudakis, MD, PhD, Assistant Professor of Psychiatry, and Genetics and Genomic Sciences.

Using electronic health record data from more than 767,000 people through the Million Veterans Project, Dr. Burstein and his colleagues applied machine learning approaches to sift through medical diagnoses, prescription medicines, body mass index (BMI) data, and other factors, looking for patterns that would predict if a person had BED. Applying their model to smaller cohorts of people with diagnosed BED, they showed the approach could meaningfully predict the disorder, even in the absence of a formal diagnosis.

Genes Point to New Binge Eating Disorder Treatments

Applying the machine learning model to some 362,000 people for whom genetic information was available, the researchers zeroed in on several genetic loci that appear to be associated with BED risk. One of the genes implicated in the new study is MCHR2, which is associated with the regulation of appetite in the brain. Two others, LRP11 and APOE, have previously been shown to play a role in cholesterol metabolism.

David Burstein, PhD

Another gene identified in the study, HFE, is involved in iron metabolism. The identification of HFE aligns with recent research suggesting iron metabolism may have an important role in regulating overall metabolism, Dr. Griffen says. In particular, iron overload seems to be associated with binge eating, the team found. Interestingly, iron deficiency has been implicated in pica, a disorder that drives people to eat non-food items such as soil or hair.

“There have been hints that iron is a player in the eating disorder world,” Dr. Burstein says. “This new study is more evidence that the mineral deserves a closer look.”

The findings also point toward new directions for treating BED. So far, treatment has mostly focused on repurposing therapies used for other disorders, such as depression or ADHD.

“This study identifies genes and systems that could serve as potential targets for treatments that finally address the underlying biology of BED,” Dr. Griffen says. “It also continues to build evidence that there are biological and genetic drivers of binge eating behaviors. The more we get that message out there, the more we can decrease stigma associated with binge eating.”

A New Tool for Eating Disorder Research

Dr. Griffen is continuing to collaborate with Dr. Roussos and Dr. Voloudakis to expand on their findings, with plans to develop mouse models and dig deeper into the mechanisms. Ultimately, their goal is to develop new treatments that target the underlying biology of BED.

Meanwhile, the researchers are eager to apply their new computational approach to other diseases such as bulimia nervosa—another common eating disorder for which no genome-wide analysis has ever been done.

“Being able to infer a diagnosis from medical records is really significant, not only for BED but for other eating disorders, which are often extremely underdiagnosed” and therefore challenging to study using electronic health records, Dr. Burstein says.

The approach can also extend the science into populations that have been overlooked in past research. Most research on eating disorders has focused on white females. Using machine learning, researchers can more thoroughly study eating disorders in males and populations with other racial or ethnic backgrounds.

“This is exciting work, with so many potential future directions,” Dr. Burstein says.

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New Study Explores Links Between Women’s Reproductive System and Mental Health Disorders

Updated on Jul 6, 2023 | Featured, Psychiatry, Your Health

Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.

She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.

The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.

Psychiatric and Reproductive System Disorders: Increased Odds

Nina Zaks, MS

The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.

The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.

Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”

Looking for Links in Mental Health and the Reproductive System

What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.

Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.

Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”

Polycystic Ovary Syndrome: PCOS and Depression

Magdalena Janecka, PhD

Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.

PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.

The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.

 Chronic Pelvic Pain

Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.

Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”

 Psychiatric Research at Mount Sinai and Beyond

Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.

The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.

The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.

“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”

Workplace Resilience Program Targets Health Care Worker Well-Being

Updated on May 11, 2023 | Featured, Psychiatry

What do resilient people do when times get tough? Researchers at Mount Sinai, including Dennis Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs of the Mount Sinai Health System, have a long history of exploring that question.

So when the COVID-19 pandemic arrived in New York City early in 2020, Dr. Charney gathered together Mount Sinai experts in trauma and resilience, who recognized almost immediately what lay ahead. They saw that their staff was at risk for stress-related conditions from the mounting crisis—and they didn’t wait to react.

By early that summer, the Center for Stress, Resilience, and Personal Growth (CSRPG) opened its doors, directed by Deborah B. Marin, MD, the George and Marion Blumenthal Professor of Psychiatry.  Over its first few years, the Center has become a firmly established resource available to all Mount Sinai staff, faculty, students, and trainees.

When developing the program, the Center’s leadership, including Vanshdeep Sharma, MD, Craig L. Katz, MD, and Jonathan DePierro, PhD, drew on their collective expertise managing the behavioral health impact of the September 11, 2001, attacks in emergency responders.

“We had existing services that predated this Center, but there was a clear need as the pandemic raged on to have an on-the-ground resource led by mental health professionals,” says Dr. DePierro, the Center’s Associate Director and an Associate Professor of Psychiatry at Icahn Mount Sinai.

The Center was designed to provide evidence-based services to increase resilience and support the psychological well-being of the people who make the Health System function. Three years later, it remains a valuable and effective resource for the Mount Sinai community, and a model for other health systems.

Treating Health Care Provider Stress

Dr. DePierro and his colleagues at the Center set out to create a program that would support staff with mental health needs while also offering preventive measures to reduce the risk of stress-related conditions. Their dedicated team includes clinical social workers, psychologists, psychiatrists, and support staff. Together, that team supports the 43,000 people who work within the Mount Sinai system, including health care workers, administrative and support staff, medical students, and trainees.

Jonathan DePierro, PhD

One of the Center’s earliest offerings was an immediate way to connect to support. “Anyone employed at Mount Sinai can call to be evaluated over the phone and referred for behavioral health care as needed,” Dr. DePierro says.

While some in-person services are available, telehealth options are also available for behavioral health services. That makes care more easily accessible for those who need it—and helps them feel more comfortable seeking services in the place where they work. “We take many efforts to ensure we’re protecting confidentiality,” Dr. DePierro adds. The Center’s faculty practice is led by Clinical Director Ashley Doukas, PhD.

While providers at the Center often help people manage work stress and burnout, their concerns don’t have to be job-related. “We started in the midst of the pandemic, but people are presenting with stress from all sorts of things: exhaustion, relationship problems, sleep problems, depression, anxiety,” he adds. “We take care of you first as a person, and second as a health care provider.”

Boosting Resilience Through Prevention

Treatment is only part of the Center’s scope. The Center’s leadership team also drew from the deep well of scientific literature on resilience to develop training materials that would help employees weather the storm of stress.

Based on that science, the team developed a series of resilience training curricula to give people the tools and skills to manage stress in healthy ways. Since 2020, they’ve led almost 400 resilience workshops with the Mount Sinai community. Those workshops are tailored to the needs and cultures of a given group. Nurses, for instance, may have different needs and stressors than hospital security staff or medical students. “One important lesson to take away from this is that there is not a one-sized-fits-all approach,” DePierro says.

The workshops are customized for each population, but they share a common goal: “They provide the tools people need to manage the ups and downs they deal with on a daily basis,” Dr. DePierro says. Scarlett Ho, PhD, Director of Education, is responsible for the ongoing expansion and evolution of the resilience workshops.

Tools that can boost resilience in the face of stress and trauma include:

  • Social support
  • Remaining optimistic
  • Facing fears rather than withdrawing from them
  • Physical exercise
  • Having a role model or mentor
  • Thinking flexibly about challenges
  • Avoiding negative self-talk

Much of the evidence in support of these strategies is described in detail in the forthcoming third edition of the book Resilience: The Science of Mastering Life’s Greatest Challenges, by Drs. Charney, DePierro, and the late Yale University psychiatrist Steven M. Southwick, MD.

An Investment in Health Care Provider Well-Being

The Center continues to grow and expand its offerings. In 2021, the team shared its resilience training program with the broader New York City community, partnering with faith-based organizations in Harlem, the Bronx, Brooklyn, and Queens.

“In 2022, we trained community health advisors and pastors in nine organizations to teach workshops to their congregations, reaching over 1,000 community members,” Dr. DePierro says. This work built on more than a decade of community-based partnerships fostered by Dr. Marin and health care chaplain Zorina Costello, DMin, Director of Community Engagement for the Center and the Center for Spirituality and Health at Mount Sinai.

In 2022, the Center and Mount Sinai’s Office of Well-Being and Resilience jointly received a $2.1 million Health Workforce Resiliency grant from the Health Resources and Services Administration to further develop the resilience training and tools. In collaboration with partners in digital health, including the Hasso Plattner Institute for Digital Health at Mount Sinai, the Center’s leadership also created an app called Wellness Hub. Available to Mount Sinai’s health care workers, the self-guided digital health platform allows users to screen themselves for stress and provides activities to boost resilience.

Staff of the Center for Stress, Resilience, and Personal Growth at Mount Sinai

The Center’s team is collecting data to evaluate the efficacy of their workshops and the app. So far, feedback has been positive. Surveys from workshop participants suggest that following the training, people feel better prepared to manage stressors from their jobs and their personal lives. “They have a better sense that they can bounce back from life’s challenges,” Dr. DePierro says.

As the team collects more data about program outcomes, they are considering packaging the material for other health systems to use to boost resilience among staff. In the meantime, Dr. DePierro says he’s happy to share his knowledge with other health system leaders who want to take steps to invest in the mental health and well-being of their providers.

“We’re exceptionally lucky that Mount Sinai has had the vision to invest in this resource at a time it was badly needed,” he says. But even as the pandemic eases, that investment is paying dividends, he adds. “We’re baked into the system now, and we’re not going anywhere.”

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