Member, Cardiovascular Institute
Honors & Awards
Trainee Investigator Honorable Mention, American Academy of Sleep Medicine (2021)
Brain and Learning Sciences
Social and Emotional Learning
Current Research and Scholarly Interests
My research examines the mechanistic contributions of sleep, cognition and affect to the onset and course of psychiatric disorders across the lifespan. I am particularly interested in adolescence as a period during which changes in circadian rhythm, sleep architecture, and sleep behavior co-occur with neuroendocrine development, psychosocial changes, and the onset of many psychiatric disorders. Given that sleep is a highly treatable target, increasing our understanding of the specific contributions of sleep to psychiatric symptom onset may facilitate the development of targeted interventions to mitigate the course of illness.
Memory reconsolidation impairment using the beta-adrenergic receptor blocker propranolol reduces nightmare severity in patients with post-traumatic stress disorder: a preliminary study.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
STUDY OBJECTIVES: Post-traumatic nightmares may exacerbate and perpetuate the daytime symptoms of post-traumatic stress disorder (PTSD) and might represent a therapeutic target. The therapeutic strategy of memory reconsolidation using the beta-adrenergic receptor blocker propranolol associated with re-exposure psychotherapy is a promising treatment in PTSD patients. Previous studies have established this therapy is effective in reducing overall clinician-assessed PTSD symptoms but to date no previous study has specifically focused on posttraumatic nightmares in this therapy. This study provides a preliminary assessment of the evolution of nightmares severity during this therapy protocol, compared with the decrease of the other PTSD symptoms.It evaluates the incidence of side effects and examines the relative effects on posttraumatic nightmares.METHODS: Patients were recruited as part of the Paris Memoire Vive study. Data were collected using a prospective longitudinal design including one baseline visit, six therapeutic visits, and two follow-up visits. During the six therapeutic visits, propranolol was administered orally 60 to 75 minutes prior to the psychotherapeutic session.RESULTS: On average, nightmare severity decreased from "severe" to "mild" during the protocol and remained stable two months after the last session. Whereas 85% of patients reported nightmares at baseline, only 50% still had them after the protocol. The protocol was generally well tolerated and, did not increase nightmare severity for any patient in the study.CONCLUSIONS: Memory reconsolidation therapy with propranolol seems promising in reducing nightmare severity, up to and including remission. However,research using a randomized controlled design, and assessing maintenance of nightmare extinction, is warranted.CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Using Reconsolidation Blockade to Treat Trauma Related Disorders After Paris Attacks: An Effectiveness Study (PARIS-MEM); Identifier: NCT02789982; URL: https://www.clinicaltrials.gov/ct2/show/NCT02789982.
View details for DOI 10.5664/jcsm.10010
View details for PubMedID 35404227
A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
STUDY OBJECTIVES: Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status (SES) experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown.METHODS: Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages eight to 11 at baseline). 58 children in a community of low socioeconomic status (SES) received the curriculum twice weekly for two years. 57 children in an SES-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured from all children at three timepoints: at baseline (i.e., prior to curriculum exposure) and at two yearly follow-ups.RESULTS: Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement (REM) sleep, per night over the two-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in REM sleep. Sleep improved within the first three months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (e.g., using the breathing exercises outside of class) was associated with larger gains in total and REM sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and REM sleep duration also experienced larger increases in perceived social stress.CONCLUSIONS: A school-based health and mindfulness curriculum improved children's objectively measured sleep over two years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability.
View details for DOI 10.5664/jcsm.9508
View details for PubMedID 34170222
Transcranial magnetic stimulation demonstrates a role for the ventrolateral prefrontal cortex in emotion perception.
The lateral prefrontal cortex, a region with both structural and functional connectivity to the amygdala, has been consistently implicated in the downregulation of subcortical-generated emotional responses. Although previous work has demonstrated that the ventral lateral prefrontal cortex (vlPFC) is important to emotion processing, no study has interrupted vlPFC function in order to test is role in emotion perception. In the current study, we acutely disrupted vlPFC function in twenty healthy adult participants by administering sham stimulation and transcranial magnetic stimulation (TMS), in randomized order, during performance of an emotional perception task. During sham stimulation, participants demonstrated increased perceptual sensitivity for happy faces compared to angry faces. Disruption of the vlPFC eliminated this difference: in this condition, perceptual sensitivity did not differ between happy and angry faces. Reaction times and response bias did not differ between emotions or TMS conditions. This pattern of perceptual bias is consistent with effects observed in a wide range of affective disorders, in which vlPFC dysfunction has also been reported. This study provides insight into a possible mechanism through which the vlPFC may contribute to emotion perception.
View details for DOI 10.1016/j.psychres.2019.112515
View details for PubMedID 31831202
My Body, Your Emotions: Viscerosomatic Modulation of Facial Expression Discrimination.
Interoception reflects the ability to observe one's innermost bodily states. Here, we assessed whether interoceptive accuracy (IA) is related to the empathic ability to discriminate others' emotions. Participants (N = 111) completed a heartbeat tracking task, as well as an emotional go/no-go task with fearful and disgusted faces. Empathic facial mimicry during the go/no-go task was measured using electromyography (EMG) of the Corrugator Supercilii muscle. Higher IA was associated with higher perceptual sensitivity for emotional faces but was unrelated to response bias. Individuals higher in IA had stronger coupling between facial EMG and task performance. IA and facial EMG were associated with Go but not with NoGo trials, consistent with a specific modulation of perceptual sensitivity. These results suggest that tuning into one's own viscerosomatic signals relates to empathic mimicry and perception of others' emotional states.
View details for DOI 10.1016/j.biopsycho.2019.107779
View details for PubMedID 31644926
Pilot Test of a DBT-Based Parenting Intervention for Parents of Youth With Recent Self-Harm
COGNITIVE AND BEHAVIORAL PRACTICE
2022; 29 (2): 348-366
View details for Web of Science ID 000793409000005
A timely reminder of the complexities and burden facing caregivers of patients with bvFTD.
2021; 33 (9): 853-855
View details for DOI 10.1017/S1041610220003646
View details for PubMedID 34607623
A SCHOOL-BASED HEALTH AND MINDFULNESS CURRICULUM IMPROVES CHILDREN'S OBJECTIVELY MEASURED SLEEP
OXFORD UNIV PRESS INC. 2021: A251
View details for Web of Science ID 000698984300640
LONGER SLOW WAVE SLEEP AND EXACERBATED CORE SYMPTOM SEVERITY IN AUTISM SPECTRUM DISORDER
OXFORD UNIV PRESS INC. 2021: A239
View details for Web of Science ID 000698984300604
Changes in Quality of Life and Loneliness Among Middle-Aged and Older Adults Participating in Therapist-Guided Digital Mental Health Intervention.
Frontiers in public health
1800; 9: 746904
Background: This study aimed to examine the effects of a 12-week multicomponent mobile app-delivered intervention, the Meru Health Program (MHP), on mental health quality of life (QoL) and loneliness among the middle-aged and older adults with depression symptoms. Methods: The eligible participants (M age = 57.06, SD = 11.26 years) were enrolled in the MHP, a therapist-supported mobile intervention. Using a non-randomized pre-post design, change in mental health QoL [WHO QoL Brief (WHOQOL-BREF) psychological health] and loneliness (UCLA Loneliness Scale) from baseline to post-treatment were examined. Time of enrollment [pre- vs. post-coronavirus disease 2019 (COVID-19)] was included as a between-subjects factor in the repeated measures analyses. Results: Forty-two participants enrolled prior to the COVID-19 pandemic; eight enrolled after the pandemic began. Among the pre-COVID-19 enrollees, increase in mental health QoL, F (1, 38) = 12.61, p = 0.001, eta2 = 0.25 and decreases in loneliness emerged, F (1, 38) = 5.42, p = 0.025, eta2 = 0.13. The changes in mental health QoL, but not loneliness, held for the combined sample, such as post-COVID-19 enrollees, F (1, 44) = 6.02, p = 0.018, eta2 = 0.12. The regression analyses showed that increases in mindfulness were associated with the increased mental health QoL and decreased loneliness. Conclusion: Therapist-supported digital mental health interventions, such as the MHP, have the potential to improve mental health QoL and decrease loneliness among the middle-aged and older adults. The findings for loneliness may not hold during the periods of mandated isolation. Instead, therapists supporting digital interventions may need to tailor their approach to target loneliness.
View details for DOI 10.3389/fpubh.2021.746904
View details for PubMedID 34957011
MOBILE INTERVENTION OUTCOMES COMPARED PRE AND POST-SHELTER-IN-PLACE FOR MIDDLE AGED AND OLDER ADULTS
OXFORD UNIV PRESS. 2021: 854
View details for Web of Science ID 000842009904169
Neurocognitive markers of passive suicidal ideation in late-life depression.
OBJECTIVES: (1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression.DESIGN: Cross-sectional study.SETTING: University medical school.PARTICIPANTS: Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O'Hara).MEASUREMENTS: Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains.RESULTS: The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume.CONCLUSIONS: Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.
View details for DOI 10.1017/S1041610220003610
View details for PubMedID 33118918
The 5-HTTLPR Long, not Short, Allele Predicts Two-year Longitudinal Increases in Cortisol and Declines in Verbal Memory in Older Adults.
International journal of geriatric psychiatry
OBJECTIVES: The short form or s-allele variant of the serotonin transporter polymorphism (5-HTTLPR), as compared with the long form or l-allele variant, has been associated with the presence of cognitive dysfunction, and particularly memory impairment in older adults. This body of cross-sectional work has culminated in the hypothesis that presence of the s-allele predicts greater memory decline in older adults (1). Yet, to date, there are no longitudinal studies which have investigated this issue.METHODS/DESIGN: Here we examine 109 community-dwelling older adults (mean and SD of age=70.7±8.7years) who underwent blood draw for genotyping, cognitive, and psychological testing at baseline, 12-month, and 24-month follow-up.RESULTS: Multilevel modeling found that s-allele carriers (ss or ls) performed worse than ll homozygotes at baseline on delayed verbal recall. Yet, s-allele carriers' memory performance was stable over the two-year follow-up period, while l-allele homozygotes experienced significant memory decline. l-allele homozygote status was associated with both increased cortisol and decreased memory over time, resulting in attenuated verbal memory performance differences compared to s-allele carriers with age.CONCLUSIONS: Overall, our findings do not support the hypothesis that presence of the 5-HTTLPR s-allele is a marker for memory decline in older adults. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/gps.5319
View details for PubMedID 32400901
Identification of Common Neural Circuit Disruptions in Emotional Processing Across Psychiatric Disorders.
The American journal of psychiatry
OBJECTIVE: Disrupted emotional processing is a common feature of many psychiatric disorders. The authors investigated functional disruptions in neural circuitry underlying emotional processing across a range of tasks and across psychiatric disorders through a transdiagnostic quantitative meta-analysis of published neuroimaging data.METHODS: A PubMed search was conducted for whole-brain functional neuroimaging findings published through May 2018 that compared activation during emotional processing tasks in patients with psychiatric disorders (including schizophrenia, bipolar or unipolar depression, anxiety, and substance use) to matched healthy control participants. Activation likelihood estimation (ALE) meta-analyses were conducted on peak voxel coordinates to identify spatial convergence.RESULTS: The 298 experiments submitted to meta-analysis included 5,427 patients and 5,491 control participants. ALE across diagnoses and patterns of patient hyper- and hyporeactivity demonstrated abnormal activation in the amygdala, the hippocampal/parahippocampal gyri, the dorsomedial/pulvinar nuclei of the thalamus, and the fusiform gyri, as well as the medial and lateral dorsal and ventral prefrontal regions. ALE across disorders but considering directionality demonstrated patient hyperactivation in the amygdala and the hippocampal/parahippocampal gyri. Hypoactivation was found in the medial and lateral prefrontal regions, most pronounced during processing of unpleasant stimuli. More refined disorder-specific analyses suggested that these overall patterns were shared to varying degrees, with notable differences in patterns of hyper- and hypoactivation.CONCLUSIONS: These findings demonstrate a pattern of neurocircuit disruption across major psychiatric disorders in regions and networks key to adaptive emotional reactivity and regulation. More specifically, disruption corresponded prominently to the "salience" network, the ventral striatal/ventromedial prefrontal "reward" network, and the lateral orbitofrontal "nonreward" network. Consistent with the Research Domain Criteria initiative, these findings suggest that psychiatric illness may be productively formulated as dysfunction in transdiagnostic neurobehavioral phenotypes such as neurocircuit activation.
View details for DOI 10.1176/appi.ajp.2019.18111271
View details for PubMedID 31964160
Pilot test of a DBT-based parenting intervention for parents of youth with recent self-harm
Cognitive and Behavioral Practice
2020; (in press)
View details for DOI 10.1016/j.cbpra.2020.10.001
Cooperative versus competitive influences of emotion and cognition on decision making: A primer for psychiatry research.
2019; 273: 493–500
Clinical research across the developmental spectrum increasingly reveals the nuanced ways in which emotion and cognition can work to either support or derail rational (i.e., healthy or goal-consistent) decision making. However, psychological theories offer discrepant views on how these processes interact, and on whether emotion is helpful or harmful to rational decision making. In order to translate theoretical predictions from basic psychology to clinical research, an understanding of theoretical perspectives on emotion and cognition, as informed by experimental psychology, is needed. Here, I review the ways in which dual-process theories have incorporated emotion into the process of decision making, discussing how they account for both positive and negative influences. I first describe seven theoretical perspectives that make explicit assumptions and predictions about the interaction between emotion and cognition: affect as information, the affect heuristic, risk as feelings, hot versus cool cognition, the somatic parker hypothesis, prospect theory, and fuzzy-trace theory. I then discuss the conditions under which each theoretical perspective conceptualizes emotion as beneficial or harmful to decision making, providing examples from research on psychiatric disorders.
View details for PubMedID 30708200
Factors Associated with Supportive Care Service Use Among California Alzheimer's Disease Patients and Their Caregivers.
Journal of Alzheimer's disease : JAD
Existing literature on factors associated with supportive care service (SCS) use is limited. A better understanding of these factors could help tailor SCS to the needs of frequent users, as well as facilitate targeted outreach to populations that underutilize available services.To investigate the prevalence of SCS use and to identify factors associated with, and barriers to, service use.California Alzheimer's Disease Center patients with AD (n = 220) participated in the study from 2006-2009. Patients and their caregivers completed assessments to determine SCS use. Cognitive, functional, and behavioral status of the patients were also assessed. A two-part hurdle analysis identified 1) factors associated with any service use and 2) service use frequency among users.Forty percent of participants reported using at least one SCS. Patients with more impaired cognition and activities of daily living and more of the following: total number of medications, comorbid medical conditions, and years of education were more likely to use any SCS (p < 0.05). Factors associated with more frequent SCS use included younger age, more years of education, older age of AD onset, female gender, and having a spouse or relative for a caregiver (p < 0.05). Caregivers frequently indicated insufficient time as a reason for not receiving enough services.Factors associated with any SCS use mostly differed from those associated with SCS frequency, suggesting different characteristics between those who initiate versus those who continue SCS use. Our findings highlight the importance of targeted education on services and identifying barriers to long-term SCS use.
View details for DOI 10.3233/JAD-190438
View details for PubMedID 31743997
Failure to Downregulate Amygdala Activation during Regulation of Emotional Conflict in Post Traumatic Stress Disorder: Results from a Large Veteran Sample
ELSEVIER SCIENCE INC. 2017: S193
View details for DOI 10.1016/j.biopsych.2017.02.957
View details for Web of Science ID 000400348700470
Framing Effects Are Robust to Linguistic Disambiguation: A Critical Test of Contemporary Theory
JOURNAL OF EXPERIMENTAL PSYCHOLOGY-LEARNING MEMORY AND COGNITION
2016; 42 (2): 238–56
Theoretical accounts of risky choice framing effects assume that decision makers interpret framing options as extensionally equivalent, such that if 600 lives are at stake, saving 200 implies that 400 die. However, many scholars have argued that framing effects are caused, instead, by filling in pragmatically implied information. This linguistic ambiguity hypothesis is grounded in neo-Gricean pragmatics, information leakage, and schema theory. In 2 experiments, we conducted critical tests of the linguistic ambiguity hypothesis and its relation to framing. We controlled for this crucial implied information by disambiguating it using instructions and detailed examples, followed by multiple quizzes. After disambiguating missing information, we presented standard framing problems plus truncated versions, varying types of missing information. Truncations were also critical tests of prospect theory and fuzzy trace theory. Participants were not only college students, but also middle-age adults (who showed similar results). Contrary to the ambiguity hypothesis, participants who interpreted missing information as complementary to stated information nonetheless showed robust framing effects. Although adding words like "at least" can change interpretations of framing information, this form of linguistic ambiguity is not necessary to observe risky choice framing effects.
View details for DOI 10.1037/xlm0000158
View details for Web of Science ID 000369440000005
View details for PubMedID 26348200
View details for PubMedCentralID PMC4738018
Reward Processing in the Adolescent Brain: Individual Differences and Relation to Risk Taking
JOURNAL OF NEUROSCIENCE
2015; 35 (40): 13539–41
View details for DOI 10.1523/JNEUROSCI.2571-15.2015
View details for Web of Science ID 000366050900001
View details for PubMedID 26446208
View details for PubMedCentralID PMC6605381
An Overview of Judgment and Decision Making Research Through the Lens of Fuzzy Trace Theory.
Xin li ke xue jin zhan
2014; 22 (12): 1837–54
We present the basic tenets of fuzzy trace theory, a comprehensive theory of memory, judgment, and decision making that is grounded in research on how information is stored as knowledge, mentally represented, retrieved from storage, and processed. In doing so, we highlight how it is distinguished from traditional models of decision making in that gist reasoning plays a central role. The theory also distinguishes advanced intuition from primitive impulsivity. It predicts that different sorts of errors occur with respect to each component of judgment and decision making: background knowledge, representation, retrieval, and processing. Classic errors in the judgment and decision making literature, such as risky-choice framing and the conjunction fallacy, are accounted for by fuzzy trace theory and new results generated by the theory contradict traditional approaches. We also describe how developmental changes in brain and behavior offer crucial insight into adult cognitive processing. Research investigating brain and behavior in developing and special populations supports fuzzy trace theory's predictions about reliance on gist processing.
View details for DOI 10.3724/SP.J.1042.2014.01837
View details for PubMedID 28725239
ADOLESCENCE, AGING, AUTISM, AND ALZHEIMER'S DISEASE: A UNIFYING FRAMEWORK FOR UNDERSTANDING THE BRAIN AND ITS BIASES
SPRINGER. 2014: S73
View details for Web of Science ID 000334408300277
Basic Mechanisms of Numerical Processing: Cross-Modal Number Comparisons and Symbolic Versus Nonsymbolic Numerosity in the Intraparietal Sulcus
JOURNAL OF NEUROSCIENCE
2014; 34 (5): 1567–69
View details for DOI 10.1523/JNEUROSCI.4771-13.2014
View details for Web of Science ID 000331455000001
View details for PubMedID 24478340
View details for PubMedCentralID PMC6827579
Developmental Reversals in Risky Decision Making: Intelligence Agents Show Larger Decision Biases Than College Students
2014; 25 (1): 76–84
Intelligence agents make risky decisions routinely, with serious consequences for national security. Although common sense and most theories imply that experienced intelligence professionals should be less prone to irrational inconsistencies than college students, we show the opposite. Moreover, the growth of experience-based intuition predicts this developmental reversal. We presented intelligence agents, college students, and postcollege adults with 30 risky-choice problems in gain and loss frames and then compared the three groups' decisions. The agents not only exhibited larger framing biases than the students, but also were more confident in their decisions. The postcollege adults (who were selected to be similar to the students) occupied an interesting middle ground, being generally as biased as the students (sometimes more biased) but less biased than the agents. An experimental manipulation testing an explanation for these effects, derived from fuzzy-trace theory, made the students look as biased as the agents. These results show that, although framing biases are irrational (because equivalent outcomes are treated differently), they are the ironical output of cognitively advanced mechanisms of meaning making.
View details for DOI 10.1177/0956797613497022
View details for Web of Science ID 000329486300008
View details for PubMedID 24171931
View details for PubMedCentralID PMC4076289
Correspondence Are Cognitive Functions Localizable?
JOURNAL OF ECONOMIC PERSPECTIVES
2013; 27 (2): 247–50
View details for Web of Science ID 000318610700012
INDIVIDUAL DIFFERENCES IN NUMERACY PREDICT NEURAL ACTIVATION DURING FRAMING EFFECTS
MIT PRESS. 2013: 59
View details for Web of Science ID 000317030500178