Cross-disciplinary Neuroscience Research at the Massachusetts General Hospital

Clinicians and researchers from Mass General Neuroscience presented at a recently held virtual lecture showcasing the breadth of cross-disciplinary research at the Massachusetts General Hospital.

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Over the course of the event, Ana-Maria Vranceanu, PhD, founding director of the Integrated Brain Health Clinical and Research Program and faculty member of the Henry and Allison McCance Center for Brain Health, presented her work on psychosocial intervention development and testing for medical patients. Sabine Wilhelm, PhD, chief of Psychology at Mass General and the program director of the Obsessive-Compulsive Disorder and Related Disorders Program, presented her work on new technology-based assessment and treatment strategies to enhance patient care. Anne Thorndike, MD, MPH, an investigator in the Division of General Internal Medicine and a member of the Mongan Institute, explained the environmental factors that influence behavior and health.

Recovering Together Initiative: Preventing Chronic Emotional Distress Across the Neuro-ICU

Dr. Vranceanu developed the Recovering Together Initiative, a multidisciplinary collaboration between psychologists, neurocritical care doctors and nurses in the Neuro-ICU at Mass General.

Dr. Vranceanu's prospective research uncovered high rates of clinically significant symptoms of depression, anxiety and post-traumatic stress at hospitalization in both patients and their informal caregivers. Her research has shown that risk and resiliency factors at hospitalization for chronic emotional distress are interdependent between patients and their informal caregivers, and mutually reinforcing over time predictive of chronic emotional distress.

"Because of advanced technologies, people are surviving their ICU stays," says Dr. Vranceanu. "As a result, approximately 60% of patients and their caregivers are developing significant symptoms of depression, anxiety and posttraumatic stress, which become chronic over time."

As no psychosocial interventions to date have been efficacious in preventing this chronic emotional distress, Dr. Vranceanu's multidisciplinary team developed the Recovering Together Program, which teaches patients and informal caregivers' resiliency and interpersonal communication skills through a combination of in person and live video sessions. The program is associated with substantial and sustained improvement in depression, anxiety and post-traumatic stress in both patients and caregivers.

"These results are very exciting—patients and families find the intervention very feasible, they love participating," says Dr. Vranceanu.

She hopes to expand the Recovering Together initiative nationally and develop a mobile application to foster easy access and implementation. She is also actively adapting the Recovering Together Program for other neurological populations for whom chronic emotional distress is common.

A Multidisciplinary Approach to Understanding and Treating Obsessive-Compulsive Disorder

Dr. Wilhelm is advancing the assessment and treatment of psychiatric problems and disorders including body dysmorphic disorder (BDD), Tourette's syndrome and obsessive-compulsive disorder (OCD). The OCD and Related Disorders Program enhances patient care through assessment tools including neuropsychological tests, electroencephalogram (EEG), neuroimaging and virtual reality.

Lately, members of Dr. Wilhelm's team have been using smartphone-based sensors to measure psychiatric states. This type of assessment, called digital phenotyping, can be conducted without effort on the part of the patient and within the context of their daily lives. For example, the GPS sensor on the phone may indicate that a patient is engaging in avoidance behavior and having difficulty leaving their home, which in turn may be associated with other negative affective states.

Dr. Wilhelm discussed the importance of assessments to match patients to interventions that are most beneficial for a particular individual at a specific point in time. Combining digital phenotyping with the information contained in patients' electronic medical records, neuropsychological test results, traditional clinical measures, as well as neuroimaging data, would allow artificial intelligence technology to process this data and recommend personalized treatment or prevention packages.

"Some patients may initially be recommended to visit a live therapist or get pharmacotherapy, while others might need a behavioral intervention with a mobile app, or a combination," says Dr. Wilhelm. "An individual might start out with a face to face therapist, but as they improve, might move to a peer support network to prevent relapse."

Together with her team at Mass General, as well as industry partners, she is currently developing and testing several smartphone-based treatments for a range of disorders including OCD, BDD and depression. Initial results are very promising in terms of clinical outcomes and patient satisfaction.

Prevention of Obesity and Cardiometabolic Disease through Multidisciplinary and Collaborative Approach

Dr. Thorndike studies the food choice behavior and healthy dietary intake by testing novel interventions that integrate genetic, psychological and social components. Her research goals are to prevent obesity and cardiometabolic diseases by making a healthy lifestyle accessible to all. To do so, Dr. Thorndike's work requires testing in the community settings, workplace, grocery stores, food pantries, and integrating in policy level programs like Medicaid Accountable Care Organization (ACO), Snap and WIC.

With a collaborator at Harvard Business School, Dr. Thorndike started testing behavioral economics interventions to promote healthy food choices. She has built on that work to utilize social networks as a way to identify food purchasing behavior.

A recent study, called Choose Well 365, will determine if a behavioral economics intervention will increase employees' healthy food choices at work and if this effect will spill over to their social networks.

"We can identify social networks through cafeteria food purchasing, and we can show that people who dine together are more likely to eat healthy or unhealthy foods together," says Dr. Thorndike.

In addition, she has taken her findings from workplace interventions and tested them in the local community at corner stores to promote fruit and vegetable purchases in low-income communities.

Most recently, she has focused her research on the Medicaid ACO population to study if a new program that provides food and housing resources will improve dietary, psychosocial and health outcomes of participants.

Large population data sets are providing a clear track for future research in the neurosciences at Mass General. These presentations demonstrate not only the value of using this combined approach of research and technique, but also the breadth of the type of research that can be done using population-level analytics.

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